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Tuesday, April 05, 2005

One order of 'sacred cow'... medium rare

I got an e-mail this morning from a fellow blogger giving me a 'heads up' about a hot-button topic she was discussing over on her site.  This was very thoughtful of her, since I don't get there every day.  Don't get me wrong, I think she is a very talented writer, but her topics don't consistently resonate with me... so hers is more of a once-a-week stop than an every day event.

The e-mail said, "I've just put up a flaming rant that I'm sure will get the ire up of all my readers and fellow bloggers." 

OK... I'm always ready for a little ire-upping.  Bring it on!

When I clicked over, I was confronted with a dilemma.  You see, she wasn't airing out one topic, but rather two.  More importantly, she didn't seem to care that she was serving up this blended menu of topics... which made it very difficult for her readers to address one issue without having to deal with a second, much more sensitive one.

The main target/object of her rant is a woman in her community who, based on her husband's expertise as a medical professional, frequently makes public pronouncements equating not getting ones children vaccinated with child abuse. 

Although the blogger never explicitly says that she hasn't had her children vaccinated, the reader is given the overwhelming impression that this is the case.  The cloak within which she wraps the decision to (presumably) not vaccinate her children is that well-worn American garment known as 'Freedom of Choice'.

The underlying subject of the rant is the blogger's history of being a victim of child abuse.  A good portion of her rant is spent addressing (correctly, in my opinion) the ease with which people tend to throw around the term 'child abuse' without thinking about what the gravity of the term.

Here's my problem: 

If you truly believe that your children should not be vaccinated, say so!  Clearly state your position and provide all of your reasons for making such a decision.  Once you have done so I will say exactly what I did in your comments section:

"Yes, the whole vaccination issue is a personal choice. But you neglect to point out that by choosing not to vaccinate, you are making a choice for others besides yourself and your family.

Unless you are willing to promise me that you and your children will not be interacting with the general population (i.e. shopping, going out to eat, attending schools, etc.) then you are in essence telling me that you have no regard for the very real possibility that you will be endangering the lives of the many people who are forced (they don't have a choice) to live with a suppressed immune system (the most obvious examples being cancer patients and others with compromised immune systems).

Yes, life is full of choices... but please don't pretend that your choices are not also taking away the choices (and potentially endangering the lives) of others."

However, it took me quite some time to get up the nerve to leave that comment, and I couldn't figure out why.  I usually have no problem sharing my thoughts with others... especially when I already have a clearly formed opinion on the subject. 

Then I realized that I had hesitated almost two hours before commenting because she had wrapped her subject matter (vaccination) inside a topic that one is loathe to attack (child abuse).  I found this very distasteful.

What finally tipped the scale in favor of leaving a comment (and ultimately writing about it here) is that I think it is extremely disingenuous for a blogger to bring up a serious issue that deserves public discussion, while making her position on the topic difficult to separate form a secondary  'untouchable' issue.

A completely made-up example:

Let's say I strike up a conversation with a whellchair-bound person on the train.  On top of this, the person in the wheelchair is a black woman who it turns out is blind.  During the course of the conversation we begin debating the level of accessibility that it is reasonable/practical for a government to mandate for the buildings under its jurisdiction. 

I opine that it is perfectly reasonable to require that all new buildings be constructed with full accessibility to the disabled... but that I don't think that it is feasible to retrofit every single building in the country to bring it up to code. 

The woman in the wheelchair responds loudly that she feels I am prejudiced because I obviously know that more black people and women are handicapped than white men, and because I probably also feel 'why make buildings suit the needs of blind people since they are incapable of living normal productive lives within society?'

Suddenly everyone on the train is staring at me, and I am now in the unenviable position of having to defend my fairly straightforward position regarding handicapped accessibility within the broader mine field of issues on which I have not taken a position.

True, this is not a perfect analogy since the target of this blogger's rant did blend the issues of immunization and child abuse.  But the blogger is no longer speaking to this woman.  She is speaking to a large audience that is confused as to what is actually making her angry. 

If the topic under discussion is vaccination, I'm sure the blogger could have easily mentioned that there is a woman in her community who frequently makes pronouncements about how wrong-headed any parent is that opts not to vaccinate their children.  I'm sure this would have generated a lively thread of discussion that would have aired most, if not all of the relevant positions.

The same can be said of child abuse.  If the intention was to trigger a discussion of people's insensitivity to the plight of victims of child abuse, then it would have been just as easy to have brought up the original context within which the offending remark was made, and then say something to the effect of "Without going in to my position on mandatory vaccination, I find it extremely troubling that this woman threw around the term 'child abuse' in such a thoughtless manner."

But by blending the two issues together, it became nearly impossible to express an opinion about mandatory vaccination without seeming to side with the woman who had misused the term 'child abuse'.

In short, don't invite me over for dinner and then serve up a a big slice of 'sacred cow' that I will feel guilty about eating.

If you would like to take part in the discussion where it originated, please go visit Aidel Maidel.  But I am also curious to know if anyone else is conflicted over the blending (deliberate or otherwise) of unrelated issues.

221_14

Posted by David Bogner on April 5, 2005 | Permalink

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Thank you for the post and the comment! I appreciate your thoughts on this.

I just want to clarify that my primary issue was with the abuse issue, the vaccination part was secondary, I was trying to lay a frame work for why I don't think it's abuse.

Thank you again david, you've given me something to think about. :)

Posted by: AidelMaidel | Apr 5, 2005 4:28:47 PM

Disclaimer: I haven't read Aidel's blog, and my comments are directed at what is written here, not there.

I think you're right and I think people do the same thing all the time. They establish their 'victim status' as part of a group that it would be very rude or otherwise unforgivable to attack, then use that status to take a pot-shot at an entirely different issue.

Examples:

  • Paraplegic anti-war protesters like the main character in Born in The USA. If I can make a cogent pro-war argument, then that means my goal is to get other people paralyzed, or I'm indifferent or hostile to disabled people. So are you for peace, or do you hate paralyzed people?
  • The race card, especially as played in the OJ trial. If Blacks have suffered unjustly in the past in the American judicial system than this specific defendant should walk.

I only came up with two but I'm sure other's will come up with some, and in any case, note my groovy use of HTML to make a bulleted list. If you don't appreciate it, it's because you don't like Jews!

Posted by: Doctor Bean | Apr 5, 2005 4:32:03 PM

I posted there and never have done so before so I couched my remarks somewhat. But I think that it is a slippery slope to blend these topics.

It is similar to saying that you are either with us or against us. If you do not agree than you are placed in an untenable position.

Posted by: Jack | Apr 5, 2005 4:36:35 PM

David, I certainly feel AidelMaidel's pain when someone made the egregious remark to her that not vaccinating her children is child abuse. It's simply NOT. It's just one of the many choices and decisions parents make.The issue of vaccination is not black and white, sad to say. Not all vaccines are safe; not all are efficacious. Some aren't necessary. Take Hepatitis B for example. I've never had Hepatitis B so there was no way my daughter could have gotten the disease congentially. And she's not sexually active, doesn't exchange bodily fluids with anyone, and she doesn't do drugs/needles. So how is she going to get the disease? When she's old enough to make the decision for herself, then she can decide on this one, to get immunized. I was vaccinated as a child for smallpox. There is no smallpox anymore. Unfortunately, what vaccines there are for it, are under scrutiny for security reasons.
Vaccination is NOT an either/or choice. You can choose some vaccines and not others. I'm an immunologist by training and that's what I've chosen for my offspring. But I think AidelMaidel was objecting to how the woman's pronouncement was made. Alikening her choice to child abuse hit a tender nerve. AidelMaidel is simply calling out to us to watch our words.
Be well,

Helene Rock
Los Altos, California

Posted by: Helene | Apr 5, 2005 7:29:38 PM

Another angle to consider:

Sometimes (and this happens to the best of, IMHO) we get wrapped up in a topic and don't realize we're straying. For example, Aidel meant to link the separate topics of "child abuse" and "vaccinations" into one topic, "not getting vaccinations is akin to child abuse". Instead, the post (according to yours and Aidel reply comment, I've not read it) devolved into something less coherent.

It's much easier to think what you want to say than to write it, sometimes. Especially if a subject upsets you.

But I do agree that some bloggers do this with less-than-pure intentions, at times.

Anyway, just my sleepy two-cents. :)

Posted by: Lachlan | Apr 5, 2005 8:21:35 PM

Dear Ms. Rock:

As you know, the people most likely to acquire hepatitis B are (1) intravenous drug users, (2) men who have sex with men, and (3) women who have sex with men in groups 1 & 2. Those tend to be groups that are very difficult to reach by physicians and public health efforts. Heroin addicts are not frequently concerned about whether their vaccinations are up to date. That is why the decision was made to vaccinate the entire population. You are clearly more certain that your daughter will never inject heroin or have sex with someone who has hepatitis B than I am. Stating "When she's old enough to make the decision for herself, then she can decide on this one, to get immunized" is simply sidestepping your responsibility. When is someone old enough to decide that? A month before one contracts the virus, hopefully.

I'm not sure I understand what you're saying about smallpox. There is no smallpox anymore because you were vaccinated for it. The vaccine is no longer administered to children.

I'm certainly not accusing you (or anyone else) of child abuse. I'm just explaining the rational for vaccination.

(David: I appologize for being so far off topic comment.)

Posted by: Doctor Bean | Apr 5, 2005 8:23:50 PM

Aidel Maidel... I'm glad you took my comment and post in the spirit in which both where written. I am by no means the sharpest tool in the shed, but if I had trouble identifying which was the more important of the two issues, I can only assume that others had similar difficulties. This is only one of the dangers of blending unrelated topics.

Doctor Bean... In this case, Aidel Maidel has a legitimate claim to victim status, but I was troubled by the fact that she used that status in such a way as to make the vaccination issue more difficult to address. I like your examples, though.

Jack... You really should make her at least a semi-regular read. As I said in my post, she is a talented writer and often has topics that one wouldn't encounter in LA or Efrat. :-)

Helene... Thank you for your thoughtful comment. I agree that vaccination is not an 'all or nothing' decision. However, there was nothing in Aidel Maidel's post to suggest that she was not one of those who is against vaccinations based on an ideology. As I pointed out, she didn't actually come out and state her position, but the reader was left with the impression that she was from the 'no vaccine' camp. After an entire of day to reflect on the topic and a relaxed re-read of her post, I now understand that the abuse comment was her main concern... and she is correct in saying that we throw around the word 'abuse' far to easily. But if that was really her main concern, then the vaccination issue should not have been dealt with in such detail.

Lachlan... Yes, I'm guilty of drifting off topic as much as anyone. But this was not some dashed off post. She wrote it... published it... and thought enough of it to send a private e-mail to many of her blogger friends and readers to elicit feedback. I also freely admit that I came down WAY too hard on her. Chalk it up to trying to write at 5:45AM. :-)

Doctor Bean... Thank you for clarifying the vaccine issue even further. People forget that vaccines require responsible decisions whether you get them or not. For example, when our kids have gotten the live polio vaccine, we have had to be very careful afterwards about exposing them to people who might not have a strong enough immune system to ward of the virus they might be shedding. While I might not agree with everything Helene said (especially in light of your response), I do agree with her that each vaccine should be viewed on it's own merits. There may be an issue of when to have the vaccine (as opposed to whether to take it. And there can also be the issue of whether or not to take a high risk vaccines (such as some of the mandatory/experimental ones I had to get when I was travelling around the world in the navy). Remember, Doctors are not infallible.

Posted by: David | Apr 5, 2005 8:41:51 PM

I'll try and keep that in mind.

Posted by: Jack | Apr 5, 2005 10:23:23 PM

Doctor Bean, What kind of a doc are you, by the way? My daughter will make the decision to be vaccinated against Hepatitis B when she becomes an adult. She'll be 18 next week. But I'm fairly certain that my child will NEVER abuse heroin or other needle drugs nor will she ever engage in unsafe sex. Again, I'll state that not all vaccines are safe and not all are efficacious. One should weigh the risks and benefits very carefully for one's children. There are things we "know" and things that we don't know. Years ago, for example, several lots of oral polio vaccines were contaminated with SV40 virus (it's a monkey virus). Years later when the children who got those lots of polio vaccine started coming down with all sorts of cancers at unusually young ages (when they were in their 20's), those doing the epidemiology on this discovered that linkage between the contaminated vaccine and the unusual numbers of cancer patients. I'm not saying that one should avoid the polio vaccine; rather that there are risks as well as benefits. I chose not to immunize my daughter against pertussis when she was an infant. The incidence of pertussis was actually less than the number of adverse reactions reported to the whole-prep vaccine used at the time. Had there been a significant number of cases of pertussis locally, then I would have gone ahead and had my daughter vaccinated AT THAT TIME. Lots of vaccines are given for public health convenience reasons that aren't scientifically based. Why, for example, do we start immunizing infants against DPT when they're 8 weeks old????? Makes no sense immunologically either. Do mothers actually put their infants down onto the grass directly, at this age, when they're not mobile on their own???? How DOES an infant this young get exposed to tetanus??? One can always WAIT and immunize later than the given recommendations. VAccination schedules are determined by convenience that's why. Another example. The chicken pox vaccine was licensed in 1978. However because the varicella zoster virus is so difficult to grow up in culture, Merck (the only VZV vaccine producer) could only make sufficient vaccine for immunocompromised patients. Once they could make sufficient quantities of vaccine, then and only then, did the vaccine become available to all children, here. For what it's worth, I did have my daughter vaccinated against Chicken pox and red measles, and mumps and rubella. However, I checked her titer and she certainly did not need a "booster" at 12 yrs. of age as recommended. My bottom line is science --- not convenience or public health concerns. But again, that's just my choice. It's NOT a black or white issue. We all have to make choices. But whether we chose to or not to vaccinate is in no way CHILD ABUSE.

Posted by: Helene Rock | Apr 6, 2005 3:03:15 AM

Ms. Rock:

I practice internal medicine (primary care for adults), so I don't take care of kids. I have no argument with or response to the rest of your comment except for three tiny points.

Your ability to predict your daughter's behavior is remarkable and probably speaks well of your relationship with her.

Typing in all caps is considered by general internet etiqutte to be the equivalent of yelling. I certainly did not say anything intending to upset you.

I specifically said that this isn't child abuse, so I don't know why you brought that up again.

Be well.

Posted by: Doctor Bean | Apr 6, 2005 4:41:39 AM

But I'm fairly certain that my child will NEVER abuse heroin or other needle drugs nor will she ever engage in unsafe sex.

Ms. Rock,

I certainly hope that you are correct. You know your daughter better than any of us, but I am willing to wager that raging hormones are a stronger incentive to act than a mother's warning.

That is not a knock/slam against your parenting skills, but a comment on human nature and how we are designed to respond to people/stimuli.

Unsafe sex doesn't imply that she is promiscuous. As you know it only takes one person to set off a chain of events.

Posted by: Jack | Apr 6, 2005 10:08:01 AM

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