autism-vaccine link?

[Beth]

Specific recommendations:

1) People interested in communicating these issues should stay in touch with reality, and not claim frustration, anger, and loudness are ineffective.

They are not ineffective short term. But there are long-term costs to such strategies. One long-term cost is a loss of credibility. Such tactics are used by fanatics and, while fanatics often have a core point that's true, that point tends to get lost in the overall din of all the different fanatics in our society yelling about their particular cause. Fanatics don't have as much credibility as messengers as people who are not. Since my perception is that much of the 'cause' of lowered vaccine uptake is perceived credibility of the people advising them, it doesn't strike me as a particularly effective approach.

2) People interested in communicating these issues should understand that emotion trumps data. We should not shy from using emotional appeals to further the message. (Yes, it is virtuous to teach people to think critically. That is a lot easier to do once you've convinced them it is important to think.)

Again, short term approach versus long-term approach. I think it would be better to acknowledge the validity of some complaints out the way policies are made and implemented and fix those core problems (like the fact that the CDC committee tends to be biased towards, rather than away from, vaccines) and fix that problem.

3) People communicating on these issues should be showing graphic and disturbing pictures of the worst outcome of diseases like polio, mumps, measles, etc. Part of the problem is that vaccination became part of our culture when parents where justifiably frightened by these kinds of scenes surrounding them. Vaccination has successfully reduced such scenes to extreme rarity, which has encouraged the anti-vacc movement.

I don't have a problem with discussing the very real and dangerous aspects of diseases like polio, mumps and measles. But, on the other hand, I don't think it's reasonable to apply the same sort of pressure to people who decline the seasonal flu shot or chicken pox.

I also think that vaccines for sexually transmitted diseases should be left up to the parents. The society risk of general contagion of such diseases is not sufficient to justify the same sorts of mandates. I'm bothered by the tendancy to lump all people who critisize vaccine policy as 'anti-vax'.

4) Anti-vaccination nuts should be frontally attacked as people who seek to harm children. Other parents should be told that such peoples' teachings pose a physical danger to their children.

This is just unwarranted. A free society tolerates the free flow of dissenting ideas on almost all subjects. There are reasonable restrictions on free speech with ideas that do pose an actual physical danger to anyone, not just children. But people who promote anti-vaccine ideas are not in the same class as terrorist or sexual predators. They don't need to be treated as such and advocating doing so makes me think that you are a fanatic. Guess what that does to my estimate of your credibility?

5) The medical community should lobby to pass laws to bar unvaccinated children from public places like schools, day-care centers, airliners, and similar opportunities to become a vector.

How about we just make them wear a yellow star so others can identify them and avoid them, or maybe a pink triangle depending on what vaccines they haven't had yet?

 

[robinson]

How about we just make them wear a yellow star so others can identify them and avoid them, or maybe a pink triangle depending on what vaccines they haven't had yet?

Vee vant to see your papers. You must have your papers at all times. Vee vill require you to show them.

 

[Skeptic Ginger]

Well here's my beef with communication from the medical community: Patient information sheets are too dumbed down. I never even read them, personally. If someone gives me one, I just toss it into recycling. I've been doing that since I was a kid. Even now, with the internet, patient information sites are incredibly dumbed down (and I get especially annoyed by sites that immediately present me with two paths, one for doctors and one for patients). They are insulting to the average patient's (or parent's) intelligence. If I were the sensitive type, I might take that kind of insult personally and maybe, ya know, distrust the source and start down that long road...

I hate to insult you by saying this is an uninformed assessment, but that is what it is.

Patient handouts serve two purposes. One, they are giving the patient the minimum required amount of information, and two, they document that we gave the patient that information.

For anyone wanting more information, there is always the provider and a zillion other resources.

As for the web pages and their medical information, some gear the information to what the provider or the patient would be looking for. But the general idea is you gear your web page information to the target audience.

If you are WebMD, you are attracting people to the site with information, but really the goal is commercial advertising. So you can expect that website to provide educational material geared to the market they are targeting for their commercial advertising. For the distributor and manufacturer's websites, the provider information is actually their 'customer' information. If they do not market directly to the public, they aren't gearing their website to the public either.

If you are talking about the county public health web site, a provider alert to watch for cases of an ongoing outbreak or change an antibiotic protocol for staph infections or that there is a new lab service public health offers, those are not directed at patients because the messages are specific to health care providers. Same with links to patient educational materials for downloading and so on.

The public information would alert the public to the outbreak rather than telling them what labs to order or drug recommendations, it might contain the times and locations of a vaccine clinic or where free screening for something was available.

You seem to have narrowly decided that because something doesn't meet your needs, it must not be useful to anyone. That's rather egocentric of you. Anyone who can navigate the web should be able to find the information they are looking for at the level of expertise that meets their needs.

 

[Ivor the Engineer]

<snip>

3) People communicating on these issues should be showing graphic and disturbing pictures of the worst outcome of diseases like polio, mumps, measles, etc. Part of the problem is that vaccination became part of our culture when parents where justifiably frightened by these kinds of scenes surrounding them. Vaccination has successfully reduced such scenes to extreme rarity, which has encouraged the anti-vacc movement.

<snip>

Were American parents justifiably frightened by Hep A or Chicken pox before the vaccines were forced on them?

I think what fuels the anti-vax movement in part is the ever increasing number of vaccines children MUST have.

 

[Eos of the Eons]

I don't understand your claims of anything being forced. People have died, and knowing you can die of these diseases is motivation to protect. Fear is the undeniable reaction to reality. It's not made up, it's just life. And as a parent you need to protect your children with prevention if you wish to prevent the risk of harm and death from now preventable diseases. It would be very irresponsible of someone to not let people know of these very real risks from diseases.

You however, have bought into the conspiracies of antivaxxers, and use their words.. forced, "must have".

These are vaccines people must get to be protected, however-it is still a choice. You don't have to get protected from these diseases, you can leave your children open to the real risks. It is your choice.

It would be very irresponsible if the real risks weren't outlined though, and we also see the results of vaccine testing. Results that antivaxxers would like to tell you are false. Vaccines are effective protection, and are far more safe than the diseases. An ounce of prevention is worth a ton of recovery.

So, listen to liars who simply hate vaccines because of paranoia and the need to blame something for things totally unrelated to vaccination if you wish. Just remember that recommended vaccines are not forced, and are not just "must haves" in the way you are alluding to.

If want protection though, then the vaccines "you must have" for that protection are readily available and recommended if you so choose.

 

[Skeptic Ginger]

I have a couple more posts on Orac's blog:

What if it's a 1 in 100,000 chance? There are quite a few genetic disorders in that probability range.

Allow me to explain the scientific method to you that we use to determine if a particular variable is affecting or related to a particular outcome. It is called matched controls. If we can add double blinded randomly assigned variables that adds to the reliability of the research outcome but we do not always have that luxury.

Yet we have still managed using the scientific method to make incredible successful advances in medicine. That gives us great confidence in the scientific method even when not perfectly applied.

By comparing two groups that are the same except for say, getting certain vaccinations, then any difference in the group would reflect the one thing that was different, the vaccinations.

To detect an outcome that only shows up in say, 1 per million doses of vaccine, or in 2% of autistic children, or however you want to look at the problem, you need a large enough sample size and repeatable results.

So, by using the scientific method, and enough studies, and large enough samples, the evidence at this point is overwhelming that even rare cases of vaccines causing autism or precipitating autism are simply not occurring.

A decision to pay an insurance claim in a single case is not scientific evidence. The scientific evidence I presume this family presented is not sufficient to change the consensus there is no connection between autism and vaccines because there is already overwhelming evidence supporting no connection.

The lack of knowledge in how we detect 1/100,000 cases is but one problem the public has in understanding why the medical community has come to certain conclusions such as vaccines do not cause or precipitate autism. The lack of understanding the public has that a single study with a single finding does not mean that finding is "true" is another problem the public has in understanding why the medical community has come to certain conclusions such as vaccines do not cause or precipitate autism. And the fact that an insurance award is not a scientific conclusion is another problem the public has in understanding why the medical community has come to certain conclusions such as vaccines do not cause or precipitate autism.

 

[Skeptic Ginger]

And

Freddy posted: skeptigirl has come up with the T-Shirt for pro-vaccine rationality:
"Keep the thimerosal, eat a few less tuna sandwiches"

Don't know how I missed this one yesterday. Thanks, I love it. I think I may actually order one.

 

[Skeptic Ginger]

And

Posted by: DocMartyn I think we may be over looking something very obvious; hyperthermia. When you vaccinate, especially babies who have been brought up in a sterile environment, you get fever.
Could we be pushing them over the edge? Hypothermia saves neurones in ischemia/reperfusion injury (blue baby syndrome); couldn't hyperthermia be doing the opposite?

Posted by: anonymous MD and PhD So, now let me translate for the non-docs out there what "secondary inhibition of oxidative phosphorylation" means. This refers to blocking biochemical pathways involved in generating the curency of energy, ATP, ie mitochondrial poisoning. This is a primary mechanism of how heavy metals such as lead and mercury exert there toxic effects upon biological organisms. Food for thought and further discussion. Cheers!

Here's some food for thought for both of you. How was the vaccination supposed to be any more harmful than the hundreds of pathogens and thousands of non-pathogen antigen exposures any child is going to have?

If anything, a parent could easily give an antipyretic after a vaccination and in fact that is included in common advice to parents when their child is vaccinated. Are the Polings claiming this was the first time their child had ever had a fever? Are they trying to claim that "9" antigens in a single vaccine was any more stressful than the hundreds of antigens people are exposed to every day? Are they claiming that the injection allowed more antigens to enter the body than the mucous membrane of the GI and respiratory tracts every day?

It is commonly but incorrectly assumed that combining multiple vaccines "stresses" the immune system just as it is commonly but incorrectly assumed injecting vaccines has a significantly different outcome than natural infections acquired by the usual routes of infection. And it is commonly but incorrectly assumed that vaccine immunity is qualitatively different than any other stimulation of the antigen antibody immune mechanisms. Other than less well matched antibodies and the shorter lasting effect of killed vaccines over live infections, the immune system response is 100% 'natural'.

So what evidence does Dr P and his wife have other than a temporal observed anecdote that the vaccines were the issue here rather than any other antigen or pathogen or cause of fever that would have inevitably triggered this if the etiology is correct?

And if this mitochondrial condition is indeed in some other children with autism, why is there no epidemiological evidence that vaccines were associated with autism? If this case was valid, regardless of how rare (Dr P's article suggests it is not such a rare etiology of autism, merely an unrecognized one) it should still have been detectable if the vaccinations triggered anything.

I propose another hypothesis. The persons responsible for the determination the vaccines were a precipitating event in this case were intimidated by the fact Dr P is a neurologist from Johns Hopkins. And I do not mean intimidated in terms of fear, but intimidated by their perception of his expertise and reluctant to question his medical opinion as so many medical professionals are reluctant to question their peers.

 

[Chris Haynes]

Were American parents justifiably frightened by Hep A or Chicken pox before the vaccines were forced on them?

I think what fuels the anti-vax movement in part is the ever increasing number of vaccines children MUST have.

HepA used to be quite common in our community. There were often news reports that a restaurant worker had HepA and had possibly infected several customers. My husband had to go in for an immuno-globolin (whatever) shot after having lunch at a sandwich shop where a worker was found to have HepA.

It actually happened recently again elsewhere:
http://film.guardian.co.uk/news/story/0,,2259197,00.html

http://blogs.wsj.com/health/2008/02...n-kutchers-birthday-party/?mod=googlenews_wsj

Also, when my kids got chicken pox, it spread throughout the school and at least one child was hospitalized with the flesh-eating bacteria. It is a vaccine that actually came from Japan, and was available in other countries before the USA. I knew another mom from Italy, her doctor told her that the next time she went home to visit relatives to get her son the varicella vaccine.

 

[Ivor the Engineer]

I don't understand your claims of anything being forced.

http://www.atlanta.k12.ga.us/content/registration.aspx

Immunization Requirements
Students must present the following documents at the time of school enrollment:
Georgia Certificate of Immunization (Form 3231)
Affidavit affirming that immunization requirements conflict with parents' religious beliefs
Certificate of Ear, Eye, Dental Examinations (Form 3300)
WAIVERS ARE NO LONGER GRANTED
Students must present an updated certificate within 30 days after the date of expiration Students out of compliance must be excluded
Children entering grades K-12 for the first time must show proof of vaccination or immunity to varicella
Only one form (form 3231) will be used effective February 1, 2001.
Children entering the 6th grade are required to show proof of vaccination or immunity to varicella and proof of a second dose of the vaccine that includes measles (usually in the form of MMR)
Hepatitis B vaccine is now required for all new students enrolling in school at any age Immunization Records Management
The Annual Kindergarten Immunization Inventory Report should be completed by October 30th of each school year.
Principals should establish a file to maintain an accurate monthly immunization tracking report.
Eye, Ear and Dental Certificate Requirements All new students must have a completed certificate of ear, eye and dental examination (Form 3300) at the time of enrollment.
A 30-day waiver may be granted for new students from out-of-state to obtain this information.

So non-religious parents who wish their child to have, say, all but one vaccine can either:

a) Lie, and claim to have religious beliefs regarding that particular vaccination,

or

b) Home school their children, with all the extra cost that incurs.

Some states (19, IIRC) allow philosophical objections.

Of course, a physician would never dream of compromising the health of a child for the (irrational) beliefs of his or her parents:

http://www.medscape.com/viewarticle/513925

Refuse Vaccine, Get 'Fired' by Pediatrician?

Oct. 3, 2005 -- Should pediatricians "fire" families if they refuse one or more childhood vaccinations?

Well over a third of pediatricians -- 39% -- say they would "dismiss" families that refuse all vaccinations, a new study suggests. That's surprising, says study leader Erin A. Flanagan-Klygis, MD, assistant professor of pediatrics at Chicago's Rush Medical College.

But another finding surprises Flanagan-Klygis even more. More than one in four pediatricians -- 28% -- say they would fire families that agreed to some vaccinations but refused one or more other vaccinations.

"We were really taken by the number of doctors who would dismiss patients who were partially accepting of vaccinations," Flanagan-Klygis tells WebMD. "We did not expect this high a number."

The study is based on questionnaires filled out by 302 randomly selected members of the American Academy of Pediatrics who provide routine childhood vaccinations. It appears in the October issue of Archives of Pediatrics and Adolescent Medicine.

Doctors aren't taking a my-way-or-the-highway attitude, Flanagan-Klygis says. It's all about trust.

"Their answers really spoke to how important the relationship between parent and pediatrician is," she says. "They did not think they would be able to forge a relationship with a family like that. They felt they would not have the trust they needed to have to move forward."

Parents refusing one vaccination is enough for many American pediatricians to consider dismissing a child from their care.

Here's what the AAP has to say about this:

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/5/1428

Continued refusal after adequate discussion should be respected unless the child is put at significant risk of serious harm (as, for example, might be the case during an epidemic). Only then should state agencies be involved to override parental discretion on the basis of medical neglect. Physician concerns about liability should be addressed by good documentation of the discussion of the benefits of immunization and the risks associated with remaining unimmunized. Physicians also may wish to consider having the parents sign a refusal waiver (a sample refusal-to-immunize waiver can be found at www.cispimmunize.org/pro/pdf/RefusaltoVaccinate_2pageform.pdf). In general, pediatricians should avoid discharging patients from their practices solely because a parent refuses to immunize his or her child. However, when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists, the pediatrician may encourage the family to find another physician or practice. Although pediatricians have the option of terminating the physician-patient relationship, they cannot do so without giving sufficient advance notice to the patient or custodial parent or legal guardian to permit another health care professional to be secured.27 Such decisions should be unusual and generally made only after attempts have been made to work with the family. Families with doubts about immunization should still have access to good medical care, and maintaining the relationship in the face of disagreement conveys respect and at the same time allows the child access to medical care. Furthermore, a continuing relationship allows additional opportunity to discuss the issue of immunization over time.

I’m struggling to tie what appears to happen in practice with AAP recommendations on what should happen in practice.

People have died,

So what? People die from making less than optimal choices all the time. On the bright side, if they do something really stupid they'll be up for a Darwin Award.

and knowing you can die of these diseases is motivation to protect.

Knowing that you will be (very) unlucky to be seriously harmed by these diseases is motivation to not protect and take your (very good) chances.

Fear is the undeniable reaction to reality. It's not made up, it's just life.

If you fear all such unlikely events, you would be in a constant state of anxiety.

And as a parent you need to protect your children with prevention if you wish to prevent the risk of harm and death from now preventable diseases.

And you need to live your life the way I live mine, else you are irresponsible and unfit to look after children.

It would be very irresponsible of someone to not let people know of these very real risks from diseases.

There's no worry of that happening with you around.

You however, have bought into the conspiracies of antivaxxers, and use their words.. forced, "must have".

No, I haven't. But the distance between what is currently occurring in the US from encouraged/promoted and forced/must have is closer to the latter than the former.

These are vaccines people must get to be protected, however-it is still a choice. You don't have to get protected from these diseases, you can leave your children open to the real risks. It is your choice.

Yes, and you will be made to jump through hoops and risk having to find a new physician for wanting all but a SINGLE vaccination for your child.

It would be very irresponsible if the real risks weren't outlined though, and we also see the results of vaccine testing. Results that antivaxxers would like to tell you are false. Vaccines are effective protection, and are far more safe than the diseases. An ounce of prevention is worth a ton of recovery.

So, listen to liars who simply hate vaccines because of paranoia and the need to blame something for things totally unrelated to vaccination if you wish. Just remember that recommended vaccines are not forced, and are not just "must haves" in the way you are alluding to.

If want protection though, then the vaccines "you must have" for that protection are readily available and recommended if you so choose.

If you refuse to listen, how are you ever going to reach an acceptable compromise with most of them?

For example, surely it is better to allow these parents to choose some vaccines from the schedule and not insist all or none, or spread the administration of the vaccines over a wider time span than recommended in the schedule? Ok, it’s sub-optimal, but it’s better than no-vaccinations at all, and helps counter the conspiracy theory that physicians are pushing big pharma products on the public.

 

[Ivor the Engineer]

HC, from your first link:

http://film.guardian.co.uk/news/story/0,,2259197,00.html

Hepatitis A is a disease that results in inflammation of the liver. Symptoms include jaundice, fatigue and nausea. According to the National Institute of Diabetes and Digestive and Kidney Diseases, it is spread "primarily through food or water contaminated by [a] stool from an infected person" or "by having anal/oral sex with someone with HAV [hepatitis A]".

It is not known whether the barman passed a stool before serving food and drinks to Kutcher's guests.

I guess that would depend on how excited he was to be serving food and drinks to all those famous rich people.

Also, when my kids got chicken pox, it spread throughout the school and at least one child was hospitalized with the flesh-eating bacteria. It is a vaccine that actually came from Japan, and was available in other countries before the USA. I knew another mom from Italy, her doctor told her that the next time she went home to visit relatives to get her son the varicella vaccine.

...and the other 499 kids were fine. ETA: Not that 1 in 500 gets a flesh-eating bacterial infection; that's closer to 1 in 300,000, IIRC.

 

[bluecollarscientist]

Beth, thanks for your thoughtful answers to my questions.

They are not ineffective short term. But there are long-term costs to such strategies. One long-term cost is a loss of credibility.

Does the long-term cost accrue to the general pro-vaccination position or just to the fanatics? Some research suggests it does not:

ommunication Research, Vol. 1, No. 3, 243-263 (1974)
DOI: 10.1177/009365027400100301

Obviously French Canadian separatism isn't the same thing as vaccination denialism. But look what effect radicalization has had on attitudes in this realm.

Is there topic-specific research about the best way to communicate the vaccination issue specifically, in the presence of the current antivaccination movement?

Since my perception is that much of the 'cause' of lowered vaccine uptake is perceived credibility of the people advising them, it doesn't strike me as a particularly effective approach.

Fair enough.

I think it would be better to acknowledge the validity of some complaints out the way policies are made and implemented and fix those core problems (like the fact that the CDC committee tends to be biased towards, rather than away from, vaccines) and fix that problem.

I'm not an expert on the issue, but I am in general under the impression that in general anything a large organization does, it does less well than it could. I can see framing a message along the lines of "the anti-vaccinationists have a point, but they take it too far." The thing I'm unclear on is how appropriating their radicalism will have any different effect on the credibility of those arguing the issue, compared to appropriating the kind of radicalism in my list. Both already exist. Maybe it is more efficient to appropriate a more popular radicalism?

Most of my training is in political science, so I'm aware of the evidence that allows one to predict the effects of co-option and differentiation in the presence of extreme positions. What I'm unaware of is what the evidentiary basis skeptics here have for favoring certain approaches to this specific issue. This is another way of asking about research, I guess.

But, on the other hand, I don't think it's reasonable to apply the same sort of pressure to people who decline the seasonal flu shot or chicken pox.

Nor I. I survived the chicken pox and would take those odds again; I would not risk polio, and I would expect policy to roughly correspond to this kind of thinking.

This is just unwarranted. A free society tolerates the free flow of dissenting ideas on almost all subjects.

I think you've misunderstood - I'm not suggesting anyone be denied freedom of speech. When I say that people should be characterized as dangerous, I'm not suggesting we stop them from replying with "no we aren't." I'm suggesting that a vigorous attack on an extremist anti-vaccination position might be effective. There's some evidence to support my position:

Communication Yearbook
2005, Vol. 29, No. 1, Pages 333-361
(doi:10.1207/s15567419cy2901_11)

Communication Research, Vol. 27, No. 2, 107-131 (2000)
DOI: 10.1177/009365000027002001

Networks of Political Action: Toward Theory Construction
David Knoke
Social Forces, Vol. 68, No. 4 (Jun., 1990), pp. 1041-1063
doi:10.2307/2579133

The applicability of this research is arguable, even doubtful, but at least I've got research.

How about we just make them wear a yellow star so others can identify them and avoid them, or maybe a pink triangle depending on what vaccines they haven't had yet?

I think we've now observed a tendency to dismiss this by making not-too-faint suggestions that the person who raised the issue harbors racist and anti-semitic genocidal tendencies. The problem is this is is already being discussed in the public dialogue. I don't have a voice in that dialogue, but I wonder why it is, if fanatical political expressions are so harmful, fanatical expressions are used by those who oppose fanatical expressions? It seems to me that either such tactics work (and that's why Beth and Dynamic employ them), or they don't. Either way there should be some evidence to inform the choice of deploying this kind of highly inflammatory attack on an opposing position, right?

 

[Ivor the Engineer]

bluecollarscientist,

Two words: Ian Paisley

 

[bluecollarscientist]

Perhaps you are somewhat new to the debate. Big pharma has them all in its pockets, see; the CDC; doctors; pretty much anyone who advocates immunization.

I get that. I thought you were saying there was an actual conspiracy (of antivax people) I was unaware of, not that they (antivax people) believed there was one.

I don't know what that physician's specialty is, or what would give you reason to regard her as an expert in risk communication, or how faithfully you "summarized" her comments.

The fundamental disagreement I think we are having is this: I don't know nor care if the person was an expert at risk communication. This person has (or had) a voice in the public dialog on this issue; this person has credentials that will cause them to be perceived as an expert by most who are listening; this person was invited to make her remarks by a legislative body and this also lends her a perception of legitimacy.

It really doesn't matter whether these people conform to your criteria, or mine, of expertise. Nor whether their position was properly summarized. What matters is how they are perceived.

Failure to recognize this is not a sign of expertise in communication....

Ever heard of the Model State Emergency Health Powers Act?

Yes. The third or fourth draft of that was introduced with some alterations in both the Alaska House and Senate in '04 (from memory). It did not pass. We currently have a situation here where a borough law (a borough here is roughly equivalent to a county in the rest of the US, except lacking elected law enforcement) is more restrictive than the state law, and awaits judicial challenge.

Do you consider biologists (or geologists) also to have failed miserably because they have not managed to put a sock in creationist nonsense?

Yes. This is an issue I do have a hand in; and I think collectively, we've done a poor job of communicating evolution, and of responding to creationism. I think it was a miserable failure to have to contest the issue at the Dover trial - my standard of success would be that the issue would never get that far, that the education on the issue would be good to the point that antiscience would not be rooted in the voting public to the extent that an antiscience school board willing to litigate would even arise. So yes, just as the recent Larry King thing is a miserable failure for vaccine communicators, Dover was a miserable failure for us (notwithstanding that we ultimately won that specific case, and notwithstanding that vaccine proponents might ultimately win the overall war).

The newspaper I read every morning still includes an astrology column. Who do I see about getting a sock put in that nonsense?

Not sure. The editor of the paper? The Bad Astronomer has some nice information about astrology you could pass along. BUT, prior experience shows you'll have more success aligning yourself with an extremist position - fundamentalist Christians, in this case - if you seek to actually get it done.

When it comes to anyone "putting a sock" in any of the nonsense that might appear in mainstream media, just how far would you be willing to go?

I'm on record as an advocate of using evidence-based techniques in support of teaching reality-based positions. In the specific case of evolution, I think more fundamental reforms are needed - one is to treat evolution as the foundation of biology (i.e., the status it has in real life) in instructional materials, curriculums, and lesson plans (this is the minority situation in the United States), not as a separate "unit" of instruction. In the case of astrology, I advocate (and practice) teaching of epistemology and critical thinking at all age levels, as well as teaching astronomy; I think the evidence is sufficient to show that this quashes astrological credulity.

Part of adopting evidence-based methods does include making emotional appeals. Virtually all of the research I've seen shows that failure to do that results in an uninterested, dispassionate interest by the audience. The biggest successes that rationalists have had have been named Carl Sagan, James Randi, and a few others, and these people are famous for making effective emotional appeals that lead people to rational beliefs. Those who fail to make emotional appeals get ignored.

And part of using evidence-based methods includes being loud. Look how loud the antivax people were last week, with huge penetration in headlines, on TV news as Orac described, on Larry King, on talk radio.... Sorry, but getting your message to as big an audience as possible, as often as practical, is a very important part of communicating these issues effectively. As research shows. And although I've noticed a lot of scientific studies over the last several years supporting vaccination, I've not noticed anything like the headline penetration the antivax people enjoyed last week.

What do we do if the scope of the problem turns out to be more extensive than what you're accounting for? Because what comes to my mind is the Straight Dope slogan: "Fighting Ignorance Since 1973 (it's taking longer than we thought)".

A syndicated newspaper column is certainly one element, and the point that ignorance will never be eliminated is well taken. I'd consider "success" to be the marginalization of fantasy points of view. In this case "marginalization" would mean such ideas (a) are statistically infrequent, and (b) result in default challenges to credulity. If that is ever achieved, I think I might retire to Tahiti.

 

[biostudent]

Starting a post off with this:

I hate to insult you by saying this is an uninformed assessment, but that is what it is.

And ending with this:

You seem to have narrowly decided that because something doesn't meet your needs, it must not be useful to anyone. That's rather egocentric of you. Anyone who can navigate the web should be able to find the information they are looking for at the level of expertise that meets their needs.

Yes, how... friendly. Such a lovely post. I think I might print it off and frame it.

My response to your first line:
No worries. You insult everyone equally. Sorry, no insult meant by that. It just is what it is. (now, doesn't starting a post off like that really get your defenses up? I know that's what happened to me when I read your "friendly" post.)

Anyway, the point of my post was just to illustrate how the material aimed at patients may be insulting to some. I was trying to point out that that may be one of the contributing problems to the distrust of the profession. I certainly didn't say that that was the case for everyone.

You know what? I actually like you. I wish you would stop being so crabby, though. I wish you would stop jumping to conclusions. I wish you would stop attacking people. This is an interesting topic for me, but you're making me want to stop reading. I'm really not sure what you're trying to accomplish, other than to drive some people, who could be your supporters, away. I really don't see how the attitude (or perhaps better described as the chip on your shoulder) that you have is helping your cause, to be honest.

Oh and egocentric? Puleeze. You need to stop being egocentric! You expect the rest of the world to conform to your profession's preferred way of communicating to the public. (I was trying to give you an example of how that method might fail in some cases and your response, as usual, is essentially that the patients need to be the ones to change)

To the mods: sorry if this post is breaking the rules. I'm not attacking her. I'm just defending myself against her attack towards me. Honestly, I really think that allowing people like her to constantly berate other posters looks bad on the JREF. With that, I think I'm done for a while. I've had enough of her bad attitude (which unfortunately I get exposed to a lot, because, as an aspiring immunologist, I am naturally attracted to the same threads to which she is attracted). And no, I won't put her on ignore. She's in the field, she has a lot of knowledge, and I keep hoping to learn from her. However, I can only take so much of the attitude...

 

[fls]

Oh and egocentric? Puleeze. You need to stop being egocentric! You expect the rest of the world to conform to your profession's preferred way of communicating to the public. (I was trying to give you an example of how that method might fail in some cases and your response, as usual, is essentially that the patients need to be the ones to change)

I will admit that I thought "insulted" was quite an odd reaction on your part. I can assure you that the desire to communicate in a way that is understandable to most is not meant as an assumption that that is all anyone except physicians are capable of. Rather, it is meant to be a starting point. I think you will find, on most patient information brochures/websites, a listing of additional resources for more in depth information, which includes discussion with your health care provider. The 'rule' our profession follows is to "make every reasonable effort to communicate with your patients in such a way that information exchanged is understood". I think Skeptigirl was pointing out, not that the patients need to be the ones to change, but that changes in the type of information provided depend upon the needs of the individual patient. It would be quite unreasonable for basic information to be geared toward your level, as it would represent information overload for most people. Failing to communicate by obscuring your message with too much detail is considered as egregious as withholding important details.

Linda

 

[Chris Haynes]

HC, from your first link:

http://film.guardian.co.uk/news/story/0,,2259197,00.html



I guess that would depend on how excited he was to be serving food and drinks to all those famous rich people.



...and the other 499 kids were fine. ETA: Not that 1 in 500 gets a flesh-eating bacterial infection; that's closer to 1 in 300,000, IIRC.

Personally, I think the issue for both HepA and Varicella is financial.

When HepA went through an adjourning office area (spread through a bowl of popcorn), there was lots of sick days paid out and one employee out for a couple of months. Though, lots of money could be saved if certain idiots would just wash their hands!

As far as chicken pox, it is one parent having to stay home for two weeks. Before the vaccine at least one hospital did have a chicken pox daycare. This was where a child could be in daycare but not infect more kids and the parent could go to work. A few employers subsidized the cost of that expensive option for their employees (one of them being the university). Those special sick room daycares no longer exist.

Because my kids got chicken pox and not the vaccine, we had a month of disruption. It mostly disrupted speech therapy sessions, and caused many sleepless nights because the six month old baby was in pure misery.

Truthfully, I'd rather that my kids had had the vaccine.

 

[Ivor the Engineer]

I will admit that I thought "insulted" was quite an odd reaction on your part. I can assure you that the desire to communicate in a way that is understandable to most is not meant as an assumption that that is all anyone except physicians are capable of. Rather, it is meant to be a starting point. I think you will find, on most patient information brochures/websites, a listing of additional resources for more in depth information, which includes discussion with your health care provider. The 'rule' our profession follows is to "make every reasonable effort to communicate with your patients in such a way that information exchanged is understood". I think Skeptigirl was pointing out, not that the patients need to be the ones to change, but that changes in the type of information provided depend upon the needs of the individual patient. It would be quite unreasonable for basic information to be geared toward your level, as it would represent information overload for most people. Failing to communicate by obscuring your message with too much detail is considered as egregious as withholding important details.

Linda

How do physicians determine the needs of the individual patient when changing the type of information provided?

 

[fls]

How do physicians determine the needs of the individual patient when changing the type of information provided?

Tarot cards.

Linda

 

[Beth]

Beth, thanks for your thoughtful answers to my questions.

They are not ineffective short term. But there are long-term costs to such strategies. One long-term cost is a loss of credibility.

Does the long-term cost accrue to the general pro-vaccination position or just to the fanatics? Some research suggests it does not:

ommunication Research, Vol. 1, No. 3, 243-263 (1974)
DOI: 10.1177/009365027400100301

I’m sorry, I don’t have access to this article. Could you summarize the point it’s making?

As far as long-term cost accruing to just the fanatics, or to the general pro-vaccination position, I would say that it is mainly the fanatics, but the pro-vaccine posters I've interacted with seem extremist to me. It may be a reaction to the extremist anti-vax folks, but I notice that posting any sort of concerns or criticism of current vaccinations or vaccination policy tends to get the poster labeled ‘anti-vax’ when that may not be their position at all. One rule of thumb I use is that extremists view everyone who doesn't agree with them 100% as being against them and fight the moderates as hard or harder than they do the extremists on the other side. The end results is that I perceive them as fanatics and weigh the credibility of those I perceive as fanatics or extremists lower than those who can communicate calmly and rationally.

Is there topic-specific research about the best way to communicate the vaccination issue specifically, in the presence of the current antivaccination movement?

Possibly, but I’m not aware of it.

I think it would be better to acknowledge the validity of some complaints out the way policies are made and implemented and fix those core problems (like the fact that the CDC committee tends to be biased towards, rather than away from, vaccines) and fix that problem.

I'm not an expert on the issue, but I am in general under the impression that in general anything a large organization does, it does less well than it could. I can see framing a message along the lines of "the anti-vaccinationists have a point, but they take it too far." The thing I'm unclear on is how appropriating their radicalism will have any different effect on the credibility of those arguing the issue, compared to appropriating the kind of radicalism in my list. Both already exist. Maybe it is more efficient to appropriate a more popular radicalism?

Good questions. I don't know. It will have an effect on people like me, who actually look into the information available in order make their decisions. I also have looked into the make-up of the CDC vaccine committee (two or three different times over a period of 20 years) in order to evaluate the credibility of those who direct vaccine policy. Currently, I rate them as having low credibility because when I’ve looked into it, it’s clear that the committee that makes those decisions has an inherent bias towards vaccinations and may fall victim to groupthink on the subject.

On the other hand, I think that most people are unable (or unwilling) to research vaccinations to the extent that I have and simply rely on the recommendations of those they trust. So who do they trust? Clearly, the vast majority of people trust their doctors and simply follow their recommendations. But if you’re concerned about those who don’t, then you need to look at why they aren’t trusting the medical profession on this matter and who they trust instead. Ivan posted some research about that recently, though it may have been in another thread on this topic.

Most of my training is in political science, so I'm aware of the evidence that allows one to predict the effects of co-option and differentiation in the presence of extreme positions. What I'm unaware of is what the evidentiary basis skeptics here have for favoring certain approaches to this specific issue. This is another way of asking about research, I guess.

I’m just expressing my personal opinion. What makes me trust in others and why I don’t sometimes. Perhaps I'm not a typical person, since I neither follow the recommendations in their entirity nor I am against vaccinations in general. But I suspect that people like me are the ones you're trying to persuade since I am willing to consider new evidence and change my mind if I feel it's warrented.

But, on the other hand, I don't think it's reasonable to apply the same sort of pressure to people who decline the seasonal flu shot or chicken pox.

Nor I. I survived the chicken pox and would take those odds again; I would not risk polio, and I would expect policy to roughly correspond to this kind of thinking.

A very reasonable position and one I would support, but not what is currently being done nor did you make such a distinction in your previous post. As near as I can tell, there are only two perceived positions, either you support the vaccine recommendation policy 100% or you are labeled anti-vax. Allowing for a middle ground would make it much easier to get the support you want on vaccines like polio and MMR.

This is just unwarranted. A free society tolerates the free flow of dissenting ideas on almost all subjects.

I think you've misunderstood - I'm not suggesting anyone be denied freedom of speech. When I say that people should be characterized as dangerous, I'm not suggesting we stop them from replying with "no we aren't." I'm suggesting that a vigorous attack on an extremist anti-vaccination position might be effective. There's some evidence to support my position:

My apologies for misunderstanding. I thought you wanted to silence their protests or perhaps restrict them to a 'free speech zone'.

How about we just make them wear a yellow star so others can identify them and avoid them, or maybe a pink triangle depending on what vaccines they haven't had yet?

I think we've now observed a tendency to dismiss this by making not-too-faint suggestions that the person who raised the issue harbors racist and anti-semitic genocidal tendencies.

Now you’ve misunderstood me. You were suggesting barring the unvaccinated from public spaces. How can you do that if you can’t identify them? My point was about how implementation of such an idea would likely occur and how attempts at segregating people that are not obviously distinguishable has been done in the past. It was also an attempt to provide some perspective on the ‘harm’ caused by allowing the unvaccinated freedom of movement versus the ‘cost’ of restricting their ability to mingle with others. It did not succeed and was apparently a bad choice. Sorry.

The problem is this is is already being discussed in the public dialogue. I don't have a voice in that dialogue, but I wonder why it is, if fanatical political expressions are so harmful, fanatical expressions are used by those who oppose fanatical expressions? It seems to me that either such tactics work (and that's why Beth and Dynamic employ them), or they don't. Either way there should be some evidence to inform the choice of deploying this kind of highly inflammatory attack on an opposing position, right?

I’m not sure what you mean here by having a ‘voice’ in the dialogue? You have just as much of a ‘voice’ as I do. What do you want to be different in order for your voice to be heard?