I'm opposed to many sorts of state interventions, but public health measures strike me as a no-brainer. I mean real public health measures: not nannying people about their trans-fat consumption, but preventing the transmission of infectious disease. The negative externalities of infection seem to me to give the state a perfect right--indeed, an obligation--to curtail your freedom to fanny about spreading cholera.
As Matt Zeitlen says, I do not recognize the "right" of parents to refuse to vaccinate their children.
It goes without saying that I don’t share Jesse Odegard’s sentiment that Marlyland needs to “stop being so dramatic” in mandating that kids receive basic shots or else not be allowed to attend school along with fining the parents for each day absent. Of all civil liberties, I don’t see the one to pigheadedly endanger and inconvenience children, who by law have to attend public school, with your un-immunized, disease-ridden child because you’re too twee to see your kid get some shots as one that needs urgent protection.
Vaccines work primarily not by protecting you, but by creating "herd immunity": denying the virus a reservoir in which to incubate. Public schools* used to be the perfect incubators, because there you have large numbers of people with no prior immunity herded together, making disease transmission a near-certainty. Vaccines have destroyed those disease reservoirs.
Now that the disease reservoirs are destroyed, of course, parents are tempted to free ride on society. They trust in other parents to vaccinate their children, thus maintaining a disease-free environment in which their own precious princes and princesses can run around safely without taking precautions. They do this for reasons logical and illogical--vaccines do pose some very small risk to kids, but more of their fears seem to be based on junk science like the thimerosol-autism connection. But even their real fears about the safety of the vaccine would be vastly outweighed by their fears of disease if other parents didn't vaccinate, so it's accurate to describe their behavior as free riding.
This behavior shouldn't be allowed for two reasons. First of all, contrary to popular belief, vaccinations don't necessarily provide lifetime immunity; that's why the vaccine's role in destroying the disease reservoir is so critical. If enough kids aren't vaccinated, they'll create new reservoirs, as has already happened in some places with diseases like measles and whooping cough. Adults whose immunity has attenuated over time catch the diseases, and as we all know, diseases you get as an adult are much worse than the same diseases are in kids. Refusing to vaccinate your kids thus endangers other peoples' lives.
Second of all, there's no way to create a social policy that says "90% of all children have to be vaccinated". Are we going to hold a lottery for the remaining 10%? Unvaccinated children are a direct menace to public health, which makes it reasonable to forbid them from going out in public.
* By which I mean, before you start screaming, "schools attended by members of the public", not the government-run school system.
Adults whose immunity has attenuated over time catch the diseases, and as we all know, diseases you get as an adult are much worse than the same diseases are in kids.
Not always. For example, my understanding is that norovirii (the class of viruses responsible for most 24-hour stomach upsets not otherwise caused by mild food poisoning) tend to hit children harder than adults.
On the other hand, many/most diseases do tend to have severest effects in the elderly for reasons of weakened physical condition, and these are a class of people who are also most likely to have severely attenuated vaccine immunities. That right there is a very bad combination if we suddenly have unvaccinated children running around as incubators of diseases that had been previously shut out of society by rigorous vaccination policies.
Why not auction off the right not to have your kids immunized to .01% of parents. The price that came out of the auction would tell you much about the real desire of parents to avoid immunization for their kids. Also, it would give parents who are terrified of immunizing their children a way out. Finally, because it's good for children to be immunized no one could claim that the auction put poor kids at a disadvantage.
Also, the proceeds from the auction that James D. Miller suggests could be used to subsidize the immunization of others.
"Why not auction off the right not to have your kids immunized to .01% of parents."
Great idea. That would be a simple way to identify the un-immunized kids so they could be quarantined for life.
I am pro-vaccination for the most part, but not necessarily on the schedule the government has set up. Babies have 3, 4, 5 shots every single pediatrician visit (at 2, 4, 6, 9, 12, 15, 18, etc. months) because the government regulations are set up to get kids the most number of shots they can while parents are still taking their kids in consistently for checkups. They're trying to get them all in before parents start forgetting to take their kids in or prioritizing other things.
So, that schedule is incredibly burdensome on a tiny, undeveloped immune system and some of us are concerned that the government is prioritizing vaccinations over individual babies' safety. I understand the herd immunity issues. But my priority is MY baby. And if delaying some shots, or skipping others (for instance, if she were to have a reaction to her first DTaP, I would not hesitate to refuse to get her the rest of the DTaP shots) is what is safer for her, then the school system can suck it.
I think the parents who are yelping hysterically about the supposed autism link are doing everyone else a real disservice. Those of us who have thought it through, researched (and not just on the crazy anti-vaccine sites), and are still selectively delaying or avoiding vaccines look crazy - when really we're just looking out for the best interest of our kids.
It's tough, because as a basic principal I do have a hard time with the government forcing inoculations into the arms of anyone, particularly kids, without their parents permission. At the same time, everything you've said seems true to me. What's more, the parents would have a better case if the fear of the supposed dangers of immunizations was backed up by some sort of scientific evidence. The vaccine-autism link, for example, is something believed ardently by many people without any solid evidence whatsoever.
Not always. For example, my understanding is that norovirii (the class of viruses responsible for most 24-hour stomach upsets not otherwise caused by mild food poisoning) tend to hit children harder than adults.
I certainly don't think she meant to be speaking universally; there are obvious examples of diseases that are more dangerous among children. I think she was just speaking generally.
My harebrained scheme: use tax money to pay parents to have their children vaccinated. If X% of the population need be vaccinated for public safety, then the subsidy can be raised or lowered to reach that level.
bil., no parent who is refusing to have their kid vaccinated for free is going to change their mind because the government offers them a little money.
Megan's post is completely correct, and there is little to add. I would however note that the government's role in the trans-fats issue is not "nannying people about their trans-fats consumption." It is to get an unhealthy ingredient out of mass-produced foods which people have no way of knowing is there on their own. This goes to the heart of the issue of public trust. You can no more do anything about the trans fats issue as an individual than you can do something about the presence of high levels of e. coli in your chopped meat. You don't know they're there and you don't know how unhealthy they are. Only the government has the scientific knowledge and the inspectors to do anything about these kinds of public health threats. If you cook all your own meals at home, using only basic ingredients, then you can to some extent make your own choices about health (though you still don't know what chemicals are in those vegetables). But if you eat out a lot, and more and more Americans do, then you need someone making sure that the ingredients in that prepared food aren't going to kill you over 40 years, or at the very minimum someone to post notices informing you of what's in those foods and what it'll do to you.
I would have thought that little cholera scare in Vietnam might have been a useful lesson in government's role in issues like these.
Leah, a reaction to a vaccine (that really is a reaction to the vaccine) is a legitimate reason not to get any more doses of the same one, and will be treated as such by the public health authorities. The only current vaccines that are the live, attenuated virus - and thus capable of causing any disease at all - are the MMR and chickenpox vaccines (as far as I can tell from a quick Google check). The rest - which include all of those given before 12 months of age - are viral or bacterial debris, incapable of causing any disease, even a mild one (although your kid might feel icky for a day or two as his/her immune system gears up for a battle it will, definitely, win). If you want to work out your own schedule to suit your conscience, feel free, but the bulk of the vaccines given to children are simply unlike those given in the past, and are no longer capable of transmitting disease - there is no real worry that the child's immune system will be "overloaded", because it's fighting a decoy.
By the way, if you put off flu shots for worrying you might get the flu itself, you can't from the modern injected vaccine. It might make you feel a bit under the weather for a day or so, but it's not the flu.
But my priority is MY baby.
It's only the fact that the horrors of diseases like the mumps are so rare today that enables you to think that you are serving your baby's needs by not inoculating it against deadly disease.
bil., no parent who is refusing to have their kid vaccinated for free is going to change their mind because the government offers them a little money.
Really?
brooksfoe wrote: I would have thought that little cholera scare in Vietnam might have been a useful lesson in government's role in issues like these.
I should think that an effort to conflate trans-fatty acids with e.coli or cholera for negative health effects requires cognitive dissonance at pitches that would make dogs' eardrums explode.
Seriously...what that merely the literary equivalent of a flaming bag of dog poop? Ring the bell and run, just for the pleasure of the reaction?
In all seriousness, before the government gets its panties in a twist about potential infectious outbreaks, shouldn't it at least try to use well-known public health containment strategies on an actual outbreak (aka AIDS)? At least, that is, if it is serious about preventing it and/or minimizing the societal impact. Contact-tracing and quarantine have worked in the past to contain incurable diseases, so why aren't they used now?
FWIW, I would tend to discount any rational that cites long latency as a reason for doing nothing. Once a vector is identified, it should be prevented from transmitting the disease to others and any pre-diagnosis contacts should be identified and notified of their potential infection.
Some useful statistics from the CDC: in 2005, 99% of AIDS cases were from one of three causes: 1)Male/Male sex and/or 2)IV drug use, and/or 3)Heterosexual sex with either of the first two groups. The cumulative total for all three groups from 1984 to 2005 was 98% of all cases.
Not always. For example, my understanding is that norovirii (the class of viruses responsible for most 24-hour stomach upsets not otherwise caused by mild food poisoning) tend to hit children harder than adults.
I'm pretty sure that MM was referring to the usual round of childhood diseases that are vaccinable(?) or, if not, no big problem w/ children: mumps, & measles, for example, both of which can have serious, long term effects when contracted at advanced ages.
anony-mouse, you are occasionally capable of not being a jerk, so I'll respond as if you weren't. Cholera is one thing you worry about when you eat lettuce in Vietnam. Another thing is pesticides. Another thing is spillover in groundwater from polluted sources. Another thing is MSG. Another thing is spillover of antibiotics from fish ponds. Another thing is the presence of a certain banned carcinogenic byproduct of the manufacturing process in soy sauce. Another thing is machine oil in the fry cooking oil. Another thing is formaldehyde in the pho noodles... and so on. Trans fats are in the mix somewhere too.
You have no way of knowing whether these things are in your food or not, because there is no competent government agency aggressively making sure they're not there. It's the same kind of phenomenon you see in Chinese toothpaste. Having a competent government agency taking these public health measures is one of the advantages of living in a first-world country. It creates transparency and public trust. You do not understand what the lack of such public trust means until you have lived in a third world country.
Not always. For example, my understanding is that norovirii (the class of viruses responsible for most 24-hour stomach upsets not otherwise caused by mild food poisoning) tend to hit children harder than adults.
I'm pretty sure that MM was referring to the usual round of childhood diseases that are vaccinable(?) or, if not, no big problem w/ children: mumps, & measles, for example, both of which can have serious, long term effects when contracted at advanced ages.
Not always. For example, my understanding is that norovirii (the class of viruses responsible for most 24-hour stomach upsets not otherwise caused by mild food poisoning) tend to hit children harder than adults.
I'm pretty sure that MM was referring to the usual round of childhood diseases that are vaccinable(?) or, if not, no big problem w/ children: mumps, & measles, for example, both of which can have serious, long term effects when contracted at advanced ages.
Pardon the triple post, The Atlantic's server was acting up.
anony-mouse, you are occasionally capable of not being a jerk, so I'll respond as if you weren't.
No kidding. (The acts like a jerk most of the time part.)
By the way, why do you think there are all these people using trans fats? Because the government and its nanny hangers-on, with all that "scientific knowledge," told everyone that they were better for people than saturated fats.
Except that trans fats are not "unhealthy" in any real sense.
http://en.wikipedia.org/wiki/Trans_fat:
"Most trans fats consumed today are industrially created by partially hydrogenating plant oils...Unlike other dietary fats, trans fats are neither required nor beneficial for health.[1] Eating trans fats increases the risk of coronary heart disease.[2] Health authorities worldwide recommend that consumption of trans fat be reduced to trace amounts...
"In 1994, it was estimated that trans fats caused 30,000 deaths annually in the US from heart disease."
"In 1994, it was estimated that trans fats caused 30,000 deaths annually in the US from heart disease."
Hopefully they didn't get this estimate from the UN.
The link in brooksfoe's post doesn't work.
Trans fats are just partially hydrogenated vegetable oils, which appear on ingredient lists in packages foods. Basically, it's a subset of shortening and margerine, plus some kinds of deep frying oil. Why is this hard to identify? Assume it's there unless someone chooses to market a product by noting either the absence of trans fat or the presence of a more interesting alternative. I look for either real butter or olive oil, as much for taste as for any other reason.
Here's a vaccine requirement that I'll raise as completely bizarre: Hepatitis B. What the hell is the point of vaccinating children for Hep B? What are they doing in schools these days that Hep B is an issue? But yet, Hep B is a requirement in a number of states.
Klug,
try this: "Ryan's veto message states that "Senate Bill 1304 would severely limit the number of pediatric disease specialists and pediatric physicians in general, who would be eligible to serve on the Immunization Advisory Committee."
This amazing statement indicates that it's difficult to find anyone to advise making vaccines mandatory other than those who are paid in some way by the corporations selling the vaccines.
This conflict of interest was confirmed by an emotional outburst against S.1304 from one of the members of the Illinois Immunization Advisory Committee at its meeting on July 12, 2001.
He said:
"No infectious disease specialist will be able to serve on this committee! We all take money from pharmaceutical companies."
Ryan's veto message acknowledged that Illinois depends on vaccine company contractors for its vaccine policy-making. Here is what Ryan wrote:
"Many physicians with expertise in the field of immunizations and infectious disease have contractual relationships with pharmaceutical companies with regards to speaking engagements. Also, many medical schools and academic centers employ infectious disease specialists that perform research funded by the pharmaceutical industry."
So that's how the racket works! "Experts" who are being paid by the vaccine manufacturers have an official pipeline through which they "advise" the state government authorities to mandate vaccines.
This incestuous relationship between the pharmaceuticals and governmental bodies is not unique to Illinois."
http://www.mercola.com/2001/sep/15/vaccines.htm
Uh, no offense, MEH, but I find Mercola to be a quack. I am sure that the ties between industry and government are overly close, but that still doesn't answer my question: what's the rationale for vaccinating adolescents for Hepatitis B?
Klug,
I hold no brief for Mercola, but he just posted the article, written by Schlafly..
To your Q, it would broaden the demand pool, no?
Or, maybe the Legislators know better, the type found within Education bureaucracy
But, really, given this:
http://www.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm
I'm hard-pressed to understand the real need..
Given that infectious diseases do kill people and that vaccinations work when broadly implemented and that there is a serious free-rider problem, I have no problem with government mandated vaccinations for children who are in school. I would support a home-schooled child's right to not be vaccinated as long as the child didn't attend school functions. I would argue that not vaccinating a home-schooled child is a bad idea, but allowing it would be an "out" for those who object that wouldn't endanger other kids.
On the other hand, trans-fats and other unhealthy foods can be fine if used in moderation, do not generally cause health problems for anyone other than the person who consumes them, and it's easy to buy and prepare food with ingredients you want. Also, food is subject to market effects where a low demand will result in a low supply. On the other hand, mislabing or concealing the contents of food prevents the market from working and can cause health problems so I prefer that the government require full disclosure of the ingredients in food so that consumers can make their own choices. Currently, packaged foods sold in stores are labeled. Rather than ban foods used by restaurants, I would like to see restaurants required to include nutritional information in their menu so that consumers can make informed decisions.
IMHO, the above two solutions (requiring vaccinations, requiring food labeling) are the least invasive solutions to market failures. In the case of vaccinations, the government action is more invasive because the market failure is more profound. In the case of food, the government action is less invasive and merely assists the market.
EI
I would argue that not vaccinating a home-schooled child is a bad idea, but allowing it would be an "out" for those who object that wouldn't endanger other kids.
I still think this goes too far. The government has the power to quarantine people who contract infectious diseases; it's far less invasive to just compel everyone to get vaccinated, which prevents the eventuality of having to quarantine them. It's a reasonable argument, but at some point you have to have public policy based on science, not based on catering to people's erroneous beliefs.
On the food issue, forcing manufacturers to make information available is a good thing. But the distinctive thing about trans fats is that they can be easily replaced by more natural kinds of fats, at only slightly greater cost. Even Crisco has managed to rejigger their formula to get rid of the trans fats. The tiny increased cost of an Oreo is not going to be noticed by any consumer; in fact unless I'm mistaken Oreos have managed to get rid of the trans fats too. It just seems like a public health intervention that would never have happened if governments hadn't taken action, but which carries almost no cost now that it is happening, and which may prevent a fair amount of heart disease.
here's another clip:
Get Kids Vaccinated Or Else, Parents Told
Pr. George's Threatens Legal Action
By Nelson Hernandez
Washington Post Staff Writer
Wednesday, November 14, 2007; Page B01
The parents of more than 2,300 Prince George's County students who failed to get needed vaccinations could face fines of $50 a day and up to 10 days in jail if their children do not meet the state's immunization requirements, county officials said yesterday.
The threat of legal action is a last resort after months in which Prince George's has struggled to get its 131,000 students immunized for chicken pox and hepatitis B, as mandated by the state. More than 2,300 students have not been immunized and have been barred from attending schools, almost two months after a Sept. 20 deadline for meeting the requirement.
http://www.washingtonpost.com/wp-dyn/content/article/2007/11/13/AR2007111301408.html
and, another:
"Thankfully, the National Center for Education Statistics has some great information about Prince George's County Public Schools online available to the public to anyone with an internet connection! (http://nces.ed.gov)
According to this government website, in the 2006-2007 school year, Prince George's County Public Schools received $11,325 per student per year! That is more than I pay for my kid's private school tuition! The breakdown was 7% from federal money or $780, 46% from the state at $5246, and 47% from local revenue at $5298. Assuming a typical 180 day school year, that comes out to $63 per child per day of school attended.
Why is this important information? If the Washington Post article is correct when they said that 2300 kids are being barred from school, all of a sudden $63 per student per day turns into an astronomical loss of $144,900 PER DAY for the school district. That would light a fire under anyone's backside to stop that hemorrhaging of loss of income, but it does not justify the way these families are being treated."
http://www.newstarget.com/022280.html
what I really don't understand is this:
http://clusty.com/search?input-form=clusty-simple&v%3Asources=webplus&query=immunity+for+vaccine+makers
if the vaccines are so safe, and all..
Let me say, up front, that all of my children are current on their vaccines, I support the vaccination of children, and do believe that many of the fears surrounding vaccination are irrational.
Having said that, we live in a free society. Parents have responsibilities for their children, and, as it has always been, they have some leeway in screwing up their children's lives (to put it bluntly). And part of this freedom should be whether they immunize their children in time. Objections to mass immunization should be argued rationally, but it should not be enforced by fiat. There are reactions to vaccines, even those with 'dead' material, that can be severe, and this alone is reason enough to make this a voluntary system (and yes, the potential harm for opting out is greater than the potential harm for opting in). But tyrannies force this, not free societies, and I want to live in a free society, idiots and all.
"In all seriousness, before the government gets its panties in a twist about potential infectious outbreaks, shouldn't it at least try to use well-known public health containment strategies on an actual outbreak (aka AIDS)?"
HIV isn't very contagious, so it's easier to contain. You have to swap bodily fluids to contract HIV, with airborne contagious diseases a quarantine could mean shutting down a city. It is what happened during small pox out-breaks before we discovered reliable vaccinations. It's far less invasive (and cheaper) to just require vaccinations rather than stop traffic in and out of a city and require everyone to stay at home.
Further, there is an incubation period for these diseases so they may spread rather quickly through the country before we realize there is a problem. With airline travel so popular we could have people infecting every major city, before we realize that a quarantine is needed.
"But tyrannies force this, not free societies, and I want to live in a free society, idiots and all."
Many things are forced on us for the public interest. When your actions start to negatively affect other people's health, the government can step in. The amount they step in depends on the nature of the threat, and if government action will work. Vaccinations work best when all children are immunized, because it eliminates public schools as a breeding ground for disease. Public schools are hot-spots because children are more susceptible to catching diseases, close quarters and a general lack of hygiene.
It has been a very successful policy for over 50 years, due to near elimination of many diseases. Some are making a comeback, because vaccinations are no longer routine.
Considering that MD law allows for exemptions from vaccinations on religious grounds, I'm hard-pressed to understand what legitimate reasons these parents have for not vaccinating their children and enduring the harsh fines and possible jail time.
MD should do some PSAs to air during cartoons that basically tell kids that parents who don't make sure they get immunized don't really love them. That would make things interesting.
So eliminating trans fats does cost more? What about other things that are cheap to replace? Should the government go through our entire food supply and ban unhealthy ingredients that are cheap to replace? Do we really want the government micromanaging our diet? I've seen too many cases where nutrionists tell us one thing for a while only to make a complete reversal later when some new information is discovered. I'd rather the government stay out of the business of enforcing healthy eating and focus on mandating transparency and protecting us from serious contamination (poison, disease, etc...) rather than "unhealthy" ingredients.
EI
But there are bigger problems with this; it's a once-removed estimate. First they have to estimate how many people died from obesity-related causes, and then they have to estimate how much of that obesity to attribute to trans fats. It's not as simple as figuring out how many people ate trans fats; eating trans fats doesn't make you obese or give you heart disease. OVEReating trans fats does.
But there's another problem with this data -- what does it mean to die from heart disease? Yes, if someone keels over from a heart attack at age 30, you can say, "if he had only kept his (bad) cholesterol lower..." But when someone dies at age 80 from heart disease, does it really make sense to say that this was a death caused by trans fats?
So eliminating trans fats does cost more? What about other things that are cheap to replace? Should the government go through our entire food supply and ban unhealthy ingredients that are cheap to replace?
Well, I don't really see the moral distinction between this and a Pigovian tax; people can't choose to spend less on cigarettes, either. Obviously the unhealthiness of cigarettes is much clearer, but that's a matter of degree. I assume eliminating trans fats must cost more, because there must be some reason why companies used them; though it may just be that it's hard to figure out how to get the same qualities without using them, so it may be just a matter of having to put in the "cost" of figuring that out.
I just think the trans fats thing is kind of a unique case. One factor is that these are down-market ingredients; it's hard to imagine anyone complaining about getting real olive or vegetable oil instead of partially hydrogenated corn oil and flavoring, so long as the cost difference isn't prohibitive, which apparently it isn't. The other thing is the question of what one regards as "artificial": trans fats are cheap industrial products which have led to a huge shift in our diets towards cheap industrialized foods. If getting rid of them makes low-quality industrialized foods slightly less inexpensive relative to healthy real food, it just seems perverse to take the view this is a bad thing, unless you happen to be Wendy's or Nabisco. And it would be something else again if we were talking about a type of food that's an essential nutrient for hungry people. But trans fats have no nutritional value, and poor people in America are obese, not starving -- partly as a result of eating too much trans fat.
I don't really see the moral distinction between this and a Pigovian tax; people can't choose to spend less on cigarettes, either.
I'd describe a tax on cigarettes meant to reduce consumption as "nannying," so if you don't see a difference, then it's fair to say the government is "nannying" on trans fats.
I hate it when taxes are used as a cudgel to fight/encourage behavior; that's a soft form of totalitarianism. Real Pigovian taxes to force people to internalize externalities are one thing, but "let's tax something we disapprove of" isn't the same. And all your talk about "down market ingredients," the superiority of olive oil, and what you call "real" food shows that you think you know better than others what they should choose to eat. I don't disagree, it's just that I don't think that their means are my decision.
Stop nannying people, for heaven's sake, and certainly stop denying that you're nannying them.
That should be "I don't think that their meals are my decision."
"unless you happen to be Wendy's or Nabisco"
Nabisco, the heretofore National Biscuit Company, is now a wholly-owned subsidiary of Kraft Foods
http://finance.google.com/finance?q=NYSE:KFT
Wendy's
http://finance.google.com/finance?q=WEN&hl=en
brooksfoe, you should check your MutualFunds, more than likely you're the proud owner of both of these shares..
And, if you really feel that way, lay on a pair trade: short KFT and go long HAIN, might even net a credit for your troubles..
JordanT-
I think you very eloquently missed my point. AIDS is indeed difficult to catch. Yet we are spending a fortune on "curing" it, and doing nothing to prevent/contain it. If AIDS is serious then treat it as a serious disease, if not, stop throwing money at it.
M,
Why aren't you also thumping your tub for quarantining hepatitis C sufferers? That disease is a good deal more contagious than AIDS and is transmitted in much the same way.
Also have you REALLY considered the cost issue? The type of quarrantine you prpose would have to be for life, not just a few weeks-- meaning you'd have to spend about 40K per person a year just on living expenses (I assume, or hope, you are not proposing leper colony or concentration camp conditions) plus all the expense of treating the disease. So we'd actually end up spending more money than we do now since most people infected with HIV are capable of working and supporting themselves. Some even have health insurance, keeping off the public dole.
Of course the real interest when this is suggested isn't money as witness the fact that no one suggests quarrantine for Hepatitis C (a mainly heterosexual disease). The real goal is to find a way to lock up gay people now that sodomy laws are in the cesspit of history.