Nuance versus certainty: The disadvantage scientists and physicians have in communicating risk


This post, although it is about an interview with a CDC scientist named William W. Thompson that resulted from the whole “CDC whistleblower” manufactroversy that’s been flogged relentlessly for the last two weeks, since antivaccine “heros” Andrew Wakefield and Brian Hooker released a despicable race-bating video flogging Hooker’s utterly incompetent reanalysis of a ten year old study that had failed to find an association between autism diagnosis and age of first vaccination, is about a more general issue as well, an issue that can apply to discussions of just about any trumped up risk, not just vaccines. It also demonstrates why we in the scientific community will always be at a disadvantage when it comes to countering fear mongering, exaggeration of risk, and even making up risks that do not exist, you know, the sort of things that antivaccinationists, the Food Babe, and anti-GMO activists (among others) routinely do.

I’m referring, of course, to the recent interview between the first author of the study that Brian Hooker “reanalyzed,” Frank DeStefano, and antivaccine former CBS reporter turned “independent” investigative journalist. Remember Sharyl Attkisson? On this blog, we first met her seven years ago, when she posted on the CBS News website an article so full of antivaccine crankery that it gave RFK, Jr. a run for his money. Since then, Attkisson has been reliably antivaccine, flogging a horribly incompetent review article by Helen Ratajczak blaming autism on vaccines, being a conduit for intelligence about happenings at CBS for the antivaccine crank blog Age of Autism, sucking up to Andrew Wakefield, abusing the Hannah Poling case, and, just last year, hideously misreporting the murder of an autistic boy while promoting Andrew Wakefield’s Autism Media Channel without telling anyone that the AMC belongs to Andrew Wakefield as well as Polly Tommey, in essence lying by omission. Most recently, she’s resurrected a tragic case of a boy who died to try to link it to vaccines.

In other words, if you’re the CDC press office, she’s the last reporter you’d want to give access to CDC scientists to. After all, she’s not even affiliated with a major news organization anymore; so you don’t even risk pissing off CBS by not granting one of its reporters an interview. Now, given the feeding frenzy of utter crankitude that’s been going on since Wakefield compared DeStefano’s study to the Tuskegee syphilis experiment and the crimes of Hitler, Stalin, and Pol Pot all rolled into one, who would be the last journalist to whom you’d want to grant access? Yep, Sharyl Attkisson. Yet, grant Sharyl Attkisson access to Frank DeStefano they did.

In a certain way, you almost have to admire the ballsiness, if it weren’t for the concern that this was done more out of incompetence than anything else. What you don’t have to admire is how DeStefano appears to be ill-suited to be interviewed by a hostile journalist. Or maybe he didn’t know that this was a hostile journalist, although he should have been prepped beforehand. In any case, even though DeStefano didn’t sound too bad on the audio, Attkisson, in her transcript of the interview, includes every single “um,” “er,” “uh,” or other pause is included. In most transcripts, these sorts of normal pauses are left out, because they are unnecessary. It was clear that Attkisson wanted to make DeStefano look as bad as possible. In any case, DeStefano repeats the usual defense of his study, similar to the CDC response. There’s nothing new here. What inspired this entire post as a sterling example of why scientists are always at a disadvantage in the PR war with cranks comes from a second part of the exchange, which was trumpeted across antivaccine blogs and Twitter feeds right after Attkisson posted it yesterday under the headline CDC: “Possibility” that vaccines rarely trigger autism. Here’s the key part of Attkisson’s spreading of fear, uncertainty, and doubt:

A coauthor of the questioned study is Dr. Frank DeStefano, Director of the CDC Immunization Safety Office. In a telephone interview last week, DeStefano defended the study and reiterated the commonly accepted position that there’s no “causal” link between vaccines and autism.

But he acknowledged the prospect that vaccines might rarely trigger autism.

It is a significant admission from a leading health official at an agency that has worked for nearly 15 years to dispel the public of any notion of a tie between vaccines and autism. Vaccines are among the most heralded medical inventions of our time. Billions of people have been vaccinated worldwide, countless lives have been saved and debilitating injuries prevented. The possibility that vaccines may also partly be responsible for autism, in individual cases, is not something public health officials are typically eager to address.

And that, my friends, is why scientists dealing with cranks are at an extreme disadvantage. Scientists and the reality-based community recognize in DeStefano’s statement nothing more than scientific open-mindedness and caution, the recognition that there might in very rare cases be an association that suggests that vaccines might trigger autism. He’s being cautious, but it’s clear from the context that he doesn’t really believe vaccines cause autism. In fact, take a look at the interview in context:

Attkisson: What about secondary?

DeStefano: Sec—I don’t understand what do you mean “secondary”?

Attkisson: What about not “causal,” but “as a result of” vaccines, as in the Poling case? The medical expert found, you know, as a result of the damages she had from the vaccines, she ended up with autism. And the distinction was made in the medical expert, ‘well, that’s not ‘causal’, it’s sort of a ‘but for’ but it’s not a ‘causal.’

DeStefano: Yeah, I mean, I mean in that case, you know, she had a, I mean, you know, she had an underlying uh biological illness that uh either vaccination, or it could’ve been an infection that that would trigger some physiological stress in her, uh, seems to have, you know, could’ve, could’ve caused uh, um, manifestations that, characteristics of autism which, you, you know, appears to be what happened in her case.

Attkisson: But I mean doesn’t that, is—isn’t that a “link”? It’s not a “causal” link, but isn’t that a potential link between vaccination and autism if certain children with a “underyling biological illness” can have a “trigger” through vaccination?

DeStefano: [Unintell] as you call it, a secondary link if you wanna call it that way, w– in certain children, I mean ri—I mean, I, maybe that, but, you know, then I guess, that, that is a possibility.

Attkisson: Do you think that’s an important area of study so we could figure out which kids might have that predisposition?

DeStefano: uh, [phone noise] Yeah, I mean, I think um…You know, I think it’s something that, uh, well I mean, you know, in terms of uh… I mean, It’s hard, it’s hard to say, you know, I mean it’s like, um…I mean how how important that is. I mean, it’s a theoretical possibility, I guess the, the Poling case maybe suggested it could happen. Uh, but [unintell] cause it’s hard to predict who those children might be, but certainly, um individual cases, uh, can be studied to try to, uh, to look at those, uh, those possibilities.

Yes, predictably, Attkisson is flogging the Hannah Poling case again, which, as has been pointed out many times before, was a “rebranding” of autism, in which children with mitochondrial disorders can develop encephalopathy if they have significant fevers. In fact, the recommendation is that children with such disorders be vaccinated. The whole claim that children with mitochondrial disorders develop autism after vaccination is yet another highly dubious claim with no compelling evidence to support it. It’s how the story morphs, just as the story about DeStefano’s paper is morphing now.

Unfortunately, DeStefano blundered right into this issue, either insufficiently familiar with antivaccine talking points on the issue or unable to articulate a message about just how uncommon mitochondrial disorders are and how the risk of not vaccinating such children far outstrips any risk of vaccinating. But the case of Hannah Poling is a side issue to a more general problem when science is communicated to the public by scientists. The real issue is this. When scientists say, conservatively and scientifically correctly from their point of view, that something, say vaccines, “might” cause a problem, no matter how unlikely causation might be (e.g., it’s “theoretically possible,” as DeStefano said, that under some circumstances in some children vaccination might “trigger” autism), what cranks hear is that something does cause a problem, and what the general public hears is that a scientist is saying that concerns about that something causing a problem are plausible—even not unlikely. The same phenomenon is common for any risk factor in the environment about which there is a lot of unjustified fear mongering, such as genetically modified organisms (GMOs) or ingredients in food. Indeed, such statements by scientists are part of the reason why even the risibly ignorant “Food Babe” can get traction when she decries the “yoga mat chemical” in bread or—gasp!—calcium phosphate and, reminiscent of antivaccine lies, “antifreeze” in beer.

It all comes down to this. Scientists see nuance everywhere. It’s our job, particularly in biomedical sciences, medicine, and epidemiology where it’s rare for anything ever to be 100% “proven.” Moreover, it’s rare, leaving out pseudoscience like homeopathy and reiki, for anything ever to be completely “disproven.” Indeed, those of us in the biomedical sciences tend to dislike even using the words “prove” or “proven” in the context of a hypothesis. That, however, is not how non-scientists think, and it’s even less how cranks, such as anti-GMO, antivaccine, and Food Babe-type activists think. Non-scientists frequently confuse correlation with causation and vastly overestimate certain risks. Not uncommonly, they seem to think that there should be no risk whatsoever to something like vaccines, when such a goal is completely unattainable for any medical intervention, regardless of how benign.

As I’ve pointed out time and time again, people happily hop in their cars every day, even though the risk of serious injury or death in a car crash is orders of magnitude greater than any risk of injury from vaccines. Several years ago, I pointed out that about four children per year in the U.S. die as a result of an injury from playing baseball or softball, an average that, as of the mid-1990′s, had not changed appreciably since the 1970′s. But deaths are only the worst injuries. Among children ages 5-14, around well over 100,000 children per year are taken to the emergency room for injuries suffered playing baseball. These include sprains, contusions, fractures, dental injuries, head injuries and concussions, and internal injuries. In fact, baseball has the highest child fatality rate of any sport. And those are just the injuries severe enough to cause the coach and parents to take the child to the emergency room. In fact, if you look at all sports injuries in children, there are approximately three million sports injuries per year! Meanwhile, An estimated 5,000 children ages 14 and under are hospitalized due to unintentional drowning-related incidents each year; 15 percent die in the hospital and as many as 20 percent suffer severe, permanent neurological disability. Yet, antivaccinationists focus on the incredibly tiny risk of vaccines compared to the benefits and happily let their children play baseball, swim, be driven around in cars, and all sorts of far more risky behaviors than receiving a few shots.

Scientists, being scientists, must acknowledge even the “theoretical possibility” of infinitesimal risk and then weigh that against other risks, such as the risk of disease in the case of vaccination. The balance of risks versus benefits clearly comes out on the side of vaccinating, but because the benefits of vaccinating are not so clearly seen any more (vaccine-preventable diseases having been reduced to very low levels by mass vaccination programs), parents tend to focus far more on even tiny risks of vaccinating, even risks that aren’t scientifically supported, such as the “risk” of autism.

So what’s the way around this? We as scientists and physicians can’t be like pundits on the news, dealing in absolute statements. (“Only a Sith deals in absolutes.”) That wouldn’t be intellectually honest. We can, however, be very aware of how the general public will perceive our statements (and how cranks will try to cherry pick from them) and be very careful to make them (1) bullet-proof as far as quote mining goes and (2) reflect the correct level of risk. DeStefano failed in both of these areas. However, his failure might remind those of us who try to communicate science to the public, be it GMOs, various environmental risks, whether real or perceived, or food safety, or whatever, to avoid these pitfalls. We are already at a disadvantage when it comes to communicating science and countering crankery and quackery. We shouldn’t dig ourselves into an even greater hole.

Oh, and we shouldn’t agree to be interviewed by quacks and cranks, like Sharyl Attkisson.


More like this

There is a disturbance in the antivaccine Force. I can sense it. Actually, it doesn’t take any special talent to detect this. You don't have to be some sort of pro-science Jedi. The evidence is everywhere. The most prominent examples of posts in the antivaccine crankosphere that tipped me off are…
It is as I had feared. I must do one more post on a story that I’ve been blogging about for one solid week now. Hopefully after this, I will be able to move on to other topics last week, but after spending this whole week writing just about this, I figured, “What the heck? It’s Friday. Might as…
The antivaccine movement and conspiracy theories go together like beer and Buffalo wings, except that neither are as good as, yes, beer and Buffalo wings. Maybe it’s more like manure and compost. In any case, the antivaccine movement is rife with conspiracy theories. I’ve heard and written about…
Here we go again. If there's anything that ignites the fevered brains (such as they are) of antivaccine activists, it's a good seeming conspiracy. Indeed, as we've seen before, if they can't find a legitimate one, they'll either exaggerate one or make one up out of whole cloth. This week, an "…

we need all scientists to

we need all scientists to develop a "How many Library of Congresses" equivalent for their field.

"As a scientist, I can not truthfully say that the risk of our planet being struck by an asteroid in the next 24 hours is zero. But I can say that we've determined the risk of getting autism from vaccines is about that low."

The contra is also true here. Benefits should be expressed in careful terms that don't give false impressions. Example: DCA and cancer, which was sold as a miracle cure via press releases.

Scientists need to get a lot better at communicating early research outcomes.

By c0nc0rdance (not verified) on 03 Sep 2014 #permalink

As the sociologists we collaborated with kept trying to explain to the scientists, our numbers do not matter. They applauded the effort it takes to accurately quantify risks but reminded us that generally when it comes to policy and human behavior, we seem as a species mostly incapable of incorporating the data into the what should I fear today part of the brain/behavior.

There is some kind of innate fear of the new, but acceptance of the risk that has always been there.

The Superfund site in your backyard that hasn't killed you, yet, may be tolerated more than the whatever the heck new thing they are going to do to clean it up. Even if leaving the site alone is projected to kill/sicken 100 people of the 10,000 people in the area and some chemical or biological frankenbug needed to clean up the pollution has a risk of 1 in a million or less.

That whole "better the devil you know" sort of thing. And it can be extremely difficult to logic people out of it.

The issue does indeed cut both ways. As George W. Bush correctly noted, many Americans don't do nuance.

How common is it for ideas that started out as legitimate scientific inquiry, or plausible but incorrect interpretations thereof, end up as standard crank tropes? I'm not so familiar with examples in medicine, but I have seen it happen in other areas closer to my own field. For instance, scientists in the 1970s who were investigating Milankovich cycles noticed that, if you considered only those cycles and ignored the effects of carbon dioxide emissions, you would predict that the climate should be cooling. Talk among climate change denialists about "in the 1970s they were predicting an ice age" comes from that work, but ignores the caveat about neglecting carbon dioxide emissions. As subsequent data shows, that was a poor approximation. During my lifetime there have been several shifts in received wisdom (at least as perceived by people like me who make our living outside of medicine) regarding things like diet, as well as gradual shifts in how we understand addiction and other mental health issues. So it wouldn't surprise me if some medical woo is based on things that were once within the scientific mainstream but have been either debunked or superceded. Not to mention outright frauds that get published in legitimate journals, like Wakefield et al. (1998).

By Eric Lund (not verified) on 03 Sep 2014 #permalink

It is sometimes difficult to communicate nuance to an audience which may have limitations such as habitually seeing outcomes in black-and-white, all-or-nothing terms**.
The general public obviously includes people with all levels of cognitive ability as well as differing abilities in areas such as executive functioning/ abstraction and social cognition/ person perception resultant in a 'heroes vs villians'/ 'good vs evil ' mentality. Unfortunately, emotional issues may cloud even average people's judgment when they are introduced to 'damaged children' and 'corrupt scientists'.

Science is based on mathematical and statistical probabilities which research shows that are often dismally understood amongst adults. Witness the popularity of gambling and lotteries.

I feel that expressing probability in more concrete terms might assist at least some audience members in getting the gist of reseach's general direction. I like Nick J's asteroid example.

** woo-meisters commonly use such terminology- whether it expresses their own limitation or is an attempt to address their followers at their own level, I cannot tell but my guess leans towards the former.

By Denice Walter (not verified) on 03 Sep 2014 #permalink

Ah yes, the difficulty in conveying nuance when your debate opponents can shriek about absolutes...

I feel that pain regularly. *SIGH*

By Scottynuke (not verified) on 03 Sep 2014 #permalink

I'm gonna have to steal that, Nick. That's genius.

By AngryScience (not verified) on 03 Sep 2014 #permalink

drat, Nick, I was going to suggest the same sort of thing...but I will just settle for more cheering for your idea and strong encouraging of scientists to use the technique

By brewandferment (not verified) on 03 Sep 2014 #permalink

When I worked at the health department, it was often difficult for me to write reports. It wasn't that I couldn't write, or that I couldn't relay information in writing. The problem was that the higher-ups didn't want me writing in absolutes. I had to replace phrases like "the influenza vaccine protects you from influenza" to "the influenza vaccine may protect most people from influenza." The same was true for so many other topics. Hand washing was not the best method of controlling infection but "one of the best methods when soap and clean water are readily available."

It gets exhausting after a while. It got worse when different egos got into it and all wanted it phrased in a slightly different way, their way. Sometimes I'd post the tracking changes version of a report when we got together to review it just to show them how convoluted their own apprehensions (or fears?) about being "correct" when issuing reports or press releases looked to regular people.

The consensus is that, no, vaccines do not cause autism. We've reached that consensus through observational and experimental epidemiological studies. For the most part, reasonable people understand this and go on living their lives. But then we have those who want to desperately believe that something, anything has caused their children's autism. For them, the slightest possibility is a 100% certainty. They hear "absolutely" when a scientists says "maybe" or "possibly."

I have played around with ways of explaining relative risk to people. One I'm fond of is the risk of a fatal accident while traveling in a car, as Orac mentions, which is about 1 in every 78 million miles traveled.

A driver with an alcohol concentration of 0.15 or greater (that's impaired reflexes, reaction time, and gross motor control, staggering and slurred speech drunk) is about 25 times more likely to be involved in a fatal car accident than a sober driver*. So a drunk driver will have about 1 fatal accident every 3 million miles, that's a 1 in 1,000 chance of a fatal accident if he drives 3,000 miles.

I'm pretty sure that few responsible parents would allow their child to travel any distance in a car driven by a drunk driver, much less 3,000 miles, yet a surprising number seem to think that allowing their child to contract measles, which has a similar risk, is OK. The risk of a serious reaction to a vaccine is about the same as that of a fatal car accident while being driven three miles by a drunk.

Why anyone would think that subjecting their child to the same risk as being driven 3,000 miles by a drunk is better than the same risk as being driven only three miles beats me. In fact I'm sure parents who refuse vaccines just don't think of it like that. If they did they would see not vaccinating as being as irresponsible as driving when drunk with your child in the car, as I do.

* I once hitch-hiked a lift from a man who I only realized was seriously drunk too late to get out of the car. He literally lurched from verge to verge, bouncing off the banks that luckily lined the road. It was the most terrifying journey of my life, and I've had some hair-raising ones.

By Krebiozen (not verified) on 03 Sep 2014 #permalink

I once had the unenviable task of explaining relative risk in regards to how interviewees had previously behaved sexually and/ or used drugs AS WELL as the interaction of these two variables.

It's easier to do in writing than it is in speech.

By Denice Walter (not verified) on 03 Sep 2014 #permalink

I think the book "Innumeracy" suggested a logarithmic scale: 10 was absolute certainty, 9 was a one in ten risk, 8 was one in a hundred, and so on. However, "x miles with a drunk driver" seems a lot better.

By Gray Falcon (not verified) on 03 Sep 2014 #permalink

I just remembered the other issue: That, for some reason, people think that risk can be totally eliminated. I've studied computer security, the only completely secure computer is one turned off, no wires hooked up, and stored in a cardboard box.

By Gray Falcon (not verified) on 03 Sep 2014 #permalink

It's well known that humans are poor at judging relative risk. That's part of why so many people refuse to travel by plane: they fear dying in a plane crash more than a car crash, even though the latter is much more likely to happen (it doesn't help that when a plane crashes, it tends to make news, whereas car crashes only occasionally make local news, and almost never go beyond local unless somebody famous was involved). In your example, people may believe, incorrectly, that measles is no big deal, but they are afraid of the injury, which when it happens usually is severe.

A nitpick on your drunk driving example: You only considered the probability of a fatal crash. There are other bad consequences that can happen with drunk driving: an accident with serious but nonfatal injuries, or being pulled over and arrested. So in fact the risk of something bad happening in 3000 miles of DUI is actually a bit higher than the risk of contracting measles. But the relative risk still stands: the chances of something bad happening if you don't vaccinate (i.e., getting measles) is much higher than the chances of something bad happening if you do vaccinate (adverse reaction to the vaccine). However, that's the average for the whole population. For certain subgroups the relative risk of vaccination really is much higher, which is why medical exemptions to vaccination rules should always be available.

By Eric Lund (not verified) on 03 Sep 2014 #permalink

@Eric Lund - I've never had a fatal car accident. However, if i'd been run over by an emergency vehicle after my pilot flew too low and undershot the runway, I'd argue your point.

By Mephistopheles… (not verified) on 03 Sep 2014 #permalink

Grey Falcon,

I’ve studied computer security, the only completely secure computer is one turned off, no wires hooked up, and stored in a cardboard box.

Even then there's fire, burglary, vermin.... A fire-proof safe in a Faraday cage full of rat poison with 24-hour armed guards, maybe. But then there's the chance of an asteroid strike, which is apparently much more likely than I thought ;-)

By Krebiozen (not verified) on 03 Sep 2014 #permalink

I do beg your pardon, I meant "Gray Falcon".I lapse into English English from time to time.

By Krebiozen (not verified) on 03 Sep 2014 #permalink

I think I mentioned here recently that before I had functional endoscopic sinus surgery recently I was warned that the risks of blindness, meningitis or a CSF leak (cerebrospinal fluid leaking out of your nose) were each about 1 in 1,000 (though the leaflet they gave me said 1 in 500 for blindness in one eye). I didn't hesitate to sign the consent form, as the potential benefits far outweighed those risks.

It is interesting to be confronted with a real-life risk like that in black and white and have to make a decision. If I had been given the option of a procedure that was 1,000 times less risky but with the same benefits (as in MMR vs measles), I would have taken that option unhesitatingly too.

By Krebiozen (not verified) on 03 Sep 2014 #permalink

True the public can't handle statistics and a surprising number of people are shocked that medical procedures are risky at all. Even surgery. I have actually had to explain that yes you really could die having an operation. (Certain members of my family aren't too bright) As an epi I find it really strange that people will obsess over the tiniest things so unlikely to cause them any harm then be totally blasé about others. Such as obsession in the grocery store to make sure each and every item is gluten/casein free, organic, free range, etc. then realizing when you go to their house for dinner they have a pool with no fence. And a toddler. It boggles the mind. My husband teaches college math and when he gets to the statistics portion he always uses real world examples (such as gambling) he says that it always shocks the students to learn just how bad the odds are. It shocks him how many are still willing to put the money down on them.

About those subjective probablilities:

we know that actual vaccine injury occurs about 1 per million and
that the risk of serious consequences from a VPD may happen about 1 per thousand
( a very rough estimate- work with me, please).

Anti-vaxxers believedeeply and truly in their hearts and minds that autism is caused by vaccines and
that one ( or more) per hundred gets autism .
They therefore see vaccines as a greater risk than VPDs.
I+ per hundred < 1 per thousand + 1 per million..

SB people see autism as being un-related to vaccines( as it is caused by other genetic and pre-natal events).
So 1 per million < 1 per thousand.

By Denice Walter (not verified) on 03 Sep 2014 #permalink

Ooops! I mixed up my signs on gthe first one :
1+ per hundred > 1 per thousand + 1 per million.
Forgive me, it's hard to think in that mode and type.

By Denice Walter (not verified) on 03 Sep 2014 #permalink

Then, of course, there's the line: "Well, people should decide for themselves what the greater risk is!" and similar. Apparent, none of them learned the mathematical axiom that two real numbers, if they are not equal, then one must be greater than the other.

By Gray Falcon (not verified) on 03 Sep 2014 #permalink

1+ per hundred plus 1 per million> 1 per thousand
vaccine risk > no vaccines (to them)
Where's my drink?

By Denice Walter (not verified) on 03 Sep 2014 #permalink

Sorry, I missed Denice's point.

I should note that in my last conversation with someone opposed to vaccination, they likened autism to dying. I pointed out I was autistic and still very much alive, and the response was: "I have nothing to apologize for, if you think not being able to talk and communicate, control yourself and s*** in your diapers is surviving well, you are sorely mistaken!”

In other words, the other issue with risk is that they do not understand what the risk is. I've worked with numerous autistic adults, that statement describes none of them.

By Gray Falcon (not verified) on 03 Sep 2014 #permalink

What I mean to say is that without a frame of reference, one's mind often slips to worst-case scenarios.

By Gray Falcon (not verified) on 03 Sep 2014 #permalink

I think the book “Innumeracy” suggested a logarithmic scale: 10 was absolute certainty, 9 was a one in ten risk, 8 was one in a hundred, and so on. However, “x miles with a drunk driver” seems a lot better.

I agree that “x miles with a drunk driver” is a lot better, but anything is better if you're speaking to the general public than a logarithmic scale.

I spent more than a few years working in communication* where we used decibels almost every day. More than once I was called upon to explain the concept to some otherwise very sharp people. Seeing the light come on when someone would get it was a great feeling, but some just couldn't wrap their head around the idea.

A logarithmic scale is a great idea to talk about very large and very small numbers without using a lot of zeros either side of the decimal point. But it is far from intuitive, and some will just never get it.

But it would be fun to say "the risk of a fatal accident is 64.77**dBddm***".

*I mean real communication, with radios and antennas and telephones and cables with hundreds of voices inside, and MODEMs where the modulator and the demodulator had separate power supplies.

** If my math is right, I haven't used this in years

***dB reference drunk driving miles

It's hard to fault Dr. DeStephano in this. He is who is he is, and he's not going to know better. But good gosh, somebody at the CDC is sure clueless, and whoever is in charge down there needs to learn a thing or two about politics but quick (and I mean 'politics' in the broadest sense, not electoral politics), at least enough to get someone on staff who 'gets it' and to defer to that person in cases like this.

"Scientists, being scientists, must acknowledge even the 'theoretical possibility' of infinitesimal risk and then weigh that against other risks, such as the risk of disease in the case of vaccination."
I submit that statement is false. Substitute "as" for "being" and I argue the statement becomes true, and the difference between those two words is the key to the problem.

A scientist is not in totality 'a scientist.' 'Scientist' is a professional role Dr. DeStanfano takes at work amongst a community of peers who understand what he means when he says 'it's a theoretical possibility' and 'cases might be studied.' As I'm not-a-scientist, and people here are, rather than speculating on how Dr. D. communicates outside of work, I'll sincerely ask you: Do you speak to your kids as a 'scientist' or as a 'parent'? (Uh, Jimmy, there's a certain theoretical possibility that if you touch the stove the burner might be on. Or not. Studies might be done to ascertain the relative risk. The whole question of touching-the-stove retains an element of nuance, and in the absence of proof it will harm you, I must remain open-minded.) OK take kids out of it. When the guy next door asks if you think those clouds on the horizon mean rain, do you reply as 'scientist' or 'neighbor'? Etc., Etc.

Not knowing your actual answers, I'll continue on the hypothetical that scientists are capable of speaking to non-scientists as 'regular human beings' in a variety of contexts. So why is it so hard to understand that giving any kind of statement to the general public is one of those contexts where a different set of rules prevail, specifically a different set of definitions of words?

"It also demonstrates why we in the scientific community will always be at a disadvantage when it comes to countering fear mongering, exaggeration of risk, [etc.]..." Gotta contend that's utterly false. Replace "will always be" with "are" and you have an undoubtedly true description of the empirical state of things at the present. But it need not always be so. Carl Sagan 'got it.' Stephen Jay Gould 'got it.' Neil DeGrasse Tyson 'gets it.' Heck even Richard Dawkins 'gets it' most of the time.

As a stab at framing what 'it' is, I'll try: whenever scientists address non-scientists they speak not as 'scientists' but as 'public spokepersons for science' and there's a world of difference between the two. That not a proposition of value ('they SHOULD speak as spokespersons'), but a proposition of fact (they ARE spokepersons whether they like it or not, and their words WILL be interpreted as such).

The thing is, whatever rhetorical disadvantage the persona of 'scientist' may bring along as (discardable) baggage, the 'spokesperson for science' has the incredibly important advantage of being right (at least most of the time, and especially vs. the quacks). You just have to frame things the right way to put that advantage into play.

If someone made me an executive in charge of overseeing a scientific research project that touched on any area of public policy or potential controversy, I would insist that at least one senior member of the research team had significant coursework in sociology, basic public speaking, and advanced argumentation, and I would make it clear from the get-go, in the contract, that only researchers with such qualifications may speak publicly about their work. Ever. Surely someone will protest that this will leave my team with less-than-optimal credentials in science. Perhaps. Now. But what if that became the norm, and everybody who wanted such a position knew those were the requirements? The field could do that. Besides, it's still a team, and I've got spots open for the science/math/tech geniuses who can't talk to another human being under any conditions and can only communicate through email. And anyway, as Destfano has just more-or-less proved, in the real world the best science doesn't get you very far if you can't communicate about it effectively in 'the marketplace of ideas'.

'We can be aware of how the general public will perceive our statements and be very careful to make them (1) bullet-proof as far as quote mining goes and (2) reflect the correct level of risk.' Good, but not good enough. You can do better. You're smart people. You may not be 'naturally' inclined toward things like mastering the art of narrative-as-argument, but to winkingly invoke an old cliche, it's not exactly rocket science. My first actual teaching assignment (1975) was in a Public Speaking class in a two-year college program. About half of the class was made up of students training to be dental hygienists, as that course was required for their certificate. At the end of the term EVERY student in the class was significantly more adept in both argumentation and presentation than they were when the term began. Same when I taught a Gen Ed Speech class ('78-'79) at in a four year university program with students from all over campus, including the sciences. (FWIW, I credit the students themselves first for their progress, and Aristotle second, and consider myself to have only had a very small mediating role.) OK, to be fair, the Gen Ed class involved a measure of self-selection, as science majors had other options for fulfilling that part of the GE. But i ask (only half-rhetorically, and half really wanting to hear your honest answers): is it so unreasonable to expect at least some research scientists to be able to communicate as effectively as a dental hygienist? (Small sample, true, but the universal improvement speaks to validity, yes? Correlation does not equal causality, of course, but I can't think of a good alternative causal hypothesis, and I'd offer experiences with students at the same level of college experience overall, but lacking similar coursework as a sort of 'control.')

“As a scientist, I can not truthfully say that the risk of our planet being struck by an asteroid in the next 24 hours is zero. But I can say that we’ve determined the risk of getting autism from vaccines is about that low.” IMHO, that's really good. In my imaginary role as research exec, I'd want my 'spokesperson for science' to always use that kind of true-to-science-yet-meaningful-to-lay-persons analogy. But I'd want them to also go on and put the case in non-science language, identified as such. "Or, to put in non-scientific terms, the chances a child will get autism from vaccines are slim and none." (Yeah, the anti-vaxers could run with "slim", but they'd look like fools doing so, since pretty much everyone understands what the trope 'slim and none' means, and recognizes it as figurative speech.)

Finally, I'll reference this thread on 'SBM' discussing the role of story in how people process the world on an everyday basis.
This may go against the grain of how scientists and skeptics wish things were, but it's an "it is what it is' condition. You persuade people by telling them a better story. (Sagan, Gould, Tyson, Dawkins: storytellers all.) There's actually research on this, though I processed it long ago and no longer remember the cites. One set of studies evaluated reading comprehension of news items for relevant facts between one group presented the material in narrative form, and another group presented the same material in the conventional inverted pyramid form. The results weren't even close: IIRC it was something like 80% for the narrative group vs. 20% for the inverted pyramid group.

Take your superior knowledge, express it in terms average people can understand (Asteroids!), and weave it into a story. I'd guess the effects on hard-core CAM crazies would probably* be slim and none. But for the 'general public' IMHO that smells like... victory.

* I'm wondering where we'd be if scientists just reminded themselves what terms like 'probable' and 'possible' mean in >99.999% of the instances in which their audience encounters and employs them, and if the scientists reflected that however modest may be their hearts, it is functionally arrogant to expect people to comprehend a very specialized use of language.

This is definitely worth a column or two. I used to write about media, including newspapers and the developing internet. One of the things that became obvious was the ignorance of most reporters about math, engineering, and science. They came from a different educational background, but that doesn't excuse their widespread contempt for the idea of quantitative thought.

This, by the way, leads to my own slightly amused interpretation of why the Thompson micro-scandal stayed at the micro level: The story, such as it was, involved (1) a scientific paper based on statistical analysis (2) a second paper taking the first paper to task by more statistical analysis and (3) a series of rebuttals to the second paper based on statistical analysis.

Not only that, the statistics weren't the usual Student's T Test or chi squared, the statistical tests that your average reporter or editor might possibly have heard of. Once they got into the more esoteric sorts of tests, they were totally lost. It was a lot different from writing a story about somebody getting convicted for lying to a grand jury.

In other words, we have the widespread innumeracy of writers and editors to thank for the fact that the Thompson case didn't get blown up any wider.

All that having been said, it's critically important that the conclusions that real scientists reach get communicated to the news media in advance of epidemics in order to prevent those epidemics. I don't think this is getting enough attention. I do, however, think that the anti-vaccination trope has reached the eyes glaze over stage for the news media. It's no longer news, and it helps when newspapers and television stations get a lot of negative feedback when they run an idiotic anti-vaccination story or a Burzynski story.

@Gray Falcon:
"I pointed out I was autistic and still very much alive, and the response was: 'I have nothing to apologize for, if you think not being able to talk and communicate, control yourself and s*** in your diapers is surviving well, you are sorely mistaken!' ”

GF, this just makes me sick to my stomach. What a self-absorbed selfish hateful monster anyone would be to say that to you. If I could apologize on behalf of the human race, I would. That s*** needs to be called out and condemned for the contemptible ugly bigotry it is.

Which takes me back to my last post. Allow me to suggest that it behooves folks who see themselves as 'pro-DBM' to focus on the specifics of the anti-vax 'movement' and cast their public presentation as 'pro-vaccination' as this opens up a wider range of more effective counter-attacks. To my eye 'scientists' and 'skeptics' seem to consider the debate starts and ends with 'who's right about the facts.' But to whatever extent John and Jane Q. Public care about being right factually, they care way more about being right morally. If you draw a functional equivalence between, say, astrology and anti-vaxism as 'Bad Science' you present to way too many people with an incomprehensible moral relativism, which they will run away from like the citizens of Tokyo fleeing the arrival of Godzilla.

The hate in that response is all too common, and it has real effects on GF, my 'Aspie' cousin, and all those kids being raised by parents who think their kids are broken and less than human because they're different. Facts are fine, but this calls for judgment. This needs to be part of the story the pro-vaxers tell.

'pro-SBM' not 'pro-DBM'

@ sadmar:

One of the woo-meisters I survey presents all of his so-called health information in narrative form ( which is easy enough for him as it's predominantly fiction): a person has a serious condition which doctors can't help so he consults the healer who then gives him a strict, exacting protocol to follow, which he does *Et voila*!
All fixed up and better than ever before.

TMs presnt their tales of woe as short stories ( they have 2 collections of TMs tales) I won't say *novellas* as he's on our side.
Other anti-vax parents have written books and blogs about their lives.

There's almost something archetypical about their stories-
an innocent child injured by evil witchery; an heroic mother who sacrifices everything for her child; a battle betwixt good and evil; the eventual triumph of the righteous.

I think we're still in Act III.

By Denice Walter (not verified) on 03 Sep 2014 #permalink

Back in the '80's people that didn't want kids with AIDS attending their school were portrayed as bigots, and there's some truth to that. But if you look at the language in the scientists' reports, they used plenty of tentative language. WE know that's normal for scientists but the general public didn't.
Of course, on the opposite end of the spectrum, we have the scientists jailed in Italy for saying there wouldn't be an earthquake, without making it clear there was a small chance there would be an earthquake.

I pointed out I was autistic and still very much alive, and the response was: ‘I have nothing to apologize for, if you think not being able to talk and communicate...

was the slime in question simply stupid to grasp that if you're pointing things out to him, that kind of necessarily implies that you can communicate?

@LW- More likely, she was trying to convince me that was how most autistic people were. The fact that I actively worked with autistic people on a regular basis and knew most of them weren't like it didn't seem to register to her at all. Hanlon's razor, it seems, still applies.

@sadmar: More than once, I've tried to explain the value of vaccination in terms that those opposed to it were not just putting their children at risk, but other people at risk as well. Unfortunately, most of them believed showing concern for the well-being of others was a form of Communism.

By Gray Falcon (not verified) on 03 Sep 2014 #permalink

Having spent the day in HAZMAT training (I was feeling chipper about having done so well until I noticed that the certificate had my name spelled wrong. An English surname that's common as dirt and for which there is only one spelling so far as I know...)

Anyway, the part on working with the media was a slide that said something like --

Rule 1. Only tell what you know. Do not speculate or guess.

Rule 2. See Rule #1.

Denice Walter wrote:
"One of the woo-meisters I survey presents all of his so-called health information in narrative form... TMs present their tales of woe as short stories..."

Just curious: How many page hits or comments do any one of these sites have compared to RI, SBM, and all the other skeptic sites combined?

If the anti-vaxers weren't better storytellers than 'scientists' they wouldn't have had the social influence to have driven vax rates down and measles rates up, given the fact that their premise is intellectual garbage.

I'll say this for those (limited) skeptic sites I have visited, what you see is what you get, and there's something refreshing about that. I had to go to Autism Media Channel to get the 'tic' video to check the audio, and I have to say that's some mighty slick presentation they've got there. Wakefield and gang seem to have mastered the old politicians trick of putting on different faces (and telling different stories) to different audiences.

If you just wander in there it's all sweetness and light on the front page, supportive, compassionate, happy-feely yada yada. I wouldn't be surprised if a lot of visitors there get a subtle anti-vax spin without ever working their way back to the forums and/or Twit tags where the real poison flows.

Speaking of 'flow', one of the classic concepts in Public Opinion research (promulgated by the field's founder, Karl Lazarsfeld) is "two step flow." This posits that only a small percentage of the public actually pays enough attention to any sort of media campaign to have their opinion shaped one way or the other, but these 'opinion leaders' go on to have a powerful force in shaping mass opinion via their interpersonal communications networks. (My friend Janet really knows about these things and she says vaccines could be bad for the baby!)

Thus, media influence is indirect, but still powerful, and all the more so because it doesn't seem to come from the media. Looks to me like Andy's got that second step flowin' pretty good.

Anyway, if Lazarsfeld is right, that supports the thesis that the hard-core anti-vaxers may be at the root, but the epidemiological problem is more centrally the parents who are deeply committed to The Cause, but just made wary enough by the narratives floating in on their periphery to delay taking the kidding in for shots because they just aren't sure.

Now, any PR account exec from junior level on up who wasn't pulling a full Weimaraner is Biz School would tell you the way to counter that is to get your own story out in circulation in all those relatively casual interpersonal circles. It's not just me, we're talking a $300 billion/anum industry here, and no, multi-national corporations don't spend that kind of jack on s*** that doesn't work. And I can guarantee you they have the best social scientists money can buy on staff to assure them it does. Science Works!? PR works better. "It is what it is," and if you want to save kids from VPDs, that's the reality you have to face.

I posted the link below before, but it's worth posting again (and again and again...) It's a pamphlet from The Center for Vaccine Awareness and Research
at Texas Children’s Hospital, called 'Vaccine Preventable Disease: The Forgotten Story." The title alone tells you somebody knows what they're doing there, and the contents do not disappoint. Beautiful layout, stunning photography, heartbreaking -- I'm not quaified to comment of the medical science, but the authors' credentials in epidemiology look legit to me. (Rachel Cunningham,M.P.H. Julie Boom,M.D. Carol Baker M.D. if those names mean anything to anybody.)

Particularly brilliant IMHO is that the final words, including, "A decision not to vaccinate will leave your child vulnerable to deadly diseases, but will do nothing to reduce the chance of autism." are delivered not by a doctor or scientist, but by a Mom, specifically one Alison Singer, ID'ed as a former VP of Autism Speaks.

Singer begins her Epilogue "My daughter Jodie was diagnosed with autism when she was 2½..." and shortly thereafter says, "When you have a child with a severe disability, it is natural to want to blame someone or something. I think this is why some parents of children with autism cling to the misconception that vaccines cause autism." Singer's bio at the bottom of the page notes she was a news producer for NBC for 14 years, and what you have above is the writing of a pro.

Compare Dr. DeStefano's mumbled reply to Asskisson (low-hanging fruit, but I yam what I yam) to, "A decision not to vaccinate will leave your child vulnerable to deadly diseases, but will do nothing to reduce the chance of autism." If a 'scientist' indeed cannot say "will" and "nothing" when presenting this issue to the public, then the scientist ought to STFU and let somebody who understands how to communicate with people do the talking.

Notice that the first thing Singer does is identify her daughter by name. The TOC is in this form:
9 Julieanna Metcalf
11 Brian Scott Jr.
13 Jenny and Andrew Wise
17 Haleigh Throgmorton
19 Blaine Hashmi
21 Breanne Palmer
[and so on]
Just names. Turn to the page number indicated, and each name gets a face in a full page photo. Only on the page after that do you learn the disease that threatened them, scarred them, or caused their death.

The power of naming and seeing faces are verifiable Things, hardwired by millions of years of evolution into the brains of hairless talking apes.

Forgive me. I get worked up about this stuff, especially after reading things like Gray Falcon reported. Here's the link, followed by a request:…

I ask you to download the .pdf, print out a hard copy, hand it in person to a friend who is not a scientist, have them read the whole thing, and then ask them what they think, how they feel. That's it.

sadmar: "I ask you to download the .pdf, print out a hard copy, hand it in person to a friend who is not a scientist, have them read the whole thing, and then ask them what they think, how they feel. That’s it."

That is a very powerful pdf. Thank you.

There’s almost something archetypical about their stories-an innocent child injured by evil witchery; an heroic mother who sacrifices everything for her child; a battle betwixt good and evil; the eventual triumph of the righteous.

I think we’re still in Act III.

"Charlie talked about Helter Skelter every night. He said the way it would start is that the blacks, who'd already burned Watts, would start burning white neighborhoods. Then the whites, with the police behind them, would start killing blacks, and that would spark total chaos. Blackie—that's what he called them—would do this. Whitey would do that. And we'd learn to live in Texas off the land. We'd live in the desert and come in on dune buggies and rescue the orphaned white babies. We'd be the saviors."

I agree that “x miles with a drunk driver” is a lot better, but anything is better if you’re speaking to the general public than a logarithmic scale.

I spent more than a few years working in communication* where we used decibels almost every day. More than once I was called upon to explain the concept to some otherwise very sharp people. Seeing the light come on when someone would get it was a great feeling, but some just couldn’t wrap their head around the idea.

A logarithmic scale is a great idea to talk about very large and very small numbers without using a lot of zeros either side of the decimal point. But it is far from intuitive, and some will just never get it.

I have often wondered if it would be easier to teach the concept by pointing to "x figures" as a crude logarithmic scale that everyone knows already - i.e., his income is five figures, but hers is six figures; clearly, hers is not just bigger but on a different level.

By Antaeus Feldspar (not verified) on 04 Sep 2014 #permalink


About that woo-meister:
his web site isn't his major mode of proselytisation because he does radio ( both landbased and internet) thus page views aren't especially relevant ( they aren't high-btw-); the radio shows link you up to a website that promotes his ideas and another that sells his products including books and videos.(; respectively). Facebook is also not the best way to measure because many of his older listeners may not use it.

Mike Adams does primarily utilise his website, Natural News, which has higher page views and perhaps a million facebook followers.

By Denice Walter (not verified) on 04 Sep 2014 #permalink

@ Narad:
Did you perchance stumble upon Mikey's latest post-Apocalyptic vision about agriculture after the demise of oil as a fuel ( probably yesterday).; goats are featured. In Tejas.

By Denice Walter (not verified) on 04 Sep 2014 #permalink

About Charle in the desert. I've actually been in some of those places and they are quite eerie- I especially remember looking towards Death Valley from the main highway west - other worldy and barren, mountains rising ominously. Abandoned ranches and hovels abound.
That environment, acid and a saviour complex create wonders together.

By Denice Walter (not verified) on 04 Sep 2014 #permalink

That [desert] environment, acid and a saviour complex create wonders together.

“We were somewhere around Barstow, on the edge of the desert, when the drugs began to take hold.”--Hunter S. Thompson, Fear and Loathing in Las Vegas

I have never been to that part of California, but I have been to some other arid places, and they can be quite spooky, especially if (like me) you are accustomed to moister climates. It's probably no accident that several religions, from the mainstream to the bizarre, have arisen in deserts. Consider the stories of Moses, Jesus, and Mohammad, to name three.

By Eric Lund (not verified) on 04 Sep 2014 #permalink

@ Eric Lund:

And obviously Carlos Castenda and Don Juan (fiction or not). At least the drugs were probably real.

I have witnessed much weirdness in that area. Especially if you walk around at night by yourself -even without drugs. It is worth a side trip if you've never been there if you are staying in LA or the SW.

My family and I also originate from- and presently inhabit- somewhat dank, misty places. My late father was rather impressed with deserts: he had great stories about scorpions, vehicles stuck in sand and endless sunburn.

By Denice Walter (not verified) on 04 Sep 2014 #permalink

Did you perchance stumble upon Mikey’s latest post-Apocalyptic vision about agriculture after the demise of oil as a fuel ( probably yesterday)

No, that would be much more than I could take. Clifford Miller, at AoA, provides another data point supporting the Helter Skelter interpretation:

Anne, if AoA approaches Obama, Sharpton and Jackson to report their positions on this then the establishment's print and broadcast media will have to accept that as they are not reporting, then the new media like Age of Autism will have to do it and take over.

The establishment's media will have to accept that if they create a news vacuum then others will fill it whether they like that or not. So lets see it happen please.

I don't expect everyone to be sitting on a first-edition hardback of Ed Sanders'* The Family, but I find the parallels to practically leap out of the woodwork.

* Anybody who's right with Tuli is right with me.

Graph Boy, however, does reveal the Achilles' heel in this approach to inciting The Race War:

Is Al Sharpton going to warn his family and friends. How about Barak Obama and Jesse Jackson?

We all want to know.

Yes, what if the Uncle Toms have been coopted?

I've got 5 quatloos on somebody's having suggested leaving printouts of something or another at BBQ shacks, or something similar.

The kind of age dependent injection-autism creation in a genetically distinct subgroup that Thompson suggests is exactly what you might expect from the animal results. Injections into infant animals of simple antigens, never mind antigen-aluminum combos were reported to cause long-term brain damage when the injections occurred during critical periods in development, even when such injections would have been harmless at other times [2,sec 4.4; 5; 6].

Meanwhile, the CDC is currently touting another study by the same lead author as its flagship argument that vaccines don’t cause autism. In so doing, even assuming this study is honest and correct, they are still and in broad daylight committing the same kind of misconduct of finding a way to slice the data that allows them to make the claims they want. The paper they cite by DeStefano et al [20] has been cited as reporting: “The Risk of Autism Is Not Increased by ‘Too Many Vaccines Too Soon’”[21]. Unfortunately this paper, as indicated in its title, “Increasing Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of Autism”, compares patients who received more antigens rather than patients who receive more aluminum adjuvants or more or earlier vaccines. This compares one group of vaccinated patients to another, and there is no reason to believe either group had more aluminum, nor more or earlier vaccines, nor does the paper make such a claim. So they wouldn’t find a connection even if adjuvant aluminum or many early vaccines were the sole cause of autism.

According to table 1 in DeStefano, DTP has 3004 antigens, while no other vaccine except typhoid, which hardly appears in the data set, has a large number. So what their study effectively compares are high-antigen patients, those who got DTP, who score over 3004 antigens, and low antigen patients, who got other vaccines such as DTaP but did not get DTP, who score several dozen antigens if they got everything else but typhoid. Their claimed results indicate that DTP isn’t dramatically more likely to produce autism than DTaP, in patients who also got other vaccines. What’s particularly frustrating about this is it looks to me like (assuming they were honest about other things and their statistics is ok in other ways I haven’t checked), if they just reanalyzed their data to weight by adjuvant content rather than antigens, replace table 1 with aluminum table and process, they would have a more pertinent result. Also if they replaced table 1 with the constant 1 per vaccine, they would have a more interesting result.

[20] “Increasing Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of Autism” by Frank DeStefano, Cristofer S. Price, and Eric S. Weintraub, Journal of Pediatrics (, DOI 10.1016 2013.02.001


Journal of Pediatrics editorial, March 29, 2013, “The Risk of Autism Is Not Increased by ‘Too Many Vaccines Too Soon’”

[2] Tomljenovic L, Shaw CA. Do aluminum vaccine adjuvants contribute to the rising prevalence of autism? J Inorg Biochem. 2011 Nov;105(11):1489-99

[5] M.A. Galic, K. Riazi, J.G. Heida, A. Mouihate, N.M. Fournier, S.J. Spencer, L.E. Kalynchuk, G.C. Teskey, Q.J. Pittman, The Journal of Neuroscience 28 (2008) Postnatal Inflammation Increases Seizure Susceptibility in Adult Rats

[6] Metabolic Brain Disease, Volume 26, Issue 3, September 2011, Pages 237-240, Peripheral immune challenge with viral mimic during early postnatal period robustly enhances anxiety-like behavior in young adult rats Konat, G. W., Lally, B. E. , Toth, A. A.,Salm, A. K.

For more…

By Nat Philosopher (not verified) on 06 Sep 2014 #permalink

Nat Philosopher: " compares patients who received more antigens rather than patients who receive more aluminum adjuvants or more or earlier vaccines. "

The paper being discussed is about the MMR vaccine, which has never contained thimerosal nor aluminum in its over forty year history.