Since I published my piece yesterday on Arthur Allen's naked disdain for parenthood, I have received several reactions and poked around a bit more.
As it turns out, David Kirby (author of "Evidence of Harm") and Allen have a bit of a traveling show going, meeting for bouts in various venues. Kirby's shtick is that vaccines have harmed kids, Allen's is that vaccines are a public health miracle of unquestionable benefit. And I mean unquestionable - anyone who questions Allen's convictions has some kind of moral or intellectual deficiency.
The issue of vaccines is much more interesting and nuanced than these brawls would make you believe. It turns out that vaccines - as a whole - are efficacious and safe, but that doesn't mean that they're above scrutiny.
And unlike other medical treatments, the trade-offs involve difficult moral and economic trade-offs.
So here we go: Imagine a vaccine A that saves the lives of 99.9% of those who get it, but that 0.5% develop a mild, 4-hour flu. Now imagine a vaccine B that lessens cold symptoms for 20% of those who get it but will kill 2%. Both are no-brainers: we keep A and never use B, right? Let's also stipulate that all vaccines fall somewhere between these two extremes, hopefully a lot closer to A than B. Add to that the herd effect, which allows for a number of people to be freeloaders. They don't take the vaccine (and thereby avoid any risk of side effects), but get nearly all the benefit, as those around him won't be infectious.
All these factors are conceivably measurable. We should know the efficacy (the frequency and magnitude of improved outcomes), the risk (the frequency and severity of adverse effects), and the herd effect (the effect on non-treated individuals of being among treated individuals) for any given vaccine. We should also know the effect of no treatment as a baseline for all of these. The problem is, we don't. Most evidence is circumstantial, some is conjecture.
And that may be all that is possible. It is notoriously difficult to isolate cause and effect in large population, as there inevitably are confounding factors. For example, reduced mortality rates in industrialized countries in the early 20th century are widely attributed to vaccines.
But it is clear this wasn't the only factor. Improved sanitary conditions, other medical technology, and improved nutrition also played a role. In addition, let's face it, we are all descendants of people who survived various and sundry childhood and other diseases. Evolution persists among humans.
I think vaccines played an important role in improving public health in industrialized countries and continue to do so in developing economies. But I think other factors are as important or even more important, such as sanitary practices, clean drinking water, and good nutrition. Vaccination is, in other words, no panacea for poverty.
But if the exact benefits of vaccines are hard to measure, the risks are even more elusive. In theory, doctors are supposed to report all adverse effects following vaccination, but there is no incentive for them to do so, and it would be impossible to convince them that a mild cold at 21 months has any link to a vaccination at 17 months. And long-term effects are impossible to measure, given the absence of a control group.
This gives rise to the moral, economic, and ultimately political question: to what extent does the state have the right to ask parents to take risks for their kids in service of the greater good? What greater good would justify what personal risk? The answer from the public health authorities so far has been: trust us, and do what we say. I don't think it's incorrect to say that the vast majority of infants and children are vaccinated without the informed consent of their parents.
In spite of all this uncertainty, vaccines have been accepted wholesale by the medical community and the public at large, especially in the United States. We vaccinate infants against illnesses that are virtually impossible for them to contract at such an early age (just try asking your pediatrician why your newborn needs a HepB vaccine), just in case and to prevent the population as a whole against these potentially infectious little buggers.
And then it turns out that we're also injecting them with thimerosal, a known toxin, without anything resembling a safety trial. Because that's less expensive. By a couple of cents.
How can Allen, the NIH, CDC, etc., be surprised that such practices are challenged?
All this uncertainty, of course, doesn't prove that thimerosal specifically or vaccination more generally causes or contributes to autism or other disorders. But it does give grounds for some tough questions and a pretty serious attempt at finding answers. And the more the questions are dismissed and those who ask them disrespected, the more suspicious it looks.
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