Respectful Insolence

Framing vaccines again

NOTE: This post, which is related to a discussion of Dr. Paul Offit’s Book Autism’s False Prophets, originally appeared over at The ScienceBlogs Book Club. However, now that the book club for this particular book has concluded, I am free to repost it here for those who may not have seen it and to archive it as one of my own posts. Besides, I know the antivaxers are more likely to see it here…

One of the major points made by Dr. Offit in Autism’s False Prophets is how badly the media deals with scientific issues and stories in which science is a major component. Indeed, he devotes two full chapters, Science and the Media and Science and Society, to a lament that pseudoscience such as antivaccine fearmongering is so easily promoted by the media and accepted by large numbers in American society. He lists a lot of the usual culprits, such as a poor understanding of science by the vast majority of Americans. Of course, there is also the false “balance” given antivaccine cranks in the media, which follows the journalistic mantra of “tell both sides,” not understanding such a tactic produces a false equivalence of the two when applied to issues of science versus pseudoscience and produces the impression that there is a real scientific controversy when there is not. (Indeed, this is so common that a term has been coined for it “manufactroversy,” which is short for “manufactured controversy”; a better description of the antivaccine reality distortion field would be hard to find.) Another excellent point is how the culture of science differs from that of the sound bite culture of media; scientists are often tentative and refuse to speak in absolutes, knowing the limitations of studies. We rarely say “never,” “always,” or “impossible.” So, when a reporter asks if vaccines cause autism, we almost always say something along the lines of, “studies thus far have found no link between vaccines and autism, rather than “vaccines don’t cause autism.” We do it because it’s more accurate and, as Dr. Offit points out, it’s impossible for science to completely prove a negative. The best we can do is estimate the probability, and the existing science is conclusive that there is very, very little chance that vaccines cause or contribute to autism. We can never say “zero” chance, but we can say the chance is vanishingly small. Unfortunately, that is perceived by the lay person as meaning that there’s still a chance. Finally, Dr. Offit even dares to go one place where I honestly didn’t expect him to go and mention the prevalence of religion and belief in the paranormal as contributing factors to the lack of critical thinking skills that allow the antivaccine dogma to flourish.

If only he hadn’t so approvingly quoted industry shills and all purpose denialists Steve Milloy and Michael Fumento, as I pointed out in my review on Wednesday, Autism’s False Prophets would have been near-perfect in hitting all the right notes on this issue.

One thing, however, I didn’t see so much in the book that I would have liked to see more of is how scientists and physicians could effectively counter the propaganda laid down by the likes of Jenny McCarthy and the movement of which she is currently the most famous member. For example, lately she’s been on CNN (as I described here, although unfortunately the video appears to have been removed), on The Oprah Winfrey Show, and all over the media promoting her book Mother Warriors: A Nation of Parents Healing Autism Against All Odds. Last year at exactly this time of year, she was promoting her previous book Louder Than Words: A Mother’s Journey in Healing Autism. Why is her message so effective, even though she is dumb as a rock when it comes to anything having to do with science and is so full of hubris that she thinks her Google education trumps expert knowledge and a wealth of solid epidemiological studies?

It’s her frame.


To recap for those who are new to ScienceBlogs thanks to the book club, two ScienceBloggers, Chris Mooney and Matthew Nisbet argued that scientists aren’t doing a very good job of communicating science issues to the public. On issues of importance that science impacts, such as global climate change and evolution education, they postulated, one strategy by which scientists could do a better job of communicating what science tells us about these issues and persuading the public of the validity of the science behind these controversial issues is to “frame” them better. As they said in their original article in Science:

In reality, citizens do not use the news media as scientists assume. Research shows that people are rarely well enough informed or motivated to weigh competing ideas and arguments. Faced with a daily torrent of news, citizens use their value predispositions (such as political or religious beliefs) as perceptual screens, selecting news outlets and Web sites whose outlooks match their own. Such screening reduces the choices of what to pay attention to and accept as valid.

Frames organize central ideas, defining a controversy to resonate with core values and assumptions. Frames pare down complex issues by giving some aspects greater emphasis. They allow citizens to rapidly identify why an issue matters, who might be responsible, and what should be done.

I was initially surprised when Nisbet and Mooney’s thesis provoked a great deal of hostility among some science bloggers, and not just members of the ScienceBlogs collective. I say “to my initial surprise” because, initially at least, the whole idea seemed so mind-numbingly obvious to me, as I explained in my usual verbose fashion in these two posts. Basically, I attibuted much of the conflict to a cultural divide between “pure” scientists and science teachers and practitioners of more applied science, such as physicians like me, the latter understanding that you have to find a way to simplify and communicate in a way that your audience understands. And so it was for many months that I remained puzzled by the extreme intensity of the debate, whose nastiness at times seemed to go far beyond the actual difference between the two camps. Before too long, the very mention of the word “framing” became all but certain to set certain members of the ScienceBlogs collective into rabid fits of vicious invective that leave rational discourse behind, inspiring Mooney and Nisbet to return fire in ways that did not bring glory upon them, to put it mildly.

Even so, at the risk of reigniting these wars, I think that the reason Jenny McCarthy, and by extension the rest of the rabid antivaccine movement, succeed is because they use a handful of very simple and persuasive frames. For example:

  1. Autism as vaccine injury. This frame has been so effective that, as has been pointed out, if you ask someone about autism these days almost inevitably vaccines are linked to it. It matters not one whit that there is no convincings scientific evidence that vaccines trigger autism and there’s a lot of evidence that they do not. Autism is now “vaccine injury.” It’s simple and, supported by anecdotes, seemingly compelling.
  2. Vaccination as an assault on personal freedom. This always resonates in the U.S., where vaccination is represented as the intrusion of the nigh-fascistic state into the affairs of families. This is very much of a piece with the “health freedom” movement that promotes quackery in the name of “freedom.”
  3. “Green Our Vaccines” and its variant, “We are not ‘antivaccine’; we’re pro-safe vaccine.” Wonderfully Orwellian in its twisting of language and arguably the most effective frame thus far used by antivaccinationists. They argue that vaccines are full of “toxins” (They’re not) and do the antivaccinationis version of the Gish Gallup whenever studies are published exonerating a vaccine ingredient in causing autism. When that happens, they just move on to move the goalposts. If it’s not mercury, then it must be the aluminum. If it’s not aluminum, it must be the formaldehyde. If it’s not the formaldehyde, it must be the antifreeze (never mind there’s no antifreeze in vaccines; they’re on a roll). And if it’s none of the above, it’s some undefined synergistic combination that demands that every ingredient be tested individually. Since there are so many “toxins” in vaccines, they must be “greened” before they’re safe. Of course, to the antivaccinationist, vaccines can never be “green” enough. Just ask one what, specifically, it would take for her to be convinced that the toxins are gone. What, specifically needs to be removed? You’ll get a vague and meaningless answer (like the one that Jenny McCarthy routinely gives) to get the “toxins” or “junk” out of the vaccines.
  4. Too many too soon. If it’s not a specific “toxin” or combination of toxins in the vaccines, then it must be the whole kit and kaboodle, the whole vaccination schedule! It’s “too many” antigens overloading the immune systems of infants, don’t you know! Dr. Offit has explained why this gambit is a load of hooey, scientifically speaking, but to the average lay person it sounds compelling. Why not delay vaccines? Why not space them out? Just in case? Oh, wait. It’s the precautionary principle again, as I discussed in my review of the book.

There are other frames, but those are clearly the Four Horsemen of the Vaccipocalypse that will, if unchecked, lead to suffering and death among children from vaccine-preventable diseases if unchecked.

One of the overarching topics of this my home blog, Respectful Insolence, since very early in its history has been combatting antivaccinationist lunacy and lies. Indeed, I was, as far as I can tell, the first person ever to point out what a cesspit of antivaccination propaganda The Huffington Post was right from its start. Resistance to vaccination and pseudoscientific misinformation every bit as ridiculous as any creationist nonsense appears to be growing, fueled by Generation Rescue, Jenny McCarthy, and the dedicated band of antivaccinationists who deny they’re antivaccinationists over at Age of Autism. It’s even progressed to the point of rallies on Washington, such as the recent “Green Our Vaccines” rally.

That is why I now ask everyone reading this post (and especially the pro-”framing” contingent) a question: How can we physicians and scientists deal with antivaccinationism? What “frames” can we use to combat the likes of Jenny McCarthy?

It’s a simple question. I would even argue that, in the short term at least, it’s a far more important problem than convincing the public of the validity of evolution or that we should do something to try to alleviate or reverse the effects of greenhouse gasses. The dire consequences of global climate change are far in the future, at least when compared to a human lifespan. None (or virtually none) of us will be alive 100 years from now, and most of us will be old or dead fifty years from now. It is not us, but our children, who will suffer if the models for global warming are correct, and it will be very difficult to evaluate end measures of effectiveness of “framing” in that length of time. In addition, the situation with antivaccine activism is very similar to the situation with creationism. The scientific consensus is that vaccines do not cause autism and are, as far as medical interventions go, incredibly safe, just as the scientific consensus supports the theory of evolution. Just like the situation with creationism, there is a hard-core contingent of antivaccine denialists who are loud, vocal, and probably unswayable, bolstered by ideology plus pseudoscience generated by a small cadre of “scientists” who have become convinced that for autism (and other disorders), it absolutely, positively has to be the vaccines. Finally, just like the situation with creationism there is the vast middle, Americans with little knowledge of science who hear the “charges” against vaccines and wonder if maybe, just maybe, the myths are true, making them hesitant to vaccinate their children. After all, the whole concept that there are “toxins” in vaccines sounds compelling to the average, scientifically untrained person, even though on a strictly medical and scientific basis it is not.

In contrast to the effect of ideologically motivated antiscience on evolution education or whether or not we as a society do anything to address global climate change, the ideologically-motivated antiscience known as antivaccinationism has a much more rapid deleterious effect. Thanks to fearmongering over vaccines, measles is already endemic again in the U.K., after previously having been conquered, while in the U.S. it is surging back as well, fueled by lower vaccination rates. If current trends continue, and antivaccine activists make good on an earlier promise of a “fall offensive” against the vaccination schedule, it won’t be long before other vaccine-preventable diseases start making a comeback as well.

If ever an effective framing strategy were needed to counter the Orwellian “green our vaccines” movement, the time is now. The question is: How? Whatever the frame, it has to be simple, scientifically supported, and able to resonate with typical parents. Hardcore antivaccine activists won’t be persuaded by any frame we can think of, but there are a lot of parents out there who aren’t hardcore antivaccinationists but have heard their rhetoric and are afraid of vaccines because of it. How do we reach them?

Come to think of it, this is an area that I really wish I had seen more of in Autism’s False Prophets. Dr. Offit does an excellent job of laying out the deficiencies in how vaccine science is communicated to the public today, deficiencies that leave a huge opening for antivaccine pseudoscience to permeate the national zeitgeist, but I’d really like to hear from him suggestions for frames or other strategies to counter it.

Comments

  1. #1 Phoenix Woman
    October 12, 2008

    For starters, I think you should put this up front and center:

    In contrast to the effect of ideologically motivated antiscience on evolution education or whether or not we as a society do anything to address global climate change, the ideologically-motivated antiscience known as antivaccinationism has a much more rapid deleterious effect. Thanks to fearmongering over vaccines, measles is already endemic again in the U.K., after previously having been conquered, while in the U.S. it is surging back as well, fueled by lower vaccination rates. If current trends continue, and antivaccine activists make good on an earlier promise of a “fall offensive” against the vaccination schedule, it won’t be long before other vaccine-preventable diseases start making a comeback as well.

    Emphasize, over and over again, that while there is not a single known and proven case of someone getting autism as a result of vaccination, there are thousands of cases of scarring, brain damage and even death in the past decade as a direct result of not getting vaccinated.

    Do visuals, too: Little children with measles, or in iron lungs, or other concrete images with power. (You’ll know they work when the antivaxers scream like vampires hit with holy water upon seeing them.)

  2. #2 Inquisitive Raven
    October 12, 2008

    Well, I think EpiWonk’s got a good approach. Inform people in visceral terms what kind of damage vaccine preventable diseases do. One thing the AJC piece lacked though was pictures. To really make the point, we’re gonna need pictures, and the more recent the better.

  3. #3 speedwell
    October 12, 2008

    It strikes me that the only possible “green” vaccine would be the old-fashioned one where you have the diseased patient in the same place as the patient being vaccinated, you draw the blood, centrifuge it by whirling the jar over your head in a circle (so as to avoid the use of problems related to the machinery and the power needed to run it), then drawing off the necessary portion and injecting it directly into the recipient’s body, undoubtedly along with the live disease organisms.

    Because that’s the natural, low-impact, close-to-Nature way. No disease organisms were harmed in the making of this vaccine. God’s plan is minimally thwarted. And so forth.

  4. #4 Ms. Clark
    October 12, 2008

    I’m not sure you need to draw blood to pass on most of the vaccine preventable diseases. You could take just a tiny bit of the feces of a person infected with polio or rotavirus and give it to them in something to eat or drink and they victim would get polio or rotavirus. I’m not sure how well that would work for infants, I would think that would be pretty risky, but then it would be quite “green” and not involve animals or anything, so long as you didn’t put the germs in some cheese or milk.

    For measles you could just swab the nose of the infected person and then wipe the inside of the nose of the uninfected one with the same swab, heck you could just walk into a room where a person with measles had sneezed an hour before and get measles (it’s highly infectious, so I understand). Diphtheria, I think you could do the nose swab thing, or maybe a throat swab.

    Catching the actual diseases is supposed to be healthier than getting the vaccines for them, so I guess this is one route, to making sure your kid gets all these diseases at an optimal time. I would think they’d have a high mortality rate, but only the good and worthwhile children would survive, most likely… according to the thinking of the antivaxers.

    I don’t know how they are going to manage the problem of HPV, I guess they’ll just pretend their kids can not get it.

  5. #5 DT
    October 13, 2008

    I don’t know how they are going to manage the problem of HPV, I guess they’ll just pretend their kids can not get it.

    On the contrary, I hear they are already arranging “HPV parties” for their adolescent kids, just so as they can get natural protection……

    PS – only joking, but I wouldn’t put something that malignantly stupid past any of them.

  6. #6 Laser Potato
    October 14, 2008

    “Do visuals, too: Little children with measles, or in iron lungs, or other concrete images with power. (You’ll know they work when the antivaxers scream like vampires hit with holy water upon seeing them.)”

    Do I get a magic alchemist’s whip and some leather armor too? Oh wait, I’m a girl, so I have to don a skimpy dress. On the plus side, I shoot doves and cats that are somehow more powerful than multiple tank rounds to the face!

    In all seriousness, though, this is what happened when I posted an image of an iron lung:
    —-
    Actually, Laser Potato, was this picture taken while the manufacturer was “studying the effects of the vaccine” or was the picture taken after mass vaccination?
    Posted by: Dawn | August 27, 2008 6:18 PM

    WOW! YOU LOSE!!! A quick trip to Wikipedia reveals…
    [The machine was invented by Philip Drinker and Louis Agassiz Shaw, of the Harvard School of Public Health, originally for treatment of coal gas poisoning.
    *** But it found its most famous use in the mid-1900s when victims of poliomyelitis (more commonly known as polio), stricken with paralysis (including of the diaphragm, the cone shaped muscle at the bottom of the rib-cage whose action controls intrathoracic pressure), became unable to breathe, and were placed in these steel chambers to survive.***]
    (emphasis added by me)
    Any /real/ questions?
    Posted by: Laser Potato | August 27, 2008 6:24 PM

    Oh yes, and…
    [Entire hospital wards were filled with rows of iron lungs at the height of the polio outbreaks of the 1940s and 50s. With the success of the worldwide polio vaccination programs which have virtually eradicated new cases of the disease, and the advent of modern ventilators that control breathing via the direct intubation of the airway, the use of the iron lung has sharply declined.]
    The iron lung became less and less necessary /because/ of the polio vaccine, in other words.
    *waits for Dawn to deflate like a sad balloon*
    Posted by: Laser Potato | August 27, 2008 6:28 PM

    —-
    Yes, I actually had to TELL HER what the iron lung was FOR. They really ARE that ignorant.

  7. #7 RideThePig
    October 15, 2008

    The whole ‘toxin’ thing is every bit as stupid as the organic food fad’s usage of the word ‘chemical’ in describing foods as ‘chemical-free’. I mean, come on, water is a chemical!

    If these people knew anything at all about chemistry they’d know that it’s not what the poison is but the dose. Why are these people so dense in understanding that?

  8. #8 thesedays
    November 30, 2008

    McCarthy, et. al. also believes that vaccines are part of a deliberate conspiracy to create a generation of disabled children. Interestingly, I have noticed that the really severely autistic people I hear and read about – the type who will probably be institutionalized before they hid double digits in age – almost always seem to have at least one physician parent. Why would anyone other than maybe a Mengele wannabe try to do that, to their own children or anyone else’s?

    BTW, even before the news broke about her publicity stunt – oops, allegedly autistic son – broke, there were reports that the REAL reason her marriage broke up, the main one anyway, was that she had numerous affairs with both men and women.