Anti-vaccine Parents - What Are The Odds?

Sometimes critical thinking can be difficult, even painful, but that does not make it any less important or advisable.

Some people are afraid to fly on an airplane.  Tell them over and over that the ride to the airport is statistically more dangerous than the flight and it does not change their minds.  In the car, especially if they are driving, there is a sense of control.  In the airplane, with both the pilot and the ground out of sight, already frightened people will feel at the mercy of someone else’s skill at best and more likely at the mercy of fate.  Their unfounded fear causes inconvenience only to themselves or perhaps to family who must accommodate them.  That same sense of not being in control is common to other fears but sometimes the stakes are much higher.

In America the fight against measles continues, as does the campaign to get parents to vaccinate.  Looking at it purely logically, measles is very contagious, around the 90% level; and the probability of vaccination side effects or other related problems is far lower.  According to the Centers for Disease Control and Prevention (CDC), moderate problems from the MMR vaccine range from 1 in 3,000 to 1 in 30,000 for children.  Severe problems occur in less than 1 in one million cases.  The potential for a problem when unvaccinated hugely outweighs the opposite decision.  From a pure critical thinking point, it would be a no-brainer, although it doesn’t exactly play out that way.

The USA Today reports:  “a new study finds that more than 70% of children's doctors have agreed to parents' requests to delay vaccinations, even though most believe that puts children at risk.”  A smaller sample of doctors reported delay or opt-out rates of more than 10% - that’s ten percent of parents not children.

The article goes on to explain:  “More parents have begun skipping selected vaccines or delaying others in recent years, sometimes out of concern that immunizations cause autism, an idea that has been debunked in dozens of studies.”  What they don’t mention is that a subsequent investigation showed the originally cited link between the MMR vaccine and autism was based on fabricated evidence, data made up to fit the desired outcome, and that its author was banned from practicing medicine due to the egregious nature of the offense.  By then it was too late; the false information was already out; and it’s so much easier to scare people than to unscare them.

Parents were left with an unreasonable fear of vaccines and relative unfamiliarity with the seriousness of the disease.  Most have no idea that measles can cause severe complications and, in one or two out of a thousand cases, be fatal.  Ordinarily that would be nothing to fool around with. 

Some of the parents who are opting out responded to AP questions with their reasoning.  They said things like, “some research points to inconsistencies, unknowns or negative effects that deserve further investigation” and worry about “how exposure to chemicals, bad nutrition and stress can affect genes and health,” considering vaccine additives and preservatives as some of those questionable chemicals.

So the debate goes on.  Usually a few unvaccinated do not pose a problem, because the herd immunity threshold, typically between 80% and 95% depending on the contagion level of the particular disease, protects the unprotected by surrounding them with immune individuals.  This does not hold where people living in the same areas and communicating in person or by social media tend to think alike and exchange similar views, so some geographical pockets are forming where the vaccination rate is as low as 40%.

Using the fear-of-flying analogy, it’s easy to understand and sympathize.  When parents are scared and feel a lack of control with so many unknowns and more perceived unknowns, how do they take control?  They do it by saying no.  It is a huge concern when parents act in such a way as to put their children in danger.

Applying critical thinking to overcome the emotional reaction can be both difficult and painful.  It’s often not a matter of being uneducated or unintelligent.  Fear plays a big role.

Do These Jeans Make My Butt Look Big...Enough?

Not too long ago women were hoping items in their wardrobes were flattering in the sense that they did not exaggerate certain proportions.  A standard joke was about a husband searching for a truthful but diplomatic answer to the question, “Do these jeans make my butt look big?”

Now it appears the shoe is on the other foot, to mix metaphors.  According to NBC News:  Two doctors' organizations have tallied up the cosmetic procedures performed last year, and butt augmentation skyrocketed.”  Why would this situation change so drastically?  Those kinds of questions are getting easier and easier to answer.  For men the influence is usually professional athletes and for women it’s Hollywood.  The number of procedures to add silicone implants or to transplant fat from other parts of the body doubled from 2013 to 2014 driven by an increase in the number of pop stars celebrating their large rear ends in music, stage and television performances and on social media.

Apparently that’s good news for the doctors, but questionable for the rest.  One study in 2013 showed a 30 percent complication rate.  In a short comment back in August 2013, I pointed out that some of those complications could be serious, even fatal.  Having paid the money and taken the risk, what do they do in a few years when those pop stars are washed up and something new becomes the rage?

Here is a good example from a website called MEDPAGE Today from September 2012.  “The need for tattoo removal has burgeoned in recent years. Surveys have suggested that almost one-quarter of U.S. students have one or more tattoos, and that half of them subsequently seek a removal procedure.”  The article describes the success rate of using lasers to remove tattoos, but the point relevant to this bottom-enhancement decision is that the median age of the tattoos was only 4 years.  Certainly tattoos can be more personal and bring back unpleasant memories, but in both cases people are deciding to alter, more or less permanently, their appearance to follow a fad that will supposedly make them more attractive. 

Perspective reminds us to follow our core values, such as, wanting someone to love you for what you are.  It also reminds us about gratitude, being satisfied with what we have rather than yearning for something more or different.  Although little more than 20,000 have undergone this procedure last year, the fact that the trend is growing is disturbing.  It’s a small number relative to the population, but it is also a rather drastic step – both expensive and potentially dangerous.  Even those of us who would never consider such a decision can learn from these people and evaluate our own behavior when it comes to letting hype and pop culture overrule our better judgment.

Tell It Like It Is

I don’t recall when they started using grander-sounding words and titles to try to build up a reputation, sell a product or otherwise change perceptions.  The first one that comes to my mind is when they started referring to the Personnel Department as Human Resources.  The sound of resources was friendlier, more human and less administrative than personnel, which may have sounded more like a processing function or an adoption from the military.  Over the years everyone adapted.  Many today may not have heard it referred to in any other way than Human Resources, but now it is still perceived as doing about the same functions.  Those who benefited the most were probably the printers of business cards.

Another business-related change was the move from employees to associates or team members.  In many cases this was a phony attempt to make the employees believe they were considered more important.  Our people are our greatest asset – until the budget doesn’t balance and then the associates suddenly become “headcount,” and are treated as a liability to be cut.  Actions speak louder than artificial titles.  (During my career I was an associate at one company and an employee at another, and the treatment at the second was much better than at the first.)  Remember, members of totalitarian societies would call their neighbors comrade just before they turned them in to the secret police.

Don’t forget the conversion of customers to guests.  They have guest services instead of customer services, but is the waiting time any shorter as you wade through the computerized telephone system and sit on hold trying to talk to a live human being while listening to a message about how important your call is?

One that caught my eye recently is the morphing of teachers and students into educators and learners.  Does it make a difference to the behavior of the ordinary citizen that Smokey Bear tells them to prevent wildfires instead of forest fires?  Yesterday people took a drink of water; today they hydrate.  In these cases, the behavior is much more important than the terminology.

Other noticeable examples include:  social justice – which sounds like a noble cause until you realize that both sides of an issue sometimes use it to defend their conclusions, because justice to one person is often different from justice to another in the same circumstances; health food – which is great marketing, using a name to imply the ability to grant people’s wishes for health, but the products are often untested against that promise; and “high school degree” – which is more impressive than an ordinary-sounding HS diploma.

There are many more examples.  Auto buffs will argue that a crossover vehicle is not exactly the same as a station wagon, but come on!  

In each case someone is trying to sell something.  Educators are trying to sell the image of enhanced status.   Human Resources is selling the idea of a less clerical or bureaucratic function.  Use of the term Associate tries to sell the idea of a more collaborative relationship.

Critical thinking is a must to defend against those who want to persuade us with fancy titles and terminology to buy something, to use a service or adopt a certain opinion.  It's important to be little skeptical of these changes in vocabulary, because using a fancier description is so much easier than actually delivering the quality we should expect.  Critical thinkers require them to mean what they say, to tell it like it is.

None of Your Business!

A few days ago I received in the mail a health questionnaire from my insurance company asking me a bunch of questions about my general health, number of prescriptions, health conditions, whether I had visited an Emergency Room in the last year, and what help I needed taking care of myself.  My first reaction was that it was none of their business.  I wanted to ignore it and toss it out.

When I thought about it from an economic understanding point of view, I changed my mind.  Unless I am willing to pay for my own medical costs it is their business.  Not only that, it is everyone else’s business as well.

Years ago thinking changed in America and elsewhere.  It was accepted that people should not have to pay their medical costs.  The employer or the government should cover some or all of the cost.  The result was an economic isolation of doctor and hospital bills.  From a very high level the costs of every office visit, hospital stay, medical procedure and Emergency Room visit, no matter how urgent or trivial, go into a big imaginary pot.  That pot of medical costs is then divided up among all the payers - insurance companies, employers who are self-insured and the government.

From an economic understanding point of view, none of those primary payers has any money of their own; they just administer, process and move around the money they collect from us, as taxpayers, customers and premium payers.  There is no magic money tree to cover any part of those bills.  That imaginary pot is filled with money that gets there indirectly from our pockets.  And as was pointed out very bluntly in the aftermath of the Affordable Care Act, healthy people must be forced into the system to subsidize the unhealthy.  No one is allowed to opt out of coverage that doesn’t apply.  That is the only way to keep the overall costs down.

The only reasonable response then, is that my health and the lifestyle required to maintain it are not only the business of my insurance company, but also of every other citizen.  Do they have a right to tell me that I should be losing weight or eating more fruits and vegetables or exercising more?  It certainly seems like they should.  Do they have any mechanism to enforce that right?  Not yet.  There probably will never be a time when your neighbor is obligated or even allowed to stop you at the checkout and insist you return that bag of chips; but, as the imaginary pot grows out of control, will the government decide that mandatory labels and sage advice not enough and begin to ramp up regulations that become more and more personally restrictive and intrusive?  Transfats and soft drink sizes may be just a start.  That is more likely to happen and something to seriously consider.

Another point that I’ve made in several past examples is that when you give up responsibility, you leave yourself open to losing some freedom.  In this case turning the responsibility of paying your doctor over to others results in having to follow their rules and sometimes fighting with insurance companies or Medicare to receive what you think is due.  It involves confusing paperwork, loss of the ability to buy only the types of insurance you need and eliminates the option of being uninsured. 

Questioning Ancient Wisdom

It’s hard to say how some subjects creep into daily conversation, but I have heard in the past and again recently about the practice of ear candling as a safe remedy for ears plugged with wax.  The theory is that putting a special candle in your ear and lighting it will draw the wax out.  It is also promoted as a remedy for earaches.

It may sound a little strange, but many people believe in it.  These candles and kits are available at national pharmacies and discount stores as well as specialty shops.  The Internet provides instructions on how to make your own ear candles.

A website dedicated to the practice warns not to trust the critics and skeptics.  According to them it is a “therapeutic relaxation technique similar to acupressure, acupuncture, and aromatherapy” highly recommended to those “within the Holistic and Natural Health Community.”  The practice dates back “many thousands of years and has been found in nearly every culture since the beginning of civilization” with “archeological evidence of stone pottery cones in antiquity” for this purpose.  In addition, it boasts that “humans have been coning or candling for eons.”  

The website goes on to defend the practice against its critics saying that it is misunderstood as are many other “Alternative lifestyle practices” that have been “passed down through the generations” and praises it as another rediscovery of “ancient wisdom” as we “attempt to remain connected to the teachings of our past civilizations.”  It goes on to question and criticize the findings of the FDA that there is “no valid scientific evidence to support the safety or effectiveness of these devices for any medical claims or benefits.”

Well, it seems the FDA is not alone.  They are even milder in their criticism of ear candling than many others.  WebMD quotes Jennifer Smullen, instructor of otology and laryngology at Massachusetts Eye and Ear Infirmary in Boston.  "You can actually lose your hearing from ear candling.  I've had to treat bad consequences of ear candling, including burns in the ear canal and on the eardrum."

Audiology.org notes the large number of websites on the subject.  “Many present reasonable and rational information warning those contemplating this activity of nonexistent benefits in tandem with significant potential for serious injury. The medical literature has clearly demonstrated ear candling has often caused serious injury without evidence of benefit (Zackaria and Aymat, 2009).”  [Emphasis added.]  They conclude: “Ear candling is dangerous (even when used as directed by the manufacturer) and serves no legitimate purpose and there is no scientific evidence showing effectiveness for use.”

The Mayo Clinic weighs in with further warnings.  “Research shows, however, that ear candling is ineffective at removing earwax. In fact, the technique can actually push earwax deeper into the ear canal. Ear candling can also lead to: Deposits of candle wax in the ear canal; Burns to the face, hair, scalp, ear canal, eardrum and middle ear; and Puncture of the eardrum.” 

Finally, a highly recognized ENT physician put together this YouTube video to demonstrate that ear candling, when used to remove earwax does exactly the opposite of what it is purported to do.  The ear candle is placed in an empty glass and lit.  Instead of creating a vacuum to draw the wax out of the ear, deposits of soot and wax from the candle form in the glass and on the inside of the tube.  Adding more debris to the ear canal can be dangerous, but the deposits inside the tube give the false impression that wax was drawn out from the ear.

Here again we find trigger words: ancient wisdom, holistic, natural health, alternative, reconnects with the past, and belief.  These are sure ways to win over many who inclined not to be skeptical.  These words sound nice and gentle and friendly, almost magical.  Science is so impersonal and objective.  All it takes is a recommendation from a neighbor, relative or a social media contact, who says they tried it and it worked.  That really means they didn’t hurt themselves and experienced subjective feelings of improvement, possibly driven by the Placebo Effect.  At this some people are willing to throw out the research and warnings from professionals, or more likely, not do simple Internet research on their own to confirm safety and effectiveness.  They trust unqualified promoters of so-called ancient wisdom more that the doctors.  (Do they only reject the use of leaches because it can’t be traced to the Orient?)

I’m not trying to be a party pooper and condemn everything alternative and natural.  I’m just asking that we raise our standards.  Require proof beyond the sample size of one or two and the feel-good hype associated with these products and practices.  In so many cases, these are just more examples of “snake oil” that do nothing but enrich the promoters while diverting money from practical uses like debt reductions and saving for retirement, while in worst cases endangering the patient.