Sunday, February 08, 2015

Measles and Vicious Cycles

As the anti-vaccination movement grows, it is just a matter of time before we see an outbreak in Texas of the sort that we are now seeing in California.  I am a pretty crunchy mama in a lot of ways - I think natural childbirth is where it's at and I nursed both of my kids past their fourth birthdays (worked full time, too - I was a super hero in those days), they slept in our bed for years, I have raised them vegetarian and pacifist and in several Montessori schools - you get the picture.

That said, we vaccinate.  Vaccination is very, very important for the health of our children and the safety of our society.

It saddens me to see other mamas of my ilk - educated moms who care enough about the health of their babies to research childbirth and breastfeeding - embracing a lot of inaccurate pseudoscience and unintentionally endangering their kids and everyone's infants by choosing not to vaccinate for diseases, like measles, that can be caught through very casual contact and that spread through schools and daycares like wildfire.  I have lots of friends who won't like this post, but I don't much like the way they have been taken in by pseudoscience myself, not about a lot of things like food and the treatment of various conditions, but especially not about vaccination, where it impacts people outside of their own families so seriously.

That said, I can see very easily how it happens and I think doctors and the pharmaceutical industry frankly have a lot to answer for in the the makings of the anti-vaccination worldview.  

Part of it has to do with the blatant malpractice that so very many obstetricians and pediatricians engage in around the issues of childbirth and breastfeeding.  These days, partly out of the cover-your-butt mentality of doctors trying to avoid lawsuits (ironically resulting in them acting in ways that deserve lawsuits) and partly out of the fact that medicalized childbirth practices have now gone on so long that there are very few doctors left who actually understand anything about natural childbirth, doctors intervene all the time in normal, healthy childbirths in ways that make them riskier for both mother and baby.  Pitocin, epidurals and c-sections are not without risk and tend to be steps that lead to each other in ways that make childbirth less safe for mothers and babies, but doctors do not tell you that.  They do not educate mothers on why they should try their best to have a natural childbirth and how to be successful at it (in most cases) and they push unnecessary interventions so that they can get things over with - a classic example of the maxim that when all you have is a hammer, every problem looks like a nail.  This malpractice has had long-term consequences on mothers and babies and parents have had to educate themselves to find another way. 

Breastfeeding is the same.  Most doctors seem not to know how to do it successfully.  They apparently learn little about it in medical school.  Even lactation consultants give some very poor advice in my experience.  The kinds of instruction that you get from nursery nurses at the hospital and most pediatricians will have most women bottle-feeding within a week or so unless they are lucky enough to have La Leche League hanging around to deprogram them.  Again, this is malpractice and women generally have to educate themselves in order to be successful in breastfeeding.  

Having started their lives as mothers having to deal with such malpractice, moms who find out about it and learn enough on their own to have natural births and/or to breastfeed successfully are often left with a deep mistrust of the medical profession for pretty obvious reasons.  If their doctors did not know what they were talking about in regards to childbirth and breastfeeding, just why should mothers trust them on anything else?  Some moms start to feel like they are going to have to be the sole expert on their own child's health care decisions.  This is not unreasonable and not totally untrue, but it cannot be done by turning to pseudoscience.  Your average obstetrician and pediatrician may not know jack about normal childbirth and breastfeeding, but your average homeopath or chiropractor quack does not know jack about chemistry or immunology either.  The recommendations of the real scientists, the CDC and the WHO and all those good folk, should be where sane people (mothers, obstetricians and pediatricians) turn.

Another big problem is condescension and over-simplification from doctors.  Many, many doctors really talk to parents like they are stupid and oversimplify things to the point that they are so generalized as to be untrue.  The DTaP vaccine which people receive now for instance, is so much safer than the old DTP with the live virus in it.  While taking it in those days was still much safer than not taking it, doctors refused to talk about the real risks because they were afraid people would choose not to vaccinate.  Today there is the issue that there truly does need to be more research done on how much of some of the inactive ingredients in vaccines, like aluminum, is too much at once for a baby or small child.  We know that too much of many of these ingredients can be dangerous but we do not really know how much is too much.  The amount in any given vaccine is minimal and safe, but what if an infant is given a lot of vaccines at once?  More study on this is definitely needed.  Meanwhile, it happens more and more often because doctors are worried that parents will not come in every week or so to get vaccinations if they are separated so they give as many as they can at once to be sure a kid gets fully vaccinated and protected.  If parents question this, many doctors shut them down and claim this is perfectly safe.  We do not really know if it is perfectly safe - we just know that a child getting fully vaccinated is safer than the child not getting fully vaccinated.  Also, there are vaccine reactions and injuries.  They will happen to some people, just as my daughter is at deadly risk from the pecans and mollusks and ant bites which are perfectly safe for most people.  Your kid is much more likely to die from measles if herd immunity is lost than to get a vaccine reaction and die, but nothing out there is perfectly safeMilk kills some people.  When doctors oversimplify and refuse to discuss risks, many educated parents just stop trusting them.

Also, there have been times when the pharmaceutical industry rushed to get vaccines on the market and promoted in doctors' offices before they were quite ready.  This has resulted in some vaccines being pulled - some of which happened when my eldest was a baby and toddler.  Because of that, I started waiting to get new vaccines for her until the American Academy of Pediatrics put the vaccine on their recommended schedule, as that always happened after there had been some time to see how things were going.

Does this make it okay not to vaccinate because of the irresponsibility of doctors and the greed of the pharmaceutical industry?  Absolutely not.  We need herd immunity.  I think unvaccinated children (for diseases that can be spread by casual contact) should not be allowed in public schools and any infant daycares unless they have a medical exemption.  Period.  I understand why so many parents have been taken in by the pseudoscience when they have been treated the way they have been treated by doctors and I certainly understand what a slippery, scary slope it is to dictate parental choices in any way, but there are private schools and babysitters that still exist for people who choose not to vaccinate.  When contagious epidemics are involved, I think public health has to come first.

I do hope that more doctors will start to see their culpability in the generation of these attitudes and develop more knowledge on birth and breastfeeding and better, more respectful communication skills.  I think it would go a long way towards forming partnerships with parents that will keep our children and society safe.


Saints and Spinners said...

Well said, LSM.

Andrea said...

This is a great post. I think you should try to get it published in another venue where it will reach more people. I had a terrible experience with the pediatrician's office where I took my oldest son. They operated like a factory and treated me like an idiot and my child like a specimen. So, yes, they (doctors in general) do bear a lot of responsibility for people not trusting them. That being said, if I knew then what I know now, I wouldn't have taken my baby within a mile of a La Leche League meeting--I'm pretty sure he was the only vaccinated one of the lot.

Lone Star Ma said...