White Coat Underground

Author Chris Mooney has a provocative piece up at the Washington Post today. He argues that scientists are misunderstanding the dynamics of science-policy debates. Because, he argues, ideology often trumps scientific fact in the minds of the public, we (scientists) need to work harder to engage the public to win their hearts before we win their minds (please forgive me, Chris, if I didn’t get this quite spot on).

While I appreciate Chris’s general point—that we can’t just “fact” people into submission—I think some of his arguments beg for a more critical analysis. Point one, scientists are missing an important piece of data:

One the one hand, the nonscientists appear almost entirely impervious to scientific data that undermine their opinions and prone to arguing back with technical claims that are of dubious merit. In response, the scientists shake their heads and lament that if only the public weren’t so ignorant, these kinds of misunderstandings wouldn’t occur.

I’m not so sure Chris is right about this. Those of us who fight against the anti-vaccine movement have known for years that it behaves like a cult, making the members nearly impervious to reason. Many of us realize that the core of the anti-vaccine movement are not our primary audience. Our real audience is fellow activists (igniting the core) and those who have not committed themselves (nearly everyone). Chris’s argument is most valid when applied to this latter group who may or may not be turned off by the aggressive rhetoric of both sides.

But as Chris argues later, their minds may be more or less made up. They may choose a side based on their basic ideology rather than rational argument. If we can’t sway the cultists, and their ideologic fellow travelers are already spoken for, what are we doing?

We are also speaking to policy makers. The public health establishment is science-based but susceptible to politics. We are arguing for them to hold fast, not to bow to the vagaries of politics and ideology. And we are bringing our own inflamed base into the fight.

Chris argues—admirably—for a more democratic approach to swaying the public on scientific issues, giving as an example Canadian nuclear waste disposal. In Canada, the government has worked to involve the public and other interested parties.

In Canada, for instance, the national Nuclear Waste Management Organization spent three years listening to the public’s views about how to handle nuclear waste disposal and promised that no dump or repository would be sprung on a community without its consent. Throughout the process, even critics of waste storage efforts remained engaged and supportive of attempts to come up with the best possible solution.

There is a fundamental problem with science policy decisions. As a nation, we are a democracy, yet science is not. Not every community has the appropriate natural resources to serve as a nuclear waste repository. What happens when, as in Nevada, a good scientific choice is a bad political choice? Is the community really open to persuasion? And are anti-nuclear activists (who, as Mooney implies, are moved more by ideology than reason) really going to ever be persuaded that any site is adequate?

Those of us arguing for sound science policy are not ignorant of ideologies and of our own inabilities to sway true believers. We get that. But neither do most of us believe we can simply open up science policy to a vote. When the public “votes” that vaccines cause autism, what are we to do, halt proper vaccination until we can convince everyone, just to go through the same cycle in another few years?

This is a representative democracy. We must convince policy makers to isolate, as much as is possible, science policy decisions from the election cycle. And we must be loud advocates of sound science policy, realizing that we are fighting ideology. The more we isolate the Jenny McCarthy’s, the more our own voices will affect policy.

Comments

  1. #1 Skeptico
    June 27, 2010

    I note that Mooney’s only example of an approach that shows any “promise” as he puts it, is to do with discussing how to handle nuclear waste disposal. This is less of a purely factual or scientific discussion (since the waste has to be disposed of somehow) but more of a political one – ie where to dispose of it.  Mooney offers no solution for how to deal with the anti-vaccine loons or the global warming deniers. Experience suggests that these people are immune to reason and that initiatives to “engage” them “in a two-way conversation” just emboldens them. As you rightly point out, our real audience is the people who have yet to make up their minds.

  2. #2 feralboy12
    June 27, 2010

    May I be the first to suggest burying the anti-vaxers under a mountain in Nevada? I’m not sure what the half-life of stupidity is, but it should be safe for a few thousand years.

  3. #3 Hibob
    June 27, 2010

    Has Mooney ever explicitly addressed the Overton Window premise (that the most divergent viewpoints in a discussion act to define its center, and that you can move the center by promoting an even more divergent viewpoint on one side), or would talking about it just highlight his exploitation of “being the center”?

  4. #4 PalMD
    June 27, 2010

    I am not your research asst.

  5. #5 Ruth Seeley
    June 27, 2010

    Very interested in the Chris Mooney article, which I’ll read, but I have to challenge your statement that any nuclear waste depository that is not on site at an actual nuclear power plant where there are workers trained to deal with nuclear fuel and nuclear waster is a good idea scientifically. And I say that as someone who used to work for a nuclear power plant.

  6. #6 PalMD
    June 27, 2010

    I don’t think I said what you think I said.

  7. #7 Maria Droujkova
    June 27, 2010

    “When the public “votes” that vaccines cause autism, what are we to do, halt proper vaccination until we can convince everyone?..”

    I am lost in who is who here.

    Who is “the public”?
    Who are “we”?
    Who halts vaccinations?
    Who vaccinates?
    Who is “everyone”?

    You have five potentially different populations listed in this one sentence.

    For myself, and as a parent, I don’t care about “we,” “the public” and “everyone” or their opinions, as long as I am the one who vaccinates AND halts vaccinations for myself and my kid.

    For some of the reasons you just enumerated here, I don’t trust collective bodies to vote on my vaccinations or lack thereof. Suppose scientists push for central, government-mandated policies on vaccinations. Once mandatory policies are established as something “everybody” accepts, the next collective vote by “the public” or their representatives can change the content of policies 180 degrees, and precious little can done about it by any “us.”

  8. #8 Donna B.
    June 27, 2010

    OK… Mooney is way off base here. There are, according to my observations, several types of parents who are likely to not vaccinate their children:

    *parents of an autistic child who are convinced a vaccine caused the autism;

    *parents who are emotionally/intellectually susceptible to new age type woo and/or strange religions;

    *parents who do not understand the concepts of risk, causation, or correlation, and are frightened;

    *and finally parents who do not have a scientific clue about anything;

    *any possible combination of all the above.

    What Mooney is suggesting would simply add another category — those persuaded by political ideology. So far (at least in my observations) the “vaccine problem” seems to be bipartisan.

    And this:

    But once again, the [vaccine] skeptics aren’t simply ignorant people. If anything, they seem to be more voracious consumers of the relevant medical information than the nation as a whole.

    is just silly. Relevant medical information??? No, if they were consuming that (and understanding it), they would not be worried about vaccines.

  9. #9 PalMD
    June 27, 2010

    When it comes to public health, i have little tolerance for your “right” not to vaccinate, Maria.

  10. #10 ianam
    June 27, 2010

    But once again, the [vaccine] skeptics aren’t simply ignorant people. If anything, they seem to be more voracious consumers of the relevant medical information than the nation as a whole.

    Mooney is an idiot. This is like saying that Fox News watchers — who are more likely than average to have the false beliefs promulgated by Fox News — are voracious consumers of relevant news information.

  11. #11 Charles
    June 27, 2010

    Have you read “The genesis and development of a scientific fact” by Ludwik Fleck?

  12. #12 PalMD
    June 27, 2010

    meh.

  13. #13 Gurdur
    June 27, 2010

    PalMD, you wrote:

    “When it comes to public health, i have little tolerance for your “right” not to vaccinate, Maria.”

    But as Maria pointed out, the issue is trust. Now obviously many anti-vaxxers don’t properly understand the medical literature, but trying to shove it down their necks sideways only makes them more determined not to be bullied, as they see it.

    Fine, with some illnesses, the issue of a right not to vaccinate is problematical, or gets that way. But it is also very problematical to appear to be authoritarian before it even gets necessary.

    The issues of proper risk assessment, and a proper POV, i.e. not regarding vaccinations as some improper, unnatural substance, all need bigger informational campaigns; but the only way that will succeed in the very end is persuasion, not simply telling people “Doctor knows best” (even if it’s often true; truth is not a sufficient ground for simply commanding).

    You also wrote:

    “What happens when, as in Nevada, a good scientific choice is a bad political choice? Is the community really open to persuasion? …. But neither do most of us believe we can simply open up science policy to a vote.”

    But whether one likes it or not, it does eventually come down to democratic agreement. The people do decide in the end, and it really isn’t as if scientists or doctors never make mistakes, is it?

    Fine, it’s grueling, frustrating and dificult. Yes, isolating scientific/medical policy as much as possible from electoral cycles is a very good idea. But that can only be accomplised by getting broad bipartisan agreement across much of the political centre.

    You really don’t have any other effective choice.

  14. #14 Gaythia
    June 27, 2010

    Here’s a case here in Colorado where (due to a local outbreak of Meningitis) people are dying, the public interest in getting vaccinated is up, and the response of the local health authorities is don’t bother, hardly any chance you’ll get the disease, too expensive anyway:

    http://www.coloradoan.com/article/20100624/NEWS01/6240346/Interest-in-meningitis-vaccination-shoots-up

    From the article:
    “But even though there have been two deaths from the disease in Fort Collins and two other people remain hospitalized, the situation isn’t so dire that everyone should rush out to get vaccinated, said Adrienne LeBailly, director of the Larimer County Department of Public Health and Environment.

    “Individuals don’t need to do anything immediately for the most part,” she said. “We’ve already treated close contacts (of the affected hockey players) with antibiotics. People need to think at some point whether it’s worth the approximately $125 to be vaccinated versus the extremely low risk that they’ll ever get it.””
    _________

    And just how is a member of the public supposed to avoid concluding that the same sorts of advice would also apply to other vaccines?

    Can we conclude that vaccination policy legitimately has a middle ground and is not sharply divided into vaxers and antivaxers?

    Where’s the science?

  15. #15 Chris Mooney
    June 27, 2010

    Hey–
    I just wanted to let you know I saw this and appreciated it. I’m doing a post tomorrow on the responses I’ve received to the Post article, and hope to say more then.

    Also, the Post article is based in part upon a much longer paper for the American Academy of Arts and Sciences that releases Tuesday, so for those who are interested, please take a look for that as well.

  16. #16 PalMD
    June 27, 2010

    Looking forward to seeing it, Chris.

  17. #17 PalMD
    June 27, 2010

    Oh, and Gurdur, I’m not sure what your point is.

    The people do decide in the end, and it really isn’t as if scientists or doctors never make mistakes, is it?

    OK, I understand (but disagree) with Chris’s point that we are more likely to advance through dialog. I not only disagree with your above quote, but I also think it reveals a fundamental misunderstanding of almost everything important about the topic. The “SKIENZ WAS RONG ONCE!” argument is not an argument but a spittle filled oral ejaculation that has absolutely nothing useful to contribute to the debate.

  18. #18 DrugMonkey
    June 27, 2010

    The authority figures trying to shove it down my neck sideways that I must stop at red lights makes me all the more determined not to be bullied.

  19. #19 PalMD
    June 27, 2010

    I’m fairly certain that it was a particularly long-winded version of concern trolling.

  20. #20 Michael Ralston
    June 27, 2010

    Can we conclude that vaccination policy legitimately has a middle ground and is not sharply divided into vaxers and antivaxers?

    Sure! The problem is that the “legitimate middle ground” is still what gets one called a ‘vaxer’ by the antivaxers!

    There are plenty of vaccines that shouldn’t be given – smallpox is the most obvious example, since the disease is wiped out… and there are a number of others that are regional-only due to climactic or vector influences, so you should only get vaccinated against those if you’re going to be in that actual region.

    That is what the middle ground is. It is having trained professionals evaluate the risk against the reward and deciding which vaccines are indicated, and which vaccines are not indicated. Anything else is simply pandering to ignorance.

  21. #21 Gaythia
    June 27, 2010

    I think that the way to isolate the extreme antivaxers described in #20 above is for the medical professionals to recognize that questions by patients are usually legitimate. New parents probably don’t pay attention to childhood vaccine issues until they have a baby of their own. Then merely hearing about such things as the supposed autism controversy may stir up fears, which need to be answered, no matter how tedious this seems to the pediatrician.

    It seems to me that if one is concerned about control of contagious disease by vaccination, one would want to analyze whether or not anti-science attitudes are actually to blame. The community wide, large scale, vaccination programs that were a feature of my childhood no longer exist. Access may be an issue.

    For example, deaths in California’s current whooping cough epidemic have been in Los Angeles, San Bernardino, Fresno and Stanislaus counties. See: http://www.mercurynews.com/ci_15358915?IADID=Search-www.mercurynews.com-www.mercurynews.com&nclick_check=1 I think it would be interesting to study this in more detail. Is it access to clinics for children? Presence of adults who came from countries where they were never immunized? Some other factor?

    Maybe the source of the vaccine problem really lies in the poor support in this country of a comprehensive public health program. Such a program would necessarily include health science education, but that may not be the only significant factor in disease prevention.

  22. #22 Michael Lisieski
    June 27, 2010

    It is very important to the function of western social systems that we allow individuals to control their bodies and the procedures that are done to them to the greatest extent possible (provided it doesn’t unduly endanger other people.) It’s hard, when a group like the anti-vax movement is so wrong about something, to step back and remember that, until we give some state-run medical organization authoritarian power, that they have a right to be wrong.

    That said, I think the best way to fight a group like that is to disseminate good and persuasive information without attempting to engage the radical movement in dialogue directly – doing so simply legitimizes their views.

    For example, we (being, presumably, anti-racist in our politics) don’t go out of our way to engage advocates of white power in public discussions of racial politics, because that would be tacitly saying that they might be right.

  23. #23 Mike Lisieski
    June 28, 2010

    Sorry about that geographic slur. “Western” was not the word I meant to use – “democratic” is. I had begun to type a sentence about eugenics in the history of western politics, changed it, and didn’t catch that.

    Man, that’s embarrassing.

  24. #24 momma
    June 28, 2010

    @ 8, i must take exception, if not offense, at your assumptions about me, a parent who was not intending to vaccinate. i’m well educated, including 8 out of my 12 years of university in science. i do in fact have a clue, i understand correlation and causation, and i’m not even a church goer, much less a zealot of any kind.

    in fact, i am a skeptic. i am skeptical of research project after research project that i have seen that either gets the results the funders are looking for or gets buried. i am skeptical of the sugar industry sponsoring a study that says sugar is good for you. i am skeptical of the motivation of scientists, researchers, and health professionals, because i am each of these things, for my job. we are not saints and we screw up all the time.

    sure, some of the autism community has gone way off the deep end. but in 1998 when wakers published, we were desperate for research that said anything at all might be the cause. we still do not know the cause of autism. if you said that it might, even remotely might, be caused by wearing the colour black, i would cease doing so immediately. autism may not be death and drama as it is now painted by that group, but it’s a lot of work, for the people and families living with it, to function in a society that is not autistic.

    frightened is the word. i have never been so frightened as when i held my baby in my arms and realized that the world is a dangerous place and i am here to protect her. it is hard to be reasonable in such moments. i’d do anything to make a better life for her.

    however, i did in fact remember that i was a scientist, and looked up a few things and was able to change my mind based on evidence and commentary that i considered plausible and credible. nope, sorry, not u. google. google scholar and pub med. and palmd and gorski. i believe that i am/was some of their target audience.

    my daughter got her MMR, pneumococcal 13, meningococcal, and varicella on thursday. i am certain that i made the best decision for her, and for her neighbors and peers. thanks to the science bloggers for helping out a tired, busy, educated, and good mom.

  25. #25 Chris
    June 28, 2010

    momma:

    if you said that it might, even remotely might, be caused by wearing the colour black, i would cease doing so immediately.

    Even on the basis of a case series of just twelve kids?

    While ignoring the several studies between 1998 and 2004 that showed to correlation?

    At least you have finally become convinced of the science.

  26. #26 Chris
    June 28, 2010

    Aaagh! I hate seeing typos just as I hit “post.” It is supposed to say “showed no correlation.”

    (And as a side note: for someone who claims to be educated in science, you are too easily swayed by flimsy evidence. It is good to have an open mind, but not so open your brains fall out.

    Take note: I say this as a parent of a child with a seizure disorder who was denied protection from pertussis while our county had a pertussis epidemic (thanks to Barbara Loe Fisher/Arthur!). I knew very well that his first year of life depended on being away from anyone who had a cough, and I did ask about the vaccine status of every child he came into contact with. Count yourself lucky that you never had to worry that your child would actually stop breathing due to someone else not vaccinating.

  27. #27 CJF
    June 28, 2010

    @21, I think you’re on to something. According to the CDC, access is an issue in vaccination coverage.

    Coverage estimates were lower for children living below poverty compared with those living at or above poverty for the 4:3:1:3:3:1 series and for most vaccines; coverage was lower by 7–9 percentage points for ≥4 doses of DTaP and PCV7 (Table 3). National coverage with ≥3 doses of Hib declined significantly compared with 2007 for children living below poverty (-3.1 percentage points), whereas coverage did not decline significantly for children living at or above poverty (-0.9 percentage points).

    –snip–

    A significant gap in coverage persists between children who live in poverty and those who do not. This difference suggests that barriers to accessing preventive health care among children living below poverty, such as the underinsured or uninsured, are not fully addressed by programs already in place, such as the Vaccines for Children Program,§§ which covers only the cost of the vaccine. Out-of-pocket costs, such as costs of vaccine administration, well-child visits, transportation, lost time from work, or other locally identified barriers must be addressed to raise coverage among all children who live in poverty (4).

    National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2008

    I found this statistic very surprising:

    The percentage of children receiving no vaccinations by age 19–35 months remained at 0.6%.

    Unfortunately, because of the current state of the economy, we’re seeing cutbacks to government programs that increase access to vaccines coupled with more families slipping into poverty. This will likely lead to decreases in vaccination coverage. I’m not very hopeful that there will be many resources devoted to addressing this problem in the near future and that worries me a lot.

  28. #28 Birger Johansson
    June 28, 2010

    A couple of months back, Science had an article about how certain parts of the public are distrustful of science and how it correlated to political beliefs. the article also had ideas about how to overcome this problem, but it is too complex to write a summary here.

  29. #29 Mary
    June 28, 2010

    I attended a CDC workshop on H1N1 this past year. I recounted it here. There were very few “on the fence” folks in this room. The crank bat-signal had gone out, and the room was full of anti-vaxxers and conspiracy theorists. When the opened the floor for questions, it was like hearing an anti-vax blog screed–it was all the fallacies and CT you know well, I’m sure.

    The public health people thanked me for showing up. They need our support. They are being flooded by cranks. This is why we do this.

    The CDC was trying. But the process was totally corrupted by cranks. Those are the kind of networks this draws.

  30. #31 Gaythia
    June 28, 2010

    @29 I think that H1N1 would be an interesting study of access from a different angle on economic forces than that I discussed in #21 above.

    Initially, people my age were told that they were too low a priority to get this vaccine. It seemed that you either needed to be younger, older, or employed by a major Wall Street financial firm. Later, when the rationale for getting this vaccine seemed less obvious to many members of the public, and the vaccine was in oversupply, advertising targeted at my age demographic expanded. And were mostly ignored. This is only tangentially related to science.

    Antivaxer cranks may have tried to get their moments of press coverage, but really, in this case, I don’t think that they influenced the public all that much.

    The political and policy issues involved would have to do with how a society can ramp up just in case there is a serious health issue, and cope with cases such as this (so far) where fears of a health crisis were not realized.

  31. #32 Maria Droujkova
    June 28, 2010

    PalMD writes, “When it comes to public health, i have little tolerance for your “right” not to vaccinate, Maria.”

    This expresses the conflict of interest I am pointing out quite nicely. When it comes to my health and the health of my child, I have very little tolerance for any group’s “right” to hurt us for the sake of their goals.

    For example, I propose the addition of the following to #8′s list of parents who don’t want to vaccinate:

    - parents who did the math and determined that their personal mathematical expectation of harm is higher with vaccinating than without, given the current rates of infection for this disease in their community, the current scientific knowledge of side effects, and their personal behavior.

    Decisions to vaccinate or not do depend on a huge number of factors.

    The easiest factor to see is your geographic location. For example, travelers are often advised to do additional vaccinations, especially going to different continents or to less affluent communities and countries. National policies don’t necessarily consider these differences on the small enough scale.

    As an example of personal behaviors, consider breastfeeding. There are studies that show that some vaccines become less effective if administered during exclusive or predominant breastfeeding. This may weigh on a parent’s decision to postpone this particular vaccination until a later stage of breastfeeding, which may happen in the second or third year of the baby’s life.

    One could lobby for including these considerations into mandatory vaccination regulations, but there are literally hundreds of them. Moreover, new studies introduce new considerations every year, while legislation is a slower process. That’s why I advocate individual, disintermediated decision-making by families and their doctors, rather than “one size fits all” policies.

  32. #33 PalMD
    June 28, 2010

    Your argument would be more interesting with citations backing up your negative and positive assertions.

  33. #34 Maria Droujkova
    June 28, 2010

    Please note that two examples of individual considerations that I provided, breastfeeding and geographic location, are just examples. There are hundreds such considerations, for example, the seizure disorder Chris named in comment #26

    Citation examples:

    Recommended vaccinations change with geographic locations, by country, for travelers: http://wwwnc.cdc.gov/travel/content/vaccinations.aspx

    Comparisons of vaccination schedules, showing diversity among countries: http://scholar.google.com/scholar?hl=en&as_sdt=40000000000&q=vaccination+schedules+by+country

    Example of breast milk lowering vaccine efficiency: http://www.ncbi.nlm.nih.gov/pubmed/20442687

  34. #35 Vicki
    June 28, 2010

    The problem with Maria’s point 8 is that, doing the math, and given even a very low but nonzero risk factor, the right answer for each individual is to have everyone except her/himself be vaccinated. That doesn’t work globally, for obvious reasons, and I see no ethical reason why Parent A’s children rather than Parent B-Z’s should be the ones to benefit from herd immunity without themselves being vaccinated. (If Child Q has an immune problem and cannot safely be vaccinated, they’ll be protected by A-P and R-Z if and only if those children are vaccinated.) It’s like handicapped parking: there isn’t room for everyone to park right next to the entrance, so we reserve it for those with the greatest need.)

  35. #36 Diane-with-one-N
    June 28, 2010

    Maria, the problem with the math you propose is that the equations change with every decision not to vaccinate. Sure measles is still pretty rare in the US (though that is beginning to change), but with each unvaccinated child, the risk of measles coming back increases. So, if you and only you, make the decision not to vaccinate, then the math stays the same. But there are others like you, and they are also choosing the same thing. And then the diseases come back. Mumps, pertussis, measles. There are outbreaks happening more and more frequently thanks to folks who chose not to vaccinate. And that puts everyone at risk.

  36. #37 Mu
    June 28, 2010

    To me, this is all coming down to our continual denial of personal responsibility. The only way you can get away with “I’m not vaccinating, and screw herd immunity” is by denying that, if your unvaccinated kid becomes a vector for a measles outbreak, you’re responsible for the immune weakened victim with meningitis. Which meshes heavily with the a lot of the autism community in searching for “factors others than those related to parents” to alleviate them from any responsibility. In fact, they’re not even responsible for the kid anymore since it’s “lost”.

  37. #38 Maria Droujkova
    June 28, 2010

    #13 Gurdur wrote: “Truth is not a sufficient ground for simply commanding”

    #34 Vicki wrote: “Doing the math, and given even a very low but nonzero risk factor, the right answer for each individual is to have everyone except her/himself be vaccinated. That doesn’t work globally, for obvious reasons, and I see no ethical reason why Parent A’s children rather than Parent B-Z’s should be the ones to benefit from herd immunity without themselves being vaccinated.”

    #35 Diane-with-one-N wrote: “The equations change with every decision not to vaccinate. (and, I’d like to add, with every decision to vaccinate)

    I really like how these quotes acknowledge the conflict of interests between the individual and the group. This conflict changes with time. For example, some people now believe it’s safe not to vaccinate against smallpox, though the fact several untrustworthy governments keep it in their labs alarms others.

    Imagine, for example, populations balancing out their own vaccination rates through individual decisions. When more outbreaks happen, more people vaccinate, and when herd immunity kicks in, fewer people vaccinate.

    People with compromised immunity present a tough slippery slope here. Inaction can mean responsibility, but where does it stop? For example, many Westerners could cut their consumption by, say, $100 a month and sponsor parasite treatments and vaccine for some ten third world kids. If these kids die of easily preventable intestinal parasites, do we blame people who did not donate money for causing it?

    There are many safety decisions populations self-regulate, for example, food. There was an attempt during the French Revolution to mandate people’s diet (which they already, back then, recognized as a public health issue). Tissue and organ donation is another area: while people are not using their bodies past death, most don’t donate them and aren’t forced to, though it would provide a very real benefit to the community at large. Breastfeeding is not mandated, despite proven health risks of not doing it. It’s not clear to me at all where laws should interfere and where they should not.

    I think I am going all over the place with analogies here, so I better wrap up. It’s a fascinating public debate topic, and I appreciate the depth of the conversation happening here.

  38. #39 Donna B.
    June 28, 2010

    @24, Momma — I have no idea why you would be offended at my list in #8 since the rest of your comment explains why none of it applied to you. A parent who overcomes a somewhat irrational, but understandable, fear with education is not on the list.

    @32, Maria — no need to add to the list. Not understanding risk is already on there.

  39. #40 CJ
    June 28, 2010

    I am concerned that substantial substance is omitted in many discussions such as this one. I am troubled by nuance and I do not see us being able to address it. Two examples come to mind.
    Regarding nuclear waste disposal in NV, if I remember correctly, that site was politically designated to the exclusion of all other candidates. Science was then pressed into the service of politics to justify the suitability of the site.
    On vaccines it seems that the number of required or recommended vaccinations is growing exponentially. Risk assessment can easily be manipulated to serve the financial interests of pharmaceutical manufacturers. I can imagine 600 vaccinations to prevent the common cold.

  40. #41 PalMD
    June 28, 2010

    Well, it may “seem” that way to you, but the number of vaccines is not growing exponentially, and in fact the total number of antigens used is decreasing. But if it were growing, that would be a good thing, right? And who do you think is being manipulated? Do you really think every public health officer, every epidemiologist, every doc is that gullible?

    Or are you simply a concern troll?

  41. #42 Dianne
    June 29, 2010

    That’s why I advocate individual, disintermediated decision-making by families and their doctors, rather than “one size fits all” policies.

    Sigh. What makes you think that there is no individual decision making going on? No reasonable pediatrician will recommend vaccination if they believe it to be unsafe and/or ineffective for that particular child. Some children do indeed have contraindications to vaccination or vaccination with a particular vaccine. For example, a child who is immunosuppressed may become ill from a live vaccine and should not be vaccinated. A child with certain allegies may not tolerate other vaccines. This makes it all the more critical that children who are healthy and have no contraindications are vaccinated on schedule to prevent serious illness in those who can not be vaccinated (and, of course, in the proband child).

    Most people like anecdotes so I’ll give one as an example. A few years ago, I started the vaccination series for FSME, a tick borne disease. The first of three planned shots went fine, but after the second I had a fever to 40 degrees for about 24 hours after the vaccination. No other symptoms. Was it vaccine related? Probably, not definitely. So, if doctors were the non-individualizing profit driven types you posit, what would have happened next? The doctor would have said, “It’s nothing, probably not even related” and pushed me to accept the third 100 Euro vaccination. Instead, she suggested caution and foregoing the third vaccination (and her presumed profit from it.) In short, individualizing the care to the patient.

  42. #43 david ropeik
    June 29, 2010

    If I may, the discussion about vaccines and all the specific issues, and even the gulf between science and the public, misses a mountain of social science evidence that explains why people’s perceptions of fact are not always ‘factual’. This is not about science literacy. As Antonio D’Amasio’s work in “Descartes Error” showed, and much other evidence supports, the human animal uses an affective system to perceive the world…a combination of fact and feeling, cognition and intuition, reason and gut reaction, cortex and limbic system.
    Many of the strongest of these debates about whether the public “gets it” center around risk-related issues, and for good reason. Risk perception taps survival systems, which are sensitive and powerful and more emotion-based than reason-based. Forgive the self-promotion, but I have tried to bring the evidence on risk perception from various fields together in “How Risky Is It, Really? Why Our Fears Don’t Always Match the Facts”. With examples including vaccines, nukes climate change, and lots of other risk issues, it explains why our fears don’t match the facts, and WHY THEY NEVER WILL, at least at this point in human evolution

  43. #44 Gurdur
    July 6, 2010

    “Oh, and Gurdur, I’m not sure what your point is.”

    Oh, it’s really easy.
    1) Maria responded to your blog post
    2) You replied to her: “i have little tolerance for your “right” not to vaccinate, Maria.”
    3) I pointed out that in the end, except for cases of genuine urgency where the public good massively outweighs individual rights, then the case for vaccination has to be done by persuasion, on a democratic basis.
    4) You wrote in your blog post, “When the public “votes” that vaccines cause autism, what are we to do, halt proper vaccination until we can convince everyone …”.

    No. How about instead simply continuing to offer the vaccinations, getting federal and state governments onside as much as possible, and continually doing public education campaigns? It really does not need to be either 100% or 0%.

    Compulsion in vaccination can be counter-productive in the USA situation, and longterm education and persuasion is better, excepting of course truly urgent specific cases.

    5) You also wrote: “But neither do most of us believe we can simply open up science policy to a vote.”

    You don’t have much choice. At some stage, governmental policy relies on the vote, and as I pointed out to you before, and which you ignored, getting broad bipartisan agreement across much of the political center is important. As you said yourself, the USA is a representative democracy.

    6) You then replied to me:

    “OK, I understand (but disagree) with Chris’s point that we are more likely to advance through dialog. I not only disagree with your above quote, but I also think it reveals a fundamental misunderstanding of almost everything important about the topic.”

    Enlighten me then, please. I do try to learn. Where am I misunderstanding things? I did not advocate dialogue with committed anti-vaxxers, all I did was point out that dialogue with the general public, and educational campaigns, work out best in the long run, and compulsion can only really be used in extreme cases.

    7) You also wrote: “The “SKIENZ WAS RONG ONCE!” argument is not an argument but a spittle filled oral ejaculation that has absolutely nothing useful to contribute to the debate.”

    No, wrong, all it was was a gentle reminder that no one single body within can lay claim to any completely error-free history, and that therefore that is one reason (among others) why the public ultimately decides, even when at second hand through the government, and vaccination policy has to take that into account. It’s something you need to take into account.

    Now, please enlighten me as to where I misunderstood things in your opinion, because your claim of a “spittle filled oral ejaculation that has absolutely nothing useful” just failed to convince me of anything at all.

    And in case you are jumping to conclusions, I am all in favour of vaccinations.

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