One size doesn’t fit all: A philosophy of medicine

by Dr. Clif Steinberg, ND

“Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don’t know which half is which.”

-Charles Sidney Burwell—Dean of Harvard Medical School, 1935-1949

The quote above is as true today as when it was first uttered to a new class of Harvard medical students many years ago. Accepted science and medical norms change over time. I have been in practice for 14 years, and in that short period of time I have seen major reversals in the field of medicine. Witness the recent headlines about dietary cholesterol and salt, for example. A recent study by the National Institutes of Health revealed consistent rates of “medical reversals” approaching 40 percent. http://www.mayoclinicproceedings.org/article/S0025-6196%2813%2900405-9/fulltext.

We live in a time of rapidly evolving understanding of what drives health and disease. This is the age of the genome, proteomics, epigenetics, psychoneuroimmunology, the microbiome and individualized medicine. There are multiple paradigm shifts happening in medicine, and the only certain thing is that what lies ahead for medicine is going to look quite different from what lies behind.

We have begun to see clearly that there is little justification for a “one size fits all” approach to healthcare. That concept is obsolete. We have known for many years that different people respond differently to the same treatments. What we have not known is much about why this is true, or how to work with it effectively. That is changing rapidly.

The same is true for vaccines, but the politics, polarization and emotions surrounding them clouds things considerably. What should not be lost on anyone is the fact that an already large and growing, uniform vaccination schedule ignores the importance of the individual and their circumstances in determining appropriate medical interventions such as vaccinations.

This is not an “anti-vaccine” stance. This is about the judicious use of vaccines. That is why choice is so important. We know vaccines are not entirely safe or harmless. There is much we do not understand about who gets hurt by them, and how that injury occurs, and even what the long-term consequences might be in administering ever-increasing numbers of vaccines. Those who would assert that we know all we need to know about vaccines are the ones I would doubt the most.

We should all be uncomfortable with mandatory medical treatments of any sort, but in particular when the treatments may be harmful to those forced to accept them. This is the stuff of science fiction horror stories and Orwellian dystopias. In fact, those kinds of cautionary tales are important to recall at moments like these when it is difficult to see our place in history. I believe we are at a critical juncture, and getting this right will be of historic significance in terms of maintaining medical freedom.

The philosophical exemption is important to preserve here in Vermont. It allows for an alternative to a “one size fits all” approach to this form of medicine. The philosophical exemption is what allows for the judicious implementation of vaccines, and offers parents with significant concerns about the impacts of vaccines a way to approach them on their own terms. We must allow for that as a society, especially in light of the fact that none of us can know with certainty that medicine will not one day view vaccines very differently.

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This letter was originally published in the Brattleboro Reformer on April 24, 2015 and was also read on the floor of the Vermont House during debate, just before the final vote in May, 2015, on H98.

Dr.  Steinberg works at the Sojurns Community Health Clinic, Westminster Station, Vermont.