The Case for Immunization

Editor's note: This article is an unofficial response to an article in the Aug. 15, 2014 issue presenting the case against immunization.

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As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition. Some chiropractors even wave it in righteous indignation. It would be one thing to simply choose not to participate as providers of vaccinations. I have no desire to vaccinate in my office. But many chiropractors go beyond that issue of scope and feel they must oppose vaccinations entirely.

The president of the ICA, Dr. Michael McLean, recently said; "The Chiropractic profession is at a decisive point in its development, with a fringe proposing DCs begin doing all manner of medical procedures, from IV drips to flu shots and DPT vaccinations... Either we stand strong as the Drugless Health Profession that Chiropractic has always been, or we will go the way of the Osteopath, and become just another variety of MD. We have already made our choice at the ICA: No drugs, no surgery, no compromise, no surrender!"¹ I certainly understand his scope precaution, but does being a "no drugs, no surgery" profession require that we therefore denounce drugs and surgeries?

I'm not aware that chiropractors oppose heart surgery for crisis heart patients or insulin for diabetics. In fact, some of us partake ourselves. Yet I discern that some chiropractors have decided to take up the cross that being a "drugless profession" somehow equates to opposing vaccinations because we are not into drugs. This is a fundamental mistake, because a vaccine is really not a drug. It is an "exposure" which turns on our natural immune system.

I agree principles of democracy support an option to decline vaccinations. I also understand that some chiropractors dislike anything they view as "unnatural." But is this really the side of science with which we want to align ourselves? In doing so, I believe we are further entrenching our reputation as anti-science fundamentalists clinging to the flat-Earth claims of a more ignorant time.

Ignorance vs. Denial

In my opinion, many chiropractors lack an adequate understanding of the immune system, perhaps because we don't treat infections. In fact, studies show that many chiropractors even deny the very science of immunization.²

I internally debated the vaccination question for myself as a young doctor, when my own five children were entering school. What should I believe about vaccinations for my own children? What should I tell my patients who ask me about their children? My knowledge and exposure has progressed considerably since I graduated in 1982.

While there are always questions about the appropriate delivery of vaccines, there really is no dispute regarding the science of vaccination. We know for a fact that controlled exposure provides immunity. Even we chiropractors accept as settled science that natural exposure to chickenpox and other common diseases provides a natural acquired immunity. We may even tell our patients to let their children get exposed to chickenpox by playing with neighbor children who have chickenpox. We accept that disease encounter as a "lesser evil" in gaining future immunity and possibly avoiding greater harm if exposed to it later in life.

Therefore, if we promote exposure to manageable diseases to gain the benefits of immunity, can we really then turn around and reject the science of immunity from unmanageable diseases – the really virulent diseases with high mortality rates?

The conquest of the polio epidemic achieved in the post-WWII era and vast bodies of empirical scientific evidence have laid the fundamental scientific questions to rest. Jonas Salk is a hero for a reason. Many of the medical Nobel Prizes in medicine honor the scientific discoveries of vaccines and immunity. Are we really going to choose to be the one major health profession still tracing silhouettes of our hands on cave walls when confronted with scientific fact?

That said, there are indeed injuries which can and do occur from vaccination delivery and immune system responses. If we could predict these cases, immunization would finally breach the final frontier of safe delivery. But the same is true with patients dying from eating peanut butter or getting stung by bees. The antigen-immune response can be unpredictable.

There may even be some rare or theoretical autoimmune links to secondary diseases in some patients, triggered by immunizations gone wrong. These would be tragic cases. But we know some percentage of any population will have a bad reaction to anything. In fact, cellular recognition is more evidence of the amazing immune system's attempt to recognize self from non-self, which is the key concept of how vaccines work.

If any child is left injured and impaired, it is a tragedy to the families involved. But so are the children who are left injured from disease when not provided the acquired immunity by vaccination. This is not a new conundrum. Reactions vary because people vary.

This is why I do support parental choice, because parents may have special family circumstances that justify declining vaccines in some instances. If they choose wrong, at least the choice remains theirs. But it should be an informed choice, not one based on rumors and lack of knowledge.

Understanding Immunity

Early immunology science began in the late 1700s, long before science understood how it worked. Yet observational evidence grew. From the time of Edward Jenner to the time of Louis Pasteur, we realized that milkmaids exposed to cowpox were not contracting smallpox, which was ravaging Europe. Weakened virus exposure / cross-immunization was observed in the late 1700s as an entirely "natural" exposure phenomenon.

Before chiropractors denounce all vaccinations as unnatural, they might do well to remember that it began indeed as a natural observation. Science observed nature and the immunity "light bulb" appeared over science's head. Are we now claiming that modern lab conditions and antiseptic conditions somehow invalidate the very "natural" immune system that was observed in the real world? That very holistic world we claim to believe in? I see too many chiropractors whose vision is clouded, in my opinion, by conspiracy theories of "Big Pharma" and evil drug capitalists trying to massacre the masses with "poisons." I didn't sign up for that paranoia.

It is an accepted medical fact that our body has three basic lines of defense: 1) natural barriers to disease like our skin, stomach acidity, tears, and even our sweat; 2) nonspecific immune responses, which include the inflammatory response and the various PMNs of the leukocyte family, like neutrophils and their roaming WBC companions; and 3) the specific immune response consisting of the various B and T cells, like plasma cells ready to produce specific antibodies to counter viral and bacterial invaders.

This third line of defense is the defense system affected by immunization. It requires training, largely by our thymus gland and lymph nodes, where these specialized leukocytes can receive the "markers" of potential enemies, thus creating a memory of what to look for. Vaccines expose our specific immune system to less virulent "mug shots" of specific diseases. We are then prepared to destroy them before they can take over our unprepared cells and cause deadly effects.

While we know viruses and bacteria can and do evolve, thus sometimes circumventing immunities we previously had acquired, the most deadly pathogens have life-saving vaccines which can prepare us to mount an effective defense ... but only if our immune system is prepared in advance for the encounter.

This science is not even debated anymore. We need only look at the American Indian populations, who were decimated unintentionally by exposure to foreign diseases brought to the New World by Europeans. We can also watch these immune responses under microscope. We have electron microscopes that Pasteur could not imagine, giving us sensitive and incontrovertible evidence of how our innate immune system works when immunity is granted. And we have empirical evidence of the successful March of Dimes campaign to halt the polio epidemic.

We are designed to have both innate and acquired immunities. Modern medical science is helping provide the latter. We should be applauding vaccines. I'll accept some vacillation on the delivery, but not on the science.

Science has proven the reality of major histocompatability markers (MHC) type II and the use of antigen presenting cells is not a mystery anymore. We know how NK cells, T helper cells, and memory cells use the concept of cellular "markers" to identify diseases and cancer. We even know how HIV disables the essential T cells, thus leading to Acquired Immune Deficiency Syndrome (AIDS).

So, not only do we know how vaccines work, but we even know that when the immune system loses its ability to turn on the cell-surface markers of certain leukocytes, we die.

The intricacies of tissue marking and cytokine recruitment to attack foreign invaders are now well-established. It is entirely natural. It is the basic science involved in not only the immune system, but also in organ transplant compatibility, bone marrow tissue typing for leukemia patients, and even blood typing for blood transfusions.

Is There Some Middle Ground?

I believe our profession could certainly support more controls over the vaccine delivery system. Even the medical profession realizes this is an evolving challenge. Tweaking "how" we deliver vaccines is certainly an area where debate may be valid. Harmful reactions are rare, but can and do occur.

But rather than chiropractors sticking to that credible and narrow debate, too many DCs prefer looking like ostriches with their heads in the sand by rejecting immunizations altogether. It is just such Neanderthal ideology that keeps us on the fringe of health care. And yet far too many chiropractors apparently think Louis Pasteur was a quack.

But which of us, in the light of blinding evidence, sounds more like ducks? When we oppose appropriate vaccination and immunization, we further brand our profession as "quacks." Would you trust your life to a pilot who still thinks the Earth is flat or doesn't believe in "newfangled radios"?

I know many colleagues will be horrified at my "ignorance" or my "betrayal" of the 1895 founders of my own alma mater. But before you go there, just ask yourselves how many scientific "facts" of the late 1800s do you still subscribe to? Let's update our thinking and quit proving to the world that we don't understand basic science.

References

1. "ICA President Dr. Michael McLean Addresses the Florida Chiropractic Society." International Chiropractors Association press release, 2014.
2. Colley F, Haas M. Attitudes on immunization: a survey of American chiropractors. J Manipulative Physiol Ther, 1994 Nov-Dec;17(9):584-90. "One-third (of surveyed chiropractors) agree that there is no scientific proof that immunization prevents disease, that vaccinations cause more disease than they prevent, and that contracting an infectious disease is safer than immunization."