Anti-Vaccinationists: A case study in pseudoscience

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Anti-VaccinationistsA case study in
pseudoscience

• Donald Miller, Pharm.D.
• Professor and Chair,
• Department of Pharmacy Practice
• NDSU

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What is Science?

• The scientific method is a self-correcting method
  of making and testing hypotheses through
  experiments (or the best available methods) that
  can be readily verified or rejected.
• At least ideally, science is an objective
  approach in which the best available evidence is
  accepted, regardless of whether it is consistent
  with ones prior beliefs. It also critically
  compares rival theories rather than seeking to
  prove one specific theory.
• Science is a method not a belief system. Its
  strengths are the ability to make predictions,
  openness to peer review and the performance of
  experiments that challenge beliefs and working
  hypotheses.

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Science vs Belief

• Science involves peer review to protect against
  influence of personal biases in doing and
  interpreting studies.
• Scientists regard constructive criticism of their
  ideas and hypotheses as standard operating
  procedure.
• Scientific research is not about proving the
  truth, but about testing our understanding of
  the truth by testing the alternatives. Paradigms
  are modified or even rejected once a better
  understanding of reality comes along. The entire
  body of evidence must be considered.
• Communities of faith naturally look for
  confirmation of their beliefs, not for
  improvement of their understanding.

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What is Pseudoscience?

• The selective use, and misuse, of scientific
  evidence to support a predetermined conclusion or
  point of view (typically based on ideology or
  authority), rather than the unbiased use of
  evidence to draw logical conclusions.
• Sometimes called junk science. Junk science
  also refers to badly done research that is set up
  to support a predetermined outcome.
• But the term junk science has been hijacked by
  pseudoscientists and politicians to disparage any
  evidence with which they disagree.
• Pseudoscientific conclusions typically do not
  change with new evidence. Since evidence is used
  selectively to support an argument anyway, new
  evidence may be ignored or dismissed.

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Legal Analogy

• If you were selected for a jury you would be
  obligated to weigh all the evidence both for and
  against the defendant.
• Lawyers for each side would take a
  pseudoscientific approach of presenting the best
  selective evidence for their side, but the judge
  and jury must be impartial.
• Assume there are ten witnesses to a car accident
  2 say the first car was speeding and 8 say it
  was traveling at a normal speed before the crash.
  The police must interview all witnesses and then
  all must be allowed to testify.
• If only testimony of the first 2 is considered we
  are being biased and pseudoscientific.

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Why Are People Attracted to Pseudoscience?

• Humans are not naturally critical thinkers or
  adept at using evidence most people judge a
  proposition by whether it makes sense or feels
  right.
• Pseudoscientific explanations of phenomena tend
  to be much simpler and more emotionally
  satisfying than complex explanations.
• We are also highly egocentric using our
  personal experience and the beliefs of our
  friends and family to judge what seems right.
• Furthermore, we are highly disposed to preserve
  our current beliefs rather than to challenge them.

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Background on Vaccinations

• Established by Edward Jenner with vaccination for
  smallpox in late 1700s.
• Polio vaccine in 1950s
• Very cost-effective (cost saving)
• Consistent with preventative medicine
• Vaccinations have been called the most important
  single contributor of any medical advance to
  reduced global morbidity and mortality1

1. JAMA 20022883155-58
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Todays Vaccines

• U.S. policy set by the Advisory Committee on
  Immunization Practices, an advisory group to the
  U.S. Public Health Service and the CDC.
• Additional guidelines by American Academy of
  Pediatrics and American Academy of Family
  Physicians.
• Childhood vaccinations series recommended for
  measles, mumps, rubella, varicella, polio,
  diptheria, tetanus, pertussis, haemophilus
  influenza type B, pneumococcus, hepatitis B,
  rotavirus, and HPV.
• Adult vaccinations recommended for measles,
  mumps, rubella, tetanus, diptheria, varicella,
  hepatitis B, plus populations at risk of
  hepatitis A, influenza, and pneumococcus.

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Efficacy of Vaccines

• Smallpox and polio have been completely
  eradicated in the U.S., while incidence of
  several other diseases such as measles and
  pertussis have been reduced by 98-99 compared to
  their baseline annual incidence.
• Protect both the individual and the community
• Yet almost 50,000 people/year die in the U.S.
  from vaccine preventable diseases.1

1. Ann Intern Med 2007147735-7
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So Why Would Anyone Oppose Vaccines?

• Individual rights and distrust of government
  (childhood vaccines are mandatory for school
  enrollment)
• Distrust of organized medicine and belief in
  alternative natural healing paradigms.
• Actual adverse effects
• Sore arms, fever, flu-like illnesses,
  Guillain-Barre Syndrome (1.8 cases/million)
• Older pertussis vaccine often caused fever,
  crying, limpness, and occasionally seizures.
• Actual infection with virus - the Cutter incident
• Alleged adverse effects
• sudden infant death syndrome (SIDS), autism,
  multiple sclerosis, vague claims of neurologic
  disorders.

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The Cutter Incident

• Initial Salk vaccine developed with inactivated
  polio virus and was successful in field trials
• In conversion to mass commercial distribution,
  Cutter Laboratories produced a vaccine in which
  some virus was still active, leading to 164 cases
  of paralysis and 10 deaths
• Cutter was found legally liable, though not
  negligent (establishing a precedent that still
  inhibits vaccine manufacturers)
• Getting the disease itself is still a remote risk
  with all vaccines that use live (attenuated)
  virus, thus immunocompromised patients cannot
  receive them.

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Risk Benefit of Vaccines

• Actual risks of vaccines are well known and are
  much less than the risks associated with the
  corresponding diseases that are prevented.
• Costs of adverse effects can be compensated by
  the vaccine adverse events reporting system
  (VAERS)
• Accurate information readily available through
  pediatricians and government web sites

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Tactics of Pseudoscientific Opponents of
Vaccination

• Appeals to morality
• Conspiracy theories
• Appeals to free choice
• Appeals to authority
• Scientism
• Appeals to emotion (anecdotes)
• Errors in logic
• Deception and outright lies

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Appeals to Morality

• New vaccines (Gardasil, Cervarix) are licensed
  for human papilloma virus, the leading cause of
  cervical cancer. Optimal vaccination must occur
  prior to sexual activity, but conservatives
  oppose this as encouraging sexual activity.
• Two vaccines (varicella, rubella) were developed
  from viruses originally grown in human cell
  cultures from aborted fetuses. No ongoing embryo
  destruction occurs.
• Interestingly, even 2 centuries ago, early
  opponents of vaccination felt it was immoral
  because it interfered with Gods plans.

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Conspiracy Theories

• A common tactic of pseudoscience is to talk of a
  conspiracy by organized medicine to hide the
  true risk of vaccines.
• In fact, the established risks of vaccines are
  easy to find in the literature and are publicized
  by the Centers for Disease Control at
  http//www.cdc.gov/vaccines/vac-gen/side-effects.h
  tm

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Appeals to Freedom, Informed Choice or Free
Choice

• A free, informed choice requires accurate
  information not something that anti-vaccination
  web sites generally provide.
• Critics of mandatory vaccinations fail to
  understand the role of public health in
  protecting populations. Individual freedoms may
  be reasonably limited to protect the greater
  public (e.g. public smoking bans, quarantine)
  under the 10th amendments police power granted
  to states.1

1. Stewart AM. NEJM 20093612015-17
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Appeals to Authority

• Celebrities and peripheral scientific figures

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Scientism

• The use of, and belief in, the trappings of
  science (big words, p values, journal citations,
  etc.) to give the false impression of accuracy
  and honesty.
• Most anti-vaccine web sites are slick and
  convincing to an uninformed user.
• Journal citations are frequent (and the sheer
  volume superficially impressive), but are almost
  all outdated, selective, or used to support
  statements not implied by the actual reference.
  E.g. http//thinktwice.com/s_autism.htm

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Claims That Several Vaccines At Once Can
Overwhelm the Immune System

• Todays vaccines mostly use highly purified and
  specific viral proteins, in comparison to the
  nonspecific proteins or whole viruses formerly
  used, so the total burden of immunologic
  stimulation is minimal and has not increased.
• In addition, children are naturally exposed to
  many infectious agents that provide a high number
  of antigenic viral and bacterial proteins.

NEJM 20083582089-91
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Emotional Appeals Through Anecdotes

• Web sites often contain personal stories and
  pictures of children allegedly injured by
  vaccines, as well as pictures of menacing
  needles.
• E.g., http//www.nvic.org/Vaccine-Memorial.aspx
• Anecdotes are misleading because there is no way
  to know if the alleged adverse effect is related
  to the vaccine (confusing association with
  causation).
• Even if a vaccine did cause the injury, anecdotes
  give no sense of how common the injury is, or the
  overall risk/benefit ratio.

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From http//thinktwice.com/faq.htm8

• In 10, down three. A lot of adult vaccines are
  really problematic too. I was recommended by a
  travel clinic to have the Japanese encephalitis
  vaccine for a luxury trip to India and Nepal.
  We're retired and this is the trip we've dreamed
  about. I went in on September 24 and had shot 1
  of 3. They do a before and after blood pressure
  check. Before was 130/80. After was 140/80. Ten
  days later, I returned for shot 2. Before was
  150/80. The nurse said she didn't want to
  administer it so I went home. The doctor said to
  go ahead and complete the series. I didn't. A
  week later my blood pressure was up to 160/80.
  Then yesterday it was 170/80, and they gave me a
  prescription for medication.

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Errors in Logic

• Association between events assumed to mean
  causation (vaccinations are given around the time
  in life when autism can first be diagnosed and
  SIDS occurs.
• Recall bias. It is normal to want to find a cause
  for unsettling events and one may inaccurately
  recall the onset of an event like autism,
  multiple sclerosis, etc. to coincide with the
  vaccination.

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The Autism Controversy

• Since vaccines are given at about the same age
  that autism is able to be diagnosed, naturally
  many diagnosed children will have received one or
  more vaccines very recently. An apparent spike in
  autism cases has occurred since the 1980s.
• The link between MMR vaccine and autism received
  wide publicity in 1998 with publication of 12
  cases of children developing gastrointestinal and
  developmental problems shortly after vaccination
  (Lancet 1998351637-41) The authors hypothesized
  that the vaccine or its thiomersal preservative
  were causative.
• The speculation caused a collapse of confidence
  in the vaccine and thiomersal, especially in
  Great Britain.

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The Autism Controversy

• Not only was speculation of cause and effect
  inappropriate, the study and publication took
  place about 8 years after vaccination and
  involved parents recollection of events.
• Several prospective studies subsequently found no
  association between the vaccine and autism or
  other problems.
• The publication was retracted in 2004 after
  coauthors discovered that the main author had
  been paid by an organization to look for evidence
  to support a lawsuit over immunizations.
• Thiomersal has been gradually removed from
  vaccines, not due to proven harm, but to increase
  acceptance of vaccines and assure the public that
  everything possible is being done to assure
  safety (but new cases of autism continue to
  occur!).

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The Autism Controversy

• Similar controversies have existed about DPT
  vaccine and Sudden Infant Death Syndrome,
  hepatitis B vaccine and multiple sclerosis, HiB
  vaccine and childhood diabetes, anthrax vaccine
  and Gulf War Syndrome, etc., all without
  confirmation.
• Such scares are typically precipitated by
  clusters of the disease in question, where people
  look for associations to explain the cluster.
  What is not generally appreciated is that
  apparent clusters of any disease can occur at
  random from time to time, with no causal etiology
  at all.

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Outright Lies and Distortions

• Claims that vaccines are ineffective or just
  temporarily effective.
• Claims that vaccine policy is motivated by
  enormous profits to the vaccine industry and
  individual physicians.
• Adverse effects of vaccines are underreported
  (implying a cover-up)
• Claims that vaccine preventable disease have
  declined for other reasons such as improved
  nutrition or hygiene.
• The majority of people who get disease have been
  vaccinated

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Outright Lies and Distortions

• The credo Vaccines are more dangerous than the
  disease.
• This is true only in so far as vaccines have
  largely eliminated many diseases. From an
  individual perspective, the actual dangers of
  each disease are considerably higher than the
  risks associated with the corresponding vaccine.
• From a societal perspective, the current rarity
  of the diseases may in fact mean that more
  persons are injured by vaccines than the
  corresponding diseases. But this is the price we
  pay for keeping the diseases rare.

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Outright Lies or Distortions

• Claims that vaccine-associated illnesses have no
  spontaneous cause. (But all the alleged illnesses
  such as autism - do, in fact occur
  spontaneously and without clear precipitating
  causes).
• Claims that vaccination in general, or too many
  vaccinations, weaken the immune system and causes
  autoimmune diseases.
• Claims that disease outbreaks in unvaccinated
  areas are rare or exaggerated by the media.
• Claims that vaccines are loaded with extra toxic
  ingredients like aluminum.

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Outright Lies and Distortions

• Blatant distortions such as citing an article
  that actually says mumps is now more common in
  older people than children, and twisting it to
  falsely claim that mumps is now more common among
  the elderly than prior to vaccinations.
• Even attacks on the germ theory of disease!

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From http//thinktwice.com/faq.htm8

• Recently vaccinated children do carry the
  disease germ and are able to spread it to other
  children. Many so-called epidemics are initiated
  and spread in this manner, even though the
  unvaccinated are blamed. some authorities
  argue that parents who do not vaccinate their
  children reap the benefits without taking the
  risks -- a curious argument since they also argue
  that such parents are irresponsible by
  unnecessarily exposing their children to greater
  risk by choosing not to vaccinate.

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From http//thinktwice.com/angry.htm

• Regarding polio, over 95 of the population can
  be exposed to the poliovirus and will not
  contract polio. This indicates that the
  poliovirus is not responsible for the illness
  that is associated with it. The health of the
  organism is the more significant factor. Doctors
  should be more concerned with promoting health
  than pushing drugs.

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Conclusions

• Vaccines in general are very safe and effective.
  The risk of adverse effects is greatly
  exaggerated by irresponsible parties.
• The distinction between scientific evaluation of
  claims and pseudoscience is crucial for all
  educated persons to understand.

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Additional Anti-Vaccination Web Sites

• http//www.gulfwarvets.com/anthrax.htm
• http//nyvic.org/nyvic/
• And pro-vaccine information sites
• http//www.pathguy.com/antiimmu.htm
• http//www.immunizationinfo.org/
• http//www.jennymccarthybodycount.com/Jenny_McCart
  hy_Body_Count/Home.html

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Further Information

• General recommendations from ACIP
  http//www.cdc.gov/mmwr/pdf/rr/rr6002.pdf
• Immunization Action Coalition http//www.immunize.
  org/safety/index.htm
• Lo B, Katz MH. Clinical decision making during
  public health emergencies Ethical
  considerations. Ann Intern Med 2005143493-8.
• Wolfe RM, sharp LK, Lipsky MS. Content and design
  attributes of antivaccination web sites. JAMA
  20022873245-8
• Davies P, Chapman S, Leask J. Antivaccination
  activists on the world wide web. Arch Dis Child
  20028722-5.