There's been a lot of talk about the difference in the public's response to 1950s polio vaccine campaigns and its response to the 2021 COVID vaccine push. There's been a lot of justifiable frustration about folks who say they've done their "research" when the research consists of dubious Facebook links shared by people inside their echo chamber. (I say this as a person with an echo chamber of her own, just so we're clear.) But there hasn't been, I don't think, much focus on the changes in the culture of medicine.
In my ten years as a La Leche League Leader, I often thought about the paternalistic approach to medicine that the founders of the organization were responding to when they started hosting meetings in 1956. "Your baby isn't getting enough food; that's why he's nursing so often," said doctors who didn't know anything about normal variations in maternal storage capacity. "Your milk isn't rich enough," said doctors who didn't know that the fat content of human milk is a moving target, changing across every feeding and over the course of every day. "Formula is scientifically designed to give babies what they need," said doctors who didn't know that the absence of LC-PUFAs in 1950s infant formula could influence both the structure and the function of infants' brains.
Don't even get me started on the long-since-debunked obstetric nonsense that was the norm in 1950s maternity wards -- practices that were hard on mothers, hard on babies. When the founders planned their physician-attended births at home, they were reclaiming their autonomy in a way that inspired many thousands of women to figure out birth options that would work well for them and their babies.
At the time, the demise of the "doctor knows best!" approach seemed to me like an unambiguously good thing. I mean, sure, doctors know best about some things, but they may not know a lot about lactation. "Watch for your baby's cues," I said to the women who came to meetings and called me seeking help. "Your baby will tell you what he needs."
There's a lot of truth in that, I continue to think, but even then it was clear that a person could take it too far. There was some anti-vaccine sentiment among the moms who came to meetings, along with some reluctance to set limits with toddlers, and there were an awful lot of people trying to determine whether their babies were fussy because they'd eaten too many tomatoes or too much broccoli or whatever else. (NB: It is very unlikely that a tomato in mom's diet will cause a baby to cry.) Sometimes your baby's cues are not the most reliable source of information. Sometimes the things that seem true to you are not actually true.
I would still say it's a good thing that we've left the "doctor knows best!" days behind us. Informed choice is better than uninformed lack-of-choice. But an emphasis on informed choice is going to mean that some patients wind up more informed than others, and some patients make better choices than others.
I was hopeful that we would see 1950s levels of enthusiasm for the COVID vaccine. It really does seem to me like a gift from God that these vaccines became available so quickly and have worked so well to reduce disease transmission, severity, and mortality. I guess, as with any gift, you can't predict how people will receive it.
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