The Asheville Citizen-Times reported today that “kindergartners with religious vaccine exemptions jumped to 4.22 percent in Buncombe County during the current school year — five times the state average and well above rates in surrounding counties.” It would be easy to start ranting about Bible Belt mountain folk, how they reject science and put the health of their children and the community at risk. But they are not alone by any means. According to the CDC, the rate of non-medical exemption from kindergarten vaccination in 2011-2012 was 4% or higher in eight states: Alaska, Idaho, Illinois, Michigan, Oregon, Vermont, Washington and Wisconsin. These figures combine “religious” reasons with “philosophic” reasons — some states allow exemptions for one reason but not the other. North Carolina, for example, allows religious but not philosophic exemptions.
By contrast, the states with the lowest rates (0.6% or less) of non-medical exemptions from mandatory vaccination were Alabama, Delaware, Kentucky, Louisiana, Maryland, New York, Tennessee, Mississippi and West Virginia (the last two states do not allow religious or philosophical objections to vaccination). It is interesting to note that these groups of states cannot be divided neatly into any red-state vs blue-state, rich vs poor, urban vs rural, or religious vs secular dichotomy.
John M. Snyder, a Tufts University pediatrics professor and a practicing pediatrician in Massachusetts, offers a clue to this “I know nothing but I know best” stance in his recent contribution to the blog Science-Based Medicine. Snyder notes that, while he sees “the children of farmers, mechanics, refugees, and university professors” in his practice, those parents who challenge the recommended vaccination schedule “tend to be highly educated, economically privileged, and part of the cultural trend [of] self-empowerment and the questioning of authority.” You may judge for yourself how well that description fits the disparate populations of Alaska, Michigan, Oregon, Vermont and Asheville.
But I uncovered another correlation. I visited the website of the so-called American Association of Naturopathic Physicians (whoever they are and whatever they claim to be) and counted the number of natural medicine practices listed on that site, for each of the states mentioned above. I then divided the number of naturopathic practices in each state by the population of the state to find the number of such practices per million residents. Finally, I grouped the results according to the highest and lowest rates of non-medical vaccination exemptions among the states:
Presented this way, it is clear that the states with more non-medical exemptions for childhood vaccinations tend to have greater numbers of “natural medicine” practitioners. Coincidence? Maybe. It may be that the people who reject the science of vaccination move to states where natural medicine is in vogue. It also may be that practitioners of natural medicine go wherever the best marks and markets for their non-science reside. But it is hard to ignore that, of the few similarities between Alaska and Illinois, one is the child vaccination exemption rate and another is the prevalence of naturopathic practice.
The online version of the Asheville Yellow Pages has no fewer than 81 entries under the heading of “Homeopathic Doctors” (an oxymoron to be sure, but that’s Asheville for you). This is a rate of 33o listings per million residents of Buncombe County, almost ten times greater than the per-capita number of naturopathic practices in Alaska. Small wonder then that there are so many vaccination scofflaws in this little town I live in.
Some people question authority without having the authority of knowledge themselves. Their thinking goes something like, “Doctors don’t know everything, therefore I will rely on my own fragmentary bits of information.” The extent to which people can defend their own ignorance, even as they acknowledge it and present it as a sign of intelligence*, is at the same time fascinating and depressing.
I say, feel free to swallow all the fish-oil capsules you want, and order all the lab tests that you think will guide you to physical and mental harmony, but please, for my sake and your neighbor’s sake as well as your children’s sake, let your children be vaccinated. Set aside your suspicions. Resist the temptation to cherry-pick stories that confirm your own bias. Embrace the fact that you are smart but do not necessarily know better than your doctor.
I leave the parting shot (if you will) to pediatric nurse practitioner Sue Ellen Collins: “There are many serious things parents have to make decisions about regarding their children’s welfare. Whether to vaccinate them is not one of them. It’s a no-brainer. Protect them, vaccinate them.”
* Amy Carson of the group “Moms Against Mercury” told the Citizen-Times: “You have to remember, Asheville is a very health-minded city… I think that people are getting smarter because they are researching and they are asking questions and they are not getting the answers they are looking for, so they’re getting scared.”
I suggest that the Moms Against Mercury would be more informed and less scared if they were to read the abstract of this 2011 article published in Annals of Pharmacotherapy: “In 1998, Dr. Andrew Wakefield, a British gastroenterologist, described a new autism phenotype called the regressive autism-enterocolitis syndrome triggered by environmental factors such as measles, mumps, and rubella (MMR) vaccination. The speculative vaccination-autism connection decreased parental confidence in public health vaccination programs and created a public health crisis in England and questions about vaccine safety in North America. After 10 years of controversy and investigation, Dr. Wakefield was found guilty of ethical, medical, and scientific misconduct in the publication of the autism paper. Additional studies showed that the data presented were fraudulent. The alleged autism-vaccine connection is, perhaps, the most damaging medical hoax of the last 100 years.”