The Risks of Rejecting Vaccinations (Continued)
Glenn Reynolds has an uncharacteristically long post with additional perspective on the vaccination "controversy."
Related Posts (on one page):
- The Risks of Rejecting Vaccinations (Continued)
- Child Abuse:
- The Risks of Rejecting Vaccinations:
- The Case of Hannah Polling:
- John McCain's Junk Science:
Fact: there are risks in vaccination. These are (often) the same pediatricians who decry firearms in homes, with a “risk factor” around 1:1million. Yet when it comes to medicine, they have no problem deliberately exposing your child to risks thousands of times greater . . . and then have the gall to claim it’s a waste of time to explain it to you.
Explain again why we ‘need’ to mandate Guardasil vaccine for our 7 year old girls.
I may not agree with non-vaccinators, but can fully understand their positions.
Which vaccine has a risk of serious side effects greater than 1/1000?
I agree with your point about firearms.
But your point about Guardasil is misplaced.
Cervical cancer is common and deadly. Moreover, since most cervical cancer is caused by human papillomavirus (HPV), it is preventable.
There might be some good libertarian arguments against compulsory vaccination; but it is also fair to say that parents who fail to get their children the Guardasil vaccine are very irresponsible.
Steve Erickson, the problem with your argument is that HPV is 100% preventable even WITHOUT the vaccine
I was going to say that that story is really frightening, and underscores why we need to keep vaccinating against diseases which are supposedly eradicated.
But as usual, the Glenn Reynolds value added is negligible... quoting other people at length hardly counts as a "long Glenn Reynolds post".
Side note: it's interesting how fringe right conspiracy beliefs (fluoride, vaccines, pollution of previous bodily fluids in general) are now turning into fringe (and not so fringe) left beliefs.
Dr. Schmidt, the pediatrician who doesn't have the time to discuss risks with parents, because he knows best, shows that dogmatic attitude Dr. Fleming recognizes: "Of course I know everything about the human body -- after all I created it on the sixth day, didn't I?"
Because it is, you know, TRUE. There is a non-zero risk and non-vaccinators do avoid it by relying on everyone else to take on that risk.
Incidently, one of the classic solutions to a free rider problem is to use social sanction to cow defectors into submission. Unfortunately with the Internets that is now more difficult since the free riders can get together and develop a mini-society of their own to resist this social sanction.
I could be wrong, but I read Malkin's post as commenting not on Polio vaccine, but on HepB?
I hope, for example, that the good doctor has time to ask if the child is allergic to eggs.
I was referring to the part where she writes: "I reiterated my refusal of Hep B, accepted DTaP and HiB, and asked to put off polio and Prevnar."
I assume she wasn't refusing it forever (and it seems she wouldn't object to even Hep B eventually), but I still think it's troubling to "put off" the polio vaccine.
Would you suggest waiting until after girls are likely to already have HPV to vaccinate them against it?
If the downsides are so small, the free rider issue doesn't make sense, because the paid-for riders haven't spent much either. If the paid-for riders have a valid complaint, we should be more willing to acknowledge and discuss the downside of vaccination.
But that's not what people are saying. The point is that any rational calculation at the societal level is massively, unambiguously, in favor of robust (and probably mandatory) vaccinations.
Preventable by whom? Surely the daughter in question does not have the ability to make sure it is 100% prevented. She may be one of the minority of women that have only one partner in their entire lives, but she has no control over what that partner did prior to meeting her. Unless the guy was raised in a bubble, she assumes a risk that he has had one or more partners before her. And his partners had multiple partners.
Now, suppose the unvaccinated daughter is like the majority of women and has multiple partners in her life. As an unvaccinated and sexually active female, she poses a danger to the rest of the population.
And the parent? The parent has zero control.
Not really a defensible position.
I assume you mean through abstinence. Yes, if a women never has sex during her lifetime (nor is raped or sexually abused) she is extremely unlikely to get HPV. So what? Car accidents are 100% avoidable by never coming near a car, does that mean seatbelts and airbags are unnecessary. Most women will have sex at some point in their lives, and they cannot count on 100% honesty from their partners, unfortunate though this latter fact is.
Is there any cost to discussing "You might some day have unprotected sex with a man, even your future husband, who had had unprotected sex with someone who had HPV and being either uncircumcised or unlucky, carries it himself"?
Is there any cost besides cervical cancer in acquiring HPV?
If it's a public health/free rider issue, why aren't boys given the same vaccination? And why must patients or their insurers bear the costs of this and other vaccines? (Nobody but the patient can be immune, but the costs can very easily be spread across all who benefit.)
(Disclosures: That "I created remark" is from a cartoon several years ago, maybe Bizarro. I suggested my daughter receive the vaccination, the pediatrician and she concurred. Having dealt with real cancers my wife elected to have a contra-lateral mastectomy at the first sign of a 5mm DCIS, and in retrospect it didn't help, because the adriamycin [heart damage] and the same radiation that gave her increased risk for breast cancer [pneumonitis] killed her first -- anybody's call if the cost of the surgery was worthwhile: the breast reduction with extreme prejudice did relieve her TMJ and make her clothes fit better, she was easier to hug, and I've dealt with the "First He Cries" aspects here and here. On the other hand, my father chose the most minimal treatment for his prostate cancer 15 years ago, figuring something else would kill him first, and he was right: he died from a hemorrhagic stroke soon after the doctor increased his prophylactic coumadin dosage for 0.5 mg to 10.0 mg and his INR spiked over 9. Those deaths leave me finding peace in "When your time is up, your time is up" and being much less risk-averse.)
But that's not what people are saying.
Dr. William Schmidt, commenting on Instapundit: And, in response to Michelle Malkin, many pediatricians don't have time to waste in their very busy day discussing the "risks" of vaccinating one's children. From personal experience, many parents, especially in the Google age, have just enough knowledge to turn this into a 5-10' conversation and will often continue to disagree with you afterwards. Ten minutes may not seem like much to the soccer mom who thinks that noted autism researcher Robert Kennedy is infallible, but it is to the pediatrician who would rather spend that time doing something more useful (like seeing another patient).
The ones that cause autism. *ducks*
You just don't understand the free-rider concept do you? And how about tetanus? The risk of rejecting that vaccine is certainly not low.
I wouldn't try to talk anyone out of the HPV vaccine, but I'm solidly opposed to making it mandatory. The disease isn't going to sweep through institutions and shut them down, nor is it going to force parents to keep their kids at home all summer for fear of an epidemic. And while it's impossible to eliminate the risk of infection entirely, there are lots of things a prudent person can do to lower the risk and to deal with any consequences before they become lethal.
Perhaps people have forgotten what real epidemics are like, and what sort of problems the vaccination programs were designed to solve.
That's an extremely rational reaction. The doctor should not be forced to provide care against his wishes.
I suspect that this will cause unvaccinated people to cluster to certain doctors. This clustering will probably not work out well for them when the inevitable diseases occur.
um. I know "men will lie to get sex!" makes for hilarious teen movies, but if you're *marrying* someone I'd hope you trust them more than that.
For whom? When?
I think there's a lot to be said for mandating tetanus (and the boosters) for little kids. After all, someone who is watching out for their safety simply cannot know when they may have gotten exposed. You would hope that the kid would tell you about every scrape and encounter with a rusty nail, but that simply is not reality for little kids.
For adults? If you fall and hurt yourself, you can mosey into the doctor's office and get the vaccine. The fact that you may not be up-to-date on your booster shots does not mean that you'll get tetanus once exposed.
Presumably, because the vaccine has yet to be tested and approved for boys. More than that, I could certainly see some people thinking that their boys aren't going to get cervical cancer, so why vaccinate them to the sole benefit of someone else?
As for women who may have unprotected sex with someone who is exposed - absolutely true. Then why not give it out at age 16, or let girls get it when they are of the age of majority, or otherwise make it available to those who are concerned, but not make it mandatory (as it is in 17 jurisdictions)? Is HPV not more like tetanus in that regard and less like, say, polio or pertussis?
And it's that trust that entails risk.
I'd be interested seeing a comparative analysis by the Freakonomics guys between voting behavior and vaccine acceptance. In each case, the probability effect on the individual is low, but the effect on the society is high.
If you think it's the risk of getting a virus that, in some decades, increases the risk of cancer, that's stopping your daughter from having sex, you're out of your mind.
The only effects of the HPV vaccine are (positive) reduced cancer risk, and (negative) whatever negative effects of vaccines in general. Waiting until she's no longer a virgin reduces the positive by the probability that her sexual partner is a carrier. There is absolutely nothing that adds to the negative.
Well, here one data point about her particular population: "In two population-based studies conducted among Asian/Pacific Islander children who were born in the United States before perinatal hepatitis B prevention programs were widely implemented, 61%--66% of the chronic HBV infections occurred in children born to HBsAg-negative mothers (72,73). A substantial proportion of these chronic infections would not have been prevented by a selective program of identification and immunization of only infants born to HBsAg-positive mothers."
My partner is a pediatrician, board certified in pediatrics, pediatric intensive care, and pediatric pulmonology. She works in a tertiary-care hospital, treating children with severe and chronic lung diseases. Every day she has to argue with parents who don't understand that the risks of vaccines (~1/1,000,000) are not worth argument time when weighed against the risk their children might die of vaccine-preventable diseases (~1/100).
Also, she treats immunocompromised kids who have been infected with vaccine-preventable disease -- because some [idiot] parent declined a safe vaccine.
If your child is being treated for leukemia, say, then a neighbor's kid with measles or chickenpox - possibly asymptomatic - is a mortal hazard.
Doctors in this country don't often see cases of tetanus, which are very instructive, especially for neurologists. So if anyone follows your advice and does come down with tetanus they will make excellent teaching material. We can use them to "pimp" the students on neurophysiology at the neuromuscular junction, asking them to compare and contrast tetanus with botulism and myasthenia gravis, extemporizing on channelopathies, talking about electrodiagnosis, etc.
It might be miserable, maybe fatal, for those who refuse tetanus boosters figuring they will just get wound care when they need it, but they will give us a teaching opportunity. (BTW, "boosters" are boosters, because they rely on previously established immunity and an anemnestic response to repeat challenges.)
Well you've missed your chance with me. Every decade or so I come into an emergency department or urgent care facility with an animal bite or other nasty wound, and the conversation goes like this "When's the last time you had a tetanus booster?" "Ida know, 'bout 10 years ago maybe" "OK, turn around and drop your pants." (Last time they added "And mice don't get rabies.") I get annual physicals and see diabetes specialists more often, and I get all sorts of flu and pneumonia vaccines, but none have ever suggested I should get my tetanus shot then because it had been a while.
Theobromophile: Presumably, because the vaccine has yet to be tested and approved for boys.
Is there any reason to think this perfectly save vaccine is more dangerous to boys than to girls?
More than that, I could certainly see some people thinking that their boys aren't going to get cervical cancer, so why vaccinate them to the sole benefit of someone else?
Isn't that what this whole discussion has been about, once we left child abuse, that vaccinations help others? And in this case that other is your future daughter-in-law, or at minimum someone who has shown your son a good time, rather than that neighbor kid with leukemia.
What if you think giving a clear and consistent message not to have sex or do drugs, and to remain a child while a child, is better than giving a mixed message of "Don't have sex, but if you do, get Gardasil before you start and use a condom and don't get a reputation; and don't drink but if you do don't go to bed drunk unless you drink a lot of water and don't waste your money on cheap beer; and don't do drugs but here is how you roll a joint..."
Someone will step up to the plate and inform the kids about the protective steps they can take to avoid disease. That person may be the parent. If not it will be peers, teachers, doctors, nurses, internet, TV, movies, women's magazines, etc. I'd hope parents who choose to abstain from providing this information to their daughters would let them know medical professionals are the best people to consult for the information. They will get information somewhere; best they have correct information.
Am I reading that right, that an unvaccinated American child stands a 1 in 100 chance of dying from a vaccine-preventable disease?
That "not worth argument time" is why people like chiropractors. (Although I wish my dentist talked to me less, given that I can't answer back.) Patient education is part of the job.
When my wife had her mastectomy she got proper, good education from her oncologist and her surgeon. A too-slick reconstructive surgeon sent his nurse into the exam room to pop in a videotape of a woman talking to her reconstructive surgeon. The nurse came back to ask if we had any questions, and we had just one: Where can we go to meet a surgeon like that, who explains things to his patients in person instead of showing them a movie?
A clear and consistent message about staying on the boat is not adequate justification for not wearing your life jacket.
Life is complex. Being simple-minded is not the best way to go.
Last time I went in for vaccines (before law school - needed Hep B to enroll), my doctor asked me when my last tetanus booster was. I had the exact same reaction as did David Chesler: "Er... five years ago? Ten years ago? How long does that thing last now?" I did not get the lecture from my doctor that you just gave to me; I think I just got a vaccine.
Now, if you would like to do the readers a favour, instead of insulting me, why not educate? Provide a few links about the risks of getting the tetanus vaccine upon exposure. Sure, it's harder than random snark, but it might prove educational to all involved. Until that happens, as there is not a vaccine against your cruelty, would you mind keeping it down to a dull roar?
I think you (a) overestimate your ability to control your (hypothetical) child, and (b) are extremely bad at cost/benefit analysis.
Personally, I'd take the choice that lowers my (hypothetical) child's risk of a debilitating disease, and trust the rest of my parenting skills to stop her from having sex before she's ready.
Why do you want to give your (hypothetical) kid cancer?
By never gaving genital sex with ANYONE. There is no way to know that your partner is a virgin.
Avoiding painful biopsies, and conizations that can impede destroy the ability to have a baby. these procedures are used to treat the precancerous conditions that the Pap smear diagnoses.
"...many pediatricians don't have time to waste in their very busy day discussing the "risks" of vaccinating one's children."
Yeah... and then these same physicians wonder why people don't trust them. The pediatricians just expect parents to accept every word that comes out of their mouth as gospel, and anybody who asks a question out of turn is subjected to condescension and treated like a tinfoil hat-wearer.
Pediatricians, of all people, should recognize the need to educate parents, because after all the parents are the first line of defense when it comes to protecting a child's health.
Instead, we are subjected to the medical profession's systemic arrogance. Because, hey, they've NEVER been wrong about anything, right?
Incidentally, unless you have a clean minor wound with vaccination between the last five and ten years (and appropriate childhood vaccinations), or you've been vaccinated within the last five years, you are supposed to head to the hospital to get a booster shot anyway.
Now, if that is incorrect, you can (kindly) provide better information. If not, doesn't that tell us that we ought to vigilently vaccinate children against tetanus (as I stated above), pregnant women (if not previously vaccinated), and ensure that adults understand that even up-to-date vaccines do not provide complete protection?
Oh, here's the warning sign for this comment. (Rolls eyes.)
---
David Chesler,
I have no idea why Gardasil was never tested on boys, nor why anyone would think it less effective and/or more dangerous [for those about to attack, "more" is a relative, not an absolute, term]; nevertheless, the FDA hasn't yet cleared it for boys.
As for preventing HPV transmission to one's lover: no complaints there. (I, however, am sufficiently old-fashioned as to believe that men owe women a duty to not transmit any STD to her - whether by vaccinating, getting fully tested, not sleeping around, or getting treatment for that which can be treated, or some combination of the above.)
I have a rather high regard for your education and intelligence, so it has been disappointing, indeed dismaying, to see you going about "miseducating" others about vaccines and related health matters so energetically. Stop it and I will have no reason to be exasperated and serve up snark. (Please start by educating yourself as to why chicken pox is not the benign infectious disease you seem to think it is based on your personal experience of it as a child.)
You can't do a cost-benefit like that. They say the HPV being vaccinated against is responsible for 70% of cervical cancer. Is it responsible for a comparable number of pre-cancerous signs? The individual must still get Pap smears, and is going to be have maybe 1/3 as many positives. What does that mean in actual numbers?
Theobromophile - I agree. A gentleman does not give a lady the clap.
Yes, the human papilloma virus causes venereal warts (condyloma), which most people would prefer not to have. And babies born to women infected with HPV can acquire the infection, the resulting being warty growths in the upper respiratory tree (laryngeal papillomatosis), a rare, but horrendous, nigh unto impossible disease to treat. (No one covered this "background" stuff before proceeding to disparage the HPV vaccine, e.g., "HPV isn't going to reduce cervical cancer rates"?)
But it is inexcusable and thoroughly unprofessional for a doctor to be unwilling to take ten minutes to explain the costs and benefits of a drug. We chose our doctor because we trust her judgment and because she explains why she wants to do what she wants to do. Any doctor willing to take the 10 minutes should find another profession.
And yes, our doctor spent about ten minutes explaining the value of several childhood vaccines, and at the end of the ten minutes, we agreed. Ten minutes well spent.
Right now, PAP smears are still recommended for patients who have received Gardasil, because it contains the four strains of the HPV virus responsible for most, but not all, cases of cervical cancer. When the next generation HPV vaccine, which includes additional viral strains, is available, PAP smears should no longer be necessary for female patients vaccinated before they were sexually active.
Yes.
OHSU RESEARCH SUGGESTS AMERICA MAY OVER-VACCINATE
"The goal of this study was to determine how long immunity could be maintained after infection or vaccination. We expected to see long-lived immunity following a viral infection and relatively short-lived immunity after vaccination, especially since this is the reasoning for requiring booster vaccinations. Surprisingly, we found that immunity following vaccination with tetanus and diphtheria was much more long-lived than anyone realized and that antibody responses following viral infections were essentially maintained for life,” explained Mark Slifka, Ph.D."
Hey! Don't leave us lawyers off the list of learned but sometimes all-to-arrogant professions.
In non-emergency situations, and certainly in routine vaccination visits, there is no reason a patient shouldn't have the FAQ in hand to read weeks in advance of the office visit.
It would probably be used against them in a malpractice suit.
When those health procedures are made mandatory by the government, as a precondition to enrolling one's child in scohol, or, as in Maryland, upon threat of imprisonment, you ought to expect the public to look with a skeptical eye at both sides of the equation. When otherwise normal parents start to do things like forgo all vaccines for their children, including those for diseases which are deadly to pretty much everyone who gets them, not just a very unlucky, very small subset of the population, it might be time to examine the scope of the current vaccination procedures.
When those vaccines are pushed by pharmaceutical companies that have financed the campaigns of politicians who push them; stand to make billions annually (in America alone) from the vaccine; have tested the vaccine in clinical trials for two years before going to market and attempting to get mandates; and are looking to the vaccine to account for over 1/3d of its annual vaccine-related revenue, you damn well better expect that the complaints will reach a crescendo. That's not tin-foil-hat-wearing, scientific and/or medical ignorance, or anti-vaccine hysteria. It is citizens demanding that their children be treated as such, not as guinea pigs or cash cows. Part of that is to question, aggressively, the costs and benefits of the mandated vaccine(s).
Such crap. I've had doctors who have been able to explain - in under two minutes - the reasons for the treatment, lack of treatment (if such is the case), and proposed plan of attack. The ones who need 10 minutes are the ones who answer with, "Because I said so," or so equivalent thereof.
In the interests of saving time, I had one doctor who sent me home with a DVD about HBOC - hour-long, or so - along with various phone numbers, email addresses, and instructions to call if I had questions. That works. No need for her to give me an hour-long personal lecture. Physicians can certainly create these materials and give them to parents and/or patients; they can email them before the exam, in the case of vaccine materials, so the parents can arrive educated. What is totally unacceptable is to say, "I'm the one in the white coat; bow down, bow down."
I agree. I would be grateful for that kind of information from my doctor. If they don't give us information they trust, they should expect us to either 1) show up with no knowledge and needing a complete explanation; or 2) have done research on the Internet and needing them to explain why I should not believe what I've read.
I'd suggest it's time to examine if those parents really are otherwise normal.
My friend has an advanced degree in some arcane biomed area, genetic engineering or something like it, along with other scientific and technical degrees. He knows his way around medical research literature. He noticed some muscular soreness and weakness shortly into his statin regime.
Being a prudent patient, he researched for possible causes and cures of the symptoms. Yes, he used the internet. But he got citations for peer reviewed articles, obtained and read them. He decided it was intuitively obvious from the literature that his statin meds were inhibiting coenzyme Q10 synthesis. So, he went and bought a jar of CoQ10 supplements, began taking them regularly, and voila! The soreness and weakness went away.
He reported the symptoms, actions and results to his doc at his next checkup. Doc almost went ballistic, condescendingly told him that a placebo would probably work just as well, that laymen shouldn't believe everything they read on the internet, blah blah blah.
He pointed out to doc the peer reviewed literature. Doc repeated the rant, and added that he couldn't possibly understand medical literature because only physicians could do that, and in his professional opinion he just got lucky that his "research" didn't kill him. Doc finally conceded that taking CoQ10 supplements wouldn't do any harm, so he could continue if he found it "comforting".
Needless to say, one more reasonable and well educated person joined the "too many MDs are arrogant fools devoid of common sense" camp.
But neither you, nor I nor my friend the patient, can read the doc's mind. I only have his account of the event. He thought the doc was concerned with a perceived affront to his omniscience, not with the likelihood that the symptoms posed a serious danger. Your observation tends to support that by pointing out the dog that didn't bark.