I’m rather pleased by the nation-wide interest (no matter how niche) that my post on the previous Lincoln-Douglas high school debate topic generated. So let’s take a few moments to look at the Nov-Dec 2009 Lincoln-Douglas debate resolution: Public health concerns justify compulsory immunization. I am pleased that this topic smacks of higher social relevance than Yet Another Bloody Standardized Test, and I’m even more pleased to have an affirmative position that features exactly no jack-booted thugs.
That stated, let’s begin with how I’m opposed to the claim: Public health concerns justify compulsory immunization.
The crucial word to understand here is “compulsory.” It has a three-word definition of “required; mandatory; obligatory.” Now obligatory denotes either a moral or legal obligation which is “something by which a person is bound or obliged to do certain things, and which arises out of a sense of duty or results from custom, law, etc.” and that’s easy enough to ignore. People shirk their obligations and flake out on their duties with distressing frequency. But when you look at the “mandatory” word, things get a bit more intense because “mandatory” comes down as “authoritatively orderd… permitting no option; not to be disregarded or modified.” So that’s pretty serious — we’re going to try to force people to do something. But it’ll be justified (“to show a satisfactory reason or excuse for something done… to defend or uphold as warranted or well-grounded”) because The Public has concerns (“a matter that engages a person’s attention, interest, or care, or that affects a person’s welfare or happiness”) about The Public’s Health. And, just to be clear, The Public is “of, pertaining to, or affecting a population or a community as a whole,” and this is relevant when cross-applied with the definition of concerns because the concern for the public’s health is always going to be based in self-interest and is not intra-populous; to put it another way, I can’t cite “public health concerns” to justify compulsory immunization of a group of people of which I am not a member. This shouldn’t be a problem — if I can justify immunizing anybody, I really should be able to justify immunizing myself. (All definitional material taken from dictionary.reference.com‘s original sourcing.)
But we’re already on thin ice for affirmative ground: We’re going to justify policy actions that impinge on personal liberties based on something as fleeting as “a person’s attention, interest or care” in the age of the 24 hour news network? I would rather see “statistical evidence suggesting the potential for epidemic prevention” than “public health concerns” before I — or rather, the Government — tells people they must undergo a medical procedure. But the really distressing thing about the notion of mandatory medical procedures is that they diminish the distinction between free citizens and prisoners of the state. Kathy Swedlow, writing for the American Bar Association, says
“incarcerated individuals… have a reduced right to refuse unwanted medical treatment. Within prison walls the rights of the state must be balanced with the prisoner’s right to refuse treatment. Thus, the state may offer a variety of medical and legal reasons to forcibly administer medical treatment to a prisoner, including the need to quell the spread of disease within prison walls…”
Two key things jump out at me here. First of all, that there is a right of free citizens to refuse unwanted medical treatment. (And as long as health care is not socialized within the United States, that will certainly be the case — which, looking at Roe v. Wade, would be the top reason why liberals shouldn’t want public health care and neo-conservatives should, but I digress.) Secondly, that the state, when imposing medical treatment upon the incarcerated, meets a higher standard than mere “concern” to justify their actions. Certainly by the time they’ve provided those medical (or in some cases legal) reasons for imposed treatments they’ve had “concerns,” but the concerns are what caused them to do the work and research to have actual medical (or legal) reasons to impose medication. The point here is that even when the state does justify mandatory medical procedures on incarcerated wards of the state, they justify with rather more than mere “concern.”
But why wouldn’t somebody want to be immunized regardless of authoritarian mandate? Well, the simple fact of the matter is that medications usually have side effects. The CDC reports that the DTaP vaccine may, in rare cases, cause “Long-term seizures, coma, or lowered consciousness; Permanent brain damage.” I’m sure we can take comfort from their claim that “Life-threatening allergic reactions from [Inflenza] vaccines are very rare.” These are the rare worst-known-case scenarios, yes, but the “mild problems” for some vaccines can affect substantial — 25% or more — portions of the population. These are statistical risks that the CDC has tabulated against immunization and any free citizen getting immunized should be aware of these risks and make the conscious decision that they’d rather take the probably known risks with the medical procedure than roll the dice against a disease. And this year, I seriously considering getting a flu shot for the first time ever because I’m seeing reports like “Get That Vaccine, It’s Going to Be a Bad Flu Year” — but that’s just self-interest, not some external mandate. And as much as I would like my co-workers with the germ-infested larvae known as children, and as much as I would like my spouse who works the the wandering plague-bearing populous known as art students, and as much as I would like the people who are serving me my tasty lunch or measuring my feet for new boots or repairing my air conditioning to absolutely not be diseased because they’ve been immunized, the simple fact of the matter is that if I am really concerned about my health, then I should get myself immunized.
And this is where we call shenanigans on “Public Health Concerns.” Because as Margaret Thatcher pointed out, “There is no such thing as society. There are men and women, and there are families. And no government can do anything except through people, and people must look after themselves first. It is our duty to look after ourselves and then, also, to look after our neighbors.” To put it another way, if I have “public health concerns” that can be theoretically resolved by my being immunized, then I should be immunized. And while I may advocate that other people get immunized because being diseased, or losing out on opportunities for gainful employment because their children are diseased and they must tend to them, sucks, “getting sick sucks” isn’t sufficient ground for inflicting compulsory medical procedures on another free citizen.
Above and beyond all of this, though, is the simple fact that compulsory immunization based on “concerns” creates a fallacy of composition. If people are going to be mandatorially immunized, then the simple fact of the matter is that the disease can’t possibly be transmitted from last person yet-to-be immunized to anybody who already has been immunized. By that point in time, the public cannot possibly be having health concerns strong enough to warrant violation of that last person’s liberty. Thus, the last mandatory immunization breaks the use of “public health concerns” for its justification — the compulsory nature of it may be justified by normalized social actions and equality of the citizenry, but the concerns are no longer well-grounded enough to justify the action.
And that’s why I can’t agree with the claim that “Public health concerns justify compulsory immunization.”
But all of that relies on understanding — or rather the assumption — that the “public” is comprised at least everybody in my geographic community, with geographic limitations possibly being bounded by the jurisdiction of the US federal government, and the US federal government being the only suitable authority to make anything compulsory for said public. But the definition of public allows for “a” community, not “the” community, and if we specify which community we’re talking about to be one that has a different point of authority, we may get different results. This would be using the “a social, religious, occupational, or other group sharing common characteristics or interests and perceived or perceiving itself as distinct in some respect from the larger society within which it exists” definition of community which has become increasingly popular in these technologically advanced times.
So let’s try this on for size: The public we’re talking about is the community of people who have health insurance provided by a specific carrier. Maybe they are senators, maybe they’re Canadians, maybe they’re all just insured by a corporation like Blue Cross. The point is that they share a common characteristic — their insurance provider — and are commonly interested in having their medical bills paid by said insurance provider. Now as you are very probably aware, health insurance isn’t just a matter of “you go to a doctor and insurance foots the bill;” health insurance is “you go to an approved doctor for an approved procedure and then hopefully insurance foots the bill.” What this means, in terms of the relationship between the community and the insurer, is that the insurer is authoritatively legislating the extent of the service they will provide to their constiuency. Therefore, if a health insurance organization has concerns for its public’s health — say, with regards to Disease X — that could be averted by proactive immunization, then it seems entirely reasonable that they could mandate that anybody who expects to have medical bills associated with Disease X covered must also be immunized against Disease X.
So, for example, let us say that Blue Cross is looking at the possibility of an H1N1 epidemic. Blue Cross also sees that there is a H1N1 Flu vaccine available. It seems entirely reasonable for Blue Cross to tell the community of people insured by Blue Cross “We are concerned for your health due to the possibility of an H1N1 epidemic. We want every one of you to get immunized against H1N1. If you are not immunized against H1N1, then we will not cover any medical costs associated with you contracting H1N1 and needing treatment because, well, we told you so.” Playing it back, the insurance provider is using its authority as bill-payer to compel its public to be immunized against a disease on threat of possible bills not being paid. That’s the enforcement mechanism. There are no fascists here; no syringe-bearing jack-booted thugs. There’s just common sense: insurance companies shouldn’t have to pay for treating diseases that the insured public could’ve prevented with immunization, no matter how many times the disease-ridden populous try to foist the bill off to their insurer.
And why shouldn’t insurance companies have to pay the bills of those people who didn’t want to get immunized? Because they’re using their public’s money to pay the bills. That’s how insurance works — they collect money from all of their policy holders and give it out to the policy holders that need it. So if one policy holder needs $20 to cover an immunization and another policy holder needs $2000 to cover a hospitalization because they didn’t want to be immunized, then the insurance company is going to need $2020 to cover both claims — which, distributed amoung the two policy holders, means that the immunized (and fiscally responsible) policy holder got shafted to the tune of $990 by being in the same — very small — insured public as the one that got hospitalized. But the insured person never sees the uninsured person’s bill — the insured person only sees that health insurance costs are going through the roof (and possibly hears their employer lamenting about it on a regular basis).
So what it comes down to for the affirmative is this: given a community of people insured by a common entity (thus forming a public), when faced with a disease for which a vaccine exists, some people are going to get immunized against the disease. If it is reasonable — and concerning — to expect that the disease poses a significant enough risk to the health of the public, then in the interests of fiscal equanimity and fiduciary responsibility, above and beyond just wanting people to not have to suffer through preventable diseases, it is not only justifiable but should in fact be expected that health insurance companies compel their policy-holding public to be immunized against the disease as a condition of having medical bills associated to that disease covered.
And that’s why, as a healthy person paying for health insurance — for myself, my spouse, employees of my federal government, and probably an awful lot of my fellow citizens within the next few years — I can stand firmly resolved that “Public health concerns justify compulsory immunization.”
Immunization does not necessarily confer immunity. The American Heritage New Dictionary of Cultural Literacy, Third Edition, cited by dictionary.reference.com, defines immunization as “The process of inducing immunity, usually through inoculation or vaccination,” while Merriam-Webster’s Medical Dictionary clarifies that vaccination is merely “the introduction into humans or domestic animals of microorganisms that have previously been treated to make them harmless for the purpose of inducing the development of immunity” — with the crucial phrase being “inducing the development of immunity.” Even when people are immunized — and this is regardless of whether or not they are immunized voluntarily or are under compulsion — they might not develop the immunity. For the affirmative, this gets rid of the negative’s fallacy of composition argument since immunization doesn’t guarantee immunity and thus public health concerns may linger while for the negative this argument comes out saying that we shouldn’t be justifying violations of rights-of-self with stuff that doesn’t even necessarily work. But this has additional implications, described by Brownlee and Lenzer, 2009, (and cited more in just a moment): “All vaccines work by delivering a dose of killed or weakened virus or bacteria, which provokes the immune system into producing antibodies. When the person is subsequently exposed to the real thing, the body is already prepared to repel the bug completely or to get rid of it after a mild illness… Unfortunately, the very people who most need protection from the flu also have immune systems that are least likely to respond to vaccine.” Which is to say that if you’ve got a strong immune system — and shouldn’t be concerned — already, then a vaccine will probably immunize you, but if you’ve got a weak immune system and should be concerned, then a vaccine may not help you much at all. For the negative, this (again) means that public health concerns can’t be solved by vaccinations, compulsory or otherwise, so making them compulsory can’t be justified. For the affirmative, however, it means that even if I trust my immune system to be able to handle the disease, I should still — and may be obligated to — get vaccinated against it to help protect the frail people with weak immune systems that won’t be helped by being vaccinated themselves.
Overall, that isn’t to say that vaccines don’t work, just that they might not work. Shannon Brownlee and Jeanne Lenzer have an impressive article in The Atlantic on immunizations and flu treatments and skepticism about their efficacy, which would be a major component of a myopic negative case. They provide the refutation that the affirmative needs for a flu-obsessed negative case right in their article. The main counter-argument would be that we’re not just talking about the flu; we’re talking about any hypothetical disease and vaccinations do have a good track record. “Public-health officials consider vaccine their most formidable defense against the pandemic—indeed, against any flu—and on the surface, their faith seems justified. Vaccines developed over the course of the 20th century slashed the death rates of nearly a dozen infectious diseases, such as smallpox and polio, and vaccination became one of medicine’s most potent weapons.” Furthermore, from that article, flu vaccines may not even immunize people against “the flu” and are therefore non-topical: “More than 200 known viruses and other pathogens can cause the suite of symptoms known as “influenza-like illness”; respiratory syncytial virus, bocavirus, coronavirus, and rhinovirus are just a few of the bugs that can make a person feel rotten. And depending on the season, in up to two-thirds of the cases of flu-like illness, no cause at all can be found… In addition, vaccine “mismatches” occurred in 1968 and 1997: in both years, the vaccine that had been produced in the summer protected against one set of viruses, but come winter, a different set was circulating. In effect, nobody was vaccinated.” To put it another way, if a vaccination successfully induces the development of the wrong immunity, then the person in question was, for all intents and purposes, not immunized. (Except that the negative should turn that last bit right around because the debate is on the compulsory nature of this process and it doesn’t matter whether the stuff in the syringe is the right stuff or not, the question is whether or not public health concerns can be used to justify jabbing people with syringes. And it goes back to the point that the “concerns” might not be valid ones, so no, we can’t justify violations of rights-of-self with mere concerns.)
Moving on to a crucial policy point, Brownlee and Lenzer observe that reliance on vaccines to provide immunizations that should lead to immunity tends to detract from our willingness and ability to pursue other pandemic-mitigation strategies: “The other possibility, of course, is that we’re relying heavily on vaccines and antivirals that simply don’t work, or don’t work as well as we believe. And as a result, we may be neglecting other, proven measures that could minimize the death rate during pandemics. “Vaccines give us a false sense of security,” says Sumit Majumdar. “When you have a strategy that [everybody thinks] reduces death by 50 percent, it’s pretty hard to invest resources to come up with better remedies.”” Looking at alternatives, we can view Mexico and the UK and constrast their “social distancing” compared to the vaccinations we prefer in the US. They continue, “In Mexico, for instance, where the first swine flu cases were identified in March, the government launched an aggressive program to get people to wash their hands and exhorted those who were sick to stay home and effectively quarantine themselves. In the United Kingdom, the national health department is promoting a “buddy” program, encouraging citizens to find a friend or neighbor willing to deliver food and medicine so people who fall ill can stay home. In the U.S., by contrast, our reliance on vaccination may have the opposite effect: breeding feelings of invulnerability, and leading some people to ignore simple measures like better-than-normal hygiene, staying away from those who are sick, and staying home when they feel ill.” This last point is particularly crucial, and Brownlee and Lenzer revisit it — or rather, send it to a hospital to encounter all the diseases that are going around. “Late last spring, as headlines and airwaves warned of a possible pandemic, patients like [Dr. David] Newman’s began clogging emergency rooms across the country, a sneezing, coughing, infectious tide of humanity more worried than truly sick, but whose mere presence in the emergency room has endangered the lives of others. “Studies show that when there is ER crowding, mortality goes up, because patients who need immediate attention don’t get it,” says Newman, the director of clinical research in the Department of Emergency Medicine at the hospital, which is affiliated with Columbia University… when patients with even mild flu symptoms show up in the hospital, they vastly increase the spread of the virus, simply because they inevitably sneeze and cough in rooms that are jammed with other people.” So did the negative side catch all that? By the time a specific disease is pandemic-looking enough to possibly warrant compulsory vaccinations, what people really should be doing is not all coming together and sharing their plethora of germs while waiting in line to get jabbed by a needle; to do exactly that — which is what happens — is to harm the collective public health, especially since the people most likely to be concerned are the ones with weak immune systems that won’t develop immunity from the vaccination but will catch whatever other communicable diseases have been brought to the waiting room. To which the affirmative should respond — if they were clever enough to used a limited definition of public such that a non-legal authority is doing the compelling — that “pandemic” is not part of the resolution; any public health concerns (like continuing to be concerned about polio or smallpox in this day and age) will do — excepting that there’s also no “on balance” or “may” in the resolution; it’s a blanket justification and a negative ballot. The better affirmative response would be that the method of vaccination isn’t prescribed by the resolution and the future of medicine is moving more towards distributed in-home self-care due to the elderly-intensive shift in national demographic which will mitigate these risks, so the implementation is moot when we’re asked to be resolved about the justifiability of compulsion in 32-ish minutes.
But getting back on the possibility that vaccinations don’t lead to immunity, the final point I wanted surface from the Brownlee and Lenzer article is that diseases are living organisms as well and just as subject to natural selection as the rest of us — which means, unfortunately for us, that the more aggressively we kill them off, the stronger the ones that survive and thrive (and don’t have to compete with their peers that we killed off for the resources) will be. “Guidelines issued by the New York City Department of Health, says Newman, “encourage us to give a prescription to just about every patient with the sniffles,” a practice that some experts worry will quickly lead to resistant strains of the virus… Indeed, that’s already happening. Daniel Janies, an associate professor of biomedical informatics at Ohio State University, tracks the genetic mutations that allow flu virus to develop resistance to drugs. Flu can become resistant to Tamiflu in a matter of days, he says. Handing out the drug early in the pandemic, when H1N1 poses only a minimal threat to the vast majority of patients, strikes him as “shortsighted.” Indeed, samples of resistant H1N1 were cropping up by midsummer, increasing the likelihood that come late fall, many people will be infected with a resistant strain of swine flu.” And when that disease — which now comes fortified with its human-resistant genes such that everybody will be getting it at full-severity — starts spreading again, we’ll have to come up with some new and different way to get rid of the disease. Or we could just call in sick and help keep the disease from spreading in the first place, regardless of whether or not the compulsory vaccinations that the public subjected itself to adequately induced the development of immunity to whatever it was the public was concerned about.
On the whole, this looks like another negative ballot. The public tends to be readily concerned, but not necessarily well-informed. Vaccines do not guarantee immunity any more than a placebo can qualify as “immunization,” therefore any concerns of the public that might be well-founded and used to justify a policy response cannot be genuinely assuaged by compulsory immunizations, so what we’re left with is ill-founded concerns that could be assuaged by a compulsory action — but can’t really be used to justify the compulsory nature of that action. And that’s a substantial part of the ground covered by a resolution that clearly reads “Public health concerns justify compulsory immunization.” It doesn’t say “in cases where immunization is proven effective, like polio and smallpox and the like.” It includes it, but is not limited to it. The resolution, in its fatal brevity, includes the spurious concerns of The Public that has, historically, been flim-flamed by charlatans and snake-oil salesmen and 24-hour news networks and wants us to use those to justify compulsory medical procedures which may or may not confer any benefit upon the recipient, but will make The Public feel better about its health until… next week?
No, Public Health Concerns do not currently justify anything. If they did, then smoking would be outlawed. High-fructose corn syrup would not be subsidized. Aspartame would not have been approved by the FDA, to say nothing of rBGH. And, honestly, we’d be much more interested in obesity-avoidance over the lifetime of any and every individual than any trivial diseases that come and go in a matter of days. But we’re busy hocking hair transplants, erectile dysfunction pills, in-vitro fertilization and, yes, speculative flu vaccinations because that’s what concerns the public rather than necessarily providing for its collective better health.
And if this were an After-Dinner Speech, the toast would be “So this tincture is for you, America. Here’s to your health.”
But it isn’t. It’s a debate. And the simple fact of the matter — looking at polio, measles, smallpox, etc — is that humans can develop herd immunity through mass-vaccinations. Dr. Harriet Hall writes in “Vaccines and Autism: a Dangerous Manufactroversy” that a decline in vaccinations has resulted in the “return of endemic measles in the U.K. and various outbreaks of vaccine-preventable diseases in the U.S. [C]hildren have died. Herd immunity has been lost. The public health consequences are serious and are likely to get worse before they get better…” The source article is specifically concerned with parents who don’t vaccinate their children based on the fear that vaccines may cause autism. In case the negative suggests that the public is concerned with negative health impacts from vaccines, the introduction to Dr. Hall’s article is a choice response:
The evidence is in. The scientific community has reached a clear consensus that vaccines don’t cause autism. There is no controversy… There is, however, a manufactroversy — a manufactured controversy — created by junk science, dishonest researchers, professional misconduct, outright fraud, lies, misrepresentations, irresponsible reporting, unfortunate media publicity, poor judgment, celebrities who think they are wiser than the whole of medical science, and a few maverick doctors who ought to know better.
The article also brings the consequences of measles returning to the U.K., steps through each of three “vaccines are scary!” points, and their subsequent discrediting. If the affirmative is concerned that the negative may run a case with Dr. Wakefield, Mark Geier, Dr. Gordon, Oprah or Jenny McCarthy cutting loose with fearmongering, Dr. Hall’s writing may help to counterpoint it.
The negative (that was running Oprah and McCarthyism), in rebuttal, would want to look at Dr. Hall’s article and say that the concerns of the public, as delivered to them by Jenny McCarthy and Oprah, don’t stop being concerns just because they’re not legitimate concerns. The word “legitimate” does not appear in the resolution. So the affirmative, in essence, is still trying to violate rights of self for any spurious reason that the torch-and-pitchfork-and-Oprah-watching crowd can toss out.
And then the affirmative would want to conclude that the mass of doctors that have legitimate concerns for public health, combined with the societal benefits that can be reaped from mass-vaccinations (we call it “dead kid prevention”), justify compulsory immunizations because 1) illegitimate concerns don’t somehow unjustify legitimate concerns and they certainly don’t undo the very real benefits of mass-vaccinations and 2) immunization is not some reckless fad and the fact that any concern is adequate to justify it doesn’t translate into any concern justifying investing in torch-and-pitchfork companies which is exactly where the negative was trying to fallaciously slippery-slope that last argument down to. To put it another way, do we really trust our health to the currently heart-felt beliefs of a Playboy bunny or to the scientific conclusions of the medical community? Because even if the negative successfully severs case for its rebuttal, the fundamental question still comes down of “Whose opinion do you listen to?” and being concerned about a fountain of illegitimate concerns — as the negative was in that rebuttal — really just says “We retain our right to be mislead by whomever Oprah chooses.” And when the public health is at stake, when children in first world countries are dying of preventable diseases because their parents are being mislead, that is not an acceptable position or value to hold.
That doesn’t mean, however, that people don’t cherish charlatans. Amy Wallace in Wired magazine’s November 2009 issue describes the situation as
This isn’t a religious dispute, like the debate over creationism and intelligent design. It’s a challenge to traditional science that crosses party, class, and religious lines. It is partly a reaction to Big Pharma’s blunders and PR missteps, from Vioxx to illegal marketing ploys, which have encouraged a distrust of experts. It is also, ironically, a product of the era of instant communication and easy access to information. The doubters and deniers are empowered by the Internet (online, nobody knows you’re not a doctor) and helped by the mainstream media, which has an interest in pumping up bad science to create a “debate” where there should be none.
Unfortunately, the existence of the debate, the ability of people like Jim Carrey to summarize vaccination advocates as “Grab ’em and stab ’em,” means that compulsory vaccination is a scary thing for the public. And this is relevant because one of the people being railed against — Paul Offit — acknowledges this when he says “People are getting hurt. The parent who reads what Jenny McCarthy says and thinks, ‘Well, maybe I shouldn’t get this vaccine,’ and their child dies of Hib meningitis… It’s such a fundamental failure on our part that we haven’t convinced that parent.” To put it another way, if our evidence, our proof, and our science in favor of vaccinations positive effects aren’t enough to convince people that we know more-and-better than a Playboy bunny, then we need to figure out how to put together better evidence, proof and science, not appeal for some kind of authoritarian mandate. Offit isn’t sure how to do this; he expects that it is an eventuality as more children die from easily preventable diseases. Wallace, however, takes a more Sagan-esque view of the torch-and-pitchfork crowd:
Looking back over human history, rationality has been the anomaly. Being rational takes work, education, and a sober determination to avoid making hasty inferences, even when they appear to make perfect sense. Much like infectious diseases themselves — beaten back by decades of effort to vaccinate the populace — the irrational lingers just below the surface, waiting for us to let down our guard.
And this trend toward irrationality is probably why Offit is right that the problem is one of convincing people, not compelling people. Because the truth of the matter is that all scientists and doctors are people, too, and may be prone to points of irrationality or fits of “geeking out” on something where even their slight potential for objectivity is compromised. And the beginning of individual rights is the right to disbelieve, to mistrust, to say “but you’re just another person — why should I trust you more than I trust myself?” The solution to that isn’t to make something compulsory, it’s to be more persuasive. But what will that take? Offit says “I used to say that the tide would turn when children started to die. Well, children have started to die… So now I’ve changed it to ‘when enough children start to die.’ Because obviously, we’re not there yet.”
So what is the evidence in favor of vaccines? Wallace hammers out a quick listing of success stories:
Before smallpox was eradicated with a vaccine, it killed an estimated 500 million people. And just 60 years ago, polio paralyzed 16,000 Americans every year, while rubella caused birth defects and mental retardation in as many as 20,000 newborns. Measles infected 4 million children, killing 3,000 annually, and a bacterium called Haemophilus influenzae type b caused Hib meningitis in more than 15,000 children, leaving many with permanent brain damage. Infant mortality and abbreviated life spans — now regarded as a third world problem — were a first world reality.
Clearly this doesn’t include the mis-targeted influenza vaccines, and we haven’t yet seen the natural selection in the listed diseases that would allow them to overcome the herd immunity we’ve developed to them. But the point is that science and progress are historically on the side of vaccines and, if you want to do a direct comparison to autism, diseases which are now preventable were causing brain damage in up to 35,000 children per year, paralyzing another 16,000 and killing 3000 more. And those are scary numbers. The problem is, the reason they don’t persuade, the reason they don’t compel people to act of their own volition, is that you can’t distrust a disease like you can distrust a person who says they want to protect you from that disease. Maybe if we had more reminders that these diseases are only out to thrive and do so by using and disposing of us such that “trust” doesn’t enter into it, people might think higher of the science. Perhaps some of the Giant Plush Microbes from ThinkGeek.com would be a good visual reminder — though it might help if they had huge fangs. Or the book The Complete Manual of Things that Might Kill You might just slake the public’s primal need to fear things. Or maybe if people as photogenic as movie stars and Playboy bunnies weren’t telling us that doctors were taking our money to brutalize our children by injecting them with toxins instead of harmless placebos.
So let’s pause here for a rationality check: if a vaccine vendor is motivated by greed, as claimed by Jim Carrey, then why aren’t they selling placebos which “might” not work — like any other vaccine — but also won’t directly cause any of those nasty and frequent side-effects, whether documented by the CDC or claimed by McCarthy? To not make and sell the cheap-as-water-and-liability-free placebos would be to raise expenses and introduce unnecessary liability, both of which run counter to the fiduciary responsibility that the pharmaceutical corporation owes its shareholders. Put another way, if they’re being greedy, they’re doing a poor job of it. Besides, as Offit expanded to Wallace: “Vaccines, after all, are given once or twice or three times in a lifetime. Diabetes drugs, neurological drugs, Lipitor, Viagra, even Rogaine — stuff that a large number of people use every day —that’s where the money is.”
(Did you catch that bit? Diabetes drugs [are] where the money is? While our government is subsidizing the corn that gets reduced to High-Fructose Corn Syrup? That is what successful greed looks like — continual mitigatory treatment of a condition so ingrained that the government is helping to facilitate its existence.)
But Wallace goes on to further discredit the irrationality of the anti-vaccine torch-and-pitchfork crowd. Of interest to debaters may be the rebuttal of Kennedy’s 2005 Rolling Stone article:
Robert F. Kennedy Jr., a scion of the most famous Democratic family of all, authored a deeply flawed 2005 Rolling Stone piece called “Deadly Immunity.” In it, he accused the government of protecting drug companies from litigation by concealing evidence that mercury in vaccines may have caused autism in thousands of kids. The article was roundly discredited for, among other things, overestimating the amount of mercury in childhood vaccines by more than 100-fold, causing Rolling Stone to issue not one but a prolonged series of corrections and clarifications.
This was reinforced by a study in mercury levels of autistic children in California. The Oregonian reported on October 20th that “In fact, researchers found that autistic children tended to have less mercury exposure than other kids, mostly because they ate less fish.” (The Oregonian also has links out to medical and research sites, if you really want to pursue this further.)
But let’s step back to the right to not trust somebody and take a brief tangent. One of the things called out in the film Food Inc. is how deeply entrenched in our government the Monsanto corporation is. Monsanto also figured heavily in The Corporation. As a corporation, I regard them with only slightly more fondness than I have reserved for Halliburton*. So our government getting agricultural advice from a corporation that holds patents on making plants sterile and actively sues farmers out of business strikes me as concerning. But I may just be buying into a failure-prone populist notion here, as Wallace expounds on:
Consider the CDC’s Advisory Committee on Immunization Practices, which reviews new vaccines and administration schedules: Back in the late ’90s and early ’00s, Offit was a member of the panel, along with experts in infectious diseases, virology, microbiology, and immunology. Now the 15-person panel is made up mostly of state epidemiologists and public-health officials… That’s not by accident. According to science journalist Michael Specter, author of the new book Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet and Threatens Our Lives, the controversy surrounding vaccine safety has made lack of expertise a requirement when choosing members of prominent advisory panels on the issue. “It’s shocking,” Specter says. “We live in a country where it’s actually a detriment to be an expert about something.” When expertise is diminished to such an extent, irrationality and fear can run amok.
Which it does anyway, but now the decision makers are being precluded from having expert advice because the public is afraid that the de facto psychopathic behavior of the corporation has tainted the brilliant and luminary experts that the corporations hired to create the products that the corporation needed to sell to make money. To rationalize it, the thinking is “We know that the entity which has subsidized your becoming the recognized expert you are in your field cannot be trusted to have, and therefore act in, good conscience and thus we do not, on face, trust you to act in good conscience in these matters either.” And because it can be thusly rationalized, corporations are increasingly wanting to be viewed as “good citizens,” as having a conscience such that the public — whether prone to fits of torch-and-pitchforkism or just rationally cautious as any properly skeptical scientist should be — won’t transfer the amorality of the corporation along with the credentials of the corporation to the expert that is theoretically trying to serve the public in a moral and conscientious fashion.
Anyway, back on topic. Wallace has loaded down her extensive article with a lot of good information and poignant anecdotes. Probably the most relevant to forming an affirmative case would be her clarification on the value and benefit of developing herd immunity:
Ah, risk. It is the idea that fuels the anti-vaccine movement — that parents should be allowed to opt out, because it is their right to evaluate risk for their own children. It is also the idea that underlies the CDC’s vaccination schedule — that the risk to public health is too great to allow individuals, one by one, to make decisions that will impact their communities. (The concept of herd immunity is key here: It holds that, in diseases passed from person to person, it is more difficult to maintain a chain of infection when large numbers of a population are immune.)… The frightening implications of this kind of anecdote were illustrated by a 2002 study published in The Journal of Infectious Diseases. Looking at 3,292 cases of measles in the Netherlands, the study found that the risk of contracting the disease was lower if you were completely unvaccinated and living in a highly vaccinated community than if you were completely vaccinated and living in a relatively unvaccinated community. Why? Because vaccines don’t always take. What does that mean? You can’t minimize your individual risk unless your herd, your friends and neighbors, also buy in.
This clearly reiterates my previous point: the choice to not vaccinate is not just a personal choice. It is a choice that the individual makes to put those around them at risk. And as a public, as a society, as a herd, it is within both the collective interest in the herd and the individual interests of every member of the herd to want the herd to be immune to a disease. Remember the fallacious fallacy-of-composition argument from before? This is where we reverse it. If everybody except me gets vaccinated on the known-wrong expectation that vaccines guarantee immunity, but I choose to not be vaccinated I am, in effect, accepting the risk of contracting disease but also re-surfacing the possibility that I will pass that disease on to friends, family, or loved ones — you know, the people you hope will care about and for you if you get sick — that explicitly took action to avoid contracting the disease. Suffice to say, such behavior is completely unfair to them. So even outside of the definition of “public,” holding as the negative perhaps might, that “there is no such thing as society,” the health concerns of the people who constitute my “herd” should be adequate for me to feel obligated and compelled to be vaccinated against the disease du jour, whether I’m concerned about Grandpa or my 1-year old nephew.
To put it another way: the McCarthy-centric negative wants us to be concerned about the damage we can do to ourselves with vaccines. I do not believe that this is a rational fear, but it may be, so we’ll let them keep their fear and not be vaccinated against, oh say, Hib meningitis. Which we may then infect them with because — on their advice — we didn’t see the point in being vaccinated either. As Offit concludes, “The choice not to get a vaccine is not a choice to take no risk… It’s just a choice to take a different risk, and we need to be better about saying, ‘Here’s what that different risk looks like.’ Dying of Hib meningitis is a horrible, ugly way to die.”
But how did we even get here? Carl Sagan, cited by Wallace, says that there’s always room for pseudoscience and its ilk when the facts that we’ve collected don’t meet the emotional needs of people — people trying to figure out what to do with the messy biological stuff that life is. I’m going to suggest, briefly, that the parents who are afraid to vaccinate their children are going to, pretty much categorically, be the same parents who will be unable to help their children with math and science homework. Intel released the results of a survey that showed while roughly 90% of parents of US teenagers believe in the value of math and science, most parents surveyed have trouble helping with math and science homework. Almost a quarter of the parents surveyed claimed they wanted to help, but just didn’t have enough knowledge to help. And while I can sympathize with the few parents who are gawking at the complexities of chemistry and calculus, wondering if their offspring will find more use for those subjects than they have, generally I would suspect that scientific illiteracy is spreading and making it increasingly difficult to learn hard-and-serious stuff and part of how it is spreading is the over-specialization of the economy has people not practicing math or science. Really, I’m a computer programmer and I’m probably incapable of solving most any calculus problem posed directly as such partly because I don’t see what the point of it is and mostly because it’s not relevant to my day-to-day livelihood. Honestly, if I didn’t actively read Burke, Bryson, Hawking and Sagan, I wouldn’t have a soapbox to stand on here. But the problem that we’re facing here isn’t how scientifically literate people or parents are, it’s how aware they are of their shortcomings and where they intend to go to cover their shortcomings. And we should be concerned that too many people and too many parents won’t know where to get sound advice when their information runs out — instead, they will pick up on whatever sounds like advice to the detriment of all involved.
Anyway, if you want to know how to win this debate…
The affirmative should focus on a small, confined definition of “public,” preferably with a strong definition of “concern.” Also, if you can neutralize the “compulsory” to avoid jack-booted thuggery, that’s a good thing. But really, you’re trying to paint a picture that shows that vaccinations aren’t dangerous, that everybody in your little herd of people should want them, and that voting against herd immunity is not just letting the person who’s going to get the disease take the risk, but also putting anybody whose vaccine didn’t provide immunity at risk — and that’s not socially acceptable.
The negative is going to want to focus on concerns and compulsions. The public is not rational. The anti-vaccine movement going on could be described as a “public health concern” that rails against compulsory immunization, even if all their concerns are a sham. The point is that you don’t want those people’s ruckus-making turned into an actual mandate — policy mandates needs to have higher standards of origin than mere “concern.” This means that you’re going to have to be ready to counter-define concern, and probably provide example phrases to justify why your definition of concern is more common parlance and grammatically correct.
Hope that helps.
Update: November 9, 2009
There is a depressingly stock Affirmative case in circulation — that is, of the two LD rounds I judged, I judged this case twice and it made me sad because the kids running it clearly didn’t know what they were running with, far more so the second time around than the first. The case doesn’t have a definition of concern, has a sorely unused value of life, a generally ignored criterion of utilitarianism, a contention about how nice herd immunity is, and some dodgy bit about executive power as defended by the US Supreme Court. It’s pretty easy to recognize, especially when they say “no pun intended.” This is what I would like to see used to utterly break it.
A good negative case should start with an aggressive cross examination:
- Do a soft-frame the debate on the United States with a question like “Your second contention relies on a Supreme Court opinion; can we agree to debate this resolution as if it specified a jurisdiction of the United States, supported by model information from other nations?” The affirmative should want to agree to this; if they don’t then they just dropped their second contention because the SCotUS can’t justify anything outside of the US.
- Call them out on the people who can’t get or won’t be immunized by vaccination. “Just to clarify, your definition of compulsory does not include people who are allergic to a vaccination? And you are aware that the act of vaccination does not always lead to the state of immunization?” The first, on this affirmative case is absolutely true and the second is scientific fact regardless of whether the affirmative knows their case well enough to agree with it. This is where we’re going to break their herd immunity, but let’s move on to ask…
- “How do we know who is allergic to a vaccination?” Because I’d bet that they don’t actually know. And a brief display of ignorance on the affirmative’s part is bad for their credibility and good for yours. Even if they do know — doubtful — they’ll probably describe a somewhat unpleasant, inconvienent medical procedure that will bolster the case you’re about to run. If you’ve got ample time — you should — you can expound on this if you’d like.
- And now we frame the compulsory part in a bad kind of way: “While I expect that we can agree that vaccines are, for the people on whom they are effective and don’t have negative side-effects, a generally good thing, would it make you nervous if I told you that I’ve got a syringe in my pocket that you must allow me stick in you because it’s a generally good thing? I can assure you that I’m only doing so because I’m concerned for my health because I don’t know where you’ve been…” If they say “OMG, what? No!” then they lose right there. But they may (lie and) say yes, but the question was for the judge anyway — you want to make the judge nervous about strangers with needles, big grins and the best of intentions.
That should set up the following oratory-oriented case, which runs more than seven minutes when read at a solid clip and thus you’ll need to nip-and-tuck it a bit to make it “yours,” which is good since I don’t want to judge just a stock case. Anyway, using almost exclusively evidence I linked to above, it goes like this…
“Just to be clear: Concerns, which the affirmative did not define, are “a matter that engages a person’s attention, interest, or care, or that affects a person’s welfare or happiness” (dictionary.reference.com). So this means that the affirmative is trying to justify policy actions that impinge on personal liberties based on something as fleeting as “a person’s attention, interest or care” in the age of the 24 hour news network. As the negative, I say we should demand something more than “concerns” in order to justify any authoritarian action.
Now that we’ve established that, I’d like to start by addressing their second contention, involving the Supreme Court saying it’s all okay because it isn’t. Free citizens in the United States — where the US Supreme Court has jurisdiction — are free to refuse medical procedures as demonstrated by citing of religious exclusions and the like. Kathy Swedlow, writing for the American Bar Association in 2003 says “As a general matter, most of us are free to refuse unwanted medical treatment, even when such treatment may be in our best medical interests; in most circumstances, we may choose to decline blood transfusions, refuse to accept lifesaving cancer treatments, and decide not to vaccinate our children… In the context of the criminal justice system, however, incarcerated individuals… have a reduced right to refuse unwanted medical treatment. Within prison walls the rights of the state must be balanced with the prisoner’s right to refuse treatment.” Acceptance of absolute governmental authority in this situation is a direct detriment to our rights as free citizens and should be rejected, and unless the card presented supporting their second contention was based on a landmark decision after 2003, I’d have to speculate that it only applies to the incarcerated.
The other half of the affirmative case rests on how wonderful herd immunity is. And herd immunity is great for generally preventing cows from getting sick and thus saving the lives of cows. But this is the only connection we’ve got between herd immunity and their abstract value of life because if we take them at the flat value of “life,” well, they’re pretty actively committing genocide against germs in violation of their value until they stand back up and — in a generally speciesist but acceptable way — clarify that they meant human life, which really has no connection to the mostly amoral (hedonistic at best) criterion of “utility,” especially since the affirmative hasn’t even attempted to measure any of the pains that they’re actively trying to inflict on other people against the happiness they’re trying to derive from such actions. And I say “trying” because it’s scientific fact that some people are allergic to or will not be immunized by whichever specific vaccination the affirmative wants to inject them with, so the utility that the affirmative is trying to achieve is already mitigated even before we’ve violated anybody’s human (not cow) rights. Above and beyond that, if we’re valuing human life, then we must value what makes them human instead of making them cows or germs — which is ultimately, as Sartre said, the ability to reject, to say “no,” to not be compelled. By trying to justify an authoritarian compulsion, the affirmative is actively de-valuing humanity in human life, which they can’t even really measure with a criterion like utility. So their reasoning behind justifying compulsory immunizations does not logically follow their value and should be rejected.
But herd immunity is a good concept and a nice thing to generally achieve, so let’s talk for a bit about why it doesn’t follow from public health concerns justifying compulsory immunization. In a large enough population, some people are going to be allergic to (and potentially harmed by) vaccines while some other people are going to have immune systems that don’t work with the vaccine to convey the person to that lovely condition we call “immunized.” This is just scientific fact. But the bigger issue is that you can’t identify these people just by looking at them — any more than you can identify somebody who rejects germ theory or thinks that Jenny McCarthy’s “mommy sense” is sound-enough science just by looking at them. And while we can compel the latter group of people to get vaccinated, we can’t compel an immunity into the first group which will always be at some degree of risk from people like themselves. They can’t get away from that.
So not knowing who these people are — could be me, you, the affirmative — we should look at this resolution through John Rawls’ veil of ignorance from “A Theory of Justice,” which wikipedia nicely summarizes as “a method of determining the morality of a certain issue… based upon the following principle: imagine that societal roles were completely re-fashioned and redistributed, and that from behind your veil of ignorance you do not know what role you will be reassigned. Only then can you truly consider the morality of an issue.” So from behind our veil, we’ve got a few roles to look at: Some people will go out and get vaccinated and be immunized. And some people won’t. And some people can’t. Not knowing which group we’re going to be in, how should we behave? The affirmative position is very supportive of a person who can’t, boiling down to “I’ve got a syringe in my pocket that you must allow me stick in you because I’m concerned for my health because I don’t know where you’ve been…” But when multiple people who can’t be immunized come together, the supposed benefits of the affirmative position which rely on successful vaccinations fall apart — even without making the people who would voluntarily be vaccinated nervous or directly violating the rights of people who don’t want to be vaccinated.
How should people who don’t want to get sick behave, given that they don’t know whether or not they can rely on vaccines, even if there are vaccines to the diseases they don’t want to get and there is an ample supply of the vaccines? Shannon Brownlee and Jeanne Lenzer compare pandemic control techniques in Mexico and the UK to the US in the November 2009 edition of the Atlantic and report that
“Washing hands diligently, avoiding public places during an outbreak, and having a supply of canned goods and water on hand are sound defenses, he says. Such steps could be highly effective in helping to slow the spread of the virus. In Mexico, for instance, where the first swine flu cases were identified in March, the government launched an aggressive program to get people to wash their hands and exhorted those who were sick to stay home and effectively quarantine themselves. In the United Kingdom, the national health department is promoting a “buddy” program, encouraging citizens to find a friend or neighbor willing to deliver food and medicine so people who fall ill can stay home… In the U.S., by contrast, our reliance on vaccination may have the opposite effect: breeding feelings of invulnerability, and leading some people to ignore simple measures like better-than-normal hygiene, staying away from those who are sick, and staying home when they feel ill.”
And that’s crucial. By thinking without the veil of ignorance, Americans are lead to believe either that they can’t become ill or clustering up with all other marginally-ill people in emergency rooms at the first sign of any illness, whether they’ve actually got the disease the public is currently concerned about or — more commonly — not. So the point here is that if we really want to help the people who can’t be immunized (even if we could magically conjure up enough vaccine for everybody, which we know we can’t, especially for the multitude of diseases that we don’t have vaccines for) then our society should be more supportive of people who want to quarantine themselves.
Let me conclude briefly by going back and picking up on those public health Concerns. These are the concerns that cause the public to congregate in the ER where they can all share their various sundry diseases for which vaccinations do not exist and thus exacerbate pandemics. These are the concerns that Jenny McCarthy creates when she goes on Oprah and claims that her “mommy-sense” tells her that vaccines are a threat to people’s health. No, people are not behaving rationally here — but should we be surprised? A segment of the public was concerned that the President wanted to have “death panels” executing senior citizens to keep the cost of socialized health care low. These are the concerns of the public. And I don’t think they can possibly justify sticking a needle in me. If you want Public Health Concerns to justify anything, then please start by justifying an absolute ban on smoking. Please ban aspartame which has been linked to all manner of personal health problems and birth defects because the it digests down to three creatively toxic substances and nothing good. Please stop subsidizing the production of corn for the creation of high-fructose corn syrup which contributes to the rising tide of Type 2 Diabetes our society is currently facing. And please start by pursuing an agenda of obesity-avoidance to improve life-long health instead of panicking about diseases that generally pass in a matter of days. Public health concerns haven’t justified doing any of those things yet, so I really find it impossible to generally believe that public health concerns can justify compulsory immunizations, and strongly urge a negative vote on this resolution.“
When reading this, I hit the seven-minute mark at “I don’t think they can possibly justify sticking a needle in me.” Do trim to fit. Anyway, if the affirmative is lucky, they’ll be able to pull out
Dr. Harriet Hall writes in “Vaccines and Autism: a Dangerous Manufactroversy” that a decline in vaccinations has resulted in the “return of endemic measles in the U.K. and various outbreaks of vaccine-preventable diseases in the U.S. [C]hildren have died. Herd immunity has been lost. The public health consequences are serious and are likely to get worse before they get better…”
except that the problem is that Dr. Hall prefaced that statement with “Thousands of parents have been frightened into rejecting or delaying immunizations for their children,” which is to say “public health concerns justify an avoidance of immunizations” which goes back to Jenny McCarthy and how dumb people are. Good science and medicine, not mere “concerns,” should justify compulsory immunizations, and that’s why this resolution should always produce negative ballots unless the affirmative did something very clever with their framing which — in this case — they absolutely did not.
Update: November 10, 2009
Slate has an article which puts a more-human face on the kids who can’t be vaccinated — specifically the kids who have cancer, especially leukemia. It has a couple of (unsourced) accounts of unvaccinated kids sharing diseases and talks lightly about the science of immunization and how immunities get wiped out by chemotherapy and the like. Unfortunately, the article is — frankly — rife with bitchy entitlement, featuring gems like
My son… can’t go into day care because of unvaccinated children… For now, we will hire an at-home sitter for him. It’s more expensive and not what we had wanted, but it’s the best, safest option… [Because of parents that exempt their children from vaccination] my son will not be able to attend a day care that would have been magical for him.
without ever realizing that day care isn’t a right and, more grievously, that her son also isn’t vaccinated and therefore brings the exact same risks for anybody just like him as I described just yesterday in the negative case featuring John Rawls’ veil of ignorance filter. So it’s good evidence for the affirmative if dealing with an incompetent negative, but it should be easy to blow away if the negative can spot the obvious flaws in it.
* In case you’re not sure how much this is, I purged a well-performing mutual fund — Brandywine Blue — from my 401k after they sent out a report saying they were pleased with how Halliburton was performing.