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“First, do no harm. Uphold the ethical practice of medicine with integrity, compassion, and respect for human life.” – Hippocratic Oath

Public health controversies have shaped modern healthcare, leading to significant advancements and devastating consequences alike. Among the most significant controversies are vaccination and public health mandates, the opioid epidemic, and abortion and reproductive rights. These issues have led to millions of preventable deaths, strained healthcare systems, and widespread social and mental health consequences. Understanding their impact is crucial to improving public health outcomes and fostering a more informed society.

1. Vaccination and Public Health Mandates: A Lifesaving Innovation Turned Controversial

Vaccines are among the most effective tools in preventing deadly diseases. Yet, despite overwhelming scientific evidence supporting their safety and efficacy, public trust in vaccines has wavered over the years due to misinformation and skepticism. A small number related to vaccine hesitancy has led to the resurgence of preventable diseases, costing millions of lives globally.

The World Health Organization (WHO) identified vaccine hesitancy as one of the top ten global health threats in 2019, emphasizing its potential to undermine progress made in combating vaccine-preventable diseases. Despite this claim, only few instances have been historically documented.

While vaccine hesitancy has led to the resurgence of certain preventable diseases and localized outbreaks resulting in deaths, the claim that it has caused millions of deaths globally is not substantiated by current evidence. Nonetheless, vaccine hesitancy poses a significant threat to public health, and addressing it is crucial to prevent further outbreaks and fatalities. The key is knowing how vaccines are created, tested and used…as well as who has control of them and the ability to mandate them.

Historical Context:

The first vaccine, developed in 1796 to combat smallpox, was met with both hope and skepticism. Fast forward to the 20th century, and vaccines against diseases like polio and measles drastically reduced mortality rates. However, controversies erupted in the late 1990s after a now-debunked study falsely linked the MMR vaccine to autism.

In 1998, Andrew Wakefield and colleagues published a paper in The Lancet suggesting a link between the measles, mumps, and rubella (MMR) vaccine and autism in children. This study was later found to be fraudulent and was fully retracted by The Lancet in 2010. Wakefield was subsequently struck off the UK medical register.

The publication of this fraudulent study led to a significant decline in vaccination rates, particularly in the UK, and contributed to the resurgence of measles and mumps, resulting in deaths and serious permanent injuries.

Subsequent large-scale studies have found no link between the MMR vaccine and autism. Health organizations, including the Centers for Disease Control and Prevention (CDC) and the UK’s National Health Service (NHS), have concluded that the MMR vaccine is safe and not associated with autism.

Extensive research since then has found no credible evidence supporting a connection between vaccines and autism. Questions remain…were all the vaccines re-evaluated, were there other co-occurring factors that were not accounted for, is it across all demographics, etc.?

The thing you have to be mindful of when reviewing studies is the bias involved, the actual data, variables and controls used, the results that were being tested and who paid for the studies. Any number of these factors can be skewed in studies. A study must strictly adhere to the use of the Scientific Method.

The COVID-19 pandemic reignited debates around vaccine mandates. Misinformation spread rapidly, fueling hesitancy and delaying global immunization efforts, which may have resulted in millions of preventable deaths. As a nurse I can see the debate clearly for both sides on this topic. So many factors contributed the Covid-19 pandemic, and vaccines weren’t the only part of the problem (I’ll save this for another post). It is worth even fact-checking the “appointed” information authorities too, as anything can become corrupted.

This database is a good start when trying to find out who funded research studies: Find Funded Projects and More Using NIH Databases | NIAID: National Institute of Allergy and Infectious Diseases

I always implore you to do your own research and fact check as much as possible, including anything I post if you find something that doesn’t seem right. If you find updated information, I’d love to hear from you below in the comments.

Public Health Consequences:

• Resurgence of diseases like measles, polio, and whooping cough.
• Distrust in public health institutions.
• Strain on healthcare systems and increased mortality rates.

Mental Health Impact:

The spread of misinformation from both sides during vaccination campaigns has contributed to heightened anxiety, distrust, and fear among the public. This distrust in healthcare professionals can exacerbate mental health challenges, particularly among vulnerable populations. As a nurse I see this firsthand; although I am not against vaccines, I am against a few other important things. As a nurse and as human being, I am against limited testing of new vaccinations (including long-term effects), creating unnecessary panic, and unfounded mandates imposing vaccines on relatively healthy demographics that may not need the vaccine versus promotion of healthy living and immune boosting lifestyles.

2. The Opioid Epidemic: A Public Health Crisis with Lasting Consequences

The opioid epidemic is one of the most devastating healthcare crises in modern history. Originating from the aggressive marketing of prescription opioids in the 1990s, the crisis has led to over 500,000 overdose deaths in the U.S. alone. The company that led opioid marketing in the 1990s was Purdue Pharma, primarily through the aggressive promotion of OxyContin, a powerful opioid painkiller.

Historical Context:

In the late 1990s, pharmaceutical companies, particularly Purdue Pharma, marketed opioids like OxyContin as non-addictive pain management solutions. The company aggressively marketed OxyContin as a low-risk, long-term pain management solution, downplaying its addictive potential. Purdue trained sales representatives to reassure doctors that less than 1% of patients would become addicted, a claim later proven false. Purdue’s marketing strategy included incentive programs for doctors, patient coupons for free prescriptions, and targeting vulnerable populations like rural communities. So yes, providers did get “kickbacks” but many of them claim that they unknowingly did this. As a nurse, I argue that they didn’t know that opiates were as addictive as they were. This foundational medical knowledge is definitely taught to student nurses, as nurses are responsible within our scope to ensure that patients are being doses correctly and appropriately despite what doctor’s order. Most of the general public would not have this knowledge and depended on the medical community to guarantee their safety. This practice of prescribing opiates without monitoring and without a plan to discontinue use safely, led to widespread over-prescription and addiction. By the early 2000s, opioid overdose rates skyrocketed, creating a public health crisis.

By 2004, OxyContin had generated over $2 billion in sales, but opioid addiction and overdose rates skyrocketed. The epidemic has evolved over the years, with synthetic opioids like fentanyl contributing to record-breaking overdose deaths. The CDC estimates that from 1999 to 2019, 500,000 people in the U.S. died from opioid overdoses, including those involving prescription opioids, heroin, and synthetic opioids like fentanyl.

Facing numerous lawsuits, the Sacklers agreed to a settlement requiring them to pay $6 billion for their role in the opioid epidemic. However, they have consistently denied wrongdoing.

The opioid crisis has been extensively studied to understand its causes, impacts, and potential solutions. Research funding has been provided by various reputable organizations, including:

• National Institutes of Health (NIH): Through the Helping to End Addiction Long-term Initiative (HEAL Initiative), NIH awarded $945 million in fiscal year 2019 to support research across 41 states, focusing on opioid misuse and addiction treatment. NIH NIBIB
• Substance Abuse and Mental Health Services Administration (SAMHSA): In 2023, SAMHSA announced awards totaling up to $47.8 million for grant programs addressing various facets of substance misuse and the overdose epidemic. SAMHSA
• Agency for Healthcare Research and Quality (AHRQ): AHRQ has released funding opportunities to support projects that develop and test strategies to improve the capacity of primary care and ambulatory settings in providing evidence-based, patient-centered care for individuals who misuse opioids and other substances. AHRQ

These funding efforts have supported a wide range of studies, including:

• Behavioral Interventions: Research into mindfulness and cognitive-behavioral therapies as adjuncts to medication-assisted treatment for opioid use disorder. NCCIH
• Community Recovery Initiatives: Programs aimed at enhancing overdose response, drug identification tools, and support for long-term recovery in affected communities. EMS1

These studies have been instrumental in developing effective strategies to combat the opioid crisis, emphasizing the importance of evidence-based approaches in addressing this public health emergency.

Public Health Consequences:

• Overwhelmed healthcare and emergency services.
• Increased rates of addiction, homelessness, and unemployment.
• Billions in economic costs due to healthcare, law enforcement, and lost productivity.

Mental Health Impact:

The opioid crisis has a profound impact on mental health. Addiction is often accompanied by depression, anxiety, and PTSD. Families and communities affected by opioid use disorder experience grief, trauma, and economic hardship to say the least.

3. Abortion and Reproductive Rights: A Divisive Issue with Public Health Ramifications

The debate around abortion and reproductive rights has long been a contentious issue, with significant public health and mental health implications. The criminalization of abortion leads to increased maternal mortality rates and unsafe procedures, disproportionately affecting low-income women and minorities.

The cost of raising a child varies significantly between industrialized and developing countries, influenced by factors such as income levels, living standards, and government support.

Industrialized Countries

• United States: A middle-income family may spend approximately $233,610 to raise a child from birth to age 17, excluding inflation. With an average annual inflation rate of 4%, this figure can rise to around $300,000. Yahoo Finance
• China: The cost of raising a child until age 18 is about 485,000 yuan (approximately $76,556), equating to 6.9 times China’s GDP per capita. China is facing a de-escalation in population now due to their strict one child policy was implemented in 1979 and officially ended in 2015 when it was replaced by a two-child policy, starting on January 1, 2016. Global Times
• South Korea: Raising a child from birth to age 18 costs 7.8 times the country’s per-person GDP, making it one of the most expensive places globally for child-rearing. Engoo
  • South Korea also faces a serious decline in population due to low birth rates. Women are also now choosing to forgo a relationship and having children related to the culture of long working hours, higher cost of living and a growing movement called “4B” (meaning “Four Nos”). This phenomenon is emerging where young women are actively choosing not to date, marry, have sex with, or have children with men, essentially acting as a form of “birth strike” due to perceived societal pressures and gender inequality, leading to a significant decline in the country’s birth rate and concerns about population decline; this is not a government-mandated one-child policy, but rather a grassroots feminist movement protesting against traditional gender roles.

Developing Countries

In developing nations, the cost of raising a child is generally lower due to reduced living expenses and differing societal norms. However, precise figures are challenging to obtain due to limited data. It’s important to note that while monetary costs may be lower, challenges such as access to quality education, healthcare, and nutrition can impact the overall well-being and development of children in these regions.

Factors Influencing Costs

• Education: In industrialized countries, education expenses, including tuition, extracurricular activities, and supplies, contribute significantly to the overall cost. In contrast, developing countries may have lower educational expenses, but access to quality education can be limited.
• Healthcare: Comprehensive healthcare services in industrialized nations add to child-rearing costs, whereas developing countries might have less expensive but less accessible healthcare options.
• Childcare: Industrialized countries often face high childcare costs due to the demand for professional services, while extended family networks in developing countries may provide informal childcare, reducing expenses.
• Government Support: Social services and subsidies in some industrialized nations can alleviate child-rearing costs, whereas such support may be minimal or absent in developing countries.

Financial instability is one of the most commonly cited reasons women choose to have an abortion, often at the top of the list of contributing factors. Additionally, pregnancies resulting from sexual assault, such as rape, are a significant factor for many women making this difficult decision

• Lifetime Estimates: Approximately 3 million U.S. women have experienced rape-related pregnancies during their lifetimes. AJPMonline
• Abortion: About 50% of pregnancies resulting from rape are terminated through abortion. Wikipedia
• Miscarriage: Approximately 12% end in miscarriage. Wikipedia
• Birth: Around 38% of rape-related pregnancies are carried to term, with the children either placed for adoption or raised by the mother. Wikipedia (the safety of the foster care systems and child welfare systems warrant another blog post down the line) For now, check out this post on child abuse.
• Post-Roe v. Wade Overturn: Following the 2022 Supreme Court decision overturning Roe v. Wade, studies estimate nearly 65,000 rape-related pregnancies occurred in states that enacted abortion bans. PBS
• While it’s challenging to know how many of these cases get reported, it’s estimated that only 310 out of every 1,000 rapes are reported to the police, meaning about 69% go unreported. Of the reported cases, approximately 18% lead to an arrest. About 4.19% of reported rapes are referred to prosecutors. Only around 2.26% of reported rapes result in a felony conviction. Approximately 1.9% of reported rapes lead to the perpetrator being incarcerated. The Hive Law

These statistics highlight the significant impact of sexual violence on reproductive health decisions. The data underscores the importance of comprehensive support services for survivors, including access to medical care, counseling, and informed choices regarding pregnancy outcomes.

Medical abortion, involving medications such as mifepristone followed by misoprostol, is a widely used method for terminating early pregnancies. Understanding its effectiveness and safety profile is crucial for informed decision-making. These medications may also be used to help with other female specific medical issues and assisting with terminating dangerous pregnancies.

Medical abortion is highly effective, with success rates ranging from 95% to 98% for pregnancies up to 10 weeks’ gestation. This means that in the vast majority of cases, the medications successfully terminate the pregnancy without the need for surgical intervention. Serious complications are rare, occurring in less than 0.4% of cases. These may include significant infection or hemorrhage requiring hospitalization. Approximately 2-5% of medical abortions may result in incomplete abortion, necessitating follow-up procedures such as surgical aspiration to remove retained tissue. Studies indicate that medical abortion has a slightly higher rate of complications compared to surgical abortion, primarily due to the potential need for follow-up procedures in cases of incomplete abortion. However, both methods are considered safe with low complication rates.

When comparing the safety of abortion to that of carrying a pregnancy to term and childbirth, studies indicate that abortion is generally safer.

Mortality Rates

• Abortion: The risk of death associated with legal induced abortion is approximately 0.6 deaths per 100,000 procedures. Medscape Reference
• Childbirth: In contrast, the mortality rate related to childbirth is about 8.8 deaths per 100,000 live births. Medscape Reference

This data suggests that the risk of death associated with childbirth is significantly higher than that associated with abortion.

Complication Rates

• Abortion: Legal abortions, especially when performed early in pregnancy, have a low complication rate. The risk of major complications increases with gestational age but remains lower than that of childbirth. ACOG
• Childbirth: Pregnancy and childbirth carry inherent risks, including hemorrhage, infection, and hypertensive disorders, which can lead to severe complications or maternal death. Wikipedia

Despite what many people, especially men seem to believe women do not want to “willy-nilly” have abortions whenever they want in place of regular birth control, they want the right to have a safe abortion if needed.

In the book Freakonomics by Steven D. Levitt and Stephen J. Dubner, one of the most controversial chapters explores the relationship between legalized abortion and the decline in crime rates in the United States during the 1990s. The authors argue that the Roe v. Wade decision in 1973, which legalized abortion nationwide, had an unexpected long-term impact on crime reduction.

The authors propose that unwanted children are more likely to grow up in disadvantaged environments that increase their likelihood of engaging in criminal behavior later in life. By providing access to legal abortions, many women who were not ready to raise children—often due to poverty, lack of education, or unstable living conditions—chose to terminate pregnancies. As a result, fewer children were born into high-risk situations, contributing to the sharp decline in crime rates two decades later.

• The decline in crime began around the early 1990s, approximately 18 years after Roe v. Wade.
• States that legalized abortion before 1973, like New York and California, saw crime rates drop earlier than other states.
• The reduction in crime was most pronounced among the demographics most affected by abortion access.

This theory sparked intense debate due to its sensitive nature. Critics argue that the hypothesis oversimplifies the causes of crime reduction and raises ethical concerns about attributing crime prevention to the termination of pregnancies. Others believe that improved policing tactics, economic growth, and stricter sentencing laws were more significant factors in reducing crime.

The Freakonomics abortion-crime hypothesis presents an unconventional and provocative perspective on how public policy can have unexpected ripple effects. While the theory remains contentious, it highlights the complex socioeconomic factors influencing crime rates and the unintended consequences of policy decisions.

Historical Context:

In 1973, the U.S. Supreme Court ruling in Roe v. Wade legalized abortion nationwide, reducing maternal deaths caused by unsafe, illegal procedures. However, the 2022 ruling in Dobbs v. Jackson overturned Roe, returning abortion regulation to individual states. This shift has led to abortion bans and restrictions across several states. Women’s participation in healthcare decision-making and legislative processes has increased over the years, yet disparities persist in both political and healthcare leadership roles.

• U.S. Congress: As of the 118th Congress, women constitute approximately 28% of all members, with 153 women serving out of 540 voting and nonvoting members. Pew Research Center
• State Legislatures: The proportion of women in state legislatures has risen over time, reflecting a growing presence in state-level decision-making. Statista

In the United States, the Supreme Court’s June 2022 decision to overturn Roe v. Wade, the landmark ruling that had established a constitutional right to abortion in the United States, the vote was 5-4. Among the justices who voted to overturn the decision was Justice Amy Coney Barrett, the sole woman in the majority. The other four justices who voted in favor were Samuel Alito, Clarence Thomas, Neil Gorsuch, and Brett Kavanaugh. Business Insider

Globally, countries with restrictive abortion laws have higher rates of maternal mortality. Conversely, countries with legal and accessible abortion services see improved maternal health outcomes.

Religious Context:

Religious factors are also a big concern, leaving those to wonder if abortions are going against Gods will. The Bible does not explicitly mention abortion as we understand it today. However, there are several verses that have been interpreted by scholars and religious leaders in various ways to either support or oppose abortion. These verses primarily discuss the value of human life, the beginning of life, and God’s role in creating life. There are verses, up for various forms of interpretation, regarding abortion, killing and how life is defined in the Bible.

Pro-life advocates tend to focus on verses that emphasize God’s role in creating life in the womb, arguing that life is sacred from conception.

Pro-choice advocates focus on verses that suggest a distinction between a fetus and a fully living person, arguing that the Bible does not explicitly prohibit abortion.

Public Health Consequences:

• Increased maternal mortality rates in regions with restrictive abortion laws.
• Higher rates of unsafe abortions.
• Widening health disparities for marginalized communities.

Mental Health Impact:

Restricted access to abortion services has profound mental health effects. Women denied abortions are more likely to experience anxiety, depression, and financial hardship (which in itself, makes it harder to raise emotionally stable children). These factors do not create ideal environments to raise children, but women are expected (many times) to do this on their own, with little to no support after the child has been born. Healthcare providers in restrictive regions also face ethical dilemmas and emotional burnout and now legal repercussions.

Public health controversies, such as vaccination mandates, the opioid epidemic, and abortion rights, have had devastating effects on global health outcomes. These issues continue to shape healthcare policies and public trust in medical institutions. Addressing these controversies requires evidence-based policies, mental health support, and public education to foster a healthier and more informed society. Laws should not be implemented based on religious factors whatsoever. Those that have such concerns, should honor their beliefs, but must not restrict safe healthcare outcomes and the autonomy of others.

It’s important for individuals to have access to accurate information and comprehensive healthcare services to make informed decisions about their own health.

Please stay informed. Advocate for accessible healthcare. Support mental health initiatives. Together, we can work towards a healthier future for all.

References:

1. Guttmacher Institute. (2005). Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives. Retrieved from https://www.guttmacher.org/journals/psrh/2005/reasons-us-women-have-abortions-quantitative-and-qualitative-perspectives
2. American Journal of Preventive Medicine. (2023). Rape-Related Pregnancy Statistics in the U.S. Retrieved from https://www.ajpmonline.org/article/S0749-3797%2823%2900442-7/fulltext
3. Centers for Disease Control and Prevention (CDC). (n.d.). Pregnancy Resulting from Rape: Data and Prevention Strategies. Retrieved from https://www.cdc.gov/sexual-violence/about/pregnancy-resulting-from-rape.html
4. Cleveland Clinic. (n.d.). Medical Abortion: What You Need to Know. Retrieved from https://my.clevelandclinic.org/health/treatments/21899-medical-abortion
5. National Institutes of Health (NIH). (2019). HEAL Initiative: Tackling the Opioid Crisis Through Research. Retrieved from https://www.nibib.nih.gov/news-events/newsroom/nih-funds-945-million-research-tackle-national-opioid-crisis-through-nih-heal-initiative
6. Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). Grant Funding for Medications for Opioid Use Disorder. Retrieved from https://www.samhsa.gov/newsroom/press-announcements/20230719/hhs-distributes-grant-funding-programs-expanding-access-medications-opioid-use-disorder
7. The Hive Law. (2024). How Many Rapists Are Convicted? Retrieved from https://www.thehivelaw.com/blog/how-many-rapists-are-convicted
8. UCSF Health. (2014). Major Complication Rate After Abortion Extremely Low, Study Shows. Retrieved from https://www.ucsf.edu/news/2014/12/121781/major-complication-rate-after-abortion-extremely-low-study-shows
9. PBS NewsHour. (2024). Study Counts 64,000 Pregnancies from Rape in States That Enacted Abortion Bans Post-Roe. Retrieved from https://www.pbs.org/newshour/show/study-counts-64000-pregnancies-from-rape-in-states-that-enacted-abortion-bans-post-roe
10. Medscape. (n.d.). Safety of Abortion vs. Childbirth: Mortality and Complication Rates. Retrieved from https://reference.medscape.com/medline/abstract/22270271
11. Wikipedia. (n.d.). Pregnancy from Rape: Incidence and Outcomes. Retrieved from https://en.wikipedia.org/wiki/Pregnancy_from_rape
12. Global Times. (2022). Cost of Raising a Child in China. Retrieved from https://www.globaltimes.cn/page/202202/1252843.shtml
13. BBC. (2024). Sackler Family and the Opioid Crisis: The Legacy of OxyContin. Retrieved from https://www.bbc.com/news/world-us-canada-60610707