Tuesday, April 28, 2015

tamie's thoughts on vaccinations for children

A few weeks ago I wrote this letter to the editor here in Sitka, after going to a pro-vaccination talk given by a local pediatrician. I'd like to share it with all of you. It's not pro-vaccination and it's not anti-vaccination. It's about what I think is one thing that needs to happen in order for the pro and anti people to be able to really talk to each other.



Dear Editor:

Last night I attended by first “Doc Talk,” by pediatrician Dr. David Vastola, about childhood vaccinations. Few topics are as socially divisive as vaccinations! I appreciated Dr. Vastola’s thorough preparedness, and I learned a lot. He explained well what he (and the American Medical Association, and World Health Organization) views as an essential part of keeping not just one’s own children, but the whole world, safe.

However, there is one area in which I wish to quibble with Dr. Vastola, and that is in his explanation about why it is that the largest demographic (in the U.S.) currently refusing to vaccinate their children are educated, upper-middle class people. My memory is that he attributed this reality to that fact that that demographic is the portion of America that reads the most, and there is a huge amount of anti-vaccine literature available. The implication seemed to be that, although they read, they are not discriminating readers, and aren’t able to parse fact from snake oil.

As an educated, upper-middle class, white woman of child-bearing age(I don’t have children), I’d like to offer an alternate explanation. “Educated” means that most people in the demographic under discussion have gone to college, and many have attended graduate school. In college, particularly in the arts, humanities, and social sciences, one encounters implicit and explicit critiques of authority and the kind of hierarchical power structures that American medicine has historically enjoyed being at the top of. Every discipline from history to sociology to journalism is rife with stories of authority figures using their power for harm, or simply not knowing what the heck they were talking about (and so inadvertently causing harm). All of those disciplines, and a whole host of others, devote years worth of classes to deconstructing and criticizing the kind of authoritative, top-down worldview in which “experts” disseminate commands to the passive masses. And yet, that authoritative worldview is still the dominant one in the medical community. (Though I do not accuse Dr. Vastola or any other specific doctor of advancing that worldview.)

I think what we have is a deeper problem than what Dr. Vastola seemed to imply last night—that people don’t vaccinate their children because they read things, but don’t read critically. No doubt non-critical engagement with all kinds of media is a gigantic problem in America, and educated upper-middle class folks aren’t immune from sloppy thinking. But in the specific case of educated, upper-middle class people refusing to vaccinate their children, I believe there is a worldview clash taking place, in which one group of people are demanding the masses submit to the authority of science, statistics, and a medical worldview, and another group of people are resisting being (as they think of it) hornswaggled by the authorities (and hasn’t history given us limitless reasons to distrust authorities of every kind?). The situation isn’t helped, of course, when anti-vaccinators try to talk to doctors and are met with either derision or a gentle condescension, which only confirms their suspicions that doctors are operating within an antiquated and wrong-headed worldview. (Obviously these are generalizations; no doubt many doctors defy the norm, and quite plausibly Dr. Vastola is among them).

My point is this: until the American Medical Association and its members take seriously legitimate critiques of the power it has long enjoyed and assumed—until we can have a conversation about that—the vaccination conversation (a crucial converastion!) isn’t going to find its feet.

Thanks to Dr. Vastola, and to everyone who makes the “Doc Talks” possible.

20 comments:

  1. I read somewhere, and I can't remember what it was called, about a fallacy where someone believes they are experts about a certain topic, simply because they've had a bit of education about it. In this way, a little education (typical undergrad degree, for example) can be much more dangerous than no education at all.

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    1. And also, thanks for responding to some of my posts lately. It makes me want to write more proper posts, not just post quotes!

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  2. I agree with you! I remember reading the quote, "A little knowledge is a dangerous thing." Who said that?

    Sorry that the formatting of this letter was weird. I didn't realize it until just now.

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  3. I'm not dogmatic on things like this by any means but I have always had a cynical view of the anti-vaccination movement. I feel like it may be an example of how privilege works. Privilege means having the luxury to construct an entire parallel universe of one's own beliefs and preferences, for better and/or for worse. If I were underprivileged and just barely getting by, I simply wouldn't have the time or energy to get involved with such a cause. However I might feel about my doctors, essentially I'd accept that following the doctor's advice is easier than finding a viable alternative.

    Maybe I have a larger issue with the way that privilege allows one to be "progressive" in all sorts of ways: recycling, carbon reduction, food allergy awareness, personality type awareness, etc., just about everything BUT the issue of privilege itself. It's not a bad thing, necessarily, but it is, at the very least, unfortunate that we allow our conversations on vital issues to become a cult of the educated, when it could be a much broader and richer discussion if more people were involved.

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  4. I think that there just can't be any doubt that you're right that it's a mark of privilege to be able to decide whether or not to vaccinate your children. For example, I think about the student I had last year in one of the college classes I taught. He was from Nigeria, and had polio as a child. His legs were deformed and exceptionally short and he could barely walk. The poverty he grew up in meant that he and his family didn't get the luxury to have a fancy debate about vaccinations. And he's just one example of so many, of course, of people around the world that would give all the money they have to be able to vaccinate their children.

    At the same time, from my casual observation of my friends who are anti-vaccination, I think that a lot of what is happening for them is that they are aware that the American medical establishment over the years have said a lot of stupid and harmful things about pregnancy, childbirth, and raising young children. And so they don't trust the medical establishment, when it comes to raising their kids. I think that's a legitimate line of reasoning. And it's a legitimate line of reasoning that the medical establishment hasn't taken seriously.

    You know, I was thinking, Kristen, about what you said yesterday that a little knowledge can be dangerous. And I agree. But the thing is that I only have a tiny amount of knowledge about vaccinations. I basically know nothing about them. I've trusted that the authorities are telling me the truth when they tell me that good stuff is inside the needles that they're pushing into my skin when they vaccinate me. But authorities--including doctors--make mistakes and fuck things up and outright lie to us all the time. Science has been wrong a million times. And I think this is probably the anti-vaccination people's position. They would agree that a little knowledge is a dangerous thing, and explain that this is why we shouldn't just blindly trust that the science textbook we read in 7th grade about vaccinations.

    (Just to be clear, if I had children, I would vaccinate them. But I also think that my friends who've chosen not to vaccinate their children have been more proactive about educating themselves than my friends who've chosen not to vaccinate, and I have a lot of respect for how proactive and intentional groups like attachment parents try to be. I also think that there's a lot of self-righteousness in that community, a critique shared by many of my friends within the community.)

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    1. The problem is not in having a small amount of knowledge. The problem is in the fallacy that some commit when they believe that their small amount of knowledge is actually a huge amount of knowledge. Some people's small amount of knowledge is better than other people's small amount of knowledge, depending on the humility they have in operating from that body of knowledge. Make sense?

      Almost all doctors believe in the efficacy and safety of vaccinations. It is virtually undisputed. They are not out to abuse their authority on this. Their authority is legitimate. The mass poo-pooing of authority has led to the kinds of arguments and debates I often end up having with my family on Facebook (and I know so many others have had the exact same kinds of experiences as me, since I was just reading an article about this very thing the other day) -- where they enter into arguments about something, such as gender and gender theory, without ever having studied gender issues and without ever having to deal with the microaggressions that come from being queer, etc. My little bit of authority from studying gender and queer issues and my little bit of authority that comes from experiencing the world as an out bi/queer person means absolutely nothing in a cultural atmosphere that has little respect for authority. Oddly enough, these poo-pooers of authority think it's fine when they have cherry-picked certain authority figures that they decide are worthy of their support and respect. In my Conservative, gun-toting brother's case, he respects the authority of Conservative politicians and anyone rallying for gun rights, for example. But if it's an authority figure representing an area of knowledge or expertise that he disrespects or does not understand, he doesn't put ANYTHING into the work that person has done in their field. Zero. Zilch.

      I understand the need to question authority, but it is a fine line indeed. I do not respect those who choose not to vaccinate, because I believe this to be a public health crisis, fueled by complete ignorance and an intensely anti-historic tunnel-vision. If I had friends who chose not to vaccinate their children, I would openly challenge them. It would likely break up our friendship if they were extremely adamant about it. But that's how firmly I believe in vaccination.

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    2. Oh and I meant to further say that those with zero experience with certain subjects, such as gender issues, will believe that their stance is just as legitimate and their arguments just as strong as the person with an ample amount of knowledge and experience. I see and experience this all the time, and was certainly guilty of it myself in my twenties. Instead of saying, "yeah I really need to read further about this and cannot yet form an opinion due to my ignorance about the issue," they actually think they know exactly all there is to know about the topic, and proceed accordingly. So infuriating. But more so, it's a really dangerous attitude to have! These people will not usually listen to reason or evidence, and they often have no idea what it means to be a critical thinker.

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    3. It's been a long time since a discussion has broken out on my blog! It's kind of fun. That used to happen all the time on my other blog. :)

      Yes--I agree that when you have only a little knowledge and you confuse it for having a lot of knowledge, that's a problem! But what's so often hidden from us is what constitutes a little bit of knowledge and what constitutes a lot of knowledge. And also, these things are relative. My tiny bit of knowledge about health would constitute a gigantic amount of knowledge if I lived in certain parts of Afghanistan or Sierra Leone. Or, conversely, I can believe that I have a lot of knowledge about something--can even have an advanced degree in the subject--and then new information can come to light that shows I only have a tiny amount of knowledge. This has happened over and over again in science and medicine and pretty much every other quantitative field.

      Anyway, I agree with you that vaccination isn't an issue of abuse of authority. But my point is that since doctors and the medical establishment *have* abused authority in the past (and in the present), and since the pharmaceutical industry has done a lot of unethical things, it doesn't strike me as stupid at all to question that authority. It strikes me as responsible, for parents to want to do their own research when it comes to vaccines, in addition to talking to doctors. And when they do try to do that research, it also makes a lot of sense that they'd feel overwhelmed and incredibly confused--and also frightened. I'm sure parents feel that way all the time, actually. When they're trying to decide whether to have a home birth or hospital birth, whether to breastfeed on demand or on a schedule or to give formula, whether to let their kids watch TV or not, whether to co-sleep or not, etc., there's SO much information out there, and so much of it is put in these horrible, demonizing terms. If you vaccinate, you might give your child autism. If you don't co-sleep then you're a demon parent who is raising lonely children. If you homeschool then you're not letting your child socialize and the child will be alienated for life.

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    4. I think that the burden that is put on parents is really crushing. Most parents really are doing their best--and yes, they might be operating from misinformation, but we have ALL operated from misinformation. Most of us don't do so maliciously.

      I think many anti-vax parents are simply thinking, "Do I really want to risk giving my child autism? Of course I don't want them to get polio either, but polio isn't something they're going to be exposed to. So it doesn't seem worth the risk." It totally makes sense that a thoughtful, loving parent would come to that conclusion. And what will it help anything to say that such people are ignorant? They're very much trying *not* to be ignorant, at least some of them.

      I guess what I'm saying is: what would this conversation, about vaccination, be like if we all assumed the best of each other? If we assumed that the people on the "other side" were good people. I feel like that kind of approach might go a long ways towards a conversation in which people were truly listening to each other--and the thing is that I'd love for people to be able to hear each other's thoughts and feelings. I'm struck by the fact that I changed my mind about evangelism because a boy named Trevor Jaynes, in 12th grade, took the time to engage me on the subject, without dismissing me or talking down to me or being offended that I tried to evangelize him. I changed my mind about spanking children, and about feminism, because my friend Buffy calmly introduced new ideas to me, and wasn't angry or upset when I didn't sign up wholesale for those ideas the first time I heard them. I'm not saying that there's not a place for passionate debate--and certainly some personality types are changed by passionate debate. But I, for one, can't think of a single passionate debate that's ever changed my mind about anything. Whereas I can think of a lot of people who've assumed the best about me (even though I was operating on misinformation & ignorance), who changed my mind about a lot of things.

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    5. I don't mean to imply that if pro-vax people are just patient and nice, then anti-vax people will stop being ignorant idiots. I think we're all ignorant, and we all need each other.

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    6. On most issues, I would agree. The anti-vaxx thing is different. The information out there is not divided at all. The proof is very clear and children are actually dying directly related to the anti-vaccine movement.

      So yes these people obviously love their children, but they apparently don't give two shits about other people's children. I agree 100% with laws that now force parents to vaccinate, because these laws are concerned with the greater good, something that the anti-vaxxers don't seem to care about.

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    7. Your way sounds really nice and happy, but just not realistic. The anti-vaxxers I've encountered are not changing their minds anytime soon, and their movement does not only exist on an individual to individual basis. The movement is massive and it hasn't changed thus far from others being kind and open to their views, unfortunately. :(

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  5. I just wrote up four long paragraphs about privilege, and lost them. I'll come back later and reconstruct what I said.

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  6. But the jist was that I wholeheartedly agree that privilege figures into this conversation a LOT. And, as the many things privilege figures into, the reality of the situation is almost completely hidden from the privileged.

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  7. I meant to say: As *with* the many things privilege figures into, the reality of the situation is almost completely hidden from the privileged.

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  8. Here are two interesting articles on why the vaccination issue is largely an issue of (white) privilege:

    http://www.xojane.com/issues/vaccination-refusal-white-privilege

    http://www.salon.com/2015/01/19/we_seem_to_be_more_frightened_than_weve_ever_been_eula_biss_on_anti_vaxxers_white_privilege_and_our_strange_new_culture_of_fear/

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    1. Totally linked to white privilege and white boredom. A stay-at-home parent has too much time on their hands and too much money in their pockets (so that they don't have many legitimate concerns, at least regarding their own survival), and so they create drama and contention where it doesn't belong. There are so many other worthy issues to put one's energy towards. The anti-vaccination movement is narcissistic, privileged, wrong-minded, and dangerous.

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    2. This was in my Facebook feed today: http://www.skepticalob.com/2015/04/vaccine-refusal-how-privileged-mothers-leverage-their-privilege-and-harm-the-less-fortunate.html

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  9. Oh...also, this is one of my favourite Frontlines: http://www.pbs.org/wgbh/pages/frontline/the-vaccine-war/
    The Vaccine War!

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