Science as the Final Authority

This morning there was an interesting interview on NPR with the author of a new book about vaccinations. The interview can be read or heard here: http://www.npr.org/blogs/health/2014/09/30/351242264/vaccine-controversies-are-as-social-as-they-are-medical

The comments on the npr.org website are also very interesting. Below is my contribution to the discussion.

I listened very intently to the interview today with Eula Biss regarding her new book, "On Immunity," regarding vaccination. I, too, am a parent, and I have also had questions about vaccination, on all sides of the question. I agree with Ms. Biss in her borrowed observation that “when you split the difference between information and misinformation, you still end up with disinformation.” However, maybe it is a shortcoming of vocabulary, but the only alternative to “information” is not "disinformation.” Where does “anecdotal evidence” fall in this spectrum? How about “wisdom?” Although I was raised to be a scientist, an intellectual and a skeptic, these approaches alone proved insufficient for fully understanding and managing my life, and I eventually branched out and became a practitioner of breath-centered exercise therapy and an acupuncturist. Some would say this puts me on the side of “disinformation” -- although I would beg to differ, classical Chinese medicine is certainly not scientific medicine, and I'm fine with that.

Ms. Biss blames some of people’s reluctance to vaccinate on a “distrust of the government,” but some people also distrust science, and especially scientific medicine. I myself believe in the scientific method, but scientific medicine is another matter. First of all, when the scientific paradigm shifts, everything that used to be true becomes untrue. This is so patently false that people turn away from, say, the latest scientific advice about a healthy diet, simply because the “truth” is constantly shifting. More aggravating to me, though, as someone whose profession and personal integrity are regularly assailed by people on “scientific” grounds, is the casualness with which even respected and experienced scientists apply the scientific method. As it happens, Ms. Biss employs this same casualness in her own approach to vaccination. In the interview she said, after much rational discussion about the science, economics and politics of vaccinations:

“I would prefer for my son to have as little medical care as possible, as little contact with the medical system as possible. I think vaccination is actually one way to try to help ensure that — making sure that he doesn't get something like pneumonia that might mean a hospital stay, where things will be done to him that will make me uncomfortable or that he will be treated in a way that might feel excessive to me. I think the best way for me to keep him out of that system is to engage in this highly effective preventative medicine.”

I can’t tell you how many people have told me, “I hate pills.” Well, I understand why they feel that way, but it’s an uninformed (or half-formed) and ultimately unconstructive point of view, because sometimes pills will save your life, or make your life better. This is essentially the same thing that Ms. Biss has said regarding her son. Because she fears (or dislikes, or distrusts, or otherwise has a negative opinion of) the “medical system,” she will “only take one” of that system’s strategies in order to avoid using its other recommendations and practices. Never mind that a hospital stay can save her son’s life, she will take this other step, that she can comprehend and that she believes has minimal risk, because she fears the experience of having a child in the hospital. In other words, Ms. Biss’ use of vaccinations for her child is an act of faith, based on her fear of hospitals and the rest of the “medical system.” This is a mother’s prerogative, but it certainly isn’t scientific.

As a body mind spirit practitioner, I have no problem with acts of faith, but I do think you should have some self-awareness, some understanding of how you are living your life and why you are making the choices you make. As a professional whose profession is under frequent attack by proponents of scientific medicine, I don’t feel so generous. If you are going to put all non-scientific points of view on a different and lower level than your own rational, scientific point of view, then have the courage of your convictions and be scientific! And if you are going to occasionally indulge in faith or emotion during a scientific discussion, please understand that this lapse blows your claims of rational, scientific impartiality clean out of the water. You can’t cherry pick the science that appeals to you – you either employ the scientific method in your approach, or you do not.

As it turns out, we are not capable of being purely rational, nor is it desirable – that’s the comic, ironic and profound point of characters such as Mr. Spock on Star Trek, and Sheldon Cooper on The Big Bang Theory. Again, I don’t have a problem with irrational behavior, but I do have a problem with those who castigate, judge or hold themselves superior to others based on the critics’ self-identification as “rational” or “scientific.” The truth of things is that there are many things we don’t understand, as patients and as practitioners, no matter how rational we are. We have to live with that ignorance, but still make the best, most well-informed and most prudent decisions we can about caring for our health, or helping others care for their health. These are not usually black and white decisions, as scientific medicine would sometimes have us believe, but shades of grey decisions, just like the rest of life’s decisions. How do you choose a spouse? Some of it is rational, and some of it is purely feel, smell, touch, instinct, mythology...

In our society, people don’t want to think about many, many things. They don’t want to think about racial inequality, gender inequality, income inequality, the Middle East, the environment… and they don’t want to think about their health. The truth is that you must engage with the world – disengagement is fatal to life. Where your health is concerned, you must keep your critical mind working at every step of the process, even though you may never arrive at “the answer.” Otherwise, you find yourself with a big surprise, a collapse of the paradigm, if you will, after which the vast majority of us become passive recipients of health care, and the scenario that Ms. Biss most fears plays itself out, like a self-fulfilling prophecy. I think it is more useful, when discussing health matters, to encourage engagement and critical thinking while accepting that some decisions will be made on other grounds – faith in the practitioner, your family’s individual needs, a close friend or family member’s experience, or just a gut feeling. Promoting either/or, black and white thinking is unrealistic in this three dimensional world we inhabit, and is unfair to people making difficult yet conscientious decisions about their or their family members’ health. Putting all your faith in “science” or “reason” is no guarantee that you will dodge the reaper, and like all magical thinking, that faith is bound to come undone at some point, when it conflicts with reality. Better to use all your human faculties, among them reason, when making such an important decision as choosing a spouse or choosing a healthcare strategy or practitioner.

By way of full disclosure, my wife and I decided to vaccinate our three sons with every vaccine that has been on the market for at least 15 years. This should help protect them from many known threats, assuages our consciences on the public health front, and perhaps avoids the dangers that can come from diving into new and as yet unproven scientific paradigms. But I consider our actions in this regard to be as much a matter of faith as of reason.