Friday, March 20, 2015

Musings on Vaccines

The vaccine debate is important to me. 

I have spent a considerable amount of my time, money, and energy to train and work as a doctor, largely because I genuinely care about helping people, especially those who are most disadvantaged (i.e. children from poor minority-ethnic families). Generally speaking, I am persuaded that  vaccines are one of the best means to this end. The vaccine debate is about more than just vaccines though. Its about how we as Christians interact with the health-care system, indeed with any secular system. I think more damage than good has resulted from those who are publicly anti-vaccine, and even MORE damage results from those displaying unhelpful attitudes (even if their vaccine-specific rhetoric is more 'moderate').

Below are some of my musings :) 

Just a few points to note before we begin. Obviously there are legitimate concerns about vaccines (and about the secular health-care system) that need acknowledging and addressing. And despite (mostly) exemplary motives, the health care professions do frequently fall short of the high ethical and communication standards society sets for them. And Christians do have a complex mix of responsibilities that are difficult to balance - which includes a responsibility to think and act differently within the world. This is far from a complete discussion on vaccines, and my aim is mainly to provide some balance to some specific biases I believe already exists. So I won't be delving into the legitimate concerns I acknowledge above - but I'm happy to discuss them if they become relevant in the comments. Also, these musings belong to me and do not officially represent any professional consensus (though I think it closely matches the medical consensus). 

I would like to see a robust discussion in the comments! We're all in need of ongoing learning, and even if our beliefs remain unchanged, I would like us all to become more understanding and empathetic of those who disagree with us. 

Ultimately I just want Christians to be able to navigate this issue well, while remaining Christlike, and without damaging the health of the most vulnerable in society.


Refusing vaccines and promoting refusal is not a benign 'natural' decision - just like 'vaccines' are reported to do, refusal has potential to contribute to diseases and death in children, particularly amongst the most deprived. We can't hide behind the excuse of 'not rushing into an unjustified decision', since both are decisions claiming huge consequences. 

And we can't hide behind our individual isolated 'rights' to choose - we also have ethical responsibilities to those around us. The effects of vaccine refusal on our community is not spread by disease, but by rhetoric and attitude as well - and so our responsibilities to others require us to take all these things seriously.


We all take informed risks all the time (think about driving a car). Acknowledging risk in no way makes a decision a bad one. And 'risk' has a pretty broad definition when it comes to contemplating different choices - this is important to remember when considering the alternatives to a choice that is deemed risky (i.e. taking vaccines, or driving a car). The 'risk' of NOT driving your car, for example, includes having less time free to work and play and do household chores, and being unable to attend your favourite band's concert in a neighbouring city. Refusing vaccines carries its own risks - not only to you, but to others - and not only of risk of disease, but of spreading ideas and attitudes and rhetoric. People have a right to make their own choice between the various risks, and other members of their community also has the right to ask them to behave in a way which (they think) maximises the wellbeing of the community.

We should never take any risks based on fear or pressure, even if your decision may happen to line up with what's best - don't take vaccines based on fear, but equally don't avoid vaccines based on fear. The motivation behind the legal requirement to interview adolescents away from their parents, and parents away from each other or their midwife / friends etc, is to remove very common external pressures. Its the motivation for 'probing' into the reasons for refusal. People are rarely emotionally coerced into choosing vaccines (though it does occasionally happen, unfortunately) - but this is a common reason for refusal. Obviously it is difficult to achieve freedom from emotional coercion - while still providing information - when one believes there are serious risks behind various choices. But we need to try.


The best chance of making an informed decision about risk, is to trust the summaries provided by those who have trained hardest to interpret the evidence and provide such summaries, and who are genuinely motivated by your wellbeing without being too emotionally attached. 

Extensive training is required to make any progress in avoiding our ingrained human biases and interpreting evidence properly. Even with extensive training, it is a headache to navigate these turbulent waters. Its not a simple matter to 'reading' studies or personal anecdotes. We are designed to jump to conclusions quickly, and from that point on to doggedly (subconsciously) interpret the world in a way that supports our conclusions. We can be drastically unreasonable about this. We can't avoid it altogether (doctors suffer from the same human condition), but at least we can minimise it through training, and through maintaining some level of emotional objectivity.

Attempts at providing information for informed risk-taking should avoid the converse problem of information overload. If doctors find it difficult to interpret that evidence, how do we expect those without training - or those with emotional investments - to do so properly? Often people react to this overload by making a decision they deem as a 'natural middle ground' - which actually means sticking with their pre-existing position i.e. vaccine refusal. 

This is why doctors find it difficult to provide 'evidence' for vaccines to concerned parents. The evidence is not simple to navigate (anyone who claims otherwise is lying), but this doesn't mean that conclusions can't be drawn which are overwhelmingly supported. And they have to navigate parental emotional investment, an inclination to refuse vaccines when faced with information overload, and powerful vaccine-refusing rhetoric (claiming that their evidence IS straightforward).


The supposed tension between 'modern experimental' medicine and 'alternative' medicine is an illusion - all foods, drugs, and treatments have a degree of uncertainty associated with their effects, but this doesn't mean reasonable conclusions can't be drawn from the evidence. Honesty about the evidence is what leads doctors to recommend what has come to be known as 'modern Western' medicine, over alternatives - there's just more evidence available for the former. Our conclusions about modern medicine are actually more robust than those that can be formed about alternative approaches to health - even IF those conclusions end up being are a complex mix of negative and mildly positive effects. This doesn't mean we've found the best treatments - it just means that, with the greater body of evidence, we can make more certain claims. Homeopathy and vaccine refusal may end up with greater health benefits than vaccines, but they can't meaningfully talk about it because they don't have as much data. Unfortunately money does drive most research, so it is difficult to gather data about treatments that can't be patented - but this doesn't change the fact that we have a better chance of being right about our conclusions regarding modern treatments, than about any claims from alternative medicine. 

Money can cause most people (not only doctors, but alternative treatment proponents as well) to become untrustworthy, including doctors. NZ has one of the least medical biased systems in the world precisely because the money side of things is removed from the picture. The politicians deal with money and advertising and purchasing. This means doctors are restricted in which treatments they can offer, but this is a reasonable sacrifice for the benefit of being free from monetary pressure and advertising bias. We are free to act based on our genuine concern for people's welfare. This is why we recommend vaccines. There is nothing more sinister going on - for most of us as individuals, anyway. 


The 'side effects' of vaccines have always been exaggerated - but they are gradually getting minimised by the accumulation of evidence. By far the majority of concerns regarding vaccines have been systematically and thoroughly disproven as we gather more data, and the position in favour of vaccines becomes stronger and stronger. There are still some unanswered questions and uncertainty - particularly surrounding newer vaccines - but the track record of allaying fears is encouraging.

Studies that demonstrate side-effects are often poorly designed to produce bias. Or, when incorporated into the big picture of all the OTHER evidence available, they don't produce significant results. Many of the studies are also taken out of context and interpreted in a way that was never intended - for example, most countries have a system for reporting adverse effects to medicines and vaccines. Even when legally 'mandatory', the data collected is still ultimately volunteered by health professionals or patients - so the system is automatically biased to collect data confirming patient's suspicions. There are no measures in place to confirm the validity of this reporting, or to discover the 'real' incidence of such 'adverse effects' in the vaccinated / unvaccinated populations. These systems can highlight areas for further robust research, but they can't produce conclusions on their own because of the rampant bias.

An important consideration is incidental correlation (as opposed to causation). People really do just randomly die, have seizures, develop influenza, get early menopause, have headaches and nausea, etc - all for no apparent reason. A certain proportion of vaccine takers will also have these things, but not caused by the vaccine. But those that occur after vaccines will get noticed, remembered, and reported (unlike many of the others). This is especially true for childhood vaccines, which are given around the time that such symptoms / effects can become obvious (e.g. learning disabilities, epilepsy, etc), leading to the assumption that the vaccine was causal.

Vaccines can contain heavy metals, but at lower concentrations than many foods. They contain immune-stimulating molecules (some call these 'toxins'), but vastly fewer than what babies encounter through their normal external environment. Very few vaccines have any link to human embryos, but some do require normal human cells to culture - these cells are almost always obtained from replication after replication stemming back to two aborted foetuses decades ago. They are normal human cells, the don't make their way into the finished vaccine product, and no further embryos are aborted for vaccine development or research.


There has been recent debate over the HPV vaccine, a relatively new vaccine which differs to most others in that it doesn't prevent a nasty childhood disease. It prevents infection with the HPV virus - a sexually-transmitted virus which is the major cause of cervical cancer. So the vaccine prevents adult cancer which is typically seen as a consequence of behavioural choices - hardly the virtuous image of vaccines we typically recognise. Because it is new, we have less data available for this vaccine than for other vaccines. And we are still learning (as we should) about the full effect of the vaccine - both positive and negative.

Some take issue with the idea that children are vaccinated to prevent an STD. Why assume they will contract the disease? Why not aim for abstinence until marriage instead? However, HPV is NOT a disease only of sexual license - any number of partners >1 can pass it on (and likely will, given that most people are infected). It can also be passed on without sexual contact. And multiple 'partners' doesn't necessarily equal immorality - think of divorcees, remarried widows, victims of abuse, and those used to live in sin but have now repented. Its not that we're questioning a child's morals - we're trying to protect them from future worry.

NZ cervical cancer rates are very high (internationally speaking). While the numbers may seem small, the risk of cancer needs contextualising - its higher than the risk of dying on our roads. This priority of cervical cancer probably resulted in more 'rush' for the HPV vaccine than for other drugs/vaccines. But this doesn't make the rush unreasonable - we just need to inform parents that there's slightly more uncertainty about its effects.


Christians are called to love, gentleness, submission, grace, humility, and a focus on the good God has preserved in society. Whereas in-submission, speaking your mind too quickly, being prideful about your viewpoint, and not giving people the benefit of the doubt is seen as anti-Christian. There's no simple formula about how to integrate these things with our commands to be wise and to stand against injustice and societal evils. But its something we should feel the weight of. This should come through our discussions.

The rhetoric I hear around vaccines all too often demonstrates the opposite - we don't 'feel the weight' of getting our attitudes right. We just blurt our minds out. We just assume we (somehow) know better. We automatically distrust others. We are happy to use misleading rhetoric (choice of words, selective reporting of facts, distraction techniques, etc) to maximise the powerful effect of our opinions till it is way out of proportion to what they deserve. For example, doctors aren't out to 'bully' you into taking vaccines, or to 'experiment on little girls' - we genuinely want to help. But stating the facts (we try to talk to pre-sexual girls away from their parents about the vaccine in order to minimise emotional coercion) just doesn't have the emotional impact. Would Christ be pleased with such rhetoric? Does it display Christ-like attitudes? I don't think so.

What frustrates me most is that displaying these opinions on the internet contributes to much of the devastation I have to deal with daily, and makes it more frustrating and difficult because the people I'm trying to help don't trust me. Those most affected by these opinions are the poor and disadvantaged - something people often don't realise when they make such statements.

Obviously I need to have the same attitudes in my promoting of vaccines. That's something I'm working on :) Hopefully the discussion in the comments below will be help!

Saturday, March 14, 2015

Faithfully Valuing the Limits of Scripture (PART 4 - MORALITY & EVIL)

So far we've discussed the impact of our (extra-Biblical) worldview on our approach to Scripture. We've used progressive revelation as a practice engagement with the tricky complexities of honest Scriptural interpretation, and being willing to challenge our worldview. We've explored the nature of relationships, and discovered the cognition and communication fall short of defining 'relationship' because of their very nature, and not just because we humans can only handle them imperfectly. In addition, it seems as if God - technically capable of using 'perfect' communication and cognition - seems to have deliberately utilised bias in these things in His pursuit of what really matters to Him - a relationship of love.


A discussion of morality flows naturally from our discussion of communication, because it functions very similarly. Morality refers to the pattern of our behaviour. Like communication, it is inherently cognitive - we consciously decide what to do, and so it is a window into another person's cognition, but also suffers similar interpretation inaccuracies as communication. And just like communication and cognition, morality finds its true purpose in relationship. It is meant to be person-based, not abstract. We are meant to want to be like Christ and to please Christ, based on our flawed cognitive understanding of Him through our relationship. 

Because cognition cannot reach a static full encapsulation of a person, our morality will never be able to fully encapsulate them either. For this reason, some argue that we are meant to disengage our morality from cognition, and just follow the rules God has set down without question or interpretation, because this is the only reliable way to reflect God. I don't think this is the case, because the only way morality can reflect anything, is through people's interpretation of it - and they interpret it by trying to see through to the person that produces it. We reflect God by being a person that people see God in, and by behaving in a way that springs forth from this person. This cannot occur if our morality is disengaged from our cognition - it actually makes the reflection of God's character less accessible, not more accessible. Besides, the very nature of relationships and people means that things like morality and cognition could never capture a person, even if we disregard the link between morality and cognition. Relationships are meant to be dynamic processes that engage with the other person, and so a static cognition and a static morality cannot fully capture this. 

In other words, you cannot legislate the kind of morality God is after through fixed laws. They could never be nuanced enough, and there is always the possibility of life situations bringing together multiple conflicting values and unique considerations for the relationship which could NEVER be exhaustively described. No doubt God has a preferred way to behave in each situation, but we can only know this if we know God through relationship. So instead of prescribed living, there has always been a need for prioritisation, flexibility, and pragmatism BASED upon the right living relationship with God. I'm not advocating a liberal lifestyle - the relationship I'm advocating includes a desire to submit to God, and also a recognition of the complexity of applying God's values to real life situations. 

But God still legislated morality - if this was not for 'prescribed personal morality', then what was it for? We can argue for some specific purposes behind the OT law e.g. Societal coherence, which was difficult to maintain in a largely 'religious' society where God was never-the-less rarely relationally known, and where cognitive understanding of God was incomplete. But a big reason - the one that applies to ongoing legislation even in the NT - ties back to the purpose of communication. God wants us to see a prioritised understanding of His cognition THROUGH the commandments, and then base our morality on the relationship, which will include submission to our cognitive understanding of Him. Our morality will often look 'prescribed', but the different emphasis allows for deviations that please God when situations arise that aren't covered by the legislation with enough contextual relational nuance. 

Because morality is cognitive, it will change with progressive revelation and an evolving cognitive understanding of God. It needs to be emphasised that God does not want us to take the burden upon ourselves to guess / determine the 'next phase' of morality and progressive revelation. Its also worth mentioning here that morality (and to a lesser extent, communication) DOES have non-cognitive influences, which could potentially reflect non-cognitive aspects of the relationship. These are, however, much less precisely expressed and are readily overwhelmed by cognitive influences.

You can see that morality behaves much like communication and cognition - dim but important reflections of the underlying important spiritual love relationship. The intrinsic biases of morality must also be deliberately designed by God as they are natural consequences of deliberately designed cognitive biases. And just like we don't need to properly cognitively understand the God we love, we also don't need to legalistically and un-critically 'submit' to any particular legislation from God in order for the love to be real - but we DO need to engage in the process of submission. 

Evil 'Gaps' in the Relationship

I've talked a lot about what a relationship intuitively means to us, and about how our modernistic mindset can cause us to wrongly perceive many 'normal healthy' aspects as imperfections. But we all know that there ARE real cognitive deviations and gaps in our relationship with God, things that should not be considered healthy. And often it can sure seem as if its the 'healthy aspects' of normal relationships that become the culprits. Using our example of progressive revelation, it is often the intrinsic bias in communication and cognition that leads to problems in our relationship with God - and yet we've discussed them as natural and healthy, and something God has deliberately designed. What is it that makes some 'imperfections' normal and healthy, and others problematic? What is God's purpose behind allowing 'gaps' in the experience of Him through relationship, when He knows they will often cause problems? If modernism is wrong and many gaps are actually healthy and good, can we find another way to talk about the reality of bad gaps, ones that are real deviations from God's ideal relationship?

I think we can :) Lets start with some definitions - these are entirely my own definitions, which I think are supported by Scripture, but they're open to debate in the comment section! 'Good' and 'Evil' are terms which describe the quality of the experience of God through relationship. God is intrinsically 'good', and everything else is 'good' to the degree that it brings about the experience of God. 'Evil' is any lack of 'good' i.e. any gaps in the experience of God's goodness. This makes sense from a more Jewish perspective as well, where 'good' and 'evil' refer to something close to 'function' and 'dysfunction'. If God's fundamental aim is for us to experience Him in a relationship of love, anything which fulfils this function (i.e. our experience of God's character through His expression) is 'good', while anything that does NOT fulfil this function is 'evil'. Evil is intimately linked to sin, because sin harms our experience of God through relationship. Because these things are tied to relationship, you can see that 'good' does NOT refer to an attainable 'full' end outcome, but rather to an ideal uninhibited experience of a process (the ongoing relationship). Even from an eternal perspective, the 'good' all things work toward is an ideal ongoing relationship with God. Likewise 'evil' refers to the inability to have this ideal uninhibited experience of the process of relationship.

Note that both of these terms are dependent on your perspective. From an eternal perspective, we know that ALL things work together for 'good' i.e. are functioning (ultimately) to enhance our experience of God through relationship, even if it is 'evil' from a temporal perspective. And this makes sense, since ultimately all things are in some way an expression of God and Christ, even if you think He is merely 'permitting' their existence. God says that He Himself performs 'evil', where the experience of God in relationship is clouded or confused in a temporal sense - and yet he also says that all His actions are 'good' in an eternal sense. Also, both of these definitions are dependent on our interpreted experience of God from various perspectives, NOT on how well God is actually expressing Himself (I'm sure He is never actually limited in the expression of Himself, even temporally). This is why some 'normal' aspects to relationships, like incomplete cognitive understandings and varied and incomplete expressions of God, can be perceived as 'evil' when occurring in specific contexts. Its not these healthy normal aspects that are the culprit per-se, but the entire context has led to an impaired experience of God, which means the whole situation can rightly be called 'evil'. I believe 'evil' will not exist in heaven, but this is not because I think relationships will fundamentally change - I still think God will express Himself in varied and incomplete ways, and that our cognitive understanding of God will be incomplete and growing. Evil ceases to exist in heaven, because God will express Himself in ways that He KNOWS we will experience clearly (in a temporal sense). In this life, 'evil' exists because God chooses to express Himself in ways that He KNOWS we will NOT interpret clearly, even though they ultimately work toward enhanced experience of relationship.

Scriptural 'gaps'

Its obvious at this point that Progressive Revelation ties into our discussion of 'evil'. From many perspectives it enhances our relational experience of God, and is clearly 'good'. But from some perspectives progressive revelation can also be called 'evil'. You've probably felt this already yourself, when considering the implication that God has deliberately introduced bias into our cognitive understanding AND into our morality . As I've discussed earlier, much cognitive bias is a normal part of healthy relationships, but in some contexts it can also function as an 'inhibition' of our experience of God through relationship, especially when we can sense the spirit-wrought ache in our hearts for a more accurate cognitive understanding. It is thus sometimes a temporal 'evil' designed by God as part of the 'good' of progressive revelation. The 'good' of progressive revelation becomes more obvious as the revelation accumulates to produce a more accurate picture, and as we learn things from God that would not make as much relational sense if not for the previous 'unbalanced' cognition, and as we realise the limited role cognition and communication can play in relationship anyway. We should experience these unbalanced views of God as part of the ongoing expression of our relational God - simultaneously acknowledging the 'evil' this can encourage / allow from our temporal perspective AND the 'good' from other perspectives.


Reality is not as idealistic as I've been suggesting in the series so far. 'Evil' refers to NON-healthy gaps in our experience of God through relationship. But its not a simple division between gaps which are 'evil', and gaps which are normal and 'good' (i.e. the nature of relationships and cognition and morality). These descriptions depend on your perspective, and since there are usually multiple appropriate perspectives, there is usually a mix of recognising 'good' and 'evil' in these gaps. And some apparently 'evil' aspects may in other contexts be considered normal and 'good' aspects to healthy relationships, and continue to exist in some form in heaven. Importantly, all forms of 'evil' are ultimately 'good' and serve to enhance our ultimate experience of God, because permitting their existence is still itself an expression of God, and He is ultimately good (which is why He works all things work together for good). Progressive revelation demonstrates this nicely, as this variously biased revelation - with all its 'problems' - is still 'God-breathed' and good and trustworthy as part of the expression of His character. 

Do you agree that morality should be relationship-based, and thus more flexible / pragmatic than mere legislation? 

Do you agree with my relational-experiential definition of 'evil' and 'good'? 
What do you think of the assertion that 'evil' is ultimately good (from an eternal perspective), and an expression of God? 
Would life or Scriptural interpretation be easier / better if things could be definitively  divided into 'good' and 'evil' categories, instead of being both from different perspectives?

Coming Soon...

  • Next I'll explore how relationships deal with the 'evil' gaps we've just discussed - through 'faith'. This will open up some more possibilities to discuss, regarding what God is doing by deliberately creating / allowing these gaps (especially those we find in Scripture).  
  • After that, I will have (almost) finished my defence of the bias God has created within Scripture :) And I can work toward positively addressing how God wants us to approach His Scriptures, given its divine inspiration, purpose, and 'gaps' / biases. 
  • Then we'll  explore this in more detail over some of the phases of progressive revelation. 
  • And then onto the practical implications of a  proper vs improper approach to Scripture.

The series so far: