The measles outbreak in Southern California has been generously made possible by California law's "personal belief exemption," which allows adults to refuse vaccinations for their children or themselves based on their so-called "personal belief" that vaccines cause autism. Here "personal belief" is extended to include not simply religious and moral teachings -- the question here isn't that religion teaches that vaccination is morally wrong -- but factual errors. This allows people in Orange County, to construe medical fallacies as "belief." So it's time for a short history lesson about Mary Mallon, who went down in history as Typhoid Mary, and her commitment to her personal medical beliefs.
About a hundred years ago, some doctors told Mary Mallon that she was carrying the germs that cause typhoid fever. She had no symptoms, because she herself was immune to the disease (she might have had it when young and survived). But, the doctors told Mary she was a typhoid carrier, one of the first ever discovered,who was infected with the disease and could infect others, even if she never felt sick herself. Mary didn't believe them.
After all, she wasn't sick. She was never sick. She certainly didn't have typhoid fever. So how could other people get typhoid fever, which she didn't have, from her? It made no sense. She preferred that the doctors go about their own business and let Mary get back to her own. Mary didn't believe in the idea of a "disease carrier." More broadly, she didn't really accept the whole germ theory of disease. It just didn't make sense to her.
So Mary just kept on doing what she was doing. Which was working as a cook.
Of course, everywhere Mary worked, numbers of people who'd eaten her food began coming down with life-threatening cases of typhoid, and a few of them actually died. This was how the doctors had originally found Mary and diagnosed her as a disease carrier: she was the one person who had worked in every kitchen involved in a mysterious string of dangerous typhoid outbreaks. But what could Mary do? She didn't understand why this kept happening, but it clearly wasn't her. She was healthy as a horse. She just needed to keep looking for another kitchen job. She kept finding them.
Did I mention that Mary didn't believe in washing her hands before preparing food? Mary didn't see the point. She wasn't sick, so what could happen?
Eventually, Mary was put in enforced medical isolation; the legal mechanism might have been a little hinky, but eventually the authorities couldn't let her keep going from cooking job to cooking job and infecting people. (At least three people Mary cooked for over the course of her career died; there may have been more.) They finally decided that Mary Mallon did not have the freedom to disbelieve the doctors if she was putting public health at risk. Her personal belief that she was not infectious was outweighed by the fact that she kept infecting people.
After a few years of forced isolation, they let Mary out. They had trained her for a new job, as a laundress, which was basically safe. As long as Mary didn't prepare food for people, everything would be okay.
But Mary preferred cooking, and it paid better than the laundry did. So after a while she took an assumed name and began hiring herself out as a cook.
After continued outbreaks, they put Mary back in isolation for the rest of her life. Was this an infringement of her liberty? Certainly. Her liberty was taken away from her entirely, because she insisted on endangering other people. What Mary believed, or refused to believe, was ultimately not the point.
I've been thinking about Mary a lot lately, because of the anti-vaccine movement. Our culture gives a lot of deference and liberty to people's beliefs, and rightly so. But refusal to believe a scientific or medical fact is not a belief. You can believe that God loves everyone, or that the good in human nature outweighs the bad. You can believe that God doesn't want you to eat cheeseburgers or shellfish. But you are not free to believe that mental illness is caused by sleeping in the moonlight. You are not free to believe that eating pork causes leprosy, or that fluoride in the municipal water supply is a mind-control drug. You are not free to treat your child's case of flu with bleeding or leeches. These are not beliefs. These are mistakes. They might be harmless mistakes. But if they grow to the point that they endanger others around you, you lose any right to them.You are not free to smoke in an enclosed public space because you believe that smoking has nothing to do with cancer. You are not free to have unprotected sex after an AIDS diagnosis because you don't believe that AIDS is sexually transmitted. You are not free to drive your infant around in a car without a car seat; medical evidence has accumulated to the point where that decision has been legally taken out of parents' hands.
There is a deep American conviction that we are entitled to our beliefs. But this is true for things that are ultimately beliefs because they cannot be tested for truth or falsehood. "Jesus loves me" or "Our people were singled out by God" are not testable beliefs in the conventional sense. They are choices of perspective. "MMR vaccine causes autism" is not a belief of this kind. It is a claim of fact that can be tested. And those tests have proved it false. We are entitled to our own values. We are not entitled to simply make things up. That was Typhoid Mary's mistake.
cross-posted from Dagblog
He's Poison, Part II
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