Reasonable People Can Disagree:  The rationale for allowing philosophical exemptions to vaccinations - POSITION PAPER ON MANDATORY VACCINATIONS - 1989/1991

by Sandy Gottstein (aka Mintz) 1989/1991

Note:  Due to conversion from DOS to Windows, some formatting errors occur throughout the paper, which I hope to correct at a later date.  Also note that the references were never reformatted to be in consecutive numerical order when some of the references were removed.  That, too, will be corrected at a later date.  - SG

In order to attend both public and private school in Alaska, the State of Alaska currently requires the following vaccinations of its children:  DPT, polio, measles and rubella.*  Exemptions or waivers from these vaccinations are only allowed on medical or religious grounds at this time.  In spite of appearances, however, there is no consensus about the degree of efficacy of all vaccines for all children.  The arguments which follow support the contention that reasonable people can disagree about vaccines and that loving, conscientious, informed parents might choose to refuse one or more vaccinations for their children.   I am hoping to engage your support to change the law to allow an additional waiver for personal or philosophical convictions.  Similar laws are currently in effect in 22 states.**(Click here for the for more up-to-date exemption information) 

The proposed law, presently before the State Senate, is a copy of current California law.  In addition, an effort will be made to include in the bill an as yet formally unidentified action or actions to be required of those seeking a philosophical exemption. The inclusion of such an action will be for the purpose of discouraging an otherwise uninformed or negligent parent from choosing the exemption as the path of least resistance.  (One idea is to require an essay of undetermined length stating the parent's position on the issue, another that well-child visits, to the health practitioner of the parent's choice, be required and timed for the same intervals were the child to be immunized.) 

I.  THE VACCINES ARE RISKY, AND PROBABLY MUCH RISKIER THAN IS CURRENTLY KNOWN OR EVEN ACKNOWLEDGED 

          A.  Reported and Theorized Adverse Effects Are Vast and Varied  

There have been numerous reports about adverse effects.  Reported adverse reactions are varied and include moderate to severe brain damage and death (20,42,44,49,170,53,60,63,64,65,66,67,69,70,71,73,74,75,76,77,79,80,85,90,91, 97,105,43,84,109,136,143b,146,149,156,163a,163b,165). These reactions appear to be the result of toxins in the vaccines themselves (65,106,109,110,152), as well as poor quality control of the product (106,135,166).  Also included in the many adverse reactions reported is contracting the very disease the vaccine was supposed to offer protection against (29,30,54,57,81,68,150), sometimes in a more virulent form than occurs naturally (45).    

It is easy to dismiss fears about long-term unknown effects as paranoia.  But legitimate concern is being raised about long-term autoimmune diseases, abnormalities of the immune system, and even cancer resulting from the use of vaccines (166,171,97,109). The difficulties in proving long-term effects are well known.  Clinical evidence is slowly mounting, however, as was the case with smoking and lung-cancer initially.  There is concern, for instance according to The London Times, 1987(177), that AIDS may have been triggered by smallpox vaccine.  To quote "The Times":  "Dr. Robert Gallo (SIC), who first identified the Aids virus in the US, told "The Times": 'The link between the WHO programme and the epidemic in Africa is an important and interesting hypothesis.  I cannot say that it actually happened, but I have been saying for some years that the use of live vaccines such as that used for smallpox can activate a dormant infection such as HIV.  No blame can be attached to WHO, but if the hypothesis is correct it is a tragic situation and a warning that we cannot ignore.'"   It has been long known that a small percentage of polio    cases were "provoked" by the pertussis vaccine (106).  We can all hope that the fears about AIDS are groundless, that "provocation polio" is an aberration, and that there are not other equally worrisome ramifications of vaccination lurking around the corner.  But the need to keep an open mind and maintain vigilance remains paramount. 

             B.  Current Vaccination Policy Is A Shotgun Approach To The Problem of Infectious Diseases  

Protecting children against relatively mild childhood diseases only to leave them vulnerable to these diseases as adults, when the diseases are frequently more serious (124,125), is an example of how short-sighted these policies may be.  No one knows for sure how long protection is afforded (32,109,92,131).  If vaccines mimicked real diseases, immunity would be life-long for most (109,121,124), and boosters would be unnecessary.  Thus the price our children may have to pay as adults, for the privilege of avoiding these diseases, may be high.  

One example of an innocuous childhood disease for which there is mass vaccination is German measles or rubella (124,122).  Women who conceive and are not immune to rubella are at risk of developing the disease in pregnancy.  Some of these pregnancies result in severe congenital abnormalities.  But the German measles vaccine is not administered to women of childbearing age, nor do we know that it confers lifelong immunity (32).  The rubella vaccine also has a reasonably high failure rate (109).  Unless there is 100% eradication of the disease, a pregnant woman who was vaccinated as a child and did not contract measles is more, not less, vulnerable than one who was allowed an opportunity to get the disease as a child (92).  As Dr. Hugh Paul stated in "The Control of Diseases"(124), before formulation of the rubella vaccine, "The disease (rubella) cannot be prevented, and in view of its very mild character, and the possibility that it may have catastrophic effects if contracted by an expectant mother, it is questionable if it should be prevented in childhood and adolescence even if this were possible.  It has been suggested that female children should be deliberately exposed to infection in order to achieve a life-long immunity from the disease and possibly from malformation in the offspring in later life.  This idea is not an unreasonable one... Rubella does not kill, and even complications are uncommon."  Perhaps it would be more prudent to vaccinate only pubescent schoolgirls, allowing those who wish to avoid vaccination to take a blood test to ascertain whether or not they have acquired natural immunity (35,109) than to require vaccinations of all children, as is presently done.          

Although it is now known that naturally acquired immunity to rubella is not always lifelong, according to Dr. Vincent Fulginiti, life-long immunity occurs far more often among the naturally immune than the vaccine-immune (90-97.5% lifelong immunity for naturally acquired vs. 20-97% for the vaccine-induced)(109). 

The hard or red measles (rubeola) is an example of a disease that generally is unpleasant, but not serious in healthy children (102,121,68,125,124), yet which can be deadly serious for adults. When this measles first hits a population, the adults contracting it are hit very hard, with whole populations sometimes being wiped out (122,124).  It then settles into the population, thereby effecting mostly children, since the adults have already been exposed. Statistics that cite disturbing incidence rates for encephalopathy and other adverse effects of measles, do not take into consideration the general health status of the individual, and socio-economic factors that have reduced disease severity, nor do they give much weight to the vast incidence of problem-free disease.  

Compounding the problem is the fact that the population most vulnerable to measles, infants, is least protected.  Vaccinating too early can cause vaccine failure more often (36,101) and/or later booster shots to be ineffective (36,96).  The Catch-22 is that in the past, most mothers passed on naturally acquired measles antibodies transplacentally to their offspring who were protected until 6-9 months (124,99,48a).  With the advent of vaccines, a higher percentage of mothers will be seronegative (have no antibodies) and will not pass those antibodies on to their children, at precisely the time that the vaccines are not effective, and yet the infant is most vulnerable (99,48a).  On the other hand, those who would ordinarily be better off receiving maternal antibodies might find themselves in the untenable position of having those very antibodies interfere with vaccine efficacy (36,100), with the end-result that neither the vaccine nor the antibodies were protective. 

The MMR (measles, mumps, rubella) vaccine probably does not confer lifelong immunity (109).  What will happen to our children when they become adults?  The medical community cannot possibly be confident that 100% eradication will occur with routine childhood immunization and that our children are not going to get seriously ill as adults (100).  At a minimum, questions like these require better answers before anyone is forced to be vaccinated.  These issues are barely being addressed in the medical literature. 

          C.  Unreliable Methods For Collecting and Analyzing Data Are Being Used To Assess Vaccine Risk

At the current time only minimal information is available about short-term, known, acute reactions, while no hard data on long-term health and behavioral effects exists. To most accurately assess all risk, controlled, human experiments would have to be conducted.  Of course, such experiments would not be considered ethical. 

The next best approach would be to conduct 20-30+ year studies of matched groups (vaccinated vs. unvaccinated) in which all problems, including even minor behavioral and learning problems, would be recorded and compared.  These have not been done, nor are they in progress.  

Current reporting methods, unlike the aforementioned are fraught with bias and inaccuracies.  First, they depend upon accurate reporting.  Second, they depend upon the doctor or parent connecting a symptom with the vaccine.  Third, they usually compare vaccinated groups to each other rather than a vaccinated group     to an unvaccinated group.  In the "Report of the Task Force...(177)" for instance, a study is cited in which immunization status is supposedly considered.  But upon closer examination, it becomes clear that immunization status was not used; instead timing of immunization was the factor.  What if a large percentage of vaccine-associated events occur after it is presumed they do not?  The result will dramatically effect conclusions.  

In fact, no one knows the relevance of time.  Dr. Fulginiti, a well-known vaccine-use proponent, who has edited the book "Immunization in Clinical Practice", says:  "A second confusing factor is the time relationship between vaccine administration and adverse event.  How long an interval is possible in a vaccine-induced central nervous system infection or other untoward effect?  Strom recorded data on some patients who first fell ill with neurological symptoms 1 week after receipt of vaccine.   Is that disease relatable to the vaccine?  Most experts accept an interval of 24 hours between vaccine and onset of encephalopathy; a few suggest 2-3 days as an acceptable delay in onset.  But there is no proof for any interval."(109) Most studies don't even make a pretense of controlling for immunization, instead opting to use time or some other equally questionable variable. 

It is not possible to predict the potential intelligence, future health, etc., of a given child.  Claims, for instance, that a child has suffered no residual effects from a vaccine and is normal based on observation are totally unfounded.  The only way to determine potential, be it intelligence or whatever, is to study groups.  When attempting to determine vaccine effects, those groups must be unvaccinated vs. vaccinated, with the distribution of effects compared.   

The utter inadequacy of the reporting system, for even the most obvious and serious effects, is accepted (42,74,80,106), even by vaccine proponents (105,43,109).  In the U.S. there was no requirement to report adverse effects until recently, but even making it mandatory cannot change the basic problem with a reporting system of any kind. Furthermore, much of the analysis of adverse effect rates uses the number of doses administered (32,43,68,77,105,106,109,115,121,124,139,140,146,152,160), rather than the number of children affected.  Who cares how many doses it takes to damage a child?  What should be sought is data on how many CHILDREN are harmed by a given vaccine, no matter how many doses have been received.  Using doses skews results in favor of lower adverse effect rates for all multi-dose vaccines, and in the case of pertussis, dramatically so, since 4- 5 doses are usually required. These dose-related conclusions are made all the more insidious when they are then compared to disease-related problems among children.  Even worse, in some known cases, reporting, as well as follow-up, appears to have even      been discouraged (170).  To quote P. Isacson (Progress in Medical Virology, 13,263, 1971, cited in a 1972 "Science" article (166), "There has been a tendency on the part of certain higher government circles to play down any open discussion of problems associated with vaccines...Perhaps this has been overdone.  Scientists how find themselves in the position of balancing the benefits of a vaccine against the risks, yet are in no position to judge what the long-term risks are."  Thus current analytical and data collection methods should be seriously questioned.    

Where more effort is made to follow adverse effects, the riskiness of one or more of the vaccines appears to increase, although the totality of adverse effects is still unknown (70,74,78,80,85,90).     

II.  THERE IS NO PROOF TO THE CLAIM THAT UNVACCINATED PEOPLE THREATEN THE GENERAL PUBLIC HEALTH    

A major argument in favor of compulsory vaccination is that the unvaccinated threaten the general public health.  However, if the vaccines work, they protect anyone choosing to be vaccinated.  Some people additionally claim, nevertheless, that since there are vaccine failures, the unvaccinated threaten those who try but fail to get protection.  Even here, however, there are mitigating effects: first, in at least one of the more serious diseases, whooping cough, a vaccinated person who contracts the disease will usually get a less serious form of the disease. (105,62,32,43,46,51,68,78,106,121,134,135); second, vaccine failure rates can be so high (32,43,46,87,100,105,109,116,131,134,135,152) that one could question the extent of any additional risk created by the unvaccinated.  Even proponents of achievement of so-called "herd immunity" admit that nowhere near 100% compliance is necessary to result in protection to the entire population, although at least 80% is usually advocated (51,22,47). 

There is virtually no threat posed by states allowing philosophical exemptions.  Five states provided their rate of philosophical exemptions: California, Vermont, Ohio, Arizona, and Wisconsin.  Less than 1% took the exemption.  Other states provided overall compliance rates: Missouri, Minnesota, Pennsylvania, and Delaware were all 98% or better, meaning philosophical exemptions have to be less than 2%.  Two other states, Indiana and Oklahoma, were 97% or better, while none of the reporting states were less than 91%(172,173,179).  We know that vaccine failure rates have been equal to or greater by far than the philosophical exemption rates which are occurring.  There is no reason to assume the unvaccinated are totally responsible for disease outbreaks unless vaccine proponents are unreasonably arguing that vaccine failures do not contribute to them in any way.  Surely no one is arguing that, while a "vaccine failure" can catch a disease and spread a disease, it cannot be the first one to get the disease in an area.  

Besides, a disease doesn't START anywhere.  When public health officials cite the unvaccinated as the source of an outbreak, they are being arbitrary.  Where did the alleged source catch the disease? Everyone gets these diseases from someone.  Outbreaks are not isolated events with some sort of spontaneous (measles/pertussis/whatever) eruption at their source; they are part of chains of events.  Where one looks for the source will determine what one finds.  Where one stops will determine who is held responsible.   

There are a number of diseases that can be mild enough that they would go unrecognized, particularly among the vaccinated.  Pertussis is a well-accepted example, as discussed earlier.  Measles has been noted to be milder among the vaccinated as well (46).  A very credible scenario would be to have, for instance in the case of pertussis, a number of sub-clinical cases among the vaccinated causing a full-blown recognized case in an unvaccinated person.  The blame could then easily be placed on the unvaccinated with no concern about where THEY got the disease. 

Let's examine the role of vaccine failure more closely.  It is commonly assumed that vaccine failure rates are low - after all, there are few outbreaks of the diseases in question, and what outbreaks have occurred are often attributed to the unvaccinated few. When actual outbreaks have occurred, however, as high as 80% of those contracting the disease have been reported to have been vaccinated (174). Upon close inspection, the success rate of the vaccines themselves must be questioned.  Estimates of failure vary widely (109,46,87,100,152,134,26,32,43,105), but it would appear that to some extent, success rates are statistical illusions - as long as no outbreaks occur, the vaccines appear to be working.  By the same token, however, being unvaccinated appears to be working as well.  Given these high failure rates among the vaccinated during disease outbreaks, it is hardly reasonable to conclude that the unvaccinated add any appreciable risk, especially in the small numbers seen in the "philosophical exemption states". 

Another concern raised by vaccine proponents is fear that formerly vaccinated adults, whose immunity has waned, will then be threatened by disease outbreaks.  Those same adults can, however, choose to be revaccinated in most cases.  One exception to that case is pertussis, which is not a safe vaccine for adults (105,108,175).  Pertussis is also not usually serious for adults, however (106).  In fact, the practical effect of waning vaccines is to make formerly vaccinated adults contributors to disease outbreaks (108,68,135).  Had they acquired natural immunity, this would be unlikely. 

But what about pertussis and infants?  Isn't it true that pertussis is mostly a problem for them?  Shouldn't everyone be vaccinated to protect them?  It is true that most fatalities occur among infants under 1 year of age (178,106).  The vaccines are not recommended for use before 2 months of age, with protection sometimes not being conferred before the third administration at 6 months.  But a number of factors make this a more complicated issue than would appear on the surface. 

First, improvements in medical management, especially the use of antibiotics, have enhanced our arsenal against this disease.  Antibiotics can, as stated in the "Task Force Report"(178) and elsewhere, prevent further contagion, prevent serious disease, particularly if timed right, and combat secondary infections like pneumonia, which are the major cause of death in infants contracting whooping cough. 

Second, even if everyone under 6 were vaccinated, infants would still be at risk.  It is widely acknowledged (108,175,105) that booster shots given to anyone 6-7 years of age or older are not recommended because of the risks involved.  Because of the known seriousness pertussis can pose to infants under 1 year of age, vaccinations are then given, but only to children up to 6-7 years old.  It is also widely accepted that pertussis vaccine significantly loses its effectiveness over time (135,109,108,131).  With widespread waning immunity from pertussis vaccine a fact of life, however, large reservoirs of susceptibles exist in the older groups capable of infecting infants (108).  Yet we do not vaccinate these older groups because of the risks associated with  doing so.  I have shown that the medical community has no hard, reliable data to back up claims of low risk from the vaccine to younger children.  The most that can legitimately be said is that although some short-term risks have been established, both short-term and long-term risks are virtually unknown.  It should not be acceptable to force young children to face risks that are unacceptable for older children and adults. The practical effect of not revaccinating either group is to put infants at risk.  But because of unsubstantiated claims that the risks are low for children 6 and under, 

children 6 and under are being asked to shoulder the burden of protecting infants even though they cannot do it alone.  I am not suggesting that older children and adults now be compromised.  I submit, on the other hand, that the addition of small numbers of unvaccinated young children to the already significant pool of vaccine failures and larger pool of immunity-waned older children and adults adds marginal increased risk. 

III.  MUCH OF THE CREDIT FOR THE DECLINE IN DANGEROUS CONTAGIOUS DISEASES SHOULD GO TO FACTORS OTHER THAN THE VACCINES

 The benefits of vaccination are over-rated since much of the decline in morbidity and mortality of the diseases targeted by the vaccines occurred before the vaccines were introduced (26,27,30,34,91a, 91b, 105,124,126,90,106,108).  Pro-vaccine reports will often begin around 1950 or later (34,68,98,178), after declines were already in effect, thereby giving unsubstantiated weight to the role of vaccines.  As implied by the declining death rate, severity of the illnesses also has diminished for the unvaccinated (89,90,124). 

Socioeconomic factors, including improved health care and living conditions, have contributed dramatically to both disease incidence and severity decreases (26,55,58,90,121,126,85,51,98,108,113b, 119,121,124,135).  Even our previous inability to treat whooping cough has been aided in particular by antibiotic therapy aimed at secondary infections like pneumonia (105,118,78,91a, 121,134,135), which is a primary factor in pertussis mortality if left untreated (107,106,152,124), and improvements in hospital care for the seriously ill (105,106,25). 

Perhaps even more important, it would appear that a well-organized effort to control the spread of whooping cough could be effective since certain antibiotics like erythromycin given to an identified whooping cough victim will prevent the spread of disease to others (107,108,120,121,117,134), and     erythromycin given to an exposed person before the paroxysmal stage can actually prevent the disease in the treated individual (120,117,118).  The "Task Force"(178) reports that erythromycin even given during the paroxysmal stage has been shown to reduce symptoms, contrary to popular belief.  Hence widespread, uncontrolled spread of whooping cough could be a thing of the past without the risks associated with the vaccine and moral dilemmas posed by making it compulsory. 

Two prominent examples of diseases, which have decreased dramatically without the aid of vaccines, are scarlet fever and TB.  Scarlet fever is no longer the scourge it once was (103,122,126). There is no vaccine for it, but if there were, the vaccine probably would be given credit for a decline it had nothing to do with.   In most places, where the general health of the population is good, TB is no longer a problem either (122,123,124,126,59,129).  What would have happened had there been a TB vaccine?  Sometimes the conditions the world used to face are forgotten - no toilets, unclean water, lack of refrigeration, crowding, lack of heat, poor nutrition, etc.  Where those conditions and/or others still exist, for instance in parts of rural Alaska vis à vis TB, disease morbidity and mortality increase.  But those conditions in Alaska, for instance, have existed for a long time, and yet do not pose a threat to the general population, because the general population does not face those conditions. 

IV.  MUCH IS UNKNOWN ABOUT THE MECHANISMS UNDERLYING VACCINE PROTECTION 

How vaccines work is not truly understood (109).  When a human being contracts most of the diseases for which there are vaccines, lifelong immunity occurs.  With the vaccines, boosters are needed and adults may go unprotected.        

How well vaccines work is also not clear since, as discussed in section II, varying percentages of the vaccinated can contract the disease, and varying percentages of the ill have been vaccinated (3,46,85,86,87,98,101,169,95,108,147).  Nowhere near 100% of the vaccinated are protected.  For example, Dr. Stephen A. Hoffman, an expert on infectious diseases at Harvard University, and a proponent of vaccines writes (130), "In the majority of recent (measles) cases , the administered vaccine apparently never took hold in the first place.  This suggests that our ability to wipe out measles may, after all, be limited by a built-in failure rate of the vaccine itself."  In the first 26 weeks of 1985, according to the Centers for Disease Control (174), 80% of those between the ages of 16 months and 28 years who contracted measles were vaccinated; in 1986(147), 57% from 16 months on up had been vaccinated. 

V.  POLICY THAT MAKES VACCINATIONS COMPULSORY IS UNJUST AND UNWISE

 Since anyone who wishes to be vaccinated has the right to do so, and built-in vaccine failures insure that the diseases remain in the population, no one can unequivocally argue that the unvaccinated appreciably affect the vaccinated.  I would like to include some of the testimony made to Congress in 1962 by Clinton R. Miller of the National Health Federation because he so eloquently framed this issue in the context of history.   

     "The only time (NHF) would feel justified in violating an American's exercise of choice in matters of health would be when such exercise of freedom violated the equal right of another.  Clearly at the present time no one is denied vaccination for themselves or their children if they desire it.  Therefore, citizens who exercise their freedom of choice by choosing not to be vaccinated are not denying an equal right to another by the exercise of this freedom.        

     This principle of freedom is a superior and more fundamental consideration than that of vaccination.  There are those people who so stoutly believe in the principle of vaccination that their enthusiasm leads them to an intolerance of anyone who just as stoutly does not believe in it...        

     Those who believe in freedom of choice in matters of politics, religion, and health, emphasize that minority views of one generation become majority views of another.  History has a wonderful lesson to teach us here if we will learn it.  History will record a man of one age as a wise man, even though subsequent research might prove his theories to be in error, if he refrained from force of any kind in sharing of his beliefs with his disciples and contemporaries.  But it will record the same man with the same theories as a fool or a tyrant, who uses, or allows to be used, force of any kind- not the least of which is governmental force - to gain acceptance for his beliefs.

     Humility about the extent of one's knowledge, or of the collective     knowledge of any age is always the mark of greatness, progress, and understanding....

          Dr. Benjamin Rush, a signer of the Declaration of Independence, and     Congressman is quoted as saying 'The Constitution of the Republic should make provision for medical freedom as well as for religious freedom.... All such laws’ (which restrict health choices)'are un-American and despotic.  They are fragments of monarchy and have no place in a Republic'.

            .... We maintain that this right was implied, if not written.... But the fact is that it was not written, and we are left to argue that it was certainly implied.  

          At the time Benjamin Rush made this plea, it was argued that this 'right' was assumed by the guaranteed freedom of religion and didn't need to be codified…Incidentally, Dr. Rush was a strong believer in vaccination theories of Jenner, but emphasized the greater need for freedom in all health matters (104)”. 

            VI.  MOST OF THE FREE WORLD HONORS THESE PARENTAL RIGHTS 

As of August 1987, 22 states allowed for personal or philosophical exemptions.  Indeed, but for the former communist-bloc countries, most of the world does not deny this basic right.  The following countries compulsory vaccination laws:  the Eastern block nations (Albania, Bulgaria, Hungary, East Germany, Czechoslovakia, Poland, Romania, U.S.S.R., and Yugoslavia) as well as the Bahamas, Bolivia, Brazil, Costa Rica, Ecuador, Granada, Mexico, Peru (93), and about 28 states in the U.S.  Obviously, allowing for this exemption is not a radical notion. I would like Alaska to join the many U.S. states and free      world, which currently allows for a choice. 

VII.  IN A FREE SOCIETY IT IS PARENTS, AND NOT THE GOVERNMENT, WHO SHOULD DECIDE AMONG  REASONABLE RISKS FOR THEIR CHILDREN

The state should not have the right to force a child to have a potentially harmful vaccine, no matter how statistically remote the possibility.  Reasonable people can argue which is riskier for an individual child, the vaccines, or the diseases they are designed to prevent.  In places where the standard of living is high and adverse effects conscientiously reported, arguments have been made to support the contention that the risks from the vaccines approach that of the disease (80,90).  But even if the vaccines in general are safer, for a particular child they may not be.  No one, not even public health proponents of compulsory vaccination, is arguing that vaccines do not harm individual children, only that the general public good is served by vaccination.  The argument regarding general public good has been addressed and I think shown to be weak.  There is incontrovertible evidence that vaccines harm individual children.  It is the parent, not the state, who should be allowed to choose risk for an individual child. 

VIII.  HISTORY MUST NOT BE IGNORED

 If government is going to force people to put known toxins into their bodies, they have a tremendous responsibility to be absolutely right.  Of course that is not possible.  History is filled with examples of medical procedures which were touted at one time, with nary a dissenting voice, which were later totally discredited.  Examples are routine tonsillectomies, appendectomies, hysterectomies, X-rays and Cesarean sections.  X-ray pelvimetry during pregnancy, DES, the original Salk vaccine, the killed-cell virus measles vaccine and swine flu shots are additional examples of now defunct or largely discredited medical approaches.  Actual dangers of procedures have often been utterly denied, radiation being a most glaring example, only much later to be admitted, leaving many damaged health-care consumers.  Where is our sense of humility and history?  While there is nothing wrong with a medical professional informing a person about all sides of an issue, giving his or her opinion based on personal evaluation of current knowledge, and getting consent to proceed according to a certain plan, there is something terribly wrong about forcing individuals to comply.

If physicians and government saw themselves as providers of information and respectfully deferred the decision-making to willing patients, I submit that fewer malpractice suits would be brought.  One cannot insist upon taking responsibility for a decision and reasonably deny responsibility for the outcome. 

Obviously, the point of all this is not that anything has been proved here or elsewhere on the scientific level, but that reasonable people can disagree on this issue.  In a free society, reasonable disagreement on matters of conscience and health should be honored.

*Interestingly enough, although mumps is not required, neither the schools nor pediatricians are forthcoming with information to that effect:  school health forms which must be submitted to the state and which indicate student vaccination histories list measles-mumps-rubella (MMR) only and pediatricians do not inform parents that the mumps vaccine is optional. 

**The following states allowed the exemption as of August 1987: Arizona, California, Colorado, Delaware, Idaho, Indiana, Louisiana, Maine, Michigan, Minnesota, Missouri, Montana, Nebraska, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Utah, Vermont, Washington and Wisconsin.  (Click here for the for more up-to-date exemption information) 

Note:  There are approximately 115 references in all.  The reason they are not numbered consecutively is that many of the articles were removed prior to finalization of the paper, but the corrections to the numbering were never made.  The references in the paper, insofar as they refer to articles below, however, are correct. Links to PubMed or other links will be made where they exist.

20.  Toomey, James A.  Reactions to pertussis vaccine.  JAMA (Feb 12)1949,:448-450.

22.  Anderson, Roy M. & May, Robert M.  Vaccination and herd immunity to infectious diseases.  Nature  318(Nov 28)1985,323-329.

25.  Harris, F., Bush, G. & Lewis, Margo.  (letter) The Lancet (Sept 1)1979, 472-473.

26.  Bassili, W.R. & Stewart, G.T.  Epidemiological evaluation of immunisation and other factors in the control of whooping cough.  The Lancet (Feb 28)1976,471-474.

27.  Miller,C.L., Pollock, T.M.& Clewer, A.D.E. Whooping-cough vaccination: an assessment.  The Lancet (Aug 31)1974,510-513.

29.  Terry, Luther L., Goddard, James L., et al.  Oral poliomyelitis vaccines: report of special advisory committee on oral poliomyelitis vaccines to the Surgeon General of the Public Health Service.  JAMA 190:1     (Oct 5) 1964,161-163.

30.  Henderson, Donald A., Witte, John J., Morris, Leo & Langmuir, Alexander D. Paralytic disease associated with oral polio vaccines. JAMA 190:1(Oct 5)1964,153-160.

32.  Burgess, Margaret A.  Update on immunisation for measles, mumps, rubella and pertussis.  Austr Fam Phys 15:4(April)1986,449-453.

34.  Bloch, Alan B., Orenstein, Walter A.  Health impact of measles vaccination in the United States.  Pediatrics 76:4(Oct)1985,524-532.

35.  Edmond, Elizabeth & Zealley, Helen.  The impact of a rubella prevention policy on the outcome of rubella in pregnancy.  Br J Obst Gyn 93(June) 1986,563-567.

36.  Wilkins, Jeanette & Wehrle, Paul F. Additional evidence against measles vaccine administration to infants less than 12 months of age:  altered immune response following active/passive immunization.  J Pediatr        94:6(June)1979,865-869.

42.  Kulenkampff, M., Schwartzman, J.S., & Wilson, J.  Neurological complications of pertussis inoculation.  Arch Dis Child 49,1974, 46-49.

43.  CDC.  Pertussis surveillance, 1979-1981. MMWR,31:25(July 2)1982,333-336.

44.  Byers, Randolph K. & Moll, Frederic C.  Encephalopathies following prophylactic pertussis vaccine.  Pediatrics,1:4(April)1948,437-457.

45.  Fulginiti, Vincent A. & Helfer, Ray E. Atypical measles in adolescent sibling 16 years after killed measles virus vaccine.  JAMA 244:8 (Aug 22/29)1980,804-806.

46.  Bell, T.M.,Tukei, P.M., et al.  Investigation of the effectiveness of measles vaccination in children in Kenya.  Journal of Hygiene, 95,1985, 695-702.

47.  Anderson, R.M. & Grenfell, B.T. (letter) Control of congenital rubella by mass vaccination.  The Lancet (Oct.12)1985,827-828.

48a. Narod, S.  (letter)  Measles vaccination in Haiti.  New Engl J Med 314:9(Feb 27)1986,581-582.

49.  Ehrengut, W. (letter) Central nervous system sequelae of vaccination. The Lancet (May 31)1986,1275-1276.

51.  Nicoll, Angus.  Contra-indications to measles and whooping cough vaccination: reality and mythology.  The Practitioner 230(June) 1986,593-597.

53.  Amsel, S.G., Hanakoglu, A., Fried, D., & Wolyvovics, M.  Myocarditis after triple immunisation.  Arch Dis Child  61,1986,403-405.

54.  Leake, J.P.  Poliomyelitis following vaccination against this disease. JAMA (Dec 28)1935,2152.

55.  Halsey, Neal A., Modlin, John F., et al.  Risk factors in subacute sclerosing panencephalitis: a case-control study.  Am J Epidem 111:4, 1980,415-424.

57.  Boffey, Philip M.  Polio: Salk challenges safety of Sabin's live-virus vaccine.  Science, 196(April)1977,35-36.

58.  Cassel, John M.  Potentialities and limitations of epidemiology. Health and the Community: Readings in the Philosophy and Sciences of Public Health.  Katz, Alfred H. & Felton, Jean Spencer.  The Free Press, 432-445.

59.  Basch, Paul F.  International Health.  New York, Oxford University Press, 1978, 241.

60.  Chin, James, Werner, S.B., Kusumoto, Howard H., & Lennette, Edwin H. Complications of rubella immunization in children.  Cal Med 114:3(March)1971,7-12.

62.  Committee on Infectious Diseases.  Pertussis vaccine.  Pediatrics,74:2 (August)1984,303-305.

63.  Kilroy, Anthony W., Schaffner, William, et al.  Two syndromes following rubella immunization: clinical observations and epidemiological studies. JAMA 214:13(Dec 28)1970,2287-2292.

64.  Cho, Cheng T., Lansky, Lester J., & D'Souza, Bernard J.  (letter) Panencephalitis following measles vaccination.  JAMA 224:9(May 28)1973,1299.

65.  Blumstein, George I. & Kreithen, Harold.  Peripheral neuropathy following tetanus toxoid administration.  JAMA 198:9(Nov 28)1966,1030-1031.

66.  Reinstein, Leon, Pargament, Jeffrey M. & Goodman, Jay S.  Peripheral neuropathy after multiple tetanus toxoid injections.  Arch Phys Med Rehabil 63(July)1982,332-334.

67.  Marshall, Gary S., Wright, Peter F., Fenichel, Gerald M., & Karzon, David T.  Diffuse retinopathy following measles, mumps and rubella vaccination.  Pediatrics 76:6(Dec)1985,989-991.

68.  Rutledge, S. Lane & Snead III, O. Carter.  Neurological complications of immunizations.  J Pediatr 109:6(Dec)1986,917-924.

69.  Globus, Joseph H. & Kohn, Jerome L.  Encephalopathy following pertussis vaccine prophylaxis.  JAMA 141(Oct 22)1949,507-509.

70.  Cody, Christopher L., Baraff, Larry J. et al.  Nature and rates of adverse reactions associated with DTP and DT immunizations in infants and children.  Pediatrics 68:5(Nov)1981,650-660.

71.  Holliday, Patti & Bauer, Raymond B.  Polyradiculoneuritis secondary to immunization with tetanus and diphteria toxoids.  Arch Neur 40(Jan)1983,56-57. 

73.  Kazarian, Edward l. & Gager, Walter E.  Optic neuritis complicating measles, mumps and rubella vaccination.  Am J Opth 86:4(Oct)1978,544-547.

74.  Gaebler, John W., Kleiman, Martin G., et al.  Neurologic complications in oral polio vaccine recipients.  J Pediatr 108:6(June) 1986,878-881.

75.  Spruance, S.L., Klock Jr., L.E., et al.  Recurrent joint symptoms in children vaccinated with HPV-77DK12 rubella vaccine.  J Pediatrics 80:3(March)1972,413-417.

76.  Gilmartin, Jr., Richard C., Jabbour, J.T., & Duenas, D.A.  Rubella vaccine myeloradiculoneuritis.  J Pediatr 80:3(March)1972,406-412.

77.  Miller, D.L., Ross, E.M., et al.  Pertussis immunisation and serious acute neurological illness in children.  Br Med J 282(May 16)1981, 1595-1599.

78.  Miller, Christine L. & Fletcher, W.B.  Severity of notified whooping cough.  Br Med J (Jan 17)1976,117-120.

79.  Thursby-Pelham, D.C. & Giles, C.  Neurological complications of pertussis immunization.  (letter) Br Med J (July 26)1958,246.

80.  Strom, Justus.  Further experience of reactions, especially of a cerebral nature, in conjuction with triple vaccination: a study based on vaccinations in Sweden 1959-1965.  Br Med J (Nov.11)1967,320-323.

81.  Ogra, Pearay L.  & Faden, Howard S.  Poliovirus vaccines:  live or dead.   J Pediatr 108:5(June)1986,1031-1033.

84.  Landrigan, Philip J. & Witte, John J.  Neurologic disorders following live measles-virus vaccination.  JAMA 223:13(March 26)1973,1459-1462.

85.  Stewart, Gordon T.  (letter)  Whooping cough and pertussis vaccine. Br Med J 287(July 23)1983,287-289.

86.  Pachman, Daniel J.  (letter) Mumps occurring in previously vaccinated adolescents.  AJDC 142(May)1988,478-479.

87.  Gustafson, Tracy L., Lievens, Alan W. et al.  Measles outbreak in a fully immunized secondary-school population.  New Engl J Med 316:13(March 26)1987,771-774.

89.  Taranger, John.  (letter)  Mild clinical course of pertussis in Swedish infants today.  The Lancet (June12)1982,1360.

90.  Strom, Justus.  Is universal vaccination against pertussis always justified?  Br Med J (Oct 22)1960,1184-1186.

91a. Barrie, Herbert.  (letter) Campaign of terror.  Am J Dis Child 137(Sept) 1983,922-923.

91b. Fulginiti, Vincent A.  (letter)  Letter from the editor.  Am J Dis Child 137(Sept)1983,923.

92.  Proudfoot, Alex.  (letter)  Rubella vaccination.  Med J Austr 146(Jan 19)1987,119.

93.  Noah, Norman D.  Immunisation before school entry: should there be a law?  Br Med J 294(May 16)1987,1270-1271

94.  Chaiken, Barry P., Williams, Neil M., et al.  The effect of a school entry law on mumps activity in a school district.  JAMA 257:18(May 8)1987, 2455-2458.

96.  Linnemann, Calvin C., Dine, Mark S., et al.  Measles immunity after revaccination: results in children vaccinated before 10 months of age. Pediatrics 69:3(March)1982,332-335.

97.  Eibl, Martha M., Mannhalter, Josef W., & Zlabinger, Gerhard. (letter) Abnormal t-lymphocyte subpopulations in healthy subjects after tetanus booster immunization.  New Engl J Med 310:3(Jan.19)1984,198-199.

98.  Hardy, Jr., George E., Kassanoff, Hyman G., et al.  The failure of a  school immunization campaign to terminate an urban epidemic of measles.  Am J Epidem 91:3,1970,286-293

99.  Dickson, Nigel. (letter)  Measles.  New Zeal Med J (July 8)1987,424.

100. Tobias, Martin.  Measles immunity in children: the 1985 national immunisation survey.  New Zeal Med J (May 27)1987,315-317.

101. Addiss, David G., Berg, Jeffrey L., & Davis, Jeffrey P.  Revaccination of previously vaccinated siblings of children with measles during an outbreak.  J Infect Dis 157:3(March)1988,610-611.

102. Top, Sr., Franklin H. et al Communicable and Infectious Diseases: Diagnosis, Prevention and Treatment. Saint Louis, The C.V.Mosby Company,1968,20.

103. Shaw, Edward B.  Whatever happened to the "old-time" infections.  (letter)  JAMA 231:10(March 10)1975,1026.

104. Hearings before the Committee on Interstate and Foreign Commerce, House of Representatives, 87th Congress, Second Session on H.R. 10541. Conducted May 15&16, 1962.

105. Cherry, James D.  The epidemiology of pertussis and pertussis immunization in the United Kingdom and the United States: a comparative study. Curr Prob Pediatr 15:2(Feb)1984,1-78.

106. Miller, D.L., Alderslade, R., & Ross, E.M.  Whooping cough and whooping cough vaccine: the risks and benefits debate.  Epidem Rev 4,1982,1-24.

107. Nelson, John D.  Antibiotic treatment of pertussis. Pediatrics 44:4(Oct)1969,474-476.

108. Nelson, John D.  The changing epidemiology of pertussis in young infants. The role of adults as reservoirs of infection. Am J Dis Child 132(April)1978,371-373.

109. Fulginiti, Vincent A.  Controversies in current immunization policy and practices: one physician's viewpoint.  Curr Prob Pediatr 6:6(April)1976,1-35.

110. Fulginiti, Vincent A.  Pertussis disease, vaccine, and controversy.  JAMA 251:2(Jan 13)1984,251.

113b.Hull, Harry.  (letter) The Lancet 309:2(July 14)1983,109.

115. Gonzalez, Elizabeth Rasche.  TV report on DPT galvanizes US pediatricians. JAMA 248:1(July 2)1982,12-22.

116. Hinman, Alan R. & Koplan, Jeffrey P. Pertussis and pertussis vaccine:  reanalysis of benefits, risks, and costs.  JAMA 251:23(June 15)1984, 3109-3113.

117. Baraff, Larry J., Wilkins, Jeanette, and Wehrle, Paul F.  The role of antibiotics, immunizations, and adenoviruses in pertussis.  Pediatrics 61:2(Feb)1978,224-230.

118. Ames, Rose G., Cohen, Sophia M., et al.  Comparison of the therapeutic efficacy of four agents in pertussis.  Pediatrics 11:4(Apr)1953,323-7.

119. Modlin, John F., Jabbour, J.T., Witte, John J., & Halsey, Neal A. Epidemiologic studies of measles, measles vaccine, and subacute sclerosing panencephalitis.  Pediatrics 59:4(April)1977,505-512.

120. Altemeier,III, W.A. & Ayoub, E.M.  Erythromycin prophylaxis for pertussis. Pediatrics 59:4(April)1977,623-625.

121. Krugman, Saul, Katz, Samuel L., Gershon, Anne A., & Wilfert, Catherine M. Infectious Diseases of Children.  The C.V.Mosby Company, 1985.

122. Ackerknecht, Erwin H.  History and Geography of the Most Important Diseases.  Hafner Publishing Company, 1972.

123. Winslow, Charles-Edward Amory.  The Conquest of Epidemic Disease, A Chapter in the History of Ideas.  Hafner Publishing Company, 1967.

124. Paul, Hugh.  The Control of Diseases (Social and Communicable)  The Williams and Wilkins Company, 1964.

125. Moffet, Hugh L.  Pediatric Infectious Diseases, a Problem-Oriented Approach.  J.B.Lippincott Company, 1981.

126. Illich, Ivan.  Medical Nemesis.  Pantheon Books, 1976.

127. Chaitow, Leon.  Vaccination and Immunization: Dangers, Delusions and Alternatives (What Every Parent Should Know).  The C.W.Daniel Company Limited, 1988.

128. Coulter, Harris L. & Fisher, Barbara Loe.  DPT*A Shot in the Dark.Warner Books,1985.

129. Lerner, Monroe & Anderson, Odin W.  Health Progress in the United States: 1900-1960.  The University of Chicago Press, 1967.

130. Hoffman, Stephen A.  Comeback diseases: why cholera, TB, syphilis and a host of "vanquished" bugs are creeping back.  Am Health (Dec)1988, 51-55.

131. Jenkinson, Douglas.  Duration of effectiveness of pertussis vaccine: evidence from a 10 year community study.  Br Med J 296(Feb 27)1988, 612-614.

133. Dyer, Clare.  Whooping cough vaccine on trial again.  Br Med J 295(Oct 24) 1987,1053-1054.

134. Fulginiti, Vincent A. & Ray, C. George.  Missed pertussis - still with us.  AJDC 139(July)1985,656.

135. Fine, Paul E. & Clarkson, Jacqueline A.  Reflections on the efficacy of pertussis vaccines.  Rev Infect Dis  9:5(Sept-Oct)1987,866-883.

136. Illingworth, Ronald.  (letter) Skin rashes after triple vaccine.  Arch Dis Child 62(Sept)1987,979.

139. Committee on Infectious Diseases, 1986-1987.  Family history of convulsions in candidates for immunization with pertussis-containing vaccines (diptheria, tetanus, pertussis).  Pediatrics 80:5(Nov)1987,         743-744.

140. Walker, Alexander M., Jick, Hershel, et al.  Neurologic events following diptheria-tetanus-pertussis immunization.  Pediatrics 81:3(Mar)1988,345-349.

143b.Wilkins, Jeanette.  (letter) What is 'significant' and DTP reactions. Pediatrics  81:6(June)1988,912-913.

146. Church, Joseph A. & Richards, Warren.  Recurrent abscess formation following DTP immunizations:  association with hypersensitivity to tetanus toxoid.  Pediatrics 75:5(May)1985,899-900.

147. CDC  Measles-United States, first 26 weeks, 1986.  MMWR 35:33(Aug 22)1986,525-533.

149. Hanebert, Bjorn, Matre, Roald, et al.  Acute hemolytic anemia related to diphtheria-pertussis-tetanus vaccination.  Acta Paediatr Scand 67, 1978,345-350.

150. CDC.  Current Trends Paralytic Poliomyelitis - United States, 1982 and 1983. MMWR 33:45(Nov 16)1984,635-638.

152. McAuliffe, Janet & Wadland, William C.  Pertussis vaccination. AFP (Mar)1988,231-235.

156. Lewis, Karen, Jordan, Stanley C., et al.  Petechiae and urticaria after DTP vaccination: detection of circulating immune complexes containing vaccine-specific antigens.  J Pediatr  109:6(Dec)1986,1009-1012.

160. Mortimer, Jr. Edward A. (editorial) DTP and SIDS: when data differ. AJPH 77:8(Aug)1987,925-926.

163a.Rasch, Deborah K., Wells, Oralia, & Fowles, John.  (letter) Fatal disseminated infection due to poliovirus type 2 vaccine. AJDC 140(Dec)1986,1211-1212.

163b.Chonmaitree, Tasnee & Lucia, Helen.  Presence of vaccine-strain poliovirus in cerebrospinal fluid of patient with near-miss sudden infant death syndrome.  AJDC 140(Dec)1986,1212-1213.

165. Denning, D.W., Peet, L., & Poole, J.  Skin rash after triple vaccine. Arch Dis Child 62,1987,519-511.

166. Wade, Nicholas.  Division of biologics standards: the boat that never rocked.  Science 175(Mar 17)1972,1225-1230.

169. Stewart, Gordon T. (letter) Whooping cough in Hertfordshire.  The Lancet (Sept 1)1979,473-474.

170. see 128

171. see 127

172. Pels, Ivan.  Dept. of Health, Immunization Program, Epidemiology Division, State of Vermont.  Letter indicating exemption rate in Vermont.

173. State of California.  Statistics showing rate of personal exemption for 1989.

174. CDC.  Current Trends Measles - United States, First 26 weeks, 1985.  MMWR 35:1,(Jan 10)1986, 1-4.

175. Linnemann, C.C., Jr., Ramundo, N., Perlstein, P.H., et al.  Use of pertussis vaccine in an epidemic involving hospital staff.  Lancet (Sept 20)1975,540-543.

176. Mortimer, Edward A., Jr.  Pertussis immunization: problems, perspectives, prospects.  Hosp Pract (Oct)1980,103-118.

177. Wright, Pearce.  Smallpox vaccine 'triggered Aids virus'. London Times (May 11)1987.

178. Cherry, James D., Brunell, Philip A., et al.  Report of the task force on pertussis and pertussis immunization - 1988.  American Academy of Pediatrics 81:6:2(June)1988, 939-984.

179. Letters from the other 15 states allowing philosophical exemptions.