Maria Konnikova summarizes some really interesting research by political scientist, Brendan Nyhan. Nyhan was interested in finding out whether various pro-vaccination campaigns would change parental attitudes toward vaccines.
Nyhan and a team of pediatricians gave a group of 2,000 parents four different leaflets of information. The leaflets showed parents the benefits of vaccinations and explained that there was no evidence that vaccinations lead to autism, but each leaflet used a slightly different method of persuasion.
“Each household received one of four messages: a leaflet from the Centers for Disease Control and Prevention stating that there had been no evidence linking the measles, mumps, and rubella (M.M.R.) vaccine and autism; a leaflet from the Vaccine Information Statement on the dangers of the diseases that the M.M.R. vaccine prevents; photographs of children who had suffered from the diseases; and a dramatic story from a Centers for Disease Control and Prevention about an infant who almost died of measles. A control group did not receive any information at all. The goal was to test whether facts, science, emotions, or stories could make people change their minds.
The result was dramatic: a whole lot of nothing. None of the interventions worked. The first leaflet—focussed on a lack of evidence connecting vaccines and autism—seemed to reduce misperceptions about the link, but it did nothing to affect intentions to vaccinate. It even decreased intent among parents who held the most negative attitudes toward vaccines, a phenomenon known as the backfire effect. The other two interventions fared even worse: the images of sick children increased the belief that vaccines cause autism, while the dramatic narrative somehow managed to increase beliefs about the dangers of vaccines. “It’s depressing,” Nyhan said. “We were definitely depressed,” he repeated, after a pause.
People are stubborn. Their particular worldviews are stronger than science. And we are more influenced by Playboy Bunnies than by smart people who have facts and figures at their disposal.
Who are these misinformed people? Are they mentally impaired? I come across confused parents all the time. I know very smart people who didn’t immunize their children. Their anti-vaccination positions stem from their alternative view of healthcare and medicine. Those parents also use specialized cleaning products for their homes and steer away from store-bought meat. Anti-vaccination is part of a cluster of beliefs about modern medicine, the environment, and child-rearing. One leaflet isn’t going to make them budge.
I talk to well-meaning parents of kids with autism, who believe that autism can be cured with strange diets or by high-pitched sounds in the ears. One quack is even experimenting with magnets on the brain. I’m very sympathetic to the parents who pursue alternative cures for autism. Their misconceptions aren’t tied to a lifestyle, but stem from sadness and desperation.
I wonder if Nyhan asked the parents in his study about their political ideology and party affiliation. My guess is that the anti-vaxxers are more likely to describe themselves as liberal. Which shows, sadly, that insanity isn’t the property of the right-wing Republicans who think that Obama was born in Africa. Crazy people are everywhere.
Apt. 11d 
One quack is even experimenting with magnets on the brain.
Well, magnets and electrical stimulation for the brain are areas of active research reported by quack outfits like the National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml “Repetitive transcranial magnetic stimulation ” has been approved a treatment for depression.
No idea if it could help autism. I suspect not.
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I was going to comment on TMS. I’m familiar with its use as a research tool. It’s not impossible that it might help relieve symptoms of autism and potentially help with rewiring. But, it is minimally invasive, and in fact, many adults would be comfortable participating in a study using the technique (I haven’t, but I would, if I were an appropriate candidate — things like the fact that I wear glasses for vision correction actually limit my participation in some of those studies. )
I believe the main studies on TMS in children use it to find biomarkers.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2423198/
I certainly wouldn’t turn to it as a treatment, but it’s not inconceivable that it could some day be one (in the same way that some pharmacological treatments are useful).
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Ha, I’d never thought that most anti-vaxxers would be liberal! The ones I know (one of which has a doctorate in audiology! I couldn’t believe it when I found out she didn’t vaccinate, maybe moving from Brazil to rural PA and marrying a rural PA guy did something to her!) are fairly conservative and also Christian.
So maybe there are be two camps of anti-vaxxers: the really conservative (home-schooler, Christian, against contraception, some fans of alternative medicine as well) and the liberal anti-establishment, alternative medicine types. What do you think?
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I think that’s correct. You see the same split with homebirthers and attachment parenting.
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Decades ago, when I first started talking to people about the measles vaccine/autism link (it’s shifted, just like the birther story, and it was different back then, based on Wakefield’s early research), I read some papers saying that the *person* conveying the information played a huge role in the effect of the information received. So a trusted friend telling you their plans and beliefs influenced your decision making and beliefs more than information that came from official sources. People waited, say, a neighbor’s opinion, more than the surgeon general’s.
I don’t know if there have been any large scale studies of that effect, but policies that might stem from it include the need to build trust first (leaflets are very untrustworthy, I think we would all agree). It might also mean that relationships with individual doctors are a necessary component of conveying medical information (so that the “family doctor” is important, and can’t be replaced with an every-changing retinue of doctors).
When I first started talking about vaccines, I thought people were stupid, stupid about science and uneducated. But, I think I’ve modified my opinion — I still think science education is inadequate, but I think that we have to deal with people as they actually behave, and not as we wish they would. I may prefer to get my information from science papers (and, I’m constantly linking them here, probably in a persevering sort of way), but, communication is about making other people understand how they need to understand. I can see why a scientist like me would design that leaflet experiment, and, also, see why it would fail. I’d like to see the experiment done with different people telling the information to the study participants.
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“I read some papers saying that the *person* conveying the information played a huge role in the effect of the information received.”
The ethos appeal is very strong. It’s also the one I have the hardest time teaching my students, fwiw.
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Science papers can be problematic, as most people aren’t qualified to read them. What they do read is partisan summaries of papers, which may be highly misleading. One sees this a lot with natural childbirth, discussions of c-sections, and homebirthing–people who are into that sort of thing can generally cite a million papers and talk a good game about “research based medicine”, which is highly impressive to the uninformed average person.
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re: TMS. A friend of mine has a college-aged son who was tragically damaged with a rare autoimmune disease that ate up a good part of brain. Her family flew out a prominent TMS scientist from CA to see if this procedure could re-route the wiring in his badly damaged brain. He also checked the biomarkers in the other kids, just for kicks. The TMS didn’t work. It gave the boy seizures. The biomarkers thing also sounded insane.
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“The biomarkers thing also sounded insane.”
Interesting to hear your perception. TMS is merely a minimally invasive method of stimulating the brain directly. It’s used to test pathways (in the descriptions in the Clinical Neurophysiology article), like the knee tapping test, which is used to test whether the corticospinal pathways that mediate that reflex are intact. In that study, they’re tweaking parts of the brain and examining the pathways (which change as children grow). None of it would be particularly seen as extreme.
In more extreme circumstances (rare autoimmune diseases, intractable epilepsy (meaning intractable to drugs), parkinson’s disease, . . . . people actually implant electrodes in the brain to test the function of brain pathways. A standard procedure, in surgeries for severe epilepsy, is to introduce electrodes to map out the epileptic areas. In some cases, these electrodes are left in place for weeks while measurements are made and research studies are conducted at the same time. Deep brain stimulation (with electrodes) has become one of the treatments for intractable epilepsy, intractable depression, and Parkinson’s. Electrode implants are a extreme treatment, not the least because of infection concerns. But, I think that TMS might, sometime, become a treatment more on par with drugs like risperidol (which is not prescribed lightly, but can be useful).
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I wonder how effective respectful counterpoints are? Most counterpoints I see to specific anti-vax arguments are framed by “you’re a stupid idiot for thinking that.”
The major anti-vax arguments among my hippie Facebook friends:
The antibodies and additives in vaccines, when injected directly into the bloodstream, have negative effects, many of which only cause vague symptoms that the medical community doesn’t recognize but can be lifelong problems (fatigue, low immunity, mental issues, etc.). These effects are more likely than long-term negative effects of the diseases themselves in well-nourished people with access to modern medical care. (This, I think, is the most difficult to refute because of the vague symptoms.)
Vaccinations don’t work; diseases were declining before the vaccination was introduced and most people in current outbreaks are vaccinated. (Likely a misunderstanding of statistics. The first point is true but vaccinations still help.)
Vaccinations don’t always lead to lifelong immunity, so I’d prefer my kid get childhood diseases and be done than risk getting it as an adult when vaccine immunity wears off. (I have no idea what the statistical reality of this is.)
They claim the polio vaccine works but really they just don’t diagnose it anymore, they call it Guillain-Barre syndrome. (No idea of the basis of this conspiracy theory.)
Vaccine makers benefit financially from pushing vaccines but risk no liability if they’re dangerous. There are a lot of diseases worse than chicken pox out there that we don’t freak out about; they generated the fear. (I don’t know that I can refute this for all vaccines…)
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It’s very similar to the ways in which education fails to change people’s worldviews. Look at any first-year physics class – most people walk in with a pre-Newtonian idea of mechanics. Sure, they might learn the equations and the ways to pass the course, but by the end of the class, most of them still interpret the world in pre-Newtonian ways. It takes a really good teacher and open, motivated students, to bridge that gap and make the switch in thinking.
People don’t want to think in different ways, especially when they’re scared and angry. If our success rate with changing students’ ways of thinking is low and they’re supposedly motivated to learn new things, imagine how much lower the rate would be with those who aren’t putting a priority on being open to education?
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I think parents of children with unusual conditions become very sensitive about whether or not medical personnel treat them with respect. It may be easy to lose respect for medical authority, if you’ve experienced medical people *not listening* to what you try to tell them. So medical arrogance and a belief that anyone who doesn’t agree with you is stupid does not lead to constructive dialogue. Calling them stupid and crazy doesn’t help, either.
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True. And, I think that medical personnel have gotten better at this, at realizing that trust won’t come with the lab coat, and they have to learn to talk and listen. Some people are better at this than others, though, and it is not a quality selected for in picking the people who go to medical school.
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I think this is a growing problem with science and perhaps science education writ large. Many important scientific issues in public discourse are just not accessible to the average person. It is complicated, the evidence consists of a large body of work developed over many years in papers written for other scientists. It is largely inaccessible to an amateur unless they have a lot of time to figure it out, even if they are a very well educated and already buy into the conclusion.* That leaves most people stuck with forming their opinions on the basis of the authority of experts. And, well, “you have your experts and I have mine”. I’m not sure what to do about it, but it seems to be a growing problem.
*Take a look at the Fifth Assessment Report from the IPCC. http://ipcc.ch/report/ar5/wg1/ It has very extensive discussion of the science, but accessible it is not.
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Laura said:
“People are stubborn. Their particular worldviews are stronger than science. And we are more influenced by Playboy Bunnies than by smart people who have facts and figures at their disposal.”
And somebody just gave Jenny McCarthy a seat on The View.
“Who are these misinformed people? Are they mentally impaired? I come across confused parents all the time. I know very smart people who didn’t immunize their children.”
A few months ago, we socialized with a friend’s sister and her unvaccinated toddler. The friend’s sister is ABD in one of the softer sciences, I believe, and is a Harvard person. She picked up anti-vaxxing from an autism parent she knew.
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Speaking of public health disasters, one of the usual suspects has just attacked the safety of the glucola they give pregnant women to test for gestational diabetes.
http://www.skepticalob.com/2014/05/aviva-romm-and-the-quack-attack-on-glucola.html
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Chatted with the author of the study… He said he didn’t check for party affiliation in this study, but other have. Anti-vaxxers are bipartisan. He also said that anti-vaxxers tend to be clustered in certain communities. So, there is a strong echo-chamber sort of effect.
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Maybe even a “Petri dish” sort of effect.
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Yes. In Australia the Northern Rivers area is notorious for low vaccination rates. It is also a go-to area for alternative lifestylers.
http://www.abc.net.au/local/stories/2014/03/28/3973394.htm
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The reason scientific campaigns don’t work to combat anti-vax sentiments is because choosing not to vaccinate has nothing to do with science and everything to do with personal identity. Choosing not to vaccinate means staking a bold claim against Big Pharma! or the Government! or for Natural Living! It’s a very clear way of saying, “I’m this kind of person and being this kind of person makes me different, special, and better than you.”
A success vaccination campaign will need to address this by associating parents who vaccinate with positive personal identities. Things like:
-Jane is an attachment parent and she vaccinates!
-Joe works to remove toxins from the environment and he vaccinates!
-Laura eats only organic and she vaccinates!
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Bravo Scantee!
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Mostly Lurking homeschools his kids and he vaccinates (except for HPV, which may or may not involve a different can of worms).
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Why would it involve a different can of worms?
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I didn’t vaccinate my second child until he was five and wish I had done the same with my first child. And frankly, scantee, I find that fairly offensive.
People I know who don’t vaccinate tend to be involved in the autism community in some way. They may, like me, have one child or another family member with autism or they’ve worked with the population. Most of them have learned through hard experience to be skeptical of what their doctors say – when you have one doctor telling you your kid is okay, YOU obviously have the problem, and another doctor telling you your kid definitely has autism and is a hopeless case, both within the same month, you get a pretty clear picture that the medical world isn’t *exactly* infallible. So the white coat doesn’t have much luster for many of us. It sucks, frankly. It’s so much nicer to be able to trust your experts. But sometimes experience proves you can’t.
By the way – most of us have encountered other parents and strangers sneering at our kid’s behavior and have learned pretty effectively to ignore and detach; the sneering, contemptuous attitude towards non-vaxxers gets the same reaction. So if anyone is wondering why “you’re a stupid idiot for thinking that” doesn’t change people’s behavior, that’s one reason.
I researched as much as I could back in the late 90s and came to the conclusion not that vaccines caused autism but that 1) something was sure as hell causing a huge uptick and 2) big pharma and medicine were way more cavalier about the safety of the rapidly increasing vaccine schedule than was okay by me. Only a few years later it came to light that no one had bothered to measure the increase in mercury-based preservatives that came with the increased schedule, so they began to phase it out. Autism didn’t decrease after that – it doesn’t seem that the increase in mercury kids were getting caused the increase in autism – but why on EARTH should I trust an establishment that didn’t even bother to fucking NOTE the increase in a chemical they are injecting into very small humans and ASK if that were wise or necessary?
If you really want more people vaccinating, both big pharma and the government need to engage with anti-vaxxers respectfully and be willing to 1) concede that some vaccines are more important than others and give parents some choice and 2) fund studies with transparent designs, data, and results that aren’t skewed toward specific results.
I don’t expect that to happen. I also expect more and more people will refuse to vaccinate.
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2) fund studies with transparent designs, data, and results that aren’t skewed toward specific results.
What do you mean by this?
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Your complaints seem to have less to do with the concept of vaccination and more to do with the way vaccines are made/produced by Big Pharma. Fair enough. But surely you concede that vaccination, done without “injecting chemicals like mercury into very small humans,” is a very much *good* thing.
I can be as crunchy and anti-authoritarian as they come, but I still vaccinate my children and have done so from a young age because the benefits far outweigh the potential costs. Even if my child gets sick, dies or becomes autistic (having a kid on the spectrum, my feeling is that it’s pretty genetic), the numbers of children who will have survived because of these vaccines is so high that the risk is one I am willing to take. What I would prefer to do is to regulate Big Pharma (I am a high-tax, high-regulation Democrat, after all) and make them do a better job, personally. Opting out seems like the wrong approach to me.
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And, Squidicious has a child with autism, and she vaccinated (though it took some time to get there.)
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I’ll go ahead and say that, on this issue, I’m completely fine offending people. I don’t think it is the most effective way to influence people’s behavior so I would never make these arguments to a person’s face but, hey, this is the internet, and offense is what it’s for.
First, no one, no one is forcing you to vaccinate your children so don’t pretend like they are. Second, we do not need any more studies. This issue has been studied to death and, be honest with yourself here, there could be a 1000 more studies on this issue and you would never be satisfied. In a time of constrained resources, devoting funding to this issue just diverts money away from supporting people with autism. Third, if you want !fuck the establishment! like a 15 year old would that is your prerogative but then don’t get mad when us adults snicker at you for your behavior.
You’ve done absolutely nothing to disprove my theory that your anti-vax stance is all about you, you, you and has nothing to do with science.
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Since I was asked, I’ll phrase it this way: can a parent who has otherwise fully vaccinated their daughter be anti-HPV without being “misinformed,” mentally impaired” “insane” or “crazy?” Have Laura’s children had the HPV vaccine (unlikely, given that they are boys, but I’ve seen some recommendations saying that boys should receive it as well)? If one is not crazy to skip the HPV vaccine, what is it about that vaccine that makes it different from the “skip it and you are crazy” variety of vaccines.
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I guess I don’t understand why you would skip it if you otherwise think vaccines are safe. You specifically don’t think this one is safe? You don’t expect your daughters will be having sex? I have two boys and I will absolutely be having them get the HPV vaccine when they are at the appropriate age 1) to help protect them from throat and anal cancers, of which HPV is a major cause, and 2) to help protect their partners from those cancers plus cervical cancer, should their partners be women.
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It doesn’t have as many years of safety data, is preventing fewer deaths, and waiting until the kid is older produces only a very marginally greater risk. I think avoiding the HPV vaccine is wrong, but not not insane (which isn’t to say that plenty of people haven’t made insane arguments again HPV vaccines). Not getting the MMR is just straight up insane. Measles alone was killing two and half million kids a year as recently as 1980.
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Another argument that won’t work with US anti-vaxers: citing worldwide death rates. It comes across as hyperbolic which makes them discount everything else you have to say.
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I don’t understand this complaint. It doesn’t matter if people in Africa are falsely lead to not vaccinate their kids because they were just going to be killed by Kony anyway? In the last year before vaccination was introduced in the U.S., only 432 people died but there were still a half a million infections with a very painful disease.
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From the CDC: “The first dose of an HPV vaccine should be given to girls and boys aged 11 or 12 years during any visit to the doctor.” I’m not sure when they added this. When I was first looking at the issue, I thought it was a girls only thing. I would be curious to see if boys are getting this routinely.
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It started out as just for girls and boys were added more recently. See above, protection from throat and anal cancer as well as added benefit of protecting any female sex partners.
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I am pretty sure we’ll be vaccinating our son for HPV. We did my daughter, and I don’t think my husband has any major objections.
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Clearly you are fine offending people. But that too is all about you you you. If you believe the science is good and vaccine compliance was important, you’d be more interested in a respectful dialog and changing minds. Whatever.
Of course my stance is purely about my kids and their kids.
Science is great and of course, I believe vaccines work. But just because they work, doesn’t mean there aren’t unintended consequences, doesn’t mean some children don’t have devastating reactions that we should do all we can to prevent, doesn’t mean it’s okay not to make sure they are as safe as possible, and I don’t think that has been done. Wendy, I’m fairly close to your position, I think.
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The rate of serious side effects to the MMR vaccine is 1 in 10,000. That means to prove a specific side effect is related to the vaccine you would need to look a hundreds of thousands or millions of cases. This is the kind of science that can only be done through a retrospective review of medical records after mass inoculation.
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I guess I don’t understand what you think would be respectful. I think vaccine proponents have been more than respectful towards anti-vaxxers for years. They took the autism-vaccine link very seriously and ran many studies trying to understand if or how they were linked. In science, that is respect.
As far as studies being skewed, the only study I KNOW to have been skewed to a particular result was the only study to find a link between vaccines and autism. That was flat out fraud.
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Ok, the competing arguments are there on HPV. On the one hand, “I think avoiding the HPV vaccine is wrong, but not not insane.” On the other hand, Scantee, who does not seem to recongize a distinction. MH’s point about the shorter track record on safety data of the HPV vaccine is well taken. My next question would be “why is it crazy to ignore some CDC recommendations and not others” and who gets to decide which recommendations can be avoided without villification. But I think I’ve made my point.
By the way, as of last summer, only 1 in 5 teenage boys received the HPV vaccine, according to the CDC. Given the vitroil contained in the blogger’s original post, I’m still curious about her own practices with respect to her sons, but I can see the case for privacy on this point.
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My next question would be “why is it crazy to ignore some CDC recommendations and not others” and who gets to decide which recommendations can be avoided without villification. But I think I’ve made my point.
Really, sometimes vilification is necessary and appropriate. For no reason but scientific fraud and associated hangers on, hundreds of millions of dollars and the equivalent of life’s work of dozens of scientists were wasted. By sidetracking those efforts and diverting so many resources, the people who put forth the MMR/autism connection were the single biggest barrier to improving vaccine safety.
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The part of the anti-vaxxing worldview that I can relate to is the amped-up fear of autism, and the relative obscurity of the countering threat (for example, of measles). Autism affects a child FOREVER, and from my perspective also makes parenting itself very very difficult. Whereas measles, I don’t even know what that would look like? Maybe you’d get really sick for a couple of weeks, end up in the hospital, maybe even die … but if you get thru it, it’s over and you pretty much go back to normal? Plus I’ve never met a soul who’s had measles. It seems like such a distant threat. Whereas autism is more like the wolf at the door. In my social circle two friends have children or nephews who’ve been diagnosed and are in pull-out programs. And in my daughter’s class of 20 kids at the local parochial school, one of the kids is on the spectrum.
When it was time to vaccinate our daughters, our hippie of a pediatrician was much more careful about it than what I’ve heard others report. He would only give one shot on any single visit; this approach led to the girls getting their shots on a non-standard (and somewhat delayed) schedule. They had everything by the time they needed to start preschool, but just barely.
But you’ll note that with this behavior he was taking the parents’ mistrust of vaccinations somewhat into account, and the patient’s long-term well-being was clearly at the center of the decision. I never got the feeling that the doctor was taking on extra risk with the vaccinations simply because he wanted to ‘get it in’ during that office visit. (Note this pediatrician did not charge for these extra visits, perhaps because he knew the insurance company wouldn’t cover it.) Now for me it was a total pain; I ended up at the pediatrician constantly. But the whole approach really put me more at ease.
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I’ve never met a soul who’s had measles.
Why do you think that is?
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Because of the vaccines 🙂 I think it’s better to be explicit.
And, actually Rubella (German Measles) causes infections in the womb that result in developmental damage to the infant. So, decreasing vaccination rates will result in a greater incidence of developmentally disabled children.
Polio is gone in the United States (I can only address GBS v polio by stating, like the earth being round, that polio is caused by the poliovirus, and that GBS is not). I recently looked up the stats on polio in India. As of February 214, there have been three full years without a single case of polio. In 1985, when India started its Universal Immunization Program, there were 200,000 incidents of polio every year. It is an amazing success story.
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I had a childhood friend who died of the chicken pox. She caught chicken pox around age 2-3, and it spread to her brain. She was in a vegetative state for about 27 years, and died of pneumonia a few years ago. She was 30.
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Vaccines prevent diseases. They prevent diseases not only in your child, but in the entire community. There is absolutely no evidence that vaccines cause autism. The rise in the rate of autism is entirely due to the increased diagnosis of lighter varieties of autism. I’m really surprised that this needs to be said. But let’s just state these facts plainly.
If a person choses not to vaccinate their child, they not only put their particular kids at risk for whooping cough, but they put the entire community at risk. These decisions are not private. They have impact on the entire community.
Several years ago, Ian and Steve got whooping cough. It was brutal. They had both been immunized. They became sick, because others have chosen not to get the shot. (Steve worked on a floor with a lot of guys from Britain. They don’t always get immunized for the whooping cough.) For vaccines to work, everybody has to have them.
This study shows the limits of talking plainly and pointing to well conducted research. So, I know that this comment is useless. I’m not going to convince anyone to change their minds.
There are alternatives: 1) Meet the anti-vaxxers half way. Change the schedule of shots, so kids don’t have to get three or four in one trip. 2) Go all out and put grusome ads on TV all the time. 3) Penalties, like a $100 fine or something.
Taking a step back, what makes me so sad about this case is how so many people bought this half-baked theory from a quack in Texas. I like to think that people are rational.
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I wouldn’t be so quick to blame the British. It was fairly recently learned that the vaccine for whooping cough works for a much shorter period of time than was previously thought. Basically every adult and most older school kids were insufficiently immunized. They put it in with the tetanus booster when they realized this, but it wasn’t until 2005 and lots of people aren’t very good about keeping it current.
(I looked this up recently because the high school down the street from me has an outbreak.)
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My understanding was that they were aware of its short period of effectiveness, but until they developed the newer version, its side effects made its benefits marginal for healthy adults.
(Another way to keep anti-vaxers from hearing your message: blame them for disease outbreaks that most likely did not originate with them.)
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Who was blaming anybody (except the British)?
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Even though I know it is probably an sound approach to treat anti-vaxxers with kid gloves I really don’t care if their feelings get hurt as part of this argument. This is a group made up of primarily white, often UMC, and frequently educated people. If they want to make decisions that put others people’s lives at risk (because, duh, why should they care, they don’t even know anyone with measles and the lives’ of brown folks here and in other countries matter naught to them) then they should be prepared to get absolutely, completely, verbally assaulted at every turn by the staggering tower of evidence that would crush them if not for the strength of their isolated bubbles of privilege.
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That’s legit, but if your goal is to get them to vaccinate their kids, it’s a poor method.
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“‘I can’t hear you over the weight of scientific evidence.”
–John Oliver
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Actually, public shaming might be the only way to get through to anti-vaxxers. This study showed the polite discourse and rational scientific arguments does not change behavrior. So, Scantee should keep it up.
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I thought the question was “can we change misperceptions?” Maybe addressing the common arguments I listed above and those others have mentioned, especially a reasonable mistrust of the medical community based on terrible experiences with doctors failing to acknowledge their kids’ challenges, would help. There’s a good amount of shaming out there already, which doesn’t seem to help.
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The evidence on trying to address point by point misconceptions of highly technical matter in order to convince people out of their biases (i.e. statistics and its role in separating the effect of better health care and vaccines on improving human health, as an example) is not awfully good, either. Among other things, the point by point objections are constantly shifting. I followed the debate following Wakefield’s research carefully (developmental damage following environmental insult was the main interest of my lab neighbor) and one facet of the work was the constantly changing hypothesis trying to maintain the connection between the vaccine and autism, mercury, thimerosol, gastrointestinal reactions, . . . . it was a constantly shifting theory, and thus a hydra to refute.
Furthermore, there’s some evidence that continued point/point refutation actually gives publicity to the non-scientific idea (most recently debated in the science lists after the Nye/Intelligent Design debate). So, I believe, first, that there are plenty of point by point refutations (the hyperbole example you give, is, in fact, addressed in the backlash example Laura gave) and they remain unconvincing to most ideological anti-vaccers.
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Also, we can certainly test the effect of shaming — “plenty of” is not really a scientific test. Most obviously, shaming comes out in the form of people stating that they think not vaccinating your children is anti-social behavior.
I also believe that it is rational to go further and impose limits on social participation of those who are unvaccinated for without a verifiable medical justification. A pediatrician talked about whether he would stop treating children who hadn’t had their vaccinations in his practice because of the hazard of spreading communicable diseases in his waiting room. Making it harder to remain unvaccinated will increase the number of vaccinated folks. When the religious exemptions were expanded into “belief” exemptions, we saw a much larger group of people take up the option to stop vaccinating (this coincided with the growth of the movement, but it might have not been independent of it). Making it harder again will help.
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Yes, I can see how point by point refutations could fail for those reasons. I can envision a lot of people changing their mind if they didn’t mistrust medical professionals though. They’re often not anti-science… they just don’t believe that the medical community is asking the right questions, and given the incredibly common experience of not having personal medical concerns taken seriously, it’s not entirely unreasonable. So competent doctors with better bedside manner could make a huge difference… and wouldn’t that be nice!
(I vaccinated my own kids by the way, except for chicken pox which they contracted naturally.)
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They’re often not anti-science… they just don’t believe that the medical community is asking the right questions
I asked this above once before, but I still don’t understand. What is an example of the right question? And what does an “unskewed” mean in a research study?
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What I find alarming is that two people your family of four–who were both vaccinated–came down with whopping cough when you think they were exposed.
There can be explanations: British superbugs? the wearing off of immunity?– but, something is not working the way it’s supposed to.
Clearly the vaccination did not do what it was intended to do: it didn’t protect either your husband or son from being infected against getting the disease.
I’m a dutifully vaccinated citizen, with dutifully vaccinated children (but just one shot per visit!), but this supports questioning the system.
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It really doesn’t. The pertussis story is complicated, but it does not provide evidence for not vaccinating. There is a thorough review (and point by point answers to the question “british superbugs? wearing off of immunity? something not working the way it’s supposed to?” at the CDC site:
http://www.cdc.gov/pertussis/about/faqs.html
The answer to British superbugs is “no”: “We often see people blaming pertussis outbreaks on people coming to the US from other counties. This is not the case”
The answer to wearing off of immunity is “yes”: Attenuated virus seems to provide less longer lasting protection. They’ve changed the virus and think immunity will last longer now. But, the vaccine does not confer perfect immunity.
Something not working the way it’s supposed to? Well, that’s a complicated question, because, it depends on “supposed to.” If we mean lifetime immunity, or eradication, we apparently have never had that for pertussis, and we are not there yet. It is also the case that researchers did not realize the timecourse over which immunity would decrease.
I think the conclusion I’m coming to is that if you cannot or feel you cannot trust the experts, my expectation is a high level of understanding off vaccines, immunology, statistics, . . . .
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I blame British people for ruining Gwyneth Paltrow’s sense of self-restraint.. She seemed relatively normal before moving there.
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PS: I try hard to provide point by point refutation, but at some point, the points I’m asked to refute start sounding like a two year old saying “why” in answer to every question. At first, you think you’re having a conversation, and answering the questions, but, eventually, you realize you are engaged in a fruitless task.
Say, for example, I could try to answer the question of why anti-vaccers may have developed a spurious (presumably internet driven) conflation of GBS and polio from brief perusals of articles on the internet. But, it would be hard, and, I fear, not of greatly useful value.
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Shame is good. And how about a fee – maybe $8000 non-vaccinated fee for attending public school? Money to be given to the department of public health of the state.
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Why no HPV vaccine? Upwards of 67% of people have contacted HPV. http://www.philly.com/philly/health/HealthDay687984_20140520_Two-Thirds_of_U_S__Adults_May_Carry_HPV.html
Even if boys aren’t vaccinated why wouldn’t you do this for your daughter?
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Tangentially related: what do anti vaxers think about the latest study that shows autism develops in utero first/second trimester? http://www.npr.org/blogs/health/2014/03/26/294446735/brain-changes-suggest-autism-starts-in-the-womb
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I haven’t seen this myself, but apparently some mothers will blame the fact that they themselves were vaccinated for their unvaccinated children’s autism.
That’s a really deep rabbit hole.
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Macaroni – we had our guys get HPV vaccine. Several reasons: we assume they are hets, but who can tell? Anyway, even if primarily het, if either of them has a fling and gives some guy a blow job, or has anal sex, this can come back to haunt them with oral or anal cancer when they are 45-60 or so. And in addition, it makes them less likely to pass it on to some young women or their wives and blight their prospects.
We have carefully explained (‘dont be silly, wrap your willy’) that the vaccine does NOT protect against all strains of HPV, and (‘only a fool doesnt cover his tool’) that they should not alter their behavior in a less prudent direction – but it still seems important both from a personal and public health point of view.
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Actually, public shaming might be the only way to get through to anti-vaxxers.
I don’t think so. Look, it’s as if the anti-vaxxers and the vaxxers are two different religions.
You believe that vaccines protect against a host of illnesses. Given the nature of the immune system, you really are taking this on faith. You can’t point to a cure, because vaccines are prophylactic measures. You have faith in doctors, researchers, and pharmaceutical companies.
Anti-vaxxers don’t. They do not have faith in any of those things. They have faith that vaccines cause harm. Ironically (although I believe they are mistaken), a certain number of children will fall ill in some way after receiving a vaccine, just because some people will get sick in some way after any point in time no matter what. Every child who breaks out in hives some time after a vaccine is (for them) proof. It reinforces their faith.
I wouldn’t expect pamphlets to change anti-vaxxers’ minds at all, any more than I’d expect a treatise from a gathering of American Catholic Bishops to change Mormons’ minds on any point of faith.
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The fuck?
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Sorry. Anyway, there’s simply no way to square what you have written there with what other people arguing the anti-vaccination side about not being anti-science.
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They’re Romantics. They are anti-science, which does align well with the whole organic/natural/anti-industrial spirit of distinct subsets of our population.
However, there’s a big difference between partially and fully refusing to vaccinate.
A relative by marriage is homeschooling. Her children are not vaccinated. She is vegan. She and her husband planned a water birth (don’t know if they went through with it.) She probably practices other ways to refuse modernity. She is anti-science, in that she does not accept nor live by the tenets of modern science. When I talk with her, it becomes clear she’s working from a different set of beliefs. (I have not inquired whether she believes the sun is the center of the solar system. However, someone gives really funny answers to surveys. A lot of someones. http://blogs.ajc.com/news-to-me/2014/02/24/many-in-u-s-think-earth-the-center-of-solar-system/)
The state could force her to vaccinate by refusing to allow homeschooling without vaccinations. I do wonder to what degree the rise in homeschooling has been fostered by parents who do not want to vaccinate.
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There are going to be hardcore advocates for anything — the only solution for the rest of society (for vaccinations) is to isolate them as much as possible. On the other hand, there are casual believers who chose the path because it’s easy and not because they are truly committed. Those people’s views, we may be able to by working hard to build trust, answering questions, and, yes, making it clear that the anti-vaccination position is socially unacceptable, one that will result in your isolation from much of the rest of society (starting with school, and continuing to other public places).
How to protect the children of the hard core? That’s a tougher question, but, maybe, social isolation will help, rather than hinder (unlike, say, in the case of those hardcore enthusiasts who wish to keep their children uneducated and intolerant).
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How to protect the children of the hard core?
As a society, I assume we have developed an answer to this. If for no other reason, the Juggalos must present this problem all the time. Faygo is very poor birth control.
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she does not accept nor live by the tenets of modern science.
It’s not as if there is one world in which the laws of nature and man are governed by the tenets of modern science and another governed by a separate set of dirty hippie laws. We all live in the same god damned world, including this lady, and she lives just as much by the tenets of modern science just as anyone. And you can be sure that when one of her children gets really sick she’s as accepting of modern science as anyone.
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I’m sympathetic to, for example, letting Quakers out of the draft. I’m a little less sympathetic to letting Amish pull their kids out of school after 8th grade, because that just closes off modern life for those kids. I’m less sympathetic, but not wholly unsympathetic, to antivaxxers, who I see as nutballs who put the rest of us at risk, but also people who believe what they are doing is right for their kids and helps their kids’ safety. Where do you draw the line on things which put children at risk? Christian Scientists who refuse treatment for their kids? Folks who are against transfusions? I think there is some kind of a sliding scale depending on how much they are harming the rest of the community, how much the harm is to their kids, not themselves, and the intensity of their beliefs. Damned if I can line it out precisely, though.
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A friend of mine is a doctor in Canada. He tells me that their solution to the problem of the child of Christian scientists who needs a life saving transfusion is to call it malpractice. And then award nominal damages of I think $100 for the ‘error’. That is to say as a society we are willing to say the doctor is wrong to ignore the wishes of the parents, but we’re not willing to do much beyond acknowledge a technical wrong.
I find that solution to that problem fairly appealing.
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One of my best mentors died last year at this time from a blood cancer caused by aggressive treatment for an aggressive cervical cancer over 10 years ago. My sons will get it not just for their own health but in the hopes that it prevents them from having to watch their partners die of a fairly preventable cancer.
For anti-vax, they are anti-science until their kids get really sick or break something and then they are all for it. Which is as it should be. I personally think the long-term solution is better science education in general.
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Mayim Bialik has had a pretty good science education (a doctorate in neuroscience). How much more science education did she need to convince her that vaccinating is a good idea?
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She apparently does some vaccines but claims that in the past we were vaccinated 25% less than we are now. Yet she doesn’t see the logic of why that is: we have learned more and are applying our medical knowledge more. In 1960, people got 100% more polio vaccines than their parents had gotten 25 years earlier. DUH.
I do appreciate her saying that AP and anti-vax have nothing to do with each other. I consider myself moderately AP and vehemently pro-vax, even though I got the flu this spring after having had a flu shot in the fall (possibly different strains–I didn’t have the actual test to confirm).
It is very weird to me to see these people I agree with on so many issues be so incredibly wrong-headed regarding vaccinations. I mean, I have a healthy and warranted skepticism of medical professionals. I chose midwives over ob-gyns because I didn’t want to be manipulated into an unnecessary c-section. I don’t think homebirths are inherently dangerous. I resisted going on BP meds until I had tried everything else and had thought about it for a few years. But vaccination is such an obvious choice and has done so much obvious good.
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Btw, there’s some sort of math error/wording issue in my reply, but I’m not fixing it now. Must go make food for Memorial Day BBQ.
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That’s true. I get so enraged by her I have to consider her an outlier.
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JennG said:
“I get so enraged by her I have to consider her an outlier.”
My take on this is that smart is area specific. Being actually well-informed in one area may just make you over-confident in another area.
Wendy said:
“It is very weird to me to see these people I agree with on so many issues be so incredibly wrong-headed regarding vaccinations. I mean, I have a healthy and warranted skepticism of medical professionals. I chose midwives over ob-gyns because I didn’t want to be manipulated into an unnecessary c-section. I don’t think homebirths are inherently dangerous. I resisted going on BP meds until I had tried everything else and had thought about it for a few years. But vaccination is such an obvious choice and has done so much obvious good.”
The connecting theme is resistance to conventional medicine and public health standards. It’s just that some people go WAY further than you do–going to great lengths to procure unpasteurized milk, concocting dubious homemade formula for babies from internet recipes, trying to outwit the Group B Strep test for pregnant ladies with garlic vaginal suppositories, doing herbal hormone therapies, etc.
I hang out at the Skeptical OB where there are a lot of discussions of these issues, and much of it just seems to boil down to knee-jerk sticking it to the man.
Or maybe it’s just a misapplication of a passion for DIY.
The culture is definitely a very powerful force and it tends to affect people who aren’t actually that deep in the woo.
A friend of mine (a very sensible person) had a funny/sad/potentially catastrophic brush with alternative health care a couple months ago. Her family had an outbreak of what seemed to be stomach flu, which came right in the midst of job interview time for her husband, which was awful. Well, on reflection, it became clear that the problem was that she’d accidentally ODed the whole family on probiotics. You know–the stuff that all the cool kids are taking now.
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I knew a vegan who was having all sort of medical problems (migraines, hair loss, etc.). Finally, she found a doctor who ordered her to eat a chicken breast once a week. Her headaches went away, her hair grew back, and she started dating a German guy.
[I realize it is very possible to eat a healthy diet while being vegan. Just that this particular women could not eat that way.]
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An interesting perspective from an experienced doctor: http://www.sciencebasedmedicine.org/danger-zones-of-parental-vaccine-refusal/.
The parents refusing vaccines are educated. They are privileged. They don’t trust authority. Unlike smoking, you can’t tell at a glance who vaccinates and who doesn’t.
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So – MH – you think if she’d taken to pork chops she coulda maybe attracted the attentions of a Norwegian?
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Pickled herring maybe?
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@Scantee, And you can be sure that when one of her children gets really sick she’s as accepting of modern science as anyone.
Not necessarily. There are many examples of Christian Science (and offshoots thereof) parents with a record of multiple children harmed by a refusal to use modern medicine.
Google “Zachery Swezey” for an example of parents who refused to call for medical help while their child died. Also, search for Herbert and Catherine Schaible, who were on probation for the death of one child, Kent, when the other child died.
Many, many examples of families with multiple, serial child deaths and serious illness:
http://www.sciencebasedmedicine.org/faith-healing-religious-freedom-vs-child-protection/
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http://www.washingtonpost.com/blogs/wonkblog/wp/2014/05/16/outbreaks-of-disease-may-not-boost-vaccination-rates-heres-why/
Wolf and colleagues had predicted that a lot more infants statewide would be up-to-date after the outbreak. But to their surprise, the proportion of infants who were up-to-date increased only 2.1 percentage points, from 67.4 to 69.5 percent. That change, the researchers said, was too small from a statistical standpoint for them to conclude that more infants were up-to-date post-epidemic. What do the findings tell us? “This finding may challenge the assumption that vaccine acceptance uniformly increases when risk of disease is high,” Wolf said in a statement.
The internet may be promulgating fear of vaccines faster than the fear of epidemics.
This is one case in which (in my opinion) privacy laws are counter-productive. The anti-vax people have parents (mistakenly) publicly stating their child was harmed by a vaccine. The pro-vaccination doctors are bound by HIPPA. They can’t publicly name children harmed by vaccines. The internet can be used as a marketing medium. Stories, names and faces “sell” better than statistics.
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