Starting With Curious

One of my favorite books is Ovid’s Metamorphoses, an epic verse collection of some 250 myths of transformation – Daphne turning into a laurel tree, Pygmalion’s statue into a woman.  I’ve always been fascinated with these stories, and the question of transitional stages.  When does Arachne stop being a human and start being a spider?  When did my sons stop being boys and become men?  At what point on the state line have I left Wisconsin and entered Minnesota?

As I go through my own major career and personal transition, I suppose it’s natural to be ruminating a bit on this. Transitions are hard and generate complex emotions.  I’ve heard the word “bittersweet” far too many times in the past few months, but I haven’t really come up with an adequate substitute.  For many of the figures in Ovid’s work, transformation was forced on them and it’s all downside.  There’s nothing bittersweet about being turned into a boar by an angry sorceress.  In my case, leaving Children’s Hospital of Wisconsin for Children’s Minnesota was a choice, and not an easy one.  I have treasured many things about my over 16 years here, both the many individuals I have come to work with and know and love, and the organization as a whole.  Many organizations have a statement of values; few truly live them.  CHW is one of them.  I will miss it here.

Looking ahead, I am heartened by the fact that my new professional home appears to be every bit as values-driven as my current one.  (Actually, that was a prerequisite to accepting the job.)  And I’ve discovered a one-to-one mapping of the values.  At CHW our first value is Purpose, acting in service to patients and families.  In Minnesota, it’s Kids first.  Collaboration translates to Join together.  Integrity is encapsulated in Listen, really listen and Own outcomes.  And finally, the Minnesota value of Be remarkable – defined in part as “We are innovators, reimagining health care and going beyond what’s expected” – corresponds with the Wisconsin values of Innovation and Health, or being at our best.  No wonder it feels like such a great fit!

So back to that question of transformation – when do I stop being a Wisconsinite and start being a Minnesotan?  (Let’s leave sports teams out of this: I will continue to root for the Packers and Badgers.  Full stop.)  Perhaps that’s an irrelevant question.  One thing we’ve learned as a society in recent years is that many seemingly categorical things, including race and gender, are less discrete and more fluid than previously believed.  Maybe Arachne kept part of her humanness even when she transformed into a spider.  My sons are no doubt both boys and men.  And I’ll undoubtedly carry some of Children’s Hospital of Wisconsin with me to Children’s Minnesota.

When you go to a beach or a gym or somewhere else with bare upper arms visible, you’ll notice fewer and fewer people with the characteristic scar those of us born before 1972 have.  That’s the year routine smallpox vaccination was stopped in the US.  In 1980, the World Health organization declared smallpox globally eradicated.  I still recall the awe I felt when just a few years later I saw a movie about the effort to wipe out smallpox in my first year of medical school.  A disease that had once been a routine, and terrifying, part of human existence – outbreaks literally changed the course of history, and as recently as the 20^th century smallpox caused an estimated 300-500 million deaths – was gone.  Gone.  All thanks to a relatively simple, and inexpensive, vaccine.

Efforts to prevent smallpox were reported as early as the 10^th century in China; the modern approach to vaccination was introduced in 1796 by Edward Jenner.  Yet real progress in eliminating this scourge did not occur until mandatory vaccination began to be introduced in England and the US in the mid-19^th century.  The reason is that smallpox, like many other highly transmissible infectious diseases, requires only a small number of susceptible individuals to remain viable in a population.  Unless everyone, or nearly everyone, is immune (either from prior infection or vaccination), the disease will persist and rear its ugly head as immunity wanes over time.

Fast forward to 2017.  Smallpox is gone, but other potentially epidemic diseases like measles remain.  And in our current climate of alternative facts and science denial, vaccines are under suspicion, raising the specter of a resurgence of dangerous, yet easily preventable infections.  There are two underlying issues, one scientific, and one philosophical.

First, are vaccines safe?  That’s easy.  Yes.  I’m not saying they are 100% risk-free.  There are rare serious reactions such as allergy or Guillain-Barre syndrome, and common but minor side effects like soreness and fever.  But numerous studies have shown that vaccines are at least as safe as almost every other medical intervention known.  And some of the more sensational claims – such as the link between vaccines and autism – have been utterly and thoroughly debunked.

Second, are mandatory vaccines justifiable?  In a free society, shouldn’t people have the right to refuse to be vaccinated for religious or other reasons?  That’s not as easy a question, but in my mind the answer is no.  In the phrase “free society” we tend, in modern America at least, to put too much emphasis on the “free” and less on the “society.”  Living in community with others always requires a balance between individual rights and societal responsibilities.  We accept that we all have an obligation to obey laws that are justly enacted.  We can’t harass our neighbors with loud noises or noxious odors.  We agree to all drive on the same side of the road, and not to get on the road if we’ve had too much to drink.  Why?  Because, as the saying goes “your right to swing your arms ends where my nose begins.”  By living in civil society, we agree to limitations on our individual rights for the protection of the health and safety of others.  Vaccines are the ultimate example of this.  Vaccines not only protect the health of the recipient, they also protect the health of others in the population as noted above.

Allowing individuals to forego vaccines in the name of personal liberty could be justified if the risk were limited to that individual.  But it is not.  If someone wants to enjoy the benefits of society, they need to bear the responsibilities, including the responsibility not to be a reservoir of illness to others.  To paraphrase Oliver Wendell Holmes, Jr., vaccines are the price we pay for civilization.