Wednesday, December 15, 2010

Science and/or Religion: The Necessity of Metaphysics in Forging a Compatible Worldview

The Meteorite
Among the hills a meteorite
Lies huge; and moss has overgrown,
And wind and rain with touches light
Made soft, the contours of the stone.

Thus easily can Earth digest
A cinder of sidereal fire,
And make her
translunary guest
The native of an English shire.

Nor is it strange these wanderers
Find in her lap their fitting place,
For every particle that's hers
Came at the first from outer space.

All that is Earth has once been sky;
Down from the sun of old she came,
Or from some star that travelled by
Too close to his entangling flame.

Hence, if belated drops yet fall
From heaven, on these her plastic power
Still works as once it worked on all
The glad rush of the golden shower.
-C. S. Lewis, Miracles


Introduction

As a pluralistic society, America is populated with great cohorts of both religious and non-religious people of all types. America has the highest rate of religiosity in the developed world; however, recent polls show that the majority of Americans know very little about religion, not enough to be considered “literate” by the lowest standards. Several books have recently been published which aim to educate the American populace about this very important aspects of human experience (e.g. Religious Literacy: what every American needs to know and doesn’t, by Stephen Prothero). When we examine America’s literacy in the sciences, we find startlingly similar low rates of basic knowledge. Add to this abundance of ignorance a plethora of pseudoscience campaigns which offer a “bridge” between religion and science, such as those by Answers in Genesis and the Discovery Institute, which seek to introduce “Intelligent Design” (I.D.) into high school biology curricula, and intolerance to non-protestant ideas (secular and religious) which continue to flourish in our society, and the result is a lot of angry rhetoric, and even more confusion. In Science Matters: Achieving Scientific Literacy, the authors Robert Hazen and James Trefil define scientific literacy in this way:


If you can understand the news of the day as it relates to science,
if you can take articles with headlines about stem cell research and the
greenhouse effect and put them in a meaningful context—in short, if you can
treat news about science in the same way that you treat everything else that
comes over your horizon, then as far as we are concerned you are scientifically
literate (Introduction, pg xii)

While the authors hold that the main culprit behind America’s lack of scientific understanding lies in the faulty educational system, they mostly ignore another very important factor behind this large problem, that of religious “skepticism” of science and its theories. Religious people have a deep mistrust of science, a mistrust that is reciprocated by the scientific community for religion. It is fair to say that nothing less than a chasm separates the two camps in the public view.

Other polls demonstrate that over 50% of those in academia and industry who do science, consider themselves “spiritual,” not necessarily affiliated with any particular religion, but still consider spirituality important. Other distinguished scientists, including Francisco Ayala, Francis Collins, Ian Barbour and Kenneth Miller, are outwardly religious or have defended the ability of religion and science to co-exist without conflict. Ian Barbour has established a vernacular to distinguish the four main approaches to the Science-Religion interaction: Conflict, Independence, Integration, and Dialogue. He distinguishes himself as a proponent of dialogue with hope for integration. The prevalence of atheism and agnosticism is higher among academics, especially among scientists, compared to the general population; however, there remain influential scientists who maintain there is no incompatibility between their personal beliefs and the picture of reality that science paints. The unique perspectives of these men and women force us to re-evaluate our traditional views about the apparent conflict between science and religion.

While every individual must resolve for themselves the conflicts they perceive between their personal beliefs and the facts of science, metaphysics is a useful, and perhaps even a necessary tool in forging a compatible worldview between them. The use of metaphysics in constructing a philosophy which combines science and religion to answer the “big questions,” such as what is the nature of reality, the purpose of life, et cetera, can bring one closer to the dialogue position, if not to integration itself (Hefner, 2007).

Metaphysics

The word metaphysics comes from the Greek for “beyond the physical” (meta = beyond, physic = physical). In philosophy, metaphysics began as an attempt to answer absolute questions about reality and the nature of essential forms. What we call “science” began as a branch of natural philosophy, and since its divergence has become a very different enterprise from the mode of dialectic seen in traditional philosophy. However, the roots of its ancestry run deep, and even the most empirical sciences (i.e. Physics, Mathematics, Chemistry) are not free of metaphysical assumptions, and the softer sciences (i.e. Biology, Psychology, Sociology) are rife with them! When it comes to religion, metaphysics has historically been a central theme in the writings of theologians who construct entire cosmogonies based on metaphysical assumptions about the universe, the nature of man, and God.

In science and philosophy, a common approach to problems is found in methodological naturalism. This method assumes that all phenomena are explicable and investigable only in terms of natural laws and evidence, and while careful not to exclude the possibility of the supernatural, remains nonetheless uninterested in its existence and application. This is essentially an agnostic worldview, consistent with the independence position. In reference to this stance, the famed biologist Stephen J. Gould coined the term “Non Overlapping Magisteria” (NOMA) to describe how matters of supernatural (i.e. spiritual) significance are unrelated and totally separate from matters of natural and physical importance (i.e. science, naturalism, etc.).

Moving beyond the realm of simple methodology, we find metaphysical naturalism—a worldview which holds that nothing exists except the material and natural. This view has its roots in the enlightenment and logical positivism, and currently can be observed in the message of new atheism, and to a lesser extent in the humanist movement. This view places supreme importance on scientific inquiry as the only means of gaining knowledge, and is at odds with any system of belief which takes for granted a supernatural being or power operating in the universe, or making contact with man. It is consistent with the conflict position.

In response to this, a separate class of conflict exists for religious people who believe the universe is contained within God, who transcends the natural and has the power to intervene at will in the universe (i.e. miracles), and maintain that any strict materialist explanation of the universe is fundamentally flawed. And so the four positions which began as a spectrum have come full-circle, and can be viewed better as a non-linear continuum with significant overlap between the categories. The practical differences between methodological and metaphysical naturalism are so small that one must ask, “is it possible to be a methodological naturalist without being a metaphysical one also?” A devout believer in supernaturalism would say, “No! Both leave no room for God.” But the scientific believer is forced to offer a solution to this apparent dilemma.

Bridging the Gap

It is apparent from this telling of the relationship between naturalist and supernaturalist metaphysical systems, that anyone who wishes to integrate a belief in God with a scientific worldview which assumes naturalism (either in methodology or in absolute terms) is faced with no small challenge! Three strategies that have been described seeking to accomplish this feet are Natural Theology, Theology of Nature, and Systematic Synthesis. The first of these is the most well known, and has been argued in three different ways; 1) the argument from design, 2) the cosmological argument, and 3) the ontological argument.

In his book Metaphysics, Peter Van Inwagen addresses the first of these arguments under the classification of teleology (teleos = “end” or “purpose” in Greek), implying a purpose and ultimate cause for the existence of the universe and man. He appeals to the strong anthropic principle (SAP), that the 20-something constants of the cosmos are set to arbitrary values which could vary, in theory, to produce multiple “cosmoi,” each with vastly different physical properties. Very few of these resulting cosmoi (less than one in two million) would be hospitable to the formation of heavy atoms and life, and ours incidentally is one of those rare few (pg 172-182). The I.D. movement is another current example of this argument. In brief, the argument from design states that the universe, and living things, have an “appearance” of order, fine tuning, and design which necessitates a designer. This argument has come under attack by scientists who have demonstrated that natural processes, including evolution, are fully capable of producing the order and “appearance of design” which we see in life, and the universe.

The cosmological argument can be summarized as the need for a linear chain of causation for every event in the universe, requiring a primal mover or original cause. Physics portends to supply this original cause with the Big Bang and M Theory. Recent works by experts in the field, such as Stephen Hawking, claim to have solved the problem of original cause by showing that the Big Bang was a natural and spontaneous event, not requiring an outside force to occur. If true, this would render what was once believed to be the “safest” of the three arguments to falsifiability and the realm of scientific inquiry, removing the need for God and any supernatural metaphysical explanation about the origin of the universe.

The last argument, the ontological, states briefly that God is beyond the highest capacity of the human mind to conceive; therefore, in order for us to conceive of him at all, he must exist by necessity. Ontological proofs are often impossible to obtain, except in mathematics, and few have courted the ontological proof since the neoclassical philosophers, all of whom found establishing this proof to be a difficult challenge, and later generations have recognized their arguments as little better than tautologies. The remaining approaches toward integration (Theology of Nature and Systematic Synthesis) are still in their infancy, and not nearly as developed as Natural Theology.

A Different View

The philosopher Michael Ruse’s depiction of Barbour’s four archetypes in his dialogue Evolution and Religion, provides a good overview of the different positions, but falls short of doing each justice. A significant failing is his depiction of the integrationist, Rev. Emily Matthews, as a flaky, new-agey cherry-picker, who uses her philosophical terms a little fast and loose. In this portrayal, it is difficult to see through the “aura” around Emily and discern the true value of her positions, especially in regards to Process Theology as a means of integration (pgs. 46, 65, 88, 101). Developed by Alfred North Whitehead, Process Philosophy was later applied to theology by Charles Hartshorne and John Cobb. This novel approach to the integration problem posits God as being encompassed by nature, a product of natural processes and not vice versa. It requires the sacrifice of the “Omnimax” principle (the omniscience, omnipotence, and omnipresence of God) in order to solve the problem of evil (theodicy), and the changing nature of religion. Process Theology explains that God, as part of nature, uses natural means over which he has influence to do his work in the cosmos.

Another similar approach that does not get the attention it deserves is that of Theistic Evolution, which believes evolution is the mechanism by which God created life here on earth, and by which he could do so in other worlds hospitable to life. This view is espoused by many faithful scientists, such as Ken Miller who believes it is through the medium of small changes (on the quantum scale) that God directs mutation in DNA and adaptation leading to speciation and diversity (pgs. 198-209). The most obvious problem with this view is that it is still essentially a “God of the gaps” argument (i.e. where science fails to explain, insert God and miracles). This also means that if science ever fully explains these phenomena at the quantum level, God will be left with no other natural medium through which to function.

In support of this view, that God works through the medium of nature, theologian Nicola Hoggard Creegan posits a system in which God participates in the act of creation and evolution, and because of his “Trinitarian” nature (hidden, felt, and incarnate) the effects of his participation are obscured behind secondary evolutionary causes; however, they are there and can be discerned by the feelings of awe and wonder associated with a study of nature, and this provides the evidence of God’s love and existence which Christian piety requires (pgs. 499-518). Yet another interesting support of this view comes from the philosopher Lynne Rudder Baker, in her book Metaphysics for Everyday Life. Baker uses the term “Quasi-Naturalism” to describe the way in which people, as products of evolutionary processes, transcend the natural, animal order and become ontologically unique (as theists claim that God is) through the exercise of reason and thought (pgs. 9-12). She explains that Quasi-Naturalism is different than metaphysical naturalism because it leaves the door open for different ways of “knowing” (epistemology) other than scientific endeavors, and remains neutral on the metaphysical claim that nature is all there is to reality. This system remains naturalistic by accepting the established facts of science (11). In this way, she establishes a clear difference between methodology and metaphysical assertions about the universe.

The Altonatural

Returning to terminology, the term “supernatural” is thus shown to be an inappropriate adjective for the God of Theistic Evolution and Process Theology. Perhaps a better term might be altonatural (from the Latin altus for “high” or “exalted”). By bringing God within the realm of the natural, these worldviews do not deny His exalted status; only question the metaphysical nature of that status. If Superman were real and his powers fully comprehensible via scientific methods, that would not diminish the awe and reverence of those who his benevolence protected. Indeed, one would be truly pressed to differentiate between such a God and the God of the Nicene Creed or the Koran while standing in His presence!

In reference to the poem at the beginning of this essay, the famed theologian and author C. S. Lewis writes of a meteor (believed in ancient times to be a tangible sign of God’s power) which falls from heaven and becomes an indistinguishable part of the natural landscape. In his book Miracles, he goes on to argue that it always thus with miracles; when they occur they are inexplicable, but the world keeps going as if nothing special has happened, assimilating the newcomer and leaving no evidence of divine intervention (Introduction, -ii). Thus it is incumbent upon the believer to hold this as evidence for faith, or not—God will not give him/her the “proof” that would make the personal choice to believe un-necessary (293-294).

Climbing Mt. Improbable

As we come to the end of this exposition, the question remains, “Why bother trying to make a compatible worldview? It’s hard; the ideas are abstract and obscure; and what will it profit me?” After all, to truly forge such a view would also require that one be literate in both religion and science (not to mention philosophy), and not only literate but have a deep and abiding understanding of both and where they can meet. It could also be argued that to have such an understanding of either of these important aspects of experience, a detached appreciation may not be sufficient to produce the depth of understanding required—that one must do religion and science, and believe both to understand them. For example, how can a student truly understand the implications of evolutionary theory, if during every lecture and experiment he/she is holding back their scientific “faith?” This, I feel, is a strong incentive to create a compatible worldview.

More and more modern professions, such as medicine, engineering and computer science, require a depth of understanding in the related scientific fields not previously necessary to achieve the task at hand. This is to say nothing of the current global problems that we face, such as vanishing biodiversity, global warming, the threat of nuclear war, and the need for political leaders to understand science. Contrary to the idea proposed by many scientists and politicians during the 20th century—that religion would recede out of the public mind and give way to secular and scientific thought—religion does not seem to be going anywhere. In fact, its modern day influence can hardly be overstated. But if religion continues to oppose itself to science, as if the two are at war, this can only end badly for religion. Either way, a deeper understanding of both is required if the two are to co-exist.

Contemporary writers have described the metaphysical quest to understand the universe with the analogy of “Climbing Mt. Improbable.” The mountain, like Yosemite’s Half Dome, has two faces: one, a smooth, sheer, and impossible cliff that nothing short of a miracle would enable a person to climb; the other, a more gradual slope, difficult to climb, but possible with the right skills and gear. I imagine, with Dr. Miller, that when the science troupe arrives at the summit, they will be greeted by the religious troupe, and be surprised they were not the first to the top. But until that day, our best chance of climbing the mountain for ourselves is to use metaphysics as the rope with which to belay-repel, with science and religion bound together, and let go of the distrust and fear. We will get there sooner, and better, if we do it together.

References

Baker, Lynne Rudder. 2008. The Metaphysics of Everyday Life: An essay in practical realism. Accessed on December 14, 2010 en: http://people.umass.edu/lrb/files/bak08perM.pdf

Creegan, Nicola Hoggard. 2007. A christian theology of evolution and participation. Zygon: Journal of Religion & Science 42 (2) (06): 499-518.

Hefner, Philip. 2007. Science and the big questions. Vol. 42Wiley-Blackwell.

Lewis, C. S. Miracles; a preliminary study. New York, Macmillan Co., 1947

Miller, Kenneth R. Finding Darwin's God : a scientist's search for common ground between God and Evolution. New York : Perennial/HarperCollins, 2002. 1st. Perennial ed.

Ruse, Michael. Evolution and religion: a dialogue. Lanham, Md. : Rowman & Littlefield Publishers, c2008.

Van Inwagen, P. Metaphysics. Boulder, CO: Westview Press. 1993. rev. ed. 2002

Monday, December 6, 2010

Forced to be Free: the Ethics of Mandatory Vaccination

“In order then that the social compact may not be an empty formula, it tacitly includes the undertaking, which alone can give force to the rest, that whoever refuses to obey the general will shall be compelled to do so by the whole body. This means nothing less than that he will be forced to be free…”

-- Rousseau, the Social Contract (italics added)

Introduction

Vaccines are considered a major public health achievement by the overwhelming majority of the scientific, medical, and political communities around the world. The Centers for Disease Control (CDC) in the United States keeps statistics on the number of infectious diseases reported each year. The CDC has determined that the rates of infection for many diseases which formerly plagued Americans, such as smallpox, diphtheria, measles, mumps, polio, rubella, and tetanus have decreased 98-100% since the policy of widespread vaccination against these diseases was declared constitutional by the United States Supreme Court in the 1930s, and adopted in the 1960s. Among this group of eradicated and nearly eradicated diseases are the deadliest and the most contagious pathogens known to man: smallpox and measles.

Smallpox has a mortality rate of up to 90% in virgin populations during outbreaks, such as Native American populations after European contact, and measles is so contagious that during the pre-vaccination era all Americans were infected at least once during their lifetime, and the annual morbidity in the 20thcentury was over 500,000(Roush, 2007). The total number of deaths in America attributed to measles in 2005 was 66, a 99% decrease from the 20th century average. However, measles continues to claim the lives of 345,000 around the world annually in areas such as Africa and south-east Asia where vaccinations are not available (Campos-Outcalt, 2010). Other diseases for which vaccines have been developed include pertusis, hepatitis A, hepatitis B, invasive pneumococcus and varicella. Significant decreases (ranging from 73-84%) in the number of cases of these diseases have also been reported since the beginning of widespread vaccination (Achievements in Public Health: Impact of Vaccines Universally Recommended for Children, 1999).

These diseases, which had previously claimed the lives of millions of Americans during outbreaks, have now been brought within clinically manageable levels. No other public health campaign (improved sanitation or access to clean water, etc.) can account for the observed decrease in infection rates and deaths. However, despite the overwhelming evidence in favor of universal vaccination, a significant percentage of the American population continues to resist a mandate that all receive vaccinations against preventable infectious diseases in order to attend public school, travel internationally, join the military, work in health care, etc. In this paper I will explore some of the reasons for this resistance and attempt to show that mandatory public vaccination has been thoroughly supported as a sound policy by the medical establishment, and is morally acceptable when considered within a modern bioethical framework.

Thimerosal Controversy

The controversy behind mandatory childhood vaccination and the potential link to autism, and other neurodevelopmental diseases (NDDs), has been an area of heated debate since the publication of an article by Dr. Andrew Wakefield in the British peer-reviewed medical journal Lancet in 1998, which first supported this linkage (Wakefield, 1998). The controversy centered on a chemical called thimerosal, a mercury-based organometallic, formerly used as a fungicide and preservative in many vaccines, including the vaccine for mumps, measles, and rubella (MMR). The theory held that repeated vaccinations in childhood amounted to excessive heavy metal (mercury) exposure, the effects of which could be seen clinically in the rise of autistic spectrum disorders (ASDs), multiple sclerosis, and other NDDs. This article was published near the time that a joint investigation by the CDC and the Food and Drug Administration (FDA) had recommended removing methyl-mercury from all consumer products. As a precautionary measure, the CDC required vaccine manufacturers to remove thimerosal, which contains ethyl-mercury (different and significantly less toxic than methyl-mercury), from all vaccinations, except some strains of influenza (FDA, 2010). Although purely a precautionary measure, this was perceived by some in the media, the medical field, and alternative medicine as “evidence” that vaccinations were responsible for the rise in reported cases of autism (Baker, 2008).

This claim was picked up by a group of independent scientists in the United States, Drs. David and Mark Geier, who published several articles in the following decade in attempt to establish a link between heavy-metal exposure, hyperandrogenism (elevated levels of testosterone) and autism. Using this premise, they developed and patented a treatment using the drug Lupron® (a gonadotropin agonist used to treat precocious puberty, and to chemically castrate sex offenders) together with chelation therapy (used to increase excretion of heavy metals in the urine) to treat autism. They offered this “miracle” therapy to the parents of dozens of autistic children, who paid tens of thousands of dollars on average for several weeks of doses high enough to leave their children permanently sterile, but reported marked improvements in the children’s cognition and behavior (Geier et. al., 2006).

The Geiers have also been called as expert witnesses in hundreds of federal court cases seeking damages from vaccinations (Stewart, 2009) through the Vaccine Injury Compensation Program (VICP). However, their work has been thoroughly rebuked by the scientific community as containing serious methodological flaws, and being impossible to interpret or reproduce (Parker et. al., 2004). Also, their testimonies in federal court have been stricken from the records due to their conflict of interest and lack of required expertise in the neurological field (de los Reyes, 2010). Other studies done in the fields of epidemiology and pharmacokinetics which seek to establish a link between vaccination and autism have shown similar discrepancies and been wholly discredited by the scientific community (Parker et. al., 2004). Later, better designed studies, published in journals such as Lancet, employed case-control methods to compare 1294 cases and 4469 controls from populations of the same sex, age, and general practice to establish a link between the MMR vaccine and an increased risk for autism and other NDDs, but found no association (Smeeth et. al., 2004).

In short, no proposed evidence for a link between autism and childhood vaccinations has withstood scientific scrutiny, and earlier this year Dr. Wakefield’s 1998 paper was formally retracted from the Lancet and his medical license was revoked after it was discovered he had fabricated the results of his study and committed other serious acts of academic dishonesty. These are examples of demagogues who preyed upon the distrust and anxiety of the public, in particular the vulnerable parents of autistic children, for personal monetary gain and fame. While a lack of evidence for a link between vaccinations and autism does not necessarily make such a link impossible, it does appear highly improbable. However, the link between vaccinations and improved public health is a fact that has significant evidence, a broad consensus, and a good track record. Given this evidence, one may well ask, “Why does the debate persist?”

Evidence Based Medicine

A strong trend in modern medicine, especially in primary care, is to incorporate the findings of current scientific studies into clinical practice in order to improve patient outcomes and health. However, physicians who seek to implement therapies and practices supported by evidence often encounter resistance among their patients, who do not understand the need for the prescribed therapy, or the science behind it. This disconnect between the physician and the patient can exacerbate the distrust the patient may already harbor for the medical establishment, including insurance companies and pharmaceuticals, which they may consider elitist or having ulterior motives (Slowther et. al., 2004). Alternative practitioners such as chiropractors and naturopaths, however, often recommend more “natural” remedies to their patients, which make more intuitive sense and in which the patient may feel more confident of success. Tapping into this vein of mistrust, some alternative practitioners have begun actively campaigning against childhood vaccination and modern medicine to varying degrees. In response to these campaigns against vaccination, immunization rates have dropped in recent years to 80%, by some estimates (de los Reyes, 2010). In connection with this, the rates of some preventable diseases, including pertusis, have climbed in recent years. It is believed this is a direct result of the anti-vaccination campaigns, and many public health officials worry that an outbreak of a more virulent pathogen, either by natural causes or by the enemies of the United States, may find us unprepared and cause considerable harm (Achievements in Public Health: Control of Infectious Diseases, 1999).

Physicians trained in modern medicine hold the position that to recommend a therapy not based upon scientific evidence, or to recommend forgoing an appropriate therapy based on such evidence is morally irresponsible. On the other hand, alternative practitioners have a broader definition of “evidence” which includes personal experience and intuition. While considering this debate, it is important not to lose sight of the social context in which it exists. Americans in general are a libertarian people. Their fierce defense of personal liberty has presented in the past with the side effects of severe paranoia and distrust of government, academia, and big business. In this context, a physician has a great responsibility to educate and persuade his/her patients, and the public, to follow sound medical advice, and to gain their trust; however, this is not always possible. It is apparent that, to a large percentage of the population, scientific evidence is irrelevant. This begs the question, “If someone does not believe in the efficacy of evidence, how can they be persuaded that they should?”

Ethics of Mandatory Vaccination

It has been said the definition of reality is that it exists whether or not it is believed. In the case of immunization, the jury is in, and has found that, despite what the plaintiffs may say or the public may feel, mandatory vaccination is a good idea. The preponderance of evidence for the benefits of universal vaccination exceeds the needed 51%, and has moved into the realm beyond reasonable doubt. Thus, this is a case where paternalistic action on the part of the government and medical establishment is justified, needed, and morally acceptable. Three systems of moral theory support this claim: utilitarianism, the Rawlsian theory of justice, and virtue ethics.
From a utilitarian perspective, individual autonomy must yield when the good of the many requires it. Dissenters on mandatory vaccination often appeal to the idea of “herd immunity”—that their exempt status will not affect the overall robustness of the population in an adverse way. However, studies have shown that even rates of 5-8% who opt-out of immunization put the entire population at significantly higher risk for outbreaks (de los Reyes, 2010). “Herd immunity” requires that the entire herd, to use that analogy, be immunized. If too many come to feel they are an exception, then, as Rousseau elegantly put it, the program becomes an “empty formula” for protecting the population.

The Rawlsian perspective places great emphasis on the “Liberty principle,” but also requires that one step behind the “veil of ignorance” to determine what is just. By performing this thought experiment in the case of vaccination, one may imagine a scenario in which another person, who chooses not to be vaccinated against a preventable disease, then contracts it, and also passes that disease to one’s self. Since the other person’s use of liberty impinges on the liberty of the self, this is unjust. In order to keep both free of disease, the other must be “forced to be free” (i.e. coerced vaccination), or must be kept away from the self, and all other vulnerable people. Rawls also makes room for differences in liberty and equality (the “difference principle”), as long as those differences benefit the worst off. Universal vaccination, even in spite of some individuals’ personal liberty, would bring needed medical services to vulnerable populations who are more likely to suffer in the case of an outbreak, and thus would benefit them.

Finally, virtue ethics holds that societal roles are imbued with values and responsibilities that are unique and essential to the fulfillment of the role. Important roles to consider in this context are those of physician and patient, parent and child. In the case of the physician, the dictum “primum non nocere” (First, do no harm) demands that they themselves be vaccinated so as not to put their patients, who may be vulnerable to disease, in harm’s way. This extends to all who work in the medical field (van Delden et. al., 2008). In the case of a parent, whose duty is to love, protect, and nurture their child(ren), personal liberty and political views must not interfere with the safety, health, and well being of their child(ren). To put them at risk, simply to make a political point, goes against their responsibility and nature as a parent. To bring in deontology to the debate, Kant might say here that, in such a case, the parent is using the child as a mere means, and not as an end. Perhaps even Kant, the champion of personal liberty, would question the morality of such an act.

This raises an interesting question, that of moral agency. If, as Kant argued, children are not moral agents but subjects to their parents, what right does society have to tell the parents how to treat their children? But, ultimately, this is not a question of rights, but of values—communitarian vs. individualist. The difference between the two value systems is where the stress falls, on the whole or on the self. Once seen in this way, the decision to opt-out is exposed as egotistic, the decision to be vaccinated as altruistic. To return to the example of parent and child, we have already determined this is a case where society must act as parent. It is known that there are various parenting strategies—some effective, others ineffective—and the question is which to use? Instead of the permissive strategy often used, i.e. allowing the subject (child) to act at will and remove or reduce the consequences of those actions, consider the authoritative strategy; to allow for personal choice, but to inform the subject of the consequences and to be consistent in carrying them out. Agency cannot exist without accountability.

If a parent insists on opting their children out of vaccination, allow this, but inform them that their children will not be able receive the full benefits of citizenship: attend public school, travel outside the country, serve in the military, work in a service industry (especially health care), etc., and then follow through with those consequences. I doubt that parents, after being informed of this, would continue their opposition to this policy, knowing that by doing so they would be closing so many doors for their children. If persuasion and education are not sufficient to influence the entire public to accept universal vaccination, then society is not under the obligation to convince those who continue to dissent. The most important priority must be the protection of the whole, and this can be achieved via the gentle form of coercion described above. Freedom from disease is comparable in impact to freedom from tyranny, and sometimes members of society must be forced to remain free of both.

References

Achievements in Public Health, 1900-1999: Control of Infectious Diseases. MMWR 1999; 48(29): 621-629. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm

Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998. MMWR 1999; 48(12):243-248. http://www.cdc.gov/mmwr/preview/mmwrhtml/00056803.htm

Baker, J. P. (2008). Mercury, vaccines, and autism: One controversy, three histories. American Journal of Public Health, 98(2), 244-253.

Campos-Outcalt, D. (2010, October 20) Vaccines: a Major Public Health Achievement, Presentation given during the Mini-Med School lecture series at the University of Arizona College of Medicine-Phoenix, Arizona.

de los Reyes, E. C. (2010). Autism and immunizations: Separating fact from fiction. Archives of Neurology, 67(4), 490-492.

Geier, D. A., & Geier, M. R. (2006). A clinical trial of combined anti-androgen and anti-heavy metal therapy in autistic disorders. Neuro Endocrinology Letters, 27(6), 833-838.

Parker, S. K., Schwartz, B., Todd, J., & Pickering, L. K. (2004). Thimerosal-containing vaccines and autistic spectrum disorder: A critical review of published original data. Pediatrics, 114(3), 793-804.

Roush SW. Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the U.S. JAMA 2007;298:2155-2163.

Slowther, A., Ford, S., & Schofield, T. (2004). Ethics of evidence based medicine in the primary care setting. Journal of Medical Ethics, 30(2), 151-155.

Smeeth, L., Cook, C., Fombonne, E., Heavey, L., Rodrigues, L. C., Smith, P. G., et al. (2004). MMR vaccination and pervasive developmental disorders: A case-control study. The Lancet, 364(9438), 963-969.

Stewart AM. When vaccine injury claims go to court. NEJM 2009;360:2498-2500.

U.S. Food and Drug Administration. (2010) Thimerosal in Vaccines. Retrieved from http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228

van Delden, J. J. M., Ashcroft, R., Dawson, A., Marckmann, G., Upshur, R., & Verweij, M. F. (2008). The ethics of mandatory vaccination against influenza for health care workers. Vaccine, 26(44), 5562-5566.

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Thursday, December 2, 2010

To Boldly Go: 'Fearless' Research Seeks to Introduce New Investigative Techniques

(This is a story that ran in my college newletter last month. The full story with pictures can be accessed by following this link)

It should come as no surprise that Arizona State University senior Jordan Roberts is “fearless.” After all, he played both ways as a lineman on the Lakeside (AZ) Blue Ridge High School state championship football team in 2001 and 2002. But it’s not between the white lines that the life sciences major fears not; it is in the laboratory at ASU’s West campus where he is working diligently on the construction of a research setup that could introduce a new set of investigative techniques into the field of heart physiology.

“Fearless” is how Francisco Solis, a New College associate professor in the Division of Mathematical and Natural Sciences, describes Roberts. He says it is the unknown that Roberts tackles with vigor.

“In my lab, we seek opportunities where there has been little work done before,” says Solis, who has worked on a wide variety of research projects alongside undergraduate students since his arrival at the West campus seven years ago. “This means we have to start a lot of things from scratch, which is a challenging situation where the student cannot simply come and use the techniques that already appear in textbooks.

“Jordan has been willing to jump in and learn what needs to be learned. He has had to learn how machines connect to each other and to think through the modifications that need to be done to apparatuses so as to make them do what we want. He has been fearless in tackling the project, not intimidated by it.”

The project that has Roberts’ attention is an apparatus called the luminometer, which measures light output from chemical reactions. It is not an uncommon piece of research equipment, and is relatively inexpensive to operate; however off-the- shelf commercial luminometers cannot perform complex environmental changes. So, Roberts is building his own luminometer that will allow him to continuously change the environment around cells and assess their cellular changes. Roberts specifically will use his newly developed machine to discover how yeast cells react to continued exposure to variable calcium concentrations over a period of minutes to hours. He knows when yeast cells are exposed to calcium that, within a fraction of a second, they sequester it. What he wants to know is how the yeast sequester calcium, what proteins are involved, what signals they watch for, and why and when the yeast release it back into the watery center of the cell, or the cytoplasm.

“The point of the research isn’t the machine itself, or any of its future applications, although I’m certain it will be useful in other applications,” Roberts clarifies. “It’s about how the machine will increase our ability to manipulate the environment of the yeast cells and observe their response.
“It’s all about the yeast.”

From the football field to the laboratory has been a journey that has featured more twists, turns and side trips than a country road. In high school, he won debate honors and was a nationally ranked member of his math club. As an Eagle Scout, his troop helped the U.S. Forest Service reseed the area burned by the infamous Rodeo-Chediski Fire of 2002 that consumed more than 450,000 acres of east-central Arizona woodland. Following his graduation from Blue Ridge, Roberts pursued a two-year mission for the Latter Day Saints Church, travelling to southern Brazil where he served as a minister at a local church, helped rebuild houses, visited the sick in hospitals, built and distributed wheelchairs and more. Upon his return to Lakeside and the White Mountains, he eyed a return to school.

“I was interested in medical school, but I was enrolling at Northland Pioneer College, and the college didn’t have pre-med courses, but did have a rigorous nursing program,” says Roberts of the Show Low-based community college. “I started in the nursing program and took as many science classes as I possibly could. I transferred with 70 credits and lots of science.”

His transfer wasn’t so matter-of-fact. He was hesitant to jump into a “big-time” college environment, but knew that ASU was “strong in science across the board.” He overheard his wife, Shauni, talking with a friend about the West campus and the availability of pre-med coursework. Heasked questions and liked the answers he was receiving – small campus, student-friendly classes, a learning environment with accessible faculty.

“I came down off the mountain (Lakeside) and talked with some of the New College faculty and staff,” Roberts remembers. “I looked around and I got real excited. I moved down here and got started.”

Roberts enrolled in time for the spring 2009 semester and met with Pam Marshall, who was recently recognized by ASU President Michael Crow as a university exemplar for her dedication to helping undergraduates participate in her research, particularly non-traditional, first-generation and minority students. A New College mathematical and natural sciences associate professor, she has mentored more than 30 undergraduates since coming to the West campus seven years ago, many of whom have gone on to medical school. She received a university-wide faculty excellence award for undergraduate mentorship in 2008 and a New College teaching award in 2009.

“Between Professor Solis and Professor Marshall, they got me interested in research and got me started,” says Roberts, who, with Marshall’s support, received a Howard Hughes Medical Institute grant through ASU’s SOLUR (School of Life Sciences Undergraduate Research) program. “I am working with Professor Solis to build the luminometer, then I will work with Professor Marshall to further the yeast cell research.”

“Jordan exemplifies the opportunities that exist at ASU and New College,” says Marshall. “He is embedded in the knowledge-driven enterprise of ASU, and the research he is doing helps to hone his observational and critical thinking skills.”

The skills Roberts is developing could have far-ranging consequences.

“The end result of the project Jordan is working on is the construction of a research setup that will allow us to investigate a much larger variety of calcium signals,” says Solis, who Roberts describes as “the go-to guy.”

“We are seeking to introduce a new set of investigation techniques into the field,” adds Solis. “If we accomplish this, there could be a cascade effect, as the research will be available to other researchers. We thus hope to contribute to the more distant but important goal of understanding calcium responses; such knowledge and its applications are important in medical contexts, especially in relation with the activity of cardiac muscle.”

Roberts says an exciting aspect of his research is the fact little has been done in the area of how different cells treat different ions, such as calcium.

“There just isn’t a lot out there to fall back on,” he says. “This isn’t duplicate research. It is meticulous, methodical, and it can be impactful.

“The heart relies on calcium to contract, to perform its regular motion, in and out. We suspect that the same protein pumps that move calcium in and out of cells in yeast are also present in human heart muscles.

“One day, our research will lead to better drugs for heart disease and a better understanding of overall heart physiology.”

There’s another consideration when it comes to the research, says Roberts, who has his sights set on a career in medicine, perhaps as a doctor of osteopathy.

“The research is rewarding because it ‘proves’ to me that all the stuff I’ve been trying so hard to learn is actually real and useful,” he says. “In addition to one day translating into better medical science, the research opportunities we have here show that normal college kids can make a difference, can do something amazing. You don’t have to be ‘lucky’ or ‘brilliant’ to help the cause of science along, you just have to be persistent, look for opportunities, and know who to ask for help.”

- Stephen Des Georges (steve.dg@asu.edu)