I’ve been a bit of a bad, bad boy. Well, not exactly. Rather, I’ve just been a bit lazy and/or forgetful. I know, I know. How can the ultimate Tarial cell-fueled supercomputer in the neat, compact form of a Plexiglass-encased cube of multicolored blinking lights be lazy or forgetful? Maybe “lazy and forgetful” are the wrong words. After all, my namesake (or should I say “‘nymsake”) Orac was well known for being easily distracted when he encountered an observation or question that interested him (such as black holes and limericks), so much so that it sometimes got the crew of the Liberator into trouble. It’s not for nothing that I frequently liken myself to Dug the Dog when he sees a squirrel.
In any case, a couple of months ago, when the Center For Inquiry launched its Keep Health Care Safe and Secular initiative, somehow I never mentioned it. There’s a lot there for skeptics to like, particularly the opposition to quackery, the antivaccine movement, and the infiltration of religious control over health care choices, particularly women’s reproductive health. I will admit that, although I’m very much in favor of withdrawing care in hopeless situations if that’s what the patient or, if the patient is not competent to decide due to unconsciousness or whatever other reason, if that’s what the family wants, as a physician I wasn’t at all pleased with CFI’s staunch advocacy for physician-assisted suicide. But overall, the campaign is something I can get behind, my disagreement with one part notwithstanding.
Fortunately, fellow Michigan skeptic Ed Brayton gave me an excuse to promote this CFI initiative by pointing me in the direction of a truly quackalicious attack on it by someone named Michael Minkoff entitled Anti-Faith Center for Inquiry Fights for “Safe and Secular” Healthcare.
Oooh. Scare quotes! That’ll convince ‘em!
You can get an idea of the silliness of Minkoff’s argument right here:
Presumably, the Center for Inquiry is all about choice and freedom of inquiry, so it’s odd that they should start a campaign that attempts to end choices and extinguish inquiry. For instance, their pro-vaccination campaign seems hellbent on forcing people to get vaccinated.
Minkoff says that as though it were a bad thing.
Of course, the CFI campaign does nothing of the sort. With exceedingly rare exceptions, we don’t “force people to get vaccinated” in this country. Rather, we do have vaccine mandates, which require adherence to the recommended vaccine schedule if parents wish to enroll their children in public schools or in day care facilities. It’s a system that’s worked for a long time (at least until the Internet helped fuel the rise of the current generation of antivaccine activists), and no one’s strapping children down against their parents’ will and vaccinating them. Moreover, as I have discussed before many times, all states permit medical exemptions to vaccination (as well they should!). As far as nonmedical exemptions go, all but but two states (Mississippi and West Virginia, believe it or not) allow religious exemptions to vaccination (which are frequently abused), while nineteen allow philosophical exemptions based on “personal beliefs.”
Nothing in CFI’s campaign says anything of the sort. Rather, CFI advocates countering vaccine misinformation promulgated by the antivaccine movement and the rolling back of philosophic and religious exemptions. It’s a massively uphill battle, as the experience in California recently has demonstrated. Two years ago, the California legislature passed California Bill AB 2109. All AB 2109 did was to require parents to speak to a doctor or school nurse and have him or her sign the form before a personal belief exemption would be permitted. True, the bill was also amended to include “naturopathic physicians” (i.e., quacks), who are the favored health care provider of many antivaccinationist because naturopaths tend to be antivaccine themselves, as “health care practitioners” permitted to sign the forms, but overall it was a win against relentless opposition, including celebrities like Rob Schneider.
Given the degradation of herd immunity occurring due to the increasing use of non-medical “philosophical” exemptions to vaccine mandates, idea was simply to make it a little more difficult to obtain a philosophical or religious exemption to the school vaccine mandate than simply signing a piece of paper, the thinking being that parents who weren’t necessarily opposed to vaccines but just never bothered might take that way out. When the bill was passed, however, Governor Jerry Brown basically neutered it with a signing statement that basically went against the clear language of the law and instructed the California Department of Public health thusly:
Additionally, I will direct the department to allow for a separate religious exemption on the form. In this way, people whose religious beliefs preclude vaccinations will not be required to seek a health care practitioner’s signature.
The result was a form that was no more helpful than the old form. Basically, Jerry Brown betrayed the children of California and subverted the clear intent of AB 2109 as a sop to the religious. This is the sort of thing CFI is opposing.
Minkoff is also unhappy about CFI’s position on women’s reproductive health, ranting that “their reproductive health campaign seeks to force taxpayers to pay for other people’s abortions and birth control.” This is, of course, a silly argument, given that the government “forces” people to pay for things they don’t approve of all the time. Pacifists can’t refuse to pay taxes because they disapprove of massive military spending, for instance. Ultraconservatives can’t refuse to pay their payroll tax because they disapprove of Social Security and Medicare. Advocates of drug legalization can’t refuse to pay taxes because their taxes go to fund the drug war. I can’t refuse to pay taxes because I disapprove of the hundreds of millions of dollars that go to fund the National Center for Complementary and Alternative Medicine (NCCAM) and the National Cancer Center’s Office of Cancer Complementary and Alternative Medicine, whose budget rivals that of NCCAM and whose acronym (OCCAM) is about as wrong as wrong can be. Supporter of quackery are forcing me to pay for research into quackery through my taxes!
You get the idea. The idea behind CFI’s campaign is that certain religions shouldn’t be able to impose their religious beliefs through government policy on women who may not share those religious beliefs, such as conservatives whose religion objects to birth control doing everything they can to deny access to birth control to women who have every right to use it.
And don’t get Minkoff started on alternative medicine:
And their alternative medicine campaign seeks to snuff out any medical practices that fall outside the “conventional medicine” umbrella.
Again, Minkoff says that as though it were a bad thing.
Of course, all CFI is doing is opposing (1) the spending of taxpayer dollars on medicine that is not science-based or is even pure quackery, as much of CAM is; (2) large pharmacy chains selling homeopathic quackery and other supplements; (3) the infiltration of pure quackery into hospitals (such as reiki); and (4) the senseless slaughter of animals to produce “alternative medicines,” such as rhinos for their horns.
In addition, the CFI has petitioned the FDA to regulate homeopathic remedies as they do drugs. Unfortunately, it’s probably an effort that’s doomed to fail without a change in the law. The reason, as Jann Bellamy explained, is that in 1938 when the Congress passed the Food, Drugs, and Cosmetics Act, the Act’s principal author, Senator Royal Copeland, was a physician who practiced homeopathy. He managed to include all the articles monographed in the Homeopathic Pharmacopeia of the United States (HPUS) in the definition of drugs within the FDCA. The end result was that, if the product is in the HPUS, it’s legal. As long as that part of the law stands, it’s unlikely that the FDA will ever regulate homeopathic remedies. Similarly, it would likely require a change in law to allow the FDA to regulate homeopathic remedies as it does other drugs, just as it would take a change in the Dietary Supplement and Health Act of 1994 (DSHEA) to allow the FDA to regulate supplements more closely. Indeed, even small attempts to tighten up the DSHEA of 1994 meet with fierce resistance from the supplement lobby, chief among them Senator Orrin Hatch (R-UT). If anything, more attempts have been made to weaken the already weak DSHEA than anything else.
Of course, Minkoff will have none of this, because to him CFI and skeptics like me are apparently totally “arrogant”:
I’m so sick of this pompous attitude. There is a reason why people don’t listen to pro-vaccination campaigns, pro-abortion rants, and diatribes against alternative medicine. Because they are just as manipulative, arm-twisting, intractable, and unreasonable as they say their opponents are. If anything, inquiry requires an open mind.
Ah, yes. Such doggerel. Skeptics are not only “arrogant” but they’re “close-minded.” Of course, this is the classic whine that, because I don’t accept your evidence-free (or even evidence-challenged) viewpoint or at least treat it with respect, even though it deserves no such consideration, I must be “arrogant.” It’s also the appeal to the open-minded. As I like to say, being open-minded is indeed necessary for science, but one can’t be so open-minded that one’s brain oozes out from his ears.
Being open-minded means considering ideas on their merit, such that if sufficient evidence can be marshaled in support of a claim the open-minded person will change his mind. Mr. Minkoff is more than welcome to demonstrate that alternative medicine is supportable by the evidence and see if he can change my mind. Instead, he cries, “Help! Help! I’m being repressed!” (By those nasty skeptics and atheists, of course!) In reality, such appeals to open-mindedness are ad hominem attacks designed to make their opponent appear intolerant without the pesky need to provide actual evidence, science, and logical arguments to support their position. What Minkoff really means by “open-minded” is “credulous,” although he doesn’t realize it, which is why his conclusion is pure hilarity:
For all their espousals of open-mindedness, the Center for Inquiry has a vision for the world that is unbendingly totalitarian and as narrow as the edge of a scalpel. The Center for Inquiry is right: religious dogma—faith—is the problem here. But not the Christian faith. As is proved time and time again, the greatest threat to freedom and inquiry in the world is the irremediably close-minded secular faith.
I’m only surprised that Minkoff had sufficient self-control not to actually mention Adolf Hitler and Josef Stalin (and, of course, Chairman Mao). The problem, of course, is that CFI is not acting on “faith,” secular or otherwise. It is simply advocating for policies rooted in evidence and science and not constructed to allow religious beliefs to be favored over others.
I was curious who Michael Minkoff is, given that I haven’t seen arguments this bad in a while. I noticed that he’s obviously creationist, having penned a howler entitled Evolutionists Continue Their War on Science, complete with tedious ranting about “materialists in white lab coats” and a lot of handwaving. It did, however pique my interest enough to think that maybe I should look at some newer creationist claims in more detail. On the other hand, if the quality of his anti-evolution arguments is any indication, creationists haven’t gotten any more clever since last I really paid close attention to their arguments.
As for Minkoff, I think Ed nails it when he tells Minkoff that if he thinks vaccinations don’t work and cause all sorts of horrible things he’s just wrong. Of course, I rather suspect that Minkoff is one of those conservative/libertarian types who is in favor of “health freedom” and is prone to antivaccine views because he hates the idea of the big evil government telling him what to do more than anything else, regardless of the effect on other people. Either way, his attempt to attack CFI is breathtakingly dumb. As one of Ed’s commenters wondered, would Minkoff complain if people with Ebola virus disease were forced to be quarantined, or would he be fine with them living next door and using homeopathy to treat their disease?
30 replies on “Quoth Michael Minkoff, let’s not keep healthcare safe and secular!”
I have a small objection to this passage:
Minkoff is also unhappy about CFI’s position on women’s reproductive health, ranting that “their reproductive health campaign seeks to force taxpayers to pay for other people’s abortions and birth control.” This is, of course, a silly argument, given that the government “forces” people to pay for things they don’t approve of all the time.
This was a rather jarring non-sequitur. As far as I can tell, Minkoff has not advocated tax delinquency. So isn’t his behavior part of what it means to live in a democracy? Creating groups to convince the government what you think should and shouldn’t be paid for, and opposing those groups whose opinions are in opposition to yours? Regardless of what you think of Minkoff’s goals, he’s doing something everyone in the US has a right (nay, an obligation) to do: attempt to influence the government.
If he doesn’t think he should be forced to pay for abortions, he has the absolute right to attempt to convince the government of that fact. If a pacifist doesn’t think she should be forced to pay for wars, she has the absolute right to attempt to convince the government of that fact. If an ultraconservative doesn’t think he should be forced to pay for Social Security and Medicare, he has the absolute right to attempt to convince the government of that fact. If a drug legalization advocate doesn’t think she should be forced to pay for the drug war, she has the absolute right to attempt to convince the government of that fact. And if you think you shouldn’t be forced to pay for the National Center for Complementary and Alternative Medicine and the National Cancer Center’s Office of Cancer Complementary and Alternative Medicine, you have the absolute right to attempt to convince the government of that fact.
Not all of the above can succeed, of course. But if everybody pulls the government as hard as they can in the direction of their ideal policy, the government ends up somewhere in the middle. That’s what a democracy is all about.
Minkoff’s ideas of what to pay for and what not to pay for may themselves be silly, but there’s nothing silly about his attempt to use personal morals as an argument. It’s the entire point of our society!
I guess it depends upon whether the core of Minkoff’s argument is “our government shouldn’t be doing X” or “our government shouldn’t be doing X with my tax dollars“.
The difference may seem inconsequential at first, but I don’t think it is. Transforming the former into the latter might successfully ward off embarrassing questions about “… and what makes that any of your business?”
A pacifist who is a citizen of a nation has a right and a duty to speak up, to demonstrate, to protest, to make his/her opposition known if that nation is heading into an unjust war.
It is much less clear that Citizen A has a duty or a right to interfere with Citizen B obtaining birth control when she needs it – regardless of how much in taxes either of them pays.
Exactly! That’s a very good distinction to draw/
The phrase ‘seeks to force taxpayers to pay for [thing]’ also frames the question in a way that assumes it’s de facto wrong for anyone’s taxes to go towards things of which they don’t approve. It suggests that it’s somehow an unusual outrage in this case, when actually it’s the inevitable result of governments spending tax money. Since I struggle to think of anything that taxes are spent on that couldn’t be opposed by someone out there, it’s a nonsense argument.
Antaeus Feldspar – I have to disagree with you slightly. Since tax dollars are, in fact, fungible the statements that “the government shouldn’t do that” and “the government shouldn’t do that with my tax dollars” are two sides of the same coin. Both mean “in my opinion the government shouldn’t do that”.
The person may also hold that such a thing should be illegal as well, but that is a separate topic.
I think part of this problem is the use of the word “access” to health care.
To some, access to birth control means the person faces no restrictions on buying it themselves.
To some, access to birth control means the person faces no restrictions on purchasing it and receives some money to pay for it from government or private employer.
To some, access to birth control means the person faces no restrictions on purchasing it and it is paid for entirely by government or private employer.
You can swap out birth control for other reproductive procedures such as abortion or sterlization and people may come to support different levels of access. But even if I disagree with a person who supports a different level of access than I do, it does seem to be reasonable.
Take this out of the health care realm to something else some people are passionate about. Some people did not want any tax dollars going to the federal inspection of horse slaughter facilities. So horse slaugther is now legal. However, USDA can spend no money on inspectors at horse slaugther facilities so there is no horse slaughter in the US. While I disagree with that result, I find the control of tax money expenditures to be a reasonable debate topic.
Presumably, the Center for Inquiry is all about choice and freedom of inquiry, so it’s odd that they should start a campaign that attempts to end choices and extinguish inquiry.
Mr. Minkoff is free to choose to swing his fist in the air. He is also free to inquire what would happen if that fist were to intersect my face. He is not allowed to choose to swing that fist into my face. Likewise, it’s one thing to choose not to be vaccinated if you are living the life of a hermit, but if you are unvaccinated (for any reason other than medical contraindication) and choose to live among the public, you are potentially a danger to that public. Pregnancy is a potentially dangerous medical condition, more so in some women than others, so it is reasonable for those women at particular risk to take steps to prevent or terminate pregnancy without interference from people like Mr. Minkoff.
Oh, and it should go without saying (but unfortunately doesn’t) that people who, like Mr. Minkoff, go around claiming to be Christian should pay closer attention to the explicit commandment about not bearing false witness.
We don’t know how the change of the law will affect California yet; in spite of the (illegal and problematic, in my view) addition by the Governor, it still can have substantial impact – the final phrasing of the religious exemption is very narrow, and hopefully not many people will be willing to state it, if not from honesty than from fear of repercussions. I hope it will still have a good effect. Though I wish he didn’t add it.
It probably won’t stand in court, if it gets there.
That’s a bit of an aside, I know.
Yerushalmi: So isn’t his behavior part of what it means to live in a democracy?
Yeah, but conservatives don’t want to live in a democracy, really. They want to live in a theocratic dictatorship.
Eric Lund: Oh, and it should go without saying (but unfortunately doesn’t) that people who, like Mr. Minkoff, go around claiming to be Christian should pay closer attention to the explicit commandment about not bearing false witness.
I thought that one expired.
As far as this post goes, I like the idea, but it’s much too little, much too late.
A bit O/T, but vaccine exemptions were at least mentioned today.
I have a bit of a heavy heart today — I visited and old friend I hadn’t seen in many years who has a son with rather complicated (and subtle) learning disability issues, and she’s convinced it was the vaccines. Oh, dear.
She said that her son had experienced some severe GI upsets right after one of the trivalent vaccine shots — I forget which one. From what I read on this blog, this seems to be a pretty common story among antivax mothers — the baby got the shot, and suffered an immediate reaction. My friend is not stupid (really!) and her theory is that there’s a small fraction of the population that suffer reactions like this, which (somehow) lead to neurological sequelae.
Mulling this over, I wondered if the large studies that have been done can really rule this out firmly. Would it be possible for a small signal from a relatively small “vaccine-sensitive” population to be swamped by the large numbers?
I thought of an inexpensive prospective study design to test this idea. Three days after a child receives the shot, the pediatrician’s office calls to follow up and asks if the parent noticed anything unusual — this could be couched (very honestly) as a study of “rare side effects”. Then, a few years later, the neurological status of the group that did have odd symptoms is compared to a group of asymptomatic controls. Any signal that was present would be strongly amplified. Because the parent was asked immediately after the fact, unreliable memories don’t enter.
Does anyone know if such a study has been done? I don’t imagine for a moment that it would persuade the unpersuadable, but as scientists we should make sure the i’s and t’s are dotted and crossed, respectively.
We may have to agree to disagree on this one. By the nature of our democratic government, everyone is going to find at some point that the government is doing something they don’t like. Because everything the government does is ultimately funded by tax dollars, inevitably that disliked thing will be funded in part by the tax dollars of one who dislikes it. Yet the only way that could possibly be avoided is if the government never did anything, at all, that wasn’t 100% approved of by 100% of citizens. No government could ever function under that impossible standard. “In my opinion the government shouldn’t do that” is a legitimate statement of opinion, but adding “with my tax dollars” to the end is an attempt, conscious or subconscious, to make it seem like the person complaining is being especially and unfairly affected by the government … not giving them everything they want just their own way, essentially.
I would also do an equal number of patients who get called 3 days BEFORE a scheduled vaccination with the same questions.
Because in some cases the “totally normal in every way before” stories don’t always hold up. Often there was some odd symptoms before the shots and you do want to account for people who only noticed them afterward.
There are rare, odd reactions to all sorts of things but I think given then numbers of people studied to date something should have shown up.
It also makes sense, at least to me, that anything that could give you “flu like symptoms” or “low grade fever” can cause some GI upset. A lot of the same chemical signals that mediate the immune system have effects on the gut. I had a bad reaction to an allergy shot and the poor doc had to give me the shot of benedryl in the butt to reverse it in the practice’s restroom because I wouldn’t leave the toilet long enough to get the shot in the exam room.
I think “Safe and Objective” might be less triggering of backlash. I think too many people misunderstand what secular means, and trying to educate them on that is too much of an uphill battle.
KM — good point. Although this could also just be asked at the visit, and indeed you’d think mostly would be asked anyway, though IANAP (I am not a pediatrician).
I think too many people misunderstand what secular means, and trying to educate them on that is too much of an uphill battle.
I suspect that in many cases this misunderstanding is willful. There are people who have invested too much in this sort of worldview. You are never going to reach these people anyway; you can’t reason somebody out of a position he didn’t reason himself into.
BTW, there are uses of “secular” which don’t involve religion or the lack thereof. For instance, the Earth’s magnetic field has a secular variation, which would be present even if a deity were responsible for it. But I don’t think Orac is using the word in this way.
It could be, but I see that rather as that being a statement of why one is entitled to state an opinion on the topic. If you were to see, say, a neighbor buying birth control contrary to the tenets of your religion and spoke to them about it, the neighbor would be well within her rights to say “who do you think you are, anyway? It’s my money, it’s my choice, and you are no longer invited to play canasta on Thursday night.” If I, not a citizen of France, were to criticize the city of Paris for hiring nude figure models using tax dollars I am sure that the officials of that city would, in their inimitable way, tell me it’s none of my business. However, as a citizen and a taxpayer one has the right – indeed, the responsibility – to question the government’s purchasing and funding decisions. Granted, paying taxes does not get one any special say compared to a citizen who (legally) doesn’t pay taxes, but one may feel that one has more responsibility to have an opinion.
Oh, it’s definitely possible. There are conditions so rare that we only know of three or four people in the entire world with them. Even if we somehow managed to do a study that enrolled every single child in the world, there would still be a limit to the statistical power of that study, and we could hypothesize a condition so rare that the study couldn’t detect it.
But if you hypothesize a condition of that rarity, the question that comes up is, why point the finger at vaccines in the first place? For all that the stories are often told as “we saw the problems within hours or minutes of the vaccine!” we know that that’s almost always an artifact of selective attention and distortion of memory. Unless there’s evidence to suggest an actual mechanism by which the vaccine could have caused the injury (and not just in the “both seem to have something to do with the immune system therefore CAUSE AND EFFECT” way favored by antivaxers, but an actual MECHANISM) then almost by definition, a condition too rare to be detected by epidemiology is too rare to be meaningfully correlated with ONE factor above all others.
Antaeus @16 —
A couple of points:
1) Any such study would of course only be capable of putting an upper limit on such a link. The question would be whether it could put an interesting upper limit on it.
2) I too seriously doubt that there’s a mechanism — the phenomenon probably doesn’t exist. But such a link is not entirely impossible, unlike (say) the claims of homeopathy.
3) The short-term follow-up question is a key feature of the design for exactly the reason you cite.
I suppose, thinking of this further, that there’s another possibility that I hadn’t considered. Suppose autism-spectrum disorder caused babies to become hypersensitive to insults such as shots. One would then see a correlation between immediate sequelae and eventual autism. This would be more difficult to control for.
If you check out all those reported “vaccine injuries” which appear on the anti-vaccine blogs, the parents claim that they were unaware of the VAERS system…in spite of the fact that every VIS for every vaccine has a huge notice about reporting severe adverse events to the VAERS and information about filing a claim in the Vaccine Court (bottom right corner) and information
And then there’s another question: if such a phenomenon exists, and is somehow related to the immune response, then it stands to reason that we would likely also see it after natural infections, with perhaps greater severity. So then we would want to look at that incidence, since we’d want to be able to compare the incidence after infection vs. after vaccination.
Doesn’t power by definition require sampling?
Todd @19 — You’re being too rational about this. We’re dealing with people who are sure that Big Pharma is hiding The Truth about the Toxins, whereas natural diseases are all trivial and never (well, hardly ever) harm us. The hard-core would certainly not believe a study like this, because they don’t think studies are a thing, but perhaps it might persuade some fence-sitters. And if it did find a definite effect, it might lead us to something interesting.
There’s been a ban on using federal funds to pay for abortion since 1976. And since that’s not presently being threatened or challenged by anyone — including, as far as I can see, CFI — the above is a little like saying, “Oh, well, he has an absolute right to use dishonest means to make people feel that the healthcare choices of women are their personal business.”
Which he does, actually.
I guess my point is more that he’s not really objecting to publicly funded abortion. There’s no need.
I’m glad to read that you were disturbed by the physician-assisted suicide platform.
To add to that previous people have said, another issue with the hypothesis of a vaccine-triggered rare condition as a mechanism for the happenstance of autism is that autism is not a rare condition, relatively speaking: we are now around 1% incidence for the whole spectrum.
A single condition, or a whole set of disparate conditions with a similar endpoint – autism or GI trouble or what-have-you – which is present above 1/1000 people would most likely have been picked up.
Would it be possible for a small signal from a relatively small “vaccine-sensitive” population to be swamped by the large numbers?
It would probably be possible. What isn’t possible is for it to be true both that there is a large increase in autism caused by vaccines AND that vaccines cause autism by a mechanism that occurs in a percentage of children so small that it can’t be statistically detected.
A few weeks ago, Orac posted about an interview with Andrew Wakefield in which he was talking about a flu vaccine being investigated for potentially causing narcolepsy. In that case, normal monitoring picked up what turned out to be a 2-3 fold increase in only some age groups, in a disorder that normally affects 1 in 2000 people. The monitoring that exists is pretty sensitive.
Thanks, everyone, for your replies. I was really quite upset and saddened to see that my dear friend had been so hornswoggled.
Palindrome, I think your friend’s question about a small and sensitive subset is the hardest of the anti-vax arguments to refute–not because it might be true, but because the evidence is shrouded in the complexity of statistical analysis and epidemiology, etc., which is real hard to explain to even a very smart layperson. And I don’t understand it well enough to even explain. I accept what I read here because it has been consciously chosen as an expert source. Sadly, even smart people often choose dopey “experts”.
I’ve often wondered why CAM advocates accept so many forms of woo and reject other forms, such as humorism and blood-letting.
Palindrome @ 9: How about this:
Have doctors’ assistants call parents after _every_ visit and ask a generic question such as ‘have you noticed any health issues in your child since your visit?’ Phrase it in a manner that is purely routine and does not suggest anything in particular. If an explanation is needed, ‘sometimes people become more alert to health issues after a doctor’s visit’ should suffice.
Collecting all the data will enable comparisons between ‘visits where vaccines are administered and ‘all other routine visits’ and ‘visits occasioned by illness.’ It won’t get false positives in relation to vaccines, or spread the accidental anti-vax message that is inherent in the phrase ‘side effects.’ it might also pick up contagious illness spread via the waiting room and thereby suggest improvements in waiting room procedures.
For example, what if it turns out that the same percentage of kids show signs of illness after non-vaxx routine visits, as compared with those who show signs of illness after visits where they get their jabs?
Regarding the concept of taxpayer money going to pay for abortions, this is actually a major conservative talking point right now, even though as you say the federal government is actually forbidden from doing so and has been for a long time. Sometimes they are merely raising the specter of this changing, though no one has suggested doing so, but lately it has gotten more significant, to the point that there’s an actual urban legend to the effect that the federal government is paying for irresponsible welfare queens to have constant abortions. This idea gains some support thanks to government funding for women’s health care services, including at Planned Parenthood, and sometimes the argument is made that it’s “subsidizing” Planned Parenthood’s supposedly massive abortion mill. And it also gains support thanks to what could charitably be called a difference of opinion on what constitutes abortion. Since some people believe that contraceptive pills cause abortions, and since federal funding does pay for these, to some, the federal government is funding abortions. And so a rumor grows and spreads and gets out of hand, and the end result is that women’s health services suffer greatly in the name of preventing something that actually isn’t happening anyway.