Jane McGonigal says reality is broken. She believes that we need to make the world more like a game. While designing a college course for game design, I realized the full truth of this.
The biggest reason that gamers prefer game worlds over real life is that game worlds offer consistent rewards. Each time a player finishes a task, a reward is provided. The biological effects of this reinforce playing the game as positive behavior. In other words, the rewards tell the brain that playing the game is good. Real life is not like this...but it used to be! This fascinating realization could be the key to improving productivity and job satisfaction on an enormous scale.
Long ago, before mass production and huge corporations, most people worked for themselves. Even the lowest classes during feudal times typically had a flat or percentage tax that allowed rewards to scale with productivity. Instead of working up through the ranks of a corporation, most people became apprenticed to an artisan or learned the family business, and once they finished this, they became self employed. When they produced something, they were immediately rewarded. Blacksmiths, tailors, carpenters, and other craftsmen were rewarded with a finished product, and when the product was sold, they were also financially rewarded. Farmers were rewarded with a harvest and money, if they could afford to sell some of it. Merchants were rewarded in money and traded commodities. With the exception of domestic servants, who were rewarded much like modern salaried workers, and nobility, who were often rewarded without much work at all (as well as occasional random events, like droughts), nearly everyone was quickly and proportionally rewarded for their efforts. Even beggars were rewarded fairly proportionally (more time and effort spent, more donations). It was well understood among the lower class that harder work yielded greater rewards. Since then though, the world has changed.
In our modern world, effort is not rewarded. Contrary to upper class clichés, working hard is hardly even part of the road to success anymore (heritage and luck being some of the biggest factors). A vast majority of employed people do not get rewarded quickly or proportionally. McDonald's workers do not get paid more for being more productive. Spending 15 seconds creating a sandwich is hardly as rewarding as spending several hours making a set of horseshoes (though equally mundane), and making the sandwiches in 12 seconds does not result in higher pay than making them in 15. Helping an endless supply of customers check out at a grocery store is nothing compared to a full harvest at the end of the growing season. In short, modern jobs are just not motivating. Unmotivated work is low productivity work. It is also typically low quality work as well. Without a good reward cycle, modern workers have lower productivity, work quality, and job satisfaction.
This can be fixed, but it would have an initial high cost. The problem is that employees are paid based on time. Either hourly or salary. Salary pay is the way nobility was rewarded long ago. Salary is a reward that is given regardless of productivity (we are going to ignore things like getting fired, because they are more likely to encourage blaming and cheating than increased job satisfaction and productivity). Hourly pay only rewards the presence of the employee. It does not reward actual work. Profit sharing can reward actual work, but it ends up being an average. If there are twenty employees, and half of them work hard and half of them do not, no one is getting rewarded proportionally, and the less productive workers are getting rewarded despite doing a poor job. If the company makes multiple products, stock based profit sharing could be rewarding workers doing a poor job on one product, when another product is successful. This kind of reward cycle is only marginally more effective than purely hourly or salaried pay.
Productivity is very hard to measure. How do you measure productivity for a cashier? Profits on sales does not work, because the cashier does not determine markup on items or what the customer wants or needs (and the job of the cashier is to get though the line fast, not to spend 5 minutes upselling every customer). Total sales is an equally poor measure, because over-staffing (the fault of management) or poor business (the cashier is the least likely person to be at fault) could affect it. In engineering and other higher end jobs, it is even harder to measure productivity, because the apparently least productive employee could be the one holding everything together and helping everyone else to maintain high productivity (this is actually fairly common). This is a major problem to fixing reality.
The only solid solution I can see is breaking things into smaller units. Even this won't solve all of the problems, but it would improve things. More smaller businesses and less larger businesses would make this far easier, but that is unlikely to happen. Retail corporations could offer more autonomy to local stores, and local stores could offer more autonomy to individual departments within those stores. Industrial corporations (everything that produces products, including software, hardware, and media) could provide more product level autonomy, and manufacturing could provide more factory level autonomy and even process level autonomy within a factory. This would allow for more focused profit sharing and productivity measurement, which would increase reward accuracy.
Recently, I discovered a solution to one of the biggest hindrances of modern businesses. The hindrance is that managers usually have a poor understanding of the processes they are managing. In tech, this means that managers often have a poor understanding of the technology, which leads to demands and expectations that are impossible to realize or significantly harmful to the workers and the business (for example, CTOs that decide it is better to use just one programming language in-house, instead of selecting the best one for each task). In other industries, this leads to large numbers of minor inefficiencies, like replacing the towel dispensers in the bathrooms every month, as the prices of different types of towels fluctuates, or retraining employees to put the ingredients of the sandwiches in a different order every few months. Perhaps a better management model would be to have managers act as oversight, instead of bosses. Those under a given manager would act fairly autonomously. The manager would provide guidance where needed but would only make executive decisions when the employees violated rules or specifically requested help. The reason I bring this up is that it fits very well into the idea of making components of a company more autonomous. Adding this would further improve job satisfaction, at the same time as eliminating a large number of common inefficiencies in businesses.
At this point, I don't think we can ever return to the reward cycle of the past, but
we can adjust things to get enough closer to enjoy many of the benefits. Our world is so different from the past. Processes are so much more complex. Much of modern business must rely on teamwork to get jobs done, and this makes a perfect reward cycle impossible. If we try though, we can get close enough to realize major improvements in productivity, quality, and job satisfaction, and this will make the world a much better place.
Showing posts with label labor. Show all posts
Showing posts with label labor. Show all posts
11 July 2015
27 November 2014
Pulling Your Own Weight
The idea of pulling your own weight is based on the idea that each person incurs costs for upkeep, including food, water, clothing, and shelter. In the U.S., we might add things like internet and electricity to this, but really it comes down to the fact that every person has an upkeep cost, and someone has to pay it. The idea of pulling your own weight is a very old idea, but also a conditional one. Each person in a society that is capable of doing so is expected to pull their own weight. Of course, there have been some deviations from this, but it is largely the most common way of running an economy.
There are some occasional historical exceptions to this, but there are also some chronic exceptions. Historical exceptions almost always involve slavery. Greek philosophy and math were built by people who did not pull their own weight. In fact, if they had not had slaves to pull their weight for them, we would probably not have modern technology and science as we know them. Slavery has been common off and on throughout history. In the U.S. and most of Western civilization, slavery (overt slavery, anyhow) has been abandoned and replaced with an economic philosophy very common to cultures that reject slavery. This philosophy is the idea that every person must pull their own weight. Chronic exceptions to this are very common and will never go away. Babies, young children, elderly people, and disabled people are not expected to pull their own weight, because they cannot. Stay-at-home mothers are treated as not pulling their own weight in many parts of modern society, however this is a filthy lie. They may not be producing goods, but stay-at-home mothers are doing work that is far more important than most of the work done outside the home. Now, the slavery exception is becoming an unusual one that is likely to overturn how we view economy, probably within the next half century.
In older economies, the pull-your-own-weight ideology was a fairly sound one. While it is possible for a small number of people to provide for a large number, the work involved has been excessive. One slave working 16 hours a day might be able to provide the needs of ten or twenty other people, but that slave cannot have any freedom because there is just no time for it. Modern technology has changed this though. Besides finding more efficient ways of producing, it has also provided ways of replacing human labor with mechanical slaves. Mechanical slavery is completely ethical. The machines can work 24 hours a day, and they never need time off or personal time. The only down time is time spent on repairs and maybe upgrades. Experts estimate that this ethical form of slavery will replace about 50% of the human workforce by 2050. This presents a very serious ideological problem.
Here is the problem: The U.S. economy is based on this pull-your-own-weight ideology. We are in the process of rapidly replacing human workers with mechanical slaves. These two things are completely incompatible. If we replace half of the human labor force with slaves and then still expect the humans to pull their own weight, we are expecting the impossible. Actually, we are perhaps doing something worse. We are missing something important. What is the actual weight of a human?
The "weight" of a human is the amount of labor required to meet that human's needs. Slavery with human slaves does not change the weight of a human; it just displaces the labor. Some human still has to pull the weight. Slavery with machines slaves, however, does change the weight of humans. Replacing human labor with machine labor directly reduces the human labor required to meet the needs of humans. This is what we are missing: As we automate more processes, we are reducing the weight of humans. The problem is that we are not accounting for this. We have high unemployment largely because we have reduced the weight of humans, and those humans that are still doing the same amount of work are now pulling more than their own weight. The result is that there is not enough work left for everyone else, because their weight is already being pulled. Unfortunately, because we have not noticed this problem, we are not distributing the results of the work appropriately. The consequence is that some people are pulling more than their own weight, and they are getting the proceeds of that. The people that are not able to pull their own weight are stuck without enough to survive, because their portion is being given to the people that are pulling their weight for them.
This is complicated, and it is not obvious that this is what is happening. Further, there is a very important reason that this is happening: We have reached a point where it is actually substantially less efficient for each person to pull their own weight. When each person's weight costs 2 to 4 hours of work per day (and, when that burden is centralized to one or two people per family), it is fairly efficient for businesses. Each employee spends enough time working to easily keep up with overhead. Now, however, each person's weight comes out to around 1 or 2 hour per day, or even less. When centralized, this comes out between 10 to 20 hours a week. Having every employee work half time doubles the overhead, because the number of employees are doubled (reducing hours does not reduce overhead). In addition to that, higher end jobs often have warm up and cool down time that results in unproductive hours on each end of a shift. This means, in an 8 hour shift, if an hour at each end is unproductive, 75% of the work time is productive. In 4 hour shifts, productivity is reduced to only 50%. In lower end jobs this effect is dramatically lower, but in high end jobs (especially in problem solving work like engineering and science), this is a major obstacle to reducing hours (note that in these jobs, longer time between shifts tends to increase the unproductive warm up time, so 8 hours three days a week is not an efficient solution either). This is an efficiency problem that is never going to go away. It is just not efficient at current human "weight" for each person to pull his or her own weight.
Is there a solution to this? Yes, but it is not a very popular one. It is incredibly unpopular among conservatives, and it is at least mildly unpopular among liberals. The solution is abandoning the pull-your-own-weight ideology. We are quickly becoming a slave state, just like Greece was, except that we are doing it ethically. If we do not abandon this pull-your-own-weight ideology, we are going to either let the majority of Americans starve as their jobs are replaced by machines, or we are going to have millions of Americans working workweeks so short that they are costing more overhead than the value they are generating. Neither of these is a good long term economic plan. One short term solution might be long vacation time, where each employee works "normal" hours, but only for 1/4 of the year, and the rest of the year is vacation time, however, that only partially mitigates overhead costs. The most efficient solution is for some people to work 20 to 40 hour weeks at least 50% to 75% of the year, while everyone else lives off of the proceeds of that work. Some kind of motivation would be necessary for those who work, and this would probably be complicated and difficult to do without resulting in an overprivileged working class and an underprivileged non-working class (ironic, given that historically the opposite happens). Ultimately though, it is going to eventually become necessary, or we are going to have an epic economic crash when so many consumers starve to death that consumption drops below an economically sustainable level.
Things are changing rapidly. Technology continues to advance faster than we can keep up with. In the past, the impact of this has been primarily limited to the tech industry itself. In the near future, however, this is going to have a massive economic impact. If we are not prepared, we are going to suffer. In some degree, the consequences are not predictable, but there is one thing that is predictable: If a large portion of human labor is replaced with machine labor, we cannot have a sustainable economy that is based in the pull-your-own-weight ideology.
There are some occasional historical exceptions to this, but there are also some chronic exceptions. Historical exceptions almost always involve slavery. Greek philosophy and math were built by people who did not pull their own weight. In fact, if they had not had slaves to pull their weight for them, we would probably not have modern technology and science as we know them. Slavery has been common off and on throughout history. In the U.S. and most of Western civilization, slavery (overt slavery, anyhow) has been abandoned and replaced with an economic philosophy very common to cultures that reject slavery. This philosophy is the idea that every person must pull their own weight. Chronic exceptions to this are very common and will never go away. Babies, young children, elderly people, and disabled people are not expected to pull their own weight, because they cannot. Stay-at-home mothers are treated as not pulling their own weight in many parts of modern society, however this is a filthy lie. They may not be producing goods, but stay-at-home mothers are doing work that is far more important than most of the work done outside the home. Now, the slavery exception is becoming an unusual one that is likely to overturn how we view economy, probably within the next half century.
In older economies, the pull-your-own-weight ideology was a fairly sound one. While it is possible for a small number of people to provide for a large number, the work involved has been excessive. One slave working 16 hours a day might be able to provide the needs of ten or twenty other people, but that slave cannot have any freedom because there is just no time for it. Modern technology has changed this though. Besides finding more efficient ways of producing, it has also provided ways of replacing human labor with mechanical slaves. Mechanical slavery is completely ethical. The machines can work 24 hours a day, and they never need time off or personal time. The only down time is time spent on repairs and maybe upgrades. Experts estimate that this ethical form of slavery will replace about 50% of the human workforce by 2050. This presents a very serious ideological problem.
Here is the problem: The U.S. economy is based on this pull-your-own-weight ideology. We are in the process of rapidly replacing human workers with mechanical slaves. These two things are completely incompatible. If we replace half of the human labor force with slaves and then still expect the humans to pull their own weight, we are expecting the impossible. Actually, we are perhaps doing something worse. We are missing something important. What is the actual weight of a human?
The "weight" of a human is the amount of labor required to meet that human's needs. Slavery with human slaves does not change the weight of a human; it just displaces the labor. Some human still has to pull the weight. Slavery with machines slaves, however, does change the weight of humans. Replacing human labor with machine labor directly reduces the human labor required to meet the needs of humans. This is what we are missing: As we automate more processes, we are reducing the weight of humans. The problem is that we are not accounting for this. We have high unemployment largely because we have reduced the weight of humans, and those humans that are still doing the same amount of work are now pulling more than their own weight. The result is that there is not enough work left for everyone else, because their weight is already being pulled. Unfortunately, because we have not noticed this problem, we are not distributing the results of the work appropriately. The consequence is that some people are pulling more than their own weight, and they are getting the proceeds of that. The people that are not able to pull their own weight are stuck without enough to survive, because their portion is being given to the people that are pulling their weight for them.
This is complicated, and it is not obvious that this is what is happening. Further, there is a very important reason that this is happening: We have reached a point where it is actually substantially less efficient for each person to pull their own weight. When each person's weight costs 2 to 4 hours of work per day (and, when that burden is centralized to one or two people per family), it is fairly efficient for businesses. Each employee spends enough time working to easily keep up with overhead. Now, however, each person's weight comes out to around 1 or 2 hour per day, or even less. When centralized, this comes out between 10 to 20 hours a week. Having every employee work half time doubles the overhead, because the number of employees are doubled (reducing hours does not reduce overhead). In addition to that, higher end jobs often have warm up and cool down time that results in unproductive hours on each end of a shift. This means, in an 8 hour shift, if an hour at each end is unproductive, 75% of the work time is productive. In 4 hour shifts, productivity is reduced to only 50%. In lower end jobs this effect is dramatically lower, but in high end jobs (especially in problem solving work like engineering and science), this is a major obstacle to reducing hours (note that in these jobs, longer time between shifts tends to increase the unproductive warm up time, so 8 hours three days a week is not an efficient solution either). This is an efficiency problem that is never going to go away. It is just not efficient at current human "weight" for each person to pull his or her own weight.
Is there a solution to this? Yes, but it is not a very popular one. It is incredibly unpopular among conservatives, and it is at least mildly unpopular among liberals. The solution is abandoning the pull-your-own-weight ideology. We are quickly becoming a slave state, just like Greece was, except that we are doing it ethically. If we do not abandon this pull-your-own-weight ideology, we are going to either let the majority of Americans starve as their jobs are replaced by machines, or we are going to have millions of Americans working workweeks so short that they are costing more overhead than the value they are generating. Neither of these is a good long term economic plan. One short term solution might be long vacation time, where each employee works "normal" hours, but only for 1/4 of the year, and the rest of the year is vacation time, however, that only partially mitigates overhead costs. The most efficient solution is for some people to work 20 to 40 hour weeks at least 50% to 75% of the year, while everyone else lives off of the proceeds of that work. Some kind of motivation would be necessary for those who work, and this would probably be complicated and difficult to do without resulting in an overprivileged working class and an underprivileged non-working class (ironic, given that historically the opposite happens). Ultimately though, it is going to eventually become necessary, or we are going to have an epic economic crash when so many consumers starve to death that consumption drops below an economically sustainable level.
Things are changing rapidly. Technology continues to advance faster than we can keep up with. In the past, the impact of this has been primarily limited to the tech industry itself. In the near future, however, this is going to have a massive economic impact. If we are not prepared, we are going to suffer. In some degree, the consequences are not predictable, but there is one thing that is predictable: If a large portion of human labor is replaced with machine labor, we cannot have a sustainable economy that is based in the pull-your-own-weight ideology.
19 August 2014
Vaccine and Vitamin K Refusal
I just read this article from Scientific American. While I have great respect for the magazine, I find the author somewhat lacking. In fact, I have found a great deal lacking in nearly every author promoting the medical industry and attacking skeptics of modern medicine. Now, I am not saying that the medical industry is wrong, but it is at fault in a large degree for the various movements opposing vaccination and other things like vitamin K shots or eye drops for newborns.
The primary problem is not the media and movements encouraging parents to avoid potentially life saving treatments for their children. The problem is general mistrust of doctors, which has been caused by their own poor behavior. My wife is a doula (a professional labor coach and educator). We have chosen to forgo both the vitamin K shots and the eye drops that hospitals typically give all newborns. Our first child was born in a birthing center, where we were educated on all of the risks involved with both sides. Further, we did some research of our own. We found that the risk of complications is extremely low without the treatments. Contrary to the article, both treatments do indeed carry risks, however they are also extremely low. Based on our knowledge, we chose not to allow the midwives to administer either of the treatments. Similarly, we have been very selective about vaccinations. Now, let me first assure you that we do not believe the claims (which have been proven false) that vaccines cause autism. This is a bunch of crock spread by celebrities that have no medical education. Our first reason to limit vaccination is that many vaccines contain small amounts of latex, and my wife and at least one of our children has shown a sensitivity to latex. Latex allergies can quickly become life threatening with repeated exposure, so we chose to limit vaccinations to limit latex exposure. We have had our children vaccinated for a few things. These are diseases that either have a high probability of fatality or permanent injury or that cannot be cured once contracted. While I have seen no empirical data on this, I have observed that people who get every single vaccine and thus rarely get sick tend to fare less well when they do get sick, while people who avoid common vaccines that are mostly just for convenience (the flu vaccine for most people) tend to get over nearly anything fairly quickly. So, why would anyone choose to forgo even vaccines for higher risk diseases?
As a doula, by wife is present when her patients give birth. This typically occurs in a hospital. Additionally, we have had several of our children born in hospitals. My wife has had multiple experiences where doctors or nurses administer treatments without informing or consulting the patient. In many cases, these treatments have not been strictly necessary and were administered either for the convenience of the patient or for the convenience of the medical professional. I am also aware of instances where a doctor has recommended an unnecessary, high risk treatment to a patient for personal convenience. In one case, the doctor used scare tactics to convince the patient to agree to a cesearan section because the birth was taking too long and was going to cut into a birthday party the doctor wanted to attend. In one case where my wife was present, the doctor and nurses completely ignored a list of documented requests from the patient without any medical reason for doing so. In this last case, the patient is now showing symptoms of post traumatic stress disorder related to pregnancy and hospitals. This is why people refuse vaccinations and other treatments for their children. After an experience where your human rights are blatantly violated by medical professionals, it becomes very natural to distrust the medical industry in general.
The problem is not those who spread lies about potential side effects of vaccinations or other treatments. The problem is the doctors that mistreat patients and breed mistrust. Sadly, the most common place this occurs is in hospitals. Private practices and family doctors tend to be much better at informing patients about treatments, with one small exception (I'll get to this). In hospitals, it is very common for nurses and doctors to treat patients without ever discussing the treatment with the patient. With births, doctors will frequently tell the patient a treatment will be administered without any concern for the desires of the patient (unnecessary C-sections and inductions are a very major problem in the US, and typically the mother is never even offered a choice). This is wrong, and to most people it is clearly a violation of human rights. It really should come as no surprise that many parents are willing to trust unknowns over the people who have violated them and lied to them.
Now I want to look at the one exception. Vaccinations always carry risks. In fact, any time the skin is pierced with something, there is a risk of infection. Modern sanitation practices have reduced this risk to almost nothing, but it does exist. There is also a risk that any given patient is allergic to something in a vaccine. Again, this is typically very small. Most pre-drawn vaccines contain latex, and the rubber stopper on vaccine containers that are not pre-drawn frequently contain latex. For those with a threshold allergy to latex (this is the kind of allergy that becomes more severe with each exposure), even this small exposure to latex can be life threatening. Even if it is not, it can cause the next reaction to be more severe. Overall though, for most people the risk of complications from vaccination is extremely small. In fact, the risks are so small that beyond asking about allergies first, I do not see any reason why doctors should be forced to discuss them in detail.
On the other hand though, there is the risk of serious complications from catching the disease that the vaccination would have prevented. For instance, the flu almost never kills. When it does, it is almost exclusively very young children and extremely old people. On occasion, it kills someone else who has a severely compromised immune system. Outside of these easily identifiable groups, the flu is merely a brief and slightly painful inconvenience. Chicken pox is even less severe than the flu (though it does carry the risk of getting shingles later in life, which rarely kills but is extremely painful). Getting these trivial diseases does little more than cause inconvenience, but they can ultimately strengthen the immune system (something like exercise strengthens muscles). Now, these two diseases are trivial, but fairly common. That is not true of the rest of the diseases that we typically vaccinate against. Most vaccines provide immunity for diseases that less than a percent of a percent of the population will ever be exposed to. Further, many of these diseases, while they can be severe, are no longer as deadly as they were when we did not know how to treat them. The chance of serious complications, when combined with the extremely low chance of exposure, may even start to approach the potential risk caused just by getting the vaccine in the first place. This is what doctors do not tell you. Most vaccinations will never even matter and may even increase the overall risk of harm.
How can we deal with this? First, I think that doctors should be required by law to discuss both potential negative and positive consequences of any treatment with the patient or guardian before administering any treatment (except in serious emergency cases where there is not time, in which case the discussion should take place after the emergency situation is over). Until this happens though, parents and patients will have to figure out how to deal with these things on their own. I would suggest asking you doctor a lot of questions. You can legally refuse any treatment (the doctor may ask you to sign a wavier though). This means that you can tell the doctor that you will not permit treatment until you are fully informed of all potential risks involved. You can also search the internet, but make sure you find sources from both sides of any debate, otherwise you will only get half of the knowledge you need to make an informed decision (also, learn to distinguish reputable sources from random people running their mouths; in medicine, celebrities are not reputable sources). Look for numbers. If you find something saying that some treatment increases the chances of some horrible outcome by 50%, try to find what it is 50% of. If the chances are 1 in 1 million, that means they are only 1.5 in one million with the treatment. Relatively, that 50% increase seems large, but the actual probability is still extremely low.
There is one other thing doctors will rarely tell you. Most vaccinations now are given to improve "herd immunity." What this means is, the chance that your child will get the measles, even without the vaccination, is almost non-existent. Your child will probably not benefit at all from it, in fact. Many vaccines target diseases that are almost extinct (at least in the 1st world). The goal of the vaccinations is to keep the disease isolated or even to eliminate it, not to benefit the individual getting the vaccine. This is called herd immunity, because it benefits the group (or "herd") as a whole, but it almost never benefits the individual. In other words, there is almost no individual risk of getting the disease to balance the negative risks associated with getting the vaccine. Now, in case you are feeling disgust that doctors would value the well being of the abstract herd over the well being of your child, you should know that this herd immunity gained from widespread vaccination is what eliminated small pox. It was so effective that we no longer vaccinate for small pox because the risk is almost literally zero. Now, with that in mind, feel free to form your own opinions.
Here is our solution to the problem. My wife and I avoid vaccinations for trivial diseases like chicken pox or the flu. If there was an extremely severe strain of the flu going around (and a vaccine was made available quickly enough; for the flu, they usually are not), then we might consider getting our children vaccinated. Otherwise, we do not consider the risk, though small, worth the minor convenience. We also opted out of many of the vaccinations for extremely uncommon diseases with very low risk of permanent harm. We did, however, get our children vaccinated for one of the hepatitis versions that is difficult or impossible to cure once contracted. One reason is that we are occasionally exposed to people who have recently come from a country where that disease is more common; the other is that a serious disease that cannot be cured is probably worth getting vaccinated for, even if it is pretty rare in the US. The hepatitis vaccination happens to be commonly administered in combination with a few other vaccinations, so we decided to get the combo, because the difference in risk between the single and the combo is negligible (if existent at all).
Our solution to the vitamin K and eye drops was to opt out. Our reasoning is this: Most complications requiring vitamin K occur in the hospital. Other complications are extremely rare (and at least one is genetic, and neither of us has any family history of it). The eye drops are designed to more or less sanitize the eyes after birth, in case some dangerous bacteria got into the eyes. This is also extremely rare. At the time, the eye drops were made of some silver compound that happens to be toxic to humans as well. There has been no research showing the silver drops to be safe for humans, so we decided the risk was higher than the benefits and opted out. (Note that most hospitals are now using a different compound for this. I do not know anything about the safety record of the new compound.) Anyhow, we have opted out of these two things with all four of our children, without any issues.
Now, all of this is personal choice. I do not want to convince you to vaccinate or to avoid vaccination. Similarly, I am not trying to encourage or discourage trusting doctors. Not all doctors are as negligent as those you frequently hear about. I want two things to come out of this article. First, I want regular people to know that they do not have to let doctors bully them. You never have to accept treatment you do not want. You can ask about the risks of a treatment, and you can refuse it if you are not willing to take the risk (this is even true of "mandatory" things, like the IV our local hospital requires for birthing mothers). You also have the ability to learn for yourself and to keep yourself well informed (most hospitals offer free WiFi; bring your tablet, smart phone, or laptop, but make sure you find reputable sources of information). Second, I really would like to see doctors be held more accountable. An honest mistake or impossible situation can happen where the doctor may not be entirely responsible, but cases where the doctor makes a judgment call without any concern for the desire or well being of the patient should never be permitted. No person should be practicing medicine who is willing to subject a patient to unnecessary surgery to get to a party on time, and a patient who comes away from the hospital with post traumatic stress disorder due to poor treatment from the nurses and doctors should be compensated very well for the suffering (not to mention be compensated for treatment for the PTSD). If accountability were higher, fewer doctors would mistreat patients, people would trust doctors more, and scare tactics and lies designed to trick people into avoiding beneficial treatments would be far less effective.
The primary problem is not the media and movements encouraging parents to avoid potentially life saving treatments for their children. The problem is general mistrust of doctors, which has been caused by their own poor behavior. My wife is a doula (a professional labor coach and educator). We have chosen to forgo both the vitamin K shots and the eye drops that hospitals typically give all newborns. Our first child was born in a birthing center, where we were educated on all of the risks involved with both sides. Further, we did some research of our own. We found that the risk of complications is extremely low without the treatments. Contrary to the article, both treatments do indeed carry risks, however they are also extremely low. Based on our knowledge, we chose not to allow the midwives to administer either of the treatments. Similarly, we have been very selective about vaccinations. Now, let me first assure you that we do not believe the claims (which have been proven false) that vaccines cause autism. This is a bunch of crock spread by celebrities that have no medical education. Our first reason to limit vaccination is that many vaccines contain small amounts of latex, and my wife and at least one of our children has shown a sensitivity to latex. Latex allergies can quickly become life threatening with repeated exposure, so we chose to limit vaccinations to limit latex exposure. We have had our children vaccinated for a few things. These are diseases that either have a high probability of fatality or permanent injury or that cannot be cured once contracted. While I have seen no empirical data on this, I have observed that people who get every single vaccine and thus rarely get sick tend to fare less well when they do get sick, while people who avoid common vaccines that are mostly just for convenience (the flu vaccine for most people) tend to get over nearly anything fairly quickly. So, why would anyone choose to forgo even vaccines for higher risk diseases?
As a doula, by wife is present when her patients give birth. This typically occurs in a hospital. Additionally, we have had several of our children born in hospitals. My wife has had multiple experiences where doctors or nurses administer treatments without informing or consulting the patient. In many cases, these treatments have not been strictly necessary and were administered either for the convenience of the patient or for the convenience of the medical professional. I am also aware of instances where a doctor has recommended an unnecessary, high risk treatment to a patient for personal convenience. In one case, the doctor used scare tactics to convince the patient to agree to a cesearan section because the birth was taking too long and was going to cut into a birthday party the doctor wanted to attend. In one case where my wife was present, the doctor and nurses completely ignored a list of documented requests from the patient without any medical reason for doing so. In this last case, the patient is now showing symptoms of post traumatic stress disorder related to pregnancy and hospitals. This is why people refuse vaccinations and other treatments for their children. After an experience where your human rights are blatantly violated by medical professionals, it becomes very natural to distrust the medical industry in general.
The problem is not those who spread lies about potential side effects of vaccinations or other treatments. The problem is the doctors that mistreat patients and breed mistrust. Sadly, the most common place this occurs is in hospitals. Private practices and family doctors tend to be much better at informing patients about treatments, with one small exception (I'll get to this). In hospitals, it is very common for nurses and doctors to treat patients without ever discussing the treatment with the patient. With births, doctors will frequently tell the patient a treatment will be administered without any concern for the desires of the patient (unnecessary C-sections and inductions are a very major problem in the US, and typically the mother is never even offered a choice). This is wrong, and to most people it is clearly a violation of human rights. It really should come as no surprise that many parents are willing to trust unknowns over the people who have violated them and lied to them.
Now I want to look at the one exception. Vaccinations always carry risks. In fact, any time the skin is pierced with something, there is a risk of infection. Modern sanitation practices have reduced this risk to almost nothing, but it does exist. There is also a risk that any given patient is allergic to something in a vaccine. Again, this is typically very small. Most pre-drawn vaccines contain latex, and the rubber stopper on vaccine containers that are not pre-drawn frequently contain latex. For those with a threshold allergy to latex (this is the kind of allergy that becomes more severe with each exposure), even this small exposure to latex can be life threatening. Even if it is not, it can cause the next reaction to be more severe. Overall though, for most people the risk of complications from vaccination is extremely small. In fact, the risks are so small that beyond asking about allergies first, I do not see any reason why doctors should be forced to discuss them in detail.
On the other hand though, there is the risk of serious complications from catching the disease that the vaccination would have prevented. For instance, the flu almost never kills. When it does, it is almost exclusively very young children and extremely old people. On occasion, it kills someone else who has a severely compromised immune system. Outside of these easily identifiable groups, the flu is merely a brief and slightly painful inconvenience. Chicken pox is even less severe than the flu (though it does carry the risk of getting shingles later in life, which rarely kills but is extremely painful). Getting these trivial diseases does little more than cause inconvenience, but they can ultimately strengthen the immune system (something like exercise strengthens muscles). Now, these two diseases are trivial, but fairly common. That is not true of the rest of the diseases that we typically vaccinate against. Most vaccines provide immunity for diseases that less than a percent of a percent of the population will ever be exposed to. Further, many of these diseases, while they can be severe, are no longer as deadly as they were when we did not know how to treat them. The chance of serious complications, when combined with the extremely low chance of exposure, may even start to approach the potential risk caused just by getting the vaccine in the first place. This is what doctors do not tell you. Most vaccinations will never even matter and may even increase the overall risk of harm.
How can we deal with this? First, I think that doctors should be required by law to discuss both potential negative and positive consequences of any treatment with the patient or guardian before administering any treatment (except in serious emergency cases where there is not time, in which case the discussion should take place after the emergency situation is over). Until this happens though, parents and patients will have to figure out how to deal with these things on their own. I would suggest asking you doctor a lot of questions. You can legally refuse any treatment (the doctor may ask you to sign a wavier though). This means that you can tell the doctor that you will not permit treatment until you are fully informed of all potential risks involved. You can also search the internet, but make sure you find sources from both sides of any debate, otherwise you will only get half of the knowledge you need to make an informed decision (also, learn to distinguish reputable sources from random people running their mouths; in medicine, celebrities are not reputable sources). Look for numbers. If you find something saying that some treatment increases the chances of some horrible outcome by 50%, try to find what it is 50% of. If the chances are 1 in 1 million, that means they are only 1.5 in one million with the treatment. Relatively, that 50% increase seems large, but the actual probability is still extremely low.
There is one other thing doctors will rarely tell you. Most vaccinations now are given to improve "herd immunity." What this means is, the chance that your child will get the measles, even without the vaccination, is almost non-existent. Your child will probably not benefit at all from it, in fact. Many vaccines target diseases that are almost extinct (at least in the 1st world). The goal of the vaccinations is to keep the disease isolated or even to eliminate it, not to benefit the individual getting the vaccine. This is called herd immunity, because it benefits the group (or "herd") as a whole, but it almost never benefits the individual. In other words, there is almost no individual risk of getting the disease to balance the negative risks associated with getting the vaccine. Now, in case you are feeling disgust that doctors would value the well being of the abstract herd over the well being of your child, you should know that this herd immunity gained from widespread vaccination is what eliminated small pox. It was so effective that we no longer vaccinate for small pox because the risk is almost literally zero. Now, with that in mind, feel free to form your own opinions.
Here is our solution to the problem. My wife and I avoid vaccinations for trivial diseases like chicken pox or the flu. If there was an extremely severe strain of the flu going around (and a vaccine was made available quickly enough; for the flu, they usually are not), then we might consider getting our children vaccinated. Otherwise, we do not consider the risk, though small, worth the minor convenience. We also opted out of many of the vaccinations for extremely uncommon diseases with very low risk of permanent harm. We did, however, get our children vaccinated for one of the hepatitis versions that is difficult or impossible to cure once contracted. One reason is that we are occasionally exposed to people who have recently come from a country where that disease is more common; the other is that a serious disease that cannot be cured is probably worth getting vaccinated for, even if it is pretty rare in the US. The hepatitis vaccination happens to be commonly administered in combination with a few other vaccinations, so we decided to get the combo, because the difference in risk between the single and the combo is negligible (if existent at all).
Our solution to the vitamin K and eye drops was to opt out. Our reasoning is this: Most complications requiring vitamin K occur in the hospital. Other complications are extremely rare (and at least one is genetic, and neither of us has any family history of it). The eye drops are designed to more or less sanitize the eyes after birth, in case some dangerous bacteria got into the eyes. This is also extremely rare. At the time, the eye drops were made of some silver compound that happens to be toxic to humans as well. There has been no research showing the silver drops to be safe for humans, so we decided the risk was higher than the benefits and opted out. (Note that most hospitals are now using a different compound for this. I do not know anything about the safety record of the new compound.) Anyhow, we have opted out of these two things with all four of our children, without any issues.
Now, all of this is personal choice. I do not want to convince you to vaccinate or to avoid vaccination. Similarly, I am not trying to encourage or discourage trusting doctors. Not all doctors are as negligent as those you frequently hear about. I want two things to come out of this article. First, I want regular people to know that they do not have to let doctors bully them. You never have to accept treatment you do not want. You can ask about the risks of a treatment, and you can refuse it if you are not willing to take the risk (this is even true of "mandatory" things, like the IV our local hospital requires for birthing mothers). You also have the ability to learn for yourself and to keep yourself well informed (most hospitals offer free WiFi; bring your tablet, smart phone, or laptop, but make sure you find reputable sources of information). Second, I really would like to see doctors be held more accountable. An honest mistake or impossible situation can happen where the doctor may not be entirely responsible, but cases where the doctor makes a judgment call without any concern for the desire or well being of the patient should never be permitted. No person should be practicing medicine who is willing to subject a patient to unnecessary surgery to get to a party on time, and a patient who comes away from the hospital with post traumatic stress disorder due to poor treatment from the nurses and doctors should be compensated very well for the suffering (not to mention be compensated for treatment for the PTSD). If accountability were higher, fewer doctors would mistreat patients, people would trust doctors more, and scare tactics and lies designed to trick people into avoiding beneficial treatments would be far less effective.
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