Thoughts on Requiring Masks

The best leaders are those who are willing to look at an issue from different angles.

Requiring masks raises a lot of things to consider: whether we should encourage wearing masks voluntarily and protect people’s autonomy but risk the wellbeing of vulnerable citizens from dying of a contagious disease or using the force of law to require wearing masks and punishing (fining/jailing) those who fail to comply for the sake of protecting public health but possibly unfairly punishing those who may have legitimate reasons to not wear masks (allergies to materials that masks are made of, unable to purchase masks, etc).

A verse to consider for pursuing public health policies by volition or compulsion would be Philemon 1:14, which states, “But I preferred to do nothing without your consent in order that your goodness might not be by compulsion but of your own accord.”

I’m personally fine with wearing masks per say Walmart’s wishes as a private business as they’re doing their part to reduce the spread of COVID-19, but I can at least empathize with some of those who have difficulty wearing masks because of the discomfort or allergies wearing one can cause. Such individuals are usually a minority, but they’re still people to care for. For a lot of others though, the reasons they give for not wearing masks (fear of being singled out, masks do not work well, extreme libertarian views that government should not dictate what citizens can or cannot wear), I find less convincing, but they sincerely hold these beliefs, so I would have to do the hard work of meeting them where they’re at and try to persuade them to wear a mask.

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.

Staying Close to Christ While Away from Your Home Church

Post graduate life in the present day sees a lot of transitions. It is not uncommon for my classmates in medical school and me to move around the United States in search of a school, rotations, and residency interviews. It can feel difficult to feel rooted in any one particular place because of the way the American medical educational system seems to structure itself around positional flexibility. Also being a minority in post Christian America can add further challenges in forming healthy social relationships with local peers.

Having grown up close to the San Gabriel Valley, I took for granted the large Asian American community. Having at my disposal many Hawaiian poke bowls, Vietnamese pho, Taiwanese hot pot, Korean BBQ, Japanese ramen and sushi, Chinese dimsum, boba milk tea, and many other Asian supermarkets and restaurants felt normative. In moving to other states, I found that I lived in areas that do not have as many Asian American restaurants available, or if they are, they are relatively out of the way for me to go on a consistent basis.

However you can still usually rely on some common American companies being present: Rite Aid, CVS, Walgreens, Walmart, Taco Bell, Chipotle, Starbucks, Panera Bread, McDonalds, etc. Yet I also find that many states have their own regional specific restaurants and supermarkets such as In n out and Stater Bros in California, Culver’s and Publix in Florida, Tim Horton’s and Wegman’s in Pennsylvania. Thus you get the feel that even within the same country, each state has their own personality.

The Bible sees Christians as “sojourners and exiles in the world.” (Leviticus 25:23; 1 Peter 2:11)

The LORD called Abram out of his country and his kindred and his father’s house to the land that He would show him. He would be the vehicle of blessing to all the families of the earth (Genesis 12:1-2). The LORD later tells Abram his offspring would be sojourners in a land that is not theirs and will be servants there, and they will be afflicted for four hundred years (Genesis 15:13).

Joseph, the son of Jacob, the grandson of Abraham, was sent to Egypt after his brothers sold him into slavery by Midianite traders (Genesis 37:28). Jacob and his family move to Egypt to survive a famine (Genesis 45:9-11). God sent Joseph to Egypt and in his stay there he blessed the house of Potiphar, blessed the house of Pharaoh, and provided for his formerly estranged brothers, and reunited with his father.

Even the plagues that God inflicted upon Egypt for Pharaoh’s enslavement of His covenant people was meant to have an evangelistic purpose. After the 10th plague, the LORD had given the people favor in the sight of the Egyptians, so that they let them have what they asked (Exodus 12:36). Also a mixed multitude went up with the people of Israel (Exodus 12:38).

Then many centuries later, the prophet Jeremiah writes a letter to those in Babylonian exile: “But seek the welfare of the city where I have sent you into exile, and pray to the LORD on its behalf, for in its welfare you will find your welfare.” (Jeremiah 29:7)

Daniel is a great example of this instruction. He stayed true to his Jewish heritage, resolving that he would not defile himself with the king’s food, or with the wine that he drank (Daniel 1:8). Even so, Daniel and his three friends sought to bless the Babylonians and submitted to their educational system: to learn the literature and language of the Chaldeans (Daniel 1:4). His steadfast loyalty to YHWH led Nebuchadnezzar to praise his God as the King of heaven and the Most High (Daniel 4:34, 37).

Throughout the Scriptures, God has a number of ways of sending His people to the nations to bless them: calling them out of their homes with Abraham, letting them be sold into slavery like Joseph, drawing them into Egypt through a famine, sending them out after great plagues of judgment on Pharaoh, exiling them into Babylonian captivity.

In the modern era, people still move around for similar reasons: war and famine. For others, we could move around places because of jobs and education. But no matter the reason, for Christians, our purpose is to hold fast to the LORD and bless the people to whom God sends us.

Abraham, Joseph, the people of Israel before the Exodus, and Daniel did not have the temple to which they can travel to offer up sacrifices and worship God. But they held fast to their faith and submitted and interacted as best they could to the local authorities without compromising their faith.

Jesus is the ultimate example of a sojourner. He enjoyed the worship of thousands of angels, but left His throne in heaven to tabernacle among the people He made in His image. Even though He was the God who created the heavens and the earth, He submitted to the Sanhedrin and the Roman government insofar as it was obedient to the Father’s will. He did so to bring many people to glory with Him.

Likewise, in light of all this biblical insight, I need to embrace my identity as a sojourner and exile in this world. I do my best to find a local church who hold a high view of Scripture and desire to stay faithful and obedient to the Lord Jesus Christ, and fellowship with brothers and sisters in Christ. The local culture of the places I find myself in may be quite different than the one I was born and raised in, but I learn to adapt to them.

I can be flexible in my external circumstances because I have God is my rock, refuge and strength. In other words, you can deal with variables when you have a constant you can fall back on. Thankfully, Bible reading and prayer are portable actions, so I can do these things wherever I go, and these two means of grace should inform and shape the actions and decisions I make. In addition, social and communication technologies such as Facebook, Messenger, Instagram, phone calls, and emails help compress the world, so distance is not always an obstacle to staying close to home, but the priority should be placed on focusing on the local people.

Since the United States is a multiethnic, multifaith, and multigenerational country, there are quite a different number of cultures and backgrounds that we will interact with. It definitely helps to be confident in your own culture enough that you know how to engage with the cultures of others.

Every now and then, I would have some colleagues or patients ask what is my heritage. Sometimes the way the question is asked makes me feel like I’m an alien in a foreign land, even though I was born and raised in the States, but other times, I can hear that the question is just a curious inquiry to help make conversation. I cannot control how other people think of me, but I can control the way that I react and converse with them. The attitude I strive to maintain is to seek the good of others, even when they may not always reciprocate that kindness, knowingly or not.

I have met people in the LGBT community in my medical school, and I have met people who are Zoroastrian and Muslim. I always welcome hearing their stories and their struggles, and I do my best to model the gospel through these relational channels. I build relationships with my peers as best I can, but if the activities involve alcohol or drugs, I am more reluctant to participate. Sometimes it is difficult to show peers that rejecting these activities is not rejecting them as friends, but they can still take the rejection personally.

In the Christian walk, it is difficult to maintain that balance between faithfulness to Christ and building friendships with others. Many times, you can be as friendly and as welcoming to others as you can be but your faithfulness to Christ can and will drive others away while it also draws others in.

Staying close to Christ while being away from home is difficult, but possible. It involves knowing your faith well enough that you can stand on your own. Joseph and Daniel are two examples of this. They were relatively separated from like-minded peers in a community that was alien to their faith, yet they held fast to YHWH and blessed their peers. The Spirit should be reshaping your desires such that you want to please and honor Christ in all that you say, think, and do. He does this through Bible reading, prayer, and the local church. The primary purposes of these is to relocate your local experiences in the context of a covenantal relationship with YHWH. Christians live under His reign and seek to proclaim the glory of His name to our neighbors. I can stay close to Christ wherever I go, because He is with me wherever I go. I can face the variables of life because He is my constant.