Tuesday, February 10, 2015

WE'RE ALL IN THIS TOGETHER (whether we like it or not)...

     Given the recent outbreak of measles in California and surrounding states (and pertussis since 2002), a disease the CDC thought eliminated in the United States back in 2000, traceable back to a family who did not have their child vaccinated against the disease (and presumably others) had me wondering just why it is the state of education when it comes to human health has fallen so because I think it goes deeper than the oft-cited phrase I use: that vaccines are victims of their own success.

     And while I think that is partly true as the group least likely to vaccinate their children are young adults 18-29 (41% believe the decision should be left up to the parents) who just so happen to be mostly second-generation inheritors of a world largely free of humanity's old scourges. You have to dig pretty deep now to find those with a living memory of measles, mumps, rubella, yellow fever, scarlet fever, smallpox, polio, typhus, pertussis, etc. My parents were among the last to get measles and mumps and for them, it was almost 50 years ago when they were still children so their memories of the illness are likely as vague as my memory of having influenza when I was 7 (I mostly remember not having to go to school for a week. I couldn't tell you how high my fever was or how much I ached, etc. anymore).
     It would be their parents who would remember the diseases and how they affected their children and in my case, all my grandparents are dead so there's no one left in my family to tell the tale. It would not surprise me if the majority of the living memory of these diseases exists in people born prior to 1940 and their number grows fewer with each passing year.
     I remember my 8th grade history teacher, who was near retirement at the time (1992 if you really care - she would retire in 1995), talking about how one of her best friends had become stricken with polio and died when she was a little girl and how Summers, times which we now associate with fun, were scary times because that's when the diseases like polio tended to strike.

     But I also think of the kinds of diseases largely eliminated by vaccines. They have something in common: all those diseases affected the population more-or-less randomly as many were airborne. Getting measles and smallpox was more a matter of bad luck rather than the result of having failed to take adequate precautions. They affected everyone, young and old; rich and poor. Famous examples include Andrew Jackson who got smallpox as a teenager and Franklin Roosevelt who got polio as an adult, not to mention the countless hundreds of millions of people who had been stricken throughout the course of human history.

     But I think it was that sucks-to-be-you factor behind the old scourges that made people sympathetic to vaccination. To be fair, it was commonly resisted even into the 20th century as this political cartoon from 1930 attests:
     Those mainly against vaccination back in the day were religionists who saw the plagues and scourges through Old Testament eyes and not, distrusting the scientific advances of the day, as microscopic diseases avoidable through hygiene, prevention, and vaccination, but as punishments from God. God would not give such diseases to those who did not deserve them so it was both insulting to offer up a vaccine to a faithful believer (implying he was somehow not favored) as well as to offer it up to sinners and heathens (who are you to interefere with God's plan?).
     There was also the argument that one's body is one's own and that they alone should be able to take care of their body (and those of their children) as they see fit. Something I'll get back to later.
      In cases like these where, typically smallpox as that was the first vaccine, vaccination efforts were resisted either at the insistence of religious and/or lay authority and those communities would invariably be affected by a resurgence of the disease until vaccination rates were on the rise once more.
     Another cause of vaccine resistance was apathy resulting from prior successful vaccination efforts. As the incidences of said diseases plummeted, and especially in the case of smallpox when it's more deadly cousin (variola major - estimated 30% mortality rate) had been eliminated, the public would start wondering why they should be inoculated against a disease which appears to have gone and when the one that remained was hardly life-threatening? (the mortality rate for variola minor was less than 1%) To combat this apathy, efforts were made to make vaccination compulsory as a matter of public health though not every state would take such measures.

      I think what has changed though, is that the diseases (with certain exceptions) you read about in the newspaper and online today are almost always the result of carelessness.
     You got salmonella poisoning? Well, you didn't cook that chicken properly nor that of your food preparation surfaces.
     You got E. Coli poisoning? Well, you didn't thoroughly wash those spinach leaves on your salad.
     You got lung cancer? Well, that's what you get for smoking.
     You got pink eye? Well, you shouldn't be rubbing your eyes with your dirty hands.
     You got West Nile virus? Well, you should've worn bug spray when outside.
     You got cirrhosis of the liver? Well, maybe you shouldn't've been drinking so much all your life.
     You got skin cancer? Well, that's what happens when you tan too much.

     The list goes on. The point is, a lot of (and I would the majority) of diseases typically encountered in life today all belong to this Unsympathetic Class. That is, they're all preventable diseases requiring oftentimes minimal hygiene practices and minor lifestyle changes to prevent. When someone gets E. Coli poisoning, with the exception of small children, it does not evoke sympathy for the sufferer as one feels that this person should've known better.

     I think the broadest class of diseases today that evoke sympathy are most forms of cancer and autism. Right now things like cancers of the breast, pancreas, brain, bone, stomach, etc. evoke strong sympathy from those hearing your diagnosis. So unless you've spent your adult life insisting upon wearing a radium pendant, no one could possibly blame you for getting such a disease. Getting cancer is (largely seen as [see above]) not your fault so the hearts of strangers are with you and much money is willing to be donated and spent in search of cures.
     A similar thing could be said of autism. As of now, its victims are seemingly random. Families who discover their child is autistic get sympathy from strangers because they see the condition for what it is: a terrible, random occurrence for which they are willing to donate and spend much money in search of effective treatments and ideally, a cure.

     Such a cure may come, though I think like Down Syndrome, the cure will not come in the form of a restorative but that of an in utero genetic test as autism is showing signs of it being a genetic predisposition rather than a developmental one like Fetal Alcohol Syndrome. Once such a test exists, it is safe to say autism will be largely "cured" through abortion rather than by a curative agent after which, the sympathy factor for autism, now that it would be entirely preventable, will practically disappear. If you've noticed, there's not a whole lot of sympathy for those who deliberately have Down Syndrome kids anymore: such parents are viewed as kind of selfish, even as cruel. I think autism's day will come too.
     And before you go thinking that what I've just written is terrible, imagine a day when all cancers are curable in a way that leaves a person healthy (as opposed to now where treatments work more by attrition, that is, kill the cancer faster than you kill the patient) how you might react to someone refusing treatment.

     And I think because commonly encountered diseases today do have this element of "it's your fault if you get them", that it affects the decision-making of that 18-29 crowd mentioned above.
     It probably also does not help that one of the last sets of diseases that are random is the common cold. As it is  it is only a minor nuisance that is easily overcome and the sympathy factor for it is practically nil as we've come to believe that it is through prevention (and even our innate desire to overcome it through force of will) that the common cold may be avoided when the reality is that it is much more the result of bad luck.
     If this is your only experience with disease, you may be more prone to overlooking the dangers. There's also the conceit factor (which I'll admit to falling for) in that the old scourges were in black and white times when technology was crappier, people were less educated, and scientific knowledge was considerably less than what it is today. It may result in an arrogance that we not only know better than our forefathers but that, in the event the disease should resurge, our technological savvy and medical know-how will keep it under control. We armchair-quarterback the past using our present-day knowledge to believe that, if we were in those situations, that it would not have happened to us, living in full denial that these scourges were not as preventable as we might like to think.
     In that way, and this is strange to think, it might be argued that the increasing stance against vaccination is surprisingly an overabundance of optimism in our medical knowledge.

     Ultimately though, what I think it comes down to is that vaccination must be looked upon as a civic duty and not a personal choice. For analogy, I would offer up environmentalism.

     Say I owned a large plot of land with plentiful resources and a river flowing through it and that I had a desire to develop that land for commercial purposes. I'm building a factory.
     Is this factory allowed to simply pipe the CO2, SO2, and soot it generates into the air? No? Why not? Is this not my land? Do I not have the right to develop it as I see fit? The smokestack rises high into the air. I don't even smell it. My air is clean.
     But what I will be told is that the air does not belong to me nor to any one person. The air belongs to all of us. The pollution I am putting into the air may dissipate but it did not disappear. Studies show that the effects of the pollution are cumulative. Downwind the soot and sulfur dioxide affect plant and animal life. Worldwide the increase in carbon dioxide slowly warms the planet. Therefore I am made to minimize my contribution to this pollution using filters and scrubbers, cleaner fuels, renewable energy, etc.
     My factory generates liquid waste so would this factory be allowed to simply dump its waste into the river? No? Why? Again, does not this river which runs through my land belong to me? Do I not have a right to use its water as I see fit? The waste is carried away leaving my water clean.
     But what I am told is the river traverses many plots of land like mine and that what I dump to flow downstream will affect such water owned by those who live along the river (not to mention the wildlife that also depends on it). Like the air, the river belongs to more than just one person so it must be treated in the same manner, as a community good. I have to also consider how I might feel about a similar factory upstream dumping its waste into the river and how it would affect my operations and the water's potability. And that's just waste water, imagine had I wanted to build a dam to hydroelectrically power my factory!
      And this analogy would continue through the dumping of solid waste. Again, is this waste toxic? Is it seeping into the ground affecting the groundwater supply? Are plants incorporating toxic metals into their fruits making them more hazardous for consumption? Is it bringing disease-carrying rats/flies/mosquitoes into the area? How long will it remain hazardous? Etc. Why am I being forced to acknowledge the impact of my actions on other people? Why do I have to spend all this money and expend all this effort on things that are not me using my land as I see fit? Why must things never be simple?

     Surely some pollution is okay, right? And to that I would say yes. Some pollution is necessary for there to be progress but not all pollution is the same. The carbon dioxide produced by this factory is taken up by plant life, neutralizing it. The trees cut down for lumber grow back and wastewood restores nutrients to the soil. Water taken from the river is replaced by rain. Etc. But small amounts of metals like lead, while they exist naturally all around, become exceedingly toxic when concentrated so this factory cannot simply dump these kinds of metals just anywhere. Rocks removed from a quarry do not grow back. Overdrawn rivers dry up affecting everyone's ability to get a drink. Deforested land may never recover. Overfished rivers soon offer up little to eat. Too much carbon dioxide in the atmosphere and plants will be unable to retake it all. Too much phosphorus in the waste water will produce algal blooms which create dead zones in the sea. Concentrated radioactivity is dangerous for all life (except weird bacteria). The list goes on.
     So while in the name of progress we must tolerate some pollution, we mustn't tolerate unnecessary pollution. I feel, if one is an environmentalist, believing that the world belongs to no one but rather everyone and that it is everyone's responsibility for our continued survival and prosperity, one should take upon themselves a similar view with vaccinations and other forms of disease control.

     It's not that these diseases, the old scourges, are deadly. Diseases like measles rarely result in death. They even produce complications like pneumonia, encephalitis, deafness, sterility, or paralysis only rarely as well. No, the problem is that they spread and thus take hold in a population easily. Far more easily than any diseases we know today. Even the latest scary disease, Ebola, spreads poorly (and arguably unsympathetically [see above]).
     I think that's why we're seeing pertussis and measles coming back first as their communicability is about 80% and 90% respectively. These diseases, in a sense, represent environmental pollution that affects more than the individual alone.
     And nothing is perfect. Just as no vaccine is 100% effective (as no one's immune system is 100% effective), no control for pollution is 100% effective either. A drought, for instance, will affect both the ability of a river to disperse pollutants (as well as supply drinking water to inhabitants and its ability to hold dissolved oxygen for its inhabitants) as it will affect a forest's ability to soak up excess carbon dioxide (and a forest fire will add to the CO2 totals). But both are kept in control by storing excess rainwater and through careful land management (and even as we've learned, controlled burns).

     I figure if one loves the Earth and its biomes and ecosystems and feels they must be preserved to the best extent possible via what amounts to the Butterfly Effect, then one ought to view humanity itself as an ecosystem and seeing as we are all in this together, look out for one and other and do our part to keep from inadvertently polluting another person's body through no fault of their own.

     Or something like that anyway...

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