Jun 06 2011
Anti-Vaxers and the Need for Clarity
Humans are not entirely rational creatures. We all know this from daily experience, although we happily assume that we are more rational than other people (which is just one of our irrationalities). We are motivated by the need for meaning, and for esteem. We tend to pick sides, and then invest our egos in that side, defending it at all costs.
We are also motivated by the need for simplicity and control. The world is a very complex place, overwhelmingly so. Therefore we need to simplify it in our minds, so that we can deal with it. We use schematics, and categories, and rules of thumb to impose a manageable order on the chaos of reality. These devices are quite adaptive, as long as we realize that they are just that – human devices to approximate reality in a way we can handle.
But too often we confuse our simplistic models of reality with reality. Further, we like our morality plays to be black and white. The villains are villains, without redeeming qualities. The good guys wear white and have no major flaws (nothing beyond an endearing quirk). The ambiguities and gray of the world make us feel uncomfortable. This tendency, by the way, leads to certain logical fallacies, such as poisoning the well. If Hitler believed something, and everything Hitler did was bad, then that belief must also be bad.
We can see this need for moral clarity and scientific simplicity at work in the anti-vaccine movement. Their core belief is that vaccines are not safe, that they are causing harm to our children. They are incorrect in this belief, but that is the bedrock of their movement.
They are not satisfied with this notion that vaccines are not safe, however. Every other belief about vaccines must also be in line with their core belief. They are particularly intolerant of complexity or moral ambiguity. Therefore they have convinced themselves that not only are vaccines not safe, they don’t work. Further, the diseases they treat are not that bad. They believe those who promote vaccines are also selfish and evil, morally compromised liars (they happily portray us as baby-eaters). They cannot wrap their heads around the notion that perhaps well-informed people who mean well disagree with them.
The anti-vaccine echo-chamber exists in a cartoon world of cardboard villains, dark conspiracies, and white-hatted heroes (a role they reserve for themselves), where the science all lines up in their favor, without the slightest compromise or ambiguity.
Before someone tries to turn this back on the scientific community, I do not think the same applies to the defenders of science-based vaccines. We admit that vaccines have risks, and harm does rarely occur. But the benefits outweigh the risks. We acknowledge that pharmaceutical companies care mainly about their own profit (they are corporations, and that’s what they do), and they need to be carefully regulated to protect the public interest. We acknowledge that, while vaccines work, they are not perfect. The flu vaccine in particular is very problematic, particularly matching the strains each year with the ones that are likely to hit in flu season. But still, we eke out more benefit than harm.
We also acknowledge that the anti-vaccine community is a diverse group. And while I suspect there are some charlatans and con artists thriving in their midst, most anti-vaccinationists appear to be sincere parents who are just trying to do their best for their children. They are simply misinformed, by a well-funded campaign of scientifically complicated misinformation. Many are caught up in the anti-vaccine echo-chamber, subject to group dynamics and all that implies.
Just take a look at the Age of Autism blog – a sociologist could make a career out of studying the comments alone. A recent article at AoA is the perfect example of the need for simplicity. David Burd writes Death by Flu, The Big Lie Crumbles. The title itself reveals much – flu is not that bad, and those who say it is are lying. Nice moral clarity.
Burd is shocked (shocked!) to discover that the number of flu deaths each year is estimated by the CDC. He writes:
“CDC makes it abundantly clear these 3K to 49K “flu-associated” deaths are not actually counted, but are instead estimates generated from computer models that hypothetically link such as pneumonia deaths to those theoretically having a prior case of influenza (with the influenza long gone).
and
Subtracting 105 from 311 we see a documented count of 206 adult flu-associated deaths. It will be interesting to see what CDC’s computer-model finally conjures up as the final 2010-2011 “flu-associated” death tally.
Interestingly, Burd glosses over an important fact that he relates – the CDC does make it abundantly clear what methods they use. They have complete transparency. Using various methods they, and other researchers, estimate the number of flu-associated deaths in the US as between 3 thousand and 49 thousand each year. They estimate the number for a very good reason – the surveillance mechanisms in place do not allow for a direct counting. Most people who come down with the flu do not undergo laboratory testing to confirm that they actually have the flu. The diagnosis is often made based upon clinical symptoms. We also know from case histories that some people will develop complications from the flu, like a secondary pneumonia, which will be the ultimate cause of death.
The goal of the CDC estimate is to figure out, as closely as possible, how many excess deaths are due to the flu – how many people died who otherwise would not have if not for the flu.
Burd makes no substantive analysis of the methods used by the CDC and other researchers. Nor does he attempt to make an alternate estimate. He simply counts the laboratory-confirmed cases as if this is the “true” number. He makes no mention of the fact that most cases of flu are not examined with a laboratory test, and therefore this number is likely to be a gross underestimate – by orders of magnitude.
He takes this pseudoscience further by comparing US and Canada laboratory-confirmed cases:
Summing up, while Americans are coerced, cajoled, or required in school and health institutions to undergo the dangers of flu shots, our Canadian neighbors overwhelmingly reject them, and the last five years Canada has averaged but a single (non-comorbidity) flu-associated pediatric death, while the U.S. toll rises ever higher.
He neglects to mention that the US has a higher population than Canada, and that differences in surveillance methods would also need to be taken into consideration. The comparison, in other words, is absurdly useless. While decrying the methods used by the CDC to estimate flu deaths, Burd abuses completely inaccurate numbers for his propaganda purposes.
But he has fed the echo-chamber another round of reassuring simplicity and moral clarity – not only is the flu vaccine unsafe, the flu is not that bad a disease anyway, and those who are pushing the vaccine are liars.
Burd makes no attempt at due diligence or respectable scholarship. He does not try to understand the CDC methods. It’s enough that he has hit upon a fable that suits the propaganda agenda of AoA.
Nor is AoA an isolated example – it is more the rule than the exception (although it is an extreme example). We see the same thing at the DiscoTute with respect to evolution, or on any news outlet with a political skew (which essentially means all of them, although to varying degrees). This phenomenon is widespread (as you would expect for anything that derives from basic human nature), which is why it is important not to rely on any single source of information. It is helpful to look for the other side to the story, assume that there is probably more complexity to an issue than is at first apparent, and to be vigilant about the need for simplicity and clarity in our own thinking.
27 Responses to “Anti-Vaxers and the Need for Clarity”
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I agree that you don’t share this black or white mindset, but to be fair it is something I’ve seen in comments to skeptical blog posts before. And of course when we have a “bad guy” we rarely mention them in nuanced terms. For example, I’ve never heard an article critical of Oprah start with, “A lot of her charitable work has done enormous good, but…”
Banyan – what you are saying is true, but on the whole the skeptical community is better than most. Do read the comments to this and other blogs – you will find many skeptics almost giddy to find nuanced fault with the blogger’s article, or to present (as you just have) a different point of view.
But you are correct – hence the last line of this post.
I think you are being somewhat simplistic when you characterise this as an “echo-chamber” “cartoon world” on the one side and honest scientific clarity on the other. The “pro-vaccination” side includes scare stories, false alerts and less than honest advice about the reasons for vaccinating. You may discount this because you know what the scientists themselves are saying, but this isn’t the whole picture.
When a headline figure of, for example, flu deaths is given, rarely is any demographic information provided. The press will always choose the highest end of any range and use this to exaggerate the danger. e.g. Your 3-49k would be presented as 49k, probably rounded up to 50k. Also, if the deaths were mainly of people who were ill anyway, very old, poor, malnourished etc, even the numbers given are not as serious a risk to the general population as they seem. Without the information, people will find reasons why they aren’t so much at risk as the numbers would suggest.
I’m not arguing against your main point that anti-vaccination campaigns are not soundly based. I do think though that one of the reasons they achieve some traction is because the arguments on the other side are sometimes hyped or exaggerated. Those who “look for the other side to the story” sometimes find what they have been told (even if only by the press) was not the whole truth, and that opens them to accepting the views of anyone else who thinks the same.
I find it odd that this writer uses Canada as an example, as if they don’t get flu shots or something. As a Canadian, I should say I find that pretty amusing, as clinics couldn’t handle the H1N1 rush for vaccines and had to tell the healthy people to not come because they were making it take longer and using up the supplies for the young and elderly.
Also, although I can’t find the article offhand, a bunch of students were actually removed from school recently near here(the GTA) for not having their vaccines up to date. So just for the US people in the audience, although we have our anti-vaxxers, this is not a bastion of un-vaccinated people living in a utopia of non diseased goodness. (Although I have to say as a Canadian say, free health care is awesome sauce, and perhaps it would be a point of interest to tie that into why less people die of flu, if that stat is any good in the first place[keeping in mind the crazy less number of people we have too]).
“Also, if the deaths were mainly of people who were ill anyway, very old, poor, malnourished etc, even the numbers given are not as serious a risk to the general population as they seem.”
I don’t get your point here. Are not the ill, poor and elderly among the general population? We are not talking about a rare minority here, and given that an important mechanism for protecting this group is through the vaccination of the healthy, this is a narrow way to see the benefit of vaccination.
Perhaps this is what makes the vaccination estimation of risks and expected benefits more difficult for people: it is an intervention that has implication on a group level in addition to the individual level. Sure, I will be unlikely to die from the flu (being in my 30′s and otherwise healthy) but that doesn’t mean much if I pass flu along to my grandfather or to ill patients in the hospital. Nearly every healthy person is going to have interactions with people in a high risk group, so thinking if individual risk versus expected benefit is an incomplete perspective.
” It is helpful to look for the other side to the story”
I think this is a major difference between those who question a proposition in good faith and truthers, vaxers, etc. In my experience, those who can earnestly play “devil’s advocate”, so to speak, will usually come to a reasonable conclusion, while those who refuse to will not.
I’m not sure if playing devil’s advocate is a symptom of fairness/ willingness to think critically, or if this is an essential part of the process that leads one out of the woods. I’d like to think the latter is true, and that it can be taught along with the other tools of critical thinking.
On the same general topic of not seeing only your own strawmen on the opposite side:
As most sceptics (I think) I’m quite left in my political views. Especially with American politics, I’ve never found any news outlet that made me see the republican side of things. Right now, my picture of republicans is that their are either greedy, like Trump, or batshit bonkers, like Palin.
Not that I would totally agree with all the democrats are doing, but still, the republicans seem just too dark a shade of grey in my sense.
Sorry, I forgot the question: Does anyone know of a news source that portrays right-wing politics for a well-read audience, or possibly a blogging right-wing politician, that doesn’t fall into the black-white trap?
@Gehackte: most people who are at risk of dying from the flu are old and already have free health care in the US (H1N1 being a bit exceptional of course). I never miss a chance to point out the we already have mostly government funded health care in the US (so we’re well on the way to communism at Ronald Reagon pointed out when our old-person only version of health care was enacted
).
@the blog: another area where I see a lot of “morality play” thinking (even in my own thoughts…) is nutrition. it would be awesome if avoiding “bad” food was all you needed to do to lose weight or maintain a healthy weight, but of course # of calories is all that matters really.
similarly alt-meders who explain all disease in terms of toxins. its too scary to think that you could do everything right and then have a deadly bacteria come out of no where and destroy your kidneys. Or get cancer just by bad luck. So they clutch their organic food like a talisman.
juga
“I’m not arguing against your main point that anti-vaccination campaigns are not soundly based. I do think though that one of the reasons they achieve some traction is because the arguments on the other side are sometimes hyped or exaggerated. Those who “look for the other side to the story” sometimes find what they have been told (even if only by the press) was not the whole truth, and that opens them to accepting the views of anyone else who thinks the same.”
Although I applaud your critical thinking, I would point out that the anti-Vax Campaigns have traction because they falsely magnify such issues instead of presenting them in context that they are scientifically meant to be interpreted. In my opinion to try to structure the truth to be more iron plated, would make us guilty of cooking the books. Instead of presenting the facts. That would give them more ammo.
Rikki – of course, your assessment can be a bit of a self-fulfilling prophesy. You think all Republicans are crazy because they conflict with your liberal ideology.
What you have to ask is – apart from differing ideology, are they crazy?
Without getting into the “conservative” vs “republican” thing, there are some writers on the right who more often than not make decent arguments. I often disagree with them, but they are not “crazy” or greedy.
You might enjoy David Brooks, for example. George Will is interesting when he covers legal issues, but goes off the rails whenever he covers global warming.
Rikki-Tikki-Tavi
“As most sceptics (I think) I’m quite left in my political views.”
This is only me, but I like to hope that skeptics take a independent but skeptical view of politics. I assume that they are all wrong and have to prove it to me on issues. I find myself more often than not with no political leanings overall. Sometimes the left has me sometimes the right has me depends upon the specific issue. This is the US since in other nations left and right politically can different meanings.
@Steven the fact that you think is George Will is alright when he’s not talking about global warming I think more reflects the fact that you are more familiar with global warming then you are with the other issues he addresses. His general disregard for the facts extends to economics (just look at poor Krugman’s face whenever Will talks on This Week). And like most of the Washington Post he enjoys trumpeting village common wisdom as fact.
I’m an software developer and whenever I hear a bad bit of technology reporting in the MSM I think “is the technology reporting uniquely bad or do I only notice when its technology since that’s what I know?” I think with George Will its the latter.
@Rikki-Tikki-Tavi
I really do think that as a medium blogging is just better for the left. The cutting edge of conservative thought is on the AM dial. However you could go overseas and find some good stuff: The Economist presents a conservative-to-neo-liberal worldview and just has good articles. Also there’s Andrew Sullivan.
I don’t think that political orientation and scientific thinking covary as much as is being portrayed.
At the risk of subscribing to the horrible bifurcation error that is modern US politics, the left-side anti-science folks are vaxers, truthers, homeopaths, healers etc., while righties tend toward denying global warming and evolution.
All of these anti-science viewpoints serve to throw science out the window in favor of some ideology, as Steve pointed out in the last thread. Most politicos are indeed ideologues, and anything getting in the way of their agenda must be nullified, rationality-be-damned. That’s why I don’t care what they have to say on either “side”. It’s essentially an advertisement for a POV.
@eean “most people who are at risk of dying from the flu are old and already have free health care in the US”
Not free. Medicare Part A is free, but only covers hospital expenses (and only part of those). Part B, which covers doctor visits, labs, etc., costs in the vicinity of 100/month or up, depending on your income. Part D, for medications, is not cheap either.
@_rand15_: well good point & thanks. And of course Canada’s out-of-pocket cost isn’t 0 either.
juga-
I think your comment is right on.
Rikki-Tikki-Tavi
If you want to understand ‘conservative’ economics, I would suggest “Free to Choose” by Milton Friedman.
If you want to understand the political stuff, I would suggest National Review. Not as good as when Buckley was alive, but if you want well written, well thought out discussions from a ‘conservative’ perspective– I haven’t found better (been looking for decades).
@Steven, eean, sonic: Thank you for the advice, I’ll have a look at all that next weekend.
@Steven: Politics is viewpoint-oriented in that goals of politicians may differ. I should clarify, that in my mind a debatable politician is one, that wants the best for all citizens of his country, rather than just for those who vote for him. A greedy politician, I would define as one whose goal it is to benefit only the rich, either by own admission or by very transparent policies. A crazy politician is one that dispenses desultory babbling about the “founding fathers” and what they supposedly stood for, without any appearance of ability to run even a lemonade stand.
So while discerning which politicians to put in those “undebatable” groups is not always easy, there have to be plenty of right wing politicians that certainly belong to neither group. It’s their opinion that I want to know.
“too often we confuse our simplistic models of reality with reality. Further, we like our morality plays to be black and white. The villains are villains, without redeeming qualities. The good guys wear white and have no major flaws (nothing beyond an endearing quirk). The ambiguities and gray of the world make us feel uncomfortable. This tendency, by the way, leads to certain logical fallacies, such as poisoning the well. If Hitler believed something, and everything Hitler did was bad, then that belief must also be bad.”
Yes it’s true that this kind of irrational thinking is very common. But I don’t think it’s because human beings are naturally irrational. For one thing, the people you notice are the ones who yell the loudest, and those are usually the irrational fanatics. It’s probably more common for parents to wonder if vaccines are completely safe, and worry about it, but decide it’s worth the risk. The ones who become raving activists are only a certain personality type, and represent a small minority.
I think most people are relatively rational most of the time. When we are irrational, it’s usually because we are confused and scared, and the available information is contradictory and hard to interpret. And some people are confused and scared most of the time, about one thing or another. We do live in a confusing time.
Yet the average person, from what I have seen, is grounded in practical rationality, most of the time. Even raving activists go about their lives in a practical and rational way, except when their fanatical beliefs system gets triggered.
I know that my faith in human rationality is directly at odds with what the organized skeptics believe. I think that when people are confused, it’s because the world is confusing, not because our brains are poorly designed.
“your assessment can be a bit of a self-fulfilling prophesy. You think all Republicans are crazy because they conflict with your liberal ideology.”
Oh very true. When we have an iron-clad belief system, we can’t imagine any sane person could disagree with us. Therefore, they must all be crazy.
But if we are real skeptics, with flexible belief systems, we try to see the other side.
Thank you Steve an excellent read as always.
In this case perhaps “Anti-Vaxers and the Need for Honesty” would have been a more appropriate title.
There are some times when I agree with “conservatives” like David Brooks. Since Obama was elected, however, I have heard very little from anyone who identifies as republican that has made even a lick of sense.
Fiscal austerity in a time of high unemployment and low inflation!? WHY???!!!???!!??
As a parent whose child had an adverse reaction to a vaccine (whooping cough) and nearly died, my strategy is not to have my child vaccinated but to encourage all others to be vaccinated. I think, after listening to SGU podcasts, this may be called something like promoting herd immunity. In evolutionary terms would this not be the best strategy to achieve survival of my individual genes at the expense of others, albeit a strategy not to be advertised?
Whilst I’m skeptical (I would be) of education as a solution for these types of problems, I think anti-vax memes would find it harder to spread if people had a sound grounding in the science of vaccination.
The only vaccination education I can specifically recall from my biology course was at age 16 and concerned Jenner’s cowpox vaccine. Until recently I’d never see what a case of Small Pox looked like, nor knew such a huge proportion of people died from it (I mean I knew it was BAD, but I didn’t know it was THAT BAD).
I’ve knowingly met only one person whose life changing deformities (wheelchair bound, and with deformed hands) were due to Polio, and whilst I understand Post-Polio syndrome is a lot more common than this type of deformity I don’t (knowingly) know anyone with it. Presumably many people could easily pass through life now without meeting any victims of Polio, and a fair proportion of people alive must be too young to have ever seen a case of Small Pox first hand.
The reason education needs improving is because I think it is largely inadequate for other reasons beside anti-vax. A lot of my biology education covered anatomy, and types of animals, and germ theory of disease, but I think from a practical perspective a lot more human health education would have been useful. Again I knew almost nothing about what having diabetes might mean, or how to spot it, despite it being very common (even then) and everyone is likely to know someone affected.
Possibly school curricula have got better since my day, but perhaps if we could persuade one of these big science communicators that what the public really need is a good TV show about what killed people in history (and currently) with lots of gory photos of Small Pox and Polio, whilst repeatedly pointing out how many people died and suffered from these disorders (and how effective vaccination has been). A healthy dose of reality might vaccinate the unwashed herd against these particular memes.
Whilst I accept there are caveats about vaccines, and vaccinations, vaccination remains the biggest single health improvement ever. If there are good guys and bad guys, then Edward Jenner, and Jonas Salk, are as close as we get to superheroes of the science world in shining white coats. Of course we should gloss over Jenner exposing a small boy to variolous material and stick with the erecting statues to remind ourselves why it was considered an acceptable risk back then, and how far we’ve come.
Rikki-Tikki-Tavion 06 Jun 2011 at 12:54 pm
Sorry, I forgot the question: Does anyone know of a news source that portrays right-wing politics for a well-read audience, or possibly a blogging right-wing politician, that doesn’t fall into the black-white trap?
Try looking for David Frum.
“lots of gory photos of Small Pox and Polio”
That is precisely NOT what is needed. The goryness of smallpox and polio has absolutely nothing to do with whether children should be vaccinated against measles, for example. Smallpox has actually been eradicated and therefore nobody can get it. To try to use it to scare people into vaccinating their children is precisely the kind of unscientific response that makes people think they’re being lied to.
neil,
the strategy you propose is not uncommon in nature. But also, species develop strategies to inhibit precisely that kind of behavior. That is why we have evolved emotions for a sense of justice, or even punishment and revenge.
This was recently described in a bird species, where those who did not participate in the group defense were not heeded when they asked for help.
But – back to vaccines – that strategy is not optimal because the health outcomes are best for individuals who get vaccinated. The benefits outweigh the risks for each individual, not just the herd.
It is also tempting, but not logical, to base decisions on one quirky case (even if it is your own) rather than statistics. The hardest thing emotionally to do is to ignore our own anecdotal experience. But controlled data is better than personal experience, which is quirky and often misleading.