Wednesday, February 20, 2008

Risk Adversity

I often think about how so much of parenting involves making cost-benefit/risk analysis type decisions with woefully incomplete data. Given the incompleteness of the data and the obvious uniqueness of each child, I try to avoid judging other parents' decisions. After all, we are all just trying to make the decisions that we think are best for our children, and who am I to judge someone who comes down in a different place on any particular cost-benefit spectrum?

However, there is some news in my home town that is making this difficult: we are in the midst of a measles outbreak here in San Diego. At last report, we were up to 12 confirmed cases, all children, none of whom had been vaccinated. Some of these kids were not vaccinated because their parents have chosen not to have them vaccinated, either for religious reasons or because they believe that the Measles-Mumps-Rubella (MMR) vaccine is associated with autism. I do not have any desire to retype all of the evidence that contradicts that theory. You can read this short summary from the CDC if you have somehow managed to miss this information. And if you don't believe the CDC, then there is nothing I can write that will sway you, anyway. (I am specifically not talking about people who choose to tweak the vaccination schedule or ask for three separate shots rather than the MMR- I may or may not come to the same decision given their family history, etc., but their kids end up vaccinated and it is no concern of mine if they do it with more shots over a longer period of time.)

The measles outbreak occurring here in San Diego began in a 7 year old child who contracted measles during a family trip to Switzerland. The child's parents had decided not to give him or her the MMR vaccine. The disease quickly spread to the child's siblings, and then to other unvaccinated children at a charter school (which, incidentally, has a relatively high percentage of unvaccinated children, probably because it is a bit of an "alternative" school). So far, I'm thinking "too bad for the kids that their parents didn't get them vaccinated". But then it started turning up in babies. The MMR vaccine is not usually given until a child reaches 12 months. So the 10 and 11 month old babies who have caught measles were not victims of their parents' decisions. They were victims of the decisions made by other children's parents and some bad luck. At least one baby has had to be hospitalized. This news article includes a graphic detailing the course of the outbreak. For those of you who don't live in San Diego, I'll just mention that the neighborhoods affected are quite wealthy areas of town. Whatever the reason these parents have for deciding not to give their kids the MMR vaccine, it has nothing to do with money or lack of access to information.

At this point, I think it is worth noting that according to the news report I cited above, three children died during the last measles outbreak in San Diego. Yes, died. I think most of us here in the developed world have forgotten how catastrophic these childhood diseases can be.

So I'm warily keeping an eye on the reports of an outbreak that is moving in circles disconcertingly close to my own, knowing that there really isn't much I can do to protect Pumpkin from the consequences of decisions made by other parents. Decisions that I think are just plain wrong. And, because I am a scientist, I can't help but wonder what has happened to make such privileged, educated people distrust the scientific evidence, which at this point is quite strong.

I do not advocate blind acceptance of every recommendation from scientific and medical experts. I have recently been reminded about the controversy over estrogen-mimicking compounds in plastic, and have printed off some studies that I plan to review soon. However, there is a world of difference between making the decision to use a more expensive baby bottle because of possibly unfounded concerns about a chemical in the cheaper ones and making the decision not to vaccinate your child because of really rather disproven concerns about autism. My decision on the baby bottles has no impact on your child. Your decision on the vaccine can have a profound impact on my child.

I am also very much aware of the limitations of any "research" I might do into these concerns. I put "research" in quotes, because to really research the baby bottle issue, I would need to read the literally hundreds of peer-reviewed research articles on the potential impacts of bisphenol A, carefully considering the limitations of each study. I might have questions about some studies that were not answered in the articles reporting them, so I might want to write to the authors and request the original data so that I could run my own analyses. This would take me weeks if not months of concentrated effort.

Of course, I do not have time to do this. I have a job and a baby who needs me to take care of her. The best I can hope to do in the time I have is to find the most recent review-type articles in PubMed and read them to see if I agree with the recommendations of the true experts. Luckily for me, there are scientists whose job it is to do the thorough research, both on the bisphenol A issue and on the autism issue. In fact, I pay them to do just this sort of research for me. These are the good folks at the CDC and the EPA. The only reason I feel the need to do a cursory review on the bisphenol A issue is that the current president's administration has a track record of having the political appointees censor the scientists.

And when I do that review of the information on bisphenol A? I will be using information from peer reviewed scientific articles. The peer review system isn't perfect, but it sure beats the internet popularity contest or Hollywood celebrity endorsement methods of information selection.

I suspect that if people would do the same thing when they research the MMR vaccine and autism, I wouldn't be worrying about whether Pumpkin will catch measles.


  1. Anonymous7:28 AM

    My parents tell horror stories of me getting the measels the day after my first birthday. This was also the point where they decided not to have another child, not knowing they were already expecting my sister. When she turned one, they didn't want to take any chances and took her in for her measels vaccination on her birthday.

  2. I thought that Dr. Bob Sears did a pretty good job reading and digesting the research about vaccines in his book The Vaccine Book. I know that it helped me do a better cost vs. benefits analysis than I would have done just listening to one side or the other on the vaccine debate. I really thought the book was a balanced look at it, and you may be interested.

    Oh, and I tagged you for a meme on my blog! :-)

  3. Pumpkin will be getting her MMR right on time, too. Vaccination is not one of the things I worry about. Maybe because I studied how it works in school (not that I could tell you more than the broad outline of that now). Maybe because I've sort of followed the whole vaccine-autism thing from the beginning (out of curiosity- this was well before I was thinking about having kids) and have never seen a theory for how the vaccine is supposed to harm my baby that makes much sense to me or has evidence I find credible backing it up. (Besides the rare actual adverse reaction, which is a risk I'm willing to take, because the risks due the actual diseases are just as bad or worse.)

  4. Herd immunity is important. We live in a generation that has never felt the terror of these diseases, and somehow imagines that vaccines are no longer necessary. People who expect, as a matter of course, that all their children will survive to adulthood: it's startling how recent such assumptions are, and sobering when waves of disease sweep through populations that have grown too arrogant or 'refined' to imagine that public health is something to be concerned about.


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