With the amount of press coverage about the recent outbreak of measles in a Disney park, reactions have frequently been loud and strident about the presumed impact of conscious objection to pediatric vaccination. It’s impossible to turn to any communications medium without polarizing statements about people who are ‘vaxxers’ or ‘antivaxxers.’ Debate has largely been absent, because both extremes assume that truth is on their side. Labels have come to serve as shorthand for often passionately-felt positions. After all: our children’s health as at stake, as the story goes. What could be more important than being right about that?
I’ve seen relationships in my own circles damaged because of my interest in having a thoughtful discussion about the issue. A good friend calls it ‘the poisoned debate,’ because it’s so polarizing that people get inflamed quickly about the issue. Emotion takes over: fear and uncertainty are powerful triggers. As doctors of chiropractic, we occupy a potentially important thought leadership position in peoples’ lives. How do we respond to concerns–on both sides of the issue–in a responsible manner? “Carefully,” is the right answer–with a rim-shot and a Kevlar body suit. But perhaps there’s a way through this.
The first challenge is to separate immunization from vaccination. As my dear friend, mentor and chiropractic leader Dr. John Allenburg has stated, “What could be more vitalistic than triggering the body’s natural immune response?” And it must be pointed out that immunization is an important, healthy response on the part of our bodies. Whether vaccinations are the appropriate, healthy and necessary stimulus for the immunization response is one question. And whether, as a medical procedure, it is always appropriate to administer vaccinations to an individual is another.
As background, we have to also remember that science is an evolving understanding of data, and that it’s very unlikely that any conclusion–or a personal or policy position based on any conclusion–is the last word. Medical history is rife with examples of widely-held beliefs that were overturned with a better or more nuanced understanding at a later time with new information. So if anyone says that the current medical and public health position on vaccination is the last word, it’s likely that new information will come along at some point and either affirm it or force reconsideration. A recent example: many have pointed out that potentially good number of prevalent childhood problems (asthma, allergies, sensitivities) may be associated (I said associated, not caused) to a generation of parents who bought the extreme version of a germ-free childhood thanks to ‘antibacterial’ marketing. Many experts now have had to revise their recommendations and now say that we should let kids play on dirty floors.
It’s also extremely difficult to challenge a group’s mind-set about an issue or problem. There is a potentially serious and substantial social, personal and economic cost incurred by challenging orthodoxy.
Rah-Rah Viral Messages
The medium is the message, McLuhan observed, and that’s never been more true than now. From blogs and other websites based on specific positions (such as this, and this) to entertainment such as Penn & Teller’s distorted, rousing commentary (link here) to ‘me too’ vaxxer/anti-vaxxer Facebook messages piling on to either extreme, emotions can easily rule the day. Finding relatively thoughtful considerations of the complexity of the issue (such as this, and this) isn’t necessarily rewarded in the same way. Our favored channels can come to define and reinforce our positions. It’s potentially problematic, though, to stop listening to those we disagree with. For one thing, by doing so we worsen the tattered social fabric in which we only find comfort in echoes of our own positions (more comment on this here). For another, listening to those with the same megaphone and soap-box over and over again relieves us of the requirement to actually think. And finally, we might simply be wrong.
Another fact that’s been lost in the ‘debate’ is that vaccinations are a medical procedure. Any procedure–repeat, any procedure–comes with some degree of risk. The risk may be slight or it may be substantial–even deadly. And it’s often individual. So choosing any procedure ethically and responsibly requires informed consent. In the case of vaccinations, if we dismiss the idea that there is risk, we are ignoring very real data that suggests otherwise. If we think the source of that data is suspect, we should ask more questions (that pesky critical thinking requirement) about whether the data are wrong, or simply not widely appreciated and reported.
[To be transparent, I should tell you my own experience with this. As a child of the 1950s, I lined up with millions of others to get the polio vaccine (Sugar cubes! Who knew?). I had the measles so badly (ill for three weeks) that our doctor made a vaccine of my shed cells and inoculated my siblings. I had my kids vaccinated, but after witnessing what clearly to me was a vaccine injury I deferred or delayed most others until my kids were a bit older than recommended. I have many friends who’ve gotten all their vaccinations with no issues; a number who’ve had none; and a number who’ve seen injuries first-hand. Tough choices.]
So what is a responsible position to take on vaccinations? Here are my suggestions.
- Stress that it is an individual decision, with important implications. It is entirely possible we’ll move as a society to restrict freedom of choice on vaccinations, or require isolation under certain circumstances. There are potential social costs.
- Emphasize that it is a procedure, with a degree of risk, and that informed consent is important. Encourage people to review that risk and come to a decision on their own. No risk should be thoughtlessly dismissed.
- Create a bibliography of resources, pro and con, so your patients, customers and their families can draw their own conclusions. A conversation is better than shouting at each other.
- Establish a position of advocacy for your patients’ individual considerations, even if you take a position on the issue that is visibly in disagreement with their conclusions. You are an individual, but DCs also occupy a position of authority. Use it wisely.
For our profession, it’s time leadership gave consideration to a carefully designed conversation about the issue. I cringe at both extremes: I fear those who dismiss all inoculations are ignoring significant data, and bluntly we look stupid and anti-science when we do so. But I also challenge those who are equally fervently pro-vaccination for everyone to review the existing oppositional evidence on their own. I don’t hear much difference in the tone–or the aspect of ‘truthiness’–in either extreme.
As with many issues, truth is often individual and likely somewhere in the middle–a shade of gray. Both extremes are emotionally rewarding and polarizing. And both are probably wrong.