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Child Abuse:

I find the following quote, from the article on vaccines linked to by Jonathan, below, horrifying:

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.

I had chicken pox as a kid, and I remember it as a very unpleasant experience, to say the least, and I didn't have an especially severe outbreak. Measles, I take it, is worse and also more dangerous. Parents like Ms. Palmer are not only exposing their own children to horrible illnesses easily preventable by vaccines, but they are putting other children, including my own daughter, at risk, since the measles vaccine is only 95% effective. (And what about adults who either received an ineffective vaccine or immigrated from a country where vaccination was not universal)? A Ms. Carlson says, "I cannot deny that my child can put someone else at risk."

Without the externality of putting other people at risk, I think mandatory vaccination would be a close call. With it, I'd say that unless a parent is going to keep his children at home and not expose them to vaccinated children, make them get vaccines. Too unlibertarian for you? Make them pay a fine equal to the monetary value of the level of risk to others they're creating, to be used perhaps to subsidize vaccination programs for the poor, thus reducing the risks from elsewhere.

Richard Aubrey (mail):
Before the advent of a vaccine for rubella--german measles--mothers would send their daughters to german measles parties so that they'd all get it and be immune later on when pregnant.
Rubella during pregnancy was associated with horrible birth defects.

Chicken pox is unpleasant. Is there a difference in risk between getting chicken pox and getting the vaccine?

I recall when the Salk vaccine came out. It was during a polio epidemic in Detroit. My parents said the reaction to the news was like that on VJ Day. But there were still some who refused it on various grounds. I've never had any sympathy for that view. But when the diseases in question are less horrible and their risks and the risk from the vaccines--more than zero--begin to approach each other, the answer is less obvious.
3.21.2008 11:37am
Spartacus (www):
Both of my children are unvaccinated. I am glad that the law in my state protects my right to do so, and to send them to school--don't move to Texas, David! I would gladly pay a fee equal to the actual monetary value of the very small risk that any child would contract a disease from my unvaccinated child--as long as vaccinated children's parents would also pay a fee equal to the value of the very small risk that my unvaccinated child would contract the disease from their child during the vaccination incubation period--likely to amount to the exchange of a few pennies each.
3.21.2008 11:44am
Spartacus (www):
I also think your subject line is unnecesarily inflammatory.
3.21.2008 11:45am
Tracy Johnson (www):
I dunno, before vaccinations, it used to be common wisdom to send kids to play with other sick kids with childhood diseases because the severity was less than as an adult. Happened to me when I was a kid, although I never them it that way, but later as a kid. Now I'm 52. I suppose it is along the same theory as inoculation, which also used to be common practice.

Setting the argument about autism aside as a red herring, I do wonder if complete vaccinations have other risks and side effects that early exposure and contraction does not?
3.21.2008 11:46am
Mr. X (www):
Vaccination is a valuable tool, but it should be used on a risk/reward basis. Polio is worse than Measles. Measles is worse than Chicken Pox.

There's also a point where a disease is so close to eradication that vaccination is riskier. Polio, at least in the United States, is eliminated. At that point, any non-zero risk of side effects from the vaccine is unacceptable.
3.21.2008 11:48am
loki13 (mail):
Spatacus,

Unfortunately, it's thinking like yours that's gotten the world into trouble. It's easy to be a free rider, isn't it? NIMBY can quickly become- for your children, not for mine! As more people begin to believe, like you, that the real problem is the vaccines, and not the rather nasty diseases that the vaccines prevent, we will see a resurgence of those nasty diseases.

Selfishness will be the undoing of America. But I guess you have put the 'i' in public health.
3.21.2008 11:49am
Blue (mail):
Spartacus, you and your ilk pose a danger to the rest of the community. It is not inflammatory to point that out in the harshest possible words.

As for the question of the original post, yes, immunizations ought to be required for all children.
3.21.2008 11:53am
M.E.Butler (mail):
Fifty years ago there were no vaccines for MMR--measles, mumps and rubella. So, we all got sick. I suspect that it was unpleasant, but the memories have faded to black--except for this really cool coloring book I remember getting when I had the mumps.

Still, for the unvaccinated purists: God help your children if they grow to adulthood without catching those diseases, and they have the wonderful experience of an adult case of measles or mumps.
3.21.2008 11:59am
Qwerty:
I don't remember needing any "special help" or organized efforts to contract chicken pox. I got the !@(*&#^$( thing all by myself!
3.21.2008 12:03pm
kevin r (mail):
Purposely infecting your children with measles, etc, does make sense. That of course assumes that you live in the 19th century, and so there is no vaccine.

Though I do agree that at some point the possible side effects of vaccination (not the BS about autism, but real side effects) can outweigh the benefits -- I am not vaccinated for smallpox, and probably neither are most of you. I don't believe I'm vaccinated for polio either (I'm 25, live in the US).
3.21.2008 12:04pm
Wugong:
When I was a kid (in the 1970's), intentionally infecting your kids with chicken pox by having them visit another kid with the virus was very much the norm. As I recall there are more risks associated with getting the virus as an adult and everyone was told it was better to get it out of the way when the kids were in elementary school. This was in very "normal," middle-class, mostly Republican, Michigan suburbs. My parents (and just about everyone they knew), were about as far from "the natural-health oriented world" as could be.

Now measles are obviously a completely different case due to the risks and the fact that a vaccine exists. If there is one for chicken pox now too then that changes things.
3.21.2008 12:05pm
kevin r (mail):
(and I caught the chicken pox by myself when I was less than 2 years old, and then gave it to my dad, who'd never had it.)
3.21.2008 12:05pm
erics (mail):
There is a HUGE difference between a chicken pox party and a measles party. I don't have so much of a problem with the former but am terrified by the latter.
3.21.2008 12:07pm
MDJD2B (mail):

Fifty years ago there were no vaccines for MMR--measles, mumps and rubella. So, we all got sick. I suspect that it was unpleasant, but the memories have faded to black--except for this really cool coloring book I remember getting when I had the mumps.

You and I didn't have severe problems, but a lot of kids do, especially from measles. I am copying a link to a Mayo Clinic site on measles complications:

http://www.mayoclinic.com/health/measles/DS00331/DSECTION=7

I couldn't find mortality rates with a quick Google search, but I found a reference to overall mortality:

http://jama.ama-assn.org/cgi/content/full/293/18/2207

I hope these facts convince readers that measles is more than a nuisance.
3.21.2008 12:10pm
Dave N (mail):
The problem is that many Americans do not understand how horrible the diseases actually are. They think of polio as a) somewhat eradicated, and b) if contracted, perhaps leading to some limb paralysis. To these people, measles is nothing more than chicken pox on steroids, and German measles must be just like measles because the names are the same.

I am just old enough to have missed the introduction of the measles vaccine. Unfortunately, so was my younger brother. We both contracted measles. I bounced back. My brother, who was a toddler at the time, did not.

A little boy who was meeting all developmental goals early (speech, walking, toilet training, etc.) was left autistic and brain damaged. Had the vaccine been available, I firmly believe that he would be a very different person today--and undoubtedly more productive than what he is now, someone who retrieves abandoned shopping carts in Walmart's parking lot.

The anti-vaccine advocates sicken me. And while I realize anecdotal experiences carry little weight, I do believe it allows me to hold these anti-vaccine zealots in profound contempt.
3.21.2008 12:14pm
MDJD2B (mail):
Thank you, Dave. When I read the testimonials of people wh had measles and did just fine, thank you-- I want to bang my head against a wall.
3.21.2008 12:18pm
Tony Tutins (mail):
All I remember of the chicken pox is being very itchy. I brought it home and gave it to my sister and two-year-old brother. When I got the measles I had to stay in a darkened room, so my father brought home a used TV and installed it in the bedroom. I remember sleeping a lot. Neither mumps nor german measles went around when I was a kid, so we got vaccinated when those things came out.

People who survived polio in the late 40s and early 50s are seeing/have seen delayed health effects in middle age.
3.21.2008 12:18pm
Triangle_Man:
From the CDC, the relevant statistic for measles is that 1 out of 1,000 people infected with the virus will die from it due to swelling around the brain. In the U.S., prior to vaccination, as many as 450,000 people contracted measles and 450 died each year.
3.21.2008 12:20pm
Mary Katherine Day-Petrano (mail):
My husband asked me to intervene in a dispute he was having with his son over his son's decision not to vaccinate his child. So I was told by my husband, his son and wife were afraid the vaccinations would cause their child to get autism like me. Intervening in the dispute at my husband's insistence brought a lot of wrath on me from the son and his wife. But, being the one with the autism, as well as one who got vaccinations that prevented me from getting worse diseases (e.g. polio, small pox, etc.), I think it is very misguided to fear the risk of autism more than these other deadly diseases to the point of not vaccinating a child -- and/or putting others at risk from your unvaccinated child.

There are many advantages to autism, and most people who are in fear of autism and/or making these crazy decisions not to vaccinate their children are doing so based on their ignorance of autism -- not a very solid basis for making such a significant public health decision. Moreover, I don't think the autism-vaccination causal link has been that well established yet. The jury is still out on the issue. And if mercury in vaccines causes autism, well folks, then so does mercury in coal plant emissions, mercury in fish eaten by pregnant mothers, mercury in cavity fillings, etc.

Finally, don't we have a crisis of some 20 million illegals in this Country? What is the vaccination status of all THOSE people? Americans who don't vaccinate their children are exposing their unprotected children to all sorts of diseases from the illegal population every time they touch the handlebar of a grocery shopping cart, handrail on the stairway pof a public building, etc.

Unvaccinated children IS a big public health issue. I never had mumps as a child, so for me these unvaccinated children run the risk of giving me adult mumps -- not something I would want to encounter.
3.21.2008 12:21pm
J Richardson:
One of the downsides to having chicken pox as a child (or an adult) is that you can now have shingles (varicella-zoster). The virus lies dormant in your body after chicken pox. As someone who has had shingles, it isn't fun. I had to take percocet just so I could sleep at night. And I was lucky in that it was caught almost immediately and the expensive antiviral drugs lessened the severity.

A shingles vaccine was released not long ago from what I have read. Unfortunately, it was too late for me. There have been suggestions that it will be a standard for those over 60.

I bring all this up because we didn't have all those vaccines when I was a kid and I got all the childhood diseases. I still remember my whole town going one Sunday to get the polio vaccine - I think it was the Sabin one as it was on a sugar cube.
3.21.2008 12:32pm
Anderson (mail):
How in the heck does someone convince himself that the risk of *vaccination* vs. a disease is greater than the risk of the disease itself?

IIRC, Mississippi schools require that the kid be vaccinated, or he doesn't come to school.
3.21.2008 12:34pm
MDJD2B (mail):

From the CDC, the relevant statistic for measles is that 1 out of 1,000 people infected with the virus will die from it due to swelling around the brain. In the U.S., prior to vaccination, as many as 450,000 people contracted measles and 450 died each year.

1. A lot more people died of measles pneumonia. Pregnant women are very susceptable to this complication, and I have seen several deaths during my medical career.

2. Measles encephalitis causes death in 1/1000 people, but leaves neurological impairment in many more.

What you say is true, but markedly underestimates the seriousness of measles.
3.21.2008 12:35pm
tarheel:

There is a HUGE difference between a chicken pox party and a measles party.

Either way . . . worst party ever.
3.21.2008 12:36pm
Dave N (mail):
IIRC, Mississippi schools require that the kid be vaccinated, or he doesn't come to school.
I am certainly glad to see that Mississippi is doing something right.
3.21.2008 12:38pm
Cro (mail):
I hated chicken pox. When I saw that there was a vaccine, I made sure my son got it. As for intentionally getting your child sick, I'd refer people to the episode of South Park where the children get revenge on their parents for exposing them to chicken pox.
3.21.2008 12:38pm
JNS405:
Spartacus, it's great that Texas protects your right to keep your children unvaccinated - does it protect the rights of my children to not catch some nasty disease from yours?
3.21.2008 12:39pm
MDJD2B (mail):
The

re is a HUGE difference between a chicken pox party and a measles party.


Either way . . . worst party ever.

Ever been to Jonestown?
3.21.2008 12:40pm
tired of blogs:
Mary Katherine Day-Petrano: Mexico has a higher child immunization rate than we do.

Link.
3.21.2008 12:40pm
stoneyforest:
Mary KDP -

Why not get vaccinated (for mumps)?
3.21.2008 12:42pm
therut:
About 14 years ago a 27 year old friend of mine caught chicken pos from his 4 y/o daugher. He had a 2 month old son. The friend got brain damage and is in a nursing home with the ability of a 3 y/o. It was devastating. My mom and fathers generation prayed that we would not die of childhood illnesses. I had them all except polio and small pox. Momma said people danced in the street when polio vaccine came out. When there were cases of polio in a town the whole little town was was shunned. Let us bring out the iron lungs!!!! Might as well become the rich third world hell hole that those who came before us strived so hard to prevent.
3.21.2008 12:43pm
ParatrooperJJ (mail):
The thing with chicken pox is that getting it as a child is relatively risk free, getting it as an adult is very dangerous. The current vaccine has no long term studies to show when it wears off. Currently I would not vaccinate my children, but instead expose them to the virus. And yes, I am a medical professional.
3.21.2008 12:58pm
Bruce F. Webster (mail) (www):
Speaking of vaccination -- I would suggest all of you at or above the age of 50 look at getting vaccinated against shingles.

I had no idea that such a vaccine existed -- and only a very vague idea of what shingles is -- until I came down with it last summer. Fortunately, a friend of mine recognized the symptoms, I called my doctor, and he put me (over the phone!) on an immediate anti-viral treatment (which is only effective when started immediately after symptoms start).

Trust me -- shingles is (are?) nasty. My case was relatively mild compared to what some friends of mine have gone through (all of which I've learned about after the fact).

One last thing: if you get shingles, you can spread it -- in the form of chickenpox (which is what shingles is: a reawakened chickpox virus) -- to any un-immunized adults or children. ..bruce..
3.21.2008 12:59pm
SG:
The woman in the article might be too stupid to be allowed loose without supervision. I could understand thinking that there's enough vaccinated kids that your kids could skip the vaccine and rely on herd immunity. Not very sociable, but I could understand it. But what sort of reasoning allows you to conclude that actually getting the disease is better than the vaccine?

I agree, this is child abuse.
3.21.2008 1:01pm
Spartacus (www):
loki: funny how my practice in one area makes me the cause of all ills. Who exavtly is the reactionary one on this issue?

Blue: like I said, stay away from Texas (and apparently 20 other states) where they are not. I guess the whole world is just crazy (at least in 20 states)

JNS405: no, but it protects your right to stay away from those 20 states, for that matter, to lock your child in the house until the whole world is vaccinated

I think the example that few are vaccinated these days against smallpox (I was) any more is apt: the need for various vaccinations waxes and wanes.

I had chicken pox and that was that.

Now we have vaccinations for HPV for children? Give me a break.

Guess what--I also don't always use a child seat or even a seat belt with my 3 year old! Gasp! Call child protective services! How did we ever survive the abuse the prior generation heaped on us? (Yes, I understand there are no additional externatilties to these examples; it just amazes me how vitriolic people can get when it comes to other peoples kid's issues)
3.21.2008 1:02pm
calmom:
There is a big difference between having chicken pox and getting the chicken pox vaccine: Shingles.

Shingles almost never occurs in people who get the vaccine. It's very common in people who've had chicken pox.

Shingles are very painful red lesions. Typically older people get them. There is no really good treatment. Let me repeat: they are very painful. My dad had them and they basically ruined a year of his life.

The parents who think that exposing their kids to chicken pox is acceptable are making a big mistake. Of course, they likely won't be there when their children, now in their 70's are screaming in pain due to shingles.
3.21.2008 1:04pm
Blue (mail):

Blue: like I said, stay away from Texas (and apparently 20 other states) where they are not. I guess the whole world is just crazy (at least in 20 states)


Unfortunately, I live in Texas so I have to deal with your utter lack of concern for fellow human beings and your horrfic disregard for the safety and security of your children.
3.21.2008 1:13pm
Andrew Janssen (mail):
Hmph. It seems to me that those arguing the loudest in support of the "vaccines made my baby autistic" idea are doing so because the alternatives are to blame either the kid's DNA or to blame God. Or both, if that's how you roll.

Having contracted whooping cough/pertussis as a 23-year old, I feel confident in saying that any parent who fails to get their kid a DPT shot is bordering on child endangerment. Whooping cough made me cough so hard that I nearly cracked a rib, and there were four or five times that the world went a little gray and fuzzy around the edges because I was getting hypoxic from not being able to inhale. It took about four to five months for the damage the bacterial endortoxins did to completely heal. That was as an adult; imagine what could happen to an infant or child.
3.21.2008 1:18pm
tired of blogs:
Spartacus: At first I was thinking that there might be an externality to your seat belt case, since if I were to get into an accident with you that had the effect of killing your unsecured child (who would have been safe otherwise, I'm supposing for the sake of argument), I might be liable for your failure to belt your child. Interestingly, though, Google has revealed to me several examples of parents charged with criminal vehicular homicide for failing to belt their own children, both in accidents in which the parents were at fault and even in accidents in which they were not. Still, though, it seems likely that you would not forgo your opportunity to sue me, whether or not I was at fault, which strikes me as a significant externality.
3.21.2008 1:22pm
Steve2:


Now we have vaccinations for HPV for children? Give me a break.


What better way to make sure the vaccine's administered before exposure to the disease can occur?

Problem with the HPV vaccine isn't that it's given to children. Problem's that they don't make one for male children, which means there's nothing to prevent one of us from contracting it and then spreading it, since there's also not much of a test for it in men.

Anyway... forgoing vaccination isn't a "right", it's a dereliction of duty.
3.21.2008 1:23pm
Fub:
Tracy Johnson wrote at 3.21.2008 10:46am:
I dunno, before vaccinations, it used to be common wisdom to send kids to play with other sick kids with childhood diseases because the severity was less than as an adult. Happened to me when I was a kid, although I never them it that way, but later as a kid. Now I'm 52. I suppose it is along the same theory as inoculation, which also used to be common practice.
Heck, in my day parents didn't even have to send their kids to play with infected kids. The kids just did it naturally without prompting, even when their parents tried to prevent it.

But we did get vaccinations against some other, more likely fatal diseases. Whooping cough was one vaccination I recall.

Richard Aubrey wrote at 3.21.2008 10:37am:
I recall when the Salk vaccine came out. It was during a polio epidemic in Detroit. My parents said the reaction to the news was like that on VJ Day.
I'll second that. I was almost of adult age when the Salk vaccine became widely available. I got the Salk, and a few years later the Sabin.

In the late 1940s and 1950s, a case of polio in any area caused massive public health prevention measures. Swimming pools and other gathering places shut down, even schools, baseball games and the like. People were advised to keep their children as close to home as possible. It was a fairly regular summertime event in those days.

The disease was horrific, and the prospect of contracting it was terrifying. It was fatal or permanently debilitating, depending on chance. I knew some kids who had survived it. And by that time everybody had long known about FDR.
3.21.2008 1:24pm
MDJD2B (mail):

At first I was thinking that there might be an externality to your seat belt case

The externality is the kid. Spartcus doesn't increase his own accident risk by not strapping in the kid-- he increases the kid's. The kid doesn't have a choice.

If Spartacus has health insurance, there is another externality, which is that the health care costs of the kid's injuries are shared. If he does not have a kid, it is likely that the public will pick up up those costs.

There is also the cost of special education for children with disabilities and and public maintenance of adults with disabilities.

If the accident is the other person's fault, the expenses of pursuing a law suit comprise another externality.
3.21.2008 1:29pm
Erick:

Guess what--I also don't always use a child seat or even a seat belt with my 3 year old! Gasp! Call child protective services! How did we ever survive the abuse the prior generation heaped on us?

What the hell is wrong with you?



I think the example that few are vaccinated these days against smallpox (I was) any more is apt: the need for various vaccinations waxes and wanes.

Smallpox is GONE. There's no reason to vaccinate for it. Measles is still very much around. If we stopped vaccinating people it would make a comeback very soon.
3.21.2008 1:34pm
Dan Weber (www):
I haven't read the comments, but I think the government shouldn't be in the business of telling people how to raise their kids.

I think people who don't immunize their kids are making poor parenting choices, but if I got the government to intrude on them, someone else could get the government to intrude on me.

If the parents significantly harm their children through their choices, we can punish them. That's freedom, letting people make mistakes.
3.21.2008 1:34pm
Anderson (mail):
Guess what--I also don't always use a child seat or even a seat belt with my 3 year old!

That will be real funny right up to the point where the kid goes through the windshield.

Next up: why Spartacus thinks condoms are for sissies.
3.21.2008 1:38pm
Virginian:
Can someone please explain the "free rider" problem? If I don't get my child immunized but you get your child immunized, how does that affect anyone other than my child?
3.21.2008 1:40pm
dll111:
I had chicken pox as a kid and got shingles while I was on a trip to Europe when I was 20. It's tough to get a girl to sleep with you when you have huge red splotches on your back and chest!
3.21.2008 1:41pm
dew:
In addition to a fine, maybe any state that allows a vaccination opt-out could require parents choosing to opt out to sign a consent form where they explicitly acknowledge that by refusing vaccination for their child, they may be liable for significant financial compensation if their child gets a disease and passes it on disease to someone else. Forcing people to acknowledge/accept a financial risk to themselves for their actions (instead of just risking their kids) might weed out many of the free riders.

Polio, at least in the United States, is eliminated. At that point, any non-zero risk of side effects from the vaccine is unacceptable.

That might be a nice argument if the US was isolated from the rest of the world. Polio is still endemic in India and other countries in that area. Believe it or not, people have, on occasion, been known to travel from India to the US (and even in the other direction). Stopping vaccinations in the US now or any time soon is a near certain recipe to sooner or later cause polio epidemics to return to the US.

Richard Aubrey: Before the advent of a vaccine for rubella--german measles--mothers would send their daughters to german measles parties so that they'd all get it and be immune later on when pregnant.

I was surprised to learn in the 1990s how common chicken pox parties were in the spring each year. If chicken pox was going around the schools, sooner or later most everyone without immunity would get it. Many parents wanted to get through it as soon as possible so that it would not infect their kids later and ruin summer vacation plans.
3.21.2008 1:41pm
hattio1:
Professor Bernstein,
I'm curious what, in your opinion, makes forced vaccinations a "close call" if you take away the externalities? I guess for me, I come down the other way. If there were no externalities, it's not even a close call, forced vaccinations are wrong. (I'm assuming here that by externalities you are referring to other people's kids getting sick, the person's own unvaccinated child still has the possibility of getting sick)*. With the extenalities, I think it's a close call, but probably come down on the side of not enforcing vaccinations.

*Obviously, if you take away the chance of anyone getting sick by hypothetically eliminating externalities, then forced vaccinations would be wrong. Hell, recommended vaccinations would be wrong.
3.21.2008 1:43pm
Qwerty:
Smallpox is GONE. There's no reason to vaccinate for it.

Yes there is. An unimmunized population is more vulnerable to a foreign terrorist attack using smallpox.
3.21.2008 1:46pm
dew:
Can someone please explain the "free rider" problem? If I don't get my child immunized but you get your child immunized, how does that affect anyone other than my child?

(a) If there is a risk from a vaccine, you allow everyone else to take the risk, but get most of the benefits (reduced likelihood of getting a bad disease) at no cost to you.
(b) Not all immunizations are 100%, so you risk innocent 3rd parties if your child does get the disease.
3.21.2008 1:47pm
Dan Weber (www):
That will be real funny right up to the point where the kid goes through the windshield.

Sometimes the comments in here remind me of a guy who has just given up smoking two hours ago.

I'm gonna go put my baby to sleep on his stomach now. And then feed him some non-organic food.
3.21.2008 1:58pm
Dave N (mail):
Yes there is. An unimmunized population is more vulnerable to a foreign terrorist attack using smallpox.
My understanding (though I may be wrong) is that smallpox has been eradicated and the only living strains are in highly secure vaults controlled by the CDC and a very few of their international counterparts. Even if a terrorist had the capability to penetrate one of those vaults and steal one of those few remaining strains, I suspect that replicating it in order to create some kind of pandemic would be close to impossible.

So could it happen? Yes. Anything is possible. Is it likely? No. Is that a reason to mass vaccinate everyone against the threat? I don't think so.
3.21.2008 2:00pm
TDPerkins (mail):
Spartacus,

I don't have a problem with you not vaccinating your children. I have a problem with your children being allowed in public.

Yours, TDP, ml, msl, &pfpp
3.21.2008 2:02pm
bearing (mail) (www):
Does the state have a right to force upon people those vaccinations that are derived from fetal cell lines, if those individuals have a religious objection to them? Although a rubella vaccine that is not so derived has been available for years in Japan -- it is manufactured by Kitasato -- the slow-moving FDA has yet to approve it for use in the U.S.

It's irrelevant whether it makes sense to have a religious objection to said vaccines; only whether public health risk outweighs freedom of conscience in this situation. I am inclined to favor freedom of conscience, especially since there exists a solution: approve the Kitasato vaccine.
3.21.2008 2:03pm
Dave N (mail):
I want to make it clear that I was speaking specifically about the smallpox vaccine in the previous post. I have stated my opinion on vaccination upthread for anyone who hasn't read it.

Readers' Digest version of my position: Anyone who doesn't vaccinate their kids is insane and I speak from personal experience about how nasty measles actually can be.
3.21.2008 2:04pm
calmom:
It is more than a little ironic that in California you can be arrested for smoking in a car with a child, but intentionally exposing your child to measles or chicken pox is okay.
3.21.2008 2:19pm
Aeon J. Skoble (mail):
David, good for you callng a spade a spade. Libertarianism doesn't mean you can beat your kids. I don't see why it should mean you can be grossly neglectful towards them either, as in exposing them to a very serious, but easily preventable, disease. You have the right to be delusional only until it causes harm to another.
3.21.2008 2:21pm
common sense (www):
Dave N- the problem with Smallpox is that the Russians lost track of theirs for a little while, so there is no 100% accountability. That's the reason Soldiers get vaccinated prior to deployment- there is a chance terrorists have smallpox, and the risk on deployment is high enough (for someone in a decision making position at least) to be worth whatever risks the vaccines entails, as well as the disruption that particular vaccine causes.

In general, absolute freedom is bad, just like too much of anything is generally bad. That's why we all give up certain freedoms to enter society. Some of those freedoms are beyond discussion- I promise not to exercise my natural right to kill people in exchange for the ability to walk down the street with some degree of safety. Some people might say that I've increased my actual freedom by the exchange, much as we say that being bound by a contract increases our freedom. Personally, I think vaccinations, especially for children who have no self-determination in the matter, are pretty clearly in that realm of freedoms that we should give up to interact in society. The numbers illustrate pretty clearly that the benefits, both for society and the individual, far outweigh the risks. If your kids are going to interact with mine, then you should have to vaccinate your kids. I think this is a fair exchange for living in a society that benefits from the eradication of smallpox and very rare cases of polio et al.
3.21.2008 2:22pm
K Parker (mail):
J Richardson, there is indeed a shingles vaccine on the market, currently only indicated for age 60 and up (though I understand it's rarely given above age 69 due to the generally poorer immune response with increasing age.) I think the expected immunity is only 60-70%. My wife and I are currently in a study testing the efficacy of the vaccine in the 50-59 age group.

Bruce, if I understand it correctly, any current use of the vaccine in under-60 patients would be considered "off-label" and you might have significant difficulty finding a doctor who would administer it.

Virginian, google "herd immunity" for your answer.
3.21.2008 2:25pm
Visitor Again:
I remember the huge fears polio engendered every summer in the early and mid-1950s. Huge stories in the newspapers about the latest polio scare. I once thought I had it, but it was probably nothing but my imagination brought on by the scare publicity. Yet the danger was very real.

I had measles and chickenpox. Got vaccinated as an immigrant for smallpox and still have the mark on my left arm. Scarred for life.
3.21.2008 2:25pm
Visitor Again:
I meant to add that what was huge fodder for the newspapers every summer--polio scares--disappeared almost overnight with the Salk vaccine. We all got vaccinated and never had the slightest worry about polio ever again.
3.21.2008 2:28pm
ejo:
I love the natural health community-all of history leading to where we are with medical science being able to eradicate diseases which were nightmares in the past for all children is thrown aside for health practices that would have been used by Theodoric of York, Medieval Barber. Perhaps we will need a resurgence of some of these diseases to put matters into perspective.
3.21.2008 2:34pm
Temp Guest (mail):
I grew up in the 1950s when some current vaccines were available and some were not. During my childhood, I and/or one of my sibs got measles, mumps, chicken pox, and whooping cough. They were extremely unpleasant diseases that have had consequences for all of us through our lives (heart problems in a brother, shingles for me). Families I knew lost children to these diseases and that other scourge, polio. While I was growing up millions of children died from small pox. Small pox deaths and permanent disfigurements and cripplings occurred in the US, so we were automatically and gratefully vaccinated against this now extinct (thanks to vaccination) disease.

Adherence to any useful ideology is fine up to a point. But an absolute, unwavering, and mindless adherence is murderous fanaticism and it's sad to see that some libertarians have passed into this dangerous mental state. I like to think it may be due just to an unfamiliarity with the subject about which some are fulminating
3.21.2008 2:37pm
Elliot123 (mail):
"Guess what--I also don't always use a child seat or even a seat belt with my 3 year old! Gasp! Call child protective services! How did we ever survive the abuse the prior generation heaped on us?"

Calling child protection is probably the prudent thing to do. When parents fail to protect their children, the larger society recognizes the child as one of them and steps in to protect him from the parent.

Note those of us reading these posts are living. Those three-year-olds who banged around the inside of cars and smashed their brains to bits are not with us. They didn't survive. We did.

Some people probably should not have chldren. I'd suggest that people who will not protect their children from disease or traffic death should simply avoid raising children. There are other paths to very productive and rewardng lives.
3.21.2008 2:38pm
Roger Schlafly (www):
One of the downsides to having chicken pox as a child (or an adult) is that you can now have shingles (varicella-zoster). The virus lies dormant in your body after chicken pox. As someone who has had shingles, it isn't fun.
Yes, but the incidence of shingles in old people is going up because of chicken pox vaccination. It used to be that occasional exposure to chicken pox would increase the antibodies in old folks, and keep shingles away. Now the antibodies wear off, and they get shingles.
3.21.2008 2:39pm
byomtov (mail):
Bernstein is exactly right, including the headline.
3.21.2008 2:55pm
Dan Weber (www):
Some people probably should not have chldren. I'd suggest that people who will not protect their children from disease or traffic death should simply avoid raising children. There are other paths to very productive and rewardng lives.

You should probably read Freakonomics, especially the chapter on parenting. (One of the authors lost a child due to meningitis so they aren't as cold about this as you might expect.)

Oh, their car seat debate already made an appearance here at Volokh. http://volokh.com/posts/1122383776.shtml

Anyway, here's the opening of their first chapter on parents:
No one is more susceptible to an expert's fearmongering than a parent. Fear is in fact a major component of the act of parenting. A parent, after all, is the steward of another creature's life, a creature who in the beginning is more helpless than the newborn of nearly any other species. This leads a lot of parents to spend a lot of their parenting energy simply being scared.

The problem is that they are often scared of the wrong things. It's not their fault, really. Separating facts from rumors is always hard work, especially for a busy parent. And the white noise generated by the experts—to say nothing of the pressure exerted by fellow parents— is so overwhelming that they can barely think for themselves. The facts they do manage to glean have usually been varnished or exaggerated or otherwise taken out of context to serve an agenda that isn't their own.
3.21.2008 3:04pm
SCARED OF THESE PEOPLE:
When a non-vaccinated child enrolls in school, is his/her teacher informed of the fact that there is a walking, talking Petri dish in the classroom? Do parents of the rest of the children in the class receive some sort of notification?

There is an informational issue here, I think, in that the parents of vaccinated children probably don't get to know that one of their child's classmates is unvaccinated. I certainly wouldn't want my kid playing with the unvaccinated classmate, and I definitely wouldn't want the unvaccinated child coming over to my house for play dates, birthday parties, etc.

If parents opt out of vaccination, they and their child should have to bear the social costs of placing others at risk.
3.21.2008 3:04pm
GenX Dad:

Guess what--I also don't always use a child seat or even a seat belt with my 3 year old! Gasp! Call child protective services! How did we ever survive the abuse the prior generation heaped on us?


The answer is, of course, that not everyone did. Check the traffic accident fatality rates from the 60s and 70s vs. today...
3.21.2008 3:15pm
UW2L:
This woman boggles my mind. "I refuse to sacrifice my child for the greater good, but I acknowledge my kid puts others at risk." Selfish much? Forget what kind of Typhoid Mary the kid might be now, I dread to see how he turns out as an adult due to his mother's "do what you want, other people do not matter and you are exempt from being a responsible social citizen" child-rearing. A disease vector AND a sociopath. Awesome.
3.21.2008 3:19pm
Spartacus (www):
I cannot believe the vitriol on this comment track. I have been accused of being unfit for parenting, and a call to CPS as the most appropriate response. Now I know whay I post here anonymously. For a supposedly generally libertarian blog (I know, not everyone here is, or even claims to be), I cannot fathom the extent of busybody-ism here. I have my own opinions about the lack in many other parents I see (kids in front of the TV, strapped into strollers all day long, talked down to, etc) but that is the parent's business. Yes, most of us survived beign brought up pre-1990s (when seatbelts became mandatory), and that doesn't make me a monster. All actions have some externalities, all parents allow their child to be exposed to some risks, and other parents need to live with that. we happen to live in a nation with a federalist approach to the issue of vaccinations, and a plurality of states allows parent not to vaccinate. I don't to claim this makes me a bad parent is not likely to either win me or the millions of parent who agree with me over. People need top take a gigantic chill pill.


I'm gonna go put my baby to sleep on his stomach now. And then feed him some non-organic food.


Thank you. I might even let mine climb a tree or ride a bicycle without a helmet.
3.21.2008 3:21pm
Loren (mail):
For all the talk about the propriety of smallpox inoculation, do any states still actually have mandatory smallpox vaccinations? I live in Georgia, the home of the CDC, and the smallpox vaccine isn't on our state vaccination schedule. (And for the record, polio is still on the schedule.)
3.21.2008 3:23pm
wfjag:

Dave N- the problem with Smallpox is that the Russians lost track of theirs for a little while, so there is no 100% accountability.


Additionally, that statement needs to be qualified that that only concerns the Smallpox virsus strains that the Russians admit to still having. In 1972 the US and USSR signed a treaty agreeing to destroy bio and chem weapons. When the USSR came apart, documents from it were made public showing that the USSR continued with its bio weapons R &D programs, including developing more virulent strains of smallpox and weaponization of them. There is no dependable information on what else was developed, where it was located, how it has handled, what security measures were used to guard it or if those were effective or followed. Rather, we know that as to what the Russians admit they had there was a loss of accountability for a while (leaving the possibility that there was replication and distribution we don't know of). But, we also know that there was a large bio weapons R &D program, that included smallpox, that we really don't have any dependable information on.

Sorry I can't give you a link on this. A couple of years ago there was an excellent discussion of this in a NPR program, and why at least having a substantial store of smallpox vaccines available appeared prudent.
3.21.2008 3:24pm
Spartacus (www):
"Guess what--I also don't always use a child seat or even a seat belt with my 3 year old! Gasp! Call child protective services! How did we ever survive the abuse the prior generation heaped on us?"

Calling child protection is probably the prudent thing to do. When parents fail to protect their children, the larger society recognizes the child as one of them and steps in to protect him from the parent.

. . .

Some people probably should not have chldren. I'd suggest that people who will not protect their children from disease or traffic death should simply avoid raising children. There are other paths to very productive and rewardng lives.


What shoudl be the consequence? Have my child taken away from me? A big fine? Are you a parent? Would you tell me how to raise mine? I need to leave this comment thread because the personal attacks are really pissing me off. If you wanted to debate the issue, you could have at least tried instead of simply hurling insults.
3.21.2008 3:26pm
Thorley Winston (mail) (www):
It is more than a little ironic that in California you can be arrested for smoking in a car with a child, but intentionally exposing your child to measles or chicken pox is okay.



So which legal change would you suggest should be done in California -- repeal the law that prohibits smoking in a car with a child or make it illegal to intentionally expose your child to the measles or chicken pox?
3.21.2008 3:26pm
Roger Schlafly (www):
Too unlibertarian for you? Make them pay a fine equal to the monetary value of the level of risk to others they're creating, ...
The risk is really small. Let's say 100 cases of measles occur in the USA, and each costs $1000. That is onlyh $100k per year. With only about 50k kids per year refusing to vaccinate, that would only be a one-time payment of $2 per unvaccinated kids. Sure, make them pay the $2.

Some kids cannot get vaccines for medical reasons. You might want to charge them $2 also.

But all these measles cases come from overseas, so it would be better to tax those who come into the USA unvaccinated from a country that has not eradicated measles. Then the tax would be higher, as it would be more focused on those who are actually creating the risk.

I am really surprised at quickly some libertarians here embrace some nanny state ideas, after reading just a minor scare story.
3.21.2008 3:31pm
Thorley Winston (mail) (www):
Re: Vaccinations

I was at a health law event last week where we had a homeopath as a guest speaker. I have to say that while I was predisposed to disagree with pretty much everything she had to say, to her credit she took the position that "conventional" medicine was terrific and a life-saver but that there were limits to it.

When she was asked about vaccinations, she said that she thought that vaccinations were great for some things like polio but she thought that the problem was that we were overusing vaccinations similar to way that we're overusing antibiotics and that one of the unintended consequences was that over-vaccinations may lead to the weakening of our natural immune systems. Rather than immunize children against things like chicken pox (she didn't mention mumps or the measles), she said that in some cases it might be better to just let the kid get it when they're young and build up a natural immunity rather than try to protect them from it.

Her main message on vaccinations -- be smart and be selective about what you do (not) immunize your children against.
3.21.2008 3:31pm
Spartacus (www):
Thank you to the last two posts, especially Schlafy, who made my (and Bernstein's) point exactly. I would gladly pay the $2.
3.21.2008 3:38pm
Aeon J. Skoble (mail):
How are very serious, yet easily preventable, diseases a "minor scare story"? One reason people had 9 kids back in the old days is that there was a good chance a lot of them would die from stuff that we now how to prevent. The commenter upthread who made the Theodoric of York reference was pretty much spot on. The "case" against vaccinations is in the same general vicinity as flat-earthism, except that instead of teaching the child a falsehood which can be unlearned in a class or via a book, the child can suffer needlessly, suffer long-term healh problems, or die. That's grossly neglectful, and unneccessarily cruel.
3.21.2008 3:43pm
John Burgess (mail) (www):
I, too, grew up in the 40s and 50s and had the regular route of what are now called childhood diseases. (Interestingly, those 'childhood diseases' were massive epidemics when they first entered human populations. Check out William McNeill's Plagues &People.)

I had classmates die of polio, went through the summers when public activities were severely curtailed, saw other kids who were debilitated by diseases we are now routinely vaccinated against. I'm definitely in favor of mandatory vaccinations against these diseases.

I made sure my son received all his vaccinations, too, at the appropriate ages, particularly because as a Foreign Service Officer I knew we would be living in countries were vaccinations were not the norm and where diseases almost extinct in the US were still widespread.

But vaccines are not proof against disease. In most cases, they simply mitigate them, causing fewer or lesser effects. As parents, we were happy to send our fully-vaccinated son to 'disease parties' with the thought that contracting the actual disease would provide better immunity than the vaccines alone, immunities that tend not to wear off, too.

Vaccinated against chickenpox, he never picked up a light case of it. Until he was 17. During one Christmas holiday,he visited me in India. Unfortunately, his boarding school in the UK had just had an outbreak and he brought it with him.

The doctors took his disease very seriously, concerned that high fevers which can accompany chickenpox could have permanent effect. And he was certainly miserable for a couple of weeks.

Childhood diseases are manageable for most kids, at least in the West. They are not so manageable in adults. Little girls who catch measles (or rubella) don't have to worry about miscarriages or birth defects in their children in quite the same way. Little boys who catch mumps don't face the threat of inflammation of the testes with the possibility of later sterility.

And yes, Spartacus should be reported for child endangerment, if not out-and-out abuse. At the least, he should suffer through the mandatory 6-hour seatbelt law course. I won't wish a child's funeral or life-long medical care on him. Maybe a stiff fine, a few months in jail, and being put on the state's child abuse watch list would get his mind around the concepts involved here.

But no, not even his accepting strict financial liability for the disease his kid gives to my kid is satisfactory, especially if my kid dies of that disease. Then, he might wish he lived in another state as TX is rather forgiving of homicides committed in the rage of passion.
3.21.2008 3:44pm
Aeon J. Skoble (mail):
D'OH! Typo. Line 4: stuff that we now know how to prevent. Moral: always use preview.
3.21.2008 3:44pm
Grumpy Old Man (mail) (www):
Although my childhood long preceded the invention of the vaccine, somehow I managed to avoid the measles until becoming an adult.

It's a serious disease, although the virus has probably declined in virulence. It more than decimated the tropical forest Indians of South America.

The externalities imposed on the public at large by those who refuse vaccination ought to trump the liberty interest in non-religious objections to it.
3.21.2008 3:45pm
TDPerkins (mail):
I would gladly pay the $2.


It's a paltry penalty indeed for perhaps killing someone.

Tell you what, in the event an unvaccinated person passes a disease to someone who, as a result, dies from it--we execute the unvaccinated person?

At the very least, they should be liable for prosecution for negligent homicide.

Or, since you are the guardian of your unvaccinated child, in that case, you should be.

Yours, TDP, ml, msl, &pfpp
3.21.2008 3:45pm
Spartacus (www):
And yes, Spartacus should be reported for child endangerment, if not out-and-out abuse. At the least, he should suffer through the mandatory 6-hour seatbelt law course. I won't wish a child's funeral or life-long medical care on him. Maybe a stiff fine, a few months in jail, and being put on the state's child abuse watch list would get his mind around the concepts involved here.

But no, not even his accepting strict financial liability for the disease his kid gives to my kid is satisfactory, especially if my kid dies of that disease. Then, he might wish he lived in another state as TX is rather forgiving of homicides committed in the rage of passion.


We can now add death threats to the incredible barrage I have been subjected to here.
3.21.2008 3:56pm
tarheel:
There may or may not be a valid argument for not vaccinating (I think not, but anyway . . .), assuming you really believe it is in the best interests of your child to not do it. There is no valid argument for not putting your child in a car seat/seat belt. That imposes absolutely no cost on you and no risk to the child and unarguably has the potential to save his/her life.

As best I can tell, you don't put your kid in a car seat to give society a big F--- You for "telling you how to parent," which is cute but doesn't really hurt our feelings and puts your kid at risk. Smart move.
3.21.2008 3:57pm
TDPerkins (mail):
We can now add death threats to the incredible barrage I have been subjected to here.


There is a very small but very real risk your actions will lead to the death of a person.

Face up to it.

Yours, TDP, ml, msl, &pfpp
3.21.2008 3:58pm
Dave N (mail):
Spartacus wrote:
Thank you to the last two posts, especially Schlafy, who made my (and Bernstein's) point exactly. I would gladly pay the $2.
I am not attacking you, and I appreciate the sincerity of your beliefs, but would you also tell your brain-damaged child, "Yes, I considered getting a measle's vaccination but I decided it wasn't worth the risk. I am sorry you caught it and it caused this damage?"

My mother still blames herself for my brother's condition ("I should have gotten him to the hospital sooner when his temperature spiked")--and he caught measles before a vaccine was readily available.
3.21.2008 4:00pm
Spartacus (www):
Call me a flat earther all day, but thank god the law in Texas protects me from some of people who have posted to this comment thread today. I suggest you move to the EU where imprisonment for failure to vaccinate is more routine.
3.21.2008 4:01pm
TDPerkins (mail):
Spartacus,

Face up to it.


Got conscience?

Yours, TDP, ml, msl, &pfpp
3.21.2008 4:04pm
Helen2 (mail):
I'm old enough that I had measles when I was five years old. It left me with severely damaged eyesight. Fortunately, our family physician administered gamma globulin to my brother and sisters, attenuating their disease, and they suffered no lasting effects.

Denying your children measles vaccination is child abuse. You have no way to know whether they will encounter the virus years later as an adult, especially if they travel. The effects on someone infected as an adult are likely to be much worse than mine.
3.21.2008 4:06pm
Buckland (mail):

Can someone please explain the "free rider" problem? If I don't get my child immunized but you get your child immunized, how does that affect anyone other than my child?


Let me take a crack at this...

For most diseases as long as the vaccination rate is high there's not going to be a general outbreak. Depending one the disease (and how easily it spreads) the rate needed to protect the population is somewhere in the 90-96% range.

However there is a small risk to any vaccination. Therefore a very viable "free rider" strategy is to not have your kids vaccinated, while making sure that everybody else does vaccinate their kids. Your kids have neither the risk of the vaccination nor the risk of the disease since the ambient vaccination rate is high.
3.21.2008 4:08pm
Aeon J. Skoble (mail):
I'm glad the laws in Texas prevent you from being murdered, but I don't think anyone was actually threatening to kill you. What I did see a lot of was people expressing shock at your views, which you haven't actually defended. Do you have some reason children shouldn't be vaccinated that the others don't know about? NB this is _not_ analogous to the over-prescription-of-antibiotics issue.
3.21.2008 4:08pm
Virginian:

When she was asked about vaccinations, she said that she thought that vaccinations were great for some things like polio but she thought that the problem was that we were overusing vaccinations similar to way that we're overusing antibiotics and that one of the unintended consequences was that over-vaccinations may lead to the weakening of our natural immune systems. Rather than immunize children against things like chicken pox (she didn't mention mumps or the measles), she said that in some cases it might be better to just let the kid get it when they're young and build up a natural immunity rather than try to protect them from it.


This generally describes my position. I am not anti-vaccine, but I think too many vaccines are being made mandatory. My 7 month old is getting the big ones (polio, DTaP, etc), but not hep B or varicella (chicken pox) (there is one other we refused, but I forget which).

She can get the hep B vaccine when she becomes a healthcare worker or a crack whore, and can get the varicella vaccine if she gets past childhood without getting chicken pox.
3.21.2008 4:20pm
Waldensian (mail):

There are many advantages to autism...

What a total and complete load of crap. I've had all I can stand, and I can't stands no more.

Okay, maybe there are "advantages" to whatever brand of "autism" afflicts people who, like you, are apparently capable of going to law school, and are fond of posting comments on blogs talking at great length about their autism. I won't pretend to understand this phenomenon. Since you talk a great deal about your autism, I don't think it's rude of me to ask: What, exactly, is your diagnosis, who made it, and when?

But let me be very clear: there is no advantage whatsoever to the autistic disorder suffered by my two sons. None. Zero. One of them is barely verbal, neither has conversational speech (or likely ever will), and it is almost certain that neither of them will be able to live independently, ever. They likely will never obtain a driver's license, graduate from college, get married, you name it. They are in constant danger because they cannot appreciate the risks presented by their unusual behavior, and by all sorts of things in their environment. And that's just the beginning.

...and most people who are in fear of autism and/or making these crazy decisions not to vaccinate their children are doing so based on their ignorance of autism -- not a very solid basis for making such a significant public health decision.

Another total and complete load of crap. Actually, people who know the first damn thing about autistic disorder are quite rationally scared to death of autism. Autism, in the form experienced by my sons and by the children like them, is a very, very bad thing. Any sane person, I dare say you included, would do anything to prevent it from afflicting his or her children. I would do anything -- anything -- if I thought it would cure them.

Moreover, I don't think the autism-vaccination causal link has been that well established yet. The jury is still out on the issue.

What jury, where? The evidence against the vaccine-autism link is, currently, overwhelming. Wishful thinking by anti-vaccine zealots doesn't make it otherwise.
3.21.2008 4:26pm
Nick P.:
she thought that the problem was that we were overusing vaccinations similar to way that we're overusing antibiotics and that one of the unintended consequences was that over-vaccinations may lead to the weakening of our natural immune systems.

Weaken the immune system? That makes no sense whatsoever. It's so stooopid it's not even wrong.
3.21.2008 4:30pm
Dan Weber (www):
"Overwhelm the immune system" is a buzzphrase that you can google for to find the anti-vaccine whackjobs.
3.21.2008 4:41pm
Anderson (mail):
I have been accused of being unfit for parenting

Uh, yeah. Exactly.

If you recite your actions A, B, and C that demonstrate you are unfit for parenting, then don't be surprised that other people say you are unfit for parenting.

Hopefully your children will not only survive into adulthood, but display better care of their own children.
3.21.2008 4:44pm
Bruce:
Waldensian: Hear, hear.

I had chickenpox and a mild form of measles (contracted from the vaccine, we believe) as a kid. I remember both as extremely unpleasant -- particularly the measles, even though I was only 4 at the time.

I think part of what explains behavior like that reported in the Times article is that people forget just how bad these "childhood illnesses" are. My mother had whooping cough as a kid, and she says that every time she went into a coughing fit, she wondered if she was going to survive.
3.21.2008 4:51pm
Dave N (mail):
Waldensian,

Hear! Hear! There is nothing great about the autism I have witnessed in my family's life. I would not wish it on anyone and I can both totally empathize and totally agree with the points you made. I know you have undoubtedly sacrificed much to care for and protect your children.

Rainman was a great film because it accurately portrayed the life of an autistic savant. My brother has some savant abilities (Gee, it's a great parlor trick to accurately tell people what day of the week they were born on) but I would give anything to have the brother who might have been--had a vaccine been available, since measles indisputably caused his autism.
3.21.2008 4:52pm
pmorem (mail):
Spartacus, maybe I can explain some of the hostility.

You have chosen a course of action which may make your children into deadly threats to me. I have no way to evaluate or recognize the level of threat, either.

Your potentially diseased children don't have any externally visible indicators. They don't even have to come within visual range of me to be a threat.

Since I can't avoid your whelps, my only sufficient means of self-defense is to ask that they be vaccinated.
3.21.2008 5:05pm
theobromophile (www):
Shingles almost never occurs in people who get the vaccine. It's very common in people who've had chicken pox.

Calmom, that has everything to do with the fact that the unvaccinated folks are my age or older (20s and up), and the vaccinated folks are teenagers and kids. Wow - the vaccinated folks don't get shingles!

My mother had whooping cough as a kid, and she says that every time she went into a coughing fit, she wondered if she was going to survive.

True story. I had it, too, when I was 14. I remember coughing and choking on the stuff that I was coughing up. This was not a normal small glob of phelgm; it was fist-sized globs of thick mucus that clogged up my windpipe. Left untreated, it can progress into pneumonia. (If anyone happens to be unlucky enough to get it, I have some non-medical advice: avoid humid environments. I coughed the hardest and the worst when in the shower or on the beach.) Thankfully, the treatment (antibiotic? albuteral sulfate, and a sleeping aid) were very, very effective. Interestingly, I was on the same thing that my grandmother was on for emphysema. We spent the summer puffing away next to each other on the lanai.

I will say that having chicken pox was roughly a million times easier than that. I simply cannot understand lumping varicella in with polio, pertussis, MMR, and the like... and then getting surprised when people rebel at the idea of giving their kids all those vaccines.
3.21.2008 5:11pm
Duffy Pratt (mail):

she thought that the problem was that we were overusing vaccinations similar to way that we're overusing antibiotics and that one of the unintended consequences was that over-vaccinations may lead to the weakening of our natural immune systems.

Weaken the immune system? That makes no sense whatsoever. It's so stooopid it's not even wrong.


How about if she put it like this: By preventing the diseases, you eliminate the opportunity to stress the immune system. That sort of use and activity of the system allows it to grow and develop. So, people who have used their immune systems to successfully fight off diseases may end up with stronger and more capable systems than those whose systems have more or less laid inert.

Kids who are exposed to cats and dogs and dirt end up having fewer allergies than kids who live in pristine environments with HEPA certified vacuums sterilizing everything every day. The thinking on this is that overly clean environments inhibit the immune system from developing the way it should.
3.21.2008 5:12pm
Thorley Winston (mail) (www):
she thought that the problem was that we were overusing vaccinations similar to way that we're overusing antibiotics and that one of the unintended consequences was that over-vaccinations may lead to the weakening of our natural immune systems.

Weaken the immune system? That makes no sense whatsoever. It's so stooopid it's not even wrong.


How about if she put it like this: By preventing the diseases, you eliminate the opportunity to stress the immune system. That sort of use and activity of the system allows it to grow and develop. So, people who have used their immune systems to successfully fight off diseases may end up with stronger and more capable systems than those whose systems have more or less laid inert.


That's actually more or less how she put it. Thanks for the save Duffy. :)
3.21.2008 5:18pm
Duffy Pratt (mail):
As for shingles, I can't find anything which says that people who got chicken pox vaccine are immune from shingles. Instead, the medical sites I've looked at say that people who have been vaccinated are at risk for shingles. They don't given any comparative risk.

One side effect of the vaccine may be that it increases shingles in adults. There has been a recent study on this. Shingles has increased since the introduction to the vaccine. The natural immunity to chicken pox tends to weaken over time, unless the person gets reexposed to the live virus. With vaccinations, adults are getting exposed to the live virus less and less. Thus, their immunity to the virus decreases. And that in turn increases the risk of the virus reactivating. Thus, the vaccination reduces the risk of chicken pox, but increases the risk of shingles, which is in every way a worse disease.
3.21.2008 5:18pm
Spartacus (www):
Do you have some reason children shouldn't be vaccinated that the others don't know about?

I think the risks are incredibly low--my children are not in day care, and have not tavelled internationally. If and when either of these changes, we will likely vaccinate. Risks of side effects (even small ones) in infants are greater, to my understanding, than the risk of infection at a very young age, and small side effects are not worth lessening an already very small risk of a greater harm.

Curiously, I never stated that I would never vaccinate, in fact, here I am (for the first time) making it clear that we likely will vaccinate at some point in the future. However, people were so quick to condemn me without asking any questions, I had little chance to respond intelligently. Perhaps you still do not think my responde is intelligent, but neither were the responses to my original post.

As for seat belts, same thing. 99% of the time, my kids are in a car seat, or in the case of the older one, a booster (at 40 inches he is big enough to forgo the car seat) and seat belt. Other times, the risk, though of a very great harm, is sufficiently small IMO that it is not worth the certain negative externatities of acting otherwise: sometimes, for example, when the baby was crying uncontrollably, one of us would sit in the back seat and hold the child rather than strapping him in (anyone who has ever had to restrain a hysterical infant into a car seat knows that it is not a plesant task). Other times, I let my older son lay down in the back seat to take his nap on the drive home, because, duh, he needs a nap, and as many will attest, children love to fall asleep in a moving car--I know, I napped in the back seat of my parents' car as a child, too.

The fact that this apparently makes me "unfit to be a parent" is mind boggling. Or to put it another way, I'm leaving this party. Talk to y'all (or hopefully a different crowd) about something else in another comment thread someday. Bye.
3.21.2008 5:20pm
Nick P.:
How about if she put it like this: By preventing the diseases, you eliminate the opportunity to stress the immune system. That sort of use and activity of the system allows it to grow and develop. So, people who have used their immune systems to successfully fight off diseases may end up with stronger and more capable systems than those whose systems have more or less laid inert.

It would still be idiotic. Vaccines are designed to elicit an immune response. If your immune system lies "inert" when you are vaccinated, then the vaccine is useless.
3.21.2008 5:26pm
Aultimer:


Roger Schlafly (www):

The risk is really small. Let's say 100 cases of measles occur in the USA, and each costs $1000. That is onlyh $100k per year. With only about 50k kids per year refusing to vaccinate, that would only be a one-time payment of $2 per unvaccinated kids. Sure, make them pay the $2.


I can play that game too. What if there are 10,000 cases of measles that result from your choice, with 9% suffering permanent disability and 1% dying?

If we do a quick tort lawyer valuation on damages, we're up to a good bit more than $10M on top of the $10M cost of care (at your $1K/case). If there are only 50K objectors after there are real costs, that's $400 you can pony up. Do we still have a deal? How about when the disincentive makes it $4000?
3.21.2008 5:32pm
Philistine (mail):
@Spartacus


I am glad that the law in my state protects my right to do so [not vaccinate], and to send them to school-



I think the risks are incredibly low--my children are not in day care, and have not tavelled internationally. If and when either of these changes, we will likely vaccinate.


I'm confused.

Do you intend to vaccinate your kids if they go to school (as seems suggested in your later post), or not (as seems suggested in your earlier).
3.21.2008 5:34pm
Nick P.:
Kids who are exposed to cats and dogs and dirt end up having fewer allergies than kids who live in pristine environments with HEPA certified vacuums sterilizing everything every day. The thinking on this is that overly clean environments inhibit the immune system from developing the way it should.

WRT vaccines, the analogous population would be unvaccinated kids who also don't get the disease. They're the ones you would expect to have a weak or undeveloped immune system (if the idea makes any sense at all). Vaccinated children would be equivalent to a kid who got all the diseases and miraculously survived.
3.21.2008 5:34pm
J. F. Thomas (mail):
How about if she put it like this: By preventing the diseases, you eliminate the opportunity to stress the immune system. That sort of use and activity of the system allows it to grow and develop. So, people who have used their immune systems to successfully fight off diseases may end up with stronger and more capable systems than those whose systems have more or less laid inert.

Yeah, and by not tossing your kids into the tiger enclosure at the zoo, they are not properly honing their fight or flight skills either. She obviously doesn't know how vaccines (especially live vaccines) work. But what do you expect from a homeopath? They believe all kinds of nonsense that has about as much basis in science as astrology, tarot and phrenology.
3.21.2008 5:42pm
Spartacus (www):
Do you intend to vaccinate your kids if they go to school (as seems suggested in your later post), or not (as seems suggested in your earlier).

When we are ready for school, we will get some vaccines but not others. But I don't want to talk to you boneheads anymore; maybe if you can track my ISP or something you can come burn a cross on my lawn.

Late.
3.21.2008 6:09pm
Alan Gunn (mail):
Excellent post, but "horrifying" and "child abuse" are a little over the top, I think. I know of cases where Dad regularly had sex with all of his kids (ages two and up) and encouraged the kids to have sex with each other; where Mom read the Bible while Dad diddled the kids; where Dad stripped the kid and hosed him down so the beating with the baseball bat would hurt more; where Mom and Dad, drunk out of their minds, played catch with their infant son in a parking lot (the kid playing the role of the ball). There's a lot of genuine and truly horrible child abuse out there. In maybe one percent of these cases, the parent does time, but there's seldom physical evidence and little kids make lousy witnesses, so it's rare. The parent you describe is a fool, but hardly evil.
3.21.2008 6:15pm
Elliot123 (mail):
"What shoudl be the consequence? Have my child taken away from me? A big fine? Are you a parent? Would you tell me how to raise mine? I need to leave this comment thread because the personal attacks are really pissing me off. If you wanted to debate the issue, you could have at least tried instead of simply hurling insults."

I'd suggest a parent who refuses to buckle up a three-year-old should lose his license. That would probably be the least intrusive way of protecting the chld.

Yes, I would tell you how to raise your child with respect to seat belts. One might ask who benefits from letting the child ride unbelted. Is it for the benefit of the child or the parent?

Debate is not really appropriate with someone who brags about not usng seatbelts for a three-year-old. At that point the parent is no longer a concern, only the welfare of the child is relevant.
3.21.2008 6:34pm
Jay:
Spartacus,
Give me a break with the victim routine. You made several rather alarming statements, with little explanation, about how you raise your children. People then pointed out, mostly with serious arguments, that those things are pretty stupid. Then, instead of responding to anyone else's arguments, you started flailing around in shocked outrage that someone had dared to challenge you. I mean, your later clarification aside, doesn't it seems pretty obvious why people might react strongly to your initial, totally unexplained comment that you sometimes don't bother to restrain your 3-year-old at all in the car?
3.21.2008 6:41pm
balfour:
At the very least, they should be liable for prosecution for negligent homicide.

And why isn't there a negligence tort for spreading a disease and causing harm thereby? There should be a duty of care to stay home when you have a potentially deadly or otherwise very harmful communicable disease.
3.21.2008 7:15pm
FantasiaWHT:

anyone who has ever had to restrain a hysterical infant into a car seat knows that it is not a plesant task). Other times, I let my older son lay down in the back seat to take his nap on the drive home, because, duh, he needs a nap, and as many will attest, children love to fall asleep in a moving car--I know, I napped in the back seat of my parents' car as a child, too.


No, it's not pleasant. Welcome to reality - being a parent means doing a LOT of things that are unpleasant because they better for your kid. Listening to my 3yo scream if I don't give him a piece of candy he asked for isn't pleasant either, but what kind of kid would I be raising if I gave in to his tantrums?

Your 3yo is unable to make intelligent choices for him- or herself about things like carseats, so yes, I'm going to call you irresponsible if you refuse to make the intelligent choice for him or her.
3.21.2008 7:19pm
ReaderY:
I think there's an argument to be made that the experience of fighting actual real diseases develops the body and helps prepare it to fight new and novel ones that might not be duplicatable by the body's experience with a vaccine. People who've never gotten sick in their lives may have a lower chance of surviving the next deadly epidemic. I don't know this, but it could be the case, and it might make sense to allow children to catch some less serious diseases as a result.
3.21.2008 7:21pm
Fub:
Thorley Winston wrote at 3.21.2008 2:26pm:
So which legal change would you suggest should be done in California -- repeal the law that prohibits smoking in a car with a child or make it illegal to intentionally expose your child to the measles or chicken pox?
You weren't asking me, but here's my answer anyhow: repeal the former and don't enact the latter.

My (longtime dead) father smoked when I was in the car, and I got puking ill from that and motion sickness. And we didn't have seatbelts in those days. But I wouldn't even consider prosecuting him for a crime even if I magically could do so.

I got measles and chickenpox from exposure at school, when some kid(s) or other came to school while incubating the viruses. I wouldn't think of prosecuting their parents, or my parents for sending me to school knowing that there was a risk of exposure.

A police state doesn't actually make anybody any safer. It just allows fools to smugly pretend they are safer because they can punish their petty enemy of the day for violating some currently chic, and at best only marginally rational, taboo. The busybodies who seek positions of power enacting and enforcing such laws are more than happy to encourage hysteria just to increase or consolidate their power.

Vaccination is wise, but vaccinating later than the medical establishment wishes is not necessarily foolish. Punishing people for not vaccinating may feel good, but it is more than foolish. Smoking may be unwise, especially around children, but punishing it with criminal sanctions is more than foolish. Such laws are model petards upon which one can only hope their proponents will someday be hoist.

Like several others here, I'm surprised that apparently libertarian thinkers can become so totalitarian, especially by blowing up rare events as if they were everyday outcomes.
3.21.2008 7:58pm
Dave Hardy (mail) (www):
People indeed don't remember what some of this stuff was like. I'm too young to remember when the polio vaccine came out, just that my parents made sure I got it ASAP, and when the form you could take orally came out, our Boy Scout troop turned out to manage the lines of people waiting.

My late father in law's sister died in childhood of it. As a child I knew a women who went about on crutches because it had ruined the nerves leading to her legs. In the 1990s I knew two people whose legs were weakened by a childhood bout of it.

I can't see where getting any disease "naturally" beats getting a vaccination for it.
3.21.2008 8:29pm
Guest12345:
Can someone please explain to me a few things... (I've not completed reading all the posts so perhaps someone has already covered it)

1) What's the difference between a child who was immunized for chicken pox three years ago and a child who had chicken pox three years ago? Because, I'm fairly certain there is no difference as far as passing on the virus.

2) What's the difference between a child who was immunized in the last twenty days and a child who has had chicken pox in the last twenty days? Again, I don't think there is a major difference. Both are capable of passing on the disease to people who are at risk (not having antibodies, or an otherwise compromised immune system.) And neither is likely to put those who have been vaccinated at risk.

I think it's interesting that everyone here is jumping on those who choose not to have their children vaccinated, but I wonder how many of you lock your children in a bubble for six weeks after receiving a chicken pox vaccination or booster.
3.21.2008 8:31pm
Steve in CA (mail):
OK, Spartacus, forget the vaccinations. What the hell would motivate you to drive your kid around without a seatbelt? That's just nuts. There are no "side effects" of wearing a seatbelt, except that if you get an accident, you're way less likely to die. It's nothing like climbing trees or playing tackle football, where the worst thing that might happen is a broken arm. There's no reason at all not to put a seatbelt on your kid.
3.21.2008 8:40pm
happylee:
One day we will all die of a strange mutant virus strain that arose as a result of over-vaccination. The last man standing will be a handsome, longhaired man driving a pickup without a seatbelt thanking the good Lord that his dad, Spartacus, didn't let the gummint' immunize him.

Stand alone and be proud.
3.21.2008 9:31pm
z9z99:
Guest12345

I don't think the attack rates of varicella in persons exposed to chicken pox and those who have been vaccinated are the same, otherwise, there would be no need to vaccinate more than a fraction of people. The strain of virus used in the vaccine would propagate in the same manner as chicken pox.

The vaccine, as I understand it, is a live attenuated virus, meaning that it has less virulence, (otherwise there would be no point in vaccinating people). It does not cause clinically apparent disease, either in the person vaccinated or in contacts of that person, absent immune deficiency. Vaccinating people people with attenuated virus reduces the reservoir of the native virus.
3.21.2008 10:00pm
cj (mail):
My two daughters had the chxpox vaccine, my younger son did not, and caught the chxpox 'naturally' at about 18 months. It was pretty nasty, but didn't have complications (i.e., I've heard of some children who had to be hospitalized -- getting chxpox down the throat, etc.).

My daughters are now 10 and 12, and at their last check-up, the pediatrician told us that they are going to have to have another dose of the vaccine, that research/clinical studies/real life is showing that the vaccine wears off, and that doctors are concerned about vaccinated kids being exposed to chxpox at a later age (not 60-year-old shingles age, but late-teens/early-twenties). Our pediatrician (an MD) said that she now prefers children catch chxpox 'naturally' as a young child, rather than be be vaccinated.

Also, I, too, withheld some 'recommended' vaccines from my youngest (I tried to with my second child, but the hospital 'accidentally' gave her the vaccine anyway at the time of birth). I think some of the hepatitis vaccines can wait until the child is older, especially since one may not be aware of the full health status of a newborn/pre-six or 12 month old.

So, I am an intelligent, educated, well-read parent, who chose to go against some conventional medical recommendations at the time (which *current* medical convention is now acknowledging as a wise choice) --- does that make me a bad parent? Responsible for the next Typhoid Mary? Liable for your child's disease response?
3.21.2008 10:07pm
theobromophile (www):
Also, I, too, withheld some 'recommended' vaccines from my youngest (I tried to with my second child, but the hospital 'accidentally' gave her the vaccine anyway at the time of birth). I think some of the hepatitis vaccines can wait until the child is older, especially since one may not be aware of the full health status of a newborn/pre-six or 12 month old.

The Hep B vaccine only lasts about 20 years anyway, so you need to immunize again around the time of college graduation. Most kids aren't even at risk for it until that age, anyway.

There is precious little that will expose a person to Hep B between the recommended vaccination age of 1 and the adolescent years (even assuming that a child has sex very early on).
3.21.2008 10:37pm
Fub:
theobromophile wrote at 3.21.2008 9:37pm:
There is precious little that will expose a person to Hep B between the recommended vaccination age of 1 and the adolescent years (even assuming that a child has sex very early on).
I think you may mean Hep C, which is almost entirely contracted by unprotected sex or contaminated injection equipment or similar invasive contact with contaminated serum. I believe Hep B is often contracted by much less invasive means, such as infected persons handling food. Hep B is also much more common, but less often fatal, and fairly often ends by immune processes. Hep C is almost always fatal, incurable, and currently has no vaccine as far as I know.
3.21.2008 11:07pm
neurodoc:
Dan Weber: I'm gonna go put my baby to sleep on his stomach now.
The evidence is clear that infants put to sleep on their stomachs, that is prone, are at substantially greater risk of Sudden Infant Death Syndrome (SIDS) than those put to sleep on their backs, that is supine. Recognition of this fact and efforts to educate parents have brought about a fall in the number of SIDS deaths in this country. So why would anyone aware of this put an infant to sleep on their stomach, do they disbelief the science or they are making a "political" statement? (The following remark about feeding the child non-organic food leaves one to wonder if it is all trollery. But Spartacus approved the sentiment, so I take it some are serious in their defiance of "conventional" medical wisdom.)
3.21.2008 11:12pm
neurodoc:
I am surprised that when vaccinations come up here on this law blog, no one brings up Jacobson v. Commonwealth of Massachusetts, a seminal police powers case about compelling vaccinations decided by the Supreme Court 100+ years ago. Very on point.

Also, I am surprised that with Professor Bernstein chosing to head a thread about parents refusing to immunize their children "child abuse," no one has mentioned prosecution of parents who refuse to seek medical treatment for their seriously ill children, believing it "unnatural" to avail themselves of medical help and/or that prayer is the only way to deal with a child's bacterial meningitis. Absent mandatory immunization laws and the requirement of immunizations to attend school, might parents be prosecuted if harm were to come to their children because they refused to get them immunized? Is it just that prosecutors might be very reluctant to undertake prosecutions of parents whose children have died or been seriously injured by illnesses that might have been prevented by immunizations, or is there too great a legal burden for them to satisfy when parents only put their children at risk in the event of exposure to infectious diseases, that they might have gotten even if vaccinated. though they would have been far less likely to do so?
3.21.2008 11:28pm
Soronel Haetir (mail):

In defense of Sparticus,

see not wearing seatbelts as a perfectly rational thing for other people to do. After all, if Sparticus gets in an accident the child is somewhat more likely to be killed and thus remove these dangerous tendencies from the population through the most natural of means.
Same with disease, for that matter.
3.21.2008 11:31pm
z9z99:
Fub

I believe that it is hepatitis A that is transmitted by contaminated food. Hepatitis B is transmitted by parenteral contact with infected blood. Also, I asked once why newbons were vaccinated against hepatitis B and was told that "this may be our only opportunity" for some people.
3.21.2008 11:37pm
David Chesler (mail) (www):
Aultimer, how is Schlafly's unvaccinated child going to infect 10,000 people?
For that matter, how is he going to get measles or smallpox and so forth unless someone else has it?

All this talk about putting people at risk, but every time you get into a car you're putting others at risk. It's tradeoffs.

Steve says There are no "side effects" of wearing a seatbelt, except that if you get an accident, you're way less likely to die. This completely ignores the reasons Spartacus gave.
3.21.2008 11:38pm
neurodoc:
Waldensian, I join Bruce and David N in commending you for answering the sweet-are-the-uses-of-adversity nonsense where true autism is concerned.

It is more than reasonable for you to ask, "What, exactly, is your diagnosis, who made it, and when?", but I'll bet dollars to donuts that you won't get any meaningful
answer(s). Curious myself, I asked similar questions about this person's diagnosis and was threatened with reporting for a HIPAA violation?! A very prominent neurologist used to teach his residents to be suspicious of diagnoses without good evidence for them, and to make his point, he would say that the president of the myasthenia gravis club is the least likely to have bona fide myasthenia gravis, a neuromuscular disease. I would venture that the person who regularly interjects herself here to speak about her own "autism" almost certainly doesn't have that disorder, but rather a distinctly different problem.
3.21.2008 11:41pm
neurodoc:
I was at a health law event last week where we had a homeopath as a guest speaker. I have to say that while I was predisposed to disagree with pretty much everything she had to say, to her credit she took the position that "conventional" medicine was terrific and a life-saver but that there were limits to it...Her main message on vaccinations -- be smart and be selective about what you do (not) immunize your children against.
Fine, that was the opinion of this homeopath. (An MD degree?) But what do the chiropracters, naturopaths, reflexologists, iridologists, herbalists, faith healers, and representatives of other schools of quackery have to say? If they start by taking "the position that 'conventional' medicine was terrific and a life-saver but...," should they be seen as reasonable, though what they then go on to say is, at best, without any scientific plausibility?
3.21.2008 11:53pm
theobromophile (www):
Neurodoc, I mentioned the Jacobson case (and it's questionable applicability to this subject) on the thread immediately below this one.

Fub, Hep B is spread from mother to infant during childbirth, during sexual intercourse, and through the sharing of needles. Here is some info from the CDC.
3.21.2008 11:55pm
z9z99:
A couple of thoughts:

1.) The "challenging the immune system" hypothesis and the notion the immunization weakens it isn't compelling. The immune system is "challenged" by exposure to pathogens, not contracting disease, although both sometimes happen. An otherwise healthy body will mount an immune response against a pathogen whether it was immunized against it or not, and the response against a previously encountered pathogen will be more effective; that's why immunization works in the first place.

2.) Whether or not the attenuated virus causes shingles is an open question, but there is reason to think either that it will not, or if it does, the outbreak will be less severe. The key is whether the virus becomes latent in the spinal cord, something we may not know until those immunized experience decreased immune function. (I would suspect though that there are a few patients with hematologic malignancies who were immunized that we would see some evidence of zoster if the vaccine causes it). Even if it causes zoster, since it is an attenuated virus, and thus less pathenogenic, any disease that it caused should be less severe.
3.22.2008 12:12am
Elliot123 (mail):
Regardless of one's ideas on vaccinations, the HBO mini-series on John Adams had a particularly riveting scene where the sores of a person dying of smallpox were removed and mashed into cuts on a healthy person's arm. They showed all the details.
3.22.2008 12:30am
Nick P.:
I think there's an argument to be made that the experience of fighting actual real diseases develops the body and helps prepare it to fight new and novel ones that might not be duplicatable by the body's experience with a vaccine.

Is that argument based on how the immune system actually works or is it all handwaving and analogy?
3.22.2008 12:38am
David Chesler (mail) (www):
Steve2 wrote:
Problem with the HPV vaccine isn't that it's given to children. Problem's that they don't make one for male children, which means there's nothing to prevent one of us from contracting it and then spreading it, since there's also not much of a test for it in men.

Anyway... forgoing vaccination isn't a "right", it's a dereliction of duty.


Is skipping the HPV vaccination dereliction of duty? HPV is easy enough to avoid, especially if you limit your sexual partners to circumcised men.

There's no direct harm to a man in having HPV, and the fact that they don't administer the vaccine to boys (the same vaccine should work for both genders) kind of belies the whole "public health" aspect of the program.

Two visits in a row my children's pediatrician has been out of one vaccine, I think chickenpox, and I guess it's a booster because the kids who didn't get it are 11 and 9. Apparently there's some shortage.

And speaking of shortages, flu vaccine (which doesn't confer lifetime immunity, because flu changes so much) is interesting. A few years ago there was a shortage of vaccine, and it was being limited to the elderly and the immuno-compromised. The public health types were making announcements like "Don't worry, if you're not old or very young or sickly it's not a big deal." The author of one letter to the editor was quite accurate when he said "In future years, when there is plenty of vaccine to go around, they will be telling everybody they ought to get it." (This year's vaccine didn't match the strains that were out, so it didn't do much good anyway.)
3.22.2008 1:25am
neurodoc:
Nick P.: Is that argument based on how the immune system actually works or is it all handwaving and analogy?
When you ask, "Is that argument based on how the immune system actually works," you mean is it based on science that is to be found in textbooks relied on by physicians and medical scientists, which bring together research findings that have been vetted by competent scientists and published in reputable scientific journals? Of course it isn't, but you knew that didn't you, since you suggest that ("the experience of fighting actual real diseases develops the body and helps prepare it to fight new and novel ones that might not be duplicatable by the body's experience with a vaccine") is really "all handwaving and analogy." (Add "appeal to intuition" and I think you would have it nailed perfectly.)
3.22.2008 1:50am
neurodoc:
Is skipping the HPV vaccination dereliction of duty? HPV is easy enough to avoid, especially if you limit your sexual partners to circumcised men.
There you go, another compelling reason for women to give themselves up to Jewish men! This should be widely advertised. (But is there data to show that the risk of transmitting HPV is very substantially less when the sex partner is a circumcised male?)
3.22.2008 2:51am
Elmer:
Without more information I find it hard to justify the abuse of Spartacus. Annual risk of injury in an auto = Risk/Mile * Miles Driven. Current fashion is to be concerned only with the first term, just as fashion favors the Prius owner who burns more fuel than I do in a Taurus.

If you broaden your horizon to measure total automotive injury risk from birth to 18 years, the majority of the risk exposure usually starts with the kid's driver's licence. Some think that the driving age should be raised to 18, while others think that changing our attitudes towards alcohol offer more benefits. How many here want to report their neighbors to CPS for letting someone drive at 16?

I was a hang glider pilot for a few years. The fatality rate was the same as that of general aviation, but many people feel that it is Really Dangerous, while they consider general aviation only Sort Of Dangerous. The feelings actuaries were highly resistant to any reevaluation based on facts, so I was nuts. My advisor in grad school actually thought that I was deficient in the perception of fear, requiring exposure to foolish risks to get the same tingle he got from public speaking. The truth was that I was rarely afraid. My first cliff launch was nothing compared to speaking at a city council meeting.
3.22.2008 3:12am
Elmer:
Dammit. The gerund is the subject, so "... offers more benefits."
3.22.2008 3:15am
Elliot123 (mail):
"The truth was that I was rarely afraid. My first cliff launch was nothing compared to speaking at a city council meeting."

What was the injury risk per launch? What was the injury risk per council presentation? Does fear effect the risk per event?
3.22.2008 3:46am
Elmer:
To get back to the topic, I saw a show on PBS about a whooping cough outbreak at a school in Boulder. Shining Mountain, I thought, and I was right. Those who don't believe in vaccinating their school-age kids are not randomly distributed. Pertussis is now endemic here, and we are the reservoir for the metro area.

Atlantic article.
3.22.2008 4:02am
Fub:
z9z99 wrote at 3.21.2008 10:37pm:
I believe that it is hepatitis A that is transmitted by contaminated food. Hepatitis B is transmitted by parenteral contact with infected blood. Also, I asked once why newbons were vaccinated against hepatitis B and was told that "this may be our only opportunity" for some people.
theobromophile wrote at 3.21.2008 10:55pm:
Fub, Hep B is spread from mother to infant during childbirth, during sexual intercourse, and through the sharing of needles. Here is some info from the CDC.
Thanks. I was definitely off by one Hep digit. I described A, not B.
3.22.2008 4:13am
Gaius Marius:
Drivers Ed classes are required before one gets their Driver's License. Why not require a parenting class on the benefits of immunization/cost of foregoing immunization for newly expecting parents?
3.22.2008 6:43am
Scaldis Noel:
There is no doubt that vaccines have been true life-savers for diseases like polio and smallpox. Because of that success, conventional wisdom is that every vaccine is good, essentially without risk, and should be mandatory.

A small, very vocal group of anti-vaccine advocates ignore the evidence of benefits and take the opposite view -- vaccines are always bad and are never valid as a preventive measure against disease.

The middle ground I see, that balances protecting the public interest and allowing people to retain as much of their freedom as possible is one that makes vaccines compulsory only for diseases that are both highly communicable AND carry a significant risk of death or permanent injury -- a very short list. My gut feeling is that measles doesn't make that list, although I could be persuaded otherwise, because I can't say that I know enough about measles to make an informed decision about whether it meets those criteria. In general, a compelling case would have to be made that individual liberty should take a back seat to public health concern before a vaccine should be made mandatory.

Vaccines for less virulent or less communicable diseases should be optional, although strongly encouraged, if the risks associated with vaccination are shown to be minimal. When the benefits of a vaccine start to become questionable when compared to the risks of not vaccinating (e.g. the chicken pox vaccine), compulsory vaccination is just nanny state nonsense. Chicken Pox is highly communicable, but has a very low risk of death or permanent injury. From what that I have read, getting chicken pox as a child is much more effective at conferring immunity to shingles later in life than the vaccine is. There is no reason that vaccination against chicken pox should be encouraged generally, let alone mandatory. A shingles vaccine for adults who never had chicken pox certainly makes more sense.
3.22.2008 7:45am
MDJD2B (mail):

And why isn't there a negligence tort for spreading a disease and causing harm thereby? There should be a duty of care to stay home when you have a potentially deadly or otherwise very harmful communicable disease.

I addressed this in the post below. Even if therewere a duty of care, it owuld be hard to win a lawsuit.

One reason is te difficulty in proving causation.

Another is that the defendant is unlikely to be able to pay the award.
3.22.2008 11:25am
Elmer:

What was the injury risk per launch? What was the injury risk per council presentation? Does fear effect the risk per event?


The overall death reate was 5 per 10,000 participants per year. I don't remember the injury rate. As an estimate of cliff launch danger, I think one of the 5 deaths was usually caused by failing to connect your carabiner before launch, meaning you ran off a cliff. My impression is that cliff launching accounted for much less than 20% of flights. Failure to acheive flying speed in the short space available is possible, but didn't seem to happen much.

There was a reward for that particular risk. I had only three steps available to start flying before I came to the edge; I was flying before the second step was finished, and ascended almost vertically, much like my typical flying in a dream.

Naturally, fear during flight is difficult to measure after a wreck. I did see one injury where excessive fear may have been a contributing factor.

Public speaking is extremely dangerous. Long term studies show a very low 100-year survival rate.
3.22.2008 12:01pm
David Chesler (mail) (www):
Dave N (3/21 11:14am) writes about how his brother who was developing normally became autistic after contracting measles:
A little boy who was meeting all developmental goals early (speech, walking, toilet training, etc.) was left autistic and brain damaged.

Isn't this the same pattern, and the same post hoc ergo propter hoc that proves vaccinations cause autism?
3.22.2008 1:10pm
Roger Schlafly (www):
What if there are 10,000 cases of measles that result from your choice, with 9% suffering permanent disability and 1% dying?
If that were a possibility, then there would be a stronger case for measles vaccination. But it is not. In American society today, measles is an extremely minor risk.
3.22.2008 2:09pm
Unvaccinated attorney:
For all of those who want to force vaccines on every child, what about religious exemptions? I got religious exemptions from vaccinations every school year growing up in Ohio. You had to fill out a little form that you turned in before the first day of school. When the measles went around when I was in public high school (not sure how that happened, since everyone else was supposedly vaccinated), the school pulled the names of the unvaccinated kids and made us leave until we got the MMR shot. I recall that there were only three or four of us in a high school of over 1,000 students, and one of them was my sister. We could have fought this in court, and likely would have won due to the state's strong religious exemption law at the time, but it was a lot easier (and quicker) to get the vaccine (my parents didn't want us to miss a lot of school).

Other than that, I have not had any other vaccinations and have lived to tell the tale at 35. I did get chicken pox my freshman year in college, and it was not pleasant. But everyone saying this was child abuse needs to consider how much they really want the government passing judgment on and interfering with religious practice.
3.22.2008 2:09pm
Dave N (mail):
David Chesler,

If you are going to quote me, perhaps you should be fair and quote me completely. You quote me accurately but fail to note that after describing my brother within that same post, I finished my post in this manner, "[W]hile I realize anecdotal experiences carry little weight, I do believe it allows me to hold these anti-vaccine zealots in profound contempt."

I suppose there is a chance my brother was destined to be autistic regardless, but the evidence does not support that conclusion.
3.22.2008 2:22pm
Dave N (mail):
I should also note that my experiences are not post hoc, ergo propter hoc.

Post hoc, ergo propter hoc describes attributing causal relationships between unrelated facts.... i.e., 99% of all federal inmates drank milk as children, and therefore drinking milk results in criminal behavior.

It is not meant to discourage exploration of potential causal factors in an intellectually honest way.

In my brother's case, it using observation to describe where he was developmentally both before and immediately after contracting measles. In the law, we tend to call that "evidence" and not a "logical fallacy."
3.22.2008 2:40pm
Elliot123 (mail):
"The overall death reate was 5 per 10,000 participants per year. I don't remember the injury rate. As an estimate of cliff launch danger, I think one of the 5 deaths was usually caused by failing to connect your carabiner before launch, meaning you ran off a cliff."

It's really not fair to consider natural selection as a risk factor.
3.22.2008 2:48pm
blawgger (mail):
As someone who has been suffering from the after-effects of whooping cough for the past two months, as an adult, despite being vaccinated as a child (yes, Virginia, many vaccinations wear off), I can't state strongly enough how important it is to vaccinate everyone! This disease was unpleasant for me, but for an infant who isn't old enough to get vaccinated, it is DEADLY.

Whooping cough has had a massive resurgence lately, particularly in the West, because of anti-vaccine types who refuse to vaccinate. It used to be eradicated, but no more! Although whooping cough, like measles, sounds like an illness which is no big deal, it can kill toddlers and infants. So think of that when you decide whether to vaccinate your children or not...
3.22.2008 3:14pm
David Chesler (mail) (www):
Dave N - so noted that you acknowledge it's one anecdote.

(You describe an apparent moderate autism -- not the high-functoning Asperger's end of the spectrum, but if he's working at all, not the profound unable to communicate at all end. It's a shame, and I'm sorry you and the rest of the world don't get to enjoy your brother's mind, and vice versa.)

I stand by my contention.
You: My brother was normal or better, then he had the measles, and soon after he showed signs of autism.

The "anti-vaccine advocates": The Polings described how Hannah was a normal, verbal toddler until she received several vaccines during a well-baby visit. Within 48 hours of the shots, she developed a high fever and inconsolable crying and refused to walk. She stopped sleeping through the night. Within three months after receiving the vaccine, she began showing signs of autism, including spinning and staring at lights and fans. For a while, she lost her ability to speak.

Unless I've missed something, you haven't shown causality here, only coincidence. (Apparently what's significant about the Poling case is they were able to show at a hearing "that vaccines aggravated a rare underlying metabolic condition that resulted in a brain disorder 'with features of autism spectrum disorder'" to the point where Health and Human Services will be awarding compensation.) Maybe the measles is what got your brother's development off track, but you have not shown evidence of that here.
3.22.2008 3:55pm
ruralcounsel (mail):
I'm somewhat amazed how many posters here have been not only pro-vaccine (which isn't a surprise) but have been so accepting of coercion, vitreol, and rather uncivil words towards someone who choses to forego vaccination. This is, after all, a quasi-libertarian blog.

I consider that to be somewhat situational ethics. When, if ever, should technology advancement be forced upon someone? Isn't that the question?

Do we force everyone to get the latest Blackberry, or computer, or other widget? "Show me your proof of purchase of Blue-ray (TM) Hi-Rez DVD player, please." So is it only because the impact is more "serious"? Which is what I mean by situational ethics. It's OK to be coercive if you think the result really matters enough to you personally? Seems a tad hypocritical.

I mean, if vaccines are only about 95% effective, as someone else stated above, it doesn't seem to me to be such a panacea. Which means your risks from someone unvaccinated aren't all that different, so long as they are pretty rare. And the whole idea of getting natural immunity from deliberate infection seems like a reasonable alternative approach ... and perhaps more effective than the vaccine, and possibly longer lasting.

If that's the case, should we force everyone to go for the natural infection/immunity route instead of vaccines? After all, we can use the same ethical arguments for that.

I think people need to chill out ... it is unavoidable that there are going to be "free riders".
3.22.2008 4:20pm
ruralcounsel (mail):
I'm somewhat amazed how many posters here have been not only pro-vaccine (which isn't a surprise) but have been so accepting of coercion, vitreol, and rather uncivil words towards someone who choses to forego vaccination. This is, after all, a quasi-libertarian blog.

I consider that to be somewhat situational ethics. When, if ever, should technology advancement be forced upon someone? Isn't that the question?

Do we force everyone to get the latest Blackberry, or computer, or other widget? "Show me your proof of purchase of Blue-ray (TM) Hi-Rez DVD player, please." So is it only because the impact is more "serious"? Which is what I mean by situational ethics. It's OK to be coercive if you think the result really matters enough to you personally? Seems a tad hypocritical.

I mean, if vaccines are only about 95% effective, as someone else stated above, it doesn't seem to me to be such a panacea. Which means your risks from someone unvaccinated aren't all that different, so long as they are pretty rare. And the whole idea of getting natural immunity from deliberate infection seems like a reasonable alternative approach ... and perhaps more effective than the vaccine, and possibly longer lasting.

If that's the case, should we force everyone to go for the natural infection/immunity route instead of vaccines? After all, we can use the same ethical arguments for that.

I think people need to chill out ... it is unavoidable that there are going to be "free riders".
3.22.2008 4:20pm
Elliot123 (mail):
"And the whole idea of getting natural immunity from deliberate infection seems like a reasonable alternative approach ... and perhaps more effective than the vaccine, and possibly longer lasting"

Smallpox and polio parties for the kids?
3.22.2008 4:26pm
Tom R (mail):

'... It is easy to say that the [medieval Catholic] Church should have waited for the alleged evil results [of heresy] instead of assuming that they would occur, and what they would be. That sounds simple enough: but if a modern Public Health Authority were to leave people entirely to their own devices in the matter of public sanitation, saying "We have nothing to do with drainage or your views about drainage; but if you catch smallpox or typhus, we will prosecute you and have you punished very severely…," it would be either removed to the County Asylum, or reminded that A's neglect of sanitation may kill the child of B two miles off, or start an epidemic in which the most conscientious sanitarians may perish... We must face the fact that society is founded on intolerance... The typical modern example... is compulsory inoculation replacing what was virtually compulsory baptism... Neither the Pasteurians nor their opponents the Sanitarians would leave parents free to bring up their children naked... We may prate of toleration as we will; but society must always draw the line somewhere between allowable conduct and insanity or crime, in spite of the risk of mistaking sages for lunatics...'



George Bernard Shaw, "Toleration, Medieval and Modern," in preface to Saint Joan (1923).
3.22.2008 4:42pm
neurodoc:
Scaldis Noel: From what that I have read...There is no reason that vaccination against chicken pox should be encouraged generally, let alone mandatory.
Really? What exactly have you read or how have you informed yourself, by consulting the standard textbooks on pediatrics (e.g., Nelson) and infectious diseases (e.g., Feigin)? Have you seen many cases of chicken pox (varicella), including any ones complicated by encephalitis? Why do you favor your own conclusions about what is medically prudent and what isn't over those which are pretty close to unanimous among suitably qualified medical professionals (not naturopaths, chiropracters, and the like)? I am genuinely interested in your answers, and those of others who think like you, to these questions.
3.22.2008 5:06pm
neurodoc:
diseases that are both highly communicable AND carry a significant risk of death or permanent injury -- a very short list...
The short list of "diseases that are both highly communicable AND carry a significant risk of death or permanent injury," for which we have good vaccines, includes: diphtheria ("lock jaw"), pertussis ("whooping cough"), measles (rubeola), mumps, rubella ("German measles"), varicella (chickenpox), some forms of meningitis, pneumococcal infections, haemophilus influenza, viral flu, polio, smallpox, Hepatitis A and B, human papilloma virus... If you or your child faced possible exposure to and infection with one of these pathogens, which of them would you risk for yourself or your child contracting rather than take the protective vaccine? (Smallpox is something of an exception, since there is no threat of exposure to it unless it should be used as a bioterror weapon.)
3.22.2008 5:21pm
Dave N (mail):
David Chesler,

The differences between my family experience and the Polings are two: 1) the effect on my brother was immediate and noticeable prior to his hospital discharge and not a matter of something happening over a few weeks; 2) there was a documented high fever for some sustained amount of time (since I was 3 at the time, I have no idea how long that sustained period was). Aside from my brother, physicians have documented brain damage in people who have had sustained high fevers.
3.22.2008 5:30pm
MDJD2B (mail):

I consider that to be somewhat situational ethics. When, if ever, should technology advancement be forced upon someone? Isn't that the question?

And my answer is that it is ethical to force technology on Person X when when the risks to X are slight, but the risks to other people are much greater if X does not accept the technology. Possibly, there should be an expectation that X would benefit as well.

This is precisely the question.
3.22.2008 5:33pm
neurodoc:
David N, I know three pediatric neurologists who have devoted their professional lives for years to the study of autism and are among the world's leaders in research initiatives to find the cause(s) of this devastating disorder. I am very confident that they would tell you that your brother's problems may be the direct consequence of his measles infection, but that he does not suffer classic autism as a result of it. Some children who suffer major brain injuries of one sort or another may be left with global neurologic impairments and have some autistic-like features, but that they are not properly characterized as having "autism," since that is a distinct syndrome.

So, I think you and David Chesler may be talking passed one another, neither of you quite right about everything, neither of you quite wrong about everything. And I accept that if you are brother had been immunized against measles and never experienced the disease, he would not have suffered the tragic devastating neurologic injury you have described.

BTW, there has been no mention of a rare, progressive, fatal complication of natural occuring measles, that is SSPE (subacute sclerosing panencephalitis), a chronic measles infection of the central nervous system. SSPE is exceptionally rare in this country as a result of immunization against measles here, while it is still seen in countries (e.g., Turkey) where measles is endemic.
3.22.2008 5:41pm
neurodoc:
And David N, I doubt very, very much for a variety of medical reasons that the neurologic injury your brother suffered was a consequence of fever rather than the direct effect of the measles virus on the brain. (Poling is an altogether different story for a number of reasons, especially for the presence of a proven rare underlying metabolic condition, that is a mitochondrial disorder.)

I am only offering help with some of the details of your brother's case based on what you have related about it, not in any way contradicting what you have said about the possible consequences of failure to immunize for measles, that is that they can be disasterous.
3.22.2008 5:47pm
Dave N (mail):
Neurodoc,

Thank you for your kind comments. And actually, your last comment may in fact give my mother peace--since she has spent 44 years blaming herself for not getting my brother to the hospital sooner when his fever did spike.
3.22.2008 5:58pm
Deep Lurker (mail):
I'm not convinced that there's a net externality from not getting vaccinated. If a benign public health despot were directing vaccinations to a disease so as to minimize the combined harm from the disease plus the vaccine side-effects, he would require that X% of the population get vaccinated vs a given disease and forbid the remaining (100-X)% from getting vaccinated. So if someone wants to volunteer to be part of the (100-X)%...

OTOH, deliberately exposure to a disease instead of getting vaccinated (when a vaccine is available) just strikes me as nuts. "Child abuse" isn't too strong a term for doing this to ones children.
3.22.2008 7:37pm
neurodoc:
Dave N, it is sufficiently tragic that your brother suffered the grievous injury that he did as a result of his bout with measles. Your mother should not be laboring under the burden that she somehow contributed to that injury, since I think it very, very unlikely that anything she did or did not do affected the outcome in any way.

Fever in children is commonplace, even very high fevers are not rare, yet few children are neurologically injured by those fevers, especially if the fevers are not complicated by convulsions and there is no underlying genetic disorder, like the rare one the Poling child has. Fever is usually a concommitant of the illness itself, not a causative factor of any neurologic injury. Measles ordinarily does not involve the nervous system, but it can, producing encephalitis, that is pathologic changes affecting the brain. (SSPE, which I mentioned earlier, is a distinct, still more rare form of central nervous system measles infection.)

You need not undertake to learn all that is known about measles and the nervous system, but a bit of reading might inform you enough to relieve your mother's terrible and needless sense of guilt. I would tell you to cruise around the Internet a bit, but I don't know what is out there and wouldn't want you to by misinformed by some of what is no doubt out there. Various medical texts, including those I mentioned before (Nelson's textbook of pediatrics, Feigin's on pediatric infectious diseases, Swaiman's pediatric neurology, etc.), would give you the basics plus much more about natural measles infections. In 1994, at the behest of Congress, the Institute of Medicine published Adverse Events Associated with Childhood Vaccines: Evidence Bearing on Causality, which might be of some help (pp 123-130):
The occurrence of encephalitis follwing a natural measles virus infection is well described. The condition is quite severe, often leading to permanent brain damage or even death. There may be no detectable pathologic lesion, but in most cases some edema and demyelination are noted. (italics mine)
That's the most basic statement of it, and fever doesn't play a central, necessary role in causing neurologic injury or death.

You might want to enlist a competent(!) specialist (most likely would be a neurologist or pediatric neurologist) to convey this to your mother. She should be disabused of the notion that had she done something different, your brother might have escaped what befell him. There was nothing she could have done differently that would have produced a different outcome, and she should be made to understand that rather than go on carrying the burden she has been carrying for so long, so unnecessarily so.
3.22.2008 8:11pm
neurodoc:
Deep Lurker, how would your "benign public health despot," who must be related to the philospher king, deal with the issue of "free riders," those who would sit back and reap the benefits from the contributions of others, while contributing nothing themselves? If your X% of the population is sufficiently large, then the 100-X part of the population is effectively protected against the disease though they have born none of the costs and risks, not even the needle stick. As the "benign public health despot" how would you chose among the too numerous volunteers for inclusion of the 100-X group? And exactly how would what you as "benign public health despot" would do differ from what benign public health non-despots try to do?
3.22.2008 8:31pm
neurodoc:
Unvaccinated attorney, would you tell us something about the nature of the sincerely held religious beliefs that caused your family to avoid immunizations (e.g., Christian Scientist?, Amish?). When push came to shove, it sounds like the "religious" convictions were not too strongly held.
3.22.2008 8:35pm
theobromophile (www):
There you go, another compelling reason for women to give themselves up to Jewish men! This should be widely advertised. (But is there data to show that the risk of transmitting HPV is very substantially less when the sex partner is a circumcised male?)


From what I've read (sorry I don't have all the citations handy, as I read and never bookmarked), yes, there is a fairly significant decrease in the rate of HPV infection in circumcised men.

I was surprised to see you write that HPV carries a "significant risk of death." (3.22.2008 4:06pm) Roughly 80% of women will get the disease during their lifetimes, but only a few thousand will die of it - and those deaths are almost entirely preventable, if a woman receives regular Pap smears. Even if vaccinated, she would need to do so: Gardasil only protects against four of the variations of HPV that cause cervical cancer; we do not know whether or not a booster shot is required; and cervical cancer can be caused by smoking, childbirth (oddly enough, the risk of cervical cancer increases with each child, even though one would expect that a woman who has a bunch of kids has been more monogamous than other women), and, from one study I saw, early intercourse. In fact, before Gardasil came on the market, health professionals said that death from cervical cancer could be mostly eliminated if women got regular Pap smears. When caught during the early stages (Stage 1, non-invasive), the five-year survival rate is somewhere between 95% and 99%.

At any rate, very surprised to hear HPV listed as having a "significant" risk of death. There are many diseases, if left untreated, undetected, or otherwise ignored, are likely to kill people.
3.22.2008 8:55pm
neurodoc:
I was surprised to see you write that HPV carries a "significant risk of death." (3.22.2008 4:06pm) [sic]...At any rate, very surprised to hear HPV listed as having a "significant" risk of death. There are many diseases, if left untreated, undetected, or otherwise ignored, are likely to kill people.
What I wrote at 4:21PM was "(t)he short list of 'diseases that are both highly communicable AND carry a significant risk of death or permanent injury,' for which we have good vaccines, includes:...(inter alia)...human papilloma virus..." (emphasis added) What exactly do you take exception to where HPV is concerned -"communicable," "significant," "death," "permanent injury," "good vaccines," or what? I presume you will grant that HPV is "communicable" and that a known complication of HPV infection in females is cervical cancer, with 70% of cervical cancer cases attributable to the HPV strains that the HPV vaccine protects against. Surely, you can't deny that cervical cancer is a non-trivial condition, one that can and does result in morbidity (illness) and mortality (death). So, does that leave us with "good vaccine" and/or the meaning of "significant" when speaking of risk?

By "good vaccine," I mean a vaccine that affords a high degree of protection for a reasonable period of time without an excessive rate of complications. Do you have different criteria for a "good vaccine," and if so, what would they be; or do you think that the Merck vaccine fulfills my general criteria? I claim no expertise about the particulars of this vaccine, so feel free to educate me about any facts I may be unware of that direct me to a different conclusion from "good vaccine." But please make it a balanced presentation of the relevant facts. ("Gardasil only protects against four of the variations of HPV that cause cervical cancer." Those 4 strains of HPV are thought to account for 70% of cervical cancers, aren't they? If it offered protection against 80 to 90% of the HPV strains that cause cervical cancer, would you endorse use of the vaccine?)

If it is about what constitutes a "significant risk," then may be you should answer the question I posed you before about a cost/benefit analysis for this particular vaccine. How many cases of cervical cancer would we expect to prevent if all of the target population could be vaccinated, and how do the $s to vaccinate compare to the $s to treat cervical cancer (including abnormal Pap smears, which must be approached as potential cancers) and compensate for disability and premature loss of life, to say nothing of the non-monetary costs of the illness. (What value would you impute to a life saved or a disease-free year of life, something that should be factored into a meaningful cost/benefit analysis?)
cervical cancer can be caused by smoking, childbirth...and, from one study I saw, early intercourse.
The American Cancer Society says about risk factors for cervical cancer, "The most important risk factor for cervical cancer is infection by the human papillomavirus (HPV). Doctors believe that women must have been infected by this virus before they will develop cervical cancer." (emphasis added) About smoking as a risk factor, it says, "Women who smoke are about twice as likely as non-smokers to get cervical cancer." Thus, if a woman never contracts an HPV infection, she need not fear developing cervical cancer; if she doesn't smoke, she may (or may not) be half as likely to develop cervical cancer. We can't say, however, that any particular woman who does not smoke is half as likely to develop cervical cancer than if she did smoke, since the increased risk linked with smoking may not all relate to smoking per se Maybe women who smoke are more likely to have first intercourse at an earlier age, have more sexual partners, or do other things that increase her chances of developing cervical cancer and correlate with smoking behavior). As a public health strategy, and as a strategy for individual women who wish to avoid cervical cancer, the HPV vaccine would seem much more promising than eschewal of smoking, though to be sure there is nothing from a health standpoint to recommend for smoking and a great deal to recommend against it, the prospect of cervical cancer much, much less than many other health consequences.
...oddly enough, the risk of cervical cancer increases with each child, even though one would expect that a woman who has a bunch of kids has been more monogamous than other women...
Those with experience/knowledge of life in these modern United States, especially many inner cities and lower SES populations (one of the ACS's "risk factors") would tell you that "a bunch of kids" and "more monogamous" are not closely correlated. (DNA testing would in almost certainly further undermine any assumption that "a woman who has a bunch of kids has been more monogamous than other women.")

I could go on like this, but since the consensus view in the public health community is that the advent of an HPV vaccine is a good thing and its use should be encouraged, I think it is your burden to marshal more facts and convincing arguments against the vaccine. If you do enough of that to shift the burden onto me, then I will look for the statistics to buttress my case in favor of the vaccine. (If cost of the vaccine is part of your case against, then you should tell us how much annual Pap smears over the course of a woman's vulnerable years add up to; how many women faithfully get annual Pap smears and how many do not; how much would be required to increase the numbers who get them regularly and decrease the numbers who do not; the rate of false positive and false negative Pap smear readings; etc.)

If you come back at me with what sounds like a strong anti-vaccine case, I will probably call in MDJD2B to answer it, since he, not I, has the relevant expertise.

(BTW, I should have asked before now, what exactly is the question that we are debating? I am focused on medical considerations, are you too, or is there some subtext, like the "morality" of how some people go about their lives?)
3.22.2008 10:41pm
MDJD2B (mail):
Neurodoc is correct. HPV infection is necessary, but not sufficient in getting cervical cancer. Other cofactors contribute, and maybe that is where smoking comes in. The sexual factors, like age of intercourse, obviously are related to the chance of catching this sexually transmitted virus.

Greek-sp[eaking-coffee-lover makes some good points. The vaccine is only effective against some of the viral strains, though the most common and the most virulent. This is not as wonderful a vaccine as polio or measles.

Cervical cancer is the second largest killer of women worldwide. It only kills a few thousand woman in the US. Pap smears, when abnormal, generaly diagnose precancerous states. Many of the several million women with abnormal pap snears need somewhat painful biopsies to definitively diagnose tis precancerous condition-- there are a lot of false positive Pap smears. Of these, between 250000 and 500000 require a LEEP cone or cold knife cone to cure the precancerous condition. 5% of the time, these operations affect the ability to conceive or carry a pregnancy.

The likelihood of unforseen damage is minimal, though obviously unknown for certain. The vaccine consists of virus coat protiens produced recombinantly. It does not have carcinogenic proteins, and no live virus is used in production of the vaccine. The protein is ubiquitous-- most women get infected some time in their lives.

Protection from the vaccine lasts at least 10 years.

I personally recommend use of the vaccine for all sexually active women. Even if hey are monogamous, theirpartners may carry the virus. I don't think it should be required for school attendance. First, I think it is likely that better vaccines will come out. Second, I agree with theo that the overall disease burden adnd alternative forms of management make this different from other vaccines. Furthermore, most of the other vaccines protect against diseases that kids will catch in school. If schools are going to gather hundreds of kids under one roof and thereby increase the likelihood of epidemics of measles or polio, it is reasonable to link vaccination against these epidemic diseases to school attendance. Finally, there are large populations with concerns that giving the HPV vaccine to girls sends the message that sex in early adolescence is OK, and they consider such behavior immoral and inappropriate. As a matter of prudential balancing and respect for others, I would want to see a greater benefit before riding roughshod over their beliefs. (I am suficiently convinced of the benefit of measles and polio vaccination that I am willing to ride roughshod over anyone's beliefs and require imminization against these diseases.)
3.22.2008 11:07pm
Unvaccinated attorney:
Neurodoc:

Christian Scientist. My sister and I were both teenagers at the time, so we discussed what was going on with my parents. I do not know what authority the school was using to justify pulling us out of class in the middle of the day and to tell us to leave school immediately and not come back until we were vaccinated.

I have not studied Ohio law, but I suspect that if we had raised a big enough stink with the school board and/or retained an attorney, we would have been allowed to return without getting the MMR vaccine. If we had wanted to fight in that way, my parents would have supported it. But as teenagers we didn't really want to draw a lot of attention to ourselves.

I recall that the school's reaction arose from only one or two students having contracted measles in a very large high school. I highly doubt those circumstances would constitute enough of a health emergency to override the legal basis of the exemption that we had used every prior year to enroll without any vaccinations.

Setting aside any religious issues, I also doubt the efficacy of what the school required of us. We were allowed to return the next day after we had gotten the vaccination. I do not know much about vaccines, but I doubt full immunity was instantaneous. Therefore, we still could have become sick and spread the illness around, either because it had already been incubating before we got the shot, or because we could still pick it up before immunity from the shot built up. I think it's safe to conclude that the school administration just wanted to CYA, and likely violated our rights of freedom of religion under the state statute for no good reason.
3.22.2008 11:31pm
Tony Tutins (mail):
I have heard that men have some skin in the HPV game, so to speak, because (considerate, naturally) men can get oral cancers from HPV they have picked up from oral sex. What's the probability of this?
3.22.2008 11:38pm
neurodoc:
Unvaccinated attorney, thanks for the reply. Much could be said in response to it, but I will take just a few whacks:

By the time some illnesses like measles declare themselves with a skin rash, they have already been incubating and maximally effective for spread via the respiratory tract. Thus, isolating the person who is now clinically sick may do little to prevent further spread. Sending you and your sister home when some others came down with measles because you were unvaccinated at that time may not have been a terribly effective strategy to protect either you from others or others from you then. But since in an epidemic outbreak not everyone gets infected at the same time, rather there may be successive waves of spread one to another, it was prudent of the school authorities to require you to be vaccinate without further delay or stay out of school for a prolonged period.

I don't know how the school authorities violated any of your individual rights by sending you home given that you were clearly at greater risk to becoming infected and/or infecting others, nor by requiring you to be vaccinated before returning to school under those circumstances. (Whether they were making all the right medical decisions, I can't say, but I don't think that immediately relevant to the question of protected "religious rights.")
I recall that the school's reaction arose from only one or two students having contracted measles in a very large high school. I highly doubt those circumstances would constitute enough of a health emergency to override the legal basis of the exemption that we had used every prior year to enroll without any vaccinations.
That there were "only one or two students having contracted measles in a very large high school" does not mean that there was not a very significant health threat to the community, to the contrary. And rather than "highly doubt those circumstances would constitute enough of a health emergency to override the legal basis of the exemption" that you had relied on to attend school up until then without being vaccinated, I would highly doubt that the school authorities did not have very solid legal ground to stand on to keep you out of school then and make your return conditional upon your getting vaccinated.

I previously alluded to cases in which parents have refused to seek and/or accept for "religious" reasons medical treatment for their children with life-threatening illnesses, asking if anyone knew what were the cut points, if there are any bright lines in this, between what was and wasn't criminally prosecutable. I would still be the answer about how a balance is struck between the wishes of the parents and the well-being of the children in such cases. Refusal to vaccinate may be a different story because that entails taking a "risk" rather than refusing to act in the face of imminent, at times certain life-threatening danger to a minor child.

Unvaccinated attorney, now as an adult do you foreswear medical care? Is it a "religious" issue for you? If you had intense pain in your lower right abdomen that was most likely acute appendicitis, you would submit to surgery, wouldn't you? A clearly broken arm? What would you do about medical care for any children you have or might have? While I think of myself as generally respectful of people's religious beliefs, I freely admit to having a very difficult time accepting any religious beliefs as a reason to refuse appropriate medical care (not talking about abortions or other reproductive issues, end-of-life questions, etc.), especially where children are involved. (Don't have children if you want to avoid a court fight over medical care, since courts may in the interests of children not only force acceptance of care for the child but also of care for the parent so that dependent children will not be left without a parent, especially a mother.)
3.23.2008 12:42am
Unvaccinated attorney:
neurodoc:

I do not think that my religious convictions (or lack therof) as an adult have any bearing on what happened when I was a minor. However, as a libertarian, I do believe parents should have the right to raise their children without excessive state interference, and I also believe a country founded on freedom of religion should make accomodations for non-harmful religious practices. (I understand that you think free riding on "herd immunity" is harmful, but I doubt it is statistically riskier than, say, riding in a car daily, and we allow parents to drive their children around regularly.)

The Ohio Revised Code very well may have changed in the interim, but it appears under the sections below that chicken pox is the only communicable disease singled out for keeping the unvaccinated out of school, and only if it certified as an "epidemic" by certain officials. It is interesting that rubeola/measles and other diseases aren't similarly singled out.

This issue may be dealt with elsewhere in the Code or regulations; I do not practice law in Ohio but did not find "rubeola" or "measles" anywhere else from a quick search of the ORC.

http://codes.ohio.gov/orc/3313.67
http://codes.ohio.gov/orc/3313.671 - relevant section for religious/conscience objection is (B)(4)
3.23.2008 1:40am
Elliot123 (mail):
"If your X% of the population is sufficiently large, then the 100-X part of the population is effectively protected against the disease though they have born none of the costs and risks, not even the needle stick. As the "benign public health despot" how would you chose among the too numerous volunteers for inclusion of the 100-X group?"

What a wonderful opportunity this would afford for idenity politics. The 100-X would obviously have to be proportionately distributed among the various racial groups and subgroups, biased for past injustice, and normed for the contextual nuances of an economically and racially oppressive post-industrial society. Religion would have to be factored into the decision, with preference given to those faiths that fondly remember the Middle Ages.

Perhaps Jeremiah Wright would be a good candidate for benign public health despot? His extensive knowledge of the source and use of the AIDS virus would be priceless.
3.23.2008 2:03am
neurodoc:
Unvaccinated attorney: However, as a libertarian, I do believe parents should have the right to raise their children without excessive state interference, and I also believe a country founded on freedom of religion should make accomodations for non-harmful religious practices. (I understand that you think free riding on "herd immunity" is harmful, but I doubt it is statistically riskier than, say, riding in a car daily, and we allow parents to drive their children around regularly.)
I think very, very few people would see it as "excessive state interference" for a school to do what yours did when facing an outbreak of measles. And so long as they did it in good faith and it was not off-the-wall crazy (e.g., an isolated report of measles in a school on the other side of the country and your school acted on account of that report, with no cases anywhere near you), I don't think any court would have enjoined them from doing it. If a court had done so, they probably would have been told they erred and needed to re-think it in light of what the Supreme Court had to say >100 years ago in Jacobson.

"Free riding" where vaccinations are concerned is not harmful to the public at large, so long as there are not more than a few free riders out there. And it is unlikely to prove harmful to the free rider, so long as there are few other free riders around and they are not exposed to those with the contagion. I don't know how one could make any comparison between the risk of free riding and that of daily driving, because the risk of the former is incalculable, especially without knowledge of a great many variables at any given time and place, most of those unknown or unknowable.

I asked about what you thought today, as an adult, about accepting what modern medicine has to offer, because it seemed that your religious convictions and those of your parents in that regard were not all that strong 20 years ago, when you accept vaccination in order that you would not have to miss too many days of school. Thus, I wondered if your own thinking about vaccinations and other medical treatment had changed much with time, especially when you were old enough to have your own children. I did not ask for the sake of any retrospections on what happened back then. So, if you want to say, is it now a matter of how threatening an illness might seem (e.g., intense right lower abdominal pain that might be due to acute appendicitis vs a few days of congestion that seems to be a viral upper respiratory infection going around among your contacts) that determines whether or not you seek medical attention, or would you forego all medical treatment for yourself, and possibly for any children you had?
3.23.2008 10:47am
theobromophile (www):
Neurodoc, I think that "significant risk of death" simply cannot apply to something that affects something on the order of 1 in 1000 members of the affected population (over a lifetime, mind you), and the death of which is almost totally preventable. Cervical cancer accounts for something like 0.66% of the cancer deaths in America.

As a definitional issue, I do consider "significant risk of death and/or serious injury" in the vaccine context to mean something like polio, measles, smallpox, or even pertussis. There is a risk of death from HPV, but it is incredibly unlikely. Again, well over 99% of people who get HPV don't wind up with problems.

You said that treatment for cervical abnormalities can cause injury. Most women who get cervical cancer and/or abnormalities are well beyond their voluntary childbearing years (even by today's standard): median age for developing cervical cancer is 50-54.

I do worry that we will give women a false sense of security. Gardasil prevents roughly 70% of the cases of cervical cancer. 30% is not insignificant, so women still need to go for Pap smears. I worry that many will not - many will think, "I've been vaccinated, so I don't need to spend a few hundred dollars on a doctor's appointment, getting a very uncomfortable procedure, to check for a disease that I can't get." There is a public health cost to that as well.

The vaccine has only been tested for two years. Granted, this is part and parcel of the patent process: the patent must issue before clinical trials (else it would be invalid for "public use" of the invention more than one year before filing of the patent application), and, of course, the company wants to market its product while still under patent protection. (Merck's patent is good until October 2015.)

I have no problem with this; what I do have a problem with is mandating this vaccine, because it helps one in an a thousand women thirty years down the road, without actually proving that it works thirty years down the road. That, to me, is a not-significant benefit. Mandating that this be given to 11-year-olds, IMHO, is total madness. We've just turned a generation of young women into guinea pigs.
3.23.2008 12:04pm
Elliot123 (mail):
"I do worry that we will give women a false sense of security. Gardasil prevents roughly 70% of the cases of cervical cancer. 30% is not insignificant, so women still need to go for Pap smears. I worry that many will not - many will think, "I've been vaccinated, so I don't need to spend a few hundred dollars on a doctor's appointment, getting a very uncomfortable procedure, to check for a disease that I can't get." There is a public health cost to that as well."

My neighbor feels the same way about seat belts and air bags. He can do anything in a car and be perfectly safe. The car may get dinged a bit, but he figures he will be protected by the seatbelt and airbag.

I suppose that's a good reason to eliminate both seat belts and airbags. That false sense of security could encourge people to do unwise things. I do worry about that. And there is no significant danger of getting hurt in a car.

At a minimum, they should be optional equipment in a car, and any teenager should be allowed to drive without a belt with a permission letter signed by a parent. Then they will not have that false sense of security and they will drive more carefully. Parents can give the kid the car knowing the risk he faces will ensure he drives in a prudent manner.
3.23.2008 2:49pm
MDJD2B (mail):

I think that "significant risk of death" simply cannot apply to something that affects something on the order of 1 in 1000 members of the affected population (over a lifetime, mind you), and the death of which is almost totally preventable. Cervical cancer accounts for something like 0.66% of the cancer deaths in America.

But a significant proportion will have precancerous lesions that have to be treated. There are something like 350,000 indicated cone biopsies each year, and over 5 million colpocopically directed office biopsies.


Again, well over 99% of people who get HPV don't wind up with problems.

The don't wind up with cancer. Many of them do wind up with problems.


You said that treatment for cervical abnormalities can cause injury. Most women who get cervical cancer and/or abnormalities are well beyond their voluntary childbearing years (even by today's standard): median age for developing cervical cancer is 50-54.

But most people who need cone biopsies are in tier 20's and 30's. And 5% of these will have problems gettting pregnant or carrying a fetus to viability.


I do worry that we will give women a false sense of security. Gardasil prevents roughly 70% of the cases of cervical cancer. 30% is not insignificant, so women still need to go for Pap smears.

A valid concern, albeit paternalistic.


There is a public health cost [if women stop going for Pap smears] to that as well.

Again, a valid concern. But not a reason to pull off the market a vaccine that prevents 70% of cervical cancer and precancerous conditions. As I said, I don't think the vaccine should be mandatory. if it is effective, then women should have ccess to it.


The vaccine has only been tested for two years.

Actually, it has been tested for over 10 years. It has been market for only 2 years in the US (Longer in some European nations, I think).


Granted, this is part and parcel of the patent process: the patent must issue before clinical trials (else it would be invalid for "public use" of the invention more than one year before filing of the patent application), and, of course, the company wants to market its product while still under patent protection. (Merck's patent is good until October 2015.)

Unlike drugs, biologicals are difficult to issue as generics after the patent expires, because they cannot be simply synthesized chemically. There are trade secrets involved, the process is complex, and the cost of entry is prohibitive. For practical purposes, Ibelieve that anyone who wants to market a vaccine must go through the new drug approval process testing for safety and efficacy, rather than simply demonstrate chemical equivalency and equivalency of bioavialability. The difference in cost to the marketer is one or two orders of magnitude. In any event, whenever a new drug or vaccine is marketed, it must be given to some cohort of people right after marketing. Somebody will have to use it the first year out.



I have no problem with this; what I do have a problem with is mandating this vaccine...

I agree, but I think you overstate the case against the vaccine, as I will indicate below/


...because it helps one in an a thousand women thirty years down the road,

Only if "help" refers only to prevention of invasive cancer. The effects are much broader, as I have said.


without actually proving that it works thirty years down the road.

That can only be proven in 30 years, and is true of any new vaccine. It is effective for at least 10 years.


That, to me, is a not-significant benefit.

But the benefits are broader.


Mandating that this be given to 11-year-olds, IMHO, is total madness.

I'm not aware that any US governmental agency mandates its use. Correct me if I'm wrong.


We've just turned a generation of young women into guinea pigs.

To the extent that we've turned a generation of middle-aged men into guinea pigs by putting them on statins, or turned my generation og kids into guinea pigs by giving them all antibiotics. All new drugs have to be given to be people for the first time. Occasionally there are disasters, like with thalidomide and DES. Overall, more people have been helped than hurt by receiving pharmaceuticals less than 10 years post-release. I'm also not saying that I like the Merck advertising campaign for Gardasil. This is not to say that the FDA approval process is perfect. Making a new drug available on a voluntary basis that prevents annoying and fertility-endangering conditions in 75% of women, and life-threatening disease in 12,000/year (the anual inciedence of Cx ancer in the US) is not turning a generation into guinea pigs. The Nuremberg prosecutors can rest easily in their graves. I'm sorry if I sound snarky, but people take writers more seriously when they don't use that sort of purple prose! It detracted from the rest of your advocacy.
3.23.2008 3:13pm
Deep Lurker (mail):
Neurodoc, the unvaccinated 100-X% aren't free-riding, they're putting themselves at greater risk from the disease in exchange for not suffering the risk from the vaccine. Or if they're "free riding" then each person who chooses to get vaccinated is "imposing an externailty" by reducing the value of vaccination to all the other vaccinated people.

Also, you can't just assume that too many people would want to be in the 100-X group; you have to show that this is in fact the case. If it isn't the case, then forcing vaccination on those people causes more harm than good.

The X% vaccinated that minimizes overall harm from the disease plus the vaccine side-effects is such that vaccinating one less person does more harm than good - and also that vaccinating one more person does more harm than good - both to that marginal person and to the total population.

So even a perfect public health despot could not do better than a population of perfectly rational individuals choosing for themselves whether to get vaccinated or not. Now we don't have a population of perfectly rational individuals - but we don't have any perfect public health officials either. Given imperfections on both sides, my money is on individual choice to do a better (although not perfect) job. Especially if the imperfect public health officials operate on the simplistic model of "vaccination is good for most people, therefore it must be good for everyone."
3.23.2008 3:23pm
MDJD2B (mail):

the unvaccinated 100-X% aren't free-riding, they're putting themselves at greater risk from the disease in exchange for not suffering the risk from the vaccine. Or if they're "free riding" then each person who chooses to get vaccinated is "imposing an externailty" by reducing the value of vaccination to all the other vaccinated people.

No-- they're free riding. The herd immunity models sow tht there is elimination of common communicable diseases when 80-90% of susceptible people are immunized. A decision not to be one of a few people to reject vaccination allows one to benefit from the sacrifices of the majority.

It's the phenomenon of the commons. Like me dropping raw waste into a river because I know that hardly anybody else will, and a certain proportion have to foul the river before the drinking water is contaminated.

These commons situtations, BTW, are a problem for libertarianism. Application of the market model (as you do in your post-- not reproduced by me) works if there is efficiency of knowledge, if there are no externalities, and if the rewards and losses can be measured in economic terms.

Yes-- if we hear of a case of polio in the school brought in by a new student from Burkina Faso, we will all go out and vacinate our children. By that time it is likely to be too late to stop the epidemic because transmission occurs before symptoms erupt (inefficiency of information). And even if the parents act as pure economic actors, the resulting misery to them and to their children (who have little role in the decision that accepts them-- an externality) have an impact that economics cannot address. Furthermore, children who have been immunized unsuccessfully (no vaccination is 100% successful) suffer from the decisions of the free riders. As discussed here and in the previous post, neither the tort system nor the insurance system is unlikely to provide a satisfactory solution to this.


Especially if the imperfect public health officials operate on the simplistic model of "vaccination is good for most people, therefore it must be good for everyone."

Medical contraindications are built into compulsory vaccination programs. And, in any event, compulsory vaccination programs are not built on this simplistic model. Only your straw man argument is. Google "herd immunity," and you will see that you need a PhD in biostatistics or epidemiology to understand the model. The model is based on what is required to eradicate the disease. I can't understand the math. Assuming that the number of free riders is less than the number of non-vaccinated people to achieve herd immunity, the remaining issue is the morality of free riding versus the morality of compulsion. (Or the constitutionality of allowing free fiding versus compelling vaccination; Jacobson and related cases have settled this issue.)
3.23.2008 4:22pm
Elliot123 (mail):
I'm curious about the attitudes of those who choose not to vaccinate their kids regarding drugs in general.

Do they use antibiotics? Tylenol? Insulin injections? Cough medicine? If so, is it because they evaluate the risk of injury from these to be less than the risk of injury from vaccines? Or do they evaluate the risk of contracting the disease targeted by the vaccine to be less than the risk of relying on nature to deal with the disease targeted by the antibiotics?

Second question: If a parent who chooses not to vaccinate in the US were to accept a job in a third world country where certain diseases were more prevelant, would he vaccinate his kids before taking them there?
3.23.2008 4:49pm
neurodoc:
Deep Lurker, you go around and around in circles, babbling about "public health officials who you suppose operate on the simplistic model of 'vaccination is good for most people, therefore it must be good for everyone';" some theoretical point in time and space at which you imagine "vaccinating one less person does more harm than good - and also that vaccinating one more person does more harm than good;" and so one, all the while maintaining that those who would enjoy the benefits of living among those who have been vaccinated and contributed to herd immunity without contributing to the common good by getting vaccinated themselves though they have no medical contraindications to vaccine are not free riders. Then, self-satisfied, you sit down, throw up your hands, and say "QED." No, it is QnonED, for the reasons MDJD2B has set out and more.

(MDJD2B refers to the "phenomenon of the commons," and illustrates it with an example of one person contributing more than his share of harm, while deriving an equal share of the bottom line benefit. I believe the original example from England is what gives this its name, that being when one person introduces more sheep on the community "commons," thereby exceeding the optimal number of sheep on the land held collectively, and that same person got all of the benefit from those extra sheep while the others using the commons to pasture their animals share equally with the greedy individual in the cost of diminished productivity from the overgrazing. That original example, the one on which the Law of the Commons was based, may be more closely resemble the issue of free riders where vaccines are concerned.)
3.23.2008 10:16pm
Dan Weber (www):
So why would anyone aware of this put an infant to sleep on their stomach, do they disbelief the science or they are making a "political" statement?

First, even if my kid sleeps on his stomach, it's still very unlikely that he's going to die of SIDS.

Second, there are benefits to sleeping on the stomach. Many babies sleep more comfortably that way. I know folks who have made that decision. They've already eliminated other big correlators of SIDS, like second-hand smoking, so their kid is much less likely to die of SIDS than the general population, regardless of how

But why the fuck is it anyone's business how they put their kid to sleep? Hey, they bottle-fed their kids, too, even though breast-feeding has proven benefits. Maybe we can arrest mom for getting a doctor's note about her trouble with lactating?

(Not that it's anyone business, but I put my kid to sleep on his back, although he flips over onto his stomach once or twice a week.)
3.23.2008 10:28pm
neurodoc:
Elliott123, your last question about the anti-vaccine crowd's thinking about other medical treatments, like the use of antibiotics, is a good one. It hints at the exceptional concerns about vaccines, and subtexts to them.

Vaccines have given more bang for the buck in terms of improved health and greater life expectancy than anything else we have ever expended health $$$ on, save perhaps providing clean water to people. And I don't know whether there is any medicine of any usefulness that has ever been more tested and proven safer and more effective than vaccines. So, it is remarkable that vaccines are a subject of such controversy. (The controversy is not entirely novel, however, since >200 years ago there was hysterical opposition to Jenner's use of cowpox to create immunity against smallpox. Some amazing cartoons from that time illustrate the hysteria vividly.) We won't get off on fluoridation of water, but the controversy over that shares some things in common with the vaccine ones. (Didn't General Jack Ripper in Dr. Strangelove fulminate about what they were doing to our bodily fluids, or something like that?) This stuff is grist for a medical anthropologist's mill.
3.23.2008 10:31pm
Bob Goodman (mail) (www):
When I was in med school 30 yrs. ago, we were told that a vaccine for chicken pox would likely never be developed, because the risk from the disease was so low compared to the potential risk of a vaccination for it. Just because the virus is attenuated in terms of varicella doesn't necessarily mean it would be attenuated in terms of ability to produce herpes zoster.
3.23.2008 10:38pm
neurodoc:
theobromophile, I could add somethings at the margins to what MDJD2B has said, but he has said the most important stuff, and said it very well.

I'm not aware that any US governmental agency mandates its use. Correct me if I'm wrong.
I believe the "mandates" have been at state or local levels, with some school systems requiring it, or proposing to require it, for girls along with MMR. Because the HPV vaccine has been recommended by the relevant government body (the CDC's ACIP - Advisory Committee on Immunization Practices), I believe it is now covered under the National Vaccine Injury Compensation Program, so that someone who could prove the vaccine caused them an injury would be able to claim compensation from the trust fund established by an act of Congress for that purpose.
Again, well over 99% of people who get HPV don't wind up with problems.
Around the world, of those infected with the virus that causes poliomyelitis, well over 99% have only a "subclinical" infecction, that is one that does not produce paralysis or any other neurologic effects. (That is not the case in countries with high sanitary standards like the United States, though.)
"significant risk of death" simply cannot apply to something that affects something on the order of 1 in 1000 members of the affected population (over a lifetime, mind you), and the death of which is almost totally preventable
Again, it was not "significant risk of death," but rather "significant risk of death and/or injury." Numbers of death avoided is not the only outcome variable of interest; we place, quite rightly, great emphasis on "morbidity," that is avoidance of "injury" and all of its consequences, including costs to care for those who become ill, costs associated with disability, loss of reproductive capacities, physical and emotional suffering, etc.
You said that treatment for cervical abnormalities can cause injury. Most women who get cervical cancer and/or abnormalities are well beyond their voluntary childbearing years (even by today's standard): median age for developing cervical cancer is 50-54.
Loss of reproductive capacities is certainly not the only "injury" short of death brought about by cancer and pre-cancerous lesions of the cervix. And if 50-54 is the median age at which the diagnosis of cancer of the cervix is made, then 50% of women get the diagnosis before they are that old, many of them at a considerably younger age.

"Surveillance"/screening (e.g., annual Pap smears) may be an excellent prevention strategy, but that is not to say that surveillance by itself is better than surveillance plus measures that actually confer pretty good protection against ever developing the disease, e.g., the HPV vaccine. And once the vaccine has been administered, patient compliance is less critical than when the only preventive strategy employed is surveillance/screening.

Fewer pregnancies may mean a lesser risk of developing cancer of the cervix, but a greater one of developing breast cancer. So, we have one of those "multifactorial" problems.

And again, all that the gyn oncologist, MDJD2B, has said about this.

(In closing, let us note that the HPV vaccine is a rather singular one, different in many ways from the other vaccines recommended for children. While not exactly OT, HPV has its own set of considerations, and the reasons why parents don't get their children immunized against the pathogens they are at risk from are distinct from the ones you have argued where HPV is concerned.)
3.23.2008 11:07pm
neurodoc:
Bob Goodman: When I was in med school 30 yrs. ago, we were told that a vaccine for chicken pox would likely never be developed, because the risk from the disease was so low compared to the potential risk of a vaccination for it.
When you were in medical school did they teach you that most peptic ulcer disease (not acute "stress" gastric ulcers, Zollinger-Ellison ones, etc.) were due to chronic helicobacter pylori infections? Who would have believed then that antibiotics would be the answer, and how many fewer surgeries have been performed? Did they teach you about prions back then? (No, I didn't learn about them back then either, for the simple reason that there were many things we did not know then that we know now, and undoubtedly much that we have yet to learn.
Just because the virus is attenuated in terms of varicella doesn't necessarily mean it would be attenuated in terms of ability to produce herpes zoster.
The same virus causes varicella (or chickenpox) that causes herpes zoster (shingles) isn't it, with the former being a systemic viral illness and the latter an activation of the dormant virus in the dorsal root ganglia of nerves causing an eruption in just a single dermatome? Is there any evidence to show that the varicella vaccine protects one against varicella but makes one more liable to herpes zoster than they would have been if they never received the vaccine? Or are you only telling us what some may have "theorized" years before there ever was a vaccine and any experience of it?

Don't you think we owe it to others to use our medical knowledge to inform others (after we have informed ourselves, of course) and knock down misconceptions, especially those that would encourage people not to immunize their children?
3.23.2008 11:59pm
theobromophile (www):
I'm not aware that any US governmental agency mandates its use. Correct me if I'm wrong.

1. My arguments are made against mandatory vaccination ONLY. I have never argued for it to be pulled from market; if you want to argue against that, fine, but please find someone who is actually arguing for it to be pulled.
2. Some 20 states have considered legislation that would mandate it. Texas may have (or it was repealed after quick signing). Virginia has an HPV mandate for 11-year-old girls.
3.24.2008 1:34am
theobromophile (www):
I'm not trying to be totally flippant here, but, if you are to mandate HPV (which is really what this fight is all about - whether or not the government can penalise you for not giving certain vaccines to your kids), why could it not mandate that women receive annual mammograms? If memory serves correctly, John Edwards made that suggestion when he was running for President.

I'm not arguing that there is no health benefit to something like the HPV vaccine; I'm simply arguing that it is not appropriate for the government to mandate it, for ther reasons I've stated above. Where is the limit upon the governmental intrusion into our lives? our health? our medical decision-making? Is it because, as a patient/potential patient, I lack a medical degree and therefore cannot be trusted to make my own decisions?

I'm too old now for Gardasil, unless the FDA approves it for use for older women... still won't get it, though, unless I'm forced to. I just cannot fathom that it would be the best use of $400. I would much prefer to use that money for things that I'm actually at a substantial risk for, and that are likely to kill me.
3.24.2008 1:50am
Fub:
MDJD2B wrote at 3.23.2008 3:22pm:
Google "herd immunity," and you will see that you need a PhD in biostatistics or epidemiology to understand the model. The model is based on what is required to eradicate the disease. I can't understand the math.
I googled, but I didn't find "the model". I did find some tables that indicate the herd immunity threshold (apparently for some prevention level, not eradication) versus basic reproduction number (usually called "R") for various diseases. I was a bit surprised at how low the herd prevention threshold was in some cases (eg: mumps ~75%). It is also apparent that R is at best a number that is difficult to estimate accurately.

Can you provide a link to "the model"? I'd really like to know what the standard ways to estimate minimal eradication thresholds (or prevention thresholds) for herd immunity.

You've tweaked my curiosity, and I've got a fairly decent immunity to mathematical hair.
3.24.2008 2:23am
Elliot123 (mail):
"why could it [government] not mandate that women receive annual mammograms?"

I don't think breast cancer is contagious.
3.24.2008 4:51pm
theobromophile (www):
I don't think breast cancer is contagious.

Why is that material? HPV is not airborne, nor is Hep B., but the government mandates that we vaccinate ourselves against those things.

Women are ten times as likely to die of breast cancer as they are of cervical cancer. So we mandate protection from one but not the best preventative tools for the other? Communicability, especially when you're talking about 9-year-olds and STDs, is a moot point, IMHO - or at the very least immaterial to the mandate.
3.24.2008 5:15pm
Elliot123 (mail):
"Why is that material? HPV is not airborne, nor is Hep B., but the government mandates that we vaccinate ourselves against those things."

HPV remains contagious regardless of the exact method of contraction. A disease can be contagious without using an airborne attack. It's a disease we give to one another. That's why we recognize a responsibility to each other to do what we can to avoid killing each other. We pose a danger to one another. I'm not aware that we pose a danger to each other regarding breast cancer. I don't think we have ever had breast cancer epidemic that jumped from one person to another.

I acknowledge that some people don't recognize any responsibility to anything beyond their own welfare. Unfortunately we have to prevent them from harming the larger group, and we have to accept their children into the larger group to prevent them being harmed by their parents.

The vaccination does two things: 1) it protcts me, and 2) it prevents me from passing the disease to you. I don't see how the tragedy of breast cancer deaths has anything to do with a collective responsibility to avoid killing each other by passing on disease. We don't pass on breast cancer.
3.24.2008 10:23pm
neurodoc:
Theo, I'm not sure I understand your point(s) about vaccines, in particular the HPV one. The HPV vaccine was not mentioned in the NYT article that occasioned this thread, and the issues surrounding immunization policies where the HPV vaccine is concerned are very different from the ones shared by the standard childhood ones discussed in that article, those being vaccines for measles, mumps, rubella, varicella, and Hib. (Note the Hib vaccine is not so much about preventing community spread of haemophilus influenza infections as it is about safeguarding individual small children against ear infections and devastating H flu meningitis. So somewhat different considerations where that vaccine is concerned too, but not nearly so different as the ones related to HPV vaccine, which really stands apart from the rest.) Yet after a couple of posts that made little more than passing mention of the HPV vaccine, you jumped in with both feet to challenge the rationale for the vaccine, questioning its efficacy, safety, cost, etc. After awhile you seemed to back off a bit on the medical and public health considerations, saying your objections were to a mandate ("My arguments are made against mandatory vaccination ONLY."), though a mandate may be only a spectre
("Some 20 states have considered legislation that would mandate it. Texas may have [or it was repealed after quick signing]. Virginia has an HPV mandate for 11-year-old girls."). Or is it ("HPV is not airborne, nor is Hep B., but the government mandates that we vaccinate ourselves against those things.")?

"Women are ten times as likely to die of breast cancer as they are of cervical cancer." Yes, but # of deaths is not the only measure of a disease's impact. And even if # of deaths was the only outcome of concern, the 1 (cervical cancer) to that 10:1 ratio would still be a significant public health concern.

"HPV is not airborne, nor is Hep B" - right, but we don't limit our public health efforts to the prevention of airborne contagions.

"I don't think breast cancer is contagious."
"Why is that material?" For many reasons, the most relevant one here being that breast cancer is one case at a time, not the threat of explosive outbreaks of cases in the community.

[The NBC evening news with Brian Williams just ran a segment on parents that don't vaccinate their kids. Seems to have copycatted the NYT article, even going to the same mother. Poorly done; no meaningful insights; won't declare the vaccines cause autism meme bogus, ony saying that many doctors disagree. Some fool identified by a subtitle only as "Dr. Bob Sears" appears for the quickest of head shots to say something about parents being concerned about all the chemicals being put into their children's bodies. Too brief and unelaborated for me to be certain who/what "Dr. Bob Sears" is, but would be willing to bet that he is a fringe type. OK, those are my "biases," representing what another poster said was my standing with the "authoritarian" medical establishment.]
3.24.2008 10:27pm
Fub:
neurodoc wrote at 3.24.2008 9:27pm:
Too brief and unelaborated for me to be certain who/what "Dr. Bob Sears" is, ...
Is this author the talking head you saw?
3.24.2008 11:51pm
theobromophile (www):
Neurodoc: Sorry, I was unaware that there is some rule against responding to comments like this.

My point in responding was the same one I had made several comments upthread: that conflating mandates vaccinations against deadly, highly communicable diseases with those against STDs is part and parcel of the problem. While we may prefer to have parents give their children every vaccine on the market, it is quite another thing entirely to use government (and social) force against those who do not. It also undermines the most basic goal of vaccination: to ensure that children don't die in deadly epidemics. Should we be surprised when people throw out the baby with the bathwater, so to speak, when our mandates for vaccines include diseases that parents got as children and recovered from without complications? Doesn't it undermine the legitimacy of the claim to absolute, unarguable (sorry, can't think of a better word now) obligation to prevent horrific, devastating (to both the individual and the community) diseases by comparing them with chicken pox?

Well, according to you, that's not a legitimate topic of discussion. (Rolls eyes.) I'm backing out. Now you can have a more enjoyable Monday evening.

Oh, by the way: 41 states have considered legislation for HPV; it is 20 that have so enacted. "Spectre?" ROFL.
3.25.2008 12:38am
Elliot123 (mail):
"It also undermines the most basic goal of vaccination: to ensure that children don't die in deadly epidemics."

I'd suggest an equally basic goal is to prevent other people from dying.

"Should we be surprised when people throw out the baby with the bathwater, so to speak, when our mandates for vaccines include diseases that parents got as children and recovered from without complications?"

I think some folks contracted smallpox as children and survived without complications.
3.25.2008 12:50am
neurodoc:
theobromophile: ...conflating mandates vaccinations against deadly, highly communicable diseases with those against STDs...
Where in the United States (or elsewhere) is a vaccine against STDs (Gardasil?) currently mandate or likely to be mandated? If nowhere, then who is conflating what?
...While we may prefer to have parents give their children every vaccine on the market...
influenza vaccine, human diploid cell rabies vaccine?, yellow fever vaccine?, Japanese B encephalitis vaccine?, pneumococcal vaccine?... (BTW, I have personally had the first three of those, took a pass on the fourth, and will probably get the fifth before too long.)
While we may prefer to have parents give their children every vaccine on the market, it is quite another thing entirely to use government (and social) force against those who do not.
"Government (and social) force" is being used against all those parents who do not "give their children every vaccine on the market," though with opt out provisions for those with "religious" objections in 48 states and for "personal" objections in 20? The consequence for not immunizing children against certain highly contagious and potentially very dangerous common infections is, of course, that the child may not be allowed to attend a public school where they can infect other children.
It also undermines the most basic goal of vaccination: to ensure that children don't die in deadly epidemics.
We have more ambitious public health goals than just trying to keep children from dying in epidemics.
Should we be surprised when people throw out the baby with the bathwater, so to speak, when our mandates for vaccines include diseases that parents got as children and recovered from without complications?
Yes, it is a problem that we have parents who are so ignorant as to believe that because they had one of the diseases we wish to protect against and they recovered "without complications," only suffering through the acute illnes, there is no good reason to immunize their children against these diseases. Profoundly and tragically stupid, indeed.
Doesn't it undermine the legitimacy of the claim to absolute, unarguable (sorry, can't think of a better word now) obligation to prevent horrific, devastating (to both the individual and the community) diseases by comparing them with chicken pox?
You really should go beyond whatever personal experience you may have of varicella and other childhood infectious diseases and read about the very serious neurologic and other complications they can entail. They are not the benign conditions you seem to believe them to be.
3.25.2008 2:57am
theobromophile (www):
Two things:

1. "Yes, it is a problem that we have parents who are so ignorant as to believe that because they had one of the diseases we wish to protect against and they recovered "without complications," only suffering through the acute illnes, there is no good reason to immunize their children against these diseases. Profoundly and tragically stupid, indeed."

That's my point. You then seem to attribute that attitude towards me in your next paragraph. Well, thanks, but - check above - I had pertussis and I was pretty freakin clear that it sucked and I support vaccines for it. Then again, you seem to be wedded to the idea that I'm some anti-vaccine nutjob. Your problem, not mine.

2. Your statement,

Where in the United States (or elsewhere) is a vaccine against STDs (Gardasil?) currently mandate or likely to be mandated? If nowhere, then who is conflating what?

Here's the answer for you:
Virginia
Colorado
Indiana
Iowa
Maine
Maryland
Minnesota
Nevada
New Mexico
New York
North Carolina
North Dakota
Rhode Island
South Dakota
Washington State
Washington, D.C.

Now, you may be referring to the fact that some of the mandates are not yet in effect (for example, California, not on the above list, has tabled the question until 2011, and other states/D.C. are waiting until the new school year to implement the mandate), but, nevertheless, those states emcompass many, many millions of people.
3.25.2008 3:19am
neurodoc:
theobromophile on possible complications of vaccines (thimerosal and/or MMR vaccine): "There are concerns about autism..."

theobromophile on the effectiveness of HPV vaccine (5/22/07): ...HPV isn't going to reduce cervical cancer rates.
theobromophile on the effectiveness of HPV vaccine (3/24 at 12:50AM): I'm not arguing that there is no health benefit to something like the HPV vaccine...

theobromophile on HPV vaccine mandates (3/24 at 12:34AM): "Some 20 states have considered legislation that would mandate it. Texas may have (or it was repealed after quick signing). Virginia has an HPV mandate for 11-year-old girls."
theobromophile on HPV vaccine mandates 24 hours later (3/25 at 2:19AM): Q. Where in the United States (or elsewhere) is a vaccine against STDs (Gardasil?) currently mandate or likely to be mandated? A. Virginia, Colorado, Indiana, Iowa, Maine, Maryland, Minnesota, Nevada, New Mexico, New York, North Carolina, North Dakota, Rhode Island, South Dakota, Washington State, Washington, D.C.

theobromophi on personal experience of pertussis and pertussis vaccine: I had pertussis and I was pretty freakin clear that it sucked and I support vaccines for it.
theobromophile on personal experience of varicella (chicken pox) and varicella vaccine: I will say that having chicken pox was roughly a million times easier than (pertussis). I simply cannot understand lumping varicella in with polio, pertussis, MMR, and the like.
theobromophile on banality of varicella(1/10/07): Chicken pox is but a discomfort...
theobromophile on varicella in the immunocompromised; pneumonic form; cerebrellar ataxia and other encephalitides; vasculitis: ???

theobromophile: you seem to be wedded to the idea that I'm some anti-vaccine nutjob
3.25.2008 4:28am
David Chesler (mail) (www):
Elliot123 "Should we be surprised when people throw out the baby with the bathwater, so to speak, when our mandates for vaccines include diseases that parents got as children and recovered from without complications?"

I think some folks contracted smallpox as children and survived without complications.


That's the hysteria in the other direction. Chicken pox is not smallpox. Letting a child sleep in the back seat is not letting a child work in a coal mine.

There is a cost in interfering with parental authority (been there) and there is a cost in teaching that all risks must be avoided.
There is a cost to the vaccines. Not just the dollar cost (and what is the cost-benefit for HPV? I was about to say that I only had to pay 75% [tax deductible] of 1/3 [I had no insurance for one in the series of 3 injections] but that just shows how insurance muddies the rational allocation of resources) but e.g. my daughter received her chicken pox vaccination just before my mother-in-law's colon cancer blew up, and they were not able to see each other for what turned out to be the last month of the latter's life.
3.25.2008 10:17am
theobromophile (www):
Discovered between the hours of 1:58:11 am and 2:13:06 am, I presume. From Washington, D.C.. "Post-hoc rationalisation" mean much to you?

Why not try this:

Thimerosal was almost entirely removed from pediatric vaccines in 2001 after some government scientists expressed concern about the amount of mercury that children who got routine vaccinations would be exposed to. Since then, autism rates in the United States have shown no signs of dropping.

That would seem to indicate that thimerosal does not cause autism - in fact, there is not even a correlation between thimerosal use and autism. This is reminiscent of John Edwards's cerebral palsy theories.


Oh, wait - because it doesn't fit in with your (obvious) agenda.

As for the mistake re: which states mandate, and how many: I could not recall, off the top of my head, how many mandate, how many have bills, and how many of those bills were rejected. The second stat is correct - more than a dozen states &Washington D.C. mandate.

Four months ago, I was on the "care" of a doctor who thought that it was wrong for me to question any of his godliness and medical wisdom. Sadly, that medical wisdom was to sit around and hope that I would get better in a few years - and live in pain. No painkillers for women who are of childbearing age, because that is unethical. Yeah, I question the medical community and medical recommendations. That time saved my sanity - but I can also say that it has saved my life to question, aggressively, the diagonses and treatments recommended to me.
3.25.2008 1:58pm
neurodoc:
Oh, wait - because it doesn't fit in with your (obvious) agenda.
Huh?! How does that not "fit in with (my)(obvious) agenda"? And what, BTW, do you see my "agenda" to be, one entirely consonant with the rest of the respectable medical community and their professional organizations and governmental bodies (e.g., American Academy of Pediatrics, American Public Health Association, Advisory Committee on Vaccine Practices, CDC, NIH, FDA, etc.)

You have had personal experience of a physician who was somehow wrong? Sacre bleu! If you will give us his name, I will see that he is drummed out of the profession, since such a person threatens our well-earned reputation for omniscience. (Sorry, don't really wish to be mean, but I do think the silliness of your "answer" should be pointed out. And you might respond in similar fashion to someone who stopped to note that neither chemical engineers, nor lawyers, nor the combination thereof were infallible, especially when speaking of things well outside their respective fields.)

Now, I have never spoken in favor of "mandates" for the HPV vaccine. (And by "mandates," I mean a requirement that girls receive the vaccine if they are to enroll in school. Is that what you mean by "mandates"?)

And do you want to retract or modify some of the "medical" claims you have made in this thread and on other blogs, including your own? For example, "HPV isn't going to reduce cervical cancer rates," or "I'm not arguing that there is no health benefit to something like the HPV vaccine..." How about,"Chicken pox is but a discomfort...," might you go beyond the Internet to look at some standard medical texts and reconsider that contention?

Finally, about "agendas," what exactly is yours? Does some of what you have said here go along with "natural family planning" (rhythym) and other religious or ideologic tenets of yours?

If you want to expound on nanotechnology, a subject about which I know nothing other than that it pertains to very small things, I will listen or remain silent, as is my wont when I have nothing to contribute of value. (There is some value to being simply "provocative," but this has gone far beyond that and has become just a waste of time.)
3.25.2008 3:32pm
neurodoc:
That's the hysteria in the other direction. Chicken pox is not smallpox.
Right. And neither is it ebola virus, a still more deadly, though probably less contagious infection. But so what? Because the morbidity and mortality associated with smallpox is greater than that associated with chicken pox, it follows that...(blank)... (Do you subscribe to theobromophile's, "Chicken pox is but a discomfort..." thinking?)

It is sad that your daughter was unable to spend time with her grandmother before her death from colon cancer on account of the fact that your daughter had just been given the varicella vaccine before the grandmother died and it was medically inadvisable to expose the woman. But how would things have been any different if instead of receiving the varicella vaccine at that inopportune time, your daughter had contracted a natural case of chicken pox. Then your daughter would have experienced much greater symptoms that she probably did after the vaccine and she would probably have been much more contagious. Aren't you misplacing "blame" onto the varicella vaccine for those unfortunate circumstances in your family?
3.25.2008 3:46pm
neurodoc:
That's the hysteria in the other direction. Chicken pox is not smallpox.
Right. And neither is it ebola virus, a still more deadly, though probably less contagious infection. But so what? Because the morbidity and mortality associated with smallpox is greater than that associated with chicken pox, it follows that...(blank)... (Do you subscribe to theobromophile's, "Chicken pox is but a discomfort..." thinking?)

It is sad that your daughter was unable to spend time with her grandmother before her death from colon cancer on account of the fact that your daughter had just been given the varicella vaccine before the grandmother died and it was medically inadvisable to expose the woman. But how would things have been any different if instead of receiving the varicella vaccine at that inopportune time, your daughter had contracted a natural case of chicken pox. Then your daughter would have experienced much greater symptoms that she probably did after the vaccine and she would probably have been much more contagious. Aren't you misplacing "blame" onto the varicella vaccine for those unfortunate circumstances in your family?
3.25.2008 3:46pm
ruralcounsel (mail) (www):
Apparently the topic of vaccination is where most VC commentors lose their libertarian principles.

And the reason? "It's for the CHILDREN!"

You know, my kids get vaccinated (I'd even force them to get an annual tetanus booster if I could talk their mother into it) ... I know the risk of the vaccine is low and the disease is nasty.

NEVERTHELESS ... I think forcing parents to vaccinate their kids is wrong. Parents should have the freedom to make these decisions ... without all the busybodies worrying about "free riders" and "herd immunity". If they choose wrong, they and their kids suffer the most. But how is that any different than anything else?

For example (and this should be a hot topic!) I would argue that the risks of having a firearm in the home, or carrying a firearm in public, puts any children present (including visiting playmates) at a slight risk. Does that mean we forbid parents to own firearms? Or do we respect the authority of the parent in their own home to make those decisions of risk/benefit? Freedom means the freedom to take risks, and make decisions.

So at what point do we curtail that freedom? Vaccinations, gun ownership, driving over the speed limit, serving leftovers that are just a bit too old, not washing the dishes in hot enough water, ... versus running a viral immunology lab in your basement, or keeping a neurotoxin depot in your backyard, or a nuke in the garage?

OK, so I'll admit there is a limit somewhere ... but at mandatory vaccines? Clearly we've touched a nerve, some primal fear of disease and contagion ... that seems to warp everyone's perception of the risks. And there is the real problem. No one grasps the actual risks very well, if they are even known and not just imagined, and should those risks come to pass, we oscillate between worst case outcomes and mild reactions without any real idea of what the odds are.

In summary, to censure some parents for choosing a personal optimum of risk/reward is to be a moral busybody with expectations of human perfectability ... and that is a sure road to hell.
3.25.2008 4:27pm
neurodoc:
Does your notion of "freedom" encompass the right to enroll your unvaccinated children in public school where my children vaccinated according to the recommended schedules will not be able to avoid them? I have a different notion of "freedom," one that allows you to home school your unvaccinated children, in the manner that the Amish educate their children within their own closed communities, but not to enroll them in public school, imposing a needless risk on others.

With what philosophical principles or systems does my notion of "freedom" conflict? 105 years ago in Jacobson, the Supreme Court sided with me; and though the question wasn't presented them when last the Court took up a vaccine case (about 1993) in Whitecotton, I was there to hear oral argument and I didn't get the sense that any of the 9 would be likely to rule differently than their forebears had.
3.25.2008 5:29pm
David Chesler (mail) (www):
neurodoc: That's the hysteria in the other direction. Chicken pox is not smallpox.
Right. And neither is it ebola virus, a still more deadly, though probably less contagious infection. But so what? Because the morbidity and mortality associated with smallpox is greater than that associated with chicken pox, it follows that...(blank)...


Fill in the blank with "it's no where near so big a deal if someone chooses not to vaccinate a child."

But how would things have been any different if instead of receiving the varicella vaccine at that inopportune time, your daughter had contracted a natural case of chicken pox. Then your daughter would have experienced much greater symptoms that she probably did after the vaccine and she would probably have been much more contagious.

So she would have been allowed to see her even less than zero? It's just one anecdote, but here is an actual cost to the vaccine that I actually experienced. Of course it was just bad timing -- we didn't know what was going to happen right after she got the vaccine, nor that it was too late for my mother-in-law anyway.

...I'm trying to think of an analogy for something parents still have a choice about...

When the symptoms of the disease aren't usually that bad, and the symptoms of the vaccine are not nill, it's getting from further "You may not starve your child" and closer to "You may not allow your child to play sandlot baseball, you must enroll him in little league." One or the other may be demonstrably better, and either has risks, but they're not so far apart that we mandate one and call the other abuse.
3.25.2008 8:59pm
Andrew J. Lazarus (mail):
I noted once that one of the leading anti-vaccine groups continued to recommend tetanus vaccination. Of course, you can contract tetanus through playground injury no matter how many other kids are vaccinated. You couldn't ask for a clearer example that the anti-vaccine people are free riders. A few religious cranks is not a problem. When the number becomes too great, well, maybe Roger Schafly can compute for us what the cost of polio was to the USA in 1950. Smallpox in England in 1650. Somehow his math on measles seems a little off, doncha think?

Incidentally, when there was a measles outbreak at Berkeley about 20 years ago, an entire class of over 100 was told to report to the infirmary for shots. Roll was taken. (I had measles as an infant, but went anyway.)

PS: Aside to Spartacus. I hope you get a ticket for not buckling in your kid. You're a shitty parent.
3.25.2008 10:24pm