Likelihood Times Impact

Yesterday, Little Miss Kickboxer got her MMR shot. She took it like a champ--lying down, with her binkie in her mouth, clutching her blankie, and crying for about 30 seconds until she noticed the Winnie-the-Pooh bandaid I had previously handed to the nurse. "Pooh Bear!" she exclaimed excitedly, "pokey and ouwie and Pooh Bear!" And frozen yoghurt afterwards (strawberry with chocolate chips, if you must know).

I tried to get her to slow down a little in the afternoon, just incase, but as soon as we started "going shopping" at home, with wooden blocks for broccoli, "wuerstchen," and strawberries, she started running through the entire house with her little shopping cart aka shape-sorter wagon. Without passing the (my) cashier's desk. Mental note: Ask daycare provider how she learned to run away without paying for a big cart of groceries.

Anyway, no fever last night or this morning, which means no visible anaphylactic reaction. The angelchild slept soundly, breathing normally, and demanding something to drink right after she woke up and commented on her mama's stinky butt (who? me? never!). In other words, everything's normal right now. First hurdle taken. First out of three, that is.

Now we wait for the bad ones--the vaccine reactions (fever, rash, vomiting, swollen glands), sometimes triphasic, that could occur within about two weeks from the vaccination date, and then the "adverse events" (the really scary stuff like encepalitis or encephalopathy, or the scary but manageable stuff like diabetes) that could occur anywhere from today to six months or longer down the road. One of my friends admitted just a couple of days ago that she never stopped monitoring her little son after this shot. So, I'm starting a log to note any changes, especially in behavior. And I swore to myself that, rather than giving her another MMR jab at age 4 (that is, 1.5 years down the road), we'll have a titer drawn first to prove immunity.

Yeah yeah yeah, I know, "vaccines are safe," blah blah blah. Sorry, but I'm not drinking that KoolAid. If they were, we wouldn't get any adverse events, not even 1 in 100,000--especially when the morbidity or mortality risk for measles in this country is far less than 1 in 1,000,000 (with zero reported deaths in the past few decades). AND dear old Merck wouldn't have to put out that long list of legal disclaimers. On the other hand, despite all my digging around on private websites and PubMed, I haven't found any data to confirm that the adverse event risk is as high as 1 in 150 (autism) or 1 in 110 (encephalopathy), as some of the more militant anti-vax websites like to point out. I'm convinced that, given the huge holes/ underreporting in the CDC's data collections, the truth probably lies somewhere in between, possibly one or two orders of magnitude higher. But then, that's just a maternal-statistical gut feeling.

What irks me most about this is this (and I know I'll probably get a pat on the back from some crazy teabaggin' dude): My taxes pay for public education. And yet, in order to access what my money already pays for, the government requires me to accept a health risk that a Merck, Bayer, or Glaxo lobbyist has greatly downplayed to the CDC in order to receive federal funding. Orwellian, much?

Fine. All states allow some sort of exemption, philosophical at the least, medical at the most. The problem with that is, while I have no issues with that paperwork, we won't be in hippie-relaxed-liberal California much longer. Any quality (as in: Montessori) school with a waiting list in the conservative Lutheran-Bible-tootin' Midwest will scoff at such a letter and then kick the can (as in: Little Miss Kickboxer) further down the road, to the next institution and then the next. I can assure you that that risk is 1 in 2. Of course, if the angelchild joins the 7 in 100,000 with encephalopathy, none of this elitist school crap will matter.

In basic risk management, the risk score is often determined as probability times impact, just as a photograph is composed of both, aperture and exposure. With a photograph, you can decide to prioritize one over the other. With complex decisions, you can decide to prioritize probability over impact or vice versa. My choice was obviously more weighted towards probability, and only the final outcome will prove whether that prioritization was a sound choice or a disastrous one.