Bachmann, Perry and HPV

Let me begin by dispensing with the easiest parts first. Michele Bachmann is an idiot.

“I’m offended for all the little girls and parents that didn’t have a choice,” [Bachmann] said. (Actually, any parent can opt out on a child’s behalf.) She said that girls who were harmed by the vaccine don’t get “a mulligan.” Later, the offended Bachmann ventured deeper into scientific illiteracy, telling Fox News that a woman had approached her after the debate and told her that she had a daughter who had “suffered mental retardation as a result of that vaccine.”

To say that I am extremely skeptical about Bachmann’s story is to be charitable. I do not believe a single word of a story about a child suffering any kind of cognitive deficit following HPV vaccination, which reads as unmitigated bullshit to me. At one point there was concern that a relatively rare neurological condition called Guillain-Barre Syndrome may occur with greater frequency following vaccination with the HPV vaccine Gardasil, but that connection has been investigated and rejected. There is zero evidence to suggest any possible connection between mental retardation and HPV vaccination (or the appropriate use of any other vaccine, for that matter). Bachmann’s demagoguery is social conservatism dressed up with the usual anti-science vaccination hysteria, a combination I find unpalatable in the extreme.

In fact, I don’t imagine the Tea Party’s own Jenny McCarthy would care about this issue at all were it not a way to take aim at an ascendant Rick Perry, who is drawing fire for trying to make HPV vaccination mandatory in Texas. As much as I find Rick Perry wholly unappealing as a politician, and would vote for a shaved ape before I cast a vote for him, on this one issue I think he was trying to do right by the kids in his state in defiance of political expediency. He has my grudging admiration in this isolated case.

That being said, I do not support mandatory HPV vaccination.

My reason why not is relatively simple — I think parents should have the right to make crappy healthcare decisions for their children with minimal government coercion. Parents are allowed to smoke around their kids, to ply them with unhealthy foods, and to allow them hours of unsupervised television viewing. As a matter of course I exhort them to do otherwise when given the chance. But unless a child is being imminently endangered by their parents’ poor decisions, I do not believe the state should intervene.

I support mandatory immunization for almost all other vaccine-preventable illnesses because a refusal to vaccinate one’s child is not merely bad parenting, but bad citizenship. Parents who refuse to vaccinate their kids believe they are obviating risks to their own children that they expect others to assume for theirs, but want to reap the rewards of the resulting herd immunity. When a sufficient quotient of parents in any given community make this choice, a threshold for herd immunity is missed and previously-eradicated illnesses begin to reappear. This happens time and again, as this randomly-selected data point illustrates. Failure to vaccinate against such diseases as measles, pertussis or diphtheria endangers everyone, particularly those who because of age or medical condition cannot be vaccinated themselves. Vaccination for these illnesses should be mandatory.

Failure to vaccinate against HPV has ramifications only for the patient and those who will later have sex with him or her. Sexual activity involves risk, of which infection with HPV is but one. While I believe it is hopelessly naive for socially conservative parents to believe their children will have lifelong monogamy with an equally monogamous partner, adherence to this lifestyle choice will effectively prevent HPV infection. There is little risk of people being inoculated with HPV through no action on their part, so the implications of vaccine refusal are much more circumscribed than they are with regard to most other vaccine-preventable illnesses.

Do I believe it is a very bad decision for parents to eschew vaccinating their kids for HPV, motivated by ideology and unrealistic expectations? You bet. You can rest assured that my children will be vaccinated against it when the time comes, and I strongly advocate for it for all of my patients. Do I further think that social conservatives’ opposition to lowering the risk of sexual activity creates consequences that fall disproportionately on women? I sure do. Believing that increased risk of cancer is an appropriate price to pay for failure to meet a ridiculous standard is horrifying and morally repugnant. However, we live in a country where people are free to make morally repugnant choices all the time, even when the consequences fall on their own children. As much as I would want every parent to vaccinate their children against HPV, I do not believe the state has sufficient justification to force them to do so.

[Update:  And, in typically fashion, Dan Savage goes way, way too far.]