Some Unintended Consequences of Good Intentions - Quareness 89th "Lecture".
Back during 2005 the United Nations Educational Scientific Cultural Organisation (UNESCO) drafted the Universal Declaration on Bioethics and Human Rights...a foundational document that establishes informed consent as the international human rights standard and points out that
- because human beings have a unique capacity to give expression to ethical principles...
- because of rapid developments in science and technology...
- because we should respect human dignity and observe human rights and fundamental freedoms...
- because health is not just about science and technology...
- because ethical issues in medicine can affect all of us (individuals, families, communities, all of mankind)...
- because innovation cannot be invoked at the expense of our rights and freedoms...
- because a person's identity is comprised of many significant, valuable dimensions (including social, cultural, psychological and spiritual components)...
any preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information, and furthermore the consent should, where appropriate, be express and may be withdrawn by the person concerned at any time and for any reason without disadvantage or prejudice.
And we sure do seem to need an ongoing and widespread awareness of this in our current era of inclination to force conformity in so many matters. Take for example the rather contentious issue of "compulsory" vaccination programs in the developed world...
The invention of vaccination in the 18th century appears to have precluded us from gaining a real understanding of naturally acquired immunity to diseases. In the absence of that "shortcut" we might have developed a more truly effective and safe method of disease prevention. The "science" of immunology is mainly concerned with the immune system's response to injected foreign matter. It does not apparently seek to understand the immunity which can follow on recovery from natural diseases and because most if not all immunologic experiments are essentially rather unrealistic simulations of the natural process, the knowledge thus gained tends to be limited to understanding only these experimental models. Despite this, most of our current medical establishment leans towards insisting upon artificial manipulation of the immune response in order to "secure immunity" without us going through the natural infection process.
Immunologic memory (which the current dogma seems to persist in equating with natural immunity) is defined as the ability of the immune system to generate faster and more robust antibody production against a previously injected antigen (a biomolecule or particle of non-self origin) after this antigen is encountered again. To induce antibody production in the first instance, a protein antigen needs to be mixed with an adjuvant (= a cytotoxic substance such as aluminum) before being injected into the recipients. And to generate a boost in antibody production, the recipients need to receive a second injection of the same protein antigen with or without the adjuvant. In effect the primary response to protein antigens is slow, weak and adjuvant-dependent whereas the secondary/tertiary responses (boosters) are faster, greater in magnitude and adjuvant-independent. It's this difference between the primary and secondary immune responses that forms the concept of immunologic memory which, however, is not actually applicable to real pathogens.
Pathogen components (with the exception of some bacterial toxins) are not capable of inducing the disease of the corresponding pathogen. When we are assured that e.g. the HepB vaccine is very safe, all this means is that there is a zero chance of this vaccine causing hepatitis B. And this of course is true because it contains only those components grown in yeast cells rather than the whole virus. The potential risks associated with alum-containing vaccines (including the HepB and Gardasil) are of a different nature from those of live attenuated viral vaccines (such as OPV - oral polio virus vaccine). The former may pose a risk of sensitisation (= a silent process with no immediately observable symptoms) and a booster vaccination in susceptible individuals might also precipitate an allergic or even autoimmune reaction with life-long consequences. Susceptibility to serious vaccine injuries might be genetic or metabolic but scientific studies (with a view to predicting such susceptibility and preventing future vaccine injuries) tend not to be funded...a situation likely set to continue for as long as vaccines are proclaimed to be safer than natural infections.
Vaccines made with live attenuated or inactivated viruses, such as MMR (measles/mumps/rubella), Varicella (chickenpox), Rotavirus, OPV / IPV (oral polio virus / inactivated polio virus) and Flu shots do not contain alum because viruses are complex particles that do not need any added adjuvant to induce antibody production. Unlike alum-containing vaccines, these attenuated or inactivated viral vaccines induce antibody production against the corresponding wild viruses. However, over time the vaccine-induced neutralising antibodies disappear and protection against the disease wanes. Indeed the so-called “vaccine-preventable” viral diseases can occur as early as 2-5 years after vaccination in some individuals.
It's now clear that vaccines do not provide lifetime protection for most of us...they simply postpone susceptibility to the corresponding diseases e.g. children vaccinated against chickenpox become vulnerable to it again once the vaccine’s protective effect expires. The problem though is that by that time they might be adolescents or adults, when chickenpox is much more difficult to bear. Other mild childhood illnesses too can be more serious if pushed into adulthood e.g. mumps is potentially dangerous for males after puberty given its power to induce sterility, while rubella can pose quite a danger for pregnant women due to its potential to cause birth defects in the developing fetus.
The immune system of infants is immature and not yet capable of effectively dealing with viruses, whether natural or artificial. Mothers who've had viral diseases during their own childhood and are thereby naturally immune, protect their babies from those diseases by passive transfer of their immunity via the placenta during pregnancy and via breast milk after birth. When exposed to the virus after weaning, such children would experience the infection and acquire life-long immunity themselves, and perhaps in turn help to protect their own babies in due course.
Before the introduction of routine childhood vaccination, many of the viral diseases occurred mainly in children. The younger infants were protected by maternal immunity and adults were protected by their own life-long immunity acquired in childhood. The use of vaccines changed this pattern with vaccinated mothers having lower levels of virus specific antibodies in the serum and transferring fewer protective antibodies to the baby than naturally immune mothers.
Acquiring measles in infancy is a risk factor for developing a fatal infection of the brain called subacute sclerosing panencephalitis (SSPE) and the frequency of SSPE in the USA was much higher in the early 1990s compared to the 1960-70s, an outcome quite possibly (likely?) due to the lack of sufficient maternal immuno-protection. And this lack can perhaps in turn be attributed to the vaccination of mothers in their childhood (routine childhood vaccination against measles had started in US during early 1960s). On the face of it, vaccination would seem to have taken away the chance of many mothers-to-be to experience measles at a safe age and thereby acquire the natural immunity that would serve to protect their babies as well.
It's quite true that live attenuated viral vaccines reduce the overall incidence of the corresponding viral diseases by making our bodies off-limits to wild viruses for some time after vaccination. Viruses are molecular parasites that cannot survive without access to the host and by limiting the number of susceptible human hosts, vaccines can help to overcome viruses. However, the underlying problem here is that of preventing the majority of the human population from developing natural immunity without achieving complete eradication by the time another generation of babies without natural maternal immunity is born. In well nourished societies of the not-so-distant past, the likes of measles and mumps and rubella were mild childhood diseases. But it seems nowadays they have become dangerous diseases to be dreaded because we have made them so.
Disrupting the natural cycle of the mother-infant immunity transfer now looks like an unintended consequence of prolonged vaccination campaigns. The risk of contracting the formerly "childhood diseases" has been pushed from childhood into adulthood, while vulnerable infants are left without effective protection. The paradox here is that the cost of success of some vaccination programs in reducing the overall incidence of childhood diseases, may be to make them potentially more dangerous both for our adults and for the next generation of babies.
When pre-existing antibodies bind to a protein, they cause the immune system to develop more antibodies to that protein...a boosting of the immune response. When pre-existing antibodies bind to a complex particle (e.g. a virion or bacterium) they act differently:..preventing unnecessary spikes in antibody production after sufficient levels have been reached. However, when pre-existing antibodies cross-react with but do not perfectly match the pathogen (resulting in their low binding capacity to the pathogen) this allows those antibodies to suppress the protective immune response, and because of their low affinity prevents them from clearing the pathogen. And because of the rapid evolution of viral influenza strains, pre-existing antibodies against flu viruses have the potential to create the conditions for a severe flu disease by inducing this state of "freezing our immune system".
Taking a flu shot might do something for seasonal flu prevention but it might also help create conditions in the immune system that can turn the next flu into a deadly disease.
We generally seem to have an inordinate fear of the acute symptoms of viral diseases...aches, cough, fever, rash, swollen lymph nodes, etc. Yet for most of us these are transient uncomfortable manifestations rather than posing any risk of deadly or permanent damage. Indeed viral diseases appear capable of causing deadly complications only in infants deprived of maternal immunity and in individuals who are severely malnourished or immuno-suppressed. On the other hand, invasive bacterial diseases (such as pneumonia or meningitis) can pose a serious problem for a much greater spread of the population but our vaccines cover only a small fraction of the great biodiversity of bacterial strains. And when vaccine-targeted strains are eliminated, other bacterial strains tend to take over. In relying on using vaccines against bacteria we might be winning battles but losing the war.
Conventional dogma blames micro-organisms for causing disease and sees using more and more exterminator vaccines as the "cure". But it's clear that micro-organisms are very adaptable and can rapidly evolve, which points to a more promising solution...by acting on the realisation that such will cause us problems only when we create conditions that allow them to do so.
One of the conditions that makes some bacteria dangerous for us is oxidative stress (= a state where the cellular damage done by free radicals exceeds the cellular capacity to repair) which seriously compromises our immune system's ability to eliminate potentially dangerous bacteria and pre-empt more invasive infections. Our immune cells can avoid this stressed state when they are replete with an antioxidant called glutathione (made in the body through the necessary precursor in our diet), the function of which is to reverse the damage done by free radicals and to return cells to their healthy functional state. When our supply of glutathione is sufficient, we do not incur oxidative cell damage and thus avoid creating conditions in the body for invasive bacterial diseases. For this purpose an overall nutrient-rich diet is vital to enable adequate production by the immune system of antimicrobial peptides with vitamins A and D (from such as butter, cod liver oil, liver, sunshine) being crucial elements therein. The stark choice facing us in all of this may be whether we continue to fight our never-ending war with germs and viruses using vaccines while potentially incurring collateral damage in the form of vaccine injuries or allergies and decimation of our natural immunity, or we simply keep our bodies in a well-nourished and glutathione-balanced state that prevents germs from becoming a danger in the first place.
A widely used "scare tactic" deployed against those who may not be enthusiastically pro-vaccination is the alleged compromising of herd immunity. Doubting parents, for example, are to "be persuaded" that unvaccinated children are parasitic on the herd immunity established by vaccinated children and thereby endanger everyone else...a tactic encouraging an unwarranted source of strife between families with opposing views on vaccination. However, this temporary herd "immunity" is known to exist only when the proportion of individuals who are not susceptible to the virus is above 68%. Because live attenuated viral vaccines are typically given only during early childhood and their protective effect against viral infections expires before adolescence, only vaccinated pre-adolescent children in the main are resistant to viral infections. The rest of the population can gradually become more and more susceptible, except for those who have had natural infection and thus acquired lifetime immunity. The way less than 68% of the whole population who at any one time are effectively vaccinated cannot maintain herd immunity for the rest.
The apparent extreme rarity of major viral epidemics in the developed world is now mostly (entirely?) due to the absence of endemic viral exposure, not herd immunity. Sporadic outbreaks (e.g. on university campuses) may occur due say to a virus brought in from abroad, but such are not deterred at all by those routine early childhood vaccinations where the protective effect will be over well before the recipients reach college age. Herd immunity is non-existent once eradication of an endemic virus is naturally achieved...and further sporadic outbreaks introduced from outside cannot be prevented even when there's up to 96% of childhood vaccination compliance.
The simple skills of careful observation and critical thinking can help us to solve not only many health issues but also other kinds of problems. When people began migrating to cities they started losing their rooted traditions and their need for self-sufficiency...and we now appear to have large proportions of our populations trained to dependency with a lack of confidence in their own native wisdom and needing constant reassurance from authority figures. In reality, though, we have to deal with things the way they are and not the way we wish they were...and for this we need some sense of being in control at the personal level.
Everyone who falls ill has to heal individually...there are no established protocols to cure diseases. Each needs an individualised diagnosis and treatment with a focus on the vital forces of the patient...we have great potential for self-healing where the patient becomes the main agent directly involved in the healing process with the therapist being a facilitator and ally. Every disease is a process of adaptation...an alarm that tells us we need a process of change to improve aspects of our life and avoid falling ill again. And where large numbers of people could be subjected to monopoly and mystifying in the treatment of diseases, it may be the better part of healthy wisdom to oppose any such usurping of consciences.
Despite the potential for tyrannical domination and/or stubborn obstructionism, I like to think that most if not all shades of "expert" and "lay" opinion on these matters are formed from a base of genuine good intentions. The overall point I'm trying to emphasise is the vital importance of looking beyond the immediate "either this or that" short term scenario when it comes to dealing with individual and societal concerns whether relating to health or otherwise. The potential downside of attempts to perhaps excessively reduce atmospheric CO2 levels in order to counteract global warming come to mind here (see my 4th Quareness "Lecture" - https://focalireland.tripod.com/
quareness/global-warming-an-evolutionary view.html)...another example of a possible unintended consequence of good intentions.
In my opinion it's crucial for the true wellbeing of each and every one of us that our autonomy in deciding matters of the health care of ourselves, and those we're personally responsible for as parents or guardians, be fully and always respected. Not to do so would amount to denial of a fundamental human right.
Sean.
Dean of Quareness.
April, 2018.
PS: Despite quite a large degree of overlapping in many cases, we do need a clear appreciation of the distinction between human and civil rights, with the former always to be afforded priority over the latter.