The first time I was right in my predictions and wished I wasn’t, it was on a subject I already beat to death: immunizations. In the very early 1990′s, as the Soviet Union fell apart, one of the results of its decomposition was a drastic drop-off in immunizations. And, seeing, to my distress, dozens of recent immigrants with few to no immunizations, I spared no effort getting them caught up to US standards. In at least one case I was too late: a little girl died of measles encephalitis while in my care. This family’s tragedy was a pale shadow of the massive disaster that befell what was left of the Soviet Union: thousands of deaths of preventable disease, mainly whooping cough, measles and diphtheria, and hundreds of thousands experiencing pain or disability.

But his is not about pushing for more mandatory immunizations. Quite the contrary.

It is a historical fact that public health works best in efficient tyrannies. Godwin’s Law states that sooner or later, Nazis will be invoked in any online discussion, so I might as well get this out of the way early: Nazi Germany and Stalin’s USSR had the most effective public health systems in the world at the time. They weren’t necessarily good, as the former was used to kill the less-than-perfect children, the latter developed psychaitric techniques for mind control, and both experimented on the unwilling, but as far as delivering their concept of health care to the masses, no one could touch them. In both cases, the motive was the same — a healthy, procreating herd of workers to be used for war or industrial development as needed; the means — an enslaved workforce including medical personnel to be used at government’s discretion; and the opportunity — the ability to deliver health care to homes and schools and workplaces bypassing the annoying complication of informed consent. As anyone who knows history can appreciate, when tyrannies fall, power plants crumble before prisons; and as public health enforcement withered away, the public rebelled against immunizations as they did against marching in goosestep. The latter was free of consequences; the former was not.

It bothers me that, as we get increasingly safer and more effective immunizations in our arsenal, and more and more information demonstrating their safety, we get more and more families asking to opt out. I think this is happening because of increasing government mandates — both for the families to accede to every single immunization in the pharmacopeia, and for us to escalate pressure on the families to do so. Tyrannies do not encourage thought; they result in either bovine acquiescence or pigheaded rebellion, and neither is a considered choice. I bothers me equally to have my patients line up to obey the Authorities, or distrust me as the agent of the Authorities. I do my own thinking and I prefer you do the same. And I’d much rather call someone an idiot than turn them in as a neglectful parent. So if you think I insulted your intelligence in our recent discussion about immunizations, well, yes, that was my intent. But, all in all, I’d rather live in a country that has freedom of stupidity. I shudder to think of how a government might outlaw stupidity successfully.