Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
The Evolution of Vaccination: Insights from Dr. Bill Campbell on Smallpox, Society, and Vaccine Hesitancy
Discover how the ancient practice of variolation laid the groundwork for one of the greatest medical triumphs in history: vaccination. Join us as we sit down with Dr. Bill Campbell, an infectious disease expert from St. Luke's, to explore the compelling evolution of vaccines from early observations in ancient Asia and Africa to Edward Jenner’s pioneering work with cowpox in the 1790s. Dr. Campbell shares captivating insights into how smallpox shaped societies, the pivotal role vaccines played during the Revolutionary War, and the historical struggles against disease that forever altered the course of human history.
In our conversation, we unravel the ongoing challenge of vaccine hesitancy, shedding light on its deep-rooted history and persistent presence. Dr. Campbell offers a nuanced perspective on public resistance, tracing it back to the mandatory vaccinations ordered by George Washington himself. This episode invites you to reflect on the enduring power of vaccines alongside the societal debate over their acceptance. Don't miss this engaging narrative that combines historical accounts, scientific breakthroughs, and societal perspectives, promising an enlightening look at the balance between public health achievements and individual concerns.
Hi, this is Jason Edwards, and I'm here with my good friend, dr Bill Campbell, an infectious disease doctor at St Luke's. Bill, how are you doing today? I'm fine, jason. How are you? I'm doing well. I'm doing well. You know, something I've been thinking a lot about recently is vaccine hesitancy. You know, the COVID vaccine was a big deal over the past few years, and then they have the booster out and I see people kind of on both sides of the fence making reasonable arguments, and so I thought it would be interesting to kind of delve into the history of vaccines, and not just where they were invented and how they came about, but also the public's reaction to vaccines over time. I think it's valuable if you want to seek truth objectively, with no ulterior motives, to look at how things are done at different places and in different times, to kind of have a better view of things.
Speaker 2:I agree, vaccines are one of the great achievements of our human race basically and probably are responsible for saving and preventing more lives from dying than anything else in modern medicine, more so than antibiotics or anything like that. And they go way back. The first time vaccines were sort of thought about goes back to like the 5th century BC or even AD in Asia and in parts of Africa, and that was because of smallpox. Smallpox came out of Africa I don't remember 12,000 years ago and went up into Asia and into other parts of the Middle East now and some very bright people in India and China and Turkey modern-day Turkey at that time noted that if people got infected with smallpox and boy you know, people die at 10% death rate, maybe higher. But if they got it once they never got it again and they noted that and they could see who had gotten it before, because people who had it had pox marks on their face and everywhere else.
Speaker 2:So they started to do things called variolation that we now call it. Some very bright physicians back then noted that if they took pus from one of the pustules of somebody who's actively infected and stuck it into their skin, they would get sick and sometimes even rarely die. But they always recovered and they never got near as sick as people who got smallpox in the first place. And that made people think that, wow, maybe there's a way we can prevent or ameliorate disease. And then, if we fast forward to the 1700s, it became apparent that this was done and we had a lot of smallpox in Boston and Europe.
Speaker 2:And during the Civil Revolutionary War not Civil War, revolutionary War the losses to men, to smallpox, were outrageous. And George Washington thought we'd probably lose the war because we don't have enough men to fight because of the smallpox. So he ordered general order that every person had to be vaccinated by the same variation of taking pus and putting it into somebody. And it worked and it caused all kinds of upset. Generals didn't want to do it, soldiers didn't want to do it, nobody wanted to do it. There was a huge uproar, protest, but he signed the order and made it happen and it was the first mandatory vaccine that the military ever had and it worked. He had plenty of soldiers and we went on and won the Revolutionary War.
Speaker 2:And it was a couple years after that, in the 1790s, that Jenner, back in England, edward Jenner, saw that women who had cowpox and that was a variation virus when they would milk cattle and they would get cowpox, that they never got smallpox. So he took cowpox lesions and injected into his gardener's son I don't know, I don't think that would pass IRB rules today and then exposed him down the road to smallpox and the kid never got sick. And so that led to modern day vaccination of what we would call an attenuated organism, something that's alive but not like it. Your body sees it, body reacts to it and it can prevent the evil twin when it shows up, causing you disease. And then after that great breakthroughs develop Louis Pasteur, et cetera, et cetera, et cetera the polio vaccine Polio vaccine.
Speaker 2:I remember as a little boy showing my age trucking down, mom trucked me down to get the shot at the local school. So vaccinations really took off and they're very effective. The current challenge is why are people frightened of vaccines? And I get it, I understand. You know, if I get a shot there's always chances of a side effect. You know Guillain-Barre or all that. So I understand that You're asking people to take something that has a known percentage of side effects various percentages to prevent from them getting something that they haven't had.
Speaker 1:Yeah, it's a bargain with the future, right? And if you're that first guy, you know. If you're Edward Jenner's gardener or the first guy in China, you know who they say. And if you're that first guy, you know, if you're Edward Jenner's gardener or the first guy in China, you know who they say. Hey, you're doing pretty good, but let me take some of this pus and inject it into your arm. I think it will work. Understandably, you know there's some hesitancy there, right, are you nuts?
Speaker 2:Yeah, I mean, that's the way I would look at it.
Speaker 1:Yeah, and so that's understandable and I'm going to just quickly go into the biology and then I want to come back to the psychology of it. So the quick and dirty of it is you have an antigen, which is the pus, or an attenuated, which means a weakened form of the virus that gets injected into the system and that's the antigen, and your body forms an antibody towards that. And now you have these circulating antibodies that, if you get infected, they're ready to attack instead of your body taking the time to mount its own response. It's 100 times more complex than that, but that's fair enough, right? Absolutely.
Speaker 2:Well and remember, a lot of infections are caused by toxins that are produced, so that one of the great breakthroughs was the development of taking the actual toxin and changing it Like tetanus, like tetanus and diphtheria Absolutely.
Speaker 1:And so. But okay, so we'll jump back to the understandable hesitancy that somebody would have in saying like I'm fine or my child is fine, and so I can see that for some people, and there's a variability in human nature and how some people are more neurotic than others, some people are more trusting than others. You know, you have all these personality traits that come into it too, and so there's always been a sect of the population that has been hesitant to get vaccines. And historically, you know, one of the most famous people was Benjamin Franklin. His son died of smallpox at a young age and he wrote about, you know, being very upset that in hindsight he did not get his son vaccinated. And smallpox is probably the biggest success story when it comes to vaccines To me it's by numbers, I would agree, if nothing else.
Speaker 2:In 1980, the world was declared free of smallpox, and it's the only time, to the best of my knowledge, in which a disease has actually been eliminated from the human race.
Speaker 1:Almost eliminated. I think the CDC still has a sample.
Speaker 2:There are a few samples, I suspect in various military places, and they do have a sample, but in terms of the general population it's gone.
Speaker 1:Amazing it is, yeah, very remarkable. And then other diseases are. There's very few cases such as polio or measles and mumps and rubella and that kind of thing. So it's not zero and there has been some comeback. And so if we kind of fast forward. So there's been different types of vaccines, whether it's the toxin or an attenuated virus or a live virus or a dead virus. You know there's been different types. And this new type of vaccine is the mRNA vaccine, which has been around for about 10 years. Is that Maybe 20 is when?
Speaker 2:the technology started.
Speaker 1:And then in use, maybe in humans, for the past 10 or 12 years, right, something like that and that. Can you explain briefly how the mRNA vaccine works inside the body?
Speaker 2:how the mRNA vaccine works inside the body. Not easily, because it's a little unclear to me how they actually do this, but basically you can take the genes that are cloned from the virus by growing them in cell cultures. You take the genes out and you can accelerate that through measuring up through polymerase enzymes and you can get this huge measuring up through polymerase enzymes and you can get this huge amount of messenger RNA, which is what you're working against for the immune system, and that gets injected in. So you're giving a really very specific small amount of basically genetic material, messenger RNA into the person and then it goes from there.
Speaker 1:And so for the non-biologists out there everybody your DNA is your genetic code and every cell has almost the same genetic code, dna.
Speaker 1:But the cells in our body are different. Some cells turn into fingernails and some turn into eyeballs. Cells in our body are different. Some cells turn into fingernails and some turns and turned into eyeballs, and and the the reason that is is because different parts of that code, which you could look at as like um, uh, you know it's, it's this, this unchangeable um, uh, uh strand of of, uh, bases, but think of it as a code gets turned into MRNA, which then gets turned into a protein, and that protein helps kind of define what the cell is, whether it's what type of cell it's going to be and the functions of it, and so it doesn't change the DNA, but the mRNA comes in and it forms directly into a protein through the ribosome. And so maybe that complicates things, but just for the people who want to know that, that's the process it doesn't change the dna, it just gets directly transcribed and put to a protein.
Speaker 1:Um, and the protein for the covid vaccine was the spike protein, correct? And so now you have the spike protein circulated and that's the antigen that your body forms antibodies against Correct and I don't know the rationale for doing the mRNA, but to me is it speed. Is that the advantage of an mRNA vaccine, that you're able to develop a vaccine quickly?
Speaker 2:That's one of the major things. It's just incredible how fast you can make these vaccines. We have a vaccine for Ebola virus that was a messenger RNA and the reason it was never directed out is because the disease went away. It's not necessary, so it's now frozen, ready to go. And that's what's extraordinary about this technology A new virus or a new infectious disease, pathogen arises, and we can quickly train the body's immune system to recognize it and defeat it and prevent it from infecting us.
Speaker 1:And so to give a little bit of historical context that everybody's aware of the when the virus spread from Wuhan to Italy and then to Spain, if I remember right, and then to New York City. I mean, of course it spread in a lot of other places, but those were the big outbreaks and I remember listening to podcasts and doctors talking about how out of control this was. I mean, the medical staff trying to take care of the patients were getting sick and it was just pure chaos. And my wife is an ICU doctor and so she's taking care of these patients, you know, when they get to St Louis. But it seemed to me like the virus kind of weakened. This is my perception, I could be wrong. The impact was not as bad once it kind of moved beyond New York and maybe Seattle, that the death rate or the hospitalization rate was not as high. But am I wrong on that? I could be wrong.
Speaker 2:Close, but a little bit Only because, remember, the virus mutates remarkably quickly, yeah, and so we've had other surges since then. Omicron was really quite a surge, but we're doing so much better treating people. It used to be. If you went into the hospital with COVID the first six months of the epidemic, we had death rates of 70, 80 percent. It was just extraordinary, and I'm going to brag about St Luke's Ours were some of the lowest death rates in the nation. That's how good our physicians were in learning and adapting to it. And as each mutation wave went by, there seems to be a lessening of the severity of the disease, and I suspect it's a combination of more people have seen the infection or more people have been immunized or both, and our immune system is better in tapping it down.
Speaker 2:We have a fair amount of them going out now, but very few coming into the hospital.
Speaker 1:And that's good news, great news. Historically too, not always, but in general viruses tend to mutate over time and typically the virus gets weaker over time, but not always.
Speaker 2:That's correct. It's a random game, the mutations and occasionally they will have a random mutation that makes things a whole lot worse. Random mutation that makes things a whole lot worse. Influenza B is wonderful in that way because of its genetic drifts and shifts and all of that. So we always have to be on guard for it and that's why we have boosters that come out every year and people will notice if I got my flu shot, it seemed to work well this year, but it didn't seem to work well the following year when I got it, and that's because it mutated a little more differently than what was predicted it would do, so the vaccine just wasn't a good match.
Speaker 1:And it's an educated guess.
Speaker 2:It's an educated guess.
Speaker 1:So when we look at the vaccine rates in the United States this is from the CDC it looked like 68% of the population in the United States got the initial two vaccines, and then it was 33% of patients or people in the population who got at least one booster which is actually, to be honest, lower than I thought got at least one booster, which is actually, to be honest, lower than I thought. And then the latest vaccine for all comers, all ages combined 17% have received the bivalent vaccine. And so you're seeing I think this makes sense that the severity of the disease has decreased and so the amount of the percentage of the population getting vaccinated has also decreased. And that's kind of what you would predict.
Speaker 2:I would agree with that 100%. The other thing is that the consequences of getting COVID now is oh so-and-so. Had COVID, they took some Paxlovid and they were sick for a few days and they're back at work or feeling well, as opposed to back in the different many generations ago when somebody got polio yeah, and it was terrible, and so that was a visual reminder about how horrible polio is and I'm not about to let my child come down with polio.
Speaker 1:Yeah. So it's a value analysis and you have as a data point somebody you know or somebody you've seen with your own eyes, and so it's not a mystery, it's not a mirage. You've seen it with your own eyes and so it's easier to believe that.
Speaker 2:That's absolutely right. My first cousin. She got polio one year before the vaccine came out and lost the ability to move her whole right arm. With time she regained the ability to move her right arm and you wouldn't know. Now, looking at her, actually, kind of an interesting side of Okay, okay and she's a teacher and would stop, pick up the chalk and then continue with the other hand and it looked absolutely the same. That's just showing off. That's showing off. But it was a visual reminder about that. Polio is not a joke and of course the president of the United States had it and everything like that.
Speaker 1:Yeah, and so I think part of the hesitancy that is now, you know, that is kind of more ever present. I think I think vaccine hesitancy is maybe at an all time high. I've heard that people are starting to not vaccinate their dogs and you know you need rabies vaccines and stuff like that for dogs. It's not for COVID, you know, it's for. You know serious things rabies, pseudo rabies, pseudorabies, a whole slew of other things and I think it comes down.
Speaker 1:I think people make decisions based off the data points that they have.
Speaker 1:And I see this in the clinic. I talk to patients about radiation for cancer and how it may decrease their risk of cancer in the future and they'll say, well, somebody from my church had radiation and this happened and it may be a side effect that's not bad at all, or really bad, or you know something and I'd say that's one data point. You know, in my mind I've got thousands of data points and like I'm going to tell you as honestly as I can points and like I'm going to tell you as honestly as I can. But I do think that you know, when I read online and you know, see what's out there on social media, I think that people have not a lot of data points and there's a little bit of a credibility crisis with the news in that I think people trust the news less now than they used to. Maybe even with the government. I think people may trust the government less now than they used to. Whether that's warranted or unwarranted, I think those things exist. I was going to agree or unwarranted.
Speaker 2:I think those things exist. I was going to agree. I mean, this is, it's been an. The COVID epidemic has been very interesting. I hate to say it in a kind of a rational way, but the vaccine hesitancy has exploded, as you say, to other vaccines. So we see people with their children not getting HPV vaccines, human papillomavirus vaccines, which prevents cancer, my goodness, and I think and I'm not an expert on communications or anything like that- and.
Speaker 2:I don't. I'm probably one of the few doctors that's not even on LinkedIn but social media allows people to just grab data from anywhere and, whether it's correct or just flagrantly false, it will feed a preconceived notion that they have. I mean, we are an interesting human species. Back in my teenage years you know it was Walter Cronkite said this and that's who everybody listened to, and of course, he's going to tell us what to do, and now people pick and choose what they want to listen to. So they aren't done that way and I think that's something with it. I think it's interesting and I don't. And I think that's something with it. I think it's interesting and I don't. I never talk politics in the office or anything.
Speaker 1:We can lightly talk politics here. Ok, that's OK.
Speaker 2:But it is interesting how, if you look at zip codes that are more Republican dominated versus Democrat dominated, it correlates with vaccination rates, I think.
Speaker 1:I think that's I think that's fascinating. The factor I saw that correlated the highest was income, and so you saw in rural counties that were poor, they had a lower vaccination rate. And then in the urban core, you saw that as well, um, and then in the urban core, um, you saw that as well, but before COVID, um, it was actually, um, uh, the people who are the most vaccine hesitant were actually educated to some degree, I see, and so so there's a lot of variables at play here. Right, I? Now, this is just, this is just um one take on it.
Speaker 1:Um, when it comes to the federal government, the federal government does a lot of things. They do a lot of things, and it's a big organization, and any organization is going to have some people in it that are dishonest, that are not purposely dishonest, but say things that are untrue, based off orthodoxy, like that's what they were told, and so they just repeat it, and that happens, actually, in a lot of things. And so the federal government's a big entity and I do think that they get most things right, but there are some things that they've gotten wrong. The Tuskegee experiments went on for years and years, where they took, I think, mostly African-Americans from the South and they had syphilis and they didn't treat them with it, even though they knew they had the cure for it, and followed them as a scientific experiment. You have things like MKUltra. These are not conspiracies Like MKUltra. These are not conspiracies. These are things that are proven to be true, where the CIA was giving people LSD and other drugs and not necessarily explaining to them what they were. Edward Snowden got in trouble for exposing that the US government was spying on their citizens, and I don't know all the details of that, but I mean, these are things that erode trust, and it doesn't take that much to erode trust. With COVID specifically, there were.
Speaker 1:One of the things that made me skeptical was there was a Lancet paper that came out in May of 2020 that was soon redacted just about two weeks later, showing that hydrochloroquine increased death rates. And then it came out and this was in the Lancet. One of our best journals in the whole world should be scrutinized to the highest degree. This is science. People started to look at their data set and they actually didn't share their whole data set and it came out that they had falsified data, or that was the presumption is that they had falsified data and so that paper was redacted.
Speaker 1:And I think you have people with ulterior motives and you have people who are ideologues. They may even think that they're doing something good by telling an untruth, you know, a white lie, so to speak, and that erodes people's trust. The CNN saying Joe Rogan is taking, you know, horse medicine, you know, with the ivermectin, which me and you know ivermectin, which me and you know ivermectin can be used for horses, but it's also used clinically and it's not the same preparation for an antivirus. And so things that are, you know, seem to be willfully untrue and that ultimately decreases people's trust in these things and increases hesitancy. And so sometimes I think you know the same people who are saying why are people hesitant? It's because what them or their colleagues have done, that have added to that, which is horrible. And you know, if you, I think, as a human being, if you're trying to orient your life in the right way, start off with never telling a lie, because it makes things chaotic and there can be real world consequences from it. And so I don't know that's that's. That's not the complete answer, but those things did not help things and it makes people more skeptical and people, I think should be skeptical, but to a reasonable degree.
Speaker 1:You know, the science is about skepticism. Nicholas Copernicus, you know, said, hey, I think the sun might be the center of the solar system, not the earth, and I don't know if he was killed for it, but he probably was. And then I think Aristotle kind of did the same thing, and and, and he wasn't. Uh, they didn't kill him, but they, they banished him. And so you know, a good scientist is skeptical. But you have to, you have to have a reasonable skepticism. And when I'm searching for truth, I I think you want, like we talked about earlier, you want to look and see have things been done over decades and been proven to be true, you know, as far as we can tell, and have they been done in different places by different people, and that can kind of weed out the ulterior motives and that gives you a stronger sense of what's true.
Speaker 2:I agree. I mean human beings are. Homo sapiens is an interesting species.
Speaker 1:No doubt about it.
Speaker 2:I kind of always start from there, and you know, even we now know, when they opened his papers they were sealed by the French until I think, about 30 years ago, louis Pasteur did some fudging, and it's like Louis Pasteur, oh yes, but you know, he needed a job, tenure, things like that going on. He had political rivals Nothing, I mean, everybody has political rivals. But you know, universities are really very good at that, and so I agree with you, you have to give time and see, and also, people just make honest mistakes, pure honest mistakes. I've done that many times. I think the other thing that was more unique to this is that because it was such a rapid epidemic that went all over the world quickly thanks to jet airplanes and the fact that a lot of countries put a lot of resources shifted into the study of this terrible disease appropriately so and we had new technologies, many of which are still available. Cutting edge is this good technology. We were flooded with information In 2022, there were like 140,000 or something scientific papers.
Speaker 2:Well, nobody's going to be able to read all that, and so I depend upon other people to read them for me, or at least a segment of it, so that when somebody tells me how a certain antigen binds, I have to trust them, and so I agree with you. And they may be wrong, maybe they put the decimal point in the wrong place but that huge amount of data coming in and the system is overwhelmed and people don't review articles quickly because now we have what is it called? The preprints that come out and it's it's a. It's a difficult time, and so I agree with you. All you have to do is sit and try to wade through it and hopefully different, different labs in different countries come to similar conclusions and from similar observations.
Speaker 1:Yeah, yeah, yeah, that's a good point. I mean it kind of came fast and hard. And you know, looking back, one thing I see a lot of is people saying I wish I would have never gotten the vaccine. I see that out there and that's easy to say when you're on the other side of it and you didn't get hurt and you know you didn't get sick and me and you both know physicians and coworkers and patients for sure who got very sick, and so it's easy for people to kind of lose that perspective and forget. And it was pretty rough it was. And it was pretty rough it was. And I think when I look at the numbers, you know 70% of the people got the initial two, or 68 got the initial two shots and it kind of trailed off. That makes sense. And I think if you look at these numbers too, the people who are the most vulnerable, you know probably were vaccinated at the highest rate, certainly by age, and then comorbidities was a big, big part of this too.
Speaker 1:That's correct and so what I understand. If somebody was 20 years old and completely healthy and said you know what, I'm not getting the booster, you know you can make an argument to get it. And if you did the best value analysis you could which you can't always have all the information, but with the most information you could, you know it's not an insane risk to not get it. As a 20-year-old it still may be worthwhile in the overall. If you have 10,000 20-year-olds, that group is probably going to do better compared to 10,000 20-year-olds who don't get the vaccine, but the difference should be relatively subtle.
Speaker 2:I agree with you and the way I address that is that I tell the 20-year-old look, I just don't want you to come down with it and give it to your grandmother. So it's more of a community health statement than an individual statement. As opposed to an 80-year-old with underlying heart disease, lung disease, I want you to get that vaccine.
Speaker 1:Yeah, yeah. So one thing that you touched on earlier is we talked about when they did the early trials and how, you know, when they injected the Gardner with vaccinia, edward Jenner, you know, back in the 1700s that there probably was not informed consent, and informed consent this you know, it's like what's that? That's when. That's the paper you sign before. The paper you sign is saying that you had informed consent when you have a procedure, the paper you sign is saying that you had informed consent when you have a procedure.
Speaker 1:And that whole process started to me it seemed like really with court cases in the early 1900s. You have stuff like Henrietta Lacks, who you know. She was a lady with cervical cancer and they took her cervical cancer cells, yeah, and they didn't tell her about it, they just said we're going to take these cells and they, they used them for research and these, these cells are now all over the world. They're called HeLa cells, named after her name, henrietta Lacks, and and so the same cells have been growing in culture dishes all over the world for you know, for decades, and but there was never any informed consent for her to give that. And there's cases where you know somebody you know said they were going to have a C-section and they did a hysterectomy too and they didn't tell the patient and the patient wasn't able to have a you know babies. After that, and and and and that went to court and so you had some case law kind of preceding it. But then the real kicker, I think, was the Nuremberg trials, where they said, hey, they looked that we want to use before. You know, these are. Informed consent is something we want to do before we have somebody do some procedure or some medical experiment. And one of the things that they said was crucial was non-coercion. You can't coerce somebody to do something. They have to do it on their free will.
Speaker 1:And something that comes up with vaccine mandates is if it's a mandate or if they say you'll lose your job for it, that's coercion and so it violates informed consent. And this is kind of a medical, ethical, political, you know argument that somebody could look at. And I think it's interesting because you know vaccine mandates were there before and they'll probably be here again and there's a precedent for them across time. And my view is it's reasonable to mandate a vaccine just like George Washington did. It's reasonable to mandate a vaccine just like George Washington did. But you have to acknowledge that you are violating informed consent, which we've kind of deemed a very important thing, and so it better be worth it. If you do make a vaccine mandate, I think there's probably a time for it, but there's also a lot of responsibility that comes with that, and I don't always know if everybody who makes vaccine mandates has kind of reverence for that history, like that's the history behind it, and so I don't know what are your thoughts on that? Do you have a take?
Speaker 2:Well, I agree with you. In fact, I happen to be also chair of the IRB here at St Luke's Hospital.
Speaker 1:That's the Institutional Review Board.
Speaker 2:And we run St Luke's, we run a lot of investigational clinical trials and so our job is to approve of them and it is interesting when you read the permission slip for people to participate. It's very well done and carried out and I agree with you. I mean this is just a growth of the modern, appropriate growth of the modern era. And so I go back to mandatory vaccines. And you're absolutely right. I mean when a patient comes into St Luke's Hospital, we have to care for that patient with all reasonable process that we don't give them influenza when they come into the hospital. We don't do that. We don't give them infections with Clostridioides difficile, and so we do those things. And if that involves vaccinating employees, cdc and everybody recommends that and that's always been upheld and I think that's the right thing to do we have to protect our patients from becoming ill right thing to do. We have to protect our patients from becoming ill and we take reasonable precautions If somebody has a true contraindication.
Speaker 2:I sign off on that. I think the other thing that you point out is really very important too is that is with children. When a children is getting measles, mumps, diphtheria, polio and all of that, the parents have to sign off on that. And boy. I would thinking of the child's welfare. What do we as the state have to do to ensure that the children are safe? And so how do we overrule a parent's decision? I don't want any of my kids to be vaccinated. And you go, well, obviously you sit down and you talk and try to persuade and all of that, but I think that's a difficult situation.
Speaker 2:You bet, and I don't have an easy answer for it. I know that some states won't let the kid come to school if they don't have their shots, and one of the best states for that is Mississippi, so Mississippi has one of the better vaccination rates the last time I checked yeah. As opposed to California, you know.
Speaker 1:Really, this is an argument that's been going on for a long time.
Speaker 1:And it's not about really vaccines. It's about what kind of society do we want to live in. Do you want to live in a society that has kind of a utilitarian view? Do you want to live where you try to do the best for the most people? But some people, will you know, things may not be great for them, but overall it's kind of the best for everybody. That was a viewpoint that some politicians or theologians had for a long time. You could live in a totalitarian society where you know a few people tell everybody what to do and even if those people were good natured, they're probably going to be wrong more often than kind of a group vote, and so that tends to not work out as far as countries.
Speaker 1:And then there was a guy that came along named John Rawls who came up with this theory called original position, and what he said was you need a veil of ignorance, you need to look at yourself as if you haven't been born yet. You don't know who you're going to be born to. You don't know who you're going to be born to and then now, before you're born, make the rules that you think would be best for society. And it's a trick it makes you not consider how something would benefit you because you don't know where you're going to be at in society, and that's, I think, really how, in a large way, how modern politics has kind of moved forward, to try to say what's kind of a irregardless of my personal position, what's kind of the best way forward, and you're never going to make a large policy decision that everybody's going to be happy with. I mean, that will not happen. It's a super complex problem for vaccines, for health care, but for anything that we try to do as a society. And there's a famous quote for every complex problem there's a simple answer. That's wrong and politicians are great at that, right. Well, here's the answer, right here.
Speaker 1:And you know, problems are complex and they're more complex than you think they are, and it's a complex issue, but I think talking about it, trying to be respectful of people when we talk about it, and trying to seek the objective truth, the best we can is it can be a difficult thing, you know, especially as a parent. You're concerned about your kid and you're talking about all these things. There is something called a heuristic where you're never going to have all the data but you still have to make decisions. And a good example is you know, if I'm at the park with my kids and it's a bright, sunny day and all of a sudden dark clouds come rolling in and I hear thunder and the storm sirens start going off, I don't see a tornado, but I don't need to see a tornado. You know you're never going to have all the information, but sometimes you have enough to make a good decision, but sometimes you don't. You know, sometimes it's tough, but sometimes you don't.
Speaker 1:Sometimes it's tough, but you've got to seek out accurate information and you're never going to have everything, but you've got to get the best information you can to make the best decision for yourself, whatever it is and I think it certainly applies here, and I think your initial statement is very true you know more than antibiotics, almost more than anything. You know vaccines have saved more lives than anything. It's okay to be skeptical. You should have some degree of skepticism, but you don't want to be a Descartes-type skeptic where you're saying are we even here? How can you prove? I'm in this room right now, because that's not a reasonable skeptic, that's trying to reach a real conclusion. Well, bill, thanks so much for joining me.
Speaker 2:Thank you my privilege. I've really learned a lot. This has been terrific.
Speaker 1:It's always been fascinating talking to you, just like your English name suggests, always polite and a true gentleman, and so I appreciate you, buddy, it's Scottish.
Speaker 2:Oh it's.
Speaker 1:Scottish Okay, okay, well, actually, it's Kentucky. Oh Scott, okay, okay, well, actually it's Kentucky. Okay, so I rescind my compliment. All right, thanks so much, buddy. No, thank you very much.