Part 6: What is Choice (Part 1 of 2)

A Community Conversation About Health and Responsibility: Vaccines and Beyond

Part 6:  What is choice?

Society is, by definition, a collaboration.  Like all group environments, there is a give and take of rights, responsibilities, and choices.  This is true whether we’re talking about a family, a town, a board, or a hospital.  This is also true whether you live in a democracy, a theocracy, or a tyranny.  In all systems, there are forces that "set the menu” from which individuals can then make a choice.

Despite the rhetoric to the contrary, limitations can be a good thing.  The human brain can only tolerate so many options before getting overwhelmed.  When overwhelmed, our ability to choose well goes down dramatically...a known fact that is sometimes used against us in aggressive and unscrupulous marketing strategies.  At other times, however, a plethora of choices is valuable.  For example, few people need every single brand of detergent to be offered at their local store.  Even fewer wish to spend hours in the soap aisle carefully weighing the advantages and disadvantages of each product.  On the other hand, people with severe skin allergies might be very interested in a wide selection of detergents; as they hope to find one that won’t give them a rash! 

In general, a collaborative society seeks to meet the needs of the community and the individual by setting a menu of options that is not too narrow and not too broad.  Most of us, consciously or unconsciously, believe that the best way to ensure “enough choice” would be to have someone like ourselves be in the “menu selecting” position of power.   However, when the menu is set by people whose values differ significantly from our own, we tend to express considerable outrage!  This leads to a great deal of amusing and ironic hypocrisy from all points on the political compass.

When speaking about public health, there are a variety of forces that overlap, conflict, combine, and collaborate to create the menu of health care choices available to individuals.  In this article and the next, we'll look at five of the most powerful group forces at play, and our access as citizens to these arenas of power.

1.  Law & Government

Our society decided long ago that legal oversight of choice is desirable.  However, where to draw the line is often a contentious question, leading to spirited debates.  This is further complicated by the fact that our government was designed to spread “menu control” around, with the federal, state, county, and local layers of governance each having limited, intersecting, and sometimes conflicting powers.  For example, the civil rights movement, marijuana legalization, and the recognition of gay marriage are all interesting areas of tension between state governance and federal governance.

When it comes to our access as citizens, some laws are passed with great fanfare, others are passed very quietly.  But, all laws in this culture are documented and there are established methods for individuals to work toward altering them.  However, just because a choice is legal does not mean it is available.  There are many other forces that limit availability like....

2. Official recommendations

Various governmental and professional groups make official recommendations.  These groups are obligated to follow the law and their recommendations are documented.  However, there is often no clear path to challenge recommendations, even though they may limit medical choice just as effectively as law.

Consider the 2008 recommendation by the American College of Obstetricians and Gynecologists (ACOG) on the subject of vaginal birth after cesarean (VBAC).  The 2008 recommendation stated that a VBAC should only be attempted if a surgical team was “immediately available."  This recommendation led to many resource-limited small or rural hospitals refusing to permit VBAC due to lack of an "immediately available" surgical team.  Thousands of women were forced into expensive and potentially dangerous surgeries they did not need and did not want.

Now, consider the education of your family doctor.  The Accreditation Council for Graduate Medical Education (ACGME) is a private professional organization responsible for the accreditation of 9,000+ residency programs.  Residency programs currently include training in all forms of legal birth control.  However, accreditation requirements are reviewed every seven years, and that review is happening now!  Will the requirement for training in birth control be weakened or eliminated entirely?  The Catholic Ethical and Religious Directives expressly forbid contraceptives, leaving 30-50% of US hospitals unable to offer a “full education” residency program due to restrictions from...

3.  Religion

The separation of church and state both protects our secular society from becoming a theocracy and allows religious groups to follow their faith with autonomy from popular opinion.  This autonomy even allows religious groups to defy certain laws with relative impunity.   A church can refuse interracial marriage, so long as it is willing to forego the tax benefits of being in compliance with federal civil rights law.  The “sanctuary movement” of the 1980's consisted of churches openly defying immigration laws to provide sanctuary for Central American refugees fleeing civil war.  Religious exemptions from vaccination laws are respected in nearly all states.

This independence gives religion unique power when setting the public health “menu.”  Historically, a variety of religious groups have sought to expand, restrict, or modify the health care menu.  One strategy is religiously-based political action.  Another strategy is social pressure, which we'll discuss later.  Yet another strategy is the ownership of medical facilities, which are then obligated to follow the religious values of the sponsoring religious organization. 

Religiously controlled health care mostly becomes problematic when a single religious group controls such a large percentage of medical facilities that it begins to function as a monopoly.  Monopolies of all kinds interfere with individual choice, thus the various legal restrictions upon them.  A religious monopoly upon a vital service like health care has some very serious implications.  The carefully crafted checks and balances of our political system do not apply to religious organizations, leaving the individual very few medical or religious rights that can be defended.  Thus a religious monopoly can endanger both our health care and our religious freedom.

So why would anyone accept a religious monopoly on health care?  In general, it’s all about....

4. Money

Which is what we'll start talking about next article.  See you then!

“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:  Vaccinesandbeyond.blogspot.com   Email:  KarenandMarch@rocketmail.com

A Community Conversation - Part 5

A Community Conversation About Health and Responsibility: Vaccines and Beyond

Part 5:  What is Science?   

The term “science” is widely misunderstood by most people.  “Science” does not mean lab coats and test tubes.  It does not mean dissecting frogs and reading textbooks.  It does not mean advanced degrees and multi-million dollar labs.

Science is simply a set of rules for organizing thoughts and information.  If these rules are applied correctly, errors in thinking become obvious.  This gives you a chance to adjust your thinking to more accurately reflect reality.  Science also scales well.  It works at the individual level.  It works at the community level.  It works at the global level.

Let's give a more specific example.  Suppose that you read some books on foraging and decide that dandelion greens sound delicious.  You are out in your yard one day, eating a sandwich, and spot a dandelion green.  You put it in your sandwich and take a bite.  After chewing for a bit, you make a decision as to whether dandelion greens are, in fact, delicious.  Then you tell your friends.

That's science....let me explain why.

You did some background research which indicated that dandelions could be easily identified, were not toxic, and might taste good.  You developed a testable hypothesis that stated “Raw dandelion greens in my sandwich might be tasty to me.”  You did a controlled experiment (sandwich with dandelion green vs. sandwich without dandelion green).  You analyzed your data and drew a conclusion.  Then you communicated your results.

Incidentally, I have done this experiment.  I have concluded that raw dandelion greens taste bad.  To me, that is.  I have no scientific data for other people.  Except my children.  They think raw dandelion greens taste bad too. 

Another backyard scientist might point out that the taste of dandelion greens changes dramatically with the seasons.  I would then have to concede that my hypothesis had left out important data.  I would modify my conclusion to read “dandelion greens taste bad to me in the summer.”  I might do another experiment in January.  Or I might decide I was no longer interested in this particular scientific experiment and move on to hypotheses regarding different cookie ingredients.

Like many things, science is defined by the rules.  So is baseball.  Baseball is baseball as long as you follow the rules of baseball.  Baseball does not require hot dogs, giant stadiums, fireworks, and million-dollar player contracts.  It's still real baseball if you're playing on a dirt field with no spectators.  Baseball is baseball.  Science is science.

The rules of science are not that complex and it doesn't take a lot of education to apply them.  Small children can learn to do high-quality science.

However, even simple rules can get broken, forgotten or misunderstood.  This is why baseball has umpires.  This is why any good game handbook has two sections: the basics of the game and the nuances of how to deal with specific and unusual situations.

Science is much the same, with one critical difference: there's no single umpire.  Instead, there are many umpires.  Other scientists serve as umpires for the most complex aspects of specific scientific studies.  But there is another group of people who hold some responsibility to act as umpires for science.

Us.  You and me.  Yes, we all have a right and responsibility to ask questions about science and call foul if we see some serious rules violation.

Imagine you were at a baseball game in a big stadium and watched a player skip first and second bases completely.  Instead, the player just ran out to third base and ran back to home.  The umpire declared it a home run.  Do you suppose that everyone would just nod politely and cheer?  Not likely!  The stadium would ring with shouts of outrage...probably from fans of both teams!

Of course, not everyone is a fan of baseball.  You may not know or care about the rules of baseball.  So why should you know and care about the rules of science?

First of all, doing basic science at home can make your life better.  Science enables you to test what will work best for you in your life and to recognize what will not work well.  Does the more expensive product work better than the cheaper product?  Do you actually need any product at all?  Do an experiment and find out!  This kind of experimentation can save you thousands of dollars.  What forms of discipline are most effective with your children?  Do some experiments and find out!  Setting up genuine experiments and honestly examining the data can save you countless hours of stress and grief. 

Obviously, certain areas are not suitable for home science.  Subsistence farmers cannot do a lot of experimenting, because a crop failure would mean starvation.  Hobby gardeners can do experimentation, since they can always buy food at the grocery store if their crop fails.  Any real experiment may confirm or disprove a hypothesis.  If the results of a disproved hypothesis would be catastrophic, leave the science to people with a greater tolerance for risk.  Tasting a dandelion to see if you like it is a completely reasonable scientific experiment.  Tasting a random plant to see if it is poisonous may be scientific, but it's also a bad idea.

But why should you care about professional science?  For one, professional scientists can sometimes do the experiments that are too risky or too expensive for home scientists.  They can also work with much larger sets of data and come up with results that can be applied to a wider range of situations.

More significantly, you should care about professional science because it affects your life.  Unlike professional baseball, scientific claims are being used every day to influence and even control your choices.  Science is used to justify laws and guide health care.  Scientific claims can be found in nearly every newspaper, often with instructions on how to modify your life based on those scientific claims.  Science is used to claim both truth and morality.  Whether you like it or not, science is a significant force in your life.

Learn the basic rules of science and apply them in your life.  If you see someone making a scientific claim, do your due diligence as an umpire.  Pseudoscience is philosophy dressed up in a costume to look like science.  Don't be fooled.  Bad science is science that has (intentionally or accidentally) broken some of the basic rules of science.  Don't be fooled.  Bad reporting is a newspaper article that takes a real scientific study and simplifies or distorts it beyond all recognition.  Don't be fooled.  See our blog for more information on recognizing pseudoscience, bad science, and bad science reporting.

Real, high quality science is a powerful tool.  Don't let the charlatans and counterfeiters deceive you.  Do your due diligence as both a citizen scientist and as an umpire.  You deserve real science.  Don't settle for less.

“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:  Vaccinesandbeyond.blogspot.com   Email:  KarenandMarch@rocketmail.com

View Documentary Film "Everybody's Business" on line...

A Stanford Graduate Student, Laura Green, chose the ongoing debate over vaccines and public health on Vashon Island for her Thesis Project.

The results of her hard work and commitment to excellence is wonderful to behold!  Without attempting to present a "clean cut answer" to this incredibly complex question...she instead pushes the conversation forward by delving into the role of relationships when discussing public health issues on a small island.

If you weren't able to make it to the screening of Everybody's Business and you want to see it...here's how you can do that!

Everybody’s Business
The small, tight-knit community of Vashon Island has become a reluctant poster child for the growing debate around childhood vaccinations. This portrait of an island community digs beneath the surface to investigate the tensions between individual choices and collective responsibilities.

With permission of the film maker, Laura Green, you can check out this 20 min wonderful piece at:  

https://vimeo.com/54813694      

Password: EB_preview

Feel free to share the link/password with anyone who might be interested!

Cooling Down A Hot Topic

Terminology Matters

Cooling down a hot topic...

In a recent conversation, the question arose about the interchangeability of two terms:  vaccination and immunization.  This is a common question that has two forms of an answer based in either social custom or medical science.

According to science, each term has its own, distinct definition which I will get to soon.  But first...let’s explore why, according to social custom, there are two “competing answers.”  

Political connotations around this subject are often generated by people who view themselves as being either “pro-” or “anti-” vaccine.  You know, the people who honestly believe all vaccines are 100% harmless for all children (and adults), or those who fear that vaccines are integral to a government conspiracy and present a very real heath danger to everyone at all times.  These people often wish to influence the decisions of others, because they believe they have found the “right” way.

Recently, I heard it expressed this way:  “Using immunizations to refer to vaccines is perfectly fine; they are often used interchangeably, and to not do so is purely a political choice.” 

Really?  Since when did politics become synonymous with science?  What’s going on here?  Here’s how the “politicizing” of these terms happened:

Over the past sixty years, alarmed citizens with concerns about vaccines attempted to clarify the terms.  From a political perspective, they observed that “immunizations” had a reassuring connotation that suggested a positive outcome...while “vaccines” were what we gave to our cats, dogs, and cows and carried an obvious medical procedure connotation.  In the face of criticism by “anti-vaccine” advocates, the “pro-vaccine” advocates reacted defensively by insisting that these terms could be used interchangeably.  There has actually been a concerted effort to “reclaim” or “hold onto” the use of the term “immunization” in place of the term “vaccination.” 

So the “social use” answer is: YES!  On a social level, these terms are often used interchangeably and which word you choose can carry a political charge.

However, from a scientific perspective, they are different.  Since furthering the paradigm of conflict is NOT helpful to current and future conversations, I would like to refer you to the explanation offered by this mainstream, pro-vaccine website:  http://www.healthwatchmd.com/2012/09/fast-fact-vaccination-vs-immunization/

Confusing “vaccinated” with “immunized” can lead to misplaced confidence and potentially deadly choices.  We will talk more about this in a second article about the importance of understanding and using terms correctly, but for now I will say this:  Germs do not check your vaccination records, they check your immunity status.  And the two are not necessarily the same.

I propose that using scientific definitions allows us to side-step historical animosity.  By so doing, we can increase the positivity, clarity, and productivity of community conversation.  

Sincerely,

March Twisdale

Beachcomber Article Correction

WHOOPS!

March Twisdale was interviewed by The Beachcomber (of Vashon Island) about her role and participation in the soon-to-be released documentary film, Everybody's Business.  Among various questions asked by the interviewer, her family's use of vaccines was not explored.  Apparently, this is because the answer was considered obvious.

March Twisdale is a Medical Choice Advocate, and she works, speaks, and writes often about WHY it is important to recognize complexity in medicine - including the inherent necessity of maintaining medical freedom and leaving vaccination choices up to the patient.

According to the article published on May 29th, 2013 in The Beachcomber, due to her advocacy work, it can be assumed that March Twisdale does not vaccinate.  WRONG.  March's family has deeply explored vaccine science, analyzed family history, considered community needs, and made conscious choices around vaccinations and natural immunity.  

March Twisdale was fully vaccinated as a child of the 70's (receiving the 10 recommended vaccines of that decade compared to the current recommendation of 36 vaccines by the age of six).  She continues to utilize tetanus boosters.  As parents, March and her husband, Jose, decided to selectively vaccinate their children on a delayed schedule.  Both of their children have been vaccinated against Polio, Measles, Mumps, Rubella, Diphtheria, and Tetanus.  They sought (and found) Chicken Pox for both boys...and encountered Pertussis in 2001 and 2002.  The vaccines for both of these diseases are known to have low efficacy rates and wear off within 5-12 years.  Natural immunity to Chicken Pox is usually close to lifelong and the efficacy of natural immunity to Pertussis is generally un-studied...but there is reason to expect that it far exceeds a vaccine-induced level of immunity.

We wish to remind our readers to AVOID ASSUMPTIONS when it comes to complex subjects.  After all, being Pro-Choice does not mean you have had an abortion...

Documentary "Everybody's Business" is Coming to Vashon!

"Everybody's Business" is coming to Vashon!

Sunday, June 2nd @ The Vashon Theater 1:30pm

Free Showing!

Community Health is complex and vitally important...

Join the Conversation!

Featured in many local and national news stories, Vashon Island has become a poster child for the debate around childhood vaccinations. This short documentary film paints a portrait of Vashon, digging beneath the surface to investigate the impact this has had on the island, and ask how people with opposing views co-exist within a small community.

Polio Vaccine & Cancer - Unintended Consequences

The elimination of polio in the Americas was undoubtedly a good thing.  However, it did not come without cost.  The Oral Polio Vaccine (OPV) that was given between the years of 1955 and 1963 was contaminated by a virus called Simian Virus 40 (SV40).  SV40 has been linked to rare, incurable cancers such as ependymomas (brain tumors), mesotheliomas (pleural tumors, usually of the lung), and osteosarcomas (bone malignancies).  See more here:

http://www.projectcensored.org/top-stories/articles/12-millions-of-americans-received-contaminated-polio-vaccine-between-1955-and-1963/

Was this a reasonable price to pay to eliminate polio?

Was it a necessary price to pay?  That is, could we have eliminated polio without also spreading SV40?

Is this the law of unintended consequences at work?  Or was this carelessness?  

When is it a wiser choice to wait for better science, and when are the known problems so severe that it's better to charge forward with imperfect technology?  

What do you think?  Add your comments.

Please note!!!  The vaccine detailed in this story has not been used in the United States for 50 years.  The vaccine currently in use in the United States is the IPV.  Unlike the OPV, it is completely dead.  The IPV cannot spread live viruses of any kind.