Post Date: 09/19/2015

Republicans: A Public Health Hazard?

In the Republican Presidential Candidates' debate on September 16, 2015, Donald Trump raised the specter of vaccines causing autism. He told of a child who received an immunization, got a fever and then became autistic. We have no idea where he got this story. This sort of claim has been exhaustively investigated. To summarize years of careful studies: there is no link between childhood immunizations and what we now call the autism spectrum. A 1998 paper by Dr. Andrew Wakefield in the British medical journal, The Lancet, that linked autism to the MMR (Measles, Mumps, Rubella) vaccine, has been withdrawn. Dr. Wakefield was found to have had financial conflicts of interest and to have used dishonest methodology to arrive at his conclusions. This has not stopped lots of people from declining immunizations for their children and, as a result, several mini epidemics of preventable infectious diseases have occurred. The most recent was a measles outbreak starting at Disneyland in California. The outbreak ran from December, 2014 to April, 2015 and sickened about fifty people. Contrary to another of Donald Trump's general assertions, epidemiologists have shown that the virus did not come from Mexico but from the Philippines.

On the platform with Mr. Trump when he made his remarks were two physicians, Drs Ben Carson, a neurosurgeon and Rand Paul, an ophthalmologist. Both noted that vaccines were beneficial but Dr. Carson said that he thought that maybe they were given too close together. Dr. Paul, true to his Libertarian philosophy, said he thought that parental freedom to make decisions for their children was very important. Both, in short, did not give an unequivocal, medically sound defense of the value of childhood immunizations to the overall health of the nation's children. Either could have pointed out that the schedules of childhood immunizations have been very carefully worked out over decades to give maximum protection as soon as possible to a young population that is at risk for infectious diseases. Whether or not a child is vaccinated for anything, the autism spectrum of behavioral disorders also starts to appear at about the same age that some of the vaccines are being administered. The temptation to link them is obvious. We humans seek and often see patterns, whether they are real or not, in what we see and hear. But correlation is not causation as every scientist knows.

And, to point out a serious flaw in Dr. Paul's ideology: letting parents decide "what is best for their own children," lets them make dangerous mistakes because of their own ignorance. Because vaccines have been so successful at eliminating childhood diseases, most parents have never seen a case of measles, mumps, or rubella. They are not afraid of any of these diseases. Most of them have also never seen a medically serious reaction to a vaccine. They may have heard of a case such as the case mentioned by Donald Trump or in a past campaign by Michelle Bachman, but they have not investigated its veracity and they draw faulty conclusions about what is best for their own child. If enough of them withdraw their children from immunization programs, then their children threaten the health of the entire community because a large group of unimmunized individuals makes it easier to start an epidemic. Sometimes one does have to think of the "general welfare" as pointed out in the preamble to the US Constitution. There is also a significant minority of parents who decline vaccinations for their children because they are asserting their ideas of their own liberty. This is dangerously stupid both for their children and the community.

The Republicans are also attacking Planned Parenthood. The general objection is that Planned Parenthood provides abortion services. This is true. Three percent of their medical activities are abortions. None of these are paid for by the federal government and have not been since the Hyde Amendment was passed in 1976. Planned Parenthood has already been "defunded." However, it has recently been revealed, through a series of heavily edited and intentionally misleading videos, that Planned Parenthood sometimes provides fetal parts from abortions to researchers and charges a fee for this service. This is a very common practice in University Medical Schools all around the country. Researchers with approved research protocols (often funded by the National Institutes of Health) obtain various fetal tissues from abortions in order to study both normal and diseased fetal development. In the case of Planned Parenthood, this practice has been misrepresented by candidates Mike Huckabee as doing abortions for profit and Carly Fiorina as killing living babies in order to harvest their parts.

I practiced pathology for over thirty years and have seen countless "products of conception" from abortions done for many, many reasons. I have donated fetal tissues to researchers. California has a very liberal abortion law, signed by Governor Ronald Reagan by the way, so abortions could be done because of a diseased fetus, to save the life of a mother whose life was threatened by toxemia of pregnancy, and because a mother just did not want to be pregnant at that time. A substantial fraction of abortions in the USA are done on women who already have children and do not want another at the time they find themselves pregnant. Planned Parenthood, and organizations like it, help them in these situations. They then provide them with contraceptive methods to prevent a reoccurrence. Contraception is the best technique for preventing abortions. Planned Parenthood also provides regular gynecologic care and women's health services in general, the majority of their health care activities. This is what the Federal Government currently funds. Parenthetically I would point out that abortions as currently practiced are safer for the mother than normal pregnancy and delivery. And, it is also clearly established that having large numbers of unwanted children, particularly born to poor parents, or single mothers, condemns these children to lives of ignorance and poverty, so the cycle will continue.

Unfortunately many Republican politicians attack Planned Parenthood to pander to the prejudices of a significant portion of their "base." These folks largely have religious objections to abortion, some even to contraception. Former Senator Rick Santorum is one of these. But by making a religious objection to a woman's right to control her own reproductive life, one is really proposing to use the Federal Government to enforce on all Americans the religious views of only one segment of America. If successful, that would make us a theocracy in the mold of Iran and Saudi Arabia. If a person has religious objections to contraception and abortion, then they should not practice contraception and should not have abortions. What they must not do, in a free society, is attempt to use Government power to force their religious beliefs on others. None of the Republican Presidential Candidates made this point. And let me ask this question. If, by doing research on fetal tissues, medical scientists come to understand and find the cure for a disease that currently causes suffering and death, and you prevent that research, what is your personal responsibility for the future suffering and death that could have been prevented by that research?

Then, of course, there are guns. All of the Republican Candidates act as if they are afraid of the NRA. So, we will continue to have 30,000 or more gun deaths per year in this country. This is a public health problem. The Second Amendment to the Constitution says: "A well-regulated Militia being necessary to the security of a free State, the right of the people to keep and bear Arms shall not be infringed." Regulation is the very first clause in this amendment. We have neglected this and are paying a clearly avoidable price in the health and welfare of the public.

Infectious diseases, women's health services, and guns are all serious public health problems. The Republican base and most of its elected politicians are on the wrong side of all of these issues both medically and philosophically. The future can be made better than the past through intelligent leadership. Who among the Republican Presidential Candidates will rise up to lead their voting base from darkness to light?
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