Total Drek

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Thursday, March 05, 2009

Parenthetical asides aside...

A while back I wrote a post that went moment by moment through an anti-vaccine video by Mary Tocco and... well... pointed out how poor her arguments are. Indeed, this post was just another in a long series of posts stretching back into the dim pre-history* of this blog. As you might guess this post has garnered quite a response, both from anti-vaccination folks as well as the more medically responsible among us. Recently, however, this post earned a new comment from someone who identifies themselves as "Chiropractic Student (not crazy)". I found this particular comment interesting enough as to warrant a post of its own. So, below, find first the text of CSnc's comment, and then my response. And if you're not at all interested in this sort of thing, you're excused. Then again, if you're not at all interested in this sort of thing, why are you reading this blog in the first place? It's not like talking about the anti-vaccination crowd and other pseudoscientific flim-flam is unusual for me.

In any case, let's give the floor to CSnc:


While I do agree with the majority of your statements, I really wish you wouldn't bash on chiropractors so much. While there is a community of D.C.'s that believe strongly in the anti-vaccine stance, not everybody in the field is included. We that aren't zealots get discouraged by those who assume that we all follow suit.

As a chiropractic student who was vaccinated as a child, I do believe that some vaccinations are necessary. I don't, however, believe that kids should be bombarded with as many vaccines at once (as they are these days). If a parent wants their kid vaccinated, I think they should at least spread it out a bit. Many claims the anti-vaccine crew have made can't technically be backed up by accepted scientific research, but what's the harm in at least spreading it out a little?

However, back to my point. Don't lump all chiropractors with the outspoken ones making radical claims. Many of us are interested in simply helping a patient with their spinal health and helping maintain a healthy nervous system. As in all things, whether it be politics or anything else for that matter, usually the most outspoken are the most radical and probably the ones you shouldn't listen to in the first place.

Thank you for your time

And now, to respond:

Dear Chiropractic Student (not crazy),

I wish to begin by, first, thanking you for leaving a concise and honest comment. I know that my post was rather inflammatory, owing to the inflammatory nature of its subject matter, and your restraint does you credit. I would also like to acknowledge what is manifestly clear to me: that while we each view the other as well-intentioned, we also view the other as misguided. I do not wish to place words in your mouth, and apologize if I have done so, but from your comments it very much appears that you regard me as wishing to do right by others, but also of having gone too far. Likewise, I believe you to be similarly motivated in the interest of others, but also to be missing critical points. I say this not to be mean or dismissive but, rather, to simply state what I think is the case: we respect each other's motivations, but disagree about actions.

If you'll permit me to address your points out of order, you observe:

I do believe that some vaccinations are necessary. I don't, however, believe that kids should be bombarded with as many vaccines at once (as they are these days). If a parent wants their kid vaccinated, I think they should at least spread it out a bit. Many claims the anti-vaccine crew have made can't technically be backed up by accepted scientific research, but what's the harm in at least spreading it out a little? [emphasis added]

Let's assume for the moment that you and I are in agreement that vaccines are necessary protection against disease. I rather suspect we disagree in part on that, given your "some vaccinations are necessary" caveat, but we will leave that alone for the time being. The issue at hand comes down to, "What harm could arise from not vaccinating children as quickly?" This is a reasonable and well-meant question but the answer, unfortunately, is "Quite a lot." You see, the issue is that until a child has been properly vaccinated** he or she remains vulnerable to contracting the disease in question. If the disease the vaccine is meant to protect against is rare in a particular area, the child may not be at risk from a delay but it is unfortunately difficult to predict when outbreaks of a disease will occur. I lived, for example, in a city that only narrowly avoided a measles epidemic deriving from an infected foreign tourist. This was an unpredictable source and any children or, indeed, adults in my community who were not vaccinated would have been in danger. Given that this is the case, what we have to do is weigh the potential danger from the infectious agent against the danger posed by the treatment and, fortunately for us, the overwhelming weight of medical and scientific evidence*** indicates that vaccines are very, very safe. Indeed, while adverse reactions to vaccination do occur (albeit infrequently), the majority of them are mild and more of an inconvenience than a real danger. Moreover, the overwhelming evidence is that the modern practice of relatively aggressive vaccination is also safe. Thus, the harm in spreading it out a little is that the child may be injured by contracting a disease that could have been easily prevented.

To really see my point, let's consider an analogous situation: you are the attendant at a below ground long-term parking structure. When people retrieve their vehicles (entering from a location you cannot see) they come up a spiral ramp, pay you a fee, and drive away. Because they are coming up a spiral ramp, the drivers of these vehicles cannot see what is immediately around the corner, and thus the top of the ramp is marked with warnings to pedestrians. Likewise, because customers enter at a location you cannot see, you have no way of knowing when a car will come up the ramp, but only that due to the nature of the patrons, it probably won't be more than twice per day. Now, one day during your shift, you notice that a child has sat down on the pavement at the top of the ramp and is playing a game. You can see that a car coming up the ramp would be unable to see the child, due to the angle of the car itself, and would almost certainly strike them. The result of such an accident would likely be significant injury or death. Let's say the child, if left alone, will play there for 30 minutes: given that only two cars typically leave the structure per day, there is a 1/24 or a 4.2% chance that, if you do nothing, an accident will occur. Knowing this, would you fetch the child out of the way? Unless I miss my guess, your answer is "yes." Now, consider that you also know that if you fetch the child out of the way there's a chance (1/10 or 10%) they may fall and skin their knee and a slight chance (1/1000000 or 0.0001%) that they may fall and break their neck. Would you still take action to get the child away from the 1/24 chance that a car will hit them? Again, I think your answer is almost certainly "yes." And this is the essence of the vaccination issue: an unvaccinated child is in effect playing in front of the ramp. Odds are good that, if we do nothing, they will be fine. But, then again, it is so easy to protect them from the danger, and the protection has so few risks, that to do otherwise seems nothing short of negligence.

Leaving this analogy behind, the issue is further complicated by the importance of herd immunity. An unvaccinated individual not only places themselves at risk, but provides a vector through which others- unvaccinated, immuno-compromised, or whose immunity has lapsed- can be infected. Thus, not only does an excessive delay endanger the child, it also endangers those around, including other unvaccinated children. I, of course, understand that you are not arguing against vaccination in general, but it needs to be understood that delaying vaccinations for no better reason than because it seems like it would be okay is, in fact, placing the child and their community at risk. And while I know that some argue that vaccination is "unnatural" and the body needs time to recover from it, the tendency is to vastly over-estimate how "unnatural" vaccination is. Consider that we all carry a sophisticated cellular response system for eradicating infectious agents. Vaccination simply gives this system experience with a weakened or dead form of a dangerous agent so that it can respond to the real thing more effectively. In other words, vaccines are a supplement to our natural defense. Antibiotics, on the other hand, are powerful but far more unnatural ways of fighting the same infection. Thus, in short, if you want to be natural, you want vaccines.

Turning to your other point, you ask that I not bash chiropractors so much. This is a reasonable request but I feel I should clarify that my intent was not to bash chiropractors so much as to bash chiropractic. I think that most of the practitioners of chiropractic are well-intentioned and, like you, simply want to help their clients be healthy. This is a respectable, even admirable, motivation. The problem is that the evidence indicating that chiropractic is actually useful in maintaining the health of the spine or nervous system is scant. Indeed, chiropractic was founded on the notion that disease is caused by misalignments in the spine (the infamous subluxations) and that spinal adjustments can, therefore, cure disease. By and large this has proven to be incorrect. Am I saying that chiropractors never help anyone? No, I'm not. Besides the simple benefit of the placebo effect, I do think that some ailments can be successfully treated by chiropractors. The thing is, such successes are in many ways accidental. Or, put differently, I might have a system for predicting what card will be pulled from the top of a deck and, even if my system is wildly inaccurate, it will still work every so often. Some ailments are amenable to chiropractic treatment just because of chance, not because chiropractic itself is a valid approach to treating disease. One might argue that chiropractic has changed since its origins and has become more scientific. Fair enough but, in this case, what is good or effective is less chiropractic and more medical or, in other words, chiropractors have become effective in proportion to their abandonment of chiropractic itself.

Again, I do not mean to be insulting so much as honest. I very much respect and commend your desire to help others. We both share such a desire. However, I view basing medical care decisions on flawed or non-existent research to be dangerous. At best, it exposes people to danger. At worst, it diverts their attention and financial resources from efficacious treatments towards nice sounding but ineffective bandaids. Thus, I must strongly contest your suggestion that spreading out vaccinations is without potential harm and question the usefulness of chiropractic.


Drek the Uninteresting

* Defined as, "Before blogger introduced tags."

** And perhaps thereafter as vaccines are not 100% effective for all individuals.

*** I do make a distinction between medical and scientific evidence and anyone who has seen the error bars at medical conferences will know why.

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Blogger JLT said...

"Antibiotics, on the other hand, are powerful but far more unnatural ways of fighting the same infection."

Most of the vaccines protect against viral infections that can't be treated with antibiotics. Once your child is ill its immune system has to get rid of the virus on its own.

That's why I can't understand anti-vaccine parents. There is no treatment, that's why we vaccinate. We can only treat some symptoms. Even in countries with high medical standards e. g. 1 of 2000 measle cases ends deadly. 1 in 10 develops an ear infection. 1 in 15 develops pneumonia. 1 in 1000 develops encephalitis which can lead to mental disability.
In pregnant women it can cause miscarriage and malformation of the child (and, because vaccination isn't 100 % effective, the best protection is if everyone around a pregnant woman is vaccinated, too).

Thursday, March 05, 2009 11:01:00 AM  
Blogger Tina "I" said...

"There is no treatment, that's why we vaccinate."

Really? So, what's your point. I had chicken pox, my children had chicken pox, and we are all super healthy.

I don't get the yearly flu like SO many pro-vaccination friends. And, funny thing is, many friends who DO get the vaccine, GET the flu!!

My kids never miss school due to illness. We are OVER-vaccinating our children.

People need to research and do what they feel is right for them. The gov't likes to make $$$ off those who blindly follow.

The reason nutrition is relevant to this discussion, is that we need to build a strong immune system so that our body can fight disease.

Research!! Pick and choose your vaccinations wisely.

Thursday, September 17, 2009 4:17:00 PM  
Blogger Drek said...

Tina "I":

I don't want to speak for JLT, but I think his point when saying "There is no treatment, that's why we vaccinate" was that we sometimes use vaccinations to combat illnesses for which there is no treatment. It's a pretty straightforward claim: some things can be prevented, but not fixed once they happen.

Your observation on chicken pox is a non sequitur. Lots of people got polio, too, and survived perfectly healthy. Unfortunately, lots of others ended up crippled or dead, too. That there were perfectly healthy survivors does not in some sense negate the reality of the deaths.

Let's take your claim that you never vaccinate for flu and never get sick while others you know who do vaccinate do get sick at face value. I know too much about confirmation bias to place much faith in arguments constructed on such a basis, but that isn't the point. I, in contrast to you, get the flu vaccination yearly because my wife has asthma. Before I started receiving the vaccine I sometimes contracted the flu. I have not gotten the flu once since I began vaccinating regularly. Obviously, our anecdotes cancel each other out, so we have to rely on population-level data and that data clearly indicates that vaccines reduce the incidence of the disease that is vaccinated against.

Leaving that aside, you're relying on a special case. Influenza (i.e. flu) is unusual in that it mutates so quickly that we produce vaccines based on our guess of what it will look like. As a result, sometimes the vaccine doesn't cover the actual main flu bug. With less protean pathogens, vaccines are obviously effective. How many of your friends have gotten smallpox, for example? Whooping cough (aka pertussis)? You can thank vaccination programs for your relative insulation from these diseases.

People do need to do research, but I would urge them to do what the weight of evidence indicates, not what they "feel" is right. Feelings are notoriously unreliable bases upon which to make medical decisions.

I couldn't agree more that proper nutrition is good for health. I couldn't agree less that proper nutrition is any substitute for vaccination.

If you'd like to continue this discussion, please respond, but if you do so, please provide something more than a set of half-assed bullet points.

Friday, September 18, 2009 12:30:00 PM  

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