Tuesday, February 3, 2015

Playing the Odds

I am going to begin and end this post with the same words, just so there is no misunderstanding: Get your children vaccinated.

That said, the recent outbreak of measles has prompted a national debate on the question of vaccination, and whether it should be mandatory. I was surprised to learn that about sixteen percent of parents choose not to vaccinate, and in some communities, like Santa Monica and Beverly Hills, the rate is much higher. The primary reason for this reluctance to vaccinate is the concern of parents that vaccination may cause autism.

Now, there is, so far as I understand it, no scientific evidence linking vaccination and autism, though there is some anecdotal evidence. And anecdotal evidence, while it can be emotionally affecting, is virtually worthless in determining matters of public policy, and even of personal decision-making. I once had a young woman tell me that she needn't stop smoking because her grandmother smokes and is healthy and 80 years old. There is simply nothing to this kind of reasoning, and it should not be allowed to determine important decisions.

One of those important decisions is whether or not to vaccinate a child. The autism link that has moved many parents not to vaccinate seems to have been alleged in a published study of a very small sample of children. That study has been discredited, and its author, I learned today, has lost his medical license. Nonetheless, the idea has stuck with some people, usually fuzzy thinkers who believe that disease can be prevented by eating natural foods and practicing holistic medicine, which explains, I suppose, why the rate of non-vaccinators is so high on the West Side of Los Angeles.

(I was stunned this morning when I heard the chief political correspondent for the Huffington Post declare on MSNBC {Yes, I do watch it occasionally.}, that the Koch Brothers are responsible for the measles outbreak. His logic ran thus: Right-wing parents who mistrust the government opt out of vaccination because they think there is a government conspiracy to harm their children. They are, he said, the same kinds of people who deny climate change because they listen to media outlets funded by the Koch Brothers. So: Conservative activists, right-wing media, climate change denial, no vaccinations, measles outbreak in California. And Rachel Maddow just nodded and did not object, and thanked the man for his input. And so, the measles has, inevitably, become a divisive political matter, as does everything in America these days.)

I can remember vividly sitting in the pediatrician's office with my first son on my knee while she held the vaccination needle in her hand. I balked. Though he was very young, I could see that he had a remarkable brain, was highly intelligent, and I had heard the rumors about autism. I agonized over the possibility that he might have an allergic reaction to the vaccine which would damage that beautiful mind. And so I spent a lot of time talking to the doctor about it, before I finally agreed to go ahead. She vaccinated him, and nothing bad happened. He was the first of my vaccinated genius children.

But at least the pediatrician took the time to talk to me, and let me decide. And I made the right decision, primarily on the basis that there was a 99% probability that my son would have no adverse reaction to the vaccine.

Now this is the point I would like to make, and I hope that parents will listen to it. Every major decision you will make in your child's young life will involve risk of some kind. There are simply no guarantees in parenting. What you must do as a responsible parent is to play the best odds you can get. If, for example, you went to Vegas and were told that there was a 99% chance that you would win at a game, wouldn't you take those odds? Of course you would. That is what we as parents must do, especially in matters of our children's health and well-being.

There are now calls for legislation to require parents to vaccinate their children, and I am quite sure that such a bill will be introduced in Congress in the near future. And if the Congress can mandate that we buy health insurance whether we want to or not, what is to stop it from mandating that we vaccinate our children whether we want to or not? Imagine the spectacle: Parents who for whatever reason refuse vaccination are arrested, their children taken away by police, and a needle jabbed into their flesh against their parents' wishes. It would be the public health equivalent of Elian Gonzales.

We live in a putatively free society, and the children are ours. Not our property - our children; there is a difference. And we must have the freedom to raise them as we think best. Still, I have held for years that no parent has the right to volunteer his child to suffer for his beliefs, no matter how strongly he holds them. This is equally true in matters of religion and health. Thus, those parents who refuse vaccination on religious grounds are not taking a risk: they are volunteering their children to take that risk. And I believe it is wrong for them to do this.

If there is an overwhelming probability that vaccinating your child will mean he or she will never contract measles, mumps, rubella, smallpox, tuberculosis, scarlet fever, typhoid, typhus, tetanus, polio, pneumonia and other diseases that have ravaged human history, you have a responsibility to play the odds and get the vaccine.

But that being said, the government should not be allowed to compel you to do so under penalty of law. This would only further intrude the power of government into our personal lives, narrowing our freedom of choice, and infringing our personal liberty. And that is too heavy a price to pay in response to 100 cases of measles. What then should be done?

If parents feel they have compelling reasons to refuse vaccination, and insist on doing so despite all the evidence to the contrary, and despite the overwhelming probability that nothing will bad will happen, and knowing what the consequence may be, then they must take the consequences on themselves. Their children will not be allowed to attend school, but must be home-schooled, or must attend a school with other non-vaccinated children. If a child becomes ill, the parents cannot insist that the rest of us pay for his treatment. If the child suffers serious or permanent damage (which, though unlikely, is possible), then they alone are responsible for paying the cost of care. In short: If you choose not to vaccinate, you, and you alone, are responsible for the consequences.

Of course, as I have said, it is not the parents who will suffer the most serious consequences of the decision not to vaccinate - it is the children who will. And because this is true, and because the children are our responsibility (not property), we must play the odds, which are overwhelmingly in our favor, and get our children vaccinated.