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Just the Facts

Get your facts first, and then you can distort them as much as you please.

—Mark Twain

There is an educational approach to becoming a doctor. It involves learning massive amounts of basic science, followed by massive amounts of pathophysiology, which barely prepares you for the clinical years of the last half of medical school and subsequent residency, with the massive knowledge dump you will have to absorb. Much of the information is given by experts in the field, usually MDs or PhDs (or both), who lecture formally and informally. Being considered an expert in infectious disease (ID) at a teaching hospital, I now spend hours a day yammering on about infections to anyone who will listen, students in all the medical fields who rotate through our hospitals. I value the facts I have learned in my field and respect those who have worked to provide me with the information. I greatly value facts and the people who provide them.

Most of the information I get in medicine is from those in the field. It is rare for people to write about aspects of medicine that I will take seriously. Yes, there are a lot of people who write on the web about medicine, but given what it takes to achieve even a solid knowledge in medicine, much less develop expertise, I usually can’t take them too seriously. Call me arrogant, but if you want to be a legitimate source of information there are dues that have to be paid.

The world of anti-vaccination discourse is small. There are few physicians who take an interest in the topic. Most doctors are too busy to care and it is like worrying about defending fresh water and clean air. I would wager that to most physicians outside the world of pediatrics, the benefit of vaccines is rarely given a thought.

The anti-vaccinationists are an equally small group of people, at last the ones that bother to write on the topic. Sometimes they seem inordinately loud, but that is only because they end up on Oprah.

I often feel that the two sides inhabit different worlds with different approaches to reality. I live in a world dominated by facts derived from the sciences. The facts always change, or better words may be evolve or refined, with time. But facts matter to me. There is a world of facts derived from observation of the natural world and in the end my opinion on a topic medicine does not matter. It is what the facts indicate that should determine my opinions, not the other way around. Facts can be tricky things, especially in medicine, with nuance and subtlety that makes the facts less clear cut than one would like, especially compared to a hard science like physics or chemistry.

Facts often do not seem to matter to anti-vaccine proponents and other CAM practitioners to the same degree that they do to me. For example, given the preponderance of information about the worthlessness of homeopathy I cannot see how anyone would ‘practice’ homeopathy. Or acupuncture. Or chiropractic. Or virtually any CAM discussed on this blog.

I have spent half of my life accumulating facts to understand the best way to practice medicine and, as best I can tell these facts, do not matter much to the CAM practitioners or anti-vaccinationists.

And I don’t get it. Why do the CAM practitioners and anti-vaccine proponents not pay attention to the facts. It is, as I have said, like we live in two separate cultures. I have spent some time in other countries whose customs are different from mine: Japan, France, Minnesota. Before visiting those foreign lands I would read texts by anthropologists and historians on what to expect and how their culture differed from mine. I would never have survived my three years in Minneapolis if not for “Lake Woebegon.” But who better to understand a foreign culture than an anthropologist. What I need is anthropologist to help understand why the facts do not matter.

Ask and you will receive. I serendipitously came across two articles. The first is by Leonard Pitts in my local paper.The other is “A Post-modern Pandora’s box: Anti-vaccination misinformation on the internet” by Anna Kata, an anthropologist from Canada. There are other studies on the beliefs of the anti-vaccinationists, but they are from the perspective of doctors and have underlying belief that if you get the right information to people they will make the right decision. Doctors believe, in the end, in rational discourse.Others do not.

The Internet plays a large role in disseminating anti-vaccination information. This paper builds upon previous research by analyzing the arguments proffered on anti-vaccination websites, determining the extent of misinformation present, and examining discourses used to support vaccine objections. Arguments around the themes of safety and effectiveness, alternative medicine, civil liberties, conspiracy theories, and morality were found on the majority of websites analyzed; misinformation was also prevalent. The most commonly proposed method of combating this misinformation is through better education, although this has proven ineffective. Education does not consider the discourses supporting vaccine rejection, such as those involving alternative explanatory models of health, interpretation strikes me that this argument is for a freedom without responsibility for the consequences of parental responsibility, and distrust of expertise. Anti-vaccination protestors make post-modern arguments that reject biomedical and scientific “facts” in favour of their own interpretations. Pro-vaccination advocates who focus on correcting misinformation reduce the controversy to merely an “educational” problem; rather, these post-modern discourses must be acknowledged in order to begin a dialogue.

Note she puts facts in quotes.

What the author did was Google for websites that opposed childhood vaccinations for any reason and she ended up with 9 sites, including the whale, vran.org, vaclib.org, and vaccinationnews.com. Why so few? Evidently those seeking health information on the net rarely look past the first 10 search results, so she tried to mirror the results of the average internet user searching for information. She then analyzed the sites for content relating to Safety and Effectiveness, Alternative Medicine, Civil Liberties and Conspiracy Theories/Search for Truth as well as design attributes of the web sites, emotive appeals and content. Interestingly, a search using the terms “immunization OR immunization” failed to find any anti-vaccine sites; anti-vaccinationists do not use the term as “they tend not to believe that vaccine confer immunity.”

The findings will be no surprise to those who frequent anti-vaccine sites, or alt med sites in general.

What 100% of the sites had in common was the assertion that vaccines are dangerous because they contain poisons or cause a variety of illnesses. It was noted that on the sites “pertinent information was not elaborated upon” and gave examples of the amount of ‘toxins’ being too small to cause disease and that the ether in vaccine is the chemical not the anesthetic not being mentioned on the anti-vaccination sites.

Also common were statements concerning the lack of vaccine immunogenicity, the lack of vaccine efficacy in decreasing childhood diseases (credited to diet, hygiene, etc) and a trivialization of vaccine preventable diseases, failing to mention the past and present morbidity and mortality of the diseases.

What these sitesdemonstrateis a disregard for facts, which at one time were considered the final arbitrator of reality. If facts do not matter, and can be ignored arbitrarily, then the conversation between the reality based approach to medicine and the alt med practitioners is impossible.

She notes that most sites endorsed the use of alternative medicines and often argued against germ theory.

Anti-vaccination website tended to reject scientific, clinical and epidemiologic studies demonstrating the safety and efficacy of vaccines. Pro-vaccinations studies were criticized as unreliable, conducted by those with vested interests in vaccination.

Again. Facts ignored or dismissed.

Three quarters of the sites cited the infringement of civil liberties by requiring vaccination. It strikes me that this argument is for a freedom without responsibility for the consequences. It is an argument for which I have some sympathy, but only as long as those who wish to exercise their freedom not be vaccinated are always at least 30 miles away for me and mine or agree to take all the financial responsibilities for the medical care of anyone they inadvertently infect. My problem with the civil liberty approach comes from having to take care of for free and my hospital treat for free people in the trauma ICU who preferred the freedom of not wearing seat belts and helmets in defiance of the man and ended up with multiple, very expensive, traumas. But we are all biased by our experience.

“The conspiracy theory theme was present on every website analyzed”. Someone, usually doctors or big pharma, is covering up of the TRUTH they don’t want us to know (but is somehow widely available) about the sordid truth that vaccination production and promotion is being motivated by solely profit.

Those who speak out against vaccination were considered martyrs to the cause, such as Dr Andrew Wakefield. I cannot wrap my head around the fact that after all the information that has been released about the conduct in his Lancet paper that people would resort to insisting that the man is out to get him rather than the fact that his study was unethical and the data falsified. I hate to risk invoking Godwins law, but I am reading the Fall of Berlin at the moment, and one of the many striking aspects of the madness of the Eastern front is how, as the Soviet’s were shelling Berlin and the Soviet troops were entering the city, there were still those who still thought and acted like a German victory was possible. I have also seen patients who deny remarkable pathology and present with advanced cancer or AIDS. The ability for people to deny even the most compelling evidence is beyond my feeble intellect to comprehend. I can only shake my head in wonder.

Religious ideology was the least represented reason against vaccination on the sites, although the morality of growing vaccines in aborted fetus or experimenting on children was mentioned, it was only mentioned in about a third of sites.

Not unsurprisingly, misinformation and falsehoods were found on every site. “88% made claims unsupported by evidence” and personal testimonials of the harm alleged to caused by vaccines were also common.

Only the Wikipedia was free of taint.

The open nature (of the Wikipedia) appears to have acted as form of peer-review, keeping the page current, unbiased and properly referenced. There appears to be no self-criticism within the anti-vaccination community; this was demonstrated by most of the analyzed website.

Free and open debate is least practiced by those who rage against the oppression of the man. That should have been an Alanis lyric; she would have had less criticism for a lack of understanding of ironic. Again the pattern: a disinterest in facts as well as no interest in having factual errors corrected. The attitude evidently being ‘if I want your opinion, I’ll give it to you.’

Interestingly, 25% identified themselves as non-partisan, non-profit or a public education group, giving the impression impartiality, but all linked to other anti-vaccination sites while only half linked to pro-vaccination sites.

If you spend time in the anti-vaccination world, or alt-med world, none of the above will come as any surprise. To my mind what was an interesting conclusion of the author.

A proponent of vaccination would likely wish to counter with “correct” information; indeed, the most commonly proposed intervention to combat vaccine misinformation is education…With acknowledging falsehoods is important, the assumptions behind educational methods must be examined. Assuming additional information will influence vaccination decisions reduces the issue to one in which the two sides are separated only by a gap in information.

She further points out that educational attempts only anger those who are corrected (AoA anyone?) and that historically education has not altered the opinion of those who have been against vaccination, whose essential messages have changed little since the 18th century, despite the massive increase in biomedical information to correct vaccine misinformation.

It is not the facts that inform the rejection of vaccines (or, more broadly, modern medicine) but “belief in alternative models of health, promotion of parental authority and responsibility and suspicions of expertise.”

It is not the facts that guide opinion, but opinion that determines the facts. She uses the relationship opinion = evidence + values, and as the former approaches zero, the latter predominates.

She also points out how the trend in medicine to patient autonomy and informed choice has had the inadvertent effect of medical consumers extending that autonomy to public health issues and rejecting the premise of vaccines for the overall societal good, noting that “parents may reject epidemiological and population-level risk arguments for vaccinations, for such statistics do not take into account specific experiences, ideologies, and health histories.”

It is both the triumph of medicine that so much benefit can be gained by ignoring specific experiences, ideologies, and health histories, and is medicines current bane. I know that the data suggests the more we treat all patients the same, the better the outcomes, but no one wants to be another cog in the medical industrial complex.

I am motivated by the facts, and have a trust in the long term validity of the results of medical research. Ideas wax and wane, but most people in the field are doing good work and are not dishonest. They are good people trying to do good work. Dr. Wakefield is an aberration. However, to the anti-vaccination crowd, not only is Dr. Wakefield a source of truth, the rest of the results of biomedical research are suspect. It is the post-modern questioning of the legitimacy of authority and science, and neither is valued nor trusted. In my world, both are valued and trusted.

So where does that leave science based medicine? I am not certain. I value facts, medical and scientific authority, always with the understanding of its somewhat fluid nature. The ‘other side’ does not value facts or the weight of expert opinion, especially when it contradicts their opinion. Those who promote anti-vaccination or homeopathy or the numerous non-reality based therapies live in a different world than I, and we do not share a common common view.

What is the proper dialog or is such a dialog even possible? I suppose the best I can do is plant a seed of doubt here or serve as a source of information for someone who is not committed to the ideas of scams. Maybe Fordor’s needs to have a new guide.

Posted in: Science and Medicine, Vaccines

Leave a Comment (187) ↓

187 thoughts on “Just the Facts

  1. BillyJoe says:

    Isn’t it ironic. My wife bought me a car recently and loaded the six stack sterio with CDs. On of them was Alanis Morissett’s “Little Jagged Pill” which contains the song “Ironic”. There was also her album “Under Rug Swept”. I had ever paid much attention to Alanis Morissett before, in fact I didn’t even know she existed for a long time, but after listening to her over the past few weeks I have become a devoted fan. Isn’t it ironic.

    Also I have known a girl called Alana Morris for about 20 years.
    Isn’t THAT ironic?

    Anyway, back on topic….

  2. BillyJoe says:

    “She further points out that educational attempts only anger those who are corrected (AoA anyone?)”

    Anger, yes, and then censorship.
    That was my experience recently at AoA trying to courteously explain the problems with “personal experience” as a legitimate form of evidence.

  3. ” Being considered expert in ID…”

    Dr. Crislip,

    Reading this during my morning coffee my half-awake mind thought you meant “Intelligent Design” for 10 or 20 milliseconds. But eventually I clued in.

    Thanks for a fun Friday morning WTF? and a great article.

  4. DavidCT says:

    Mastering real knowledge in the real sciences is hard work. That is part of the appeal of the other ways of knowing concept. These folks have never taken the time to master enough knowledge to reach a threshold where one can actually start to think for oneself. It is far easier to make things up as you go along. They truly live in a different world but they do not know enough to appreciate that fact.

  5. windriven says:

    “Religious ideology was the least represented reason against vaccination on the sites, although the morality of growing vaccines in aborted fetus or experimenting on children was mentioned, it was only mentioned in about a third of sites.”

    This made me laugh out loud, not because of any intrinsic humor, but because in my estimation religious nonsense lies at the root of why, for instance, facts don’t seem to matter. We are taught from an early age to believe the unbelievable, the unverifiable, in some cases the patently ridiculous.

    Mix that taught-from-the-crib willing suspension of disbelief with a good measure of clenched-jaw paranoia (medico-industrial complex, corporatist, cover-up! BIG HARMA!!!), shake, bake (but only halfway) and you have an antivaccinationist (or some other flavor of moron).

  6. rosemary says:

    There have always been humans living on the realistic end of the continuum and others on the fantasy end with the majority dwelling someplace in between.

    Evidence changes. As it does, so do conclusions based on “presently available evidence”. Realists base conclusions on independently verifiable evidence. commonly referred to as “facts”. Others, many of whom find the real world just too unpleasant to dwell in or who were born with vivid imaginations, prefer to create and live in their own fantasy worlds. The Internet enables large numbers of both groups to find and reinforce each others views.

    This will never change. However, what we are seeing now is something people of our generations haven’t seen before, large numbers of very vocal fantasizers (sp?) who are very articulate and who strongly influence public opinion.

    My guess is that the pendulum will swing back the other way again, but I have no idea when. Till it does, I think that by arguing and debating with those who live in fantasy worlds will be counter productive especially for doctors and scientists since it reinforces the stereotypical doctor alts rally against. IMO, realists have to aim their educational efforts at the general public, not those on the extremes, and accept the fact that there will always be people who reject objective evidence.

    I think that the reason the number of people living in Fantasy Land has increased so dramatically within the last few generations is that people not only no longer have personal experience with unscientific medicine, the days when there were rabid dogs running loose and everyone suffered from childhood diseases, but they haven’t even heard the stories or seen movies about those times.

    I also think that educating the general public should include stories about such things and, if possible, movies and videos, media which get through to many more people than words on a computer screen or in print.

  7. windriven says:

    @rosemary

    “I think that the reason the number of people living in Fantasy Land has increased so dramatically within the last few generations…”

    Why do you believe this number has grown? Fear and superstition are powerful forces and they have been around forever (Heraclitus: dogs bark at what they don’t see). Could it be that the number, the percentage actually, hasn’t changed so much but that the accumulation of knowledge casts them in sharper relief?

  8. micheleinmichigan says:

    windriven “my estimation religious nonsense lies at the root of why, for instance, facts don’t seem to matter. We are taught from an early age to believe the unbelievable, the unverifiable, in some cases the patently ridiculous.”

    Yet the vast majority of the people I know have some spiritual belief. Still, they get their children vaccinated, use conventional medicine exclusively, work in technologically advanced fields that require an in depth understanding of science. Statistically, the number of people who have a religious belief in the U.S. is high, but the number of people who refuse vaccination is far, far, far, lower.

    Do you see any statistical correlation between countries that have a higher secular population and lower vaccination refusal rates? I have not seen any data on that.

  9. micheleinmichigan says:

    “What is the proper dialog or is such a dialog even possible? I suppose the best I can do is plant a seed of doubt here or serve as a source of information for someone who is not committed to the ideas of scams.”

    Yes, and that is important, because a whole lot of parents are NOT committed to the anti-vaccination movement. They are just looking for good information. It’s important it be available.

  10. micheleinmichigan says:

    Great Mark Twain quote, by the way.

  11. rosemary says:

    Windrive, you are correct. I may be wrong. The number may not have grown. However, although I haven’t investigated, I believe that the number of people who reject scientific medicine, the kind of medicine that is based on objective evidence, and embrace the unscientific kind, has dramatically increased and that that can be seen by the large numbers of what were previously scientific institutions which now promote the unscientific kind, the kind based on subjective experience as opposed to objective evidence. It can also be seen by the numbers of health care practitioners who practice nonsense like TT, the number of media reports that promote crazy “medical” practices, the fact that “dietary supplements” and homeo “remedies” are sold in pharmacies next to OTCs, the number of parents refusing to vaccinate their children, the ads aimed at mainstream consumers telling them what non-experts like “doctor mom” think of their products, government policies, etc. I believe that ads and government policies in particular reflect what the majority either believes or at least is not offended by.

    In my experience until very recently, scientific medicine and its practitioners were highly regarded by western societies. Their opinions were, for the most part, valued and trusted because people assumed that they were based on objectively verifiable evidence. But that has all changed within the last two decades and we now live in a populist age where everyone with a computer is an expert in whatever suits his fancy.

    While I am not religious, I do not believe that religious beliefs by and of themselves indicate that people are irrational simply because I have known far to many religious people, including doctors and scientists, who were very rational. For the most part, they kept their religious beliefs and their medical opinions separate believing that religious beliefs cannot be objectively demonstrated as true or false and that they must be accepted or rejected “on faith” while at the same time believing that science and medicine can and must arrive at conclusions based on objective evidence. Those were basically a cultural views shared by most of society whereas the view that someone detecting energy emitting from a human body that no one else can detect, waving their hands over the person and redirecting the energy to cure them of disease would simply have been considered crazy by most of society in the recent past. (As it probably still is although not to the extent that prevents large numbers of nurses from practicing it.)

    I’m sure someone can state this better than I can, but psychologists maintain that holding an irrational belief that is believed by the society or group in which one lives is a cultural thing. Whereas holding an irrational belief different from that of those around one is a delusion. What I’ve never been able to find out is at what point such an idea is considered to move from a delusional idea to a cultural one.

  12. Jay says:

    ‘Why do the CAM practitioners and anti-vaccine proponents not pay attention to the facts.’

    I think that, essentially, humans are not consistently logical or ‘fact based’, and that most people are a combination of ‘irrational’ nonlinear, and the ‘rational’ linear, and that some people are mostly intuitive in their approach to understanding the world about them, e.g. I once took an art course and I found this out very quickly! Medical types are not good at this type of brain processing.

    Our schooling process as medical professionals in the western world (taught to us by similar thinking professors, by the way) has created an emphasis on one type of brain processing that is rational, and understands the world in this way. It’s a very useful and practical way…. but to say that it’s the only way to get at reality misses the point about how the mind works in the average person, perhaps.

  13. WilliamLawrenceUtridge says:

    I know it has been mentioned before in previous comments, but Mistakes Were Made (but not by me) (C. Tavris & E. Aronson) really can’t be recommended highly enough. It actually addresses Wakefield specifically, along with a lot of other interesting stuff.

    Tavris & Aronson would give a very simple answer to why antivaxers resist evidence. Once anyone makes an initial decision, irrespective of the reason or evidence, it becomes an act of willpower to admit an error, review new evidence, and resolve the cognitive dissonance. In this case, the dissonance between “I am a smart person who educates themselves about their risks to their children” with “there’s no good evidence to believe that the vaccines I have denied my child are harmful”. Instead of carefully evaluating the new and disconfirming evidence to arrive at a new conclusion, their energies go towards “how I can I dismiss this new evidence and thus continue to support my self-perception that I’m a smart, caring parent”. That means pulling out all the conspiracy theories, belittling people who believe, and shutting down all actual critical thinking in favour of mindless criticism.

    Kata is correct that it is a mistake to attempt to address this through education. Tavris & Aronson would probably suggest solutions that emphasize and support the belief that the parent is a good parent, that skepticism is warranted, that drug companies can be dicks, but resolve the dissonance in another way – perhaps an appeal to openmindedness.

    Or my approach – sell their fellow anti-vaxers down the river, throw ‘em under a bus, and make them look smarter for rejecting it. Emphasize that by changing their mind in response to new evidence, they’re actually smarter than their former peers, who are too bloody-minded-stubborn to change their minds. It’s like coaxing someone off the ledge – you do it by appealing to their sense of self.

    Anyway, good book and its implications are immediately apparent for the antivax crowd.

  14. Very good observations, grasshopper.

    I agree with youy generally that it is very odd how the anti-vacc crowd will fight and carry on in the face of contrary evidence. I don’t think imunizations cause autism, and my children have been immunized per schedule.

    However, along with your medical knowledge, it seems like you are on a good path to figure out how “facts” might be different from “knowledge,” and how “knowledge” might be different from “wisdom.”

    One recent real-world issue is the idea of vaccination for rotavirus.

    Before Rotashield, did you know a “fact” that rotavirus was a serious health threat? Were there ID discussions of the unaddressed specter of rotavirus? Or, was there just a “fact” that it happens, and we should monitor for dehydration?

    After Rotashield was approved, and was heavily promoted, the medical community had a new “fact:” rotavirus is a serious, life threatening disease and we need to do something about it. Here, take this shot.

    It is probably a fact that Rotashield protected infants generally from rotavirus, and for a small portion, gave them intussusception.

    Were you “for” Rotashield when the “facts” seemed to say the benefits outweighed the risks? Before the intussusception facts emerged?

    What was the process like for you to hear the emerging information that Rotashield was causing more U.S. deaths than it was saving? Was there a transition period, where you were first skeptical of the dangers of Rotashield, then suspicious, then fairly concerned, then convinced in the other direction?

    Adjusting to emerging “facts” is a good thing, generally. But a point is that the picture painted by “facts” changes as more “facts” emerge.

    Maybe that gets at the idea of “knowledge.”

    When Rotateq was approved, were you on-board immediately, after reading the couple of studies concerning safety as well as efficacy? Or were you hesitant, having been burned once? Being hesitant might be getting at what I am trying to say with the word “wisdom.”

    Currently, is it a “fact” that Rotateq is safe?

    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5610a3.htm

    Is there actually a fact that sounds like this: “Rotateq is safe.”

    If there is, then why have post-approval surveillance?

    Or is that “fact” a qualified “fact”? “As far as we know, from post-approval surveillance, Rotateq is safe.”

    That is sounding less like a fact, and more like “a summary of current evidence-based opinion.”

    Here is one “fact” concerning Rotateq that is puzzling to me: the CDC link above notes that rates of intussusception are not higher WITH wide use of Rotateq, compared to no Rotateq use.

    Each incidence would be a fact; the two facts together add up to “safe.” The CDC says intussusception incidence with Rotateq “was not elevated above the age-adjusted background rates.”

    However, the puzzle is this: how is Rotateq making intussusception incidence dramatically lower?

    This CDC reports a drastically reduced 20-day-post-rotateq-vaccination incidence of intussusception. RR = .3:

    If this data were framed as a prevention-of-intussusception study, Rotateq would be wildly successful in reducing incidence of intussusception.

    But it is not.

    What does the CDC make of this “fact?”

    My take is that the difference is accounted for by differing surveillance measurement used for the base rate incidence and for monitoring rotateq-related incidence.

    I am moved to believe that it is a fact that we do not have adequate intussusception incidence “facts.” Either one incidence measurement or the other is dramatically off to give a RR of .3 when we should expect a RR of 1.0. Either one estimate/measurement or the other is pretty far out of range of being a “fact.”

    If we don’t have good incidence measurements, then how factual is our “fact” that Rotateq is safe?

    And if my local pediatrician cannot answer these questions decently, then why should I trust him regarding the next round of vaccinations?

    Even more scary:
    If my local pediatrician has not even thought of these questions, which seem reasonable to me, why should I trust him with the next round of vaccinations?

  15. pumpkinpie24 says:

    Dr. Crislip, first I would like to thank you for this post and for your work on this blog. I too am a science minded, fact-based person and find a wealth of information here. Nothing gets my blood boiling more than the anti-vaccination movement and I’m always happy to have more talking points.

    Second, could you explain or direct me toward another post of yours that explains why you believe Minneapolis/Minnesota to be a “foreign county?” I have lived here for 3 1/2 years and have mostly encountered rational, sensible people. Of course, I work mostly with scientists and science-friendly folks, so I may not encounter those you speak of.

    Thank you.

  16. windriven says:

    @micheleinmichingan
    “Statistically, the number of people who have a religious belief in the U.S. is high, but the number of people who refuse vaccination is far, far, far, lower.”

    I did not mean to suggest that everyone exposed to religious teachings becomes an anti-vaxer. My point is that we teach conflicting values. When we teach children that inchoate belief is (at least in some confessionals) more powerful than scientific evidence, we prepare the fields in which the weeds of magical thinking can flourish.

  17. Galadriel says:

    It’s always interesting to me when someone insists on believing something which is contrary to all observable facts; somehow that just don’t see the facts. And can’t be made to see the facts. This does seem to happen in everything, not just medical knowledge.

    “Interesting” isn’t always “non-harmful,” although I do think in a lot of cases irrational beliefs are harmless…too bad there are those exceptions.

    On a tangential note–and one that will be of limited help, what with that willful ignorance I mention above–I saw a lovely graph a while ago and can not find it again. It was a graph of individual disease incidences (deaths or just diagnoses? I don’t know) over time, with a marking for when the vaccine for each disease was introduced. It was a fascinating and compelling graph, but I didn’t look into it any more at the time, and I can not recall where I saw it. Can anyone point me to the source?

  18. windriven says:

    @rosemary
    We do not, in large part, disagree. But there are many factors at work here. Doctors may well have been held in higher esteem a couple of generations ago. But a couple of generations ago the relationship between doctor and patient was far different: patients generally paid for their care themselves; doctors made house calls; medicine was less commercial than it is now.

    And I think that much of the alt.med nonsense was around a couple of generations ago – just different nonsense, often under the name of home remedies.

    “psychologists maintain that holding an irrational belief that is believed by the society or group in which one lives is a cultural thing.”

    I maintain that holding an irrational belief is irrational. A commonly held irrational belief might be construed by some as culture, by others as mass delusion. The Heaven’s Gate people all shared the same irrational belief. Is the fantasy of Heaven’s Gate really different in kind from the Roman Catholic dogma that condom usage is sinful?

  19. micheleinmichigan says:

    “My point is that we teach conflicting values.”

    But I often wonder if that is a bad thing or a good thing. Kids and adults all need to learn to distinguish between conflicting values. We do it all the time. I can see that dogmatism can lead to a lack of differentiation but dogmatism can happen with or without religion.

    But then I tolerate a certain number of weeds in my garden. That is my ‘choose your battles’ philosophy at work.

    My main complaint with the religious right is evolution in schools and reproductive choice . That is the equivalent of Campanula L. Bellflower (terribly invasive things) in my garden. But, I will note that most religious people I know agree with me on those two things.

  20. tmac57 says:

    rosemary-”What I’ve never been able to find out is at what point such an idea is considered to move from a delusional idea to a cultural one.”
    Thats an interesting question. An incorrect idea could understandably be held by a person who is ignorant of the facts, and not be considered irrational. The irrationality comes into play when the person is taught, and understands why a belief is wrong, but still continues to believe it despite the evidence. But that is also tricky to pin down, because cultural beliefs that contradict evidence, that are well ingrained in a person are hard to overcome with facts. Does that make the person irrational? Or does it just mean that cultural beliefs are more important, or that the individual really does not understand the idea of what constitutes good evidence? I think the latter, along with confirmation bias, and the avoidance of cognitive dissonance, are what are driving the anti-vax believers.

  21. And then we get into psychological distinctions between “normally irrational” and “abnormally irrational.”

    Human beings are not that rational. A very rational, dedicated-to-rationality human being is usually one who has a particular talent for rationality and has then been rigourously educated in the discipline.

    People normally live their lives using a lot of irrational shortcuts. One common one is, “Distrust enemies.” Rather than dispassionately dissecting everything said by someone who is acting against my interests, I simply discount it.

    If I am your enemy and you know it, I can’t reasonably expect you to listen to anything I say.

    Ways you can know if I am your enemy and acting against your interests:
    — My actions and/or values and/or persona are viscerally repellent to you.
    — I get richer while you get poorer.
    — I try to constrain your private actions.
    — I tell other people not to listen to you.

    The fact that most people accept public health measures like vaccination is a testimony to the great effectiveness of education in overcoming these non-rational (but powerful and not necessarily wrong) shortcuts.

  22. Dacks says:

    This whole discussion reminds me of the challenge of countering climate change deniers, Tea-Partiers, and any number of other angry, distrustful groups. It seems like a good first step to recognize that rejecting vaccines is an expression of belonging to a certain subculture. This movement, like the others, derives from an underpinning of shared beliefs, such as mistrust of authority, fear of losing autonomy, frustration with complexities of modern life, etc.

    I’m not claiming that these shared beliefs are the same across or within the movements, or that any of these categories are the ones that motivate the cohesion of a particular movement. But perhaps a global attempt (like the one taken by the anthropologist) to place behaviors that we skeptics find baffling, such as vaccine rejection, within a particular worldview may be helpful in developing counter strategies. Refusing vaccines makes sense to the antivaxxers – if we want to influence their behavior, we might do well to try harder to understand why that is.

  23. Fifi says:

    Alison – “Human beings are not that rational. A very rational, dedicated-to-rationality human being is usually one who has a particular talent for rationality and has then been rigourously educated in the discipline.”

    No kidding that we’re generally not that rational! Though even the most outwardly irrational act usually has an internal rationalization or rationale that can be understood even if it’s entirely faulty in objective terms. It’s been my (subjective) observation that some people have a “talent” for a certain kind of rational or linear thinking, while others have a talent for more intuitive or associative kinds of thinking – but that both can be learned to a certain degree. They can actually be quite complimentary and some of the most creative scientists seem to be able to harness both speculative/creative and rational/logical ways of thinking. However, these two different ends of the spectrum often end up in opposition (as do people who express one end of the spectrum or the other) and can lead to great misunderstandings and conflict between people.

  24. Fifi says:

    Oh, and the very human tendency is to believe that the way we (meaning ourselves and our tribe) are wired or think is far superior to the way those other people are wired or think. Even when we try to place ourselves in another’s shoes, so to speak, we tend to imagine what it would like to be ourselves inside their mind (or undoubtedly ill-fitting shoes). One of the many functions of art – or at least some art – is to try to express and share this subjective and experiential aspect of being human.

  25. Lenoxus says:

    Possible typo: “immunization OR immunization”. They’re both the same word… should one of the Zs be an S?

    In a Futurama episode, the following dialogue occurs:

    FRY: Y’know, when you flush [alligators down the toilet], they stay alive in the sewers.”
    BENDER: “Really?”
    FRY: “Yep. My friend’s cousin’s caseworker saw one once. It’s a widely-believed fact.”

    Since everyone uses the terms “fact” and “factual” to describe their beliefs, perhaps a better word is “empiricism”. Lots of people who are empirically wrong are quite willing to admit that they might be — but, well, there’s more to life than cold, heartless, empirical facts, right? Maybe vaccines are empirically safe — but in a warm, fuzzy, spiritual way, they’re evil and toxic. (The inverse for homeopathy.)

    MedvsTherapy: Your argument seems to come down to suspicion because Rotateq was made safer with regards to intussusception. Huh.

    You say:

    Is there actually a fact that sounds like this: “Rotateq is safe.” If there is, then why have post-approval surveillance? Or is that “fact” a qualified “fact”? “As far as we know, from post-approval surveillance, Rotateq is safe.” That is sounding less like a fact, and more like “a summary of current evidence-based opinion.”

    Do you… will you… ever understand why scientists don’t hold out for 100% certainty? No vaccine will ever be either “100% safe” or “100% effective”. No human activity is either of those things (have you driven a car lately?). The point is that Rotateq (especially since it has been made even safer) is a very good idea.

    But because of what happened in 1999, you are permanently suspicious of rotavirus vaccines (for you “Rotateq” is “Rotateq”), and would rather risk the intangible, don’t-have-to-feel-guilty-that-my-kids-got-sick-cause-it-was-just-Mother-Nature disease. That’s like refusing a polio vaccine because its 1950 version had a small likelihood of causing the disease, even though the likelihood is even tinier or nonexistent today.

  26. Cloud says:

    I actually went to the trouble to register for this site so that I could point you to this article from Nature:
    http://www.nature.com/nature/journal/v463/n7279/full/463296a.html

    It discusses how our identification with a community can color how we interpret facts, even to the point of disregarding them.

    I have been thinking about the vaccine issue with this article in mind, because it explains why I occasionally get emails from people telling me that I’ve convinced them to get their kids vaccinated after I leave a comment on someone’s blog post about it. My initial reaction to this is “WTF??? Why would you trust some random stranger on the internet, who won’t even disclose her real name more than you trust your pediatrician???” But now I get it- it is because I am a part of their community. My comments were left on blogs that I comment on frequently. I am known there as a mother with vaguely attachment parent leanings, not as a scientist (which I also am).

    Anyway, it is interesting to think about how we might better conduct the argument, because I think convincing more people to vaccinate their kids is worth the effort it takes us to have the argument in the most effective way possible.

  27. David Gorski says:

    I hate to risk invoking Godwins law, but I am reading the Fall of Berlin at the moment, and one of the many striking aspects of the madness of the Eastern front is how, as the Soviet’s were shelling Berlin and the Soviet troops were entering the city, there were still those who still thought and acted like a German victory was possible.

    An amazing book. Actually, it was fascinating to note how “normal” life was in much of Berlin right up until the Soviets had advanced within shelling range.

  28. Watcher says:

    Lol @ Minnesota? You betcha!

  29. Fifi says:

    Dr Gorski – “Normal” for those who were left! We’re talking about a society that was already in deep denial about what was going on inside itself and heavily invested in conforming to the “normal” narrative lest they themselves get shipped off for being subversive. Acting “normal” and believing in the narrative of superiority and victory would have been pretty much required to get by I’d suspect.

  30. Wolfy says:

    Dr. Crislip:

    Very nice article. There’s a lot more to Minnesota than Garrison Keillor, dontcha know! Perhaps you should return to this frosty land for another visit :)

  31. yeahsurewhatever says:

    What these sites demonstrate is a disregard for facts, which at one time were considered the final arbitrator of reality.

    Scientists, for the most part, subscribe (whether they realize it or not) to a particular school of philosophy called “logical positivism” (or logical empiricism, if you like), codified pretty well by AJ Ayer’s “Language, Truth & Logic”. This way of thinking has never, as a matter of fact, been very popular in the wide world. The notion that the only two ways of knowing anything are either (a) to deduce it from that which is already known or (b) to observe it as carefully as possible in the material universe, is considered by most people to be self-evidently false, because they see ghosts and Jesi all the time. Most people would prefer to believe in the supernatural and the subjectively arbitrary. Around the 1960s, French writers began to pick up on this and became postmodernist philosophers, and they see their duty today as convincing the world that, essentially, the universe is only really there when your eyes are open, and even then just barely. Since this is the sort of thing that most people are told when they’re children, it seems they’ve just been waiting to be given permission to go back to believing it, and totally abandon the reality of big people.

    Only the Wikipedia was free of taint.

    Wikipedia is not free of taint; it is merely free of unpopular, implausible taint. More subtle taints grow freely on Wikipedia, because, after all, anyone can edit it at any time for any reason, and everyone has equal potential to contribute, whether expert or imbecile. Thus, the balance of information on Wikipedia is defined by what more than half of active contributors consider to be correct. It’s been described as a “quantum encyclopedia”, in a sort of superposition of accurate and inaccurate, depending on the exact moment you consult it.

    historically education has not altered the opinion of those who have been against vaccination, whose essential messages have changed little since the 18th century, despite the massive increase in biomedical information to correct vaccine misinformation.

    In fairness, the point of education isn’t to change the messages of the ignorant; it’s to reduce the number of ignorant. A better statistic would be what proportion of the population in the 18th century rejected vaccination compared to the proportion today. That’s your yardstick of success.

  32. Zoe237 says:

    Good points Medsvstherapy. I know it probably puts me in the evil anti-vax camp, but I will wait a year or two before giving my kids, future or otherwise, the rotateq vaccine. Not because of the unknown, probably miniscule risk, but mostly because there is almost no tangible benefit to avoiding rotavirus in a first world country. But after an initial post licensure surveillance, I’m fine with it. Same thing with gardasil.

    Other than that, I’ll have to agree: people are not by nature rational. They tend to be even less rational when the rational ones treat them like idiots (whether they are or not).

  33. Stroh says:

    Lots of interesting comments here. A few thoughts:

    For me, the way I counter the postmodern concept of viewing all opinions as equal is by this argument:

    1. There is an objective reality independent from subjective thought.

    2. Empiricism has a proven record of being superior to non-empirical methods when it comes to interpreting the objective reality.

    3. Hence: opinions based on empiric facts are superior to opinions not as they will come closer to reality in the long run.

    At least as long as you actually care about what works from a practical standpoint.

    Now, there are obviously exceptions. Interpreting a painting empirically correct is not superior to doing it intuitively as a painting is per definition subjective, not objective. Similarly, when one only considers the existential aspects of faith atheism is not superior to religion even though it is more empirical as existentialist questions are internal and subjective.

    Vaccines do not qualify here. Vaccines are objective and have a mission in an objective world: to make children healthier. Hence, when discussing vaccines, empirical opinions are superior as they are better at reaching the mission goal.

    Of course, we all know this here on SBM but its still interesting to dissect the philosophical underpinnings. At least I think so.

    ———————————————————————————-

    No for something completely different: the conundrum of reason and faith. As been said, there are tons of people who are have both. This is actually quite amazing seeing how the two are utterly juxtaposed. On the one hand, faith ordains belief in spite of proof, anecdotes before evidence and suspension of disbelief. Not to mention claims running counter to all known science. Reason requires only two things: empirical evidence and logic. Faith lacks both.

    So how can people still combine them? As I see it, through compartmentalization. They simply never allow the two to meet. Instead the two operate within their own theaters and are seamlessly switched between at will.

    Take a Christian doctor: when he enters the hospital he takes on the persona of a person of reason and science along with his white coat. If he is a good doctor that is, I’m not getting into the failure that is an M.D. subscribing alt-med for anything but as placebos. His belief in his work stems from proof through science, not personal belief – although the latter can strengthen his resolve.

    Yet when he is not a doctor he is free to be faithful. Free to go to church, take communion and pray devotedly even though the same person he was earlier would rightfully yell to him that there is no proof for any of it.

    This double-think works because it is a highly effective way to establish parallel strategies for different situations even when their justicative stories counter each others.

    Unfortunately this does not mean faith is reasonable. And some people will continue to choose faith over reason if they find reason too tasking precisely because both are revered equally, if differently.

    This is the problem with religious society. It offers an alternative reality which, frankly, is not as well in sync with objective reality as is empiricism and science.

  34. Stroh says:

    @ Zoe237

    If that is your choice your free to do so. You don’t become evil anti-vax until you go on a crusade to convince others to do the same and use lies and deceptions to do it. We’re cool.

    My view of vaccines has always been “the more the merrier”, especially for myself. I sort of consider it an immunobooster (fully knowing this is not really the case) but, nonetheless, the truth is that after having taken a vaccine, there’s one more disease out there that can’t get to me.

    Kinda empowering. And yes – I can’t wait for the first neuroimplants to hit the markets. I view things sort of different from the CAM-people I guess :D Naturalistic fallacy indeed, I take cerebral nanomechanics over fruit any day.

  35. JohnW says:

    While slightly off-topic, the special Vaccine Court has issued a ruling in three separate test cases that the mercury-containing preservative thimerosal does not cause autism.

    http://www.latimes.com/news/nation-and-world/la-sci-autism13-2010mar13,0,5900639.story?track=rss

  36. Enkidu says:

    @Zoe237

    The Rotateq vaccine is only offered up to 32 weeks of age. if you opt out in that time, I’m pretty sure you won’t be able to get it as a “catch-up” vaccination.

  37. Th1Th2 says:

    Stroh,

    “the truth is that after having taken a vaccine, there’s one more disease out there that can’t get to me.”

    It just did. Actually, you have acquired the disease antigens so that makes you no longer naive to the disease.

  38. squirrelelite says:

    @JohnW,

    Interesting article.

    I noticed that Trine Tsouderos (!) was a contributor.

  39. weing says:

    “It just did. Actually, you have acquired the disease antigens so that makes you no longer naive to the disease.”

    That’s the point of the vaccine. Even my 2 year old nephew understands that.

  40. Th1Th2 says:

    weing,

    “That’s the point of the vaccine. Even my 2 year old nephew understands that.”

    Right. Hence, vaccines do not protect the people from the disease antigens but rather introduce the disease antigens to their naive immune system. In short, vaccination is a disease-promoting process.

  41. Chris says:

    Obvious troll is obvious.

  42. weing says:

    “Right. Hence, vaccines do not protect the people from the disease antigens but rather introduce the disease antigens to their naive immune system. In short, vaccination is a disease-promoting process.”

    I asked my 2 year old nephew and even he knows it’s a disease mimicking process.

  43. Draal says:

    I’m torn between the possibilities that Th1Th2 is a jackass, just for the sake of being a jackass (is that you pec?), or he/she/it really believes in the dribble he/she/it is posting.

  44. GPaulson says:

    come on…France, Japan, MINNESOTA??

    It wasn’t that bad, donchaknow.

    General Surgery 1982-88
    Hennepin County Medical Center (The Mother Hen)
    Mpls, Mn

  45. Zoe237 says:

    @Zoe237

    “The Rotateq vaccine is only offered up to 32 weeks of age. if you opt out in that time, I’m pretty sure you won’t be able to get it as a “catch-up” vaccination.”

    Right, same thing with HIB. Rotavirus is really only dangerous to young infants. It would only apply to future infants for me, and I’m past the post surveillance period that I’m comfortable with, so I’d be fine w/ them getting the vax, even though I think the benefits are minimal for my individual child, the risks are even less so.

  46. Chris says:

    I don’t know, rotavirus is pretty common. Some of the nastier gastrointestinal bouts that adults get can be rotavirus.

    When I had it, I could not be more than a few feet from the bathroom. I even borrowed some diapers, and still could not contain the outflow. It was horrible.

    In comparison, the prep prior to my colonoscopy was a cakewalk.

    I’d hate to imagine the same happening to a baby or toddler, especially since they often become dehydrated.

  47. Zoe237 says:

    My son had it when he was three (about ten years ago) and it was horrible, although he didn’t get dehydrated or go to hospital. Still, I’d rather buy the vaccine for an infant (hypothetically speaking) in a third world country, who can die from rotavirus.

  48. kdv says:

    Small points:

    I agree with Coyote. I saw ID and thought “Intelligent Design”. Admittedly, only for a few moments, because the rest of the sentence made it clear, but a bit distracting nonetheless.

    Berlin:
    There’s no need use that example and risk having Godwin’s law applied to you. Just remember Saddam Hussein’s information spokesman, nicknamed “Comical Ali” by the media, who happily gave live interviews just prior to the fall of Baghdad, earnestly claiming that Saddam was winning, and the enemy would never touch Baghdad – while in shot, behind him, you could see and hear the city falling apart under artillery bombardment.

    [ Afterwards, when Saddam's henchmen were being rounded up, Ali voluntary surrendered himself at the American HQ. He was told to go away, they were busy. Talk about humiliating! ]

    @Draal

    “I’m torn between the possibilities that Th1Th2 is a jackass, just for the sake of being a jackass (is that you pec?), or he/she/it really believes in the dribble he/she/it is posting.”

    You have to look at the posts … no understanding of the topic, self-contradictory, intended to create arguments … yes, it’s pretty clear to me. He/she really believes it. Trolls usually take the trouble to say something at least slightly worth arguing about.

  49. AState says:

    I didn’t read all of the comments, so I don’t know if this has been mentioned yet, but this article is in desperate need of an editor. One would think that in all of those classes that the author had to take there would have been an English class or two.

    Edit this article. Seriously. It reads like it was written by someone in a remedial English class. I can’t take it seriously, or recommend anyone else read it solely for this reason.

  50. BillyJoe says:

    “S/he/it really believes it.”

    Believes what?
    You mean this…

    “vaccines do not protect the people from the disease antigens but rather introduce the disease antigens to their naive immune system. In short, vaccination is a disease-promoting process.”

    But what is there to believe?
    You can’t even make any sense of it.

  51. BillyJoe says:

    pumpkinpie24

    “Second, could you explain or direct me toward another post of yours that explains why you believe Minneapolis/Minnesota to be a “foreign county?” I have lived here for 3 1/2 years and have mostly encountered rational, sensible people.”

    In Australia, it’s Queensland. Quaint sprt of place. :D

  52. BillyJoe says:

    Stroh.

    ” the truth is that after having taken a vaccine, there’s one more disease out there that can’t get to me.”

    The truth is that your risk is lowered ;)

  53. BillyJoe says:

    Zoe,

    “psychologists maintain that holding an irrational belief that is believed by the society or group in which one lives is a cultural thing. Whereas holding an irrational belief different from that of those around one is a delusion. What I’ve never been able to find out is at what point such an idea is considered to move from a delusional idea to a cultural one.”

    I think if you call it “delusional idea” and “cultural delusion” it sort of solves the problem.

  54. andrewc says:

    I work in both Cambodia and Australia. I invite all comers to join me on ward rounds in both countries in order that they may see the effect of vaccination. I will offer no commentary, although the patients and their families may.

  55. micheleinmichigan says:

    # BillyJoeon 13 Mar 2010 at 5:51 am

    “S/he/it really believes it.”

    Believes what?
    You mean this…

    “vaccines do not protect the people from the disease antigens but rather introduce the disease antigens to their naive immune system. In short, vaccination is a disease-promoting process.”

    I also feel torn. I feel he/she could just be stirring the bees nest for fun. He/She could be in the grip of some group propaganda or pet theory that He/She feels the need to proselytize about or they could be in a more delusional phase of a mental disorder. The quoted phrase sounds a bit like a highly organized “word salad”. But I am not expert, the last may only be a remote possibility.
    Of course the other possibility is that he/she is just lonely and this is the main way they know how to reach out to people.

    Gosh, I could go on for awhile. I guess, I’ll never know. Unfortunately, it does seem necessary for someone to vigilantly post science based facts in response. I am happy that there are people here capable of doing that.

  56. provaxmom says:

    Sanofi has just produced a pro pertussis vax commercial with JLo. Fight fire with fire I suppose. To me, it will be interesting to see how the anti-vaxers respond. Seeing as one of our major criticisms is that JM is nothing more than a actress and pinup…..to which we always hear “But she’s a mommy. Mommies know.” So I will be interested to hear if they fling the “JLo is not a doctor” retort at her.

  57. Stroh says:

    BillyJoe: Come on, of course I know that! I’m just being optimistic here: take the Hep B vaccine I got at medschool for example. It provides almost complete immunity and lasts well over 25 years, if not indefinitely – to me that means I won’t have to worry about getting Hep B any time soon. If ever. Even though there might be an itty bitty risk left.

    Of course there are other vaccines that are not as effective. But its not those I’m thinking about.

    And as for Th1Th2… sure I got exposed to the disease. But most people, me including, does not think it counts until we actually get sick. Hence: protection; not infection.

  58. micheleinmichigan says:

    “So I will be interested to hear if they fling the “JLo is not a doctor” retort at her”

    If it’s a betting pool, I’d place my money on a ‘She’s just doing it for the money’ with the implication that she’s a bad mommy gambit.

  59. Dr Benway says:

    The monkeys are tribal.

    Crislip, you identify with the science-minded tribe. It’s who you are. Others identify with different groups that value other stuff.

    Solution: make respect for basic rules of evidence something that’s important to all the cool kids, be they mods, rockers, Jesus freaks, or geeks. Make facts as American as free speech, baseball, and apple pie.

    Civics textbooks should include stories of brave American heroes sacrificing safety and sometimes their very lives in the fight against tyranny and for the preservation our precious right to know the scientific consensus.

    In the teleplay of this thread, the part of Th1Th2 shall be played by an obese middle-aged pedophile with bad skin.

  60. Lenoxus says:

    Wow, my psychology is so weird. When I read Th1Th2 and the replies, it’s like there’s a tiny anti-vaxer in my head going “Yes! Yes! Speak truth to power!” I dunno. Even though nearly all anti-vaxers are in theory supportive of the vaccination principle, I think there’s a subtext of what Th1Th2 is saying to everything they say — that vaccination is doo-doo at every level, and polio was just “renamed” (the standard conspiracy theory on the subject).

    It’s like the way intelligent-design folks talk about common descent. “Oh, of course all organisms are related, except I’m really suspicious about that and Darwinist scientists tell nothing but lies and more lies, but really, it’s true, but it isn’t.”

  61. Sir Eccles says:

    I think the problem is that when conventional medicine admits the limits of its knowledge such as when we say we can’t cure the common cold or we don’t know what causes autism the alternative side steps in with easy answers. Frustrated patients want easy answers. Patients become easily frustrated by doctors who don’t offer solutions. It comes across in poor bed side manner or just dismissiveness “it’s just a cold, you’ll get over it”. Alternative medicine on the other hand often rather eloquently says things like “take this 20C preparation of bullshitium it cures all”. They swipe your credit card and you miraculously get better. Another anecdote is born.

  62. JMB says:

    When you exercise you damage muscle. The body heals the muscle and it is stronger. When you breathe oxygen, oxygen does some damage to the tissue, but the body heals and has a source of energy. That is life. Medicine is mostly about helping the body heal itself, it’s not about the absence of disease.

  63. JMB says:

    Sorry, my comment didn’t make much sense from the order it appeared in. I was addressing the comment that vaccination is a disease promoting process. A little challenge to the immune system strengthens the immune system.

  64. JMB says:

    @Sir Eccles
    “Alternative medicine on the other hand often rather eloquently says things like “take this 20C preparation of bullshitium it cures all”. They swipe your credit card and you miraculously get better.”

    Back when explicit placebo use was acceptable to medical practitioners, there were ethical guidelines taught for its use. They could only charge a nominal fee (such as the cost of the sugar pill), for the placebo. I wonder what the fees are now for various CAM treatments.

  65. BillyJoe says:

    stroh,

    “BillyJoe: Come on, of course I know that! I’m just being optimistic here: take the Hep B vaccine I got at medschool for example. It provides almost complete immunity and lasts well over 25 years, if not indefinitely – to me that means I won’t have to worry about getting Hep B any time soon. If ever. Even though there might be an itty bitty risk left.

    Of course there are other vaccines that are not as effective. But its not those I’m thinking about. ”

    Oh, come on, I was just inviting you to be a bit more accurate (smily and all ;))

  66. rosemary says:

    Andrewcon, “I work in both Cambodia and Australia. I invite all comers to join me on ward rounds in both countries in order that they may see the effect of vaccination.”

    That is exactly the kind of education that people need. If they can’t observe in person, then they should be taught with videos or at least stories told in print. Aside from the small core of true believers, the majority of people who are presently deceived by them, would, I believe, learn if they experienced the facts, the human facts.

    As an animal lover, I have friends who swallow most of alt. “med.” hook, line and sinker. They go to alt practitioners and have never met a supplement they didn’t love. But that all stops when they hear anyone preach the “dangers” of vaccinating because they remember what the bad old days were like, before all the animal vaccinations we have now, and how diseases spread rapidly through kennels and catteries. They experienced the sufferings and deaths for themselves and experienced the changes brought about by vaccinations.

    Like it or not, we all learn by experience. The trick is that we must also learn that experience alone is not sufficient to draw accurate conclusions, but usually it is the place where most leaning processes begin.

    Now if someone could prepare and post video lessons showing what life is like in areas where scientific medicine is unavailable as well as in areas where it is, I think it would have a major impact on making the majority of people believers in evidence based medicine.

  67. Stroh says:

    @ BillyJoe

    Sorry about the grumpiness, no hard feelings intended :) ‘Guess I woke on the wrong side this morning.

    OFC you’re right about me being slightly inaccurate. But I still like vaccines. A bit too much possibly. :P

  68. lkregula says:

    Spot-on article; thanks for putting these thoughts together in one place.

    Although, I have to ask- you state

    “the data suggests the more we treat all patients the same, the better the outcomes”

    Can you share some papers that state this conclusion? I thought individualized care led to better outcomes? Thanks!

  69. Dash says:

    Great article. Does anyone out there seriously believe we’re going to get through to the hard-core anti-vaxxers? I think we all know it isn’t going to happen, even as we struggle to understand how they can think that way.

    What we can do is counter their misinformation and their philosophies for the uncommitted. So in that sense education is vitally important. And a way this view of anti-vaxxers can help is that part of that education needs to be showing parents what the basis of their objections are – that they have nothing to do with health and everything to do with worldview. This is one of the reasons we have Stop the AVN in Australia – we know we can’t change the minds of the AVN, but we can destroy (or realistically, delay) their ability to get to parents.

    On my blog and parenting fora I’ve been using a simple tactic that seems to work quite well whenever conspiracy theories come up. I point out, with a lot more detail, that it’s an accusation of mass murder and they’d better have some darn good evidence to back it up. It very quickly stops them. I don’t know if they stop because they think I’ll be mean to them or because they actually reflect on what they’re saying, but the information is out there for moderates to see.

    Oh and it’s not Queensland – it’s the NT. Admit it, you forgot all about us, didn’t you :D

  70. sampennella says:

    Good read for students

  71. Caryn says:

    This is why we need willing combat epistemologists to point out that regardless of their values, everyone holds the same worldview when it comes to finding things out about stuff we can check. Because denialists *do* actually value facts; if they didn’t, they couldn’t find their car keys.

    They don’t find their car keys using the sort of sophistry they use to defend their adoption of alt-med; they use observation, induction, and deduction. Science simply does this more carefully. None of them are radical skeptics when it comes to locating the doorways they walk through, or expecting that their car will not turn into a penguin.

    Epistemologists are handy for quickly delineating knowledge as something arguably near to “true justified belief” and talking about how one might check whether beliefs like “this vaccine will protect my child from measles” are true or justified, and what might count as a way of doing that. We need more of them knocking around the medical field generally.

  72. DREads says:

    Thanks for the excellent blog post, Dr. Crislip! When it comes to vaccines, I defer to the experts in mainstream medical science. While I support vaccination, I mostly keep quiet because I am not an expert on the subject, (see earlier comment on vaccines).

    I have one minor criticism that has nothing to do with vaccines. You wrote,

    Most of the information I get in medicine is from those in the field. It is rare for people to write about aspects of medicine that I will take seriously. Yes, there are a lot of people who write on the web about medicine, but given what it takes to achieve even a solid knowledge in medicine, much less develop expertise, I usually can’t take them too seriously. Call me arrogant, but if you want to be a legitimate source of information there are dues that have to be paid.

    Yes, there are definitely dues that have to be paid to be a legitimate source of information. Certainly, posing as a Playboy model or being Hollywood star does not give one any authority to speak on vaccines or medicine. Being an expert requires years of hard work and sleepless nights as well as extensive immersion in facts and information. I couldn’t agree with you more on this point.

    However, it is unfair to say that if someone does not have a degree in medicine or biology, there’s not much of a chance you’d take their writings on medicine seriously. By following the same line of reasoning, a statistician or computer scientist[1] could dismiss an MD who writes about medicine from a statistical perspective. After all, most doctors have not spent 80+ hour work weeks for years proving theorems to make mathematical guarantees for statistical estimation algorithms. Many of them probably have never written a proof longer than two pages, never mind ten pages or longer. When a doctor is asked to take gigabytes of raw sequence data and perform alignments, most wouldn’t even know where to start. Even if a doctor learns how to program, knowing how to prove an algorithm is correct (i.e. show it gives the best result mathematically possible) requires significant experience, which usually isn’t acquired during medical residency. A doctor might be able to recite formulas from memory but this is not the same as fully understanding the body of lemmas to derive the formula. A doctor might be very savvy on how to use excel/S-plus to perform plotting and analysis, but this is as superficial as a typical statistician’s knowledge of the immune system. Speaking with authority in medicine requires dues to be paid. However, doctors should not outright dismiss scientific experts from other fields who write about non-biological aspects of medicine, especially when the expert is very careful not to assert authority on matters beyond the scope of their expertise.

    As technology advances, the field of medicine is moving from data-starved to data-drowned. In order for discovery of novel medical science to keep pace with technology, doctors will need to invoke expertise from fields outside biology, chemistry, and medicine such as statistics, computer science, engineering, and physics. Medical science and biology are both going through growing pains. As medicine increasingly uses knowledge and tools from other fields to make advances, it will need experts from those fields to ensure such knowledge and tools are applied appropriately and correctly[2]. This will ensure new discoveries meet high standards of validity in all the sciences.

    ——-
    [1] There is a blur between stats and CS. Some statisticians are more like computer scientists, focusing their work on the development of sophisticated algorithms for performing computationally intensive statistical analyses. Some computer scientists do very little programming and applied research, and focus their research on theoretical and mathematical problems. Sometimes this heavily involves statistics.

    [2] I’ve been monitoring CS postdoctoral jobs for some time. I’m pleased to see postings for computer scientist postdocs at medical schools.

  73. BillyJoe says:

    Mark Crislip: “the data suggests the more we treat all patients the same, the better the outcomes”

    lkregula responded: “Can you share some papers that state this conclusion? I thought individualized care led to better outcomes? Thanks!”

    Mark doesn’t usually respond to comments, I think, because lack of time, so I hope you don’t mind if I respond.

    I’m pretty sure Mark was referring to the *individualisation* practised by alternative medical practicioners.
    Alternative medical practitioners use *individualised* treatment as an excuse for ignoring clinical trials which show that what they do doesn’t actually work.
    (Of course, it is untrue that individualised treatments cannot be subjected to a clinical trials)

    On the other hand, what you are referring, I think, is the idea that science-based medical practitioners should apply the results of clincal trials to their individual patient. In other words, they consider whether, and to what extent, the results of the referenced clinical trials apply to the particular patient in front of them.
    ( As an example, a patient in his 90s who is found to have high cholesterol may not necessarily benefit from cholesterol lowering drugs especially since the trials generally have not included patients in this age group.)

  74. micheleinmichigan says:

    I think you have an excellent point. The interplay biology, chemistry, statistics, computer science, engineering, and physics are important in medicine. On a pragmatic and anecdotal level, as someone who worked in web development (as a art director, not IT or computer engineering) I was frustrated for years watching doctors, practitioners and medical offices dealing with incredibility outdated, inefficient medical records systems.

    After many years, our hospital system finally implemented long overdue good computerized record keeping system (Hallelujah!) and to me the benefits to both the doctors and the patients are clear.

    I would point out that the esthetics are lacking, :) but I do not want to let the perfect be the enemy of the good.

  75. micheleinmichigan says:

    Whoops, my above comments were response to DREads comments…

    regarding “However, it is unfair to say that if someone does not have a degree in medicine or biology, there’s not much of a chance you’d take their writings on medicine seriously. By following the same line of reasoning, a statistician or computer scientist[1] could dismiss an MD who writes about medicine from a statistical perspective.” etc.

  76. Mark Crislip says:

    I am a slow writer and by the time I formulate a response, the conversation has moved far past any response I would make.

    Currently there are numerous guidelines to treatment of diseases. In the world of ID, the better the adherence to the guidelines, the better the outcome in terms of length of stay and mortality.

    What is curious is that in the world of ID the guidelines often concern initial antibiotics, before the bacterial cultures return and you have a specific dx and treatment plan.

    So for emperic therapy for, as an example, community acquired pneumonia, it is better to treat everyone the same than to individualize the therapy.

    A recent review:

    Semin Respir Crit Care Med. 2009 Apr;30(2):172-8. Epub 2009 Mar 18.
    Impact of guidelines on outcome: the evidence.
    Martínez R, Reyes S, Lorenzo MJ, Menéndez R.

    Servicio de Neumología, Hospital Universitario La Fe, Valencia, Valencia, Spain.
    Pneumonia continues to be the main cause of death due to infection in the world, and it produces a high consumption of healthcare resources. The guidelines established by the scientific societies improve the care of patients with pneumonia. One way of evaluating the effect of the guidelines is to analyze their impact on the prognosis of the infection. To evaluate this effect, cohort studies have been performed using before-after, observational, cost-effectiveness, and, to a lesser degree, randomized designs. The most recent studies show that the implementation of the guidelines is accompanied by an increase in the process of care percentage and a lower inpatient hospital mortality rate- including the first 48 hours and after 30 days. These findings are consistent across various studies, and they have been confirmed in patients admitted to the intensive care unit. Clinical stability is also reached earlier in patients hospitalized for community-acquired pneumonia (CAP) when the antibiotic treatment is begun early and complies with the recommendations. Finally, the choice of antibiotics that adhere to the guidelines is cost-effective in CAP requiring hospitalization, which is responsible for 80% of the total cost of this disease.

    PMID: 19296417

    ===

    Those are good examples of people outside of medicine I would pay attention to, depending on the topic. They are examples I had not considered in preparing the entry.

  77. The Blind Watchmaker says:

    When dealing with parents about vaccines, most parents are confused by the misinformation that they hear from the media, family and other places. Education works well with them.

    For some, the emotional fear invoked by the anti-vaccinationists is so hard to overcome, even if they can logically acknowledge the facts and understand relative risks and benefits, education simply creates cognitive dissonance. Most of these scared parents already are carrying a lot of guilt baggage and attempts at education simply increase this. For them, they have to arrive at good decisions themselves. Fortunately, if one gives such parents good sources of information and some space and time to think, they usually end up making good decisions.

    For the parents that are die-hard antivaccinationists, all attempts at education fail and just end up in conflict. This ruins everyone’s day. However, many of these folks don’t come to scientific doctors anyway.

  78. rosemary says:

    Dash, “What we can do is counter their misinformation and their philosophies for the uncommitted. So in that sense education is vitally important.”

    But how do we educate? I get the impression that most scientists and intellectuals believe that means stringing words together – either talking or typing them one after the other, and quite frankly I suspect that the general public, the target audience, pretty much ignores that.

    I don’t have the answers, but I suspect someone does.

    Communication is a science too though certainly not as black and white as the “hard” sciences or even the medical sciences, but I would guess that anyone who has studied communication scientifically would say that stringing words together to educate people is relatively ineffective especially if it is done in a dry, abstract, unemotional fashion, exactly the way most scientists have been trained to communicate with colleagues when writing professionally.

    My guess is that anyone who has studied the science of communicating would conclude that people learn with all their senses and that the best way to educate is with experiments, stories illustrating points and/or videos of such things. If you think about it, even scientists learn a great deal this way. They don’t just read journals. They have labs. They experiment. Doctors see patients, lab specimens and perform or observe surgery. They don’t simply learn anatomy from a book. They dissect bodies so that even their basic education includes learning through all of their senses, not just through words strung together sequentially.

    TIME had an article saying that Jenny McCarthy can’t be ignored. As most of us know, she has reached a major part of the public even if the majority doesn’t yet completely believe her. She has their attention because she speaks their language.

    http://www.time.com/time/nation/article/0,8599,1967796,00.html
    One quote, “…in McCarthy’s world, there is scientific truth and there is emotional truth. There is the fact of a mother looking into her son’s eyes and knowing something has gone very wrong and the fact of about two dozen studies showing no link between vaccines and autism. There is the truth of the parents and the truth of the doctors.”

    My guess is that it isn’t really about scientific vs. emotional truth, but about ineffective vs. effective communication. I think that to be effective one has to adapt one’s style to one’s target audience and that the failure of large numbers of people to do that is one of several reasons why those with crazy ideas about medicine have successfully convinced the majority of the public as well as lawmakers that those crazy ideas are either correct or have some validity and should be promoted, or at the very least permitted.

  79. windriven says:

    @AState

    “Edit this article. Seriously. It reads like it was written by someone in a remedial English class. I can’t take it seriously, or recommend anyone else read it solely for this reason.”

    Gee, there are a goodly number of people who would disagree with you about Dr. Crislip’s language skills, which are not I might add, the subject of this blog. So why don’t you remove your right index finger from whichever nostril it is in and click on down the road.

  80. micheleinmichigan says:

    regarding windriven’s response to @AState.

    Gosh, I was kinda enjoying the retro feel of someone who thought they could easily dismiss a writer by correcting their spelling. I haven’t seen that since I was in an alt.goth newsgroup in the ’90s.

    Kinda makes me feel young again.

  81. DREads says:

    rosemary,

    It’s hard to educate the masses since most people don’t have the attention span or motivation to understand the mechanisms of vaccines and their complexity. Scientists are careful with their words when communicating because science is complex, and diluting or simplifying the discourse can easily result in inaccuracies, which can do more harm than good. There is an effort on part of mainstream medicine to educate the public with simple terms (see the CDC for a good example). If people are unsatisfied with the simplicity of information they find from trusted sources, their doctor, or pamphlets in their doctor’s waiting room, then they will need to read and study information from scholarly sources. However, as Dr. Crislip points out, it is hard for lay people to digest this information without years of training in medicine, biology, or other fields. Cherry-picking knowledge from textbooks and various scholarly sources at the public library without having the wealth of knowledge acquired in graduate education/medical residency can give an incomplete and wrong picture of the science.

    Productive scientific dialogue from two opposing groups can only result when they both adhere to the highest standards of evidence-based scientific discourse. No productive debate can be expected by engaging people like Jenny McCarthy because they are not scientifically-minded individuals. It’s true she can’t be ignored but it does not mean that scientists should spend their time engaging her. A more productive approach is to educate the public about the serious consequences of not vaccinating, and let them judge Jenny McCarthy for themselves.

    At some point, it’s irrelevant. No matter how much effort scientists and doctors put into educating the public in honest, scientifically-supported, and honorable terms, there will also be laypeople who believe what they want to believe. There will always be people who always deem information coming from the mainstream medical establishment as suspect. There will always be people who believe in conspiracies despite either scant evidence or implausibility. What’s left? Rational people. Even then, fear and misinformation can completely disrupt a rational person’s belief system.

    Damian

  82. I hadn’t noticed AState’s comment before, but I agree that good writing is very important and I have voiced this in the past. Interestingly, I have specifically held up Mark Crislip as an example of a good writer. The cardinal quality of poor writing is that it betrays sloppy thinking. Mark Crislip’s writing is not polished, but it reveals both sharp thinking and and an engaging persona. I can’t ask for more from a blogging volunteer, and I don’t.

  83. windriven says:

    @ DREads

    “If people are unsatisfied with the simplicity of information they find from trusted sources, their doctor, or pamphlets in their doctor’s waiting room, then they will need to read and study information from scholarly sources. However, as Dr. Crislip points out, it is hard for lay people to digest this information without years of training in medicine, biology, or other fields.”

    WTF is that supposed to mean? The choices are only “vaccines are heap big powerful medicine” or a medical degree? That is USDA Grade A bullcrap. By your, ahem, logic, non-specialists would be unable to comprehend the fundamentals of string theory, anthropogenic global warming, or the differences between Austrians and Keynesians.

    Lucky for the rest of us, science writers including the bloggers on this site go to some length to bridge the gap between pablum and professional understanding of research esoterica. It has been said that Aristotle was the last man to know everything that was knowable in his time. Think through the implications of your reasoning reductio as absurdum. Is that the society you’d like to live in?

  84. micheleinmichigan says:

    # DREads
    It’s hard to educate the masses since most people don’t have the attention span or motivation to understand the mechanisms of vaccines and their complexity.”

    I do agree that it is hard to educate the public (the masses, really? as in unwashed…:) I think that it has been shown that you can change public opinion regarding activities even when complex scientific processes are involved.

    For instance, I know that cigarettes are bad for me and lead to lung cancer and emphysema. Yet, I have no idea of the actual mechanism that is causing the cancer or the emphysema. The same goes for seat belts, lead, mercury, etc. I think it is a mistake to think that you need to convince each person scientifically. Yes, the science should be there as support, but it is not the whole conversation.

    That said, you are not going to convince everyone. There are always going to be people who do dangerous ill advised activities and find ways to rationalize their decisions. Ditto, conspiracy theorists. The goal is to keep those individuals from endangering others.

  85. Th1Th2 says:

    Stroh,

    “And as for Th1Th2… sure I got exposed to the disease. But most people, me including, does not think it counts until we actually get sick. Hence: protection; not infection.”

    And so are people who don’t get sick amid exposure to natural infection. The only difference though is that you certainly have the injected disease antigens in your system, courtesy of vaccines of course, whereas the unvaccinated has the capability to fend them off from invading the body. Thus, anyone who thinks that by being a carrier of disease antigens is a kind of protection is seriously in a gross state of delusion—and they need immediate help.

  86. Mark P says:

    [Wikipedia] been described as a “quantum encyclopedia”, in a sort of superposition of accurate and inaccurate, depending on the exact moment you consult it.

    That makes it a perfectly normal encyclopedia.

    I don’t understand why Wikipedia has to be exactly right all the time when no other encyclopedia can possibly meet this challenge.

    Unless you can show me an encyclopedia free of any taint, error or out-dated information.

  87. Dash says:

    Actually, rosemary, I have a Master of Education (which I think is different in Australia), so I do think about the science of communication and education a lot! :)

    On the internet I use words because that is what is available to me – I belong to parenting fora and have developed long term relationships and authority, especially on vaccines. So it’s not about dry words, it’s about conversations and relationships. I also have a reputation as the devil’s advocate, or at least the one who is willing to buck the general agreement on all sorts of issues, so people are primed to listen to me because they know I will have an interesting, thought-provoking reply – again, it’s about relationships. I’m well known as an extended breastfeeding, cloth nappying, co-sleeping Mumma who is passionate about science and vaccination.

    And I use social media, because that is where so many parents hang out. Stop the AVN uses satire, information, and legal means against the AVN.

    For my more creative contribution, I run a blog promoting science for babies, toddlers and kids, with the explicit aim of showing parents how easy, natural and fun science is and giving them activities to play with. I state upfront that learning to love science and think critically is vital for future informed citizens and occasionally throw in a vax piece. I’m also in early stages of talking to the local education department about their primary science.

    When I say we need to educate parents on where anti-vaxxers are coming from, I mean opening it up. Most things I’ve seen over the years from pro-vax people are facts and ridicule. For a parent who’s looking for information ridicule is often a bad tactic. They don’t have the expertise to understand why it is justified and it just sounds mean. I agree it’s sometimes justified and effective, but we need more. I’ve never seen anyone else actually say “Do you realise this is based on a conspiracy theory?” and then logically work out what must be involved and the consequences. Which isn’t to say it doesn’t happen all the time – I live in my little corner of the internet! :)

  88. Tsuken says:

    @ rosemary – re: delusions/culturally-sanctioned beliefs etc.

    As a psychiatrist, this is exactly why I don’t like content-based definitions of phenomenology, preferring definitions based in form – as described beautifully many years ago by Karl Jaspers. A delusion then is defined by how the belief arises, rather than by what the belief is; so a delusion can potentially be true, and a false belief not delusionary. ;)

    Relevance? The ideas – even of the rabid antivaxxers – are unlikely to be delusionary, as they don’t arise de novo/out of the blue, as something “just known” to be true (although they do achieve that level of faith).

    I would however characterise them as (in Jaspers’ terminology*) “overvalued ideas”: a non-bizarre** idea that develops over time, and grows to overwhelm the person’s thinking and behaviour. Sound like anyone we know of? ;)

    *More recent definitions of overvalued ideas are kind of “delusion-lite”, and I would argue they’re pretty much useless.

    **”bizarre” in this context means things like the blue aliens put a chip in my tooth to spy on me because the government are making deals with the greys …. To me, the antivaxxers’ beliefs are – in a lay, rather than a phenomenological sense – bizarre indeed.

    [/tangentiality]

  89. Enkidu says:

    The more you present facts, the more you get this “rational” appeal to fear and the toxin gambit… at least that is what I am finding when I go to parenting sites and encounter gems like this one:

    “DOSE MAKES THE POISON
    Perhaps in a general laboratory setting. Each individual will have his or her own tolerance level to toxins. There’s not really a good way to predict who will react badly to which toxins at which point. Also, many toxic ingredients can be cumulative in the body. Exposure to a small amount of a toxic ingredient might be fine…if it were just one time…but exposing a tiny developing body to not one but several toxic ingredients many times throughout infancy is just lunacy.

    Sure we can get toxins other ways besides vaccines, and there’s nothing wrong with trying to avoid them if at all possible. [We avoid aluminum as much as possible (nope, we don't do antiperspirants or tin cans.) There's no good reason for it.]

    Toxins = crap.
    Injecting crap into the body without a direct obvious need and justification is asking for trouble.”

  90. JMB says:

    @michelleinmichigan

    “For instance, I know that cigarettes are bad for me and lead to lung cancer and emphysema. Yet, I have no idea of the actual mechanism that is causing the cancer or the emphysema.”

    Sometimes the science gives you answers to more than one question that you didn’t know were related. Did you know there is as much radiation exposure in one cigarette as one single view chest xray? So smoking 4 cigarettes will give you about as much radiation as a mammogram (although, you would probably have to adjust that to a full pack, if you are only interested in the breast tissue exposure). Radiation exposure from smoking is just one of the factors in causing cancers. It isn’t considered a major factor in emphysema.

  91. JMB says:

    Oops, made another mistake. The risk of smoking one cigarette is equal to the risk of 1 chest xray, not the radiation exposure. It takes about 5 packs of cigarettes to equal the radiation exposure of a chest xray, or 2 cartons to equal the exposure of a mammogram.

  92. tcw says:

    You betcha Minnesota is a different culture, but I don’t know what would be more difficult: moving to Minnesota or leaving there after growing up there. Sometimes I felt like I lived some episodes of Lake Wobegon; Keillor is uncannily accurate. My dad often told a legend of a reclusive northern Minnesotan lumberjack who, before antibiotics, ate moldy bread and “never got sick”. I reckon he may have got cancer from the aflatoxins in the mold :)

  93. Chris says:

    I spent one year in Minnesota. That was enough.

    Dr. Crislip, if you want more suffering… you should try a year in Texas or (shudder) western Missouri.

    I am an Army brat. I have lived in many varied spots in this country. Some good, and some bad. The worst bits have one thing in common: they are near I-35.

  94. DREads says:

    “If people are unsatisfied with the simplicity of information they find from trusted sources, their doctor, or pamphlets in their doctor’s waiting room, then they will need to read and study information from scholarly sources. However, as Dr. Crislip points out, it is hard for lay people to digest this information without years of training in medicine, biology, or other fields.”

    WTF is that supposed to mean? The choices are only “vaccines are heap big powerful medicine” or a medical degree? That is USDA Grade A bullcrap. By your, ahem, logic, non-specialists would be unable to comprehend the fundamentals of string theory, anthropogenic global warming, or the differences between Austrians and Keynesians.

    I think you are missing my point. When it comes to deciding whether you or your child should be vaccinated or not, it is much safer to rely on expert advice from trusted sources. “Comprehend[ing] fundamentals” is very different from being an expert in a subject. Laypeople are much less likely to understand the full complexities of vaccination and immunology and more likely to believe ideas circulated outside medical mainstream that may seem, on the surface, scientifically plausible and supported with some evidence. When making decisions about my health, I’d prefer to take the advice from those arrogant pricks (j/k) who’ve dedicated their career to medical science over a lay blogger or some conspiratorial medical narrative book at Borders. Taking information at face value without weighing the authoritativeness of each source is only potentially dangerous if it influences your health decisions or someone else’s.

    As for string theory, again, I don’t think a non-specialist can be an expert. One of my good friends and colleagues got his Ph.D. in Theoretical Physics, studying theoretical general relativity and string theory. He spent five years working 100+/hours a week working out a single open problem. He read several hundred non-trivial math books to eventually acquire the mathematical background to make headway on his problem. Could a non-specialist have had a shot at making a similar impact in string theory? I highly doubt it. Could they have written an interesting blog on string theory that’s inspirational, colorful, and thought-provoking? Sure.

    I spent over a year of my PhD delving into computational complexity and computability. It’s a fascinating subject. Go to the popular science section of any major bookstore, and you’ll find books on Alan Turing, Kurt Godel, Turing Machines, etc. Some of these books will certainly give you a grasp of some of the basics of decidability. Would reading them make you an expert? Hardly. Popular books and blogs are written to captivate the lay reader, which is why most pages are sparred of mathematical detail. In order to know enough to make headway on an open problem in the field, I had to spend many 100 hour work weeks reading a significant number mathematically dense original sources to understand the body of theorems supporting the current state of knowledge of the field. Sometimes, I would focus 2-3 days trying to understand a single page of math. In the end, I learned an extraordinarily massive amount of information but it was enough to prove a single open problem. Retrospectively, do I find popular blogs and books on Turing Machines and the like worth reading? Not anymore. They tend to be too simplistic and usually gloss over important details. I cringe when people gloss over details I know too well. But do these books have their usefulness? Certainly. They create an awareness, fascination, and appreciation of the subject to a more general audience. This is a good thing. If someone considers themselves an expert because they spent a few days reading such books, well, that’s their business but I’d rather consult my colleagues on the subject.

    Lucky for the rest of us, science writers including the bloggers on this site go to some length to bridge the gap between pablum and professional understanding of research esoterica.

    The bloggers on this science-based medicine site are doctors, not non-specialist, laypeople. What’s your point?

    I certainly sympathize with doctors who defend vaccine science in the face of a flood of misinformation perpetuated by non-experts.

    It has been said that Aristotle was the last man to know everything that was knowable in his time. Think through the implications of your reasoning reductio as absurdum. Is that the society you’d like to live in?

    You mean reductio ad absurdum? This is a useful proof technique but the word “absurdum” makes it sound like it might be a bad thing.

    What kind of society do I want to live in? A society where the key players in science are experts because they have the best shot in advancing the body of scientific knowledge.

    Damian

  95. BillyJoe says:

    rosemary

    “…stringing words together to educate people is relatively ineffective especially if it is done in a dry, abstract, unemotional fashion, exactly the way most scientists have been trained to communicate with colleagues when writing professionally…”

    Simon Singh tried to buck that trend and speak directly to the layman in layman’s language. For his efforts, he has spent the last two years of his life defending himself in court.
    Sometimes you can’t win.

  96. BillyJoe says:

    windriven

    “WTF is that supposed to mean? The choices are only “vaccines are heap big powerful medicine” or a medical degree? That is USDA Grade A bullcrap. By your, ahem, logic, non-specialists would be unable to comprehend the fundamentals of string theory, anthropogenic global warming, or the differences between Austrians and Keynesians. ”

    It’s not a dichotomy, it’s a spectrum.
    On the one extreme is the person who doesn’t know and doesn’t care and, according to their inclination, blindly follows either the expert advice or the contrary/conspiratorial view. At the other extreme, there is the expert with his 100-plus-hours-per-week-for-six-years knowledge and experience. In the middle there is the person who understands the basics but not the detail and who has faith (because he has no option – he cannot spare 100 hours per week) that the peer-reviewed details that underlie the basics that he understands is solid.

  97. BillyJoe says:

    dash.

    “I’m well known as an extended breastfeeding, cloth nappying, co-sleeping Mumma who is passionate about science and vaccination.”

    I hope it’s not a straightjacket they’ve placed you in – worse still, one you’ve placed yourself in. ;)

  98. Stroh says:

    Th1Th2: That’s so far off from reality it’s not even wrong.

    Here is how it really works: when you inject yourself with a vaccine, your body receives a cocktail of dead or half-dead infectious agents. These agents are too weak to put up a fight against your immune system and make you sick.

    What your immune system does is completely destroy the agents and harvest them for immunological markers, antigens, which are then used to create pin-point targeted antibodies from B-cells and Memory Cells for future immunity. Note one important point: the agents and their antigens are eliminated. Those vaccinated do not carry antigens but antibodies, which are wholly beneficial and are fully a part of ourselves.

    The exact same thing happens when you contract a disease, but with one key difference: in these cases the agents are still viable. They can, and will, put up a fight and if they win it they might proceed to kill you. If you win you will eliminate the agents, harvest them for antigens and procure immunity through antibodies and Memory Cells.

    Now, what would you prefer? An easy fight with a guaranteed win or an all out struggle for your life? That is the primary difference between immunity through vaccination as compared to immunity through infection.

  99. BillyJoe says:

    thimple1thimple2

    “And so are people who don’t get sick amid exposure to natural infection. The only difference though is that you certainly have the injected disease antigens in your system, courtesy of vaccines of course, whereas the unvaccinated has the capability to fend them off from invading the body. Thus, anyone who thinks that by being a carrier of disease antigens is a kind of protection is seriously in a gross state of delusion—and they need immediate help.”

    You have to smile, don’t you. :)
    …well, a sad sort of smile.

  100. DREads says:

    michelleinmichigan,

    I do agree that it is hard to educate the public (the masses, really? as in unwashed…:) I think that it has been shown that you can change public opinion regarding activities even when complex scientific processes are involved.

    For instance, I know that cigarettes are bad for me and lead to lung cancer and emphysema. Yet, I have no idea of the actual mechanism that is causing the cancer or the emphysema. The same goes for seat belts, lead, mercury, etc. I think it is a mistake to think that you need to convince each person scientifically. Yes, the science should be there as support, but it is not the whole conversation.

    Yes, good point. In my posting, I was going to mention condom advocacy programs as an example but it slipped my mind. We don’t need to teach kids the likelihood about contracting different diseases or their pathophysiologies for them to get a good sense that wearing a condom is a good idea.

    Damian

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