February 13, 2013
Picture this: you are at your dentist’s office for a regular, routine check-up. He tells you that everything appears to be in good working order, but then proceeds to ask if you have considered whitening your teeth. You tell him that you have not. “Well, perhaps you should. It is one of our most popular procedures.”
Picture this: you are preparing to send your child to school for the first time, and are sifting through piles of paperwork in preparation. Within the stack, you find a vaccination exemption form. “Though opting-out of vaccination for certain specified reasons is allowed, all parents are encouraged to vaccinate their children for the good of all members of the school community.”
Picture this: you are reaching the end of your growing years, and waiting to see the image your plastic surgeon has worked tirelessly to perfect: your own face. “Here it is! After this, you will look perfectly normal and exactly the same as everyone else! Congratulations!”
Some of these scenarios may seem accurate and applicable, some more far-fetched, but all are, or are posed to soon become, surprisingly realistic. They are all connected by the emerging and ever-increasing role that society and social norms play in decision-making. In all areas of life, nothing is completely and truly immune from societal influence; from the clothes you buy, to the gender-norming behaviors you impart on your children, even the smallest of decisions are partly and directly affected by society. The pictures presented by the situations above are all strikingly similar in the way they represent the crossroads of medical modifications and the “herd” mentality of society.
As new technologies become even more available and widely accessible to the public and social media’s influence allows the world to grow ever smaller, society’s role only increases. From the perpetuation of unneeded technologies and modifications (i.e. teeth whitening, hair color, cosmetic surgery), to the consistent and largely unquestioned rise and plateau of immunizations, to the constant quest for normalcy, to fit in, the two motivators are constantly intertwined and often indistinguishable in context. It is their common inability to be differentiated that makes the mélange of the two so dangerous. The motivation behind choosing a procedure or not is of the greatest importance; blindly submitting to the whims of the herd creates passive thinking about the future. Ethically-speaking, the values called into question by this issue on the rise are critical and immense: from the frightening idea of paternalism at the loss of individual liberty, to the democratic and personal value of autonomy, to the difficult question of who decides how the future will look and what will shape it, the issues associated with herd mentality’s role in “personal” decisions are anything but personal. They are universal. They affect everyone, from the young to the old, and the rich to the poor, everyone with a body to modify and decisions to make. To be aware of herd mentality’s role in decisions of medical modification now is of the greatest importance, for without current knowledge and awareness, the future is not ours, but someone else’s.
Rarely is it that one’s opinions, thoughts, and actions are fully and completely their own. You may disagree, citing, your own style, for example. You don’t conform: you wear white after Labor Day and sandals in December. Your style, your call. But is it? From whence do these “non-conforming” clothes come? Surely not a department store, or boutique, their appearance there dictated by the taste of others. Perhaps from a thrift store, after they were discarded by someone making a conscious choice to do so; there again your “internal” choice is dictated by an “external” pressure. And if your style choices are still uniquely your own, why, then, are you breaking only these smallest of “rules”? Why not full Victorian costume, simple loincloth, something futuristic, or nothing at all? Even the aspects of self not dictated by society are still dictated by society at some level. Such is the case of herd mentality. It is, in essence, the way an individual’s thoughts are shaped by society. Herd mentality can often be extremely beneficial. Consider a few of the many roles it plays in today’s society, such as recycling. The benefit posed to an individual person for recycling one bottle, can, or newspaper is arguably negligible; it will not repair the hole in the ozone layer or slow rising sea levels. Yet, little by little, person by person, and bottle by reusable plastic bottle, a greater impact can come to be made. The impact itself is globally beneficial. By working together, a great, popular mass can accomplish amazing things. It could be said that, at its most basic core, the recycling, Earth-friendly movement is a fad. A fad with good intentions and supported by science, but a fad nonetheless. Until recycling became the “cool,” “popular,” “majority,” thing to do, it was simply not done. Now, as more and more have taken up the torch, it has become a truly global movement. In this way, herd mentality and society present the most subtle and truly genius of peer pressures. In other ways, the bad far outweighs the good. When one thinks as a group, passing the buck becomes standard operating procedure. With a few, hundreds, or thousands of others to pick up the slack, taking responsibility loses its necessity in all areas, from direct action to so-called personal thought.
“If a man does not keep pace with his companions, perhaps it is because he hears a different drummer. Let him step to the music which he hears, however measured or far away.” (Thoreau). Age-old words, spoken first by Henry David Thoreau, noted philosopher, author, and middle-of-the-woods cabin dweller. He could never have known then just what his words and the ideas behind them have come to inspire: revolutions in countries nonexistent in his time, chains of colonialism fractured for the good of the little guy, movements started, charities founded, new paths and ideas forged, and new examples set for posterity. All of these and more were undoubtedly accomplished by the relative few, sparked perhaps by the genius of one, Thoreau’s all-encompassing and –powerful “individual.” Thoreau and other great thinkers like him have always stressed the individual as the greatest source of power and the strongest root of truth. Individuals have accomplished great things, in Thoreau’s time as in ours, as in years before. Similarly, individuals have great knowledge, great skill, and great power. Yet, as a single brick is to a wall and a single fiber to a woven basket, when the power of individuals is combined, many times as much greatness can be achieved. The human condition itself supports this observation: if humans were better served to survive by living alone and functioning as such, we would have evolved to reflect such a truth. The fact is, we are social creatures. Physically, we spend the majority of our days in the company of each other, in all areas of life, from work to school to home. Yet, even without physical proximity, we are never truly separated from our herd and their ideas. Like chicks of individuality to the society of a mother hen, when can we truly be alone with ourselves and our decisions?
In his book, The Wisdom of Crowds, James Surowiecki notes the impossible knowledge that the herd can be shown to have over that of the individual. He cites the 1986 Challenger disaster as just one such example. Following the disaster, before any reasonable guess could be made as to its cause, stocks of several companies who had taken part in the project plummeted several percent, three out of four between three and six percent. Yet one company was hit far harder than the other three: by the end of the trading day, stock in Morton Thiokol was down almost twelve percent. It was not until approximately six months after the initial disaster that the cause of the explosion was deemed to have in fact been caused by Thiokol’s faulty O-ring seals. Call it coincidence, but Surowiecki still argues, “what this means is that the stock market had, almost immediately, labeled Morton Thiokol as the company that was responsible… the steep decline in Thiokol’s stock price- especially compared with the slight declines in the stock prices of its competitors- was an unmistakable sign that investors believed that Thiokol was responsible…”(Surowiecki, 7). This is just one instance where the herd can be shown to have superior and more accurate knowledge than any one individual, but it is a telling and crucial one.
It can thus be said that, on the surface, there is no problem here. If the herd is that much smarter, more experienced and higher functioning, why not just cede to their judgment? The answer lies barely buried in an Einstein-ism, turned childhood maxim, condemned to hang on the walls of first grade classrooms and be easily forgotten for all eternity: “what is right is not always popular and what is popular is not always right.” (Einstein). Hearing the words so often makes many an elementary school graduate immune to them, but their message should not, and must not, be forgotten. From the playground, to the board meeting, to the doctor’s office, these words are put to the test daily.
In ethical terms, the role of herd mentality is becoming more important than ever, with the advent and spread of new technology. Primarily, the ethical consideration of autonomy is ever-increasingly called into question. As society’s role increases, the role of the individual is forced to shrink. To say fighting back against the power of the herd is “good” or “necessary” all the time would be a gross simplification. There can be no clearer advocacy than awareness for when the two meet and are at odds. Additionally important is the question of who decides just how the future will look and what it will be like. It is physically impossible for every small, individual piece of society to take part in every decision that could in some way contribute to the shaping of the future, but what is important is to decide is, what is the most important piece they want to attempt to shape? Finally, but no less importantly, are the issues of paternalism and compliance. It sometimes feels easiest to pass the buck to a “higher” authority, be that the government, a celebrity, a particular cause, or the simplest authority of a simple majority.
Currently, herd mentality is already hard at work in the seemingly small, insignificant, and highly personal area of immunizations. Required in many states for children before they enter school, immunizations help keep destructive and preventable diseases out of the herd. If a significant majority of the population is vaccinated, the whole population reaps the benefits of herd immunity, a similar concept that most simply means that the vaccination of the majority of the population (above a certain percentage) will be a strong enough force to keep the disease out of the rest of the population.
Also to be considered is the fact that many of the diseases vaccinated for in the United States have been virtually eradicated in recent history because of this concept of herd immunity. According to the Global Polio Eradication Initiative, an organization funded by national governments and disease-preventing groups such as the World Health Organization, only 222 total global cases of polio were recorded in the year 2012, with not one occurring in the United States (“Polio This Week – As of January 2013.”). Compare that to significantly less than a century before, and a clear picture of improvement emerges, according to the Centers for Disease Control and Prevention:
“Periodic epidemics occurred since the late 19th century and they increase in size and frequency in the late 1940s and early 1950s. An average of over 35,000 cases were reported during this time period. With the introduction of Salk inactivated poliovirus vaccine (IPV) in 1955, the number of cases rapidly declined to under 2,500 cases in 1957. By 1965, only 61 cases of paralytic polio were reported.” (“Polio Disease – Questions and Answers.”).
Through the successful use of large-scale, population-wide vaccination, the last case of polio observed in the United States occurred 20 years ago, in 1993 (“Polio Disease – Questions and Answers”).
Similarly, smallpox, a once common and deadly disease, has been completely exterminated from the planet. Today, a vaccination for smallpox will not even be among the list of those bound for a young child’s arm, as it would be negligible and redundant. In the United States, smallpox has not been seen since 1949; globally the same is true since 1977. (“Smallpox Overview.”). Such truly remarkable statistics could only have been achieved through the successful use of large-scale vaccination.
The concept itself is altruistic; by choosing to be vaccinated, an adult or adolescent chooses to protect not only themselves from the inconvenience of disease, but also the elderly and extremely young that they come into contact with, who are far more at risk of adverse harm from the disease.
Especially today, the enormous implications of the importance of mass vaccination have never been clearer. This winter alone, influenza has taken the country by storm. “In New York state alone, 19,128 cases have been confirmed this season, a jump from the total of 4,404 during the 2011-2012 flu season.” (France-Presse). On January 12, 2013, Governor Andrew Cuomo went so far as to declare a health emergency in the state. With his announcement came this seemingly simple and unobtrusive message:
“Since the flu virus can spread through coughing or sneezing, it is important that family members and people who regularly come in contact with young children or individuals at high risk get a flu shot. In addition, all health care workers should be vaccinated against influenza and other communicable diseases to protect their health and the health of their patients.” (Executive Order.)
With a closer look, it is easy to see that a herd mentality style of thinking is behind the governor’s message. Simply stated, it is remarkably clear: get a shot, not because you will likely need one, but because it will protect those at especially high risk. Such an act seems like nothing other than the right thing to do, but it also begs the question: how far do the responsibilities of one extend to the many? In this particular case, the sacrifice is not particularly large, and could, in fact, be beneficial to the individual as well as the herd.
Yet, no rose can be without its thorn, and mandated childhood/infantile vaccination is no exception. At the cost of autonomy, the herd is protected, but for years, a small subsection of the population has been calling “foul play.” Parents blame their “normal” or “healthy” child’s sudden onset of autism and other diseases on the countless shots they are constantly poked and prodded with since birth. Celebrities like model Jenny McCarthy have been especially vocal in the pushback against immunizations. McCarthy’s son, Evan, was diagnosed with autism in 2005, a tragedy she blames on the vaccinations he was prodded with since the moment of his birth (“Jenny McCarthy.”). In a 2009 interview with TIME Magazine, McCarthy voiced her concerns:
“INTERVIEWER: And yet in many cases, vaccines have effectively eliminated diseases. Measles is among the top five killers in the world of children under 5 years old, yet it kills virtually no one in the U.S. thanks to vaccines.
McCARTHY: People have the misconception that we want to eliminate vaccines. Please understand that we are not an antivaccine group. We are demanding safe vaccines. We want to reduce the schedule and reduce the toxins. If you ask a parent of an autistic child if they want the measles or the autism, we will stand in line for the f___ing measles.” (“Jenny McCarthy on Autism and Vaccines.”).
Science has been slow to catch up with their reasoning, but even so, is there an even deeper case to be made here? Yet, still, a study conducted by the University of Michigan revealed that one in ten parents “skip or delay” the vaccines recommended by the Centers for Disease Control (Park). According to an Institute of Medicine report published in in 2011, which reviewed eight vaccinations, including those against the diseases Hepatitis A, HPV, and Influenza, “these vaccines are generally very safe and that serious adverse events are quite rare,” and, “There are no recommendations in this report.” (“IOM Report on Adverse Effects of Vaccines.”). It seems childlike or whiny to even ask, but, offense aside, is it really the responsibility of the individual to protect the herd, including individuals they themselves have never met and never will?
If the external forces are stripped away, it becomes far more difficult to answer the, “Why am I doing this?” question. Gone is the, “for the common good,” answer, as well as “for my own health,” (the chance of contracting many of the diseases vaccinated for today is almost nonexistent). All that remains is a particularly dissatisfying response: “I guess I did not really think about it.” It is easy for one not to think when the herd is thinking for oneself. Yet, stripped down, the herd itself is made up of individuals. Odds are, one mindless individual, floating through, expecting to be supported by the supposed knowledge of the herd, is not alone in their complacence. Add ignorance and carelessness to ignorance and carelessness and you are just left with more of the same.
Similarly current but less crushingly important is the medical perpetuation of unneeded modifications. From teeth whitening, to cosmetic surgeries, and acne treatment to countless other treatments, medicalization is on the rise, and its rise is remarkably fast. Already the herd is playing a role: society says having mild to severe acne means you are not attractive, so it must be fixed; society says having not-so-pearly pearly whites means you do not take care of your teeth, ergo you are not attractive, ergo another so-called problem that requires fixing. An entire new definition of “physician” is being created. Instead of healers, doctors can now be described as perfectors, peeling away societally-defined blemishes to reveal the true, sad normalcy within.
As accountability declines, paternalism and mindless compliance rush in to take its place, which is all good and well until the individual wakes up and remembers who they are and what matters to them. The only hope can be that the individual awakens before it is too late to ask, “How did I get here?” and work to fix the potential problem. As individuals and patients begin to lose their personal liberty and self-definition, they lose themselves. At some level, however deep, a doctor cannot know more than their patient about the patient’s individual preferences and feelings. A doctor cannot feel a patient’s pain or suffering, nor can they truly judge the values and choices of another. Eventually, medical knowledge, training, and schooling reach a limit in their humanity. It is at this point that the patient must take over, feel confident in their feelings, and work with their physician to develop a proper plan of action. Blind submission is a medical philosophy of the past; time and again the paternalism it represents has been tested and proven to be a fallible model. Consciousness must be present in order for decisions to be truly representative of a patient’s wishes and a doctor’s need to at least do no harm, and do as much good as possible. The choices made today affect the children and children’s children of tomorrow. If a continued rise in medical modifications is allowed to escalate at its current rate, who is to say what will be around the river bend for our posterity?
Thinking as a herd has potentially destructive implications for the future. A diverse array of medical modifications, some rare today, some common, could become standard operating procedure for all people. As the aforementioned technologies of teeth whitening and acne treating have come to illustrate, what is taboo or simply uncommon today can quickly become tomorrow’s accepted and necessary fact. If the individual continues to blindly submit, what could the consequences be? When does the occasional, recreational acquisition of cosmetic plastic surgery become standard and true? When does the use of pre-implantation genetic diagnosis to select for cosmetic traits become commonplace and accepted in the medical field? The answer: when the thoughts of the herd start to make decisions for the individual.
This is not to say that neither current nor future applications do not have positive implications for both the herd and the individual in society. What has already been accomplished by the gradual normalization of vaccinations is no small task, and other similarly positive applications can only be just around the corner. What they will be or how they will look are questions with answers only available in one’s imagination, but the consequences can surely be expected to have a diversity of both positive and negative implications. As has been said, herd mentality is, nor can be, all black or all white, all good or all bad. That which is true in the present can surely be expected to remain true in the future.
So what is the right answer? Should we cede to the power of many, though our personal convictions may tell us a different story? Or should we instead forego the potential knowledge and all-encompassing benefits of learning from the successes and mistakes of others and go with our proverbial gut? There can be no right answer; every situation, every dilemma, and every encounter could require one or the other of the two possibilities, but more often encompass a combination of the two. Sign your child up for the vaccinations recommended for them, but consider the positives and negatives behind such a choice and weigh the necessary pros and cons. Get this or that cosmetic plastic surgery you have been dreaming of, but question your reasons and challenge yourself to be able to find a true and realistic “because.” Take a page from Henry David Thoreau’s earliest example of the self-help book and march to your own drummer’s beat. Thinking as part of the herd is ultimately inevitable: understanding why and working to sometimes challenge such thinking is what is of the greatest importance. As stated by author James Surowiecki, “diversity and independence are important because the best collective decisions are the product of disagreement and contest, not consensus or compromise.” (XIX). To be truly successful in decision-making, both of a bioethical nature and otherwise, the individual must recognize the troubled waters constantly around them and see all sides and possible outcomes stemming from their choice. Only having been conscious in that decision can an individual be truly independent. The choice made is of no consequence; the recognition is what matters to be released from one’s dependence.
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Madeline Pensiero is a senior at Kent Place School and is thrilled to be a part of The Bioethics Project 2012: The Medically Modified Human. Throughout the project, Maddie loved having the chance to engage in challenging discussion and debate with some of the brightest minds at Kent Place and in the field. Her individual research has focused on the role society plays in decisions of medical modification. Maddie is also an Editor-in-Chief of Ballast, the Kent Place School newspaper. She has been a student at Kent Place for four years and looks forward to continuing her studies in college this fall.