Sometimes the decision of when, how and whether to immunize children can feel like the battleground in a larger culture war. Parents can feel under fire from social media influencers, relatives and friends, and confused about who to trust and what to believe.
Whenever I have conversations with parents about immunizations, I try to approach it in an unemotional way and meet them where they are, providing them with sound information and allowing them to make their decision. My goal is to help them look at the scientific data, if they are willing. Because that’s what these decisions should be based on rather than emotion or anecdotes of personal experience. I’ve discussed the data in other posts and I want parents to realize that as a medical community we have nothing to hide.
After having many of these conversations, I’ve come to realize that sometimes vaccine decisions get made on a faulty understanding of science or cherry-picked data. And other times they don’t get made on scientific evidence at all, but instead on emotion, culture and even political grievances, as illustrated in “Stuck: How Vaccine Rumors Start- and Why They Won’t Go Away” by Heidi Larson. But what would healthcare be like if we didn’t subscribe to the importance of science, and of science done correctly?
In this post I want us to take a step back and think about the philosophical underpinnings of science and why following it is so important for our health. This is extremely relevant for the vaccine question, but also for many other areas of health and society. Many of these thoughts were inspired by another good book I recently read called “The War on Science” by Shawn Otto.
The case for science
What is science? Most simply, it is the structured observation of nature. Our nation’s founding was in part based on the enlightenment belief in empiricism and the democratization of knowledge- which is that any person could observe nature and gain knowledge about natural processes through study rather than blindly accept the teachings of the powers that be– whether they were priests, kings or landowners. In that sense, science is actually anti-authoritarian and ultimately skeptical. It’s the great leveler. It challenges the status quo. It’s not afraid to ask, Do things really have to be this way? How can we make things better? Science chases the unflinching ideal that there is such a thing out there as objective truth and that we can collect evidence about it through the scientific method. But it has to done the right way. We can be fooled by our observations. If you cross a black cat on the way to a meeting where you got let go from your job, was it really the cat that brought you bad luck? That’s where the importance of structure comes in- we need to control the variables in an experiment, use critical thinking, and repetitive observations and, better yet, controlled experiments to see if results are consistent.
Are you a scientist or a lawyer?
If you want to learn how not to do science, do like a lawyer. Lawyers use a top-down a priori approach to collecting data. They begin with a conclusion (someone is innocent or someone is guilty) and collect evidence that supports their already formed conclusion. That’s their job. If something doesn’t support their conclusion, they look for ways to discredit it, suppress it, or distract from it. If we did science that way, we could get blindsided. Scientists use a bottom-up method called the scientific method. They draw their conclusions after reviewing the evidence. They go where the data leads them. The scientific data determines the truth of a matter as it is apparent. They begin with a hypothesis, collect the data, analyze it and then reject or accept the hypothesis. But this means nothing until other scientists show that they also get similar data. When findings are replicated, scientists call this a “preponderance”of data. There is strength in numbers that supports a hypothesis.
This process has brought us sanitation, electricity, engineering, transportation, modern healthcare, and so much more, including the eradication of smallpox, the near eradication of polio, and the drastic reduction of other vaccine-preventable diseases. In fact, the scientific method is the most powerful tool mankind has ever used to improve the human experience. Because of science we can rise above superstition and guesswork.
So why is there a war on science in our post-modern world? Why the distrust? I think there are a few reasons. One is that many people are confused by the inherent uncertainty within science. Scientists don’t profess to know the complete truth, and our understanding of the truth can change based on new evidence. Since science is anti-authoritarian and challenges the status quote, we can always get new information that changes our views. That’s the way it should be if we want to keep learning and improving. That’s why we sometimes get recommendations that contradict past ones, like wearing masks to stop the spread of COVID or placing babies to sleep on their backs. If you don’t understand that, you might see scientists changing their minds as evidence that “they don’t know anything” when in reality they are using the scientific method to do exactly what it was meant to.
People at times trust their own observations (their “n=1 experiments”) over higher quality observations (i.e. studies). They hear about a child or even have a child who was diagnosed with autism soon after getting a vaccine. But was the vaccine really the cause of that child’s autism, or was it a coincidence? Does the assumed link between autism and vaccination hold up when you study groups of children? If there were a link, then you should see more autism among vaccinated children than unvaccinated children. (But we don’t.) Science reminds us that we can’t draw broad conclusions from single, or even a few, instances. Instead we need to analyze a preponderance of data.
Another reason people become anti-science is they confuse science itself with how science might be applied, or the power or money that science is used to obtain, or the political wrangling leaders go through to try to influence science. Some of those things absolutely deserve to be attacked, but not the science itself. If we lose sight of which is which, then we risk throwing out the baby with the bathwater.
When leaders, corporations or even scientists have gotten things wrong, it’s because they are swayed by money, power, or other incentives to drift away from the preponderance of data. Similarly, parents can be swayed away from the preponderance of data by influencers that cherry-pick the data that support their interests. These parents will say they are not outright anti-science, but they are, because they are ignoring the evidence that doesn’t fit their pre-formed conclusions and only paying attention to the evidence that does. They are approaching science like lawyers. That’s not science.
Science reporting in the information age
People are dependent on what they read from news sites and social media for science information. Social media has given everyone a megaphone, whether they are qualified to report science or not. “Influencers” are rewarded for having large followings and attracting clicks, not for reporting the facts without bias. Social media becomes an echo chamber. People listen to what they want to hear and there are plenty of people willing to say it. Even news outlets are prone to this, especially as they have increasingly shunned the “fairness doctrine” and have had to compete for attention. Many traditional news outlets have had to jettison science reporters and even science sections to streamline their budgets. Increasingly, journalists come from training in the humanities and often don’t have an understanding of what makes a scientific study of higher or lesser quality of evidence- as in the difference between an observational cross-section study, a retrospective cohort study or a randomized controlled trial, hence the confusion about hydroxychloroquine being an effective treatment for COVID-19, or why side effects found in the Vaccine Adverse Event Reporting System (VAERS) haven’t been verified and therefore can’t be trusted as true.
Furthermore, embedded in humanities training is the tenet that there is no such thing as objectivity, that the truth is only as it is perceived in the eye of the beholder, which is fundamentally different from the science view that the actual truth is “out there somewhere” even if we don’t see the complete picture yet. So there is a tendency for some reporters to say “it’s all subjective anyway” and discredit the preponderance of data as just being how “the experts” see it, and science as just “one way of knowing”. The problem with that is if you believe that all viewpoints are of equal quality, then you nullify the value of expertise. This leads to a sense of “false equivalence” when a scientific issue is reported. For example, a scientist or doctor citing the preponderance of quality studies that support the safety of an immunization is countered with a celebrity or news anchor who cites the few poor quality studies that don’t. But why would we trust the health advice from Jenny McCarthy or Jim Carrey or even a journalist over a doctor or a scientist?
Political influence on science
Politicians on either side of the aisle are always willing to selectively represent facts from science to justify their positions. But science itself is not inherently partisan. The knowledge and ability that come from science, however, may challenge the status quo and therefore become the target of politicians. We should not rely on political leaders for health advice except for as they consult with qualified public health authorities and scientists who understand the data and are not politically motivated. When political leaders seek to influence, muzzle or pressure science, it is a recipe for disaster. But science is a powerful tool to protect public health, and it works in our favor when it has its place in shaping public policy. Even though people disagree about how to best apply the science, they should seek to be clear on what the science actually says and not on what we want it to say.
On the other hand, people have a tendency to literally censor their own intake of scientific information because of their identity politics. Too often they fail to see past their own confirmation bias when it comes to a scientific or health issue that has become politicized.
Politicians in turn capitalize on this, as we’ve seen when vaccine-hesitant messages get parroted in political debates. And studies have found evidence that vaccine misinformation has been propagated on social media by international political actors with ulterior motives.
The influence of culture on science
In decades past, vaccine hesitance seemed to be a phenomenon of college educated, urban political left-leaning parents. In the post-COVID era it seems to be shifting and becoming more of a conservative bias. Some of the mistrust of science we have today grew up in the 1950s and 1960s under the threat of atomic warfare and the nuclear fallout, both products of the darker side of the use of science and its power. This was coupled with a mistrust of authority in the 1960s and 1970s that felt the pull of energy healing and other alternative medicines (some of which is supported by data but much of which is not). This fermented into anti-government sentiment in the 1980s. This coincided with a time in which supposed side effects from whole-cell pertussis vaccine (which is no longer in use) got a lot of media attention but were later found to be due to an unrelated neurological disorder called Dravet syndrome. Government programs were set up to protect the vaccine industry and ensure a stable supply of vaccines. The 1990s and the turn of the century brought the explosion of the internet in the Information Age, and then moving into the 21st century social media poured gasoline on the fire. With it came an abundance of conspiracy theories and alternative interpretations of facts. Now we are in what sociologists call the “postmodern” age where expertise is meaningless, and believing there is such a thing as objective truth is close-minded and absolutist. Today what seems to matter is being true to how you see the world and living and speaking “your truth” regardless of the evidence. People talk about the importance of listening to “both sides” without giving authority to the preponderance of evidence or its absence on one side or the other. People assume that all voices have equal authority.
However, the American Academy of Pediatrics, the American Academy of Family Physicians, the Institute of Medicine, the Center for Disease Control and Prevention don’t deserve more authority to speak on vaccines just because they are the top experts in their field, but because they follow the preponderance of data. Hundreds of trusted children’ health organizations and hospitals across the country including Primary Children’s’ Hospital, John Hopkins University, Children’s Hospital of Philadelphia agree with those professional organizations, not because they blindly follow their recommendations, but because their doctors also examine the evidence and follow the data.
Landmines, casualties, and protection
Let’s talk about one prime example of how science has been ignored, misrepresented or manipulated to fit social, political or financial incentives, and the harm that has caused.
In 1997, Andrew Wakefield published a study of 13 case reports of patients who he claimed got autism from the MMR vaccine. However, after publication it was discovered that he did not disclose his funding for the study, which came from a group of lawyers who were seeking evidence for suits against the maker of the current MMR vaccine. He hid the fact that these lawyers had paid him a personal £400,000. An investigation into Dr. Wakefield’s methods (which you can read about in detail here) found that he essentially conducted the study like a lawyer, cherry-picking the data that supported his conclusion and ignored the rest, and even fabricated some data. The study was highly unethical and fraudulent. Furthermore, Dr. Wakefield was in the process of filing a patent for a single non-combination measles vaccine that he would have been in a good position to market once the combination MMR vaccine was discredited. Dr. Wakefield manipulated science for monetary gain.
On the other hand, there is a preponderance of data replicated in dozens of studies done with no conflicts of interest involving over a million children that show no higher rates of autism among children who are MMR vaccinated than children who are not vaccinated. Furthermore, science shows that vaccinated children perform no differently on a variety of neuropsychological tests than unvaccinated children. Dr. Wakefield’s erroneous ill-motivated “science” went against this preponderance of data, and science, done correctly, has proved him wrong.
Unfortunately, MMR vaccination rates fell in England, Japan and other countries where people believed the anti-science, for many of the reasons mentioned above. Measles rates spiked in places it was close to being eliminated, including in pockets around the USA. Autism rates though? No decrease.
Dr. Bob Sears is one of the many who have been willing to cash in on the resulting fear of vaccines stemming from the Dr. Wakefield fiasco. Now worth $5 million, he published a best-selling book presenting his own vaccine schedule, which he claims is safe. Yet he offers exactly zero studies showing his alternative schedule is any safer, or even as effective in preventing disease. This is a great example of anti-science: how is Dr. Sears, a single rank-and-file pediatrician, more knowledgeable about vaccines than networks of the nation’s top vaccinologists, epidemiologists and infectious disease specialists, all working together? He raises questions and concerns about vaccines that can in fact be answered, and have been answered- by science. Many of the very scientists he claims to know more than have since refuted his claims.
Contrast Dr. Sears and Dr. Wakefield with the example of Rotashield. Soon after it was put into use, post-licensing safety monitoring data detected 1-2 more cases then expected of intussusception (a serious intestinal illness) per 10,000 children who got that vaccine compared to children who didn’t. Since it was a rare event it wasn’t detected prior to that, until larger groups of children received it. The Vaccine Adverse Event Reporting System (VAERS) that has been set up for this purpose detected the problems quickly. Emergent scientific studies were done through the Vaccine Safety Datalink to gather data and verify whether there really was a relationship between Rotashield and intussusception. There was, and the CDC pulled it from use. Eventually Rotashield was replaced by safer vaccines (Rotateq and Rotarix) that were demonstrated to not have that problem. Ever since these vaccines have been put into use, cases of rotavirus have plummeted without an increase in cases of intussusception. The science, and the system set up to use it, worked! In regard to other vaccines currently being given, data is constantly being gathered and analyzed to make sure vaccines are safe. The example of Rotashield should reassure parents that this system works. Indeed, vaccine preventable diseases have plummeted the world over and the vaccine schedule continues to be monitored for safety.
I don’t ask parents to blindly trust that all vaccines are perfect and I wouldn’t give any child a single vaccine without knowing the data behind it. I do ask them to trust the science that has already been done, that demonstrates the safety of the vaccines currently in use. I want them to know that there is a safety system in place based on science. (Read more about this safety system here, here, here and here.) I do ask them to be cautious about interpreting scientific data and consider the sources from which they get their information. Do these sources of information have a political, economic or other motive to share dis- or misinformation? If parents trust this information over the preponderance of validated scientific data, they should ask themselves if that is for reasons related to emotional, political or cultural grievances? Ultimately, the most important consideration needs to be the wellbeing of our children.
Ultimately, the “war” that is going on is not a war between two different points of view- antivaxxers vs. scientists/doctors- it is a war between ulterior motives, disinformation and the objectivity and process of science. Science gives parents the power to keep their children healthy, and have a reasonable confidence in their decision. Science gives us evidence, and with that evidence we can chose the best path, instead of being crippled by superstition and anxiety.