A Humanities-Based Case for Vaccines
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There is an argument against vaccines that has been widely circulated on social media which goes something like this: “If man is designed so poorly that now we need this many shots as children to survive into adulthood, then how did we get this far before having them?”
What this argument assumes has been countered numerous times in the past by philosophy, literature, economics and theology from all corners of the world. The facts of history do not support it. (I will leave science out for this particular response; suffice it to say that “survival of the fittest” implies a need for fitness in the world and that not everyone has been blessed with or acquired equal amounts of it.) It assumes that our environment is Edenic and that we live in what is classically referred to as a “prelapsarian” time. It assumes Pandora’s box was never opened – it is Utopianism in reverse. It almost assumes that memento mori does not apply to us (as if we are immortal gods or angels). However, we live in what some refer to as a broken world that needs repairing (or, if you prefer, a fallen one), with dragons that we can see, and those we cannot. To put it less figuratively, everything in the world – including the world itself (and, as I will later demonstrate, war) – is a complicated mixture of (not always expected) good and bad; something like the Chinese concept of yin-yang. That truth – along with many others – is illustrated best by the humanities.
We stand on the shoulders of giants, and the experience of Robinson Crusoe – while fictional – mirrors well that of the real-life people who came before us. When he found himself suddenly back in the wilderness, outside of civilization, in what can be called a primitive state, he commenced to rebuilding those things one needs to survive and thrive in a hostile place. He had to do this, because man is not naturally equipped to deal with all potential dangers; a daily allowance of manna is uncommon. Necessity, it has been said, is the mother of invention. Recall the proverbial “God helps those who help themselves.” It is interesting to note that the author of Robinson Crusoe, Daniel Defoe, also wrote A Journal of the Plague Year, which blends history and fiction while describing a devastating outbreak that occurred in London in 1665; that is, before vaccines and the widespread acceptance of germ theory. That plague is a subject I will return to.
In ancient times, it was believed that by placing a baby in a tortoise shell – as one does in a crib or bassinet – that it could protect the baby from common (and potentially fatal) illnesses. The demand for this kind of protection that far back in time is proof that it is an ancient unmet need. And until relatively recently, successful products have been in short supply. Variolation, a method of inoculation first used to immunize individuals against smallpox, while no longer used today, has been dated back to 16th century China, and its use from there spread to India, parts of Africa and the Middle East before its being introduced into both Europe and North America. This, I say, is evidence of its not only satisfying (or attempting to) an ancient unmet need but also one that is universal. (Variolation is an interesting example of man’s creativity, which so often connotes the production of something artificial and wholly original; for here, we are using something natural – the scab of a smallpox victim – to activate and harness the power of an individual’s innate immune system. I say this because of the trepidation some have around anything perceived as ‘unnatural.’ But it is as natural as the turtle’s shell, and as weird, for the latter is a fusion of the creature’s ribs.)
To further illustrate my previous point, I will remind readers that man, it has been taught, must live by the sweat of his brow; along with cultivating the soil, this can include the discovery or production of life-protecting therapeutics. Since the dawn of civilization, that is what man has done. And has done and has done; so much so that the marketplace is perpetually flooded – with tortoise shells, amulets, magic spells, tinctures, various oils (e.g., snake), variolation and (more recently) vaccines.
I do not wish to brush past the benefits of other medical and legal advancements that have occurred in the same period as vaccines, such as antibiotics, more knowledge of nutrition, refinements in sanitation, and laws to protect children from hazardous occupations. To say that we have been abundantly blessed these past hundred or so years would be an understatement. Human ingenuity is a wonder. Like vaccines, they all deserve some credit for making our lives significantly better than they were before. (The spread of democracy and private enterprise have also helped, to put it mildly.) And, they have all made the following statement by the philosopher Thomas Hobbes seem – in peacetime, at least – obsolete: “The life of man is nasty, brutish, and short.” But that was true of life before today. We live in a miraculous period – what the past might have termed anni mirabiles.
War – chief of life’s perennial evils – very frequently gives birth to both medical and technological advancements, despite its otherwise hellish nature. While pediatric vaccines have not been directly affected by war, the pediatric well-visit schedule in the United States has been (the well-visit is when vaccines are most often recommended and given). It came about because of the Vietnam War. During the draft, the government noted that a significant number of otherwise eligible males were being disqualified for health reasons. The well-visit schedule was, at its inception, an effort to ensure that children grew up healthy enough to serve in the military if the need should arise – a policy not unlike those Lycurgus gave to Sparta. And, while politicians may campaign in poetry, reality always forces them to govern in prose – the United States military, more than any other profession, mandates several vaccines for its members to maintain a strong and ready fighting force. Make of that what you will.
Here is Benjamin Franklin (in his autobiography) on his feelings about the smallpox vaccine:
“In 1736, I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if the child died under it: my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.” (Emphasis mine.)
That is the recommendation of one of America’s most revered founding fathers. As the authors of The Federalist Papers tell us – all three of them among our founding fathers too; one of whom, as the titular lead of the musical Hamilton, sings the hit song, “My Shot” – men are prone to forming factions. We are moral and judgmental beings – political animals, if you will. I sometimes wonder if this topic has become too moralized (i.e., politicized), or if some physicians unawares put vaccines “on a pedestal,” thusly eschewing shades of gray (something which science can more readily appreciate and look at objectively, with its various scopes, all of them lacking – ideally – a moral lens, than can any man; man, unlike Justice, is not perennially blindfolded), and, I wonder, if they can no longer see why any patient would choose other than to get the vaccination. It is as if we sometimes forget that nothing gains universal acceptance, which is both a positive aspect of human nature for the greater good (despite appearances to individuals sometimes), since it protects us from the universal acceptance of an error and the disastrous consequences that would follow, and a reason to think that any attempt at gaining it for something – like a vaccine – would be futile; a pie in the sky; a great expectation – which to Buddhism is the root of suffering (i.e., depression) – naturally and always followed by an even greater disappointment. Physicians, for the sake of rapport, are trained to maintain an objective and nonjudgmental attitude in talks with their patients, but many will drop all pretenses when it comes to this subject. We forget that people like to feel superior (a negative aspect of human nature) and will look at things in a way to buttress a feeling of moral superiority; it is the secondary gain that many ignore. And people do not like to be judged negatively, so they will seek out evidence that it is the judge who is bad (at which point, science becomes an afterthought). They will also seek out birds of a feather – in this case, other people with negative experiences or doubts around healthcare in general, people who feel shamed or even ostracized, perhaps, by their physician or the industry – and they will flock together. As with all things, it is possible to go too far, and I suspect we have done so in the degree that we have moralized vaccines. I have always thought that if we continue teaching people how to think, that the majority will make the right choice; I like to see this not as naivete, but as an example of tragic optimism. While nothing gains universal acclaim, most people will, even without education and being taught what to care about, choose life over death; most, if given a choice, will opt for freedom as opposed to any form of authoritarianism. In this way, with our most basic values, man is not so unlike other animals, excepting that we have named the different values to discuss, see (conjure?), dissect, consider and understand them further and more fully than can any other animal. And our hierarchy of values is certainly deeper, their ordering more diverse and complex than any other life form’s; this can easily be seen not only when comparing our species with the rest, but even when contrasting one human’s with another’s: this person never wears a mask, while that person never leaves home without wearing two, and both must be certified as gluten-free. (That also might be our source of humor, a less heralded but – when compared to poetry – more lucrative branch of what is called the humanities.) I hope this essay is in part proof that the humanities can do this, can teach one how to think – for it is poetry that helps us to see what is otherwise invisible (with music, we hear it – that beautiful otherworld) and to learn what is real and what is not, and when it comes to making the right decision, poetry can, on occasion, make all the difference. Perhaps this essay also makes a case for the existence of a literary canon and – whether we like them or not – its necessary angels; that is, for selecting and preserving the best of what has been said, as well. They are touchstones, the giants’ shoulders, as much as are any scientific discoveries. They are memorable and readily at hand – even if one should be aboard a sinking ship, it would be no problem at all to carry them with you as you swim to safety. Of what other possessions can we say that? Of what other public property can we make such a private use without offending the state? Limpet-like, those necessary angels cling to our collective tongue. Our memory loves them, as it does both myth and music. Who can forget God?
Rhetoric, the art of persuasion, consists of logos, ethos and pathos. When done well – that is, when successfully persuading its listeners – it is not always done nobly. Many among us know that easy scared is easy duped. And physicians are aware that mental health is in a poor state in all communities right now. In gently suggesting a course correction, I would also like to add – without straying for too much longer from the main topic of my essay – that we should engage in less accommodating when it comes to anxiety, as we know that when dealing with it, accommodation, the opposite of Cognitive-Behavioral Therapy and desensitization, is the number one reason for treatment failure. The temptation to accommodate, we know, comes from its seeming like so many virtues, e.g., kindness, empathy and compassion; tough love, it is true, is for the lover tougher. And less buying-in, by physicians, to any cognitive distortions that we might be fed by the 24-hour news would also help. Regarding distortions by the news industry, and thus, how it shapes both perception and opinion, we have this famous line from the titular character in Citizen Kane: “[I]f the headline is big enough, it makes the news big enough.” (Film, it goes without saying, is also a part of culture and the humanities.) This is just a modest proposal in addition to the one above (a plea for less moralizing-politicizing; it was never stated explicitly). There are things, generally those involved in group-formation, that have a corrupting influence – history can show you – and they are best avoided by industries that wish to appear pure and without blemish. Or, at the very least, by individuals within them. (At the same time, it would serve each individual well to remember that every industry, including his or her own, is a group.) Recall that one cannot chase two hares nor serve two masters at the same time. I will no longer veer off-topic to make humanities-based suggestions for my peers that, if put into effect, I believe would help us regain some recently lost trust. Let us return to the subject at hand.
I assume that all adults know how perilous life was for infants, children and adolescents about a century before our present time. I do so because any history book or fiction from earlier eras will show how often they perished before reaching adulthood. Consider Beth March (from Little Women), President Lincoln’s sons and Helen Keller; the latter being a good example of how vaccines preserve not only life but also function, that is, they can protect from disability (because many infections can and do disable survivors). If someone arguing against vaccines says, “We don’t need manmade things,” I might say in response that vaccines are to empower, like swimming or taekwondo lessons (they are a lesson for the immune system); they are a tool, like the shelter, the shield, the clothing and the car, which have the potential – like everything on earth – for both good and bad, but which exist to make life less hard, to make us even more hardy and more free, and – by the grace of God – they have largely succeeded in their endeavor so far. And if someone arguing against vaccines online shares an infographic, I will make sure it discusses all vaccine-preventable illnesses, and not only a few – lies of omission are legion, almost on a par with those of exaggeration. (Ask any expert in political science.) At the same time, a student of history and literature must admit that very often diseases do suddenly ravage before either God ends them or they burn themselves out; their behavior without is very often like that of anger within (but on a different timescale). Consider the Plague of London or that of Athens or the ten that one by one plagued Egypt. Consider those, based as they are on the nature that they hold a mirror to, which is our own, in La Peste and The Decameron. Consider Ireland’s potatoes when they were plagued by the blight. While the desire to do so is understandable, it is not always in man’s power, nor need it be, to end one. (I think of King Canute before the tides…) “This too shall pass” applies. A plague reaching its natural end is not a miracle, although it can seem like one, since everybody prays for it before it comes. However, every leader knows that “Hope” is the worst plan and it should only be the last one. (As Emily Dickinson tells us, it – oddly enough – also has feathers, and life, being stranger than fiction, has shown us that they too flock together. Benjamin Franklin might say that they “hang together,” while other founders might say they form factions.)
Here, I remember this poem by the great A.E. Housman, simply titled VI (from “More Poems”):
I to my perils
Of cheat and charmer
Came clad in armour
By stars benign.
Hope lies to mortals
And most believe her,
But man’s deceiver
Was never mine.
The thoughts of others
Were light and fleeting,
Of lovers’ meeting
Or luck or fame.
Mine were of trouble,
And mine were steady,
So I was ready
When trouble came.
If I may briefly return to Hobbes, he also says the following: “For such Truth, as opposeth no man's profit, nor pleasure, is to all men welcome.” This cynical word to the wise implies that some degree of general distrust or skepticism towards other men is indicated when living amongst and dealing with them. In counterpoint, we have Jonas Salk, who invented the first polio vaccine; when Edward R. Murrow asked him who owned his invention’s patent, he said, “Well, the people … There is no patent. Could you patent the sun?” Magnanimous individuals and philanthropic souls do exist. And selfless ma’asim tovim (“good deeds”) do happen. Bias of Priene says, “Most men are bad,” but he does not say all are. If love and work are the cornerstones of humanness, then Salk’s achievement is one of their crowning glories. There is an aphorism in medicine that goes like this: “Wherever the art of medicine is loved, there is also a love of humanity.” Like anything, distrust can be taken too far.
Having come this far, I consider the word ‘culture,’ and how it has separate meanings in science and the humanities. Two famous lines by William Wordsworth are mysteriously recalled by this: “The world is too much with us” and “oh, the difference to me.” ‘Culture,’ in the societal and non-scientific sense, comes down to us from Cicero. I think, perhaps, that Wordsworth is telling me this: Let us keep talking and not be shut up by any Mark Antony; for surely, one option is less painful than the other. Interestingly, there is no scientific sense for the word ‘counterculture.’ Perhaps its equivalent would be whatever is deemed a pseudoscience…
On a personal note, I am both a published poet and a pediatrician, like William Carlos Williams before me. His short story, “The Use of Force,” is well known and considered a part of the American canon. In it, he describes a house call wherein the physician protagonist fears that his young patient has contracted diphtheria, and he must use force to examine the child’s tonsils (because the patient, as young children are wont to do, is kicking and screaming, despite his desire to help her). This story was first published in 1938. I began practicing medicine in 2015, and I have never seen this illness. Many doctors I trained under – despite their having been in practice for years, in some cases decades before me – said that they too had never seen it when we discussed topics that I needed to know for the board exams. I would hear the same thing, time and again, about epiglottitis due to Haemophilus influenzae type b (Hib), pneumococcal meningitis, polio, measles, etc. (And I am familiar with the expression about the plural of anecdote not being data, but (to quote the physician-poet), “This is just to say.”).
On a final note, every relationship is a two-way street, and doctors can learn much from the humanities, too. They teach us to respect patient autonomy (one of the four pillars of medical ethics, which so often comes into conflict with medical decisions that have become a moral imperative) – that the patient is, as one ought to be, free to choose, – and they teach well the importance of humility. In our Hippocratic Oath, we find the phrase, “Above all, I must not play at God.” We also must not play at the honored roles of mother or father; did we abandon paternalism only to embrace maternalism? We are the sage counsel sought in times of illness, but not the executive, are we not? The humanities teach us to beware of hubris, both within and without, to avoid the fates of Drs Jekyll, Frankenstein and Faust (those literary guardrails that presumably influenced or inspired Michael Crichton, M.D., when he wrote Jurassic Park). The humanities warn against overconfidence in general, as Edward Gibbons says, “History is, indeed, little more than the register of the crimes, follies, and misfortunes of mankind.” (Emphasis mine; he does not say ‘solely.’ He leaves room for hope and what Viktor Frankl terms ‘tragic optimism.’) If medicine itself should ever overdose on amour-propre, “Physician, heal thyself,” is one memorable antidote (as is the rhetorical question of Joseph, when he asks, “Am I a substitute for God?”); antidote, or, if you prefer, vaccination against the tyranny of arrogance. And we should avoid any behavior which gives credence to the perception voiced by George Bernard Shaw in his play, The Doctor’s Dilemma, in which he says, “All professions are conspiracies against the laity.” Ultimately, the humanities ask us one question: “What is sacred?” Can science? Is science? (Medicine is an applied science. Recall that it too has been labeled an ‘art.’) Lastly, I will only add that my favorite recent history book is one by the late Roy Porter entitled, The Greatest Benefit to Mankind: A Medical History of Humanity.