Reproduced from https://www.acatoday.org/content_css.cfm?CID=5242 as archival material for this course. Vaccines and Public Health By Stephen M. Perle, DC Prior to matriculating at the Texas Chiropractic College (TCC) in the Doctor of Chiropractic program in 1979, I had not given much thought to vaccination. It just seemed to be one of those many procedures performed on one in a medical doctor’s office. Likewise, when I went to my DC’s office, I didn’t think too much about those procedures that the DC performed on me. I was a reasonably compliant patient. Even if I didn’t know it at the time, I lived by the principle of credat emptor (let the buyer have faith). When I attended TCC, I started hearing about how horrible the side effects of vaccinations are. Like most students with a predominantly science-based undergraduate education, I had been trained not to be a critical thinker, but instead had been trained to think analytically using the “facts” I read in my books or heard from the teachers. So I learned a lot of pseudo-facts about the horrors of vaccinations, medication and really most things medical. I was a credulous and gullible young man. As I started to investigate the veracity of those criticisms of standard medical practice, I came to learn that a fundamentally different approach between our professions is in how we define therapeutic conservatism.1 One of the medical doctors who practiced with me said, “Surgery is for the failure of other treatment options.” And while I agree, I think there is a more conservative approach that starts with earlier steps. And medications are for the failure of natural and more conservative treatments, although there are times when a disease is so severe or results in such rapidly deteriorating health that more aggressive treatment is needed earlier. Where does this leave us when it comes to vaccinations and infectious disease? The tremendous scourges that are most epidemics (e.g., typhoid, cholera, influenza, polio, smallpox and tuberculosis) have substantively gone by the wayside, predominantly because of public health measures—clean water, waste disposal and massimmunization programs—that have either eradicated the disease or dramatically reduced the infection rate and prevented epidemics. Yet we are left with diseases that can cause a significant burden of illness and even death. But somehow our profession’s philosophical bias toward therapeutic conservatism and naturalism has not allowed us to see that there is a time and a place for vaccination. Recently, when speaking about vaccinations, I heard from many doctors that vaccinations cause autism. During a break, a female doctor came up to me and told me her child had autistic spectrum disorder. I was expecting to hear from her how childhood vaccinations caused this to happen to her child. Instead, she told me how so many in the profession had filled her with fear of vaccination that she had never had her child vaccinated! Given the fact that whatever led her child to develop autism would have continued had she vaccinated her child, she said that in that case she thought she would have known for sure, in her mind, that vaccines cause autism. But instead she knew that vaccines didn’t cause her child’s autism and her position on vaccinations changed dramatically. There comes a point when our moral duty of beneficence, to help our patients, must supersede our bias against treatments that aren’t “natural,” much as we hope the medical profession’s bias against “alternative” treatments will go away and allow the medical profession to make many more appropriate referrals to DCs. That time for our beliefs regarding vaccinations should be now.2-6 References 1. Coulter ID. Chiropractic: A Philosophy for Alternative Health Care. Oxford, UK: Butterworth-Heinemann Medical; 1999. 2. Gerber JS, Offit PA. Vaccines and autism: a tale of shifting hypotheses. Clin. Infect. Dis. 2009 Feb 15;48(4):456–61. 3. Price CS, Thompson WW, Goodson B, Weintraub ES, Croen LA, Hinrichsen VL, et al. Prenatal and infant exposure to thimerosal from vaccines and immunoglobulins and risk of autism. Pediatrics. 2010 Oct;126(4):656–64. 4. Hallmayer J, Cleveland S, Torres A, Phillips J, Cohen B, Torigoe T, et al. Genetic heritability and shared environmental factors among twin pairs with autism. Arch. Gen. Psychiatry. 2011 Nov;68(11):1095–102. 5. DeStefano F, Price CS, Weintraub ES. Increasing Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of Autism. J. Pediatr. 2013. 6. Surén P, Roth C, Bresnahan M, Haugen M, Hornig M, Hirtz D, et al. Association between maternal use of folic acid supplements and risk of autism spectrum disorders in children. JAMA. 2013 Feb 13;309(6):570–7. Dr. Perle is a professor of clinical sciences at the University of Bridgeport College of Chiropractic, where he has taught an ethics course for more than 15 years. To read ACA’s code of ethics, visit www.acatoday.org/ethics. Send questions to ethics@acatoday.org. Published in the August 2013 ACA News.