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Dr. Robert Klitzman: Piercing Your Armor

Grace Bello talks to Columbia University bioethics professor Dr. Robert Klitzman about the anti-vaccination movement in the U.S. and its potent mix of misinformation, partisan politics, and fear.

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Image by John Vachon via The Library of Congress.

Although the U.S. had eradicated measles in 2000, a growing movement against vaccinations has caused the disease to return. Most notably, pestilence struck Disneyland where exposure to the sickness resulted in 42 cases of measles within California and over 120 nationwide. “In the US, the CDC typically expects only 220 cases,” The Guardian reported. “Last year there were 644, a nearly two-decade high.”

Though the affliction is easily preventable, it’s also deadly. In 1988, children’s author Roald Dahl wrote about losing his daughter Olivia from complications due to measles: “I noticed that her fingers and her mind were not working together and she couldn’t do anything,” he wrote. “’Are you feeling all right?’ I asked her. ‘I feel all sleepy,’ she said. In an hour, she was unconscious. In twelve hours, she was dead.”

Parents might choose not to immunize their children due to religious exemptions—or due to more broad “personal belief” exemptions. While some on the right resent the legislation of this preventative measure, others across the political spectrum simply fear the shot, think that they are unlikely to encounter the disease, or, most likely, falsely believe that vaccinations cause autism.

I spoke with Dr. Robert Klitzman, director of the Masters in Bioethics program at Columbia University and author of The Ethics Police?: The Struggle to Make Human Research Safe, about the political, historical, and psychological underpinnings of the anti-vaxx movement.

Grace Bello for Guernica

Guernica: What are the contours of this public health panic versus others? Can you think of other public health scares that are comparable to this or that contrast this?

Dr. Robert Klitzman: There’s a natural human instinct to want to have a zone of safety around oneself, to want to distance oneself from danger and to stigmatize people whom you feel are dangerous. Yet that instinct doesn’t always map onto the fact of the situation. Unfortunately, it means putting up a resistance to things that are not dangerous and, at times, it means not putting up resistance to things that are dangerous.

People are not getting vaccinated, but they’re afraid of Ebola.

The comparison with Ebola is interesting. People overreacted to Ebola saying, “Let’s lock them up”—but they didn’t want to do anything themselves to protect themselves. So people are not getting vaccinated, but they’re afraid of Ebola.

There are similar issues that have come up in other epidemics: How do we negotiate the fact that one could potentially infect others? How much do we intercede? I discussed some of these issues regarding HIV in my book Mortal Secrets: Truth and Lies in the Age of AIDS. Should we force people to tell their partners that they are HIV-infected? Should we force people to have safe sex if they are HIV-infected?

Guernica: Let’s look at this in terms of policy. Sen. Rand Paul, who is a doctor, has stated that vaccinations should be a matter of personal choice. Gov. Chris Christie alluded to this opinion as well.

Dr. Robert Klitzman: I would say that it’s not just a matter of personal choice because your personal choice is going to affect other people. Ironically, of course, Christie is the one who locked up the person who had returned from an Ebola area. So in that case, he took away personal choice. When it’s a matter of you endangering other people, I think that society generally has said that we need to not leave it up to your personal choice.

Senator Paul, with all respect, is no longer a practicing physician; he’s a politician.

Guernica: Well, what do you think about Rand Paul in particular? He has medical training, so he has unique authority when he’s speaking about this particular intersection of politics and medicine.

Dr. Robert Klitzman: I would hope that we train physicians to value public health and to value not putting other people in danger. I would say also that Sen. Paul, with all respect, is no longer a practicing physician; he’s a politician. And he’s a politician who’s possibly interested in running for president. So it’s not clear to me that his medical judgement is what’s most guiding his opinions on this matter.

It’s similar to when Sen. Frist spoke about Terri Schiavo. He got on the floor of the Senate and said, “I know, as a physician, that she’s functioning mentally!” But he had never examined her. It turned out, in an autopsy, that she was by no means cognitively intact. Unfortunately, sometimes physicians sometimes end up saying things that reflect their ideology more than scientific fact or public health prudence.

Guernica: In your opinion, what’s the deeper philosophy that lies at the heart of refusing vaccination? Why is a significant segment of the American population less afraid of the disease than the inoculation?

It’s not a class issue; it’s not that the poor or the rich are more likely to get measles.

Dr. Robert Klitzman: Measles has not been a problem in the United States in recent decades because everyone had gotten vaccinated. So with this outbreak at Disneyland and the few other outbreaks: “We don’t see it, so it’s not a big problem.” We did the same thing with AIDS. It was only when we saw that AIDS was affecting the gay community very heavily that people became very aware of it. It’s a case of out of sight, out of mind.

You also have people refusing vaccinations for different reasons. It’s not a class issue; it’s not that the poor or the rich are more likely to get measles. There are conservative people—and that’s what Rand Paul is speaking to—”the government is telling me to do this, and if the government is bad, therefore, this practice is bad.” But there are people in California who are on the left who feel they don’t want to do this. I just don’t understand that, why they don’t see the scientific merits of this public health issue. I’ve also discussed [in The Huffington Post] that the paper that initially suggested a link between vaccinations and autism—the data in that paper had all been falsified.

With the measles vaccine, if it were a pill that one took rather than a shot, I think that people wouldn’t be as against it. The shot is a little more invasive. It’s literally breaking down your bodily defenses. Your skin is your protection against the world, it’s your armor. It’s piercing your armor. And that, I think, is something that people find viscerally upsetting.

Fear drives a lot of decisions. In this case, some is undue fear of autism and some is fear of government. That’s a lethal combination.

Grace Bello is a writer based in Queens, NY. Her articles have appeared in The Atlantic, NBCNews.com, the New York Daily News, and elsewhere. Her fiction has appeared in McSweeney’s and The Morning News.

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