On NPR's Science Friday today

I listened to that segment twice and it was a "damned if you do, damned if you don't" situation. They couldn't cut her off without playing into the paranoid fantasies of the anti-vaccine contingent. However, nothing they could say was going to sway Shantal (sp?) from her pre-conceived notions about vaccines. It was interesting to hear her points raised and addressed but they let her crankery dominate slighter more than 10 minutes out of a segment that was only about 18 minutes long. I think that time could have been better spent discussing the dangers that people like Shantal represent to their community - for the immunized as well as the non-immunized.

My take is that this is another case of people being incapable of understanding risk, comprehending it, or balancing it. Shantal and others are like squirrels crossing the street. They assume where they are is safe, and "crossing the street" cannot be countenanced unless they can be assured there is zero risk, they won't do it. This is the case of extreme examples dominating the typical, a long known problem, both in the positive case and in the negative. (Lottery winnings on the positive.) Also, they also see themselves as completely divorced from "the commons", that they owe nothing to the community, that they are individualists, whether in their personal property, in their opinion of public versus private schooling.

Folks like this are like some customers I've encountered, who want a probability of detection at 0.995 but have no notion of what that implies in terms of cost to establish that is it true, or what typical consequences are if that's pursued in isolation. They somehow think it's free to establish this.

This is simply lack of education and ignorance. Without education, a lot of things are driven by superstition; always have been.

As far as managing the caller goes, she was the prototype of a lot of people out there having these arguments. I think to educate, you need to engage. It's unfortunate that some of these other issues weren't covered in the time available, but unless they took a Sean Hannity or Rush Limbaugh approach to the caller and just cut her off, I don't see what else they could do.

I don't think you can ascribe it to any one cause that could be cured--i.e., you can't say "it's just the lousy state of education today" that would be solved by more education.

Science and medicine in general seem to have lost the trust of these people. We will likely lose more people as the number of unbelievers increase, just through the good old hegemony effect, "so many people can't be wrong."

Why and how we lost their trust is not so simple. Education is one factor certainly, but there are others. Another reason I've seen is that people who have minimal access to doctors, e.g. uninsured, underinsured and insured people who simply don't have many doctors available in their area, are not able to develop a strong enough relationship with the medical community in order to develop any trust. And I've seen that in people who are forced to switch doctors often, even when they are well-insured, they just never develop a strong relationship with the medical community that leads to a trusting relationship. Add in the people who have valid reasons to distrust doctors (malpractice victims, people who have been misdiagnosed for several years for whatever reason, people who have experienced discrimination or some other social injustice from medical staff, and all their friends, neighbors and relatives), and that's a lot of people who have an ax to grind with very little positive experience to counteract the negative ones.

Add to that a bunch of woo-meisters who are, in sharp contrast, pouring honey in the ears of folks like Chantal: They validate her negative feelings, spend time talking to her, make her feel understood, give her hope, empower her. So when we try to appeal to her reason, and then get angry with her ourselves for not being reasonable, it merely reinforces her negative perception and dis-empowers her. The key sentence from her was, "I don't believe that." She believes, she feels, she is basing her understandings on emotions. If we make an argument based on logic, we're going to lose, because this isn't about logic or reason, it's about emotion.

In an ideal world, there would be plenty of doctors and medical staff to go round, and they would all be perfect and ensure that everyone had a great experience every time they needed medical care, thereby earning the trust of the populace. In reality, we've got too many things working against that ideal. I would have liked to hear Dr. Offit understand Chantal's fundamental issue (i.e. that she's barking mad) and somehow deal with her emotional issues as a clinician rather than as a scientist, that might have been a better way to handle things, but that's tricky on the radio. It did seem like he got kinda angry, and I sympathize and understand why, but that wasn't a helpful response.

Under the circumstances, I don't see how Dr. Offit could have done much better with the caller.

At the outset, the caller impugned Dr. Offit's integrity by saying (without evidence) that he was making "millions of dollars" by coming on programs like this to promote vaccines. As Ira pressed her further, she virtually called Dr. Offit a liar, arguing that no evidence he could provide would change her mind.

Within the radio-caller framework, I really don't see how Dr. Offit could have done any better. Indeed, I thought he showed considerable restraint.