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As an example, the first rotavirus vaccine was withdrawn from the market less than one year after its launch because it was linked to intussusception.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 Yet the vaccine was still withdrawn.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.