Sunday, April 03, 2011

Refusing to cry, refusing to laugh

"My dear Kepler, what would you say of the learned here, who, replete with the pertinacity of the asp, have steadfastly refused to cast a glance through the telescope?  What shall we make of this?  Shall we laugh, or shall we cry?" 

--Letter from Galileo Galilei to Johannes Kepler

Somalis in Minnesota have experienced a higher than predicted rate of measles and resultant excess of preventable deaths in the past year. A similar measles outbreak occurred in 1996-97 in Minnesota in children who were members of a religious group who eschewed immunizations. It also happened in 1977. Same place, same disease, same issue.

California and elsewhere have seen outbreaks of Pertussis (whooping cough) in recent years.

And last but not least Polio continues to win skirmishes in a war thought won 60 years ago.

I personally participated in immunization drives to combat a measles outbreak in Philadelphia in the late 1980's. I've also had the "privilege" of performing a lumbar puncture on a three month old infant with Hemophilus Influenza Type B. 

All of which leads me to struggle with how to respond to those who continue to warn of the risks of immunization. Autism! Seizures! ADHD! Asthma! Diabetes! Death! And worst of all Peanut Allergies! OMG!

Are you as non-plussed by the sensationalism, hucksterism, and general snake oil feel to the anti-immunization fringe as I am? Puh-lease save me your "What your doctor doesn't want you to know...", "We have real qualifications too...", "Just buy this..." and especially your "God doesn't want you to vaccinate...".

Yes, Immunizations are risky. We no longer use oral polio vaccine because of the risk of vaccine associated polio. We use inactivated polio instead.

Yes, Immunizations are not perfectly effective. But perfection is the enemy of the good, and immunizations are much more than good enough, measuring higher even than chocolate or Cliff Lee on the goodness scale.

Immunizations are not a choice between disease and no disease; they are a choice between less vaccine preventable disease and complications (with all the costs that come with vaccination) and more vaccine preventable disease and complications (and all the costs that come with no vaccines.) If you wish to save money, vaccinate. If you wish to reduce overall morbidity and mortality, vaccinate. These choices are not imaginary; they are written in the history of those who've made them before us, and those who forget the past...

Lastly, immunization is a social act. The risks of vaccination are borne by those who vaccinate, while the benefits of immunity are received not only by the vaccinated but also by those who aren't, whether they ask for it or not. The least the un-immunized could do is gracefully and thankfully accept that saner, braver folk are not only willing to tolerate their fear but also work to ensure that it doesn't kill the rest of us. But history also tells me that this expectation is too great. Sigh.

Sometimes my patients ask me "Do I have to take this medicine for the rest of my life?" or, in another version "Should I get this immunization?", and my answer to both remains the same. Yes, until we know  better, or until something better comes along. Knowing better or identifying something better is often hard, except in the case of immunizations. That one is easy. For most of us anyway. So long as we wear head protection.

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