Tuesday, January 14, 2014

Is the Jury Still Out on Vaccines?

Recently on Facebook, I posted an article regarding the new trend of anti-vaccination and offering a rebuttal. It was a pretty poor article, I realize in hindsight, and I'd only skimmed it at the time. But I posted it in the interest of getting a conversation going. It, er... well, it worked, let's just say.

A lot of people posted a lot of things; some facts and documentation on both sides combined with anecdotal and authoritative experiential accounts, also on both sides. As with the original article, I sloppily skimmed all this material, and now (as with the original article) I'm hastily posting my own thoughts on the matter. I am, if you haven't noticed, A Guy With A Blog.

But before talking about vaccines, first I want to talk about jury duty.

Today I called the jury overlord people in Philadelphia to ask to defer for a second time my summons to report for jury duty. My reasons, I explained, are myriad. It would frankly be both a personal and a professional hardship at the present time, and next month would be better. Something is in the mail, they told me, and so I'm hoping it is a new questionnaire and not a citation for contempt of court.

G.K. Chesterton was famously sanguine about juries, you may recall, a facet of his long-suffering faith in democracy. Specifically, he contrasted the wisdom of a lottery-selected jury of peers with the modern fetish for specialism:
Our civilisation has decided, and very justly decided, that determining the guilt or innocence of men is a thing too important to be trusted to trained men. It wishes for light upon that awful matter, it asks men who know no more law than I know, but who can feel the things that I felt in the jury box. When it wants a library catalogued, or the solar system discovered, or any trifle of that kind it uses up its specialists. But when it wishes anything done which is really serious, it collects twelve of the ordinary men standing round. The same thing was done, if I remember right, by the Founder of Christianity. 
To quote Samwise Gamgee, "I like that."

I like that, but...

There's also part of me that consistently struggles with my philanthropic core, part of me that wonders about the central impulses of democracy. There are some good reasons for this.
Also, I work in politics. I work in one of the most contentious and emotionally-charged issues in politics. And I know first-hand how stupid the average person can be. But even beyond that is the worse problem of the simply disengaged persons: the ones who can't even be bothered to think about learning something, let alone actually learn something, about the issues.

So, I started off by saying there was this conversation about vaccines on my Facebook timeline. These were people who were informed about the issue, and had their opinions and beliefs, and seemed to believe passionately about them.

But as I was distracted most of the day with work, and so unable to participate in the debate I'd baited; and as instead I watched it unfold with periodic checking-in and lurking; and as I cringed at some remarks, smirked at others, furrowed my brow at times when clicking through to a linked source... suddenly I began to realize maybe this wasn't the debate I'd wanted at all.

The argument seemed to have categories lining up in opposition to each other like checkers: provenness, effectiveness, utility vs. provability, effects, necessity - the first lot proceeding under the banner SCIENCE and the opposing set parrying under a belligerent jolly roger INTERROBANG. But to an observer like me, admittedly rather poorly informed on the subject except in one particular aspect (which we'll get to) a lot of the artillery on both sides seemed to be over-firing. Speaking from the point of view of someone who has studied logic but neither medicine nor homeopathy, it seemed at times like both sides were asking the other side to disprove a negative, thus setting up an impossible task: "What about X number of deaths which would have occurred without vaccines?" or "If vaccines had been used Z complications would've prevailed: what say you to that?" These are, at least, typical examples of the discourse more generally, and if not there per se in the particular conversation in my wall, operative anyway in implicit ways. And of course, it is impossible. You can't prove any number of kids would have died absent anything, any more than you can prove a particular supposed side-effect not-present would've been present absent something. But all this is a digression, and to a very narrow point (if any of it seem too broad or ungenerous): the point being, this wasn't the debate I'd wanted at all.

I didn't know it at all myself. I'd posted the article I'd posted but it was too aggressive, too self-serving, too polarized in the field. It set up the match, and the thing was played out before it started as people came with their heels dug in. But is there no common ground?

Relevant here, I need to reiterate from my interlude about jury duty, are two sentiments (or presentiments) that need, I think, to be held in tension: here, first, that part of me that struggles up through my rationalism and cynicism, that faith in humanity and confidence in the common sense of common men. Second, the true and undeniable value of specialism and expertise, which I guard in my own fields are jealously as any periti do among the diverse arts and sciences which we must, in unity, divide in order to conquer. Also relevant is the notion of overdetermination in a system. Briefly, for those unfamiliar, overdetermination is deemed in analysis when it would appear that two or more distinct and separate causes attain to an effect and each is sufficient to the effect (the question of necessity adding a whole other mind-boggling wrinkle to the affair). Catholics, if I may say, tend oftentimes to groove with this pretty happily, being all about et... et rather than aut... aut (i.e., "both/and" and "either/or") , to which the phenomenon of overdetermination at least feels analogous if it is rarely analytically so.

With the present issue we're talking about a bone of bitter contention at that precise intersection between the common man's wisdom and the specialist's trained knowledge. And to make matters worse, the bone is being chomped on by a rabid dog of overdetermination hopped up on bath salts.

The specialist, for his part, seems (in my analysis) to have some good solid facts and data on his side. The science in the larger frame seems pretty settled upon the point that vaccines have done a lot of good for society generally. On the other hand, the common sense of the common man has going for it the perception of something rotten in the den of Merck (see what I did there?). This latter perspective (when care is taken to avoid fanaticism, which-alas!-is care too seldom taken) sees and acknowledges the positive aspects, albeit perhaps not as appreciatively as the specialist with his training, but also sees the gaps which the specialist may miss being quintessentially too close to the thing to observe them. "To see what is in front of one's nose needs a constant struggle," Orwell noted -- or, simply, to not have it in front of your nose.

Here, then, is the debate I suppose I wanted (but did not realize I wanted, choosing the dumb article that I did), on vaccines. It would look at:

  • The frequency and amplitude of administration of vaccines: could they not be evaluated differently, paying attention to factors like risk, environment, lifestyle, and the like? The true levels and likelihoods of communicability in the event of infection, for example, are topics that could potentially be better analysed and at least add to our cultural understanding.
  • Education and information: how to set up a good network for this which is trustworthy and disinterested. If something of a culture of distrust has arisen regarding, say, the CDC, it seems there are very reasonable causes - a fortiori major pharmaceutical companies. If you watched TV today, chances are you've heard this phrase at least once: "Ask your doctor is X is right for you." Think about this for a moment. It's weird.
  • Hygienic (in the broadest sense) advancements having been made or able to be made moving forward: are there certain holistic improvements that need to be made in an already quick-to-medicate culture (especially given the foregoing point)? The debate and controversy over Gardasil comes to mind in this respect, certainly, and bring up another aspect: there might also be improvement that needs to be made in the care-giving community on a micro-level so that recommending life-style changes rather than writing a script, indeed refusing a script absent those changes, is seen as true care and not being a busy-body. And I do believe there are vaccine-cases where this is relevant, too, if it seems I'm just talking about antibiotics here.
  • The economics angle: woaaah nelly. Let's face it: there is, deep down at the root of this thing, at least a sense that certain economic interests and impulses are corruptive of the culture of pharmaceutical care; and at the very least this perception corrupts the culture of trust that ought to characterize good relationship between medical caregivers and consumers of the same. This, for me, is where that rabid dog of overdetermination snarls most angrily. This goes everywhere, like mercury on the lab floor. The journals that publish the vaunted studies, the government grants, the care guidelines from insurers... all the way to the food we eat and the fuel we put in our car. And if you think this sounds tin-foil-hatted, you're entitled to that view, I'll warrant. But I live according to simple beliefs, one of which is that money corrupteth, and where there's big money there's big corruption. Another of which principles is, "by their fruits you shall know them" - which is to say, the corruption is already there. Which is my next point:
  • Certain indisputable institutional corruptions in the pharmaceutical industry (such as unethical research and development practices which use human children as mere material resources) demand real reform, and like yesterday. This is a complex facet of the issue, but the one most in my wheelhouse and also the one most of concern to me. The Vatican has given firm guidance on this matter, and I'll cut to the chase and say that it is two-fold: (1) it is permissible to use vaccines originating from repugnant sources for a good reason; however (and this is often elided) (2) we are morally duty-bound to seek alternative sources for those vaccines (and I would say the implication here is also that we should analyze-by which I really mean we should have more medical professionals more willing to analyze-pretty scrupulously how necessary and how serious the reasons are for complicity and participation in a medical procedure that involved at some point the willful destruction of innocent human life: a trade of destruction which continues and is as dependent on supply and demand issues as any other economic reality. (And once again, this truly does put integrity questions on the table, and I say this not for me or for other - let's face it - mere ignorance consumers of health care, but I say this more so - and emphatically - for healthcare workers, scientists, and the like: we need you to break this structure of sin apart. We'll trust you to know better than us when it comes times to face the knife or the needle, but do us the favor of using that better knowledge to find the weak points of the system and to inform us so that together we may break it apart.)
And so that's the debate on vaccines I think worth having, the debate I'd have liked to have had. I titled this post with a question: "Is the Jury Still Out on Vaccines?" I think the question deserves a kind of "both/and" answer, a no and a yes. The jury might have moved past (or, let's hope, is able to move past) certain questions. But there are some very much still worth deliberating.

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