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Wednesday, February 27, 2013

A Community Conversation - Part 1

A Community Conversation About Health and Responsibility: Vaccines and Beyond

Part 1:  Our Goals for This Series and A Beginning...

Over the past several years, our island has become a veritable battle ground around the issue of public health.  In particular, the method by which island residents manage their personal immune decisions has been thrust under a nation-wide microscope.  Various members of the media from The Stranger to PBS Newshour to The New York Times to a Stanford Graduate-Student Filmmaker have come to interview local residents on the issue.  The interviewers always focus on a few simple issues.  “Do you vaccinate?  Why?  What do you think of others who choose differently?”  The interviewers often strive for balance, but the result is usually polarization. 

As frustration builds, coercive ideas begin to surface.  “If people can’t be swayed to make the right choice,” goes the reasoning, “then perhaps we should mandate their health decisions for the good of all?”  From gun control to abortion to end of life decisions to vaccines, there is a human tendency to try and force people into "right behavior," as defined by majority opinion.  And yet, how often is the majority opinion less than perfect?  The history of health care is filled with tragic examples of the harm that can result when commonly held medical beliefs are either false or incomplete.  

The history of cholera provides an excellent example of this concept.  During cholera outbreaks, all manner of "solutions" were proposed, often based on nothing more than fear and hope.  The few who were trying to use a scientific approach misunderstood the data and concluded that cholera was an airborne disease.  John Snow and Henry Whitehead looked at the existing data, did some independent research, and concluded that cholera was waterborne.  They were mocked and condemned mercilessly for this outrageous claim.  They were also right.  And their courage and persistence eventually led to city governments prioritizing clean water supplies and ended the scourge of cholera.

Think of it this way.  Most of us understand that freedom of speech is essential to democracy.  Protecting the minority voice is uncomfortable, but in the long run it protects us all.  Informed consent is to ethical health care what freedom of speech is to democracy.  The principle of informed consent is what gives us the right to ask questions and to make the final decisions about our health care.  When it comes to vaccines, it is vital that we protect informed consent.

What we hope to show, over the next twelve months, is that there are as many right decisions as there are people making them.  When it comes to health care, a “one size fits all” model is absolutely contraindicated.  Every disease is different, every vaccine is different, every individual is different, and every community situation is different.  It is okay for our health care decisions to be different as well.  

Over the next twelve months, our series will explore a wide variety of public health issues that relate to disease control and vaccines.  We hope that you, our reader, will use these articles as a starting point for interesting conversations.  Our goal is to come at this complex issue from all sides, offering tools that will reduce polarity and increase respectful communication. 

Additionally, we will be offering a moderated Blog through which you can reference previous articles, explore resources, and make constructive comments.  We will actively discourage the use of divisive and inaccurate terms such as "anti-vaccine" or "pro-vaccine."  These are terms that quickly turn an incredibly interesting (and vitally important) subject of conversation into a dogmatic and polarizing battle.  Our goal is to create a safe place to explore questions and share information.  Join the conversation!

On the subject of credentials, we are going to challenge our readers to think beyond the letters.  Credentials are an indication that someone has completed a certain amount and type of formal schooling, which is an admirable achievement.  However, credentials are not a guarantee of being correct, unbiased, or even honest.  People with credentials are people and have all the variation of genuine human beings.

If you have credentials, welcome to the conversation.  If you have no credentials, welcome to the conversation.  If you have extensive scientific background, welcome to the conversation.  If you have no science background at all, welcome to the conversation.  We'll talk together, we'll share what we know, and we'll all learn important things.

For next month, we will be offering new language that will recognize and respect the three main strategies people use when making medical decisions.  Listening to each other is a first and vital step when dealing with complex subjects.  By better appreciating the most prevalent decision-making styles, we hope to empower our readers to engage positively on this extremely important issue.  

“A Community Conversation About Health and Responsibility: Vaccines and Beyond” is an ongoing series written by two close friends with a passion for improving community cohesion and building respectful relationships in a diverse world.  This article was co-created by Karen Crisalli Winter and March Twisdale.   BLOG:   Email:

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Welcome to the conversation. Knowledge changes. People respond best when this truism is kept in mind. In community, March & Karen