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Messaging and Public Health

Affecting public health has a few components. It includes providing a safe environment at home, at work, and in public spaces. It involves protecting the food and water supply from pathogens and toxins. Perhaps the most challenging component, however, is affecting people’s behaviors. Humans are complex psychological animals, and simply providing information to facilitate a rational decision may not always have the intended effect.

Those in power wishing to protect the public from themselves can simply pass laws that coerce people into safer behavior, such as seat belt laws and helmet laws. This approach amounts to outlawing certain unhealthy choices. There is also the “nudge” approach where the unhealthy choice is not outlawed, but the healthier choice is facilitated or made the default choice so that people have to work harder if they still wish to make the unhealthier choice for themselves.

Short of passing laws to force or nudge people in the right direction, the default approach to improving healthy behaviors is to provide information via either public service announcements or warning labels. How effective, however, are such measures?

A recent survey (all the usual caveats about the limitations of surveys apply) looked at various methods for increasing the intent of parents to vaccinate their children. This was a survey, not a measure of actual vaccine compliance, but the results are sobering nonetheless. 1,759 parents were surveyed:

Parents were randomly assigned to receive 1 of 4 interventions: (1) information explaining the lack of evidence that MMR causes autism from the Centers for Disease Control and Prevention; (2) textual information about the dangers of the diseases prevented by MMR from the Vaccine Information Statement; (3) images of children who have diseases prevented by the MMR vaccine; (4) a dramatic narrative about an infant who almost died of measles from a Centers for Disease Control and Prevention fact sheet; or to a control group.

The results were no what we would have hoped:

None of the interventions increased parental intent to vaccinate a future child. Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects.

None of the four messaging styles had a positive effect, they just had different kinds of negative effects. Most interesting, telling parents who tended to be anti-vaccine to begin with that the MMR vaccine is not linked to autism reduced their belief that MMR causes autism, but at the same time reduced their willingness to vaccinate a hypothetical future child from 70% to 45%.

Just like in the movie War Games, it seems the only way to win this game is to not play at all. The authors caution that, given vaccination rates overall are already quite high, any messaging about the safety of vaccines has a greater potential to inadvertently reduce vaccine compliance rather than increase it further.

The authors further speculate that the paradoxical result is due to the parents digging in their heels and being motivated to defend their initial vaccine negativity. This is consistent with other research (nicely summarized here by Chris Mooney) indicating that people will tend to react to new information that contradicts their existing beliefs by clinging to them even more tightly. The new information motivates them to think of other reasons to support their initial belief, in addition to reasons to dismiss the contradictory information. In the end they may be even more convinced of their original position.

The situation reminds me of the parable of the sun and the wind who decided to compete to see who could get a man to remove his coat. The wind tried to blow the coat off, but the harder it blew the harder the man held onto his coat. The sun then had its turn – it simply shined down on the man until he became warm and took off the coat.

In public messaging, we have to be more like the sun than the wind. A successful campaign would get people to want to engage in the healthier behavior, and perhaps even think it was their idea all along. Yes, this is psychological manipulation (just like all politics, by the way). Rational people have a knee-jerk negative reaction to the notion of such manipulation. We want to live in a world where giving people information is enough for them to make rational decisions, but that is not the world in which we live.

One approach, therefore, is benign psychological manipulation – making the healthy choice seem more desirable. One such approach is called social norming. This approach essentially leverages peer-pressure by telling people that most people do not engage in unhealthy behaviors, or do engage in healthy behaviors. It would therefore have been interesting if the above survey had a fifth group who were simply told – “most parents protect their children from infectious diseases by vaccinating them.” This is not deceptive, it is entirely true, but it is selected to coerce with positive peer pressure.

Such social norming campaigns are especially effective when people believe that an unhealthy behavior is more common than it actually is. Giving them correct information about actual prevalence of the behavior does seem to reduce the unhealthy behavior whereas warning people about the dangers of a behavior may just foster further belief that the behavior is more common than it is, which can actually increase the unhealthy behavior.

Conclusion

Public health campaigns have the potential to significantly increase the health of the public and reduce the cost of health care. We should not make naive assumptions about the efficacy of such campaigns, however. Like any other intervention, they will be most effective if they are evidence-based.

What the evidence is telling us so far is that public messaging can easily backfire if human psychology is not taken into account. Further, basic human psychology can be leveraged to have very successful public information campaigns.

There is, however, another approach. A public that had greater scientific literacy coupled with greater critical thinking skills would be more likely to respond rationally to simple information. This is not just an assumption – there are studies that show that skeptics are more likely to engage in analytic cognitive thinking and make fewer logical errors in their reasoning. Skeptics are also more likely to engage their inferior frontal gyrus, which is involved in cognitive inhibition.

In other words, when confronted with new information it is possible to inhibit the automatic response to defend one’s existing beliefs, and to engage in the hard work of analytic thinking and metacognition. A greater emphasis on teaching such critical thinking skills would therefore create a populace that is better prepared to receive future messaging about healthy and unhealthy behaviors.

Posted in: Public Health

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74 thoughts on “Messaging and Public Health

  1. goodnightirene says:

    “ A greater emphasis on teaching such critical thinking skills would therefore create a populace that is better prepared to receive future messaging about healthy and unhealthy behaviors.”

    Although this is the last paragraph of your post, it is the thought that leapt to my skeptical mind at the outset.

    Any ideas how to begin to implement this strategy?

    1. TheFlyingPig says:

      Maybe someone around here could start a podcast or something. Maybe name it after some science-friendly work of fiction… I’m thinking “The Podcast at the End of the Universe” or some such.

  2. liz says:

    Interesting post and I can offer another example GMO. Even when I explain that the only way we will be able to feed all the people in this world is to develop plants that are more nutritious and can tolerate less water. The individual will say they support such research but they will not eat GMO foods and will pay extra for “organic”. Well known Organic Food Chains are making lots of money selling products that have little if any advantage over the regular item found in a regular store. Shop at a local Farmers market and support your local fish or meat store and cook at home.

    1. WilliamLawrenceUtridge says:

      Organic foods generally require substantially more land and water to grow on a per-calorie basis, they’re much less efficient. And that’s just comparing organic and conventional, let alone the enhancements that are, and might be possible, through genetic modification.

  3. stanmrak says:

    There are studies that show that skeptics are more likely to engage in analytic cognitive thinking and make fewer logical errors in their reasoning.

    The study linked to only included religious skeptics vs. believers – not skeptics in general. Is that really a scientific delineation? My perception is that many skeptics, of all kinds, make up their minds first, then gather the evidence.

    1. There is a large body of research into this question. I just gave a couple links as examples.

      The same holds true for paranormal belief, which seems to be driven by a lack of critical thinking, a tendency to see signals in noise, and a preference for false positives.
      http://www.ncbi.nlm.nih.gov/pubmed/12031145
      http://www.ncbi.nlm.nih.gov/pubmed/15505516
      http://www.ncbi.nlm.nih.gov/pubmed/10085547

    2. WilliamLawrenceUtridge says:

      My perception is that many skeptics, of all kinds, make up their minds first, then gather the evidence.

      That’s rich coming from you Stan. Your primary arguments are of the “shill” type, and your citation of the evidence is overwhelmingly selective, whe you aren’t simply making raw statemetns without any sources. And that’s not even counting when you’re simply wrong.

  4. Alex says:

    I think that using principles from Robert Cialdini “Influence” book may help.
    http://en.wikipedia.org/wiki/Robert_Cialdini#6_key_principles_of_influence_by_Robert_Cialdini

  5. Sawyer says:

    A public that had greater scientific literacy coupled with greater critical thinking skills would be more likely to respond rationally to simple information

    I’m always frustrated with the paradox that occurs here. Greater scientific literacy eventually leads to more rational decisions, but there seems to be an uncanny valley that a lot of people get stuck in. I don’t know about public health measures, but I think there’s been pretty extensive research that shows this is true for other forms of pseudoscience (climate change denial, physics crankery, parapsychology, etc). You have to reach a pretty high level of education before you can start making any sense of complex topics.

    I’ve noticed that my both of my surviving grandparents (~90 years old, backgrounds in nursing and biology) don’t spend a lot of time questioning the decisions of their doctors. They accept the advise of experts, and as a result, they probably end up making far better decisions about their healthcare than they would trying to reason things out on their own. I doubt they are utilizing “critical thinking” skills any more than someone that is 50 years younger. For them medical decisions are driven more by cultural attitudes and a historical perspective. They grew up in an age where it was your civic duty to get the polio vaccine when it came out, because you trusted the scientists that developed it and didn’t want to be a walking disease vector.

    I wonder if there’s a way to transfer the attitude my grandparents have to a younger generation. Unfortunately it seems to be a lot more difficult than just promoting critical thinking.

    1. mousethatroared says:

      Hey Sawyer, Excellent point about the learning curve. I just want to make an side observation. I’m sure that getting the polio vaccine was also considered a civic duty, but I remember my parents (born in the 20′s) talking about polio and my impression was that they were happy to be vaccinated because they were terrified of the disease.

      Not much that can be done to recreate that experience in this generation…nor would we want to, clearly.

      1. Sawyer says:

        “Not much that can be done to recreate that experience in this generation”

        Well I just listened to the TWiV episode on viruses in videogames. Maybe a hyper-realistic version of Pandemic 2?

        1. mousethatroared says:

          Hmm, after watching my nephews playing grand theft auto*, I’m kinda hoping that video games behaviors don’t translate into real life behaviors.

          Sorry, I’m a video game idiot. That’s probably an antiquated reference now.

    2. WilliamLawrenceUtridge says:

      You are describing Dunning-Kruger pretty exactly :)

      1. Sawyer says:

        It may be a consequence of Dunning Kruger for my grandfather (director of a large ag. research lab at one point), but that doesn’t apply to his entire generation. Despite the stubbornness that comes with age, most seem willing to accept their doctor’s advice over their own internal beliefs, regardless of their level of scientific literacy. I think if you looked at attitudes towards the shingles vaccine you’d see something very different than looking at MMR (primarily young parents) or flu vaccine (entire population).

  6. Marion says:

    I gotta question the negative conclusion of the survey.
    If 99% of the surveytakers already would vaccinate their kids,
    and if the survey asks: “Does this information increase your willingness to vaccinate?”
    then the proper answer is “No”, because they are going to anyway.

    I’ve encountered this type of questioning in various political surveys,
    where I’m asked is such-and-such scandal makes me hate candidate X more,
    and I honestly answer “no”. Because I already hate candidate X for a million other
    far more important reasons.

  7. oldmanjenkins says:

    This is something Robert Todd Carrol talks about in The Critical Thinker’s Dictionary in what is called the Backfire Effect. When provided with contrary information to their beliefs, individuals actually become more convinced of their beliefs to be true.

  8. Bill says:

    So, are the studies saying that the way my brain processes information affects my tendency to believe in the supernatural and such?
    I remember even as a kid I questioned everything in the bible, even made of list of questions one time and took to the pastor to ask why the bible really didn’t make sense.
    If this is built in to my brain, can you really teach someone better critical thinking skills?
    Or maybe only up to a point?
    Just like my cousin can pick up piano playing faster and better than I can, I will always be able to think critically better than he can?

    Thanks.

    1. Frederick says:

      Everybody have “cognitive biases”, but you can learn to know them, and learn to also know you belief bias. You can train yourself in into thinking more objectively.

      It does not mean that you previous opinions were false, but sometimes you change you mind, or ad more accuracy and facts you what you already know.
      You can also train into accepting facts. The troll that post here all the time ( he posted here” Stanmark is a good example of what not to do. whatever facts and evidence he is shown, He will just Shielded his brain against it, and make up a new way to continue his belief.
      There’s lot of books about all that. I think SBM have couple of them.

  9. stanmrak says:

    “Interesting post and I can offer another example GMO. Even when I explain that the only way we will be able to feed all the people in this world is to develop plants that are more nutritious and can tolerate less water.”

    If only this were true, and not just Monsanto ‘science’. Studies have confirmed that GMO crops don’t necessarily have greater yields and are mostly less nutritious, not more. Not to mention the drastic increase in the use of pesticides and herbicides, which they claimed were going to decrease with GM agriculture.

    1. squirrelelite says:

      Do you have links to any of those studies?

      Personally, I am very glad we have GMOs because my wife is diabetic and has to take insulin. Also, golden rice should be a major nutritional benefit in low income populations that eat a lot of rice, even if the yield is no different.

      Thanks.

    2. Sam says:

      You are making a giant mistake in reasoning here. Even assuming those studies are perfectly valid in exactly the ways you claim, that can’t lead one to conclude that GMO crops can’t accomplish those future goals stated. And besides your point is a straw man, the quote never claimed what you refuted.

    3. WilliamLawrenceUtridge says:

      Studies have found that GMO helps in some regards, doesn’t help in others, has unexpected benefits in some cases, and unexpected downsides in others. It’s complicated. Nathanael Johnson has a very readable series of posts on GMOs here, and for undertaking the task of reviewing the actual evidence of GMOs and not proclaiming them the very essence of the feces of Satan, he is called, repeatedly and at length, a shill for Monsanto. Because when you can’t argue with someone’s factual conclusions, you try to undercut them through libel and slander.

      Specifically regarding pesticides, genetic modification has helped. Regarding herbicides, they have not. It might help with improving conservation tillage.

      In other words, it’s complicated.

  10. harriet huestis says:

    Was there any follow up later. Some ideas, especially ones that challenge strong beliefs, need reflection before making an impact. Was reading Pinkers’ book Better Angels of our Nature and studies were referenced that tested beliefs (some sort of prejudice). The subjects were given humanizing stories. Initially their views were intractable however follow up weeks later showed the stories had made impact.

  11. Kevin Moore says:

    I think part of the problem is a general distrust of people and institutions in positions of authority. Policy is seen determined more by money than science or logic. Polls show that confidence in many U.S institutions at or near historic lows.

  12. Keating Willcox says:

    over 30 refereed and published papers have vindicated Wakefield. And you are blaming us for being unscientific. If anything, U.S. consumers can smell turds even if they are covered with perfume. Unless you live under a rock, you know, autism is epidemic and essentially permanent, Wakefield’s ideas have been at least partially found to be accurate, and there is enormous profit in those making the vaccinations .

    Here’s how Congressman Dave Weldon (R-Florida) put it in a 2003 letter to Julie Gerberding, director of the CDC.

    “A review of (supporting) documents leaves me very concerned that rather than seeking to understand whether or not some children were exposed to harmful levels of mercury in childhood vaccines in the 1990s, there may have been a selective use of the data to make the associations in the earliest study disappear,” Weldon wrote. “Furthermore, the lead author of the article, Dr. Thomas Verstraeten, worked for the CDC until he left over two years ago to work in Belgium for GlaxoSmithKline (GSK), a vaccine manufacturer facing liability over TCVs. In violation of their own standards of conduct, Pediatrics failed to disclose that Dr. Verstraeten is employed by GSK and incorrectly identifies him as an employee of the CDC. This revelation undermines this study further.”

    http://youtu.be/8UAVBRg8wQ8

    The U.S. Centers for Disease Prevention and Control (CDC) recently revealed, as a result of oversight requests by Congress, a research paper written by Thomas Verstraeten, MD titled “Increased risk of developmental neurologic impairment after high exposure to thimerosal-containing vaccines in the first month of life” that documents statistically significant adverse health outcomes associated with exposure to the mercury-based preservative thimerosal. The announcement of yet another thimerosal paper that was written by CDC officials, but not publicly made available until now, is sending ripples throughout the autism community and elsewhere.

    According to the newly released document, CDC epidemiologic surveillance officers utilized the Vaccine Safety Datalink (a large linked database from four health maintenance organizations in Washington, Oregon, and California) containing demographic, medical and immunization data on over 400,000 infants born between 1991 and 1997 to conduct the investigation. The data was categorized according to cumulative exposure to ethylmercury (thimerosal) after the first month of life and the subsequent risk of the infant developing degenerative, neurologic or renal disorders. In the paper the authors found an elevated relative risk (RR) for the following disorders: Autism 7.6, nonorganic sleep disorders 5.0 and speech disorders 2.1. In a court of law, a relative risk of 2.0 typically implies cause and effect.

    from what I can see here, you and most of the comments are simply personal attacks and settled science. What complete lies. The science is far from settled, and we are now seeing the corporate nature of the bribes to hide problems….You never respond to my facts, my evidence, I guess you just hope your little friends will just say settled science and make some personal attacks.

    Our only hope is to keep hammering the media with books such as Big Pharma, and science

    1. Sawyer says:

      “over 30 refereed and published papers have vindicated Wakefield”

      Utter baloney, no they haven’t. I find it inconceivable that anyone spending more than 30 minutes on this website has not run across one of the hundreds of refutations of this statement. Are you lying or willfully ignorant Keating?

      Here’s a quick post I read just a few weeks ago explaining why this is not true:

      http://lizditz.typepad.com/i_speak_of_dreams/2014/02/is-it-true-that-wakefields-studies-have-been-confirmed-by-over-two-dozen-studies.html

    2. steney01 says:

      “You never respond to my facts, my evidence…”

      The entire line of evidence you just copied and pasted from somewhere was addressed only two days ago.

      1. Chris says:

        Plus he has been given the link provided by Sawyer multiple times, here and elsewhere.

        His usual thing is to drop a bunch of cuts and pastes, and then run away. He does not respond to replies to his comments. Then he comes back and repeats the same drivel.

        He personifies a classic “closed mind.”

        1. Sawyer says:

          Well what we need now is a well-organized, randomized trial for “idiot spam” comments to measure their impact on overall public health perceptions. Perhaps people like Keating and yogalady are actually doing our job for us!

          1. mousethatroared says:

            I have thought that many times. But here’s something else I’ve thought. These folks (not CAM practitioners, laypeople or patients) come on this board, many of them sound just like typical people/parents. When lots of pro-SBM people start jumping on their remarks…particularly in ways that are very provocative or insulting. It sorta forces a viewer to pick a side. That’s our instinct with social conflict.

            When a person who doesn’t have enough information is forced to pick a side (and as you pointed out, the expertise to understand the science is not commonplace, so a lot of people don’t have enough information), they will often go with the person that they identify as in their group (social animals and all that). Mom’s may identify moms, or other women or laypeople identify with laypeople, etc.

            So, if the conflict with an anti-vax person causes a viewer to identify with anti-vax person as the norm (the person they identify with) then that’s not a good place to be for the pro-vax position. Particularly if the viewer feels insulted due to the insults being thrown at the person they identify with.

            This is speculative, but I believe it’s pretty basic sociology and it’s pretty intuitive.

            So why do we (and that is a sincere we, because I know I do this) get into these heated conflicts when there is a good possibility that they are counterproductive?

            1. Chris says:

              Sometimes we get frustrated by folks like Mr. WIllcox. The first time he came to this site with a similar cut and paste he was corrected (though my comments with the JustTheVax website disappeared).

              So here he is again with the stuff that he just posted on Respectful Insolence almost two weeks ago. And again he was asked questions, and given the same website that goes over the thirty studies. Which he ignored.

              What are we supposed to do? My response is to now explain he has a habit of doing this. I suspect Mr. Willcox will come and repeat

              1. Chris says:

                Coffee just finished brewing, so I forgot to finish a sentence:

                ” I suspect Mr. Willcox will come and repeat the same stuff here in about a month or so.”

              2. mousethatroared says:

                “What are we supposed to do? My response is to now explain he has a habit of doing this. I suspect Mr. Willcox will come and repeat”

                That seems like a pretty good response, to me.

                I don’t know and if I did know, I couldn’t tell you, because if I did, you wouldn’t believe me and you would want to do the opposite. :) (Reasearch shows…individual results may vary)

                I suspect, as sawyer says, when in doubt, be nice. Personally I always thought if I could channel Diane Rehm I would be ahead in the communication department.

                Also, I wonder if the less fuss the better? Isn’t there some thinking that disputing a untrue rumor can only reinforce it?

                Anyway, I don’t pretend to have the answers. For me socializing is generally like a train wreck. I can see it coming. I know it’s going to be bad. I don’t know what the heck to do about it.

              3. Chris says:

                I do try to be nice. Though it comes from asking some fairly pointed questions. Usually trying to get them to realize there is a relative risk.

                A few times those questions have made someone realize there was a different way of looking at the issue.

                But it is very difficult when someone appears for the third time repeating the same nonsense.

            2. Sawyer says:

              I await the data that shows what strategy works. I still try to follow the “when in doubt, be nice” mantra whenever possible. It is often trumped by “when people are lying about medicine and it will result in dead children, you should not validate their delusions”.

              I love the SBM comments section because it allows me to interact with some wonderful people, but I suspect what we will eventually discover is that this format is TERRIBLE for public health information. I hope it’s a long way off, but I suspect the open commenting policy here will eventually be greatly restricted to improve the overall quality of discussions.

              1. harriet huestis says:

                I try to play nice especially because I mostly post in news forums and there are probably fence-sitters watching. However some of the techniques the anti-vaxxers use are so devious: JAQing off and spinning their position (pro safe vaccine) I drop gloves and out them as deliberate condescending manipulation.

                Of course I have a shield to aggressively attack their anecdotes as false. I had measles encephalitis at 4 months old. I can match them anecdote to anecdote except mine only personalize the data and are in support of the science rather than trying to be data in and of themselves. Encephalitis occurs in 1 in 1000 measles cases. I am on the mild side of the severe consequences of measles. And autism is not encephalitis.

            3. mousethatroared says:

              Chris “I do try to be nice.”

              That’s apparent. To be clear, my comment was in no way directed at you or your conversation with KW in this thread. I was thinking of sawyers comment in a more generally way and wondering how to try to apply the information from SN’s article. Sorry if it seemed more pointed than it was.

              1. Chris says:

                Thank you.

                I used to be more caustic, but the decade or more that I have been dealing with these issues has taught me some things.

                My first experience with John Scudamore (the guy who does whale.to) on UseNet was quite an eye-opening experience. For that venue I adopted a more poisonous persona. I was even “rewarded” with my own whale.to badge of honor.

                Then many many years ago someone on a listserv wanted me banned for the audaciousness of politely explaining in a thread about the MMR vaccine had never contained thimerosal. That was fun.

                I left that listserv, that I had been on since we had a phone modem, when the folks pushing “vaccines are bad” took over. Especially when it turned out one was an employee of a particular doctor who promised a “cure” (who got ripped about by one of the special masters in the Autism Omnibus cases). Even though the listserv was for a speech disability, not autism. I just checked, and after over a decade they still have my two essays on their website.

                So there is a reason I get impatient when I see the same old tropes dragged out. Especially when it is from one person multiple times.

              2. mousethatroared says:

                @ Chris – Boy, those links are eye openers. And when your child is struggling with speech and health issues, it sucks to have, what could be a good support network, turn so harmful.

                I have been lucky in that I haven’t ever been active in a newsgroups that turned like that. I did become inactive in my group of adoptive parents of kids with clefts because it experienced an influx of kinda vocal homeschoolers that were just kinda not my style…really sold on this at home speech therapy package. While speech at home is good, there is just no substitute for a good speech therapist, sadly it’s really hard to find a ST who has a good background in cleft issue…Any way they were just not as useful as the previous crop of parents had been. Nothing like that though.

            4. WilliamLawrenceUtridge says:

              The people who usually get into heated conflicts, or attract abuse, are the ones who don’t ask questions but insist on their rightness in the face of contrary evidence.

              1. mousethatroared says:

                That doesn’t actually address my initial comment, WLU. Look up thread in my reply to Sawyer.

  13. Keating Willcox says:

    Vaccinated Children Likely to Have a Higher Risk of Developing Autism

    To date, there has been no government-funded study on health outcomes in vaccinated vs unvaccinated populations. In other words, the rates of autism, ADHD, asthma, diabetes, and other chronic diseases have not been compared in vaccinated and unvaccinated populations.

    In 2007, Generation Rescue funded a Cal-Oregon Vaccinated vs Unvaccinated Survey. Amongst boys age 11-17, the study found an RR (“relative risk”) of 2.12 for autism and 4.17 for ADHD when comparing prevalence amongst vaccinated versus unvaccinated children. These findings suggest that vaccines may have been a contributing causal factor in boys born from 1990-1996 in approximately 68% of autism cases and 81% of ADHD cases. Generation Rescue wrote on this website:

    “Generation Rescue is not representing that our study proves that the U.S. vaccine schedule has caused an epidemic in neurological disorders amongst our children. We are a small non-profit organization. For less than $200,000, we were able to complete a study that the CDC, with an $8 billion a year budget, has been unable or unwilling to do. We think the results of our survey lend credibility to the urgent need to do a larger scale study to compare vaccinated and unvaccinated children for neurodevelopmental outcomes.”

    A study by Brimacombe et al in 2007 (Brimacombe M, Ming X, Parikh A. Familial risk factors in autism. JChild Neurol. 2007; 22:000-000) found that children born to families with certain medical histories (e.g., thyroid disorders, epilepsy, rheumatoid arthritis, diabetes) have a much higher rate of autism prevalence. In a 2008 article, SafeMinds board member Scott Laster extrapolated from this data and the 2007 CDC autism prevalence report to calculate the risk of autism for children born with certain family medical histories. The calculations indicated that autism risk in certain sub-groups ranged as a high as a 1 in 7 chance for children born into a family with a medical history of thyroid disorders. A 2009 article by Laster used the results from the initial article, plus the Generation Rescue vaccinated vs unvaccinated study, to analyze the potential for reducing autism rates. The article determined retrospectively that allowing an alternative vaccination schedule for about 2% of the population could have avoided 30% of the autism cases.

    1. Sawyer says:

      I suppose Keating Wilcox deserves some sort of award here for proving the exact thesis of this post and the underlying mechanisms. The ability of anti-vaccination groups to invent their own universe where bumbling idiots are magically elevated to the status of experts, science and reason are thrown out the window, and life threatening infectious diseases are treated like paper cuts complete cripples the entire mission of public health workers. Once someone is convinced that Generation Rescue is interested in the truth, there is no bringing them back to reality.

    2. ConspicuousCarl says:

      Generation Rescue funded a Cal-Oregon Vaccinated vs Unvaccinated Survey.

      Brilliant, they went to hippie-central and did a phone survey. Golly gee, I wonder if they found any meaningless confounded data?

      For less than $200,000, we were able to complete a study that the CDC, with an $8 billion a year budget, has been unable or unwilling to do.

      For less than $200,000, Generation Rescue found a way to completely waste nearly $200,000. If only the CDC had the ability to be that stupid with $8,000,000,000, then magic twinkle fairy ponies bazinga.

  14. yogalady says:

    The assumption here seems to be that if only the public were more rational, they would trust and obey the authorities.

    But I think distrusting the authorities IS rational.

    Even if those in political power genuinely did care about our health — which I kind of doubt — they don’t always know what is best for us. Very often, I think, they are wrong.

    I don’t have an opinion about vaccines. But it does seem obvious that very young infants would have limited tolerance for being injected with unnatural substances. Evolution did not prepare them for that.

    Some vaccines are necessary, but so are caution and restraint.

    Parents hear varying opinions and blindly trusting mainstream science is not rational. I am glad that people think for themselves wonder.

    The “skeptics” at this blog are all-out pro-vaccine, the more the better, no restraint needed. They even defend mercury-containing preservatives, as if infants had unlimited capacity for absorbing toxic metals.

    1. Sawyer says:

      I don’t have an opinion about vaccines ….

      … followed by what’s clearly an opinion on vaccines. And a very misinformed and paranoid opinion.

      Can you at least attempt to maintain consistency within a single post yogalady? If you’re wondering why we think the CDC or WHO is more reliable than random strangers, this is one of the many reasons.

    2. Andrey Pavlov says:

      I don’t have an opinion about vaccines.

      Taken in a vacuum, that would mean you are woefully uneducated on vaccines.

      But it does seem obvious that very young infants would have limited tolerance for being injected with unnatural substances.

      Why would that seem obvious? And to whom? On what logical basis does that seem obvious to you?

      Because to me, as someone who has a reasonably deep understanding of human physiology, immunology, and evolution that does not at all seem obvious to me. In fact, what would seem obvious is that the human body would, over all these millions of years, develop a process to handle an essentially unlimited amount of antigens. If you are growing up in the wilds of our long distant ancestors being exposed to innumerable pathogens and antigens would be par for the course. In fact, there are currently some theories in medical science that we have become too clean and that some of our current illnesses (like asthma and IBD) are caused by too few antigenic exposures in early childhood.

      Evolution did not prepare them for that.

      Besides an MD I also hold an undergraduate degree in evolutionary biology. If evolution did not “prepare” us for exposure to myriad antigenic challenges we never would have made it this far! I can only assume it is because it is “injected” and needles aren’t “natural” so evolution could not have “prepared” us for it. Well… cutting your skin sliced open, having projectiles stuck in them, etc are functionally no different. There is evidence of tattoos using finely honed points of wood to pierce the skin and inject dyes found in nature as far back as 100′s of thousands of years. Unless you wish to posit that the cavemen of that era sterilized their equipment, it seems to me that we’ve had ample exposure to vastly greatly antigenic challenges than what vaccines expose us to.

      Some vaccines are necessary, but so are caution and restraint.

      This, to me, sounds like a gussied up version of the “too many too soon” trope. How do you determine when “caution and restraint” are necessary? You do realize, of course, that there are actually many more vaccines available than are given to all children, precisely because some are not needed except in certain circumstances (immune compromise, travel, etc). That seems like “caution and restraint” to me. How much more do we need? And what is your basis for determining that?

      Parents hear varying opinions and blindly trusting mainstream science is not rational.

      Blind trust is never such a good thing. But knowing that a whole bunch of people who know the relevant science and medicine vastly better than you (and even I) have convened and discussed and come up with a plan seems eminently rational. I mean, is it irrational to “blindly trust” aviation companies, pilots, and the FAA? Do you “think for [yourself] and wonder” before you get on an airplane? Do you try and pick up a tiny bit of knowledge and question whether Boeing and Airbus really know what they are doing?

      The “skeptics” at this blog are all-out pro-vaccine, the more the better, no restraint needed.

      Well, we are all-out pro-vaccine because we know the history and literature and relevant science and medicine. For the same reasons we are all-out pro-flying in a modern aircraft.

      The rest of that is simply not true. Yes, we like very much vaccines that have a demonstrated benefit on real problems like measles, HPV, hepatitis, etc. A vaccine for HIV would be an amazing breakthrough and save millions of lives. But you don’t see us demanding that everyone get the Pneumovax – we have certain select populations that would actually benefit from it. We don’t recommend the shingles vaccine to just anyone, because not everyone would benefit very much from it. We target who to give it to as well. If that is not “restraint” I don’t know what is.

      They even defend mercury-containing preservatives, as if infants had unlimited capacity for absorbing toxic metals.

      Well, yes and no. We know the difference between an organometallic and an atomic compound and we know the effects of each. But even then there are almost no vaccines left with any thimerosol in them. That’s been the case for around a decade now. But even when it was there, we looked very carefully and found no harm from it. It is simply too minute in quantity.

      We also do not assume anyone can absorb any such compound. That would actually be pretty bad and we would advocate very strongly to have a compound that builds up in tissues be removed from the ingredients, regardless of whether there was any data to show it caused harm. Tissue build up over time can lead to unforeseen consequences, after all.

      If you mean elimination, well no you’re not correct there either. We do not assume an “unlimited” ability for elimination of any compound. We actually characterize rather well what the capacity for elimination actually is. And in the case of thimerosol, the amount injected is many, many orders of magnitude less than the ability to eliminate it by the kidneys.

      So perhaps you would have more of an opinion on vaccines and see how incredible of a medical breakthrough they are if you actually read up on them from reliable sources.

    3. Harriet Hall says:

      “young infants would have limited tolerance for being injected with unnatural substances. Evolution did not prepare them for that.”

      Evolution did not prepare you for surgery or unnatural antibiotics. Do you dispute that they save lives? Why should vaccines be any different?

      Evolution did not prepare you for the Internet, but that doesn’t stop you from using it instead of the “natural” way of communicating by talking to others face to face.

    4. Harriet Hall says:

      “They even defend mercury-containing preservatives, as if infants had unlimited capacity for absorbing toxic metals.”

      No, we defend thimerosal because infants have adequate capacity for excreting tiny amounts of one specific mercury compound that has never been shown to harm humans even in considerably larger amounts and that allows the use of multidose vials to reduce the cost of vaccination.

    5. TheFlyingPig says:

      @yogalady,

      “But it does seem obvious that very young infants would have limited tolerance for being injected with unnatural substances.”

      Yes, infants have a limited tolerance for such things. What’s not obvious is where that limit is with regards to vaccines. So it’s been studied and our understanding of these limitations continues to improve. And though it might seem like the current vaccine schedule is excessive, the data bears out the fact that it’s not.

      I agree that it’s good that people think for themselves are aren’t overly trusting of institutions like the government. If I have doubts about some medical intervention, I’m certainly not going to simply rely on government press releases or officials. Also, I won’t blindly rely on what dubiously-qualified friends, family, news organizations, or internet ‘experts’ have to say. The correct course of action for areas outside of one’s expertise is to learn what professionals/experts have to say, see if they have the facts to back up their claims, and find whether they have adequate responses to naysayers. Do you disagree with this?

      Using this methodology, I have reached the conclusion that vaccines are generally safe and effective. Furthermore, the evidence seems clear enough that mercury preservatives are not a problem, despite the fact that it may seem obvious that it should be a problem.

      TFP

      1. WilliamLawrenceUtridge says:

        Furthermore, the evidence seems clear enough that mercury preservatives are not a problem, despite the fact that it may seem obvious that it should be a problem.

        Particularly given the fact that mercury has been removed from all American vaccines but one for over a decade.

    6. Chris says:

      “But it does seem obvious that very young infants would have limited tolerance for being injected with unnatural substances.”

      Please tell us which is better for a baby to get, be sure to provided some verifiable scientific documentation to support your answers:

      A DTaP vaccine or a pertussis infection?

      A DTaP vaccine or a diphtheria infection?

      A DTaP vaccine or a tetanus infection?

      An HiB vaccine or a haemophilus influenzae type B infection?

      An IPV vaccine or a polio infection?

      A HepB vaccine or a chronic hepatitis b infection?

      A rotavirus vaccine or a rotavirus infection? (trust me, those are nasty, the kid had rivers of poo)

      A pneumococcal vaccine or a pneumococcus infection?

    7. WilliamLawrenceUtridge says:

      If the public were more rational, they would realize how little they know about medicine, toxicology and immunology and defer to the experts. But the public doesn’t know, and those who think they can know are victims of Dunning-Kruger. Claiming that 30 minutes on google will make you equivalent to an expert researcher who has dedicated their lives to the subject is wrong. “Authorities”, particularly those in mid-level positions who produce evidence-based position statements, are far more informed and capable of understanding the topics they write about than the average citizen.

      Evolution did not prepare them for that.

      Given their lethality, particularly regards young children, evolution apparently didn’t prepare them for the quite natural infections of pertussis, smallpox, polio, cholera, typhus, tetanus, measles, mumps, rubella, tuberculosis, and just about every other disease we vaccinate against.

      Evolution does not work towards perfection, it works towards “good enough”, as in “good enough for a pool of genes to survive”. Evolution doesn’t improve individual survival, it works at a gene pool level. Evolution doesn’t attempt to make babies more likely to survive to their teens, and in order for it to be shaped by selective pressure, a sizeable portion of the gene pool must be eliminated. If you want evolution to ensure we are resistant to vaccine-preventable diseases, keep in mind that it would require probably 90% of the world’s population dying off. How do you feel about that? How do you feel about nearly everyone you know drowning in their own mucous, bleeding to death through their eye sockets, or being locked into muscle contractions so strong they break bones? And of course, one must recognize that for every evolutionary step humans make to become better protected against infectious disease, the disease takes steps to become more lethal. That’s why smallpox was so devastating in North America, it had been through centuries of slowly-ratcheting infectivity and lethality.

      Some vaccines are necessary, but so are caution and restraint.

      Yes, and that’s why vaccines are tested before they are used, and that’s why the vaccine schedule is based on the opinion of a panel of world-leading experts on specific diseases, pediatric immunology, epidemiology and other relevant specialties. It’s not pulled out of thin air or selected with a dartboard. Every vaccine, timing and combination is carefully selected through a review of the evidence availalbe. You should learn more about how vaccines are made.

      Parents hear varying opinions and blindly trusting mainstream science is not rational. I am glad that people think for themselves wonder.

      The thing is – if you want to have a meaningful discussion with mainstream science, you have to understand science. And not just a charicature “vaccines prime the immune system” sort of way, you have to know which molecules are upregulated, how the antigens are presented to the immune system, all of the cells involved in the immune system, the chimeric nature of antigen production – and that’s just what I know about as an informed layperson. Actual experts would have hundreds more points to add. Parents simply can’t understand what’s going on with vaccines and adjuvants, and don’t have the experience to realize how dangerous these diseases can be – because vaccines have essentially eliminated most of them.

      What is irrational is the expectation that you can, in your spare time, learn enough to meaningfully contribute to the discussion about the microbiology of vaccines, autism and related issues, in your spare time and without a PhD. I spend probably half of my reading time, which is not inconsiderable, on this sort of thing. After all that time, all I have learned is how fearfully ignorant I am of the real issues. For instance:

      The “skeptics” at this blog are all-out pro-vaccine, the more the better, no restraint needed. They even defend mercury-containing preservatives, as if infants had unlimited capacity for absorbing toxic metals.

      The skeptics are absolutely pro-vaccine, because they understand the risk of vaccines compared to the risks of the diseases they prevent. Skeptics don’t defend mercury-containing preservatives because American vaccines no longer contain thimerosal and have not for over a decade now (except for one type of influenza vaccine). Skeptics also understand that there is a difference between the highly toxic methylmercury, which accumulates in tissues and causes significant nerve damage, and ethylmercury, which is eliminated from the body at much higher rates and does not appear to bioaccumulate in significant doses. Fortunately for infants who were vaccinated with thimerosal-containing vaccines, the ethylmercury found in that compound was quickly excreted from the body.

      It’s not like scientists are stupid, or don’t have children. Scientists understand these issues, and make rational choices when deciding which vaccines to use and what adjuvants to include. Those choices include the toxicity of the individual ingredients, as well as more sophisticated concerns. For instance, the live polio vaccine is no longer used in North America because we have a supply chain that adequately preserves the killed version, and because the risk of iatrogenic polio is unacceptably high given the risk of catching wild-type polio. Smallpox isn’t used at all because it only exists in freezers in two countries (Russia and the United States). Formaldehyde is used as an ingredient of killed-type vaccines because it kills the virus while retaining the protein coat that enables an antibody response. Formaldehyde is considered safe because the body produces formaldehyde as part of regular metabolism. Antivaccinationists consider themselves smarter than the doctors and scientists, despite the fact that they do not know things like this.

      So maybe lower your contempt a bit, and perhaps learn more about the vaccines you are criticizing. Arthur Allen’s Vaccine and Paul Offit’s anything are good starting points.

      1. Chris says:

        WLU: “(except for one type of influenza vaccine).”

        Actually, four out of eight influenza vaccines approved for children.

        Plus one DTaP vaccine out of three different brands. Though they are often a trace or very small amount.

        Sorry for being pedantic, but it helps to be precise. Also several states have legislated that neither children nor pregnant women may receive vaccines with thimerosal. It is part of a “precautionary principle”, which kind of backfired when children and pregnant women were dying from influenza when there was not enough of the thimerosal free influenza vaccines (that happen to be more costly).

        I would still like yogalady to tell which is better for a baby to get: any vaccine given during the first six months, or an actual infection those vaccines prevent.

        1. WilliamLawrenceUtridge says:

          Don’t apologize, thank you for the correction.

    8. harriet huestis says:

      Governments and corporations aren’t a single imutable homogeneous entity even within itself. So when someone says they don’t trust the government what exactly are they saying. There are very few people who have complete trust in either the government or large corporations. You are not just distrusting the current set of politicians but the previous ones in different ideological and social conditions. The government is not just made of politicians but millions of workers. What precise situation and behaviour is being distrusted. It might be rational to believe politicians are padding their expense account but not that they are embezzling millions or billions. Nor are they entirely unaccountable. We need to stop accepting these acknowledgements of distrust without challenge to be specific. We can’t counter fight something that hasn’t been defined. So who precisely do you distrust and what behavior do you specifically distust and in what situation?

  15. Interestingly, even an educated population doesn’t necessarily follow evidence.

    In 1996, Pathman, Konrad, Freed, Freeman & Koch took a look at why physicians were not vaccinating their patients. What they found was that even when physicians were aware of recommendations, there were other obstacles to be considered. This group may not agree, and if they agreed they may have found barriers to adoption….and once they figured out a way to adopt different practice, they may not stick to it. So, even the educated individual may not follow recommendations….even when they are aware of them.

    How to combat this? Develop interventions that correspond to the steps of change which all people go through. Behavior change is a process, not an infomercial.

  16. LindaRosaRN says:

    Unfortunately, some states have jumped into requiring some education before being allowed to opt their children out of vaccine mandates. Unfortunately for these states (CA, OR, and WA), they additionally allow naturopaths to do the educating.

    Even before this study’s findings were released, California authorities have been concerned that their law, taking effect January 1st, may cause vaccination rates to fall.

    I hope we’ll be able to see if the parents in these states who chat directly with a pediatrician or nurse will have the same reaction as those who opt for the online vaccine education.

    Now Colorado and Iowa have similar bills currently before legislators, and proponents of the Colorado bill are trying to explain away the findings of this study.

  17. Bob Casey says:

    It is also worth mentioning to parents that we live in a society where some children cannot be vaccinated because they have compromised immune systems, through no fault of their own. A responsible parent would want to protect all of the children in their community, by assuring that their child was not the cause of serious harm to another child.

  18. PMoran says:

    Vaccination is a special case, because critical thinking doesn’t come into it much.

    Only a tiny percentage of the population will ever have the ability to access and sift through the data, and then factor in all relevant evidence, so as to reach reasonable certainty on matters of vaccine safety.

    The rest of us have to take what we are told on trust, and it takes only a little uncertainty on that score for persons to start to act according to instinct. Which ones? Mainly the one that makes us inclined to avoid remote but potentially serious immediate risks when any benefits are deferred and/or unclear.

    So most of the results of Steve’s disturbing study can be attributed to simply getting people to think about risk. The child nearly dying from measles will have no immediacy for them. They will probably never have heard of a measles outbreak.

    I don’t pretend to have answers some of these conundrums, but I will mention, once again, that how where people are prepared to invest their trust probably plays a key role. This is one way in which HOW we say things, and how we disport ourselves generally, can be as important as WHAT we say.

    To merely touch on another matter: a healthy society needs people who are prepared to challenge authority. Too much trust can be a bad thing. Too little can produce a lot of bad outcomes in medicine, but we don’t have to look far for examples of the reverse.

    1. MadisonMD says:

      Only a tiny percentage of the population will ever have the ability to access and sift through the data, and then factor in all relevant evidence, so as to reach reasonable certainty on matters of vaccine safety.

      If you mean primary data, then this is true for just about any field of science. It is actually less true for vaccines because, for example, the VAERS data is publicly available.

      If you mean scientific publications, then this is accessible online or at the nearest library–and yes there has to be an element of trust and honesty. Yes individual scientists have been known to be dishonest and fabricate data in all fields of science. More commonly scientists interpret data in a positive light without fabrication. Yet the idea that there is 50+ years of concerted fabrication on vaccines is just loony conspiracy theory.

      So I don’t think it’s a lack of access to data or science. It’s a lack of understanding of science. This should be addressed by proper grade school education.

      1. PMoran says:

        “So I don’t think it’s a lack of access to data or science. It’s a lack of understanding of science. This should be addressed by proper grade school education.”

        It’s not only access, and I can’t see that ever happening. I don’t think the resources will ever exist that could raise even 25% of the population to the level of interest, motivation and self-confidence that they would personally consult VAERS or other source of primary data, and be able to understand its strengths and weaknesses.

        For that matter, how many here have ever done that for themselves, as opposed to absorbing and more importantly trusting what others are saying?

        The truth is that we all possess much more efficient, if not wholly objective or trustworthy short-hand ways of managing risk and benefits in our lives, and this is what most people do with vaccination decisions.

        For example, it is easier not to act than act, whenever there is any uncertainty and especially when the action may carry immediate risk. The knowledge that no amount of personal effort will yield certainty (and the perception that perhaps science cannot be totally sure either) will play a part. Yet one respected person saying “you must do this” will override any qualms in others.

        We sceptics kid ourselves that we are involved in in-depth analyses of The Evidence all the time, but is that really true? I don’t think we give sufficient credit to pre-existing states of mind, ingrained attitudes and beliefs that make us instantly inclined to accept certain viewpoints but not others, and to then seek reasons to defend them when they are challenged. Everyone does that.

        It’s the “shorthand” again, a collection of rules of thumb that we expect to give the right answers with minimal effort. It is these kinds of influences that we perhaps should be thinking about in relation to vaccination concerns and also to some extent in the understanding of CAM use.

        Where do these prior attitudes come from? I don’t know. I don’t know why I am so savagely sceptical about so many matters, including a few (very few, actually), like this, that crop up regularly within SBM.

        One of the problems with the “if only people were better educated” attitude is that fantasising about a highly improbable future absolves us from having to think about the here and now . There may be OTHER important reasons why people are mistrustful of medical science and what it is saying. What are we doing about them? What do we do that might inadvertently increase suspicion? What approaches might best arouse (a justifiable) trust?

        The “education” thing is also a subtlety ad hominem position, slanting our side of dialogue towards homily and trumpet-blowing. It leaves us with a scarcely well-earned sense of superiority, while treating any inclination to dispute of our viewpoints as an aberration to be stamped out, rather than as a healthy part of normal life, and indeed of science itself.

        We can reinforce this tendency in our own minds by paying too much attention to lunatic fringes that probably very few take too seriously. They can perhaps most elegantly dealt with by minimal attention or disregard, along with calm assurance, and a simple “this is what we think and why”.

        1. Andrey Pavlov says:

          It’s not only access, and I can’t see that ever happening. I don’t think the resources will ever exist that could raise even 25% of the population to the level of interest, motivation and self-confidence that they would personally consult VAERS or other source of primary data, and be able to understand its strengths and weaknesses.

          An interesting comment. And one I generally agree with, but not for the reasons that I believe you are making them.

          I certainly do see a future where everyone has access to all information and an education to match. In fact, there is ongoing and serious discussion about declaring internet access a basic human right. I would argue that if you can’t imagine that sort of thing happening and a genuine democratization of information, access, human and civil rights, then your imagine simply isn’t good enough.

          But on the flipside, I do agree that most people wouldn’t have the motivation or desire to look up and parse the primary source data. Not because they don’t have the access or acumen to do so, but because it will be (rightfully) considered a waste of time.

          The goal should not be to have everyone do all primary source work themselves, but to create a world populated with individuals educated enough to have a good BS detector and accurately question claims. We may be a long ways off from that, but to me it seems undeniable we are headed in that direction and I don’t see any insurmountable reason why it wouldn’t eventually happen. From my perspective it is either that or a total collapse (and perhaps extinction) of the human race. In other words I see this sort of thing as a “sink or swim” scenario in the (very) long term. I’d just rather we get there sooner rather than later.

          We sceptics kid ourselves that we are involved in in-depth analyses of The Evidence all the time, but is that really true? I don’t think we give sufficient credit to pre-existing states of mind, ingrained attitudes and beliefs that make us instantly inclined to accept certain viewpoints but not others, and to then seek reasons to defend them when they are challenged. Everyone does that.

          Who here has ever said that? In fact I have argued many times that the fact that we don’t – and can’t – do so at all times and for all topics is why we who do so on specific topics at specific times should be more vociferous to demand that rigor across the board. For example why quackademia is so incredibly dangerous and why I heckled and complained about the CAM lectures at my medical school.

          It is also why Dr. Novella writes extensively on the topic of neuropsychological humility.

          So no, we don’t always do it, but we do do it much more than the average Joe. In other words, that is a straw man.

          One of the problems with the “if only people were better educated” attitude is that fantasising about a highly improbable future absolves us from having to think about the here and now

          You may think it is highly improbable. I don’t. But the very fact that I am thinking about such a future is precisely what motivates me to think about the here and now (and, I would argue, the others here as well). Because, believe it or not, I am not stupid enough to think these things will just magically happen on their own. That future won’t happen without people actually working to make it happen. Which is precisely what we are a part of doing here. It is a movement based on fundamental ideas and processes and it is rapidly gaining traction. Because of what we do and say in the here and now. Sure there are missteps along the way and in retrospect there may have been better ways to go about it, but it is certainly happening.

          There may be OTHER important reasons why people are mistrustful of medical science and what it is saying. What are we doing about them? What do we do that might inadvertently increase suspicion? What approaches might best arouse (a justifiable) trust?

          All things that we consider regularly. Despite the fact that you seem to think you are alone in this amazingly clever insight.

          The “education” thing is also a subtlety ad hominem position, slanting our side of dialogue towards homily and trumpet-blowing. It leaves us with a scarcely well-earned sense of superiority, while treating any inclination to dispute of our viewpoints as an aberration to be stamped out, rather than as a healthy part of normal life, and indeed of science itself.

          An amazing example of using an ad hominem to argue someone else is ad hominem. Like the Inception version of ad hominem. Well done. But still an ad hominem.

          We can reinforce this tendency in our own minds by paying too much attention to lunatic fringes that probably very few take too seriously. They can perhaps most elegantly dealt with by minimal attention or disregard, along with calm assurance, and a simple “this is what we think and why”.

          And of course the standard Peter Moran close, though admittedly more gussied up this time.

          “You should be writing about what I think you should be writing about and your tone is too nasty”

          1. pmoran says:

            Andrey, you have a habit of basically agreeing with much of what I say, but then trying to find reasons to object to my saying it.

            I enjoyed what amounts to a reduction to absurdity of the very sceptical fantasies I am challenging — that the population will not only have access to ALL information, but “an education to match” (really? when?) — and that without more critical thinking skills mankind might be hurtling towards extinction (that will probably happen one day but not through CAM use or lack of vaccinations).

            The unexpected findings from studies such as Steve’s should be a jolt to our ribs. Along with similar studies it should be helping to raise disturbing questions.

            Could, for example, more of the much-vaunted “critical thinking” have the similarly perverse effect of making a percentage of the population MORE inclined to challenge medical authority? So much of science is not clear cut, and the evidence can be subjected to different interpretations. This is not an outrageous suggestion. Among other things, there has to be freedom from bias for critical thinking to work properly.

            The belief that the dangers of CAM can/will be solved by better education or critical thinking skills should be examined as critically as we examine anything else in science, especially when it has become our dominant strategic response, and depends upon such improbable outcomes arising any time soon, for the objectives of medical scepticism. Long before that happened the natural pendulum of public interest in “woo” and CAM will have swung back, I suggest.

            1. Andrey Pavlov says:

              Andrey, you have a habit of basically agreeing with much of what I say, but then trying to find reasons to object to my saying it.

              I don’t try to find them. They are just there, at least from my perspective.

              Your argument basically sums up as “I don’t believe this sort of thing will ever happen.” Followed up by a more mild “I also don’t think it will matter even if it does happen.” I simply flat out disagree with the former. And I more mildly disagree with the latter.

              I enjoyed what amounts to a reduction to absurdity of the very sceptical fantasies I am challenging — that the population will not only have access to ALL information, but “an education to match” (really? when?)

              So if I don’t give you a specific date it somehow obviates the argument? The fact that data access is spreading at unfathomably rapid levels, wireless connectivity is becoming cheaper, more wide spread, and with vastly higher bandwidth, and there are multiple programs such as the $100 laptop program to develop rugged wifi enabled crank and solar powered battery operation isn’t perhaps a good idea of where the trajectory is going? Things like the Khan Academy, the Coursera free online courses from extremely prestigious universities on topics from quantum physics to cooking to medicine to study design and statistics, the Google Guttenberg project… none of these seem to indicate to you that at some point in the not-too-distant future access to essentially all information, with much of it structured in a lecture and course style format with live and direct feedback from educators will be available to essentially everyone? Really? And your only counter argument is “really? when?” as if your incredulity plus my inability to give an exact date is a meaningful rebut?

              and that without more critical thinking skills mankind might be hurtling towards extinction (that will probably happen one day but not through CAM use or lack of vaccinations).

              I agree, likely not through CAM or lack of vaccinations. And yes, it is a non-zero possibility. But as I said, that is a non-zero possibility. If we don’t go that route then what are the other options? I suppose a completely broken and dystopian future as in District 9 or Elysium is a possibility, but I’m hoping that’s not the case. And if it is the whole of anything we are currently doing is basically moot anyways. So sure, I’ll focus on the only real and viable future where any action we here take ends up mattering one way or another. Seems reasonable to me, not reductio ad absurdum.

              The unexpected findings from studies such as Steve’s should be a jolt to our ribs. Along with similar studies it should be helping to raise disturbing questions.

              I don’t know how unexpected it was. It certainly didn’t jolt me in the ribs, anyways.

              But I’ll bite, what disturbing questions are those that are raised?

              Could, for example, more of the much-vaunted “critical thinking” have the similarly perverse effect of making a percentage of the population MORE inclined to challenge medical authority?

              That one? I don’t find that particularly disturbing. To me it indicates that our varied tacks may not be as effective as we perhaps thought and hoped, but it doesn’t mean it doesn’t work.

              But the real question is… what is the better option? You constantly allude to it but also always fail to actually elucidate it. Finding out something doesn’t work as well as we’d hoped is indeed important to know, but without a better option what shall we do about that?

              The belief that the dangers of CAM can/will be solved by better education or critical thinking skills should be examined as critically as we examine anything else in science, especially when it has become our dominant strategic response, and depends upon such improbable outcomes arising any time soon, for the objectives of medical scepticism. Long before that happened the natural pendulum of public interest in “woo” and CAM will have swung back, I suggest.

              Sure, I agree. And we are all still waiting for your better option. Unless I am taking your last sentence to indicate that your suggested strategy is to just shut up, sit back, and ignore the problem until it goes away on its own. That, I disagree with quite vehemently and there is mountains of evidence to show that is a bad way of dealing with bad ideas.

  19. yogalady says:

    “Evolution did not prepare you for surgery or unnatural antibiotics. Do you dispute that they save lives? Why should vaccines be any different?”

    Surgery and antibiotics should be used with restraint, and only when definitely needed. Even the most mainstream MD would seldom prescribe surgery or antibiotics to healthy children, just because surgery and antibiotics can be helpful.

    Vaccines are different, because healthy children do need them. However, they should not contain mercury, or other substances that are known to be highly toxic. And only vaccines that prevent very serious diseases should be used.

    1. Chris says:

      Please tell us which is better for a baby to get, be sure to provide some verifiable scientific documentation to support your answers, especially on the level of “serious” for each disease:

      A DTaP vaccine or a pertussis infection?

      A DTaP vaccine or a diphtheria infection?

      A DTaP vaccine or a tetanus infection?

      An HiB vaccine or a haemophilus influenzae type B infection?

      An IPV vaccine or a polio infection?

      A HepB vaccine or a chronic hepatitis b infection?

      A rotavirus vaccine or a rotavirus infection? (trust me, those are nasty, the kid had rivers of poo)

      A pneumococcal vaccine or a pneumococcus infection?

    2. Sawyer says:

      “However, they should not contain mercury”

      And most of them don’t in the US. Do you own a calender? Do you know it’s 2014 and not 1998? Why don’t you enlighten us with your stellar medical knowledge and list out how many vaccines in the childhood vaccine schedule have mercury in them, along with the concentrations used, and the well-controlled trials that show thimerosal causes autism.

      While you’re at it, please explain why it’s okay for fear-mongering parents to demand preservatives be pulled out of vaccines that will eventually be sent to third-world countries. The places in the word where we still have polio don’t have a CVS on every corner. What do you think it’s like for a doctor living in rural Pakistan to get a shipment of polio vaccine, only to learn that it is several weeks past its expiration date thanks to brilliant Americans and their “Mommy Instincts”?

    3. Chris says:

      “However, they should not contain mercury”

      Let me rephrase Sawyer’s question:

      Which vaccine on the American pediatric schedule is only available with thimerosal?

      I warn you look at this table very carefully. Plus I will give you a hint: do not include influenza since half of them are thimerosal free, and not not include DTaP because most of them are thimerosal free.

      Now go and answer the questions that I have now asked you twice on what is safer for a baby to get. Support your answers with PubMed indexed studies by reputable qualified researchers that the vaccine is worse than the disease.

    4. WilliamLawrenceUtridge says:

      Surgery and antibiotics should be used with restraint, and only when definitely needed.

      No duh. Go into your doctor’s office and ask for a voluntary appendectomy. See what happens. Go in and ask for cipro, “just in case”, and see what happens.

      Even the most mainstream MD would seldom prescribe surgery or antibiotics to healthy children, just because surgery and antibiotics can be helpful.

      Again, no duh. The same reasoning applies to vaccines, you just appear to be unaware of it. The difference is, the reasoning is passed up the scientific chain and occurs at the nation- and state-wide public health levels. The CDC schedule is based on the recommendations of a panel of experts with highly specific specializations. It’s not pulled out of thin air. These are people who do nothing but study the minute issues of immunology or vast issues of epidemiology, and come together to answer very specific sets of questions.

      Vaccines are different, because healthy children do need them. However, they should not contain mercury, or other substances that are known to be highly toxic.

      By that reasoning, vaccines shouldn’t contain sodium, because it is explosive, or dihydrogen monoxide, because in high doses it causes hyponatremia. You are hearing “mercury” and automatically assign it a label of “dangerous” because you are applying public health warnings about a completely different mercury-containing molecule. Molecules behave very differently from their constituent atoms, and each molecule in and of itself has completely different properties. Even chirality, the difference between the same atoms arranged in mirror images, have massive implications. If you tried to survive on proteins based on chiral amino acids, you would die.

      And only vaccines that prevent very serious diseases should be used

      Duh. Your statement assumes that this isn’t already taking place. What vaccines would you eliminate from the current schedule? Measles? Kills 150-175K people every year, and that’s with a vaccine program. Whooping cough? Kills two out of every hundred active cases (why don’t you read this, by the way). Maybe you’ll pull out “the flu” as a “harmless” infection. Yeah, not so much.

      But I suppose what it really comes down to is whether or not you consider it a big deal if a child dies. I suppose that depends on whether or not it’s your child.

      I would happily stab you in the face if it meant my children didn’t die of pertussis, because the thought of them breaking ribs while they cough and slowly choking to death while I watch helplessly doesn’t really appeal to me.

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