Friday, September 16, 2011

A Serious Post

I stray from our blog's mission with this serious post only because I have something to say and no other forum in which to say it.

Much has been made of Gov. Rick Perry's HPV vaccination program. I know more about the scientific and legal issues surrounding vaccines than your average person, including, unfortunately, every Republican running for President (except perhaps Gov. Perry). Instead of admitting their lack of knowledge, these candidates resort to Limbaughian rhetoric and spin to make Perry look bad. I am so appalled by their words that I urge you to vote for none of them.

1. They do not know the science

No candidate articulated an accurate or even coherent position on the scientific merits of HPV vaccination, not even Dr. Ron Paul who called HPV vaccination "bad medicine." Human papillomavirus (HPV) causes genital warts, but, more seriously, can cause cervical and other cancers. The HPV vaccine prevents HPV infection, and thus prevents contracting these diseases.

Vaccines are one of the 20th century's ten greatest achievements in public health. Vaccines completely eliminated wild-type smallpox and polio infections in the US, and almost completely eliminated diptheria and measles infection. Not only do vaccines improve morbitity and mortality statistics, they decrease the cost of medical care by preventing diseases.

Simply put, a significant number of us would not be alive today but for vaccines. And they save money. This duality of efficiency should appeal to conservatives of the "law and economics" stripe.

Vaccines do not cause autism or mental retardation, despite what Rep. Bachman thinks. If they did, the FDA would bar their sale. And drug companies would not sell them.

As an example, the first rotavirus vaccine was withdrawn from the market less than one year after its launch because it was linked to intussusception. Intussusception isn't a major problem in developed countries like ours because it is relatively easy to treat, and the vaccine caused a fleetingly small increase in its incidence. Yet the vaccine was still withdrawn.

If vaccines really caused serious irreversible conditions like autism and mental retardation, there is no way in hell that anyone would manufacture them (imagine the liability!) or that the FDA would allow their sale. Believing the contrary is like believing the sun revolves around the earth.

2. They do not know the law

State vaccination policies have no place in a Presidential debate. Fans of the 10th Amendment know that protecting the public health is a traditional state police power, which means that issues of public health are reserved to the states. So long as a state's law is reasonably related to protecting the public's health, it is legal under the US Constitution. The Supreme Court set this out over 100 years ago. Thus the President can do nothing to impact state vaccination policies, short of withdrawing a state police power that the Founders reserved to the states (i.e., repealing the 10th Amendment, at least in part). Saying that this is not a particularly conservative idea is like saying that Aaron Boone is not particularly popular in Boston.

Today all fifty states require childhood immunizations in order to attend public schools. The requirements vary from state to state (exactly as the Framers intended) and most allow students to forego immunization for religious or philosophical reasons.

Contrary to the Republican candidates' characterization, childhood immunizations are not "forced." A vaccine goon squad does not show up at your doorstep to shoot your children full of antigens. Gov. Perry does not arrive in classrooms with a cadre of thugs to hold little girls down while he administers vexatious innoculations. As all parents know, vaccines are administered during routine visits to the pediatrician. If you don't want your child to receive the shot you can refuse it. The worst that can happen is that your child can't go to public school (if you're in a state that doesn't provide exemptions).

Former Senator Santorum criticized Texas' HPV vaccination program because if you didn't want your child to receive the vaccine you had to "opt out," and he said that if he designed the program it would be an "opt in" regime. Whether you must "opt out" (i.e., tell the doctor "don't give my kid that shot) or "opt in" as Sen. Santorum would prefer (i.e., tell the doctor "yes, give my kid the shot") the mechanism is the same: parents must give their doctors permission to immunize their children when they bring their children in for regular checkups. Sen. Santorum's "opt in" rhetoric is a distinction without a difference.

Rep. Ron Paul is both a physician and a Texan, so his statements during the debate are the most repugnant, especially in light of his alleged libertarianism. Rep. Paul criticized Texas' HPV vaccination program because it was enacted by an executive order instead of going through the legislature. I have not read, let alone studied, Texas' Constitution or other laws, but if such a vaccination program may be legally enacted by executive order then Rep. Paul has no room to gripe. The people of Texas voted Gov. Perry into office knowing that he could use all of the powers available to the office, including enacting laws by executive order. As my libertarian professors used to say, you get what you bargained for. If Rep. Paul doesn't like how Texas' HPV vacccine program came into being, he should take it out on the voting populace of Texas or the drafters of the Texas Constitution. Or vote Gov. Perry out of office and replace hims with someone who will repeal the law. Or convince the Texas legislature to overturn the law (which they did). Gov. Perry simply did what he thought his constituents wanted and enacted a law through a perfectly legal mechanism. That's how democracy works. Rep. Paul should brush up on his intellectual conservatism (and his medical training too).

The policy rationale against HPV vaccination is irrational. The Republican candidates act as if receiving HPV vaccination will turn 12-year-old girls into raging whores. The vaccine does not come with X-rated tutelage from a lecher like John Malkovich's character in "Dangerous Liaisons". Merely being immunized against a disease that is transmitted sexually will not cause children to run out and have lots of sex. Polio is transmitted via the fecal-oral route, but there are no reports of children eating dung because they got their polio booster.

And how will children know that they are immunized against a disease that is transmited sexually unless someone tells them? To this day I'm not sure what rubella is or how it's transmitted, and I sure as hell didn't know when I got my MMR shots as a child. Do you? How about pertussis? Mumps? Diptheria?

None of the candidates articulated a logical reason why it isn't reasonable to give people the opportunity to protect their children from a potentially deadly disease that is transmitted by an act that almost everyone engages in at some point in their lives.

3. They do not deserve your vote

An intellectually honest and coherent conservative response on this topic would be something like "I am running for the office of President of the United States, not Governor of Texas. This is an issue properly decided by the people of Texas and their elected representatives. I respect the 10th Amendment and states' rights, and as President I would do nothing to influence how the State of Texas administers their childhood vaccination programs."

If you want to punch it up a bit you could add "If I was the Governor of Texas, I would not enact a mandatory HPV vaccination program because this is not the type of communicable disease for which we typically require vaccination to attend public schools. The route of transmission is uniquely different from the other diseases on Texas' mandatory vaccination schedule, and in order to maintain the uniformity of the vaccination schedule I would not include HPV."

Or you could punch it up by justifying the use of the vaccine for all the reasons laid out above.

But no one did that, not even Gov. Perry. Rather than admit a less than complete understanding of the scientific and legal issues surrounding mandatory vaccination programs, the current Republican Presidential candidates made inaccurate, incomplete, incorrect, and inadequate arguments in order to smear another candidate's record. None of them know the century-old law on point, or worse, they refuse to acknowledge it.

The "conservatives" on stage completely ignored bedrock principles of conservatism and medicine, and pandered to the lowest common denominator by spouting misinformation to get votes. Do not give them yours; we deserve better.

42 comments:

Jessica said...

Thank you, thank you, thank you. And thank you to Bioethicist Art Caplan who is offering over 10k to anyone who can prove *ha* Bachman's claims are right.

rob said...

so you're trying to tell me that the earth revolves around the sun? wait until i tell the inquisition.

Danimal said...

shazam! that'll get the wheel turning here this friday afternoon.

fortunately there are a lot of candidates out there on both sides who never b.s., lie, embellish, exaggerate, or talk out of their asses - giving us lots of solid options.

will be viewing jets game for entertainment purposes only. but thanks for the feedback.

T.J. said...

Normally I go back in and put labels for these posts...but I just left it alone today.

T.J. said...

Someone call for the Inquisition?
http://bit.ly/qDCDwK

jerome said...

The earth is still flat, right?

Shlara said...

Maybe this explains ZMan's post?

http://www.businessweek.com/magazine/generation-x-reality-bites-09082011-gfx.html

Marls said...

First a mighty Huzzah to the z-man.

Second, Mark, I know we haver met and are not likely to soon, but do you care to make a small wager in Jets/Jags?

Danimal said...

A Football Life with Bill Belichick may get you to like him if you didn't already.

Whitney said...

Kudos to Zman. Well articulated and intelligently, thoughtfully defended.

Just a shame that neither the political folks in either side of the aisle nor the great masses of the United States are capable of the intellect and consideration necessary to digest these seemingly simple points. Look at the Billboard charts an Nielsen ratings: Smarmy, simplistic, and loud rules the country, your "facts" and "logic" be damned.

Mark said...

Marls- I'm likely to be in NY next summer. Let's wager a happy hour tab on the Jags-Jets spread. Actually, fuck that. I'm not betting on Luke McCown...

Dave said...

sorry i haven't been around to share my thoughts on exciting topics like "HPV vaccinations" and "autism and mental retardation," but it was 8th grade soccer try-out week.

for a "taste" of what i've been dealing with, head over to Sentence of Dave, but block some time-- today's sentence is a long one (but i promise you, it's worth it).

rob said...

acc football teams are 0 for their last 32 against teams ranked in the top 5. tell me again why it's considered a major conference?

zman said...

I am seriously considering voting Republican for the first time since 1992. All I want is an unashamedly intelligent candidate with a sound economic plan and a willingness to provide centrist compromise. Someone without "more guns/more God" rhetoric would be ideal but I suppose I could live with it if I had to. Instead I have a bunch of knuckleheads and/or panderers.

Danimal said...

If you thought the Terps uniforms were heinous last week....

zman said...

The antidote for a serious post:

http://youtu.be/369FGAb1iI8

rob said...

i hear you, z, but i'm terrified of this version of the gop controlling all three branches. i'd consider a vote for mitch daniels or gary johnson, but they've got less chance of winning the nomination than i do.

more importantly, why in hell does syracuse wanna join the acc?

zman said...

Re: Cuse ... perhaps because the ACC is a traditionally stronger basketball and lacrosse conference? Most of their away games would be really far away.

rob said...

how is auburn going to snatch victory from the jaws of defeat this week?

Squeaky said...

TR, I know you used to rock the fro but this is amazing.

http://bit.ly/pnBfh6

Danimal said...

Irish w 2 Turnovers in first qtr. Odd. 2 belonging to Rees.
7-3 Irish. Took Msu and the points.
Looked this up last year at one point. The previous 12 games nd was 3-9 against the spread......0-2 this year.

Danimal said...

Brian Kelly on valium today fer sher

T.J. said...

danimal, you bet on Irish this week?

Danimal said...

teej...funny you should ask. i usually never bet on the irish. this wkd - i bet AGAINST them. don't worry, i will continue to do so. MSU was getting 6 points which i just thought was nutso. they had 3 f'n turnovers - msu had 2 i think. a shame what happened in 1st 2 nd games b/c they are really very good. and when they aren't very good, i'm the first to say it. but they are good. top 5 caliber? no...but def top 10. i await feedback from others on that. whatever.

Danimal said...

mark - didn't see much of ut/fla game as a result...flipped back and forth a bit. interested in knowing a couple of things:
1) is tennessee what you expected or better?
2) are your gators what you expected or worse? i did see they had a shitload of penalties but really saw less than 5 min of game.
i ask b/c i have vested interest in both ut's season and uf's....
word.

Danimal said...

anyone paying attn to navy/so. car game? ummmm....navy is up 21-17 after a 93-yard drive ending w/a td.

omg....erin andrews really loooks good tonight. funny how nobody ever talks about the size of her sniffer though. it aint' small

TR said...

Been watching 2nd half of Navy-Cocks. Whatever the opposite of silencing the critics is, that's what Spurrier's team is doing.

Danimal said...

if u don't have navy game on now....u need to.

Danimal said...

they just converted a 4th & 17....down 3 with 90 sec left...

Danimal said...

this guy on fsu is not in good shape....
but it shouldn't be a flag.

TR said...

Ohio State has no business being ranked. QB play is piss-poor.

Danimal said...

jmu w/ a last second field goal to beat liberty.
and w&m by 3 over...new haven????

Squeaky said...

Liberty, is that the Falwell school?

Danimal said...

yes

Danimal said...

struggling to find new haven - where do they play out of?

zman said...

In case you aren't joking, my guess is New Haven, CT.

Danimal said...

yeah, knew that....what conference?
this fsu game going to go down to wire

rob said...

what in hell is a new haven? starting to think the tribe ain't all that. jmu in the 'burg next week. little bit skeered.

Danimal said...

rob - check out their schedule. their game today was akin to w&m playing the packers

Danimal said...

next week's lock of the week - lsu vs wvu, unless line is greater than 21.5

Marls said...

Took the jets 61 seconds to cover the spread.

rob said...

new post up. not serious at all.