Immunizations

This is a thinking out loud/stream of consciousness post.

A common dichotomy in the conversation revolving around vaccinations is personal freedom and public harm.

We generally engage in cost-benefit analysis. We weigh the benefits of vaccinations with the risks of vaccinations.

Anti-mandatory vaccination

Some physicians are anti-mandatory vaccination.  Vaccines are complicated. Children may receive as many as 69 doses in the first 6 months of life. Informed consent for the patient should be prioritized, but the Medical Board of California does not always exercise its authority well.

Medical exemptions can be defined too narrowly for the good of the patient. Patients may have very severe brain damaging neurological injury or they go into anaphylactic shock and nearly die.  Physicians may be afraid to write medical exemptions, even when warranted, because they may lose their licenses if the Medical Board does not consider their medical exemptions appropriate.

Physicians consider some of the following for vaccine safety evaluations: genetic risk and family history of vaccine reactions.  However sometimes the only vaccine reactions that warrant exemption are CDC contraindications: severe brain injury or anaphylactic shock. So the question becomes “Is the limit for medical exemption set too high or defined too narrowly?”

What do physicians do in the grey areas where we try to distinguish between a moderate allergic reaction and a terrible one?

Ideally, physicians are given the freedom to selectively and carefully vaccinate an exempt patient based on need.  But mandatory vaccination policies can take this judgment away from doctors. Instead of a bilateral dialogue between doctors and their patients, a unilateral decision is made by the public health department or a bureaucrat. The decision making process is moved away from the doctors and their individual patients. 

The MMR vaccine can cause very severe brain injury reactions. There have been 48 confirmed cases.  The health care consumer and patient should be able to have conversations with their doctors and assess all the data and kind of make these decisions for themselves.  Other individuals would say the government should step in and make this decision for you and make it mandatory for the sake of  the collective public health.

Personally, I wish patients were free to ask their questions without fear of being ruthlessly ostracized.  They should be free to ask “What’s in the vaccine?” and “Are there any adverse reactions?” without being ostracized as a hippie. 

Now measles, polio, and whooping cough are real dangers.  There is real fear.  But parents that talk about vaccine injuries also have real fears too.  Everyone is weighing the risks and they come up with their own decisions.  They should be free to do so without intimidation or stifled conversations.

In an environment that mandatory vaccination policies create, doctors may kick patients out unless they comply with the full vaccine schedule.  Doctors may also falsely believe that vaccines are so critically important that there is only one right answer.  They start developing tunnel vision and downplay or ridicule looking for and developing viable alternatives.  They commonly believe vaccine reactions are not real and only coincidental.  Yet while vaccine injury may not be common, it does exist. 

Parents may be kicked out of school for not getting vaccines.  The common argument for this course of action is to prevent the risk of their kids spreading vaccine-preventable diseases to other kids.   For physicians who want to adopt a more moderate approach to vaccination, they risk their license and reputation. Malpractice insurance may double or insurances may refuse to contract with them even when physicians seek legitimate medical exemptions for their patients.

In addition, a world where vaccination is mandatory can create a system that is very difficult to remove once in place.  Insurance contracts could state that for every MMR and chickenpox vaccination, a 150 dollar year end bonus will be added.  Sensible reforms from politicians may be difficult to put in place and enforce.  Legislators who want a more moderate approach to vaccination, even when warranted, than their more hardline colleagues may lose the support of their fellow party members. 

Big business donates to legislators.  Legislators are beholden to those who donate to them.  In 1986 a Vaccine Injury Compensation Act was passed.  This law effectively takes away liability for big pharmaceutical companies.  There is a pro and con to this law.  One could say that removing liability allows pharmaceutical companies to make their products without fear of lawsuits, but at the same time, it puts a lot of faith in the pharmaceutical companies that they will not take advantage of the public trust. 

Congress did Pharma a favor to take away liability.
Pharma returned the favor by donating billions of dollars.
Congress returns the favor by mandating liability free products.

For some individuals, this sequence of events looks fishy.  There appears to be a conflict of interest just as bribes distort justice. 

The philosophical assumption behind the vaccination debate is again freedom versus public harm.  We basically have a bureaucrat deciding if a child was injured enough to be exempt from the vaccine as opposed to the physician.  There should be patient autonomy: just as private decisions can be made between an OB and a woman, so there should be private decisions between a pediatrician or family physician and parents.

Mandatory vaccinations does not seem a wise course of action so long as we have a system where large corporations can exert unduly large influence over the government.  Pharmaceutical companies can use the force of law to bully parents asking about vaccine risks into silence.  Physicians seeking a moderate approach such as delayed vaccination or parents with severely vaccine injured children may face segregation or discrimination from the system.

Pro-vaccination

People who are pro vaccination believe vaccines prevent suffering, hospitalization, and death.  Pharmaceutical companies have the resources and expertise to make the vaccine. Usually 1.2 billion dollars are spent on the company’s part to make a vaccine.

Some physicians want to follow the CDC schedule for vaccinations as the benefits outweigh the risks. They acknowledge that vaccines can cause type 1 allergic hypersensitivity but vaccines only prevent vaccine preventable diseases and not everything else.  

They favor the HPV vaccine because it is a cancer preventing vaccine.  They favor the flu shot because the flu normally kills 30,000 to 40,000 people, from the very young to the very old and the flu shot is 40 to 60 percent effective.

They admit some vaccinations are made from the two cell lines from elective abortions in England and Sweden in the 1960s: chickenpox, hep A, rubella/German measles, one of rabies. 

Some physicians believe good information leads to good decisions, but some parents will put their children or the children of other parents in harm’s way.  They cite the measles outbreak as an example. They say 500,000 children cannot be vaccinated because they are immunocompromised.  If we have bad information, bad decisions will be made. Parents who refuse to vaccinate their children are effectively making decisions for other people’s children. 

Vaccination has no link to autism.  Quality studies prove shots are the best way to deliver those vaccines. The season we give flu shot is also the season we get colds and other viruses. Correlation is not causation.  The amount of aluminum in the first six months from vaccines is less than that in diet.  The usual side effects from vaccination would be redness, swelling in injection site, and mild fever.  Anaphylaxis is 1 in a million, and reversible by epinephrine. Vaccinations are the best treatment we have given the information we have.

Physicians who favor vaccination also care about informed consent. They would say there is a lot of statistical evidence.  Statistics, studies, and research.  Yet there is a micro issue: each vaccine should be evaluated. Each set of vaccination has different set of adverse reactions.

For the child that has an adverse vaccine reaction, the physician would ask what about the children that have an immunodeficiency and a non-immunized child spreads deadly illness to them.  A child may have an adverse reaction to vaccine, yet the doctor may say continue getting vaccines to protect all of us.  He is also engaged in risk benefit analysis and says herd immunity exists.

Some physicians want to make sure parents are giving quality care to their child.  Just because they’re your child does not mean they can do whatever.  If the child does not get vaccinated, it is medically and statistically proven that the parents are endangering their child to develop these deadly diseases.

The axiom: “Parents know their children best” may indicate that bias will play a role in judgment and decisions.  It helps to share personal stories, relate emotionally and reasonably to your patients.  People who are hesitant about vaccinations may find themselves isolated by family, the medical community, and society.  We should find common ground.

Pregnancy and Its Implications

I feel at the heart of the abortion issue is the inability to see the developing child as someone worth protecting.

Human life begins at conception. When the sperm and oocyte meet, a zygote forms. A zygote is a unique entity with its own unique DNA that is dependent on the mother’s body to develop.

Whenever I hear the term “my body, my choice,” it basically sounds as if women wish to distance themselves from the very process of pregnancy itself.  The impression that I get is that they do not want to have their body be used as an incubator for someone else’s body, even though that other body is still their own child, with half of their DNA.

The process of pregnancy is a unique biological, physiological process in which a unique human being develops inside another human being’s body.  The mother and the developing child are intimately related to each other in this biological context.  It is difficult for me to fathom mothers wanting to reject this process, because it’s a rejection of such a fundamental process of life and nature.

Now I can see why motherhood would be difficult for a woman, because this involves accepting the potential risks of pregnancy such as pre-eclampsia, uterine rupture, placental problems, and ectopic pregnancies, and considering if the woman is in the best financial and social situation to raise a family.  These are legitimate concerns.

But I disagree with the view that the active termination of an unborn child is a legitimate option.  For most potential risks of pregnancy, the treatment is typically a C-section and supportive measures.  The one risk of interest would be ectopic pregnancies where the child is developing in a location outside of the normal uterus location.  Usually the location would in the fallopian tubes, where if the child continues growing, the mother would be at risk of tubal hemorrhages.

In the cases of ectopic pregnancies, the treatment is usually surgical removal of the child from his or her attachment site to save the life of the mother, which will usually lead to the child’s unfortunate demise.  Given the constraints of reality where we do not have the medical technology to save the detached child by reimplanting them to a normal uterine location, surgical removal is the best current option.  But it is still important to keep in mind, surgical removal is not abortion since physicians are not actively seeking to kill the developing child but to save the life of the mother from the deadly results of a misplaced implantation.

Now in the cases of inadequate financial and social supports for a mother, there are options available that does not involve the termination of the developing child. There are local community pregnancy centers that can help a young mother out.  There are adoption centers that are willing to take care of the child.

Some may say that we should focus on creating more affordable and accessible daycare centers for young teenage mothers, and for young working college-age mothers. Some also say that we should reform the foster care system so the kids inside have a better quality of life.  I agree, these are sound ideas, but we do not have to wait until these options are available before we decide not to actively kill a developing child.

The impression I get from such an argument, where we have to improve quality of life before we stop having abortions, is that there is this belief that no life is better than a poor quality life.  In other words, it is better to kill a developing child in the womb than to bring it into a poor-quality life.  But a poor-quality life is still a life worth having and protecting.  Homeless people frequently do not enjoy the luxuries of modern life such as a home, Internet, electricity, and water, but they are still alive and living.  They generally are not seeking to kill themselves, and no one, I hope, is suggesting that they should be killed to put them out of their misery.

Also this argument that killing a developing baby in the womb to spare it from a hard life is not much different morally than a single working mother of 5 killing one of her own children to better make ends meet for herself and the surviving children.  The child that would die would no longer suffer from poverty and starvation, but the child was killed.

Killing a baby in the womb to spare it from potential harm is just as horrible as killing a child in a low-income home to spare it from poverty and starvation.  Instead of killing babies, we should seek to increase abundance and resources for these families.  Yet even as we seek to increase available resources for single mothers, we do not have to wait until these resources are available to stop killing developing children in the womb.  They may not initially enjoy life well, but at least they would be alive, as they have been from conception.