Zero Sum
How wonderful that we have met with a paradox. Now we have some hope of making progress. — Neils Bohr
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Posted Aug 22nd, 2008 by ravi    / Permalink /

This post is the first in a series of ruminations that fall under the title offered (“Science and the public”).

An article in the New York Times brings up the fallout from recent resistance to vaccination:

Measles Cases Grow in Number, and Officials Blame Parents’ Fear of Autism – NYTimes.com

More people had measles infections in the first seven months of this year than during any comparable period since 1996, and public health officials blamed growing numbers of parents who refuse to vaccinate their children.

Rather typically, the issue is immediately cast as a confrontation between two warring camps:

The language has changed, but the message is the same. Infectious disease prevention is to be feared. It is against the natural order of things. Instead of “vaccines are against God’s will”, it’s now “vaccines are against Nature’s will.” They’re “unnatural”, not “green”. In the old vernacular, interfering with God’s will could lead to “bad things”, like flood, famine, or other divine punishment. In the new language, it leads to “autism”.


And just in case this is not stark enough, here is the same author claiming the twin prize of morality and truth:

Who has the moral high ground in the vaccination wars?

My initial response is that I do, “I” meaning the medical and public health fields—those of us who prevent disease, disability, and death.

[…]

Those of us who are professionals have made the evidence available. The science is clear—vaccination is a good thing, and more important, it is better than the alternative. True believers will never be convinced by something as simple as truth.

The most charitable role offered to parents is that of gullible fools who need better education. But is that really the case? Most parents are not experts in the relevant fields of medicine or public health. Does that deny them a role in attempting to seek the truth rather than accept what is made “clear” by “science”?

Similarly, The Washington Post proclaims: On Vaccines, Immune to Reason:

When mysterious disorders like autism strike seemingly healthy children — at about the same age when childhood vaccines are typically administered — frustrated parents lash out at doctors and pharmaceutical companies. And today’s vaccine inventors must contend with a powerful force that had yet to arise when Jonas Salk created his revolutionary polio vaccine — mass litigation.

One such prominent case from the recent past is that of Hannah Poling whom the US government agreed to compensate for the symptoms she developed immediately after a set of vaccination shots. But, far from the “frustrated parents lash[ing] out at doctors” that WaPo speaks of, or the morally inferior “believers” castigated in the paragraph before, the father of Hannah Poling, a neurologist offers:

“I don’t think the case should scare people,” says Poling, 37, who emphasizes that vaccines, like all of medicine, carry risks and benefits.

[…]

Proving the link legally is quite different than proving it scientifically, Poling says. “When you are talking about the courtroom vs. science, the burden of proof is different,” Poling tells WebMD.

“We showed there was a plausible mechanism, we showed that an injury occurred shortly after her vaccination. Her growth curve went flat for months.”

To prove something scientifically, rather than legally, he points out, only a 5% possibility (or one in 20 chance) that something happens by chance is allowable.

[…]

The experience with Hannah, Poling says, has not turned him against vaccines. “I want to make it clear I am not anti-vaccine,” he says. “Vaccines are one of the most important, if not the most important advance, in medicine in at least the past 100 years. But I don’t think that vaccines should enjoy a sacred cow status, where if you attack them you are out of mainline medicine.”

A parent approaching the health choices of his or her child is confronted by a reality that is significantly different from the black and white results of lab experiments and mathematical models. The parent has to deal with garden-variety incompetence (our own paediatrician[s] measured our son’s height as being lesser than what they had registered three months earlier) to disinformation: many doctor’s offices in New Jersey (USA) sport bulletins urging you (the patient) to contact your congressman to impress upon him or her the need to bring under control spiralling healthcare costs — claimed (in the notice) to be a result of medical malpractice lawsuits (echoing the finger-pointing to lawsuits by the WaPo, quoted above). The truth is significantly different: not just malpractice settlements but costs have been found to have decreased or stayed constant over the past few years, the same period during which the AMA stokes alarm about a malpractice crisis.

Parents are also faced with state imposed mandatory programmes of vaccination that administers recently developed drugs:

Bypassing the Legislature altogether, Republican Gov. Rick Perry issued an order Friday making Texas the first state to require that schoolgirls get vaccinated against the sexually transmitted virus that causes cervical cancer.

By employing an executive order, Perry sidestepped opposition in the Legislature from conservatives and parents’ rights groups who fear such a requirement would condone premarital sex and interfere with the way Texans raise their children.

In light of the dubious role of Merck in pushing the drug:

Merck is bankrolling efforts to pass state laws across the country mandating Gardasil for girls as young as 11 or 12. It doubled its lobbying budget in Texas and has funneled money through Women in Government, an advocacy group made up of female state legislators around the country.

Perry has ties to Merck and Women in Government. One of the drug company’s three lobbyists in Texas is Mike Toomey, Perry’s former chief of staff. His current chief of staff’s mother-in-law, Texas Republican state Rep. Dianne White Delisi, is a state director for Women in Government.

The governor also received $6,000 from Merck’s political action committee during his re-election campaign.

and questions regarding the effectiveness of the vaccine (from the NEJM):

Despite great expectations and promising results of clinical trials, we still lack sufficient evidence of an effective vaccine against cervical cancer. Several strains of human papillomavirus (HPV) can cause cervical cancer, and two vaccines directed against the currently most important oncogenic strains (i.e., the HPV-16 and HPV-18 serotypes) have been developed. That is the good news. The bad news is that the overall effect of the vaccines on cervical cancer remains unknown. As Kim and Goldie point out in this issue of the Journal, the real impact of HPV vaccination on cervical cancer will not be observable for decades.

The contingent nature of scientific facts and theories, is not a matter entirely lost on the general public, even if it is not explicitly noted. In the case of the autism controversy, multiple studies in the past few years have concluded that there is no reason to believe that there is a link between autism and the presence of mercury/Themerisol in vaccines. One of the justifications offered is that there has not been a significant drop in incidences of autism since mercury was dropped from vaccines. However, as the opposition points out, the lack of such a drop could be attributed instead to growing awareness, and hence diagnosis, of autism.


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2 Responses

  • divya says:

    while i sympathise with the parents of autistic children, (and have along with the spouse decided to give the new baby only a few vaccines at a time – vs the 4-5 the first guinea pig got) they need to realise that skipping vaccination works well for them in communities where every other child is vaccinated. if more than a certain number of children were not vaccinated we would have outbreaks of disease. ofcourse this is not true for the vaccine preventing cervical cancer and the concerns of those parents are valid (except i don’t think that is the one reason their children are going to go out and have sex). i don’t see them controlling teenage hormones, peer pressure, attractive mates but finally deciding to do the deed because of the vaccine!

  • ravi says:

    I agree with you about the illogic in the argument that education and/or prevention encourages bad behaviour (by bad behaviour I don’t mean sex, as conservatives do ;-), but unsafe sex).

    In general, the argument, in favour of population wide healthcare measures based on statistical and empirical findings, is a good one. However, what I find problematic is that many of those defending this position feel the need to define everyone else in some adversarial framework (“good vs bad”, “cult”, “believer”, etc), so that a war of words can be indulged in. The result is that the spoils of the war (the attitude of the general public) is sacrificed, as they are forced to take sides, and they often choose the side that at least pretends to understand their issues.

    Thus parents, who are not out to deny science or statistics, but are nonetheless faced with a world of science and technology that is at once incomprehensible and untrustworthy, have the heavy and solitary burden of making the choices for their children (solitary because the purveyors of the technology — in this case, paediatricians — often have little personal or scientific interest in the questions that arise, but are merely clerical in their execution of conventional wisdom in their discipline, or worse the received notions of their education many decades ago). To them, the doctor who invariably values his or her time over yours, and is often nakedly concerned only about his or her insurance or BMW payment, seems a poorer choice than some religious quack who pretends to sympathise with their condition.