23 October 2009

Science media continues to advance in a different direction

Vaccines, and the lousy science used to oppose them

In the Apologia, Socrates makes an implied point to demonstrate that in every field, already in Classical Greece, there are experts to whom the people and even the leaders of a nation will defer to.

"Come hither, Meletus, and let me ask a question of you. You think a great deal about the improvement of youth?"
"Yes, I do."
"Tell the judges, then, who is their improver; for you must know, as you have taken the pains to discover their corrupter, and are citing and accusing me before them. Speak, then, and tell the judges who their improver is. Observe, Meletus, that you are silent, and have nothing to say. But is not this rather disgraceful, and a very considerable proof of what I was saying, that you have no interest in the matter? Speak up, friend, and tell us who their improver is."
"The laws."
"But that, my good sir, is not my meaning. I want to know who the person is, who, in the first place, knows the laws."
"The judges, Socrates, who are present in court."
"What do you mean to say, Meletus, that they are able to instruct and improve youth?"
"Certainly they are."
"What, all of them, or some only and not others?"
"All of them."
"By the goddess Here, that is good news! There are plenty of improvers, then. And what do you say of the audience, - do they improve them?"
"Yes, they do."
"And the senators?"
"Yes, the senators improve them."
"But perhaps the members of the citizen assembly corrupt them? - or do they too improve them?"
"They improve them."
"Then every Athenian improves and elevates them; all with the exception of myself; and I alone am their corrupter? Is that what you affirm?"
"That is what I stoutly affirm."
"I am very unfortunate if that is true. But suppose I ask you a question: Would you say that this also holds true in the case of horses? Does one man do them harm and all the world good? Is not the exact opposite of this true? One man is able to do them good, or at least not many; - the trainer of horses, that is to say, does them good, and others who have to do with them rather injure them? Is not that true, Meletus, of horses, or any other animals? Yes, certainly. Whether you and Anytus say yes or no, that is no matter. Happy indeed would be the condition of youth if they had one corrupter only, and all the rest of the world were their improvers. And you, Meletus, have sufficiently shown that you never had a thought about the young: your carelessness is seen in your not caring about matters spoken of in this very indictment."

While the logical consistency of Socrates' arguments (comparing horses to people) is rather fluky at best, the point is that experts are to be trusted with the care and improvement of human beings. Indeed, throughout society we do this in the form of public and bureaucratic insistence for childhood safety rules or the reliance on public schools and education, entrusting to experts to tell us what improvements we might make. So for whatever reason, we object when the expert is an educated doctor providing a product which in fact makes us safer? It is true that there are on occasion drug product failures or vaccines which are perhaps most useful for a few over the many, or are not as effective as their cost would demonstrate. This is not the case for vaccines which have been developed and marketed all around the world for decades to use on a variety of childhood diseases. Considering the massive importance we place upon children already, it is not surprising that development of treatments and prevention schemes for their health and well-being have been funded at an accelerated rate and have successfully eliminated or substantially reduced various scourges of disease and illness. Such efforts however only work when people follow the learned advice of experts. Which leads us now to this paradoxical world where people ignore this advice and place their children (and, more importantly, other people's children) at greater risk.

It is curious to me that people would accept these greater risks in favor of an illusion of safety from other risks. Risks which are in fact, almost non-existent. But it doesn't seem any different from any other pursuit of security. We accept and tolerate all sorts of intrusions on basic liberties in order to get on board an airplane when we ourselves offer so rare and so incomplete a risk to other travelers that this sort of policing is utter nonsense to design and implement. It provides instead an illusion of safety from a nondescript risk. More likely the general fear that people seem to have of flying in the first place is to blame more than "terrorists". I'm assuming in the case of vaccination that the invisible germ warfare involved, something which is still incompletely understood by the public if it is not to be called deliberately ignorant of it, becomes a proxy for the general fears of parents at surrendering their children into the broader world.

Yet there are not these associated autism scares in European nations which use vaccines, indeed vaccines of the accused type, more commonly (denser urban population for one thing is a good excuse). Why would this be? Probably one explanation would be a greater amount of deference to authority generally, but also a greater scientific literacy. There seems to be a good deal of questioning that goes on when a scientific study is put out in this country which contradicts a conventional wisdom. Much less when a whole series of them does. Scientists are said to be in the pocket of major businesses and dismissed as business advocates (rather than scientific advocates). Rather than looking at a basic and simple scientific explanation for a child's autistic tendencies (Autism is a not uncommon neurological and largely genetic development which occurs naturally at around the time children get many of their vaccines), it becomes a causal linkage that must be regulated away or have new, more expensive products designed to satisfy our curious want of "safety" where it already exists.

What's more, we have an even more curious reliance on expertise to demonstrate these tenuous logical links. Only now instead of scientists and journalists who have clearly investigated the correlations and causation chains, we enter celebrities and anecdotal stories from tortured parents. In a world where Jim Carrey and John Kerry are united on something and appealing to our populism, I will gladly run the other way.

All of this then brings me to the issue of consent regarding vaccines generally. It appears to be a general wish to appeal to individual choice and parent autonomy to allow citizens to disregard vaccination as a personal whim or based on some sort of religious or other anti-scientific belief. Where there are legitimate and credible scientific claims, or significant and valid economic cost/benefit considerations against a mandate for a vaccine, the vaccine, in my opinion shouldn't become mandated. This might be the case, as I posted earlier regarding men and teenage boys getting the HPV vaccine shot or anyone with the current H1N1 vaccine (I am not a scientist or a vaccine expert, but both of these groups seem less convinced of a need for a required shot than usual on these two in particular). This is most assuredly not the case regarding MMR shots and the various battery of vaccines children get as they prepare to enter primary schools. The reason a mandate overpowering individual choice can be acceptable is because of the costs of not having a vaccination. These costs affect not only the children involved (who are presumably not at an age of consent), but also the entire social structures of schools and the children of others. The benefits of largely eradicating a disease from the map are enormous in terms of social welfare, public health, and general education; lost time to sickness, additional opportunity cost of health care treatment rather than prevention, general ease and comfort provided to parents whose children are protected from potentially life-threatening childhood diseases. On a simple cost-benefit, these decisions ought to be no-brainers for anyone. Which brings back the mandate "problem". This can be easily and certainly provided a basis from the utilitarian grounds that it will prevent significant harm inflicted on others from behavior. It is flatly irresponsible to ignore the expert scientific advice and government legislation and not get a child their normal routine vaccination shots. One can believe all they want that their vaccination shots gave their child autism, that doesn't give them some entitlement to ignore a public responsibility to vaccinate a child. If they can prove that this was true in court using scientific evidence then I say they are entitled to some sort of compensation and we would be entitled to perhaps more carefully monitored vaccines (as if there isn't already plenty of government and industry oversight into public health). They cannot so demonstrate any claim with scientific inquiry, only anecdotal "wisdom" of the uninformed, so quit wasting our time with debates over public safety where there ought not to be. It's bad enough we have to fight back against safety considerations on a civil libertarian grounding with "proper" car seat use or airplanes with all the attending supervision and government/public intrusion that these have entailed. There shouldn't have to be a fight over things that actually do incentivize and create safety with a minimum of intrusion as a result.

One other good point addressed in the article. "They ain’t curing AIDS. They ain’t never curing AIDS. Don’t even think about that shit. There ain’t no money in the cure. The money’s in the medicine." - Chris Rock. Vaccines are not "big Pharma". Know what is? Heart disease medication or erectile dysfunction pills. Health problems that are caused, in large part, by lifestyle choices that people are well aware (from scientific advice and media scare tactics) should be more considered and personally harmful than vaccines. But are instead more than willing to have health insurance pay for thousands of dollars over a lifetime of medications than to make minimal effort on their own to improve their own health. Seems to me if people want something to be afraid of for public health, it might be at least marginally sensible to look at what they're putting into their bodies by choice that ends up in their arteries. And then wonder why their medication bill is skyrocketing.
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