I’d like to know Professor Roth’s take on the seasonal hysteria over the media-hyped “outbreak” of childhood diseases, supposedly due to ignorant and backward people exercising their lawful religious and/or philosophical rights to opt out of vaccinations for themselves or their children. Many people in the public and MSM are calling for these rights to be revoked. What rights, and what else are truly at stake?
My understanding is Americans have the right to refuse vaccinations and other medical treatment — this is protected in state and federal law, and also as the result of high court decisions. What is the relevant legal history, and where do you think it will go next?
Is this a patients’ rights, consumers’ rights, and/or first amendment issue? Is it a sphere sovereignty conflict between the authority of the state and the family? Is there a deeper conflict between a Judaeo-Christian view of the freedom and integrity of the person (body and soul) under God versus the modern state’s idea of the individual body as subject to the state’s authority, will, and representation of a collective public interest?
While this issue could be approached from the theological, philosophical, political, sociological and medical perspectives as well, I am most interested in the legal facts and opinions with reference to their implications in these other arenas.
–Tony
It seems questions like this boil to the surface every year or so, and, given that the recent measles outbreak at Disneyland was tied to voluntary non-vaccination, many people wonder why society doesn’t just force everyone to get vaccinated, regardless of how the unvaccinated feel about the issue. The short answer to that question is that we can, but this doesn’t answer the question of whether we should.
I will try to answer the question by focusing primarily on explaining the “can” part of this equation, and I’ll put out a few thoughts on the “should” side of things, but there simply isn’t space to fairly treat all of the issues your question brings up in an article that would be read by anyone other than my mom (and even her only begrudgingly).
We Can, Since It’s Primarily NOT a Constitutional Issue
One way of conceiving of the rights protected by the U.S. Constitution is to think of the core concerns which (at least ostensibly) drove its founding. The Declaration of Independence proclaims the “self-evident” truth that all people, created equal, are endowed with the right to “life, liberty, and the pursuit of happiness.” These
rights can be grouped into the idea of self-determination, and the core of this right is the freedom of thought.Radiating out from this, the right to free expression of thought (i.e. freedom of speech) is the most meticulously protected right of all rights explicitly granted by the Amendments to the U.S. Constitution.
However, U.S. Courts have long distinguished between the virtually absolute freedom to think what you want and the more limited right to do what you want. In line with a value of self-determination, privacy and the freedom to generally do what you will to yourself is largely protected. However, when someone’s actions start to impact other people and society more generally, our freedom of action is weighed against the government’s interests in preserving a safe and orderly society. At its greatest extent, when we avail ourselves of government benefits, particularly those funded by our fellow taxpayers, we do so largely on the government’s terms.
In general, the countervailing government interest in this whole arena is a responsibility for public health. While we all acknowledge this interest, it’s important to note that the goal of achieving public health may at times stand at odds with individual concerns for private well-being. The biggest complication here is that vaccinations are never 100% safe. Some people are allergic to them, and improper administration could lead to complications. At the same time, the concept of herd immunity says that a population where enough people are immune to a disease will provide so little fertile ground for that disease to grow that the disease will be essentially eradicated. In other words, not everyone has to be vaccinated for everyone to be protected. For this reason, individuals actually stand to benefit most if they personally choose not to be vaccinated while everyone else has to be. This incentive to want to benefit at everyone else’s expense is known in economic circles as the tragedy of the commons.
With these general observations in place, let’s look at how these ideas play out in the Supreme Court’s answers to a few specific questions in this area:
Can I refuse to be vaccinated?
There was a significant outbreak of smallpox in 1902 in Cambridge, Massachusetts. This led the health board of that city to pass an ordinance providing free vaccinations for its citizens and mandating them to get vaccinated, even if they had previously done so. Henning Jacobson did not trust the Smallpox vaccine, claiming it made him sick as a child and that he did not want either himself or his son to take the vaccine. On the basis of his refusal, Jacobson was assessed a $5 fine under the terms of the applicable state law.
In Jacobson v. Massachusetts, the Supreme Court roundly rejected Jacobson’s objections to vaccination. It did not hold that Jacobson’s concerns were invalid (although it did question them), rather, the Court said that the State’s interest in public health and safety overrode personal concerns. Although this case was decided over 100 years ago, it stands as more or less undisturbed precedent for the idea that the government can mandate vaccinations in times of need.
Can I refuse to vaccinate my children?
This question is largely answered by the issue above, but there are a few other governmental interests at stake here. First, while parents have extensive latitude to determine how they would like to raise their children, the ancient concept of parens patriae (“parenthood of the state”) says that the state’s overarching obligation to protect its citizens can allow it to step in and prevent parents from harming their children.
This concept has been applied in numerous contexts, even overriding a parent’s religious prerogatives in the case of Prince v. Massachusetts, where the Supreme Court in 1944 applied child labor laws to prevent a Jehovah’s Witness from having her child preach on the street corner. In that same case, the Court referred to Jacobson and also cited a decision from New York’s highest state court (People v. Pierson) which said, “The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.”
Going further, the government’s interest in public health and child welfare give it broad latitude to condition the receipt of a public benefit on complying with things like vaccination laws. This issue was addressed in part by the Supreme Court in 1922 in Zucht v. King, where the Court dismissed a challenge to a San Antonio, Texas city ordinance that prohibited admission to public or private schools without proof of vaccination. That is, the Court supported the idea that the individual right to education does not trump the state’s interest in public health.
What about my personal religious rights?
At this point, we may see why personal preference in a time of emergency and parental interests might be overridden in certain circumstances, but what about personal religious freedom? The Court’s answer to this is also why this area of law is primarily a state-by-state concern, and I’ll discuss it below.
We Can, But It’s Primarily an Issue of State Law
In 1990’s Employment Division v. Smith, the Supreme Court determined that the Constitution’s guarantee of free exercise of religion could not create exceptions to “neutral laws of general applicability.” Specifically, this meant that laws banning the use of peyote did not have to make an exception for the sacramental use of the drug by Native Americans because the law was concerned with the dangers of the drug trade generally and not with suppressing religious belief. This would surely mean that laws concerned with public health generally, and achieving herd immunity specifically, would not be required by the Constitution to carve out exceptions for religious objectors.
However, as you may well imagine, this decision by the Supreme Court was not universally well-received. In response, Congress passed the Religious Freedom Restoration Act, which, although limited by later ruling to apply only to the federal government (which has no vaccination laws), has been passed in similar forms by 19 of the states. (see this link for a list of the relevant states) This law requires that states only restrict free exercise when absolutely necessary and that they do so only in the least restrictive manner possible.
What this really means, though, is that it’s up to the States to determine exactly how much latitude they are willing to give to religious or personal philosophical beliefs with regard to vaccination. While the vast majority of states do permit religious exemptions from mandatory vaccinations, and almost half permit personal belief exemptions, the States are not required to do so.
We Can, But Should We?
This is where I venture out into dangerous water, leaving what the law says and addressing what it should say. As pointed out in several places, few, if any, world religions on the whole promote abstention from vaccination, even where it presses up against that group’s concerns with blood (Jehovah’s Witnesses), vegetarianism (Hindu and Buddhists), ceremonial purity (Judaism/Islam), and the use of fetal tissue in research and development (Catholics and many Protestants).
However, I’m uncomfortable with the idea of using a general consensus, even within a religious group, to define which beliefs are truly “religious” for all members of that group. For instance, there are a significant number of folks who share the Dutch Reformed tradition (esp. in Canada and the Netherlands) who object to vaccination on the grounds that it interferes with humankind’s reliance on God for provision and protection. Although I do not share their concern, I find it difficult to push the conclusion that these are just irrational fears or ignorance masquerading as religious conviction as defined by some objective measure.
I think the underlying concern in the United States that we allow people to think freely dictates that we be very careful about cataloging and then running roughshod over practices that reflect beliefs that we disagree with. Of course, that shouldn’t cave to the tyranny of the minority, especially when it might threaten all of our health, but in this arena, the tiny size of the minority may actually argue for its protection. For many diseases, herd immunity can be achieved with as much as 10% of the population abstaining. While the number of objectors remains low, I don’t think it costs us much to respect their freedom.
At the same time,
with diseases like measles and whooping cough, which are much more difficult to eradicate, I believe it’s fair to push for greater vaccination.Achieving true herd immunity might not be possible without strapping objectors down to gurneys and forcibly immunizing them, and I’m not sure anyone advocates that, but current strategies of requiring education classes for objectors and even fining people for noncompliance seem appropriate to me.
I know I couldn’t get to all the nuances of the question, but hopefully this identifies the primary rights at issue, along with the relevant legal precedent related to those rights. We certainly can enforce vaccination, but I think we should do so carefully and with as much respect for people’s beliefs as we can reasonably offer.
Comments 14
Is my body a commons? For whom?
Great answer, but it leads to ever more questions….
Wasn’t the right to refuse care established as a first amendment right thanks to the Jehovah’s Witnesses? They also won the right to refuse to participate in the pledge and flag salute in public schools under a similar argument. See “Blood Transfusions, Jehovah’s Witnesses, and the American Patients’ Rights Movement,” by Charles H. Baron, Boston College Law School. It’s public online in their law school’s digital commons.
I tend to find myself disliking and distrusting what that state and powerful companies see as “a commons” and what they refuse to see as such. The problem to me is the increasing lack of reasons to trust “the authorities” in an age of indiscriminate testing of nearly every new technology on the public in the name of security, innovation, deregulation, profit, etc. Does it matter what toxins are in a shot, what age it is administered, and in what combination or volume with other shots? Does it matter that we never have long term outcome studies? What if we start to be injected with genetically modified materials, or vaccines slip into gene therapy? Why not add some nanotech if you can? When we have no choice or say in the matter, what protects us from abuse?
Thanks for your comment, Jean.
As far as an individual right, yes we do generally have the right to refuse care for ourselves, as this typically falls more in the “self-determination” sort of camp. The tricky thing is when we’re dealing with contagious/infectious diseases. In these cases, our individual rights run squarely up against the fundamental power of the state (here referring to the 50 states) to promote the general welfare, and the balance of these conflicts has long been settled to say that the interests of the state can override.
Note that I say “can” and not “will” or “should.” Even in the most exacting examination of legislation by American courts, government action which is narrowly tailored to advance a compelling government interest will be upheld. (a standard known as “strict scrutiny”)
When it comes to vaccinations, we’re talking about an interest in public health, one of the most compelling government interests available, set against important individual rights, the most clear of which would be either privacy or free exercise. If the government cannot respect an individual’s rights without endangering the public (the argument regarding herd immunity) it’s very likely that a government action which falls short of physical compulsion (such as a fine or mandated information session) would survive even this strictest scrutiny.
I think it’s beneficial for our society to have a healthy fear of tyranny and to respect people’s beliefs to the greatest degree possible. I want the marketplace of ideas to be as robust as it can be, allowing for views way out on either extreme. This can’t completely paralyze the government, however, and there will be times the government does things we don’t like. Even though I don’t share some of the concerns about GMOs and other things mentioned in your questions, I want us to protect your right to ask those questions and even act on your views as much as possible. That’s why I support laws that impose strict scrutiny on the decision to override someone’s religious beliefs, even though I think that bar may be reached here. Ultimately, you still would not be forced to vaccinate, but there would be some cost to making that choice. Perhaps that’s some comfort, perhaps it’s not, either way, I appreciate you sharing your thoughts.
Good response, Donald, on a particularly sticky issue. There are several issues with mandatory vaccinations, both legally and otherwise. The truth of the matter is that a certain number of children are harmed by vaccines, so are we as a society making a decision as to how many children can be sacrificed in the name of the greater good? If so, then we better be darn sure that those vaccines are worth the cost.
Potential problems:
1) we don’t know what the true cost is, as adverse reactions are reported voluntarily.
2) there are questions as to whether herd immunity can be achieved through vaccination–the term did not originate because of vaccines.
3) there are no double-blind, true placebo, independently-funded studies on the long-term health outcomes of a vaccinated vs non-vaccinated population, not for one vaccine and not for the vaccine schedule as a whole. Even the Institute of Medicine acknowledges this.
4) we continue to learn more about the immune system with each passing year, but many acknowledge that there’s so much yet to learn
5) since correlation doesn’t equal causation, how much of the reduction in mortality from disease can be attributed to more vaccines, and how much is attributed to other factors, such as increases in sanitation, clean drinking water, healthy foods, etc?
6) In the interest of brevity, I’ll skip problems 6-100.
While you were responding to the legal issue, and this is a complicated, multi-faceted issue, I don’t believe the legal questions can be answered without answering questions in other facets.
For me, those questions have not been answered satisfactorily. Is the state ever allowed to force a medical intervention upon everyone across the board? Cookie-cutter medical treatment? Not for me, and not for my family. As you probably already gathered, we don’t vaccinate our children, as we are anti-science wackos who prefer to take our medical advice from former Playboy bunnies and discredited doctors. I’m kidding, of course, but after over 1,000 hours spent in research on this issue (and I’m still learning), the risk/benefit analysis does not sway me to vaccinate my children.
I know, I know. This comment may open up an entire 50-gallon drum of worms. Name-calling may ensue shortly. But again, I don’t believe the legal/ethical questions can be answered without more answers in the scientific literature. And I’m tired of hearing what my responsibilities are to the rest of society when those questions remain unanswered. Major news media have run articles that parents like me should be jailed, our addresses should be published, and that we should have our children taken and forcibly vaccinated. “Hit” pieces with little-to-no sources cited have blamed recent outbreaks on the backward unvaccinated. And yet, a review of the literature reveals that many outbreaks occur in mostly-vaccinated to fully-vaccinated populations (e.g. Dordt 2010, mumps). And people have been so concerned about this measles outbreak, and yet we haven’t had a death from measles in the U.S. since 2003.
I could go on and on, but I know that opinions won’t be swayed from my comment here. Just wanted to make a voice heard on behalf of those of us who have carefully reviewed the research and have decided that the risks don’t outweigh the benefits, and for those reasons and others, believe the legal system should continue to protect parental rights in choosing which medical interventions are imposed upon their children. Certainly the state can step in when there is abuse, but I wonder in what world can the argument be made that withholding a vaccine is equivalent to abuse.
Thanks for your comment, Tom.
You are absolutely right that a resolution of the legal issues turns on conclusions about the underlying medical question. Unless we’re rather certain that vaccines are effective and unless we have some concept of the type and scope of adverse reactions, it’s difficult to properly weigh the public policy concerns that go into what shape any resultant legislation should take. Similarly, without a sense of what the goalpost is (be that 100% coverage, 90%, etc.) and what the level of social resistance is (i.e. how many would prefer to abstain), it’s hard to determine how stringent policy measures should be.
At the same time, our government also struggles to properly balance respect for the interests of the few without giving in to tyranny of the minority. Typically, this means that our strong protections of things like freedom of speech can still be overridden in very narrow ways by laws which serve a compelling governmental interest (precious few laws pass muster for this sort of thing, but it is possible), and our right to life, liberty, and property can be taken from us following due process. That is, our rights should be strongly protected, but they are not absolute.
To make this tangent relevant, the issue I think we run up against with vaccination is that there is adequate evidence of the effectiveness of the approach out there for the overwhelming majority of people. We have seen the near eradication of many previously dire diseases, and it’s not just that care is so much better that people survive, the incidence of the diseases themselves has been virtually stamped out. This is to say, for most people, the underlying medical question has been sufficiently answered, even if we do respect and value individuals, like yourself, who want to probe further.
Now, although I balance the risk/reward calculus differently than you, I don’t really want to belabor the point. As you said, this isn’t really the best forum for convincing one another of the relative merits of our positions. However, I’m curious what your thought is as to the proper expression of the general consensus. To me, I’m loathe to see anyone forcibly vaccinated (and question the legality of it), and I strongly disagree that it’s child abuse to not vaccinate; however, I do think that mandating vaccination for school attendance and measures like requiring certain education classes before accepting a declination of vaccination seem appropriate. Yes, it’s the majority flexing its muscle against the minority opinion, but given that there is a certain perception of risk shared by all, it seems justified to me.
What are your thoughts?
What about private and religious schools? Should they be compelled to require vaccinations? What if the religious school is tied to a denomination or population that has biblical or other beliefs and teachings against vaccines?
I’m not sure how much this is an actual issue today in the US, but there have been concerns in the past about aborted fetal tissue used in some vaccines and animal byproducts. Introducing foreign blood products into the body by any means has been seen as violating Mosaic law by Jehovah’s Witnesses, but I believe they now see this interpretation as non-binding and vaccination as an individual choice.
An article you can find online entitled “Large ongoing measles outbreak in a religious community in the Netherlands since May 2013” ( Eurosurveillance, Volume 18, Issue 36, 05 September 2013 ) covers the Dutch Reformed “bible-belt” in the Netherlands where opposition to vaccines has been doctrinalized over the past several centuries after some bad experiences with early vaccines. They specifically believe vaccines interfere with divine providence.
I am not a proponent of these religious beliefs, but the clash between religious freedom and personal-familial-communal-church autonomy versus “the compelling interests of the state” interests me greatly.
Thanks for your comment, Roger.
I actually link to that very article in my piece. (It’s hyperlinked to “Netherlands” in the second paragraph under my last heading) Of course, the technical answer in the US would depend on whether the state the school is in has a version of RFRA or not. If it did, then the government would need to show narrow tailoring and a compelling interest to force the school to have this requirement; otherwise, a public health regulation like this would very likely be totally enforceable with respect to private schools.
I think the issue ends up mapping on to the same concerns with individual parents, but I agree with you that striking the proper balance in this area is fascinating.
Donald,
great reply. I feel as though I can’t fully respond without getting into the merits of the entire vaccine debate, which I said I didn’t want to do. I completely agree that gov’t must weigh certain decisions for society as a whole, without allowing the tyranny of the minority ruling to the Nth degree. But as you said, “Unless we’re rather certain that vaccines are effective and unless we have some concept of the type and scope of adverse reactions, it’s difficult to properly weigh the public policy concerns that go into what shape any resultant legislation should take.”
That’s exactly right. But with every passing year, for those paying attention to this stuff (geeks like me), new studies come out showing that vaccines are less and less effective than previously thought. Consider even the MMR vaccine for this measles virus that’s going to wipe all of us out (pardon the sarcasm…couldn’t resist :)): there are currently two whistleblower events going on related to the MMR vaccine. One, where two Merck scientists are claiming that Merck manipulated data to maintain the gov’t contract for the vaccine by making it look like the vaccine was more effective than what the actual data showed, and two, where a CDC scientist admitted that they failed to follow proper study protocol in data analysis because they didn’t like the results.
Or how about the swine flu that was supposed to run rampant through the world and so countries stock-piled the fasttracked vaccine? Now they sit with those stockpiles, and several sovereign health ministers have taken the pharmaceutical industry to task for it and for the billions spent on it. Research the ‘Canadian problem,’ where of 12 million Canadians (no small sample size), those who received the flu vaccine were twice as likely to contract the swine flu. All those stockpiles didn’t go to waste, though. Now the seasonal flu vaccine has the swine flu vaccine in it as well. That flu vaccine was a big hit this year, completely missing the mark for the virus (though there were some completely healthy children and adults who died days after receiving the vaccine – always a coincidence, of course).
Then there’s the incredible amount adverse reactions to the recently-brought-to-market HPV vaccine. Safety trials were for 3 years, but cervical cancer caused by HPV takes 15 years to manifest…hmmm…how do we know that it works? An anti-body titer test–that’s it. Nevermind the over 100 associated deaths (and counting), or the thousands of adverse injury reports of girls’ lives forever harmed by the vaccine (so much so that this vaccine is actually being watched by gov’t watchdog groups who typically don’t have an interest in the vaccine fight). And not just girls, as this vaccine is now being recommended for girls AND boys starting at age 9…again, for an STD. And nevermind that 90% of the most common HPV’s are cleared from the body naturally within 2 years.
The pharmaceutical industry pays Billions (with a B) of dollars annually in fines for fraud. Yep, fraud. Are we supposed to take industry-funded studies at face value when the prestigious medical journals such as the BMJ acknowledge that 1) studies funded by the industry are 80% more likely to have a positive outcome, and 2) there is an enormous amount of influence that the industry has over which studies make it into the medical journals?
Then there’s the issue of why are we injecting newborns with vaccines when they don’t even have the developed immune system required to mount a proper response? Hello, boosters. And given that HepB is usually an STD, why inject a newborn with the vaccine the day they are born? It’s rare, but possible that a HepB positive mother could pass it to her newborn during the birthing process, but wouldn’t most mothers know if they were HepB positive prior to giving birth?
So how do we KNOW how effective vaccines are? Then there are the problematic mortality tables that show that deaths from ‘vaccine-preventable’ diseases were in a serious decline prior to mass vaccination due to increased sanitation, clean drinking water, refrigeration, etc etc. Again, without a longitudinal double-blind, true placebo, properly controlled study comparing the health outcomes of a vaccinated vs unvaccinated population, how would you know how effective they are and how prevalent the adverse outcomes might be? You wouldn’t. And why won’t that study ever be done? Because it would be ‘unethical’ to withhold the wonders of vaccines from a specific population. That’s the argument. So in order to test the true long-term safety of vaccines, we’ve STARTED with the assumption that they are safe, and therefore made it unethical to look at the long-term safety on our immune systems. Insert terrible/circular/backward logic comment here. 🙂 In short, legal vaccine mandates are using limited safety studies based on 100-yr-old medical theory.
Speaking of medical theories, herd immunity was originally a term used regarding those who had contracted a virus, recovered, and therefore obtained lifelong immunity. If enough of the herd went through this cycle, the remaining members would be protected based on the naturally-obtained immunity of the others. It was not a term used for vaccination, and vaccination-induced protection has a spotty track record in showing ‘immunity’ for the herd.
Another observation: everyone knows that anecdotal evidence, a story or two, simply doesn’t make a case one way or another (and yet people let their own experience dictate their decisions all the time: “The one year I got the flu shot is the year I got the flu, so I’m never getting it again”). But what about 2,000 stories? Here’s a host of short videos posted on youtube regarding the heartbreaking stories of those severely harmed by vaccines. It’s excruciating: https://www.youtube.com/channel/UCFCrfK5rP_B6huriP1hLApw
I like the idea of vaccines. I like the hypothesis behind them. I started out as a vaccine-supporter. My research led me elsewhere, and I don’t like what I’ve found so far. I believe we’re a long ways from having the evidence necessary to make vaccines mandatory. I welcome more research, better research, longer studies.
I’m just scratching the surface here, but I feel like I’ve gone too far already with ‘not arguing the merits of vaccination.’ While it’s true that most people believe vaccines to be mostly safe, I think you’d have a hard time making the argument that most people have put quite a bit of time into researching the topic. I’m not talking natural health blogs, crackpot conspiracy sites, etc…I’m talking CDC pages and peer-reviewed medical studies. But yes, even those can be fraught with peril, and the untrained eye wouldn’t know the difference.
So I’ll leave you with this: people like to claim “the science is in.” Is science irrefable? Are scientists cold, calculating, impartial robots who have no agendas? Or do you, I, and everyone else suffer from biases, including confirmation bias? And isn’t science always progressing? Are we not learning new things every day about the human body? Isn’t the immune system one of the least-understood pieces of this complex creation that God put together? Is it possible that we are doing significant long-term harm by injecting known neurotoxins, recombinant DNA, and a host of other antigens directly into the blood stream, bypassing our natural intake system for infection? I don’t have definitive answers, but I do know the long-term studies haven’t been done. The Institute of Medicine admits this, as does the former head of the New England Journal of Medicine (Marcia Angell), tons of respected doctors, and the former head of the Nat’l Institutes of Health, Bernadine Healy.
For more on the evolution of science, and how doctors who step out of line put their credibility at risk, I highly suggest Thomas Kuhn’s classic: “The structure of scientific revolutions”. It was eye-opening to me in my coursework at Dordt.
For more on bad science, I highly suggest the convincing/convicting TedTalk video: http://www.ted.com/talks/ben_goldacre_battling_bad_science?language=en
Thanks for the dialogue. Feel free to respond, though I might not reply, as I’ve put in way more than I should have already.
Tom
That’s an awfully good couple of comments Tom. I think it boils down to, “Do you at this time trust the pharmaceutical industry enough to let them inject stuff into your body and your childrens’ bodies on blind faith that it will do no harm? Do you trust your government to protect you from fraud, failure, incompetence, and craven profit-driven ‘science’?”
Tom,
I sincerely appreciate the effort you have put forth to engage here, and I’m not scared off by text wall comments. I also understand that there are limits to how much time to sink into this, so I’ll keep my comments brief.
The one caution I would make to a lot of the information you’re relating here is that you are generalizing from one specific case to another, making problems in the pharmaceutical industry generally into problems for vaccines and problems with one vaccines into evidence that undermines all of them. You are absolutely right about some of the issues in the industry, although the fraud settlements are almost all for off-label marketing, not fraudulent science. Similarly, issues with newer vaccines like the ones for HPV or the Flu shouldn’t discredit the effectiveness of long-established ones like those for measles.
Even if we quibble with the science and certainty behind the MMR vaccine, the fact that the disease, which is endemic to all human populations, went from hundreds of thousands of cases a year in the U.S. to less than two hundred for a period of almost 20 years (while the disease has remained endemic in parts of the world without vaccination) certainly suggests something made that difference, and I don’t think a natural decline in cases can possibly explain the near total eradication of the disease.
Anyway, not to get into the issue too far, but I think this raises the important question that underlies my article: at what point is society certain enough to act on an issue? It appears that you want science to be totally certain and to have answered substantially all outstanding questions before we proceed forward from saying “hey, we might have a vaccine” to “you should take it.” I don’t think that that’s a tenable line to draw and that the substantial consensus that we do have on the issue is adequate. That said, I don’t think we should ever stop asking questions or being open to admitting areas where our reasoning might be lacking, and I appreciate the pushback you’ve given on those fronts.
It seems very reasonable to me for consumers to connect problems in an industry to their choice to consume the goods produced by that industry. If a car manufacturer gets a bad reputation for truly inferior products, is it primarily the consumer’s responsibility to research each new model carefully, looking for reasons to trust it? What if good information is suppressed, distorted, and not very accessible? What if the industry is a monopoly?
Is this not a prime opportunity for a Reformed insight about the need to limit the power of totalizing institutions if we wish to preserve a humane and just society?
I think Tom did a good job of highlighting some of the serious ethical and accountability issues that are all but ignored by the press, the courts, the government, the scientific and medical communities. There is a failure of public trust because too much power and control has been consolidated in entities that can play scientists, the state, and the press like its puppets. If there was a commitment to do long term studies, to hold vaccine manufacturers accountable for fraud and malfeasance, and to generally tell the truth about the knowns and unknowns, the risks and the benefits I don’t think there would be any problem.
Hi Roger,
You make fair points, but I don’t think the analogy is workable. The off-label fines involve drugs being regularly prescribed to treat diseases/conditions that they were not approved by the FDA to treat. It’s not really about the quality of the product, and we’re not talking primarily about new products here. The MMR vaccine has been around in one form or another since the 60s. Yes, we might have questions about the HPV or Flu Vaccine, but those are significantly more recent developments, and their relative merits really have nothing to say about the efficacy of a totally different treatment. It’s also hard to think of the industry as a monopoly. Of course pharmaceuticals are produced by pharmaceutical companies, but that seems definitional rather than devious.
We should absolutely work toward a humane and just society, but it’s inaccurate to imply that these groups are simply “playing scientist” or that the state has no valid regulatory role here. The government does hold manufacturers responsible for malfeasance (hence the billions in fines), but the malfeasance has not involved fraud with established products like the MMR vaccine, and I don’t think that the nature of the troubles elsewhere can be fairly extended to assume something nefarious going on behind the scenes with these established products.
I do agree that there is a reticence to explain all known and unknown factors, but I think this stems from a concern that allowing for any unknowns will just generate “aha!” finger pointing from the group seeking to oppose vaccination. While I am sensitive to the need to audience perceptions of our message, I don’t agree at all that we should let our reasoning or our inquiry be curbed by concerns for how others might manipulate or misconstrue them. That’s why I openly encourage the type of questions that both you and Tom are raising; however, I apparently resolve those issues in a different manner from both of you, and in a democratic order, that’s okay. There comes a point at which action can/should be taken, despite continued objection.
I wasn’t thinking about the off-label fines or MMR in particular. I was thinking about “hot lots” that make people sick and ones that don’t do anything — or the fatalities caused by the unnecessary HPV vaccine.
Contrary to your statement, MMR has in fact changed; it used to contain thimerosol (mercury) until public opposition to this effected a change. The hypothetical link between thimerosol and autism remains controversial for some, but I always thought shooting mercury into infants was a bad idea period. To get a shot without thimerosol, you need to ask for it or you may get an old one containing thimerosol. At least that used to be an issue. Doctors and nurses routinely behave with newborns, children and adults just like dentists who decide for you what kind of material your filling will be made of if you don’t inform yourself and interject a choice.
I would say that is rather despotic and unethical behavior from people in fields that think and act like monopolies. To me, it is a monopoly if you don’t have a choice in the product you use. You don’t get information or options about who produced the vaccines, when and where they produced it, the risks involved, and your legal recourse if you or your child is injured or dies.
Donald,
thanks for your replies. You’re absolutely right that the state has a valid regulatory role. But what happens when that regulation is so tainted by industry influence? I’m not a conspiracy theorist. Yes, some days when there are 36 states considering legislation to remove philosophical or religious exemptions, it feels a little bit like the plot to V for Vendetta. 🙂 But I think it’s just business. Even review of the ACIP board (they make the vaccine recommendations) often reveals significant financial ties to the pharmaceutical industry. Julie Gerberding was head of the CDC until Jan 2009 when she accepted the head position for Merck’s vaccine division. Just like the financial industry, it’s a revolving door. If you dig around a bit on opensecrets.org, you’ll find that the pharmaceutical industry ranks as one of the top industries in terms of dollars spent on lobbying and campaign contributions. Why? It works. It’s just business. It’d be great if I could create a product, have a guaranteed buyer every year (the gov’t), have a workforce of trusted professionals who recommended my product daily, have a board of members that continued to expand how many of my products it recommended, both in numbers of products and the population for whom it’s recommended, and have no liability for any harm my product caused. That’s a great business model! If I’m feeling especially cynical I would add that any harm caused by my product might create a life-long customer for another or, more likely, several more of my products.
Yes, there is some generalization in my post, because I was trying to simply highlight a few examples, as opposed to an in-depth argument (which would be a book), about problems that various vaccines pose, and the trust that we place in the manufacturers. These are icebergs, in my opinion, and I was pointing out the visible tips.
And I disagree that the fines and cases I listed are all about off-label uses (though I’d argue that it’s another example of a culture of profits over people). Two of the items I listed were specifically about fraudulent science related to the MMR vaccine. For additional fraudulent/unethical science practices, view the Ben Goldacre TedTalk video on battling bad science. Or do a search for Dr. Poul Thorsen, a Danish researcher who helped write some key studies for the CDC (including for the MMR) before it was discovered that he took off with $2 million of grant money and is now on the lamb and on the most wanted list.
Please know that I do think vaccines have some effectiveness, even if new studies each year (I’m not going to list the dozens of sources) show they are less effective than previously thought. And yes, that happens each year. But yes, I think they can bring down incidence of disease as well as severity and infectiousness. But again, at what cost?
By the way, here’s the mortality statistics for the US and UK for measles: https://childhealthsafety.files.wordpress.com/2009/01/us-uk-measles-1901-1965.gif. Mass vaccination began in 1968. Here’s another one: http://www.everythingbirthblog.com/wp-content/uploads/2011/10/measles-deaths-decline.jpg.
“At what point is society certain enough to act on an issue? It appears that you want science to be totally certain and to have answered substantially all outstanding questions before we proceed forward from saying “hey, we might have a vaccine” to “you should take it.” I don’t think that that’s a tenable line to draw and that the substantial consensus that we do have on the issue is adequate.”
* You believe that to be adequate. I do not. And a society certain enough to act on an issue such as mandating a medical procedure with known and unknown risks requires a society that’s well educated on the issue. That’s a hard case to make.
* Science will never be totally certain. I state in my previous comments that science is continually evolving, especially when it comes to the immune system. To date, no studies have been done on the long-term health outcomes of a vaccinated vs unvaccinated population using a proper, standard study protocol without industry funding influence. Not on one vaccine, and certainly not the vaccine schedule as a whole. I see a big difference between wanting to know the long-term effects, even with ONE study, and supposedly wanting science to be totally certain. How can a risk-benefit analysis even be completed without knowing the long-term adverse outcomes? It can’t.
* And each vaccine will have its own risk/benefit analysis, will it not? But part of my problem is that nearly all vaccines are mandated for school attendance, regardless of that analysis. The vaccine schedule today shows no signs of stopping, with new vaccines being developed for ebola and even, ironically (to me, at least), autism symptoms. Today’s children will face 49 doses of 14 vaccines by age 6. Forty-nine. It’s a gold-mine for pharmaceutical companies (I couldn’t resist the pun).
* In 2011, Texas Gov. Rick Perry made the HPV vaccine mandatory for all girls age 12 and older. In the face of fierce opposition of an unproven vaccine, he retreated. As an aside, in 2008, a local Christian high school here in NW Iowa offered the HPV vaccine with registration. Yep, they preach abstinence and won’t hand out condoms, but you can get your STD vaccine at registration.
* My question is, as we go down this road where religious and philosophical exemptions are being thrown out by state legislators, when does it end? Where’s the stopping point in this loss of personal freedom, including the freedom to exercise one’s religion? And what do we do with the marginalized population in this debate, the ones whom we have sacrificed in the name of the greater good, the thousands of vaccine-injured families who have to go through a hellish court process with an average turn-time of 4 years to try to get some measure of financial compensation for their losses? “Hey, thanks for taking one for the team. Here’s a million dollars. We’re not sure why it happened to your loved one, but if it makes you feel better, know that vaccines are quite safe and effective.” No one actually says those words, of course, but testimonial after testimonial shows they get the message loud and clear.
“That said, I don’t think we should ever stop asking questions or being open to admitting areas where our reasoning might be lacking, and I appreciate the pushback you’ve given on those fronts.”
* I appreciate your willingness to engage on this issue. What typically happens is that those who share my viewpoints get shouted down, marginalized, called quacks, freeloaders, conspiracy theorists (I’ve been told I don’t care about children), or much worse. And yes, reticence to dig into these issues smacks a bit of A Few Good Men belief system (“You can’t handle the truth!”).
Again, I’ve said too much.
Tom,
Thanks for your continued engagement on this. I don’t mean to keep pulling you back in, but I do respect the fact that you are not crying out either conspiracy theory or saying that vaccines have no effect. Your concerns seem based in genuine research and concern for the topic, and I can definitely respect that.
I do have a couple of rejoinders to what you mention, however, and I’ll try to hit them in the order of your comments.
1) The revolving door between industry and regulatory agencies are, I think fairly, a source for raised eyebrows and concern. However, it’s a norm across many industries and Washington, something I can speak to firsthand. I’m not asking you to abandon your skepticism, but perhaps a more ordinary explanation: the FDA is looking for top scientists and other bright minds with a genuine understanding of pharmaceuticals. Where do they look? Since this isn’t something just anyone is an expert in, it’s not necessarily (notice the necessarily here) bad that the agency looks to the leading experts, most of whom will have ties to the industry. Now, everyone who is appointed to their position will be replaced when a new president comes in, that’s more or less a given. Out of work, they have to figure out who to work for. Who’s the most likely to hire them? The pharmaceutical industry.
The reason I give this example is to point out that the cycle may have nothing nefarious at heart in its operation. That doesn’t mean that there’s not a genuine risk involved and that skepticism isn’t a healthy thing or that good transparency and oversight isn’t essential. I’m just saying that evidence of closeness shouldn’t necessarily be evidence of wrongdoing.
2) My comment about off label uses was primarily targeted at the “Billions” number you were throwing out earlier. The largest fraud settlements out there are tied to off label uses, but I’m not an expert in this area, so I’m not saying that there might not be issues with more established products, like the MMR vaccine.
3) I think the focus on dropping mortality rates obscures the issue a bit. Measles was certainly far less fatal before the vaccine was developed, but the incidence was still consistent. Virtually every child contracted the disease by the age of 15, and the complications that come with the disease (pneumonia, encephalitis, and other issues) remained serious. The introduction of the vaccine saw a near total reduction in not just the mortality rate (which was dropping), but the incidence. So much so that the disease was no longer considered endemic to North America by the late 20th Century. This is true of many other serious illnesses as well.
I recognize that some of the population will still remain susceptible to infection (i.e. the vaccine won’t work for them), and I recognize that some have allergies that prevent them from taking a vaccine, and there are complications that may result from taking them. I still think the substantial reduction in the incidence of these diseases clearly links to the vaccines, and that the social benefits of a high rate of vaccination (i.e. benefiting anyone who’s vaccine “didn’t take” and those who didn’t take it) justify applying regulatory pressure to achieve that goal. I would actually oppose legislation that removes the right to religious or philosophical exemption, but I would support efforts made to ensure that anyone making that choice is doing it from an informed perspective. That is, the government can advocate its position, but those set on their path can still abstain.
I am also okay with the government mandating vaccination to attend public school (a publicly-funded benefit); although mention of religious schools or other groups choosing to form vacc-free schools or something seems at least initially acceptable to me.
What are your thoughts about this topic?
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