Re: Gardasil and the GOP

Let me preface this by saying I think Rep. Michele Bachmann, after making a couple of worthy points, went over the top in her critique of Gov. Rick Perry on the Gardasil executive order he issued in 2007. Her language is too strident (“innocent children,” “government injection,” “very dangerous consequences,” the “damage” caused in the body, etc.); the intimation of corruption in Perry’s decision process was unwise; and I sure hope she’s ready to deal with questions — because there are certain to be lots of them — about her allegation that, according to a mother she did not identify but was quick to quote, the vaccine caused mental retardation in one young girl. But all that said, and with due respect, I find much of Dr. Miller’s post unpersuasive.

Dr. Miller does a very good job of refuting the suggestion that the vaccine is unsafe. The fact that there were no serious side effects in such extensive clinical studies is highly significant, especially in light of Rep. Bachmann’s aforementioned allegation. And I am sensitive to the concerns raised by Yuval and Adam Keiper about fear-mongering on vaccines. But Dr. Miller misses the main point of the complaints lodged against Perry, and the rebuttal he offers to Bachmann’s argument about infection prevention is a nonsequitur.

To take the second point first, Miller notes that Bachmann “tried to distinguish Gardasil from other required pediatric vaccines that prevent infectious diseases” (my italics). From there, he snarks that Bachmann should take note that Gardasil “prevents [most strains of HPV] infection” (his italics). But Bachmann never made any claim to the contrary.

Put aside what appear to be her overblown claims about the risks attendant to the vaccine. Bachmann is not saying Gardasil is ineffective against HPV. She is saying that people tolerate government vaccination mandates because school attendance is compulsory and diseases like mumps and Measles are infectious in the sense of being easily communicated — one child can pass them on to the next through routine classroom interaction. It is that sort of infectiousness, not the kind Dr. Miller refers to, that is the rationale for permitting state vaccination mandates. That is, we permit what is otherwise the primacy of parents when it comes to a child’s medical treatment to be overridden in this narrow area, not because the state knows best what is good for the child but because the state has a heightened interest in protecting the broader community. (See, e.g., Centers for Disease Control and Prevention website regarding immunizations: “Parents who choose not to vaccinate their own children increase the risk of disease not only for their children, but also for other children and adults throughout the entire community.”) HPV, to the contrary, is a sexually transmitted condition — I know the schools are pretty wild, but I don’t think we’ve yet reached the point where sex is routine classroom interaction.

And it is on this point where Dr. Miller is way off base. He declares, “I am as opposed to [sic — I think he means “as”] anyone … to non-essential government intrusion into our lives.” But it turns out he’s really not. The Gardasil mandate was an unnecessary government intrusion. As Robert explains, it was not cost-effective, requiring vaccinations for every child at $360 a pop to prevent an infection that (a) may cause a usually non-fatal form of cancer in less than half a percent of women and girls, and (b) can be avoided by abstaining from sex (or, at least, unprotected sex).

Moreover, the lack of a government mandate would not mean Gardasil was unavailable. It would simply mean that parents, rather than the state, would decide whether the child should be immunized. That is, it would be up to parents to consult their doctors and buy the vaccine for their children if they chose to do so — i.e., to borrow Robert’s point, we would not be encouraging sexual promiscuity by socializing its cost. And while there’s plenty of room for disagreement, a parent might well decide against the vaccine out of a conviction that it would undermine the parent’s encouragement of abstinence from sex. (Personally, I would not consider that a convincing reason to refrain from having my child vaccinated, but I certainly wouldn’t condemn as unreasonable a parent who came out the other way, particularly given the very low probability of infection.) 

I often joke that my mom only sent me to law school to learn how the enemy thinks. But the point of the joke is serious: the conventional wisdom that society needs to defer to legal experts whenever there is some public policy question that touches on the law is wrong and degrades our freedom. The same applies to public policy questions that involve medicine. Dr. Miller’s expert opinion on the safety of Gardasil is clarifying and welcome. But his medical degree doesn’t make him any more of an authoritative voice on the question of parental rights and the proper role of government than my law degree makes me.

I emphatically agree with Kevin’s argument that we shouldn’t much care about the views of politicians on scientific matters about which they lack competence. But, just as emphatically, I think Dr. Miller is all wet when he suggests that politicians should “keep quiet” whenever science intrudes on some public issue. A great deal of litigation involves issues of science, technology and medicine. We don’t farm the cases out to expert panels. We have the experts come testify and subject themselves to cross-examination. This provides the necessary instruction for lay people on the jury to grasp the matters that are outside their ken. But it’s the jurors — the representatives of the community — who decide the case. The same thing is true of legislation: the experts come testify, and they are liberally consulted by lawmakers, but it is Congress that writes and votes on the laws. (That is why Rep. John Conyers became a laughing stock when he mocked the suggestion that a congressman should actually read the bills rather than delegate that basic task to staff lawyers.)

Gov. Perry’s Gardasil order is not trivial. Voters are entitled to weigh what it says about his small-government credentials, whether he really was chastened when the legislature overrode him, whether he grasps that this is not just a process issue, and what motivated him to do what he did. But neither is this as enormous a matter as Rep. Bachmann is making it out to be. There was, after all, an opt-out. To be sure, this was an upside-down way of doing business: It should have been an opt-in, to reflect that it is parents, not politicians, who are primarily responsible for their children’s healthcare. But an opt-out is not nothing — it’s a little much to argue that parents must be trusted to make important decisions about their children’s healthcare but then imply that they can’t be trusted to inform themselves about an opt-out provision in a public healthcare program.

However one comes out on all this, though, most of the issues that make this episode relevant to an election do not require specialized knowledge to sort out. Rep. Bachmann will obviously be accountable for the assertions she has made, but she shouldn’t have felt the need to “keep quiet” just because she lacks a medical license.

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