Vaccines are the most revolutionary health intervention in human history. In the space of a hundred years our species drastically reduced the number of infants and children who die and cut down infectious disease. For most healthy individuals there is no logical reason not to be fully vaccinated. My purpose in writing this piece is to allay what concerns people may have regarding vaccines and provide useful links, articles, and information. I have tried to write this so as to be entertaining as well as informative, but given the immediacy of the issue I encourage you to jump around where necessary. There are nine sections and a works cited list. Please refer to the “table of contents” after the “Opening” section to find what is most relevant to you.
In my introductory post I mentioned that I hold a PhD in a discipline called “Paleopathology.” Let me explain what that means. Archaeology is complex and depending on exactly how you want to approach it there’s different sub-disciplines you can go into. We had an exercise back in Berkeley where we were trying to figure out what theoretical literature best matched out personality and I chose “reconstructing past lifeways.” On it’s face that is pretty post-processual, but the way I choose to interpret it maybe isn’t. Without defining all of those things I just said I’m going to shorthand this for you and get to the point. I wanted to find the most direct evidence for how people experienced life in the past and to my mind the best means of doing that was examining their corporal remains.
Bones. I look at bones.
Even within just archaeologists who look at specifically human bones (yes, I have friends who look at animal bones in their study of human behavior) there are sub-disciplines. I will sometimes refer to myself as an Osteoarchaeologist or a Bioarchaeologist depending on exactly what sort of research I’m doing or what I’m saying. But technically my training and my degree are specifically in Paleopathology. Literally the study of old diseases.
If you look through medical journals you will see a lot of case studies. I don’t quite look at medical journals enough to tell you if this corresponds to a historical trend or if it’s just something that happens in medicine. What I can say is it used to happen quite frequently in Archaeology and that now the Archaeological community is sort of backing away slowly whip in hand. The reason for that is that — as Charlotte Roberts (and numerous others) points out in many of her publications — pathology has to be rather advanced to appear on bones and it is therefore relatively difficult to say given only a skeleton what a particular individual may have suffered from in his or her life. Now this said, it is extremely rare to find particularly an adult skeleton in an archaeological context that isn’t — and this is a technical term — messed up. And the fact of the matter is that if they don’t have any osseous issues they probably died quickly which means something rather severe was wrong with them.
Archaeologically it is not generally useful to look at just one individual. Sometimes it can tell you about empathy and care as is the case for Hawkey (1998) in reference to an individual who suffered from juvenile osteoarthritis. But in general you want to look at the whole population so you’ll be looking at demographics rather than individuals. So with that in mind I want to say a few words about premodern and current cemetery demographics or “mortality profiles.” In general in a developed society we expect people to survive infancy, childhood, adolescence, and be at risk of death only once they’re past about 70 or 80 years old. Even that’s a bit young to die. But our cemeteries do reflect this. There are individuals in modern cemeteries from all age groups, but the over 50 group is the highest percentage by a long shot.
This was not the case prior to …. vaccines. The first vaccine was beginning to be developed in the last years of the 18th century by one Edward Jenner, but the vaccine age didn’t really get underway until about the 1920s or early 20th century (Malone and Hinman, 2007). If you look at a pre-vaccine cemetery the mortality profile is MUCH different. There’s two additional mortality peaks. There’s a huge number of infants and small children dying and there’s often a smaller but significant number of young adults dying.
The infants and young children are pretty easy to explain. Aside from the normal risks associated with infancy, eg. being very small and putting literally everything in one’s mouth, babies and small children are particularly vulnerable to infectious disease. And infectious disease has a higher chance of killing a small child than an adult. There’s tons of reasons for this. Infants cannot regulate body temperature as well as adults, infants are nonverbal, infants do not have developed immune or endocrine systems, infants are far more susceptible to diarrhea and related dehydration (which can and does kill them), infants are often entirely reliant on their mother’s milk for nutrition, infants are growing and therefore need to divert resources to rapid development and may be unable to allocate them to fight off infection. All this puts infants and children at a greater risk of death if they are exposed to infectious disease.
Now let’s talk about that death bump for young adults. This might seem a little strange in that I’m ramping up here to talk about vaccines in today’s society, but I need to make a few comments about the “Black Death.” Today the basic consensus with a great heaping dose of scientific caveat is that the Great Plague or Black Death or whatever you want to call it (Peste Noire if you want to be fancy) was some form of the bubonic plague that may or may not have been another gift from Mongolia along with superior cavalry tactics and fire arrows. There’s a few problems with this theory, but whatever the hell it was it killed a startlingly high proportion of seemingly young and healthy adults and adolescents. That lead to some interesting art (see: the danse macabre) and philosophy, but it also raised some alarm among my particular brand of scientists. Why should young adults be so susceptible to infectious disease when they otherwise seem so hale and hardy?
The answer lies with the theory of biological stress. This is actually a rather complex subject involving things that I can go on about so I’m going to severely shorthand it (and only provide two references (Klaus, 2014) (Tan & Yip, 2018)). When a child experiences a severe stressor during development — and that can be psychological, traumatic, nutritional, or pathological — they can sometimes experience a temporary cessation in development where their body reroutes resources to protect the heart and brain and better ensure survival. This can have permanent effects on the immune system particularly if the stress is repeated or “chronic.” However, the development which was temporarily halted during childhood must complete at some point and these individuals usually complete that development in late adolescence and early childhood. This means that even though they survived the first onslaught or onslaughts and seem to be strong or a “survivor,” they will undergo another period of relative weakness where their body is trying to direct resources towards development AND they may have a weakened or over-reactive immune system as well. This means if they experience a severe infection or other major stress during late adolescence or early adulthood … it can actually kill them (Dewitte, 2014). (That reference is a little more complicated than I made it sound and actually talks about health post-plague. I recommend if you have the patience and access that you give it a read.)
So essentially with infectious disease it is the very definition of the adage “once bitten, twice shy.” Kids don’t just get over a disease like measles. Even if they receive the best of care and survive and don’t have any brain damage (which can happen pretty easily with measles) they still have what you can think about as ‘internal scarring.’ They might never get measles again, but other infectious diseases could have a far more serious impact on them than individuals who were inoculated and avoided the disease. Basically, without vaccines you are NEVER out of the woods.
I have a lot more to say on this subject and it is all very complicated so rather than just launch into it I will divide this article into sections. You can read it all the way through if you like, but I will hopefully be able to set this up so that you can look at the part that is most pertinent to you. I will divide it up into the following sections:
- Fear: Is the cure truly worse than the disease? (TL:DR, no. No it’s not.)
- What’s in a Vaccine and why that’s actually okay
- Herd Immunity: What is it and why can’t I just use that?
- Exemptions: Medical, Religious, and Legalized Antisocial Behavior
- The dangers of geographical clustering
- Why you CAN actually trust me (and also your doctor and the medical and scientific community at large)
- “Alternative Medicine,” and why — besides the obvious — you shouldn’t drink your own urine
- Racism, Sexism, Homophobia, and vaccine refusal.
Some people will never be convinced, but for those of you who are engaged in a battle to the death or worse an internet “debate,” I hope to provide you with some good information.
- Is the cure truly worse than the disease? (TL:DR, no. No it’s not.)
Any time a new medicine is developed and in fact any time scientists propose a study involving living or dead humans or animals or even medical records those scientists first must prove that the benefits of their study well outweigh its dangers. This is an actually pretty new development in medicine, but it is very strictly enforced. Some medicines do have really nasty side effects but those medicines will treat things like cancer.
A sort of funny sort of horrifically ironic example of this is male birth control. During pregnancy a woman’s biological system is taxed in countless different ways. And pregnancy can cause some dangerous to fatal side effects of its own. So if that’s the disease female birth control is considered ethical even where it can cause blood clots simply because …. so can pregnancy, and at least with birth control you get fair warning and a fighting chance. But for men who experience basically no biological issues it isn’t strictly ethical to provide birth control with any side effects unless you’re prescribing at a population level. If you’re giving men medicine to protect women it makes sense, but as men experience no pregnancy related issues it doesn’t make sense at the individual level. And this is why it’s really hard to develop an ethically unimpeachable male birth control pill.
So then the holy grail of medicine would be if you could administer a medicine just once or twice with approaching 0 side effects that not only treats but wholly prevents deadly communicable diseases AND has the added benefit of eventually eradicating those diseases. We have that. They’re called “vaccines.” The CDC absolutely raves about the effectiveness of vaccines and …. they’re right to (CDC, 1999b, 1999a; Malone & Hinman, 2007; Wang et al., 2014).
But I’ll break it down a bit further. The diseases which vaccines prevent include pertussis, measles mumps and rubella (these are covered by the MMR), varricella (chicken pox), hepititis B, HPV, and meningococcal meningitis. Other diseases for which the vaccine has either changed over time or been eliminated due to eradication of the disease are polio and small pox.
The oral polio vaccine did have a very very small chance of causing paralysis, but it’s no longer administered in the US and hasn’t been since the year 2000. So if you’re an American and you’re worried about getting vaccine-derived polio …. don’t. It’s not a thing anymore. (For further details go here: https://www.cdc.gov/vaccines/vpd/polio/public/index.html) Wild polio however can be transmitted even if the carrier has no symptoms AND can cause paralysis and death. It is not common for an infected individual to become paralyzed and die, but it happens with far greater frequency from the wild virus than from even the oral inoculation. If you’re rolling the dice your best odds by far are to get the injected form of the vaccine.
Smallpox is a vaccine success story. It the first disease shown to be preventable via inoculation and due to consistent vaccine use it has been eradicated. (It also had a similar uptick as people started questioning the disease versus vaccine as we are presently seeing in pertussis and measles, but that’s another story.) Smallpox was also incredibly communicable and incredibly deadly. The vaccine was relatively safe, but from an ethics perspective it could have caused a severe fever in a majority of patients before the cure was anywhere near the severity of the disease. To give you an idea of how bad smallpox was I would suggest image searching it, but it’s really disgusting even to me, so don’t do that.
So now let’s talk about vaccines routinely administered today for diseases that we still sometimes see outbreaks of.
If you go to an American university you may be required to get an additional meningococcal vaccination. The CDC recommends the initial vaccination at about 11 or 12 years of age with boosters at 16 and 23 (https://www.cdc.gov/vaccines/vpd/mening/index.html). I’ll give you the possible vaccine side effects at the end of this section, but let me tell you about this particular disease. This one’s nasty. Part of my education was in England where it apparently isn’t a required vaccine so a flatmate of mine contracted it. For a skinny guy, he was really heavy. I know, because I carried him into the emergency room. He went from, “I’m uncomfortable and my neck hurts,” to a half conscious lump who lost his English skills in the space of a few minutes. That was the second time I’ve had to translate from Mandarin and that’s a problem because I don’t really speak Mandarin. Anyway, he could have died, he was in so much pain he couldn’t even cry, he was begging for a blanket but couldn’t have one as he would have overheated and essentially cooked his brain, and I had to hold him down as they did an emergency spinal tap before they could medicate him. And he was an adult. Children even infants can be infected with this disease and they are at even greater risk than my friend was. He’s alive today because another flatmate called for help and I carried him into an emergency room. If we had been out he would be dead. A vaccine could have saved him all that pain and danger.
HPV is a pretty ethically conflicted one, or at least it was when it first came out. HPV — the virus — is linked to several cancers including cervical cancer which is the big one as well as cancers on the penis, on and around the vulva and vagina, and even cancer at the back of the throat. HPV also can cause genital warts and it can be passed by people showing no symptoms. Many of the cancers which can be caused by HPV are aggressive meaning if you develop one of these cancers you might die even with treatment. The reason the HPV vaccine was considered an ethical issue is because HPV is transmitted through sexual contact. The idea was that people particularly girls and young women who sleep around should get cancer and die. Obviously, that’s awful and there is the unfortunate reality that victims of sexual assault are often infected with sexually transmitted infections (STIs) compounding the attack. The HPV vaccine comes in a series of three and is recommended for teens and young adults both male and female. Children can start the series as young as 11 years old and men can complete as late as 22 years of age, and women or men who sleep with other men or have weakened immune systems can complete the series as late as 27 years of age (https://www.cdc.gov/vaccines/vpd/hpv/public/index.html). This is preferable to death by cancer.
Hepatitis B is another disease which can lead to cancer. More usually it causes generalized liver problems including cirrhosis. It can be transmitted through sex, but it is also a bloodborne disease meaning it can be transmitted via bodily fluids particularly blood. It is found in saliva but is not generally transmitted through kissing, coughing, sneezing, or hugging. That said, if you someone with hepatitis B had an open wound and you accidentally came into contact with their blood, you could be infected. It is possible to live a long relatively healthy life with this disease, but it does require treatment, it can cause liver failure and cancer (both of which can be fatal), and it will effect other aspects of your life.
Varicella is commonly known as chicken pox. This is going to be the least scary disease in this list. Weirdly, varicella in children is usually mild. Adults and teens however have a rough go of it. In children, chicken pox usually only involves a fever and rash of small blisters. As long as they are kept cool, comfortable, and hydrated most children will no develop additional symptoms. However, chicken pox can be dangerous to newborns and pregnant women as well as adults who are not immune and individuals with weakened immune systems. I was too old to receive the varicella vaccine, so I did have chicken pox as a child. If I remember (although this would have been before my fourth birthday) it was very poorly timed because my mother was pregnant with my brother concurrently. She then had to care for her sick daughter while staying as far away from said daughter as possible to protect her next child. Possible complications from chicken pox include skin infections, encephalitis, joint pain, shingles, and pneumonia. While chicken pox has a much lower chance of killing the individual, it is a dangerous disease for people with compromised immune systems, infants, and pregnant women. It is far easier and more responsible now that a vaccine is available to simply get that vaccine.
Measles is often thought of as chicken pox but worse. In a way this is a reasonable analogy in that measles involves a skin rash, fever, and dehydration. However, chicken pox only rarely kills. Measles has a significantly higher rate of permanent scarring, brain damage, and death. It can also cause pneumonia and ear infections leading to hearing loss. There are basically two ways a child especially can die of measles. Those are dehydration through diarrhea and encephalitis. Measles does not have as high a death rate as smallpox, but there is no treatment. Once an individual is infected the only real treatment is isolation and fluids. Additionally measles is highly communicable. Some of the diseases I’ve mentioned can only be contracted through direct and personal contact with infected individuals. Measles can be transmitted through droplets hours after the infected individual has left. And while particularly in the modern era most individuals do survive, it really is rolling the dice. The Mayo Clinic reports that some 100,000 people die each year from measles (https://www.mayoclinic.org/diseases-conditions/measles/symptoms-causes/syc-20374857). The MMR vaccine does have some serious side-effects, but they are incredibly rare and less common than the rate of death or permanent disability in individuals who are infected with measles.
Mumps can also cause encephalitis and remains a leading cause of acquired deafness in children. The WHO estimates that deaths from mumps occur once in every 10,000 cases (https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/passive/mumps_standards/en/). This is a low mortality rate, but the rate of even severe complication from vaccine is considerably lower.
Rubella is likely the least dangerous of the MMR trio, but it also poses significant risks to pregnant women and their fetuses as well as a risk of encephalitis. Once again, it is simply more responsible to just get the vaccine.
Lastly, I need to talk about pertussis commonly known as whooping cough. In adults pertussis will start much like a particularly bad cold but will develop a violent cough. The coughing can cause enough strain to pop blood vessels in the face and cause minor bleeding. It also causes the patient to have difficulty getting enough air. In adults the inhalation between coughs can make a “whoop” sound from which the common name is derived. Adults can usually recover, but children particularly infants can experience cyanosis, brain damage, and death. Pertussis is again, highly communicable so even if you are an adult and expect to survive it you can easily and unwittingly transmit it to infants and children who may not be able to survive the infection.
This is not an exhaustive list of diseases which can be prevented via immunization. This is a selection of the more common ones. Most of these diseases are not a death sentence and even the more serious ones do have a lower rate of mortality than they might have in the past. That said, why take any risk when you don’t have to? Vaccines do carry some side effects. Common side effects for the vaccine are mild redness and swelling at the site of injection and occasionally a slight fever. I do try to keep up my tetanus shots as I am an archaeologist and the risk of me cutting myself on a rusty old piece of metal is pretty high. Tetanus shots have some of the worst and most common side effects of any vaccine. Every time I get it it feels like I’ve been doing three hours of Judo. However, a bit of muscle soreness for a few hours is infinitely preferable to the “lockjaw” that a tetanus infection can produce.
Most vaccines for most people involve slight discomfort at the very moment of the injection and then no further issues. Very rarely are there even moderate complications and allergic reactions occur in about 1 in 1 million patients https://www.cdc.gov/vaccines/vac-gen/side-effects.htm. For this reasons, doctors will keep patients in the clinic long enough that if an allergic reaction were to occur it would do so while they were watching and armed with epi-pens.
In the extremely unlikely event you or a member of your family do experience an adverse reaction from a vaccine (a vaccine injury) you can use this resource to report it, obtain appropriate treatment, and claim benefits https://vaers.hhs.gov/.
As several authors have shown vaccines are victims of their own success (Feikin et al., 2000; Malone & Hinman, 2007; Ołpiński, 2012; Omer et al., 2006, 2008). When a vaccine particularly for a deadly disease is first introduced there is usually a high rate of compliance. Patients try to get immunized and parents make sure their children get the shots. This is because these individuals know of or have personally witnessed others dying from the disease. However, as compliance rises, infection rates and mortality drops. This is the point, but it also means that fewer people have seen the disease in action. They stop fearing the disease and start fearing the vaccine. Historically, with smallpox this leads to lower rates of inoculation, a resurgence in the disease causing one or several epidemics and numerous deaths and a resultant uptick in vaccination eventually leading to eradication of the disease. At that point, the vaccine can be discontinued as the disease no longer exists.
2. What’s in a Vaccine and why that’s actually okay
This is a bit of a misnomer as a section title because I am not a biochemist and so I cannot really go through scary bit by scary bit and allay people’s fears. I can however address some of the more common concerns. The big fears center around the inclusion or use of aluminum, mercury, preservatives, hydrocloric acid, DNA, and human or animal cells. Some of these “ingredients” are not actually in the vaccine itself, but I’ll get into that as I go. I am using the FDA’s and CDC’s information on the subject as well as a UK fact sheets from the NHS. The former will give you information right from the horse’s mouth as it were. As for the latter, the UK tends to be a close medical correlate to the United States. The academic and scientific literature vary primarily in writing style and most companies producing vaccines are American so UK vaccine information is going to be largely relevant here. (https://www.fda.gov/biologicsbloodvaccines/safetyavailability/vaccinesafety/ucm187810.htm, https://www.publichealth.org/public-awareness/understanding-vaccines/goes-vaccine/, https://www.nhs.uk/conditions/vaccinations/vaccine-ingredients/, https://www.vaccines.gov/basics/vaccine_ingredients/index.html, https://www.cdc.gov/vaccines/vac-gen/additives.htm, https://www.fda.gov/biologicsbloodvaccines/vaccines/default.htm)
Aluminum has been blamed for causing all manner of ailment and some of the more insane posts I’ve read … invovled a government microwave …. I don’t even know how to address that last. It’s simply bonkers. But for everyone else, the aluminum included in vaccines is aluminum salt. To put this in perspective, your table salt is NaCl or sodium chloride. Most of you still consume it and as long as you aren’t seriously over-salting your food it’s fine. The aluminum salts that are included in some vaccines are there to activate the immune system. The FDA explains that you consume more aluminum in the course of eating and drinking than you ever will from a vaccine. Decades of medicine and scientific research have shown no problems with the inclusion of aluminum.
Mercury is a preservative as used in vaccines, but here I’ll address the general use of preservatives other than mercury. Vaccines, like any other perishable item, can go bad particularly if they are contaminated by bacteria or fungus. In some cases it is also necessary to keep the “active ingredient” from decaying. It also lowers the cost of vaccines if they can be manufactured and delivered in large batches. Preservatives are a safe and effective way of lowering the cost of production so that more people can have the vaccine whenever they happen to visit the hospital, doctor or clinic. Unfortunately, due to fears, many vaccines are now only sold or distributed in small batches without the preservative. If not used quickly they can spoil and have to be thrown out. This means a health provider will have to carefully schedule his or her patients regardless of their own schedules to ensure that when the vaccine arrives it can be distributed to as many people as possible. Moreover, most of these preservatives are naturally occurring. Formaldehyde, is in your body right now at higher doses than any vaccine would give you. It is not from a vaccine you received in the past, it’s just a byproduct of your metabolism. Regardless of what you eat you produce formaldehyde several orders of magnitude greater than what you would find in a vaccine.
Then there’s acids added to the vaccine. Hydrochloric acid sounds scary. But again, it’s there for a reason and it’s naturally occurring in your body. Your digestive juices are mostly hydrochloric acid. Now, that said, I do understand that the idea of injecting that into your bloodstream is still scary so I will explain why it is present in some vaccines. It’s there to balance the pH level. Without the addition of a tiny amount of acid vaccines would be basic solutions. (That is, basic as opposed to acidic.) Basic solutions are about as caustic or corrosive as acidic solutions of the same order. But you can use an acid to balance a base and a base to balance an acid. That’s why you might see acids in vaccines. They are tiny doses just there to make sure that the pH balance is a net 0. I did however read one comment where the OP was asking why not just use lemon juice as that is also acidic. So, yes. Lemon juice is acidic. But it’s more than just the acid. So assuming the OP meant citric acid firstly that would have to be isolated which isn’t easy and secondly the chemical formula for hydrochloric acid is just HCl. It has a hydrogen and a chlorine. The chemical formula for citric acid is C6H8O7. Citric acid has six carbons, eight hydrogens, and seven oxygens. That’s considerably more complicated than HCl and in biochemistry simple is best.
I’m going to lump the use of DNA and human and animal cells together because they all have to do with the “active ingredient” in vaccines. In the case of DNA what you’re getting is usually the antigen sequence. That’s it. You are not getting a partial or full DNA molecule, you are just getting the one little sequence that pertains to creating the protein that will then form the antigen. This is enough to teach your body how to fight the disease that little sequence pertains to but not enough to risk infection. It’s basically the best of all worlds and is described as “third generation” vaccination. With DNA vaccines you are not getting the live disease or the dead or disabled disease, you are getting just a tiny part of it that cannot hurt you but which will teach your body about it in such a way that you can later defend yourself. Human and animal cells which can include human blood, bovine fetal serum or eggs are used as a growing medium. Some of the diseases are very specific as to what they’ll grow on and so to cultivate them and then later inactivate them for a vaccine it is necessary to use essentially their favorite food. In all cases the mediums will go through a process of cleaning even before they are used to cultivate the pathogen. The human blood comes from donors who have given their consent and have been fully tested. And these byproducts are carefully cleaned from the virus or bacteria before it is used in a vaccine. With this said if you have an allergy to in particular eggs be sure to bring that up with your physician before getting any vaccine. There are alternatives, but your doctor has to know you need it. (I will be touching on this issue again in section 9 so buckle up.)
I’ve left mercury for the last because it’s the one a lot of people have erroneously associated with the development of autism, and my next section concerns autism. Mercury in vaccines is actually ethylmercury and is referred to as thimerosal. It’s a preservative. In actual fact due to public concerns thimerosal is not used in any vaccine except the one for influenza. It is there to prevent contamination and prevent the growth of bacteria and fungus in the vaccine so particularly for large batches it is useful to have and reduces the cost of the medicine. Once again, decades of research have proven its safety. However, because so many people have erroneously pointed it out as a danger it has been removed from all but the influenza vaccine.
I hope that helps to allay people’s fears of the ingredients in vaccines. Again, this has not been exhaustive, so if you still have concerns please refer to the websites I linked at the opening of this section. As a final thought for this section vaccines like any other medicine in the modern age go through several iterations of testing and medical compliance. Most of the vaccines on offer now have been used for decades with no actual issues. (I’ll cover made up issues in the following sections.) In 1 in a million cases it is possible to have an allergic reaction to a vaccine. But the disease is far worse. Most of these diseases have at least a 1 in 10,000 chance of killing you which seems low, but keep in mind in the US pregnancy has less of a chance of killing you than measles and we have one of the worst rates of maternal mortality in the developed world. When a vaccine has a 1 in a million chance of giving you a severe allergic reaction you are much better off just getting the vaccine.
Before I really get into this I need to make a personal disclosure. I’m probably on the autism spectrum. I have not sought a formal diagnosis because — and this is crucial — it’s not a disability. My biggest symptom is prosopagnosia or facial blindness and I have a suite of lesser symptoms that variously impact my life. So, if I am autistic I have what is called a “high-functioning autism.” There is a form of severe autism which can be better classed as a disability, but most autistic individuals, even those with more severe forms can care for themselves and successfully integrate into society as long as they receive sufficient understanding and compassion from “neurotypicals.” I actually consider autism a super-power because it allows me to concentrate better and longer than normal people and I get heightened perception out of it. (That’s another one of my symptoms actually. I can in some cases not only pick out different people by smell, but how they feel.) Autistic individuals also happen to be more empathetic. Once you find a way for your autistic child to express compassion or affection in a way that doesn’t set off their perceptual alarms (many individuals with autism have extreme reactions to textures and physical touch) you are going to have on your hands a child with a whole lot of love. So you should be so lucky as to have an autistic child. In the vast majority of cases, they’re a blessing rather than a curse.
So then we need to talk about how autism develops. Autism and like “disorders” if we’re calling them that, are nearly evolutionary in nature (for an in depth discussion on exactly how this works see this article and associated citations (Neubauer & Hublin, 2012)). As hominins developed and as different types of hominins (eg Neanderthals) branched off neurological development evolved. Autistic children experience neurological “overgrowth” particularly in their frontal and temporal lobes, and then do not experience the same degree of neurological paring as neurotypical children. Basically, the autisitic brain has so much connectivity particularly in the frontal and temporal lobes that it sort of overloads. Functional autism involves some neurological paring, but extreme forms of autism sometimes do not have any. Autism is very closely related to genetics and is strictly related to specifically human evolution. I say this because 1. you can’t catch it and 2. no, your dog is not autistic no matter what the internet tells you. (Someone did actually claim that vaccines turned their dog autistic. I wish I was kidding.)
Very simply extended from that theme a vaccine will not give you or your child autism. It is simply not possible. There was a study which has since been widely discredited that linked the MMR vaccine to autism. Part of me wants to read that study simply to observe the mental gymnastics in first person. Given what we know about autism it is simply impossible for any vaccine to cause or even contribute to it. Some of the pseudo-pathogenesis includes concerns about mercury or brain damage. I have explained how mercury is not actually a valid concern. But let’s talk about brain damage. In extremely rare cases the MMR can result in brain damage (again, it is more likely to have brain damage from measles, mumps, or rubella than the vaccine against them). Typically brain damage involves neurons being damaged or destroyed. There can be atrophy or the naturally occurring ventricles in the brain can start to get bigger. Autism is exactly the opposite of that. Autism is about too much neurological growth. It is not about brain damage. Brain damage won’t help anyone including individuals with autism, but it also does not have any relation to autism.
The danger of this misconception lies primarily with parents of autistic children or children suspected of being autistic. If I’m autistic my mother was too, so when I showed an inability to recognize her face this made zero difference to her. She knew almost instinctively how to deal with me because she had lived all her life with the same suite of symptoms. For parents who don’t have any experience with spectrum disorders however, it can be scary. People sometimes have extreme reactions.
Before I go on, I need to caution against misdiagnosis with autism. One of the reasons I haven’t sought a formal diagnosis is because I don’t really need any help, and people usually classify autism as a completely debilitating disorder. There are some organizations that talk about eradicating it and individuals who have it. But with research going into autism it is becoming more and more clear that it is a spectrum disorder and with that come many misdiagnoses of neurotypical kids. A friend of mine who is not autistic was very nearly diagnosed with it as a child. At about five years of age she decided that, and I quote, “talking is stupid.” And when she decided that she just kept her mouth closed for a year. That might be a bit weird, but it’s hardly indicative of a wider issue. My friend had attentive parents and a good physician who was able to allay their concerns. But in the present day a lot of parents ignore their physician’s diagnoses in favor of their own misconceptions.
This is where things get quite frightening. There exists a scam group out there that advocates treatment of autism with bleach enemas and by forcing children to drink bleach. You read that correctly. The group in question calls themselves a church, I assume to avoid taxes. Their modus operandi is to convince people that they are sick, that Western medicine doesn’t work, and that for some — usually exorbitant — sum of money his church will provide a cure. The “cure” is usually bleach. They call it “Miracle Mineral Supplement,” or “MMS,” but it is bleach. (If this interests or horrifies you, you can start down the internet wormhole here: https://www.skeptical-science.com/medicine/church-falsely-claims-bleach-can-cure-any-disease/ check the “Further Reading,” section for more shock and horror. This is also eminently googleable.) There’s a spa treatment called I think anal bleaching which is supposed to make one’s anus the same color as the surrounding skin. I personally see no purpose in this because I don’t go about showing people my whole ass, but it is relatively popular. (If you do it kumbayah and please don’t show me.) Doctors recommend against it. In general you shouldn’t be applying bleach externally or internally.
Parents torturing their own children with bleach enemas is unfortunately not as bad as it gets. If you thought I already told you the worst part you don’t know me very well. Which is fine. Most of you don’t know me from Adam as it were. Anyways, if you give someone an enema with bleach it will strip their intestinal wall and bits of that can protrude from their anus in long strings. This is the intestine being destroyed. Those are strips of the victim’s internal organ chemically peeled off of that organ and now being pushed out of their body. The “church” promoting this torture as a cure all has created it’s own fake illness to explain this. And here’s where all this loops back to vaccines. This “church” holds that vaccines inject parasites (they don’t) and that the vomiting and diarrhea induced by drinking bleach is the child expelling the parasites (it isn’t) and that the strips of membranes and flesh are actually worms (they’re not) and that autism is caused by the parasites in the vaccines (not even close).
The “church” further explains that doctors simply aren’t trained to recognize either parasites in general or specifically these parasites. I’ll speak to that a bit more in section 7 but in lieu of that at the moment I will recount another story. Years ago I was a graduate student on a dig in Japan and it was my job to look after the undergraduates. One day we took a little field trip to see a local river. There was a pretty large downed tree that ended up traversing the river entirely. One of the boys had a huge crush on one of the girls. So he decided to impress her he was going to walk across that tree super cool and calm. He slipped, fell into the rushing river and I kid you not his hat bobbed up Indiana Jones style well before he did. Anyway, I did not think, I just jumped in after him try and save him. We both got out of the water just fine although he lost his passport, wallet, and hat. Unfortunately for my effort I had swallowed some of the water and found out a few days later I had picked up a parasite. I went to the doctor told him in broken Japanese what had happened, he gave me some medicine to clean me out and I’m now perfectly fine. The point is, don’t jump into rivers after lovelorn undergraduate archaeology students and doctors know about parasites.
4. Herd Immunity: What is it and why can’t I just use that?
In the words of Plans and colleagues
“The herd immunity theory proposes that in diseases passed from person-to-person, the chain of infection is blocked when the prevalence of protected individuals in the population is higher than a disease-specific threshold, known as the herd immunity threshold.” (Plans et al., 2014: pp. 81)
I’ll break that down a little because it is sort of in science-speak. What this is saying is that “herd immunity” is achieved when enough people are immune to the disease that the infectiousness of the disease is effectively overcome. So for a disease which is strictly transmitted through sexual contact the threshold won’t need to be as high, but for a rather communicable disease like measles which can infect you through droplets left hours previously the level of immunity must be at 90% before herd immunity is achieved. The more communicable or infectious the disease or the easier the disease is to transmit from person to person, the more people in the population will need to be immune before everyone is effectively safe (Feikin et al., 2000; Gostin, 2015; Malone & Hinman, 2007; Plans et al., 2014; Stadlin et al., 2012; Wang et al., 2014).
As with any medication there are going to be individuals for whom a vaccine is “contraindicated” or legitimately not safe or useful to that individual. Most people can have a vaccine so if you are reading this probably you can have a vaccine. People who shouldn’t vary from vaccine to vaccine — some are recommended for pregnant women and others are not considered safe — but in general individuals with compromised immune systems cannot have vaccines. These are people awaiting organ transplants, cancer patients and other people with very serious medical profiles. Such patients don’t have an immune system that would be able to respond in any meaningful way to the vaccine and if they get the disease itself they are at severely increased risk of complications and death. These are the people that herd immunity is meant to protect. So, if your doctor says you are healthy enough to have a vaccine then the best thing you can do to look after the health of other members of society is to get that vaccine and ensure that you do not become a vector for disease.
A friend of mine had a baby with a heart defect. The little girl is now a vivacious little toddler, but it was touch and go for awhile there. She had to undergo several surgeries and was constantly monitored in her first few months. Her mother was terrified of exposing her to so much as influenza because if she got sick she couldn’t have the surgeries and the surgeries were timed with her development. If you fail to get your vaccine you run the risk of transmitting disease to the caretaker or friend of a child like that and inadvertently killing them or destroying their life.
Additionally, vaccines are not 100% effective. In all of the recent outbreaks of Vaccine Preventable Illness (VPIs) a significant majority proportion of infected individuals were unvaccinated. But in all cases people who had been vaccinated were also infected. They were infected in far smaller numbers, but they were still infected (Feikin et al., 2000; Gostin, 2015; Lieu et al., 2015; Malone & Hinman, 2007; Ołpiński, 2012; Omer et al., 2006, 2008; Plans et al., 2014; Wang et al., 2014; Yang & Silverman, 2015). Some vaccines approach 100% effectiveness, but others are a bit lower. Additionally, some vaccines do require multiple injections or booster shots and so it is possible for well meaning individuals who are mostly up to date and fully vaccinated except for that one shot they plan to get tomorrow to simply be caught at just the wrong moment.
Several of the authors I have been relentlessly citing use an metaphor of the “tragedy of the commons,” (Gostin, 2015; Hardin, 1968; Malone & Hinman, 2007). I happen to think it’s a bit of a faulty metaphor but as it is based on a relatively important essay by the same name authored I believe in the wake of a resurgence in either smallpox or polio well after vaccines for both were introduced and widespread I’ll take you through it. The idea is that there is a common grazing area available to ranchers in the community who have cows, but do not have enough land to feed them. Ideally most of the community would graze their animals on their own land leaving the commons as a fallback for the few who really do need it. But because no laws or rules are imposed on the use of the common area more and more ranchers let their cattle graze there so that they can have access not only to their own grazing land but also to the commons. As more and more ranchers let their cattle graze in the commons the quality and quantity of the milk decreases in those animals sent to graze there because there is less grass available. Ranchers continue to do it however because that loss is offset by the animals on their own land and they theorize that if they don’t take advantage of the system everyone else will and will therefore be more competitive than them.
The metaphor then goes individuals or parents refusing vaccines are trying to take advantage of the commons or herd immunity even though others need it far more because they erroneously believe that those others who cannot have vaccines are reaping some benefit that they are not. By doing this they are decreasing herd immunity or the quality of grass in the commons and putting the entire community at risk for a minor or even non-existent reward.
5. Exemptions: Medical, Religious, and Legalized Antisocial Behavior aka Philosophical Exemptions
Before we get into this section I would like to note I am relying heavily on Malone and Hinman (2007). For those interested I recommend a thorough read of their article as it gives in far greater detail the court decisions which underscore the division between personal liberty and public safety. I will also be citing cases from their article at the end to which you can refer.
Vaccines — especially where they prevent communicable and deadly disease — are part of public health and safety. Being fully inoculated where the individual is healthy enough to do so is not just a good idea for one’s personal health and not simply a personal choice or right; it is a responsibility you personally owe to everyone else in your community and wider society. This is not simply me spouting off my opinion. This is a matter of law with Supreme Court cases decided essentially the way I’ve just explained. All states have laws which require vaccination particularly of children. All states also have medical exemptions because there are individuals who are medically unable to have the vaccines. Unfortunately, most states also have religious and philosophical exemptions. (48 have religious exemptions and 15 allow philosophic exemptions.) And this is where things get dicey.
As with just about any law the moment it goes on the books there are court challenges to it. So it was for vaccines. The first highly cited case is Jacobson v Massachusetts which was decided in 1905 and upheld states’ rights to compel vaccination. The Supreme Court decided that public safety does come before personal rights and that while personal rights are important, they must end where they begin to impair the health and safety of others in the society. The following is part of the decision from that case.
“The liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. On any other basis organized society could not exist with safety to its members” (197 U.S. at 26, 25 S.Ct. at 361).
It should be noted that Roe v Wade gets dragged into this debate quite frequently so I would like to briefly address that. Firstly, Roe v Wade did consider Jacobson v Massachusetts and held that privacy rights need to be balanced with the states’ and nation’s interests. So, Roe v Wade is not in conflict with Jacobson v Massachusetts. Additionally, deciding to not carry a fetus to term usually only has health ramifications on the mother who should have the ultimate say. (Also, given the danger of pregnancy, choosing no to be pregnant is a safety and health conscious decision.) Conversely, choosing not to be vaccinated carries health ramifications not only for he individual but his or her entire family, neighborhood, community, and anyone he or she accidentally comes into contact with or potentially even passes near. Roe v Wade does have to do with individual rights and privacy, Jacobson v Massachusetts does not. Both cases were argued with consideration of the due process clause in the Fourteenth Amendment, but this is only upheld in the case of Roe v Wade. Basically, if you’re forcing a woman to carry a pregnancy to term against her will you are violating her human rights. And that makes sense. That’s at minimum nine months of her life assuming everything goes well. Unwanted pregnancy for the mother is basically a prison sentence for no real reason (note, we haven’t spoken about under what circumstances she got pregnant or even her health). In contrast, if you’re requiring someone get a vaccine you are putting them at almost zero risk so that they do not need to worry about most deadly diseases in the future and can’t accidentally kill anyone else. The time requirement is about half an hour and it protects everyone with virtually no downside.
Moving on, another rather important case pertained to states’ rights to require vaccination for children to be enrolled in school. This was Zucht v King and was decided in 1922. There are a few other pertinent cases surrounding precisely this and virtually all come to the conclusion that — once again — requiring vaccinations is not a violation of due process under the 14th Amendment and it is about public health rather than some draconian and arbitrary exercise of power.
Religious exemptions are where the very clean cut ethics of vaccination policy start to fray. If a religious group is well incorporated into the surrounding community and not isolated among themselves then the state can still reasonably assert it’s right to protect public health. But what about religious groups for example the Amish who do physically and socially isolate themselves? If such a religious group refuses vaccines and agrees to impose self-isolation if they experience an outbreak, does the state still have the right to intervene? According to the 1944 ruling in Prince v Massachusetts (which was actually about child labor rather than vaccines, but which mentioned vaccination in the decision) the answer is yes. Prince v Massachusetts established parens patrie (or the states’ right to protect those unable to protect themselves) in regards to children. So if the state decides reasonably that a religious practice endangers the well-being of, in particular children, it may legally intervene.
With such decisions on the books it is strange that 47 out of 50 states have religious exemptions and 18 have philosophical exemptions (http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx). The reason for this is that not all court decisions were as straightforward as those I’ve cited, and also politics. Most people are relatively well versed on the antics of definitely-not-MDs Jim Carrey and Jenny McCarthy so I won’t dwell too much on them here. They were not, however alone. Besides Oprah and Larry King giving their tacit approval of the subject by hosting them on their TV shows there was also the book (which will NOT be making it into my bibliography) The Vaccine Book: Making the Right Decision for Your Child by Dr. Robert Spears. That book is the origin of the now widely used alternative vaccine schedule. I am not an MD so I will not theorize on whether altering the schedule to vaccines changes anything, but Dr. Sears did not provide any reasonable evidence for or against it in his own book where he proposed it and he also encouraged parents to be somewhat secretive about any decision not to vaccinate particularly in regards to the MMR vaccine (Ołpiński, 2012). Dr. Sears at the time of publication was already a well known pediatrician known popularly as “Dr. Bob,” and so his publication in that light seems less interested in children’s or public health and more a sort of celebrity piling on.
Unfortunately, the damage was done. With such celebrity endorsement larger pockets of parents began demanding particularly of their state legislatures a relaxation of compulsory vaccine laws often as a condition for re-election. In 2015 Senator Rand Paul of Pennsylvania entered the fray suggesting that states should not have the right to legislate vaccination (Gostin, 2015). As his statements were largely concurrent with another deadly outbreak of disease he quickly had to walk back his statements. (This is a contemporary article: https://abcnews.go.com/Politics/rand-paul-show-senate-vaccine-hearing-controversial-comments/story?id=28868892) Rand Paul is himself an MD and specialized in cataract surgery before being elected to the US Senate, so he likely understood the dangerous nature of the statements he was making.
From the loins of religious exemptions sprang philosophical exemptions. There’s no good reason for this. Religious exemptions in and of themselves are not really required by law, but are nonetheless provided in most states. In cases where religious exemption is not — for various reasons — obtainable some groups have succeeded in adding philosophical exemptions.
The rigor by which a religious or philosophical exemption may be claimed varies from state to state. Some states require a signed and notarized letter including certain phrases. Some states provide simple forms or require only a statement. The reason this becomes important is that in states where it becomes easier to obtain a philosophical exemption than a religious one the rates of religious exemption will decrease and sometimes general exemption will increase (Wang et al., 2014). When philosophical exemptions become difficult to obtain or are outlawed, religious exemptions increase. This highly suggests that some people are simply finding the easiest way to avoid vaccination.
Another pair of issues are largely bureaucratic but they are worth mentioning because they do represent a challenge to public health and they will impact how the US can advance towards Universal Healthcare. Wang and colleagues (2014) mention that in some cases parents may obtain an exemption simply because they cannot locate paperwork pertaining to their child’s receipt of vaccines. This is really best case scenerio, but could potentially impact care if the family takes the child to a new physician or if the child has to be hospitalized. Centralized records and an improvement of archival systems could prevent this. Most crucially though vaccines do cost money. In 1994 the Vaccines For Children Program (VFC) was introduced to cut down costs to low income parents and ensure that all children could be vaccinated. (More information can be found at these sites: https://www.medicaid.gov/medicaid/quality-of-care/improvement-initiatives/vaccines/index.html, https://www.vaccines.gov/getting/pay/index.html, https://www.cdc.gov/vaccines/programs/vfc/about/index.html) The system takes care of most but not all families. And where a family can put off getting a vaccine by obtaining an exemption if they are very low on funds they might make that decision. Essentially they are forced to make the bet that their child will not encounter the disease in question before they can afford to get the vaccine. Part of increasing immunity will be eliminating options for exemptions (as California did in 2015), but another part will be ensuring that good record keeping exists and that vaccine costs are not transferred to the patients.
6. The dangers of geographical clustering
The CDC is rather concerned about pockets of vaccine refusal because it is in these areas that outbreaks occur (Gostin, 2015; Lieu et al., 2015; Omer et al., 2006, 2008; Wang et al., 2014). This is not at all a coincidence. The anti-vaccine community is an online behemoth and I do await with baited breath the misspelled hate mail, but parents who attempt to avoid vaccination of their children tend to live in the same geographical areas. Wang and colleagues (2014) had another interesting observation that some of this may have to do with finding pediatricians who will indulge their beliefs. I am from San Rafael in Marin County of California and that county happens to ‘boast’ a dangerously high rate of exemption (Lieu et al., 2015). The literature is not sure whether or not parents with similar misconceptions seek like minded individuals or whether proximity to people with such ideas spreads the idea, but the effect of clustering is easily observable.
The dangers — which I promised to discuss — are relatively simply stated. If you refer back to the section on herd immunity (Section 4) you basically have your answer. The higher the number of individuals in a small area who are not immune the higher the number of vectors for disease. Diseases like measles — which can be passed not only from person to person but may survive in droplets left behind for several hours — require a rather high proportion of individuals in the given community to be inoculated. Plans and colleagues (2014) put it at about 90%. And the reason Plans and colleagues wrote that article is because immunity in Catalonia, Spain dipped below that percentage and there was a measles outbreak. Lieu and colleagues (2015) showed that when Marin County was taken as a whole some 17.9% of children were underimmunized and the rate increased in some pockets to 22.7%. Marin County’s only grace in this was that the disease was miraculously not imported.
Quite simply, if a community has a relatively high proportion of unvacinated individuals — and that need only exceed about 10% — that community has a far higher risk of disease. The reason I am rehashing and restating this issue is because underimmunized people tend to cluster together. Many of the studies cited above found a relationship between income and underimmunization. In some cases families were avoiding vaccination because they could no afford it or feared they could not afford it. However, those same studies often found a relationship between relative education and underimmunization. Very strangely, this tendency towards avoiding vaccination seems to be a problem of the rich relatively well educated white family. I will address in part why I think that’s so weird in the next section. What is notable here is that such families group together and when they do they increase the likelihood that a single incidence of disease imported into their community can result in an outbreak.
7. Why you CAN actually trust me (and also your doctor and the medical and scientific community at large)
As I note repeatedly until people hate me I have a doctorate degree. I also hold two masters degrees and two bachelors degrees the latter which I earned concurrently. The reason I’m repeating it here is I can tell you from personal experience what higher education looks like. And I’m about to. Buckle up.
I find a mountain climbing analogy to be most efficacious in this area. In high school you are on a beginner’s climbing wall indoors with a spotter who’s mostly hauling you upwards on a pully system. In undergraduate you are actually on a real mountain, but you’re one of many on the face of the mountain, you’ve got guides all around you, and you don’t have to put in your own little …. I don’t actually mountain climb …. nails? And your harness is still pretty good and you still have spotters. For a masters degree suddenly there are far fewer people on the mountain, you’re much higher up, you do have to drive in your own little pegs or nails and while you’ve got a team with you they’re not necessarily climbing exactly the same route. As a PhD, you’re alone. Well, your supervisor is there at the tiny narrow ledge you’re trying to reach before you need to scale yet another face shouting down encouragement, but you are up higher than the Masters students with no harness all alone. It’s not indoctrination, it’s a free climb.
Now, I did a PhD which is a doctorate of philosophy. There’s also MDs and JDs. So I am intimately well acquainted with what it is to get a PhD but I can only tell you about MDs and JDs from my interactions with people who have them. We do get together to cry from time to time. That’s what the Free Masons actually are: a safe place for people with doctorates to sob uncontrollably. The reason I say this and the reason I’m making that analogy is that when earning one’s doctorate one is not “indoctrinated.” Even the level of hands on teaching really varies depending on the supervisor and institution. For my doctorate degree in my first year my supervisors basically gave me a booklet which was just bibliographies and told me if I had any questions I should ask. Most of my questions were, “can you point me to more reading on this subject?” and at one point, “I understand step one and step three, but I can only assume step two involves underpants gnomes.” That last one took some contextualization. In my second year I was in lab. And that’s an accurate description of my life. When I wasn’t at my side job, eating, sleeping, or pooping, I was in lab. No one stood over my shoulder and told me what to think. Occasionally they asked to see my data, but that was it. I was in lab. The remainder of my degree was split between writing, more reading, more lab, calculating, sneaking geeky references into presentations, and editing. In the end I actually found out something that no one knew and that no one expected I or anyone else would find. Had someone been standing over my shoulder telling me how to think I wouldn’t have found that. In fact, most people thought my PhD proposal was eight kinds of crazy. It turned out to be only seven.
Now let me tell you about the publication process in science. It’s basically the PhD again, but with more egos. Again, you read up, you do your ethical checks, you get reviewed, you gather data, you write up the data, you submit your findings, people tell you how disappointed they are in you, you resubmit your data, they relent but ask you to cite such-and-such, you do that and MAYBE you get published. At no point are you allowed to go off on a tangential opinion. If you remain skeptical, read these scant articles I’ve supplied. I’ve supplied them because they are accessible without belonging to a specific institution (that’s a problem with academic journals and the economic structure … it’s another story really). But as you read you’ll note that those authors do not make any claims they can’t back up with data and statistics. If they’re not sure or can’t back it up they will say, “we’re not sure and we can’t back it up, but this may be why we’re seeing this thing, here is how you can prove it or disprove it.” In science — and that includes medicine — if a thing is not provable, it doesn’t get published. In rare instances where it does get published it gets retracted. And even if you do get published — and you have to to have a career in science — your articles are going to be rated by number of citations. Go to google scholar and search these articles and you’ll note a little “cited by” stat. That is often how I and other academics decide what we’re going to read and what we’re going to ignore.
Then there’s medical ethics. I’ll delve into this in Section 9 a bit and it deserves its own stand alone article in the future, but in America with laws as they currently stand you need not fear being experimented on or being given any form of medication or procedure without having it fully explained to you in terms you can understand with an opportunity to ask questions. The reason for that is in the past … bad things happened. And now we have a few laws and a lot of regulations (some of which my own mother wrote) which protect you.
There’s two big reasons a person might want to get a MD and those are 1. to help others and 2. to learn more about helping others. The second one can get into a bit of ego and trouble because some researchers will try to cut corners at times and although there’s generally not money involved there certainly is ego. But for the most part doctors are there treating patients because they want what’s best for their patients. Pediatricians especially LOVE kids. They’re not going to hurt yours. My doctor who delivered me and then treated me for all my bumps and scrapes as a kid had a wall in his office dedicated to all the babies he’d delivered. He was immensely proud of all of them. Doctors do have ROUGH schedules and particularly if you’re meeting a new doctor it might be a little intimidating or rushed or even cold, but most doctors get into the profession because they want to heal the sick and to prevent sickness where they can. These people are not going to want to hurt you, and even if they did there are legal and civil restrictions in place to make sure that that never happens.
Additionally, I’ve mentioned in previous sections the very very rare incidence of severe side effects for vaccines. One in a million people has an allergic reaction to vaccines but because one in a million people has such a reaction, doctors make sure to keep their patients in the clinic long enough to confirm that they won’t have that reaction. But the other thing is that by the time a medication is a medication and not a test drug it’s gone through relentless testing. It starts out on paper and goes through a few iterations of theoretical study, then it goes into microbial or chemical studies. Then it goes into small animals, then it goes into larger animals (beagles are available for adoption after they’ve been test animals btw), then there are several stages of human studies (all of which you have to opt into and which involve the doctor sitting down with you and explaining things and culminate with you regurgitating what you understand from the consent form before you sign in the presence of the doctor) and if it makes it through all those levels and still is efficacious and ethical THEN it might go into circulation. You won’t be given a drug unless it is safe. Or at least safer than the disease it fights.
Some of you still won’t be convinced and there’s a point at which I can’t combat that. Throughout this I’ve referenced the CDC, the FDA, and academic and medical studies. If you’re determined to be suspicious of those groups there’s not much I can do other than say, you’re wrong to be so suspicious of them. I do understand people’s fear of the government particularly in the era of Trump, but the CDC and FDA largely represent what’s good about the government. These are groups dedicated to making sure you remain healthy and what you put in your body is safe. They are large government organizations because an enlightened democracy should look after it’s people, and because there is no other way to gather such large amounts of information and successfully implement laws and regulations.
8. “Alternative Medicine,” and why — besides the obvious — you shouldn’t drink your own urine
Some of the issues people seem to have with vaccination are cynically cultivated by the alternative medicine industry. It is frankly pretty reasonable to be somewhat suspicious of “Big Pharma” because where money, pricing, and insurance comes in they are kind of evil. But, consider this. Health is probably the most valuable thing in the world. If you can delay or prevent the death of a loved one you will move heaven and earth to do it. So health makes you particularly susceptible to sociopaths. In the case of “Big Pharma” you’ll find the sociopaths in the upper echelons of the companies sitting there with MBAs but no MDs or really care for human life. It takes time and effort to get into those positions. But to hawk a fake cure in alternative medicine is considerably easier. All you have to do is tell people it works and tell them if it doesn’t work it’s because they haven’t bought enough product or believe hard enough.
I do need to make a distinction here. There are forms of so-called “alternative medicine” that definitely work including acupuncture and some Chinese medicine. Basically, if you’re going to supplement your health with alternative medicine make sure it’s brought to you by people licensed in it, that it has a few hundred years of history under its belt and that it’s not being brought to you by way of cultural appropriation. Acupuncture is great for things like relieving pain, but an acupuncturist might miss some pretty clear signs of cancer. (I know, that’s how my mom lost her life.) So if you do want to do that go for it but make sure you keep your doctor appraised of what you’re doing and taking. Sometimes it might interact with other medicines and sometimes it might be all wrong.
Let’s get back to snake-oil salesmen. For privacy reasons I can’t get too far into he story I’m about to tell but one of the patients I was evaluating for an MS trial was having ISSUES completing the tests. They were forgetful, their hands were shaking, everything was going hopelessly wrong. I actually checked the charts several times because when I originally read up on this patient I had read that their MS had just been diagnosed a few months ago and was not terribly advanced. So it was weird that they were having the sort of trouble they were. You don’t usually see that advanced level of motor difficulty and cognitive issues until the disease is much further along than they should have been. So I went to the PI and told them what was up. I really did think I had the wrong chart. The PI interviewed the patient and it turned out the patient had gone to an “alternative healer” and had “bee sting therapy.” MS is an auto-immune disorder. It doesn’t help to inflame the immune system further. That “therapy” advanced the patient’s disease process several years in the course of a few months. They had to be removed from the study and I think they had to change their medication. That patient will die sooner of their disease and has irreversible brain damage because of what that “alternative healer” did to them. And the worst part is that the patient seriously believed they were doing better.
This sort of thing unfortunately happens quite frequently. In an emergency situation doctors and nurses are not necessarily going to have time to ask you if you’re taking homeopathic remedies. Most of the time it’s fine, but every now and then there’s some weird root or leaf that’s going to interact poorly with what they would normally give you. It can cause your blood pressure to tank unexpectedly, it can seriously confuse your immune system, you may even have a respiratory or cardiac incident. And that’s just when your “alternative healer,” is legit. When they’re not they’ll sell you on expensive “treatments,” like bee sting “therapy.” And the worst part is once they’ve got you hooked they have literally invested interest in keeping you sick and keeping you coming back to them.
And this is where things get really truly awful. If you go to anti-vax forums or blog sites or whatever it is you’ll start to notice there are a lot of “alternative” cures being hawked. Some of it is just ad space and I’ve even seen a few examples of sellers of crystals saying, “no, I won’t give you that; take your kid to a hospital now.” But as I said before, there’s also a few sociopaths. This is where that debunked study that said the MMR vaccine causes autism came from. Telling people that actual medicine doesn’t work and may actually make you sick does two things: 1. it makes people scramble for an alternative and 2. it guarantees sick people who don’t trust doctors. If you have no soul and want money, this is a surefire means of earning it. (Remember the Church of Bleach from the Autism Section?) Normally alternative medicine has to rely on people who want the extra care and have the money to spend for it. But if you manage to convince everyone that vaccines don’t work, you can get anyone who has any money at all, they’ll keep coming because they have nothing but faith to hold onto, and when they get sick they’ll spend even more money. So that’s pure evil, but apparently so is most of business.
I do kind of want to address a few of the so called alternative cures or natural remedies. Some of this is just because I find them so absurdly amusing. The bleach thing is horrifying, but most of the rest is mostly just funny. Or would be if it didn’t seriously raise the rate of morbidity and mortality among small children.
One of the biggest so-called cures is bathing in or drinking your own urine. You can read that as many times as you like; it won’t stop being what I wrote. Urine is mostly sterile. You might pick up a little something as it passes through your urethra, but it’s mostly not the worst. In a survival situation where you cannot find fresh water and cannot sufficiently purify what water you can find then drinking your urine is a reasonable means of not dying. That’s about the only time you want to do that. Urine is at the end of the day a waste product. Your body is expelling things it cannot use. So if you put that right back into your body it’s just going to get filtered right back out again and you’ve made your body go through that process uneccessarily. If you just do it once or twice it’s probably not an issue, but it can cause fever, diarrhea, fatigue, and muscle soreness. As for bathing in it, it’s mostly water plus urea. That’s not going to help you.
Another big cure-all I’ve heard is apple vinegar. Honestly, this one’s just stupid. If you want to use apple vinegar to cook then fine. You do that. That’s what it’s for. But if you’re drinking huge portions of it or bathing in it you’re going to get dehydrated. It’s not going to help you.
Which brings me to another crazy fake cure. Your diet. So …. it does actually matter what you put in your body. You need things like B12, vit A, vit C, fat, vegetables in general, and a whole lot of other stuff to stay alive. Eating a diet with too much fat or salt can cause problems, but alternatively, not getting enough of certain vitamins also causes huge problems. People get mad at me for saying this but the reason vegans have to take a B12 supplement is because they’re not getting it naturally and without it you get irreversible brain damage, go into a coma, and then die. So if someone tries to tell you that animal proteins are bad for you …. they’re just wrong. In today’s world with a B12 supplement some people can strike dairy, meat, AND eggs from their diet, but if you take away that B12 supplement they will die. (Oh, and before you get angry at me, one of the early symptoms of B12 deficiency is anger. Not even kidding.) So yeah if you’re eating three steaks a day that’s too much. Don’t do that. You’re going to die if you keep that up. But also don’t cut entire food groups out of your diet calling them toxins and expect to magic up the vitamins you’re losing from doing that. Foods are not toxins. If you have the time and budget to research where your food is coming from and eat a healthy locally sourced diets using only meats from farms which employ humane practices then absolutely do that to achieve a well-balanced diet. But two things. The keyword here is “balanced.” Don’t go cutting things out or adding huge unseemly portions of something because some guru tells you two. And secondly no matter how healthy and consistent your diet is it will not safeguard you from all disease all the time. It helps, but if you get sick it’s no necessarily because your diet sucks.
Another supposed alternative is breastfeeding. First off if you can breastfeed your child you absolutely should and if you look into the osteoporosis literature breastfeeding your child may be beneficial to the mother’s health as well if done upwards of a year or so. Breastfeeding does help a neonate’s immune system and it is part of post-natal fetal neurological development. (Basically, our brains are so huge that for us to have children naturally due both to the efficiency of our metabolism and the width of our hips infants are born before their brain is really ready for it. So breastmilk helps make up for that by supplying all the nutrients and fats a neonate’s brain needs to complete its first landmark of development.) As such I’m not saying don’t breastfeed. But what I am saying is that breastmilk only helps keep an infant relatively protected from disease for a short time. Antibodies pass through the placenta to the fetus in the last few months of pregnancy and are supplied via breastmilk for about two months post-partum. But that’s it. Also, the infant only gets the antibodies for things their mother has been vaccinated for or has had. Breastmilk is not magic. It’s great, but it doesn’t inoculate the infant for life and it only pertains to the diseases the mother has antibodies for.
Other dietary cures include honey, garlic, various mushrooms, and ginger. And probably quite a bit I haven’t mentioned. Some of these are actually rather amazing foods and I will give you a few home cures I actually do use for colds. But, as effective as these foods can be at fighting a cold or a bit of phlegm they won’t cure polio, or measles, or help you fight off rubella. Absolutely include them in your diet, but also just get the vaccines because as nice as these foods are they cannot save your life. (Okay so — and this is actually backed up by some 14th or 15th c. Japanese male diaries I’ve translated, long story just roll with it — when I feel a cold coming on I chew on a raw clove of garlic until I think I’m going to die and then I swallow it or spit it out. That has a few times turned things around for me. However, it REALLY sucks. Then a flatmate of mine once noticed that I had a really persistent cough so she boiled some ginger root and had me drink it with lemon and honey. That goes down considerably smoother than the garlic and it does break up the mucous quite well. That said, I had a cold. I did not have measles.)
There’s quite a bit more foolishness out there. I did go to a few anti-vax forums and blogs to see what they were talking about so now you don’t have to. Do not do. Just …. I took the hit for you, okay? You cannot unsee that crap. But the major theme in most of these pseudo-cures is a weird combination of guilt and faith. Essentially, when anti-vaxxers become ill or their children become ill, or their partners insist on vaccination for their children they do not re-evaluate their beliefs but double down. The WORST part of those blogs and forums was that in the event of life threatening illnesses including things like cancer anti-vaxxers including those who were actually dying would blame the sick person or their parents essentially saying the reason they were sick was not because cancer happens or if you don’t get vaccinated you are at risk of contracting that illness, but because that person didn’t do enough to avoid vaccines or didn’t believe in these cures hard enough or didn’t drink enough urine or whatever it is. Some of them go so far as to find people whose relatives or even children have died and tell them the reason is that their relative was vaccinated. This is truly cruel. It is statistically provable that individuals who fail to vaccinate themselves and their children are putting themselves and their communities at greater risk. That is fact. So it’s pretty nasty to lie in the first place and pretend that vaccine avoidance is in any way a good idea. It’s either delusional or antisocial to do that in the first place. But placing blame on someone when they’re sick or telling bereaved relatives that they are somehow responsible for the death of a loved one is never appropriate. It does not matter if they were up to date on their vaccinations or an anti-vaxer, you can reserve your disapproval until the crisis has passed. But this kind of antisocial behavior is unfortunately pretty common in the anti-vax communities.
9. Racism, Sexism, Homophobia, and vaccine refusal.
This brings me to my last point. It isn’t just victim blaming that is rife in the anti-vax communities. It gets considerably darker. At its root, vaccine refusal is about fear. And its manifestation is sort of Dunning-Kruger manifesting in a potentially fatal form. Earlier I mentioned that vaccine refusal tends to correlate with income. Studies were a little divided on whether or not it also correlated with race, but in general vaccine refusal is championed by upper middle class white people with some college education. The problem with having just some college education is people tend to be rather sophomoric. Literally. College helps people start questioning the world around them which is generally a good thing, but this is where we get back to Dunning-Kruger. If you only have some college education you simply don’t know what you don’t know and are likely to have little conceptual space to consider how vast your lack of knowledge really is. But if you also have a decent pay grade you might have a great deal of confidence in things you just don’t know about. This is a trap everyone falls into in some way or another so you need not feel ashamed if you’re suddenly recognizing this, but you do need to be aware of its existence.
So, some of you might have read that and said to yourself, “wow, this Ari is quite the elitist.” And I am. I started this whole hour long article telling you I have a doctorate degree. One of the reasons I did that is because if I’m introduced as “Miss Schulz” or “Mrs. [name I won’t disclose]” people aren’t going to listen to me. But if I’m introduced as “Dr. Schulz,” they absolutely will. And then I contextualized why my studies make me concerned with the increasing rate of vaccine refusal. Get mad at me all you like if that helps, but then get inoculated.
But this fear of elitists paired with just enough college to make you start questioning things weirdly enhances quite a few biases. On the one hand people start fearing “Big Pharma,” or Western medicine, or the government, but on the other they start coming up with some truly insane theories to reinforce discriminatory attitudes.
One of my black facebook friends, I actually forgot who it was, noticed how pro-BLM I was during 2016 when there was even more serious controversy aimed at that organization than usual. He had found this weird anti-vax thing and was seriously concerned about it. What I’m about to tell you about is shockingly racist. The article he sent me was written to try to convince black people that vaccination was a means of causing brain damage to their children. It was basically someone — probably a white someone — assuming that black people would fall for this crap and telling them that vaccines were bad for them. There’s several variations on this particular myth. There’s one that says there’s two kinds of vaccines: one is for mind control and the other is the actual vaccine, but you only get the good one if you’re part of the in-group. And depending on who the story is being told to the in-group can be white, Asian, rich, members of the government, or doctors. I’m sure there’s also one of these aimed at trying to convince people that Jews are poisoning the wells, but I haven’t seen the anti-Semitic brand of this one yet. So let me assure you — elitist though I am — there is only one kind of vaccine and its the one that keeps you from dying.
One of the most deeply racist and often anti-Semitic arguments against vaccines is that if you are evolved you somehow don’t need them or that if you get them you’re interfering with evolution. (Alternatively, the overtly racist reason for trying to trick black people out of vaccines involves this weird conspiracy about a disease being released that will only infect people who are not Aryan.) This one in a way can be traced back to Hitler himself. Hitler was a vegan. It’s often cited as proof that even the worst people have some small amount of good in them. But …. no, no we can’t have nice things. The reason Hitler was a vegan was not because he loved animals but because he believed in the “Blood and Soil,” I-can’t-call-it-a-theory. The “Blood and Soil,” argument is that Aryans have the longest history of agriculture (not really true) and are therefore uniquely evolved among humans to be able to survive without animal products (absolutely not true and in fact look up how lactase persistence works). Jared Diamond with his book Germs, Guns, and Steel somewhat inadvertently gave this argument new life in the way that he talked about pathogens from Europe wiping out huge proportions of the Native American populations. I’m perhaps being a little unfair to Diamond but the man is cancelled among Anthropologists as many of his unquoted and uncited sources were Anthropologists who claimed he essentially Gilderoy Lockharted them. Vaccines are about supplying antibodies. They do not interfere with natural selection and Aryans aren’t magic. (Also, Aryans aren’t actually Aryans and there is actual court-law that says precisely that.)
Another awful theory relates to the growth mediums I mentioned earlier. This one may also be re-purposed depending on which discriminatory tactic you’re hoping to employ. Before I get into this remember that those human and animal cells are cleaned from the active ingredient and don’t make it into the vaccine itself, so the entire premise of this is flawed from the get-go. But whatever; as the President’s lawyer said, “truth isn’t truth.” The idea here is that if those animal or human cells do not match your child’s sex and race it will turn them gay or make them sick. Again, yes, you read that right. I have had to wade through some horrifying crap. Now, you don’t even need “some college education,” to know how insanely stupid that is. Firstly, there’s not going to be that kind of DNA in the vaccine and secondly even if there was, that is not how DNA works. If it were anyone who ever had major surgery or was in an accident might suddenly switch their sexual preference. There’s a joke about reassignment in here somewhere, but after all of that, I just don’t have the heart to look for it. Gay is gay. You can’t catch it. And yes, the polio vaccine was developed through use of the HeLa cell line which was harvested and cultivated without the consent or knowledge of Henrietta Lacks — a young black woman who died of cancer in 1951 — so there are continuing questions regarding the ethics of medicine and how it pertains to race. But you’re not getting bits of Ms. Lack in your vaccines and she’s not going to make you gay or black …. which is apparently the fear.
As for sexism this sort of gets into the same old same old. The racist appeals to come out of the anti-vax movement largely assume that black people are somehow inferior. That’s pretty awful, but one of those assumptions is recycled for women. American women still make most of the childcare and household decisions even if they are working full time and even if they are outpacing their male partners. So if you want to change how children are raised and cared for you must target women. So there is a lot of condescending crap out there. I know I’ve used the word “crap” a lot, but it’s really the only way to describe some of this. As with that link one of my black friends sent me aimed at scaring black people away from vaccines largely by assuming they’re dumb, a lot of the scare tactics used on mothers to scare them away from vaccines assume that women are easily shamed and pretty stupid. There’s also quite a lot of mom shaming. “How could a mother vaccinate her child knowing that [imaginary foolishness] happens [made up number] % of the time??” There’s also quite a bit of, “you need to educate yourself,” followed by links to blogs or some other completely irrelevant source. And, both people of color and women get to have the standard name calling treatment. The n word is tossed about as are several defamatory words for women. One Australian politician was asked to “get cancer and die,” which in and of itself is neither sexist nor racist, but likely would not have been directed at a male politician (https://www.abc.net.au/news/2016-10-21/anti-vaccers-sending-abusive-messages-victorian-minister-says/7953308).
Essentially the issue is with the ability or inability to control behavior. White males typically do not experience or expect to experience the kind of criticism that women and PoCs do. Additionally, white males tend to have the often erroneous belief that they are always right particularly when arguing with a woman or PoC. (And white women often buy into this narrative as well imposing their own brand of paternal racism, but I’ll get into that another time.) So if you have a white man or even a white woman who fears vaccines, they are very likely to launch particularly sexist and racist attacks against politicians, the medical community, or society at large.
There is a fundamentally flawed perception that the anti-vax movement is entirely made up of “hippies” or at the very least the far left. I will explain in another post why I think the entire conceptual structure of politics as left and right is at best obsolete by about two hundred years, but even taking the standard measures of right and left the anti-vax movement does not fit neatly into either. The left is supposed to be about universal tolerance and acceptance of things like government provided healthcare. There is also a perception of liberals as more likely to eat organic foods and be health conscious so if you really squint it does make sense in a very perverse way that the anti-vax movement would be leftist but that’s about as far as it goes. Much of this goes back to Jim Carrey and Jenny McCarthy. Hollywood is perceived as liberal. If it truly were we would have a lot more movies with diverse leads and the MeToo movement would not have hit Hollywood as hard as it did, but nevertheless as creatures of the film industry McCarthy and Carrey were seen as liberal. I believe that that is where the association begins and ends, because fear of big government, rejection of science, and intolerance towards minority groups all tend to be espoused by the far right as opposed to the left. However, I also wouldn’t even blame the far right for this.
As I see it, the anti-vax movement came about largely due to people’s misconceptions regarding medicine coupled with a few select people’s desire to unscrupulously make money. From there, bias, misconception, fear and hate grew it into what is now a very … toxic … movement. This post took me an embarrassingly long time to write, but the reason I did it is I see children suffering and dying from preventable diseases. I chose not to work with infant skeletons because they’re small and haven’t fused yet and because it is near impossible to determine whether porosity is due to growth or disease. But even though my reasons for excluding infants from my research are largely practical rather than emotional, it does deeply bother me in this modern day and age when parents who think they’re doing the right thing find their children growing ill. Normally when I write a thing I will not come back to it unless I absolutely have to. This one though I wrote to try to encourage people to get vaccinated so I am willing to add to it. That said, I’ll keep the sections in because it is quite long and it’s too much to ask for people to read it all the way through if they’re just looking for one specific argument.
CDC. (1999a). Impact of vaccines universally recommended for children — United States, 1900–1998. Mortality and Morbidity Weekly Report, 48, 243–8.
CDC. (1999b). Ten great public health achievements — United States, 1900–1999. Mortality and Morbidity Weekly Report, 48, 241–3.
Dewitte, S. N. (2014). Health in Post-Black Death London (1350–1538): Age Patterns of Periosteal New Bone Formation in a Post-Epidemic Population. American Journal of Physical Anthropology, 155, 260–267. http://doi.org/10.1002/ajpa.22510
Feikin, D. R., Lezotte, D. C., Hamman, R. F., Salmon, D. A., Chen, R. T., & Hoffman, R. E. (2000). Individual and community risks of measles and pertussis associated with personal exemptions to immunization. Journal of the American Medical Association, 284(24), 3145–3150.
Gostin, L. O. (2015). Law, ethics, and public health in the vaccination debates: Politics of the measles outbreak. JAMA — Journal of the American Medical Association, 1099–1100.
Hardin G. The tragedy of the commons. Science 1968;162:1243–8.
Hawkey, D. E. (1998). Disability, compassion and the skeletal record: using musculoskeletal stress markers (MSM) to construct an osteobiography from early New Mexico. International Journal of Osteoarchaeology, 8(5), 326–340. http://doi.org/10.1002/(SICI)1099-1212(1998090)8:5<326::AID-OA437>3.0.CO;2-W
Klaus, H. D. (2014). Frontiers in the Bioarchaeology of Stress and Disease : Cross-Disciplinary Perspectives From Pathophysiology , Human Biology , and Epidemiology, 155, 294–308. http://doi.org/10.1002/ajpa.22574
Lieu, T. A., Ray, G. T., Klein, N. P., Chung, C., & Kulldorff, M. (2015). Geographic Clusters in Underimmunization and Vaccine Refusal. Pediatrics, 135(2), 280–289. http://doi.org/10.1542/peds.2014-2715
Malone, K. M., & Hinman, A. R. (2007). Vaccination Mandates: The Public Health Imperative and Individual Rights. In Law in Public Health Practice (pp. 338–360). Oxford University Press. http://doi.org/10.1093/acprof:oso/9780195301489.003.0014
Neubauer, S., & Hublin, J.-J. (2012). The Evolution of Human Brain Development. Evolutionary Biology, 39(4), 568–586. http://doi.org/10.1007/s11692-011-9156-1
Ołpiński, M. (2012). Anti-vaccination movement and parental refusals of immunization of children in USA. Pediatria Polska, 87(4), 381–385. http://doi.org/10.1016/j.pepo.2012.05.003
Omer, S. B., Enger, K. S., Moulton, L. H., Halsey, N. A., Stokley, S., & Salmon, D. A. (2008). Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis. American Journal of Epidemiology, 168(12), 1389–1396. http://doi.org/10.1093/aje/kwn263
Omer, S. B., Pan, W. K. Y., Halsey, N. A., Stokley, S., Moulton, L. H., Navar, A. M., … Salmon, D. A. (2006). Nonmedical Exemptions to School Immunization Requirements. JAMA — Journal of the American Medical Association, 296(14), 1757–1763.
Plans, P., Torner, N., Godoy, P., & Jané, M. (2014). Lack of herd immunity against measles in individuals aged ❤5 years could explain re-emergence of measles in Catalonia (Spain). International Journal of Infectious Diseases, 18(1), 81–83. http://doi.org/10.1016/j.ijid.2013.09.015
Stadlin, S., Bednarczyk, R. A., & Omer, S. B. (2012). Medical exemptions to school immunization requirements in the United States — Association of state policies with medical exemption rates (2004–2011). Journal of Infectious Diseases, 206(7), 989–992. http://doi.org/10.1093/infdis/jis436
Tan, S. Y., & Yip, A. (2018). Hans Selye (1907–1982): Founder of the stress theory. Singapore Medical Journal, 59(4), 170–171. http://doi.org/https://doi.org/10.11622/smedj.2018043
Wang, E., Clymer, J., Davis-Hayes, C., & Buttenheim, A. (2014). Nonmedical exemptions from school immunization requirements: A systematic review. American Journal of Public Health, 104(11), e62–e84. http://doi.org/10.2105/AJPH.2014.302190
Yang, Y. T., & Silverman, R. D. (2015). Legislative prescriptions for controlling nonmedical vaccine exemptions. JAMA — Journal of the American Medical Association, 313(3), 247–248. http://doi.org/10.1001/jama.2014.16286
Pertinent Court Cases
Brown v. Stone, 378 So. 2d 218 (Miss. 1979), cert. denied 449 U.S. 887 (1980).
Cantwell v. Connecticut, 310 U.S. 296, 303–4, 60 S.Ct. 900, 903 (1940).
City of Boerne v. Flores, 521 U.S. 507, 117 S.Ct. 2157 (1997).
Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261, 278, 110 S.Ct. 2841, 2851 (1990).
Employment Div., Dept. of Human Resources of Oregon v. Smith, 494 U.S. 872, 110 S.Ct. 1595 (1990). Jacobson v. Massachusetts, 197 U.S. 11, 25 S.Ct. 358 (1905).
Lemon v. Kurtzman, 403 U.S. 602, 91 S.Ct. 2105 (1971).
Maricopa County Health Department v. Harmon, 156 Ariz. 161, 750 P.2d 1364 (Ariz. Ct. App. 1987).
Mason v. General Brown Central School District, 851 F.2d 47 (2d Cir. 1988).
Prince v. Massachusetts, 321 U.S. 158, 64 S.Ct. 438 (1944). Roe v. Wade, 410 U.S. 113, 193 S.Ct. 705 (1973).
Sherbert v. Verner, 374 U.S. 398, 83 S.Ct. 1790 (1963).
Sherr v. Northport-East Northport Union Free School District, 672 F.Supp. 81 (E.D.N.Y. 1987). United States v. Seeger, 380 U.S. 163, 85 S.Ct. 850 (1965).
Walsh v. United States, 398 U.S. 333, 90 S.Ct. 1792 (1970).
Wisconsin v. Yoder, 406 U.S. 205, 92 S.Ct. 1526 (1972).
Wright v. DeWitt School District, 238 Ark. 906, 385 S.W.2d 644 (Ark. 1965).
Zucht v. King, 260 U.S. 174, 43 S.Ct. 24 (1922).