Public health’s mixed messages

Last fall, I read “Raising Elijah” by Sandra Steingraber. This book eloquently describes the scientific evidence on the health risks of many ubiquitous industrial chemicals, particularly for children. She tells the story of scary pollutants in our water, food, and air that are propelled by strong corporate interests and remain un- or under-regulated by a government that is supposed to be protecting us.

Runaway corporations harming people and the environment with no oversight. It’s a story we all know. You can see it with a down-and-out but scrappy heroine (Erin Brokovich), in space (Avatar), or animated (The Lorax). It’s one of those “truths” that many have come to accept as the defining feature of our time. Witness the Occupy Wall Street movement. And in the case of the industries and compounds targeted by Steingraber and many others, it happens to be true.

The story is so ingrained, though, that we find it in places where it doesn’t belong. Take the anti-vaccine movement. Pharmaceutical companies are colluding with government bodies (FDA, CDC) to make money at the expense of children, right? But in this case, the classic tale just doesn’t fit the facts. Vaccines, unlike gas drilling, simply don’t command the kind of profit margins that incentivize massive corporate lobbying. (Their low cost is part of the reason public health is so in love with them.) Instead, it is the failure to vaccinate children that is harming the most people where this debate rages. Think of the thousands of infants who were sickened and 10 who died in California during 2010 due to the PREVENTABLE illness, pertussis (whooping cough). Now, I know there’s a lot more that could and has been said about this debate. It’s my not purpose to lay out the cost/benefit analysis for childhood vaccinations here.

My point is that we, in public health, are sending extremely mixed messages. When the topic is BPA in plasticware, we say, “Advocate for removal now! The government’s not protecting you!” But when asked about vaccines, our response is essentially, “Don’t worry about it. The risks are small. Trust us. For the good of society, do what we say.” And this inconsistency is fundamentally problematic. Why should the public believe us? How should an individual decide when advocacy is warranted and when it’s not? When the scientific and administrative authorities can be trusted and when they should be challenged?

The world is a confusing place for an informed consumer. Take the simple act of trying to eat or feed your child. Eating heavily processed foods isn’t good for us, nutritionists tell us. Evidence (and publicity) is accumulating to support the role of probiotic organisms in human health. Yogurt and other cultured dairy products are living foods that seem to support a healthy body flora. Unpasteurized milk, too, is a living food. But the simple fact is that consuming unpasteurized milk greatly increases your risk of contracting a severe foodborne illness.

In short, I can sympathize with the vast majority of vaccine deniers. They are using a shortcut to decide what is most likely to cause harm based on their experience with government and science. I took this same type of shortcut when I avoided YoBaby yogurt. It’s a mass-marketed food product for children. It probably has a ton of sugar, right? (Actually, it doesn’t I discovered.) The government isn’t protecting us from BPA, a vaccine denier might reason, so why should I believe they are protecting us from thimerosal? The link between BPA and endocrine disruption has not yet been rigorously proven (though science is getting there on this one), but toxicologists tell me to avoid it. So, too, the link between MMR and autism is tenuous (completely false I think we can now safely say), but shouldn’t I also avoid that? As science journalist, Seth Mnookin, pointed out this week at the International Conference for Emerging Infectious Diseases in Atlanta, most vaccine deniers are parents trying to protect their children. Although parents who elect not to vaccinate may be getting the true risks wrong by using the “government’s-not-protecting-me” shortcut, in a complicated world it’s easy to see why they do.