I suppose you have heard about the recent Disneyland measles outbreak. The story is receiving wide coverage in the media, triggering a fresh wave of angst over the increasing reoccurrence of preventable diseases in the United States–and outrage over the small percentage of parents who do not vaccinate their children.
Last year, per the Centers for Disease Control (CDC), there was a spike in measles cases in the United States, stemming, it seems, from unvaccinated travelers who brought the disease back with them from the Philippines, where a large outbreak has been occurring since 2013. A general media narrative taking shape now with the Disney outbreak story is informed by this CDC graphic from last year.
So what’s the latest news on the Disney-centered outbreak? Via the Associated Press (AP):
In a rash of cases that public health officials are rushing to contain, at least 70 people in six states and Mexico have fallen ill since mid-December, most of them from California. The vast majority of those who got sick had not gotten the measles-mumps-rubella, or MMR, vaccine.
Some of the media coverage has focused on “pockets” of unvaccinated children in certain California communities where vaccine-averse parents have clustered.
As the CDC notes of the three largest measles outbreaks of 2014, “transmission occurred after introduction of measles into communities with pockets of persons who were unvaccinated because of philosophical or religious beliefs.”
A new study (PDF) on these geographic clusters has just been published in the journal Pediatrics. A high concentration of unvaccinated children make these communities much more susceptible to outbreaks.
The Los Angeles Times, advancing a theme echoed in many media stories, writes that the Disneyland outbreak “has generated increased concern about the rise in the number of parents who do not immunize their children.” Similarly, the Washington Post wonk blog, referring to a 2014 survey, says that “only 51 percent of Americans were confident that vaccines are safe and effective, which is similar to the proportion who believe that houses can be haunted by ghosts.”
The two impressions you get from such articles is that more parents are not vaccinating their children and that many Americans are not confident in the safety of vaccines–and both these impressions would be dead wrong. Dan Kahan, a Yale researcher who studies science communication and risk perception, was dubious about the findings in that survey cited by the Wonk blog. In an email exchange with me, he said:
I don’t know what the survey item was, but I do know that if one constructs valid measures, one can easily show that there is overwhelming confidence in vaccine safety. Items that ask whether people are “concerned” about vaccine “side effects” are not a valid predictor of vaccine hesitancy among parents; even parents who make sure their children get every vaccine will say “yes” to that question — it’s simply not a valid indicator of vaccine hesitancy.
Indeed, no public opinion survey of the general public can give anyone useful information on vaccine risk concerns. The only valid evidence of that generally is the National Immunization Survey, which uses actual vaccine behavior to determine vaccination rates. It shows that there has been no drop off in vaccination rates in more than 10 yrs — & no measurable increase in people exempting from vaccination (that figure is below 1%).
Nonetheless, the recent spike in measles cases in the United States is the background context for the Disney/measles outbreak story. So, as the New York Times reports:
The latest outbreak has renewed a heated debate about an anti-vaccination movement championed largely by parents who believe discredited research linking vaccines to autism, or who believe that the risks of some vaccines, including the measles inoculations, outweigh any potential benefit.
This kind of narrative framing taps into the frustration of medical professionals on the frontlines of pediatric health, who lash out at vaccine-hesitant parents. Examples below.
From the AP:
“Some people are just incredibly selfish” by skipping shots, said Dr. James Cherry, a pediatric disease expert at the University of California, Los Angeles.
From the NYT:
Dr. James Cherry, a specialist in pediatric infectious diseases at the University of California, Los Angeles, said the outbreak was “100 percent connected” to the anti-immunization campaign. “It wouldn’t have happened otherwise — it wouldn’t have gone anywhere,” he said. “There are some pretty dumb people out there.”
This soundbite was picked up by other journalists on Twitter:
On anti-vaxxers, UCLA prof says: “There are some pretty dumb people out there.” http://t.co/EPZt0Xv5pC
— Charles Ornstein (@charlesornstein) January 22, 2015
@charlesornstein seriously unhelpful approach to talking about this issue
— Brendan Nyhan (@BrendanNyhan) January 22, 2015
On the quotes in the AP and NYT highlighted above, I asked Nyhan via email to elaborate:
I’m concerned that some vaccine advocates and doctors have been labeling people who aren’t vaccinated as “selfish” or “dumb” during coverage of the Disneyland outbreak. We need to maintain and strengthen the consensus around vaccination, but the most effective way to do so isn’t by polarizing and dividing people. The vast majority of parents who don’t vaccinate are intelligent and well-meaning people who are trying to do what’s best for their children. We need to help them make better choices, not ridicule them.
There are communication studies from experts that point to more constructive approaches, some of which I wrote about last year. Meanwhile, it’s worth asking if the media, in its Disneyland/measles outbreak coverage, is 1) overstating the importance of the anti-vaccine movement, and 2) eliciting the kinds of reactions from public health professionals that are more likely to unnecessarily demonize and alienate vaccine-hesitant parents?
This is not to downplay the real consequences of misguided decisions made by vaccine resisters. Clearly, they are endangering their fellow citizens. But we should be careful about drawing the wrong conclusions from these episodes.
As Kahan also remarked to me:
I’m sure it’s true that outbreaks are more likely to occur in areas with undervaccination enclaves. But that’s been true forever; it’s not new. The claim that outbreaks are tied to declines in vaccination rates or growing parental resistance, etc., is not true.
The media narrative here is comparable to the one on whooping cough [in 2013], where media kept insisting that the outbreaks were caused by lower vaccination rates. Vaccination rates hadn’t dropped. It turned out the new booster shot–made with dead rather than live pertussis — was not as effective. Reporters ignored this for quite some time, but eventually the word got out.
Kahan thus cautions against jumping to the wrong conclusions again with the latest measles outbreak:
The low-vaccination enclaves *are* a public health problem. But attributing them to general anxiety over vaccine risks in public is not useful — and in fact is itself dangerous.
Misdirected concern also ends up confusing private funders, who are more likely to be suckered by advertising consultants into a “social marketing campaign” when what they ought to be doing is supporting the research of a guy like Doug Opel at the University of Washington, who has developed a very decent screening instrument to help pediatricians identify parents who are likely, out of fear or confusion (they aren’t marching around like Jenny McCarthy et al; they’d be easy to spot then!), to have their kids skip shots. With an instrument like that, doctors can focus attention strategically on parents who might well respond to counseling. Of course, one can use empirical methods to develop good counseling protocols too — if you can identify who the likely nonvaccinators are in an effective way.
That’s where the real public health attention should be: on supporting valid studies to designed targeted identification and counseling.
As this latest measles outbreak runs its course, perhaps some of my colleagues in the media will take a look at the emerging research that aims to foster more constructive engagement on vaccine issues.
UPDATE: Julie Leask, a social scientist at the University of Sydney, Australia is an essential source for anyone seeking insight into risk communication and vaccine-related issues. I queried Leask as I was writing this post. Below is her response, which, due to our different time zones, came in after my post went up. Please take a minute to read her perspective:
The extent of the Disneyland outbreak is a big concern because measles can be a very serious disease, causing pneumonia, convulsions, croup, inflammation of the brain (encephalitis), which could result in hospitalisation and even death. But the way the problem is being explained in the media right now generally is unhelpful.
To be committed to the science of immunisation ideally comes with a commitment to the science of immunisation behaviour. Media often present this problem as refusal to vaccinate. But the evidence is clear and it’s more complex: under-vaccination is broadly about a lack of acceptance and a lack of opportunity to vaccinate fully or on-time. It’s not just the haves, but the have-nots who don’t fully vaccinate.
A typical measles outbreak will reveal this. There will be children whose parents refused vaccination; children whose parents were unwittingly not up to date for lack of access; affordability or awareness; adults and travellers who didn’t get a needed booster; and babies who are too young to be vaccinated.
Some of the solutions to under-vaccination are at our fingertips. For vaccines to reach people you need to have ‘well oiled’ systems, which include free and accessible vaccines, national registers, reminders, incentives and reasonable sanctions. Ensuring services are culturally respectful is important so people are not put off attending. If we keep focusing only on the active refusers alone, governments get off too lightly.
Having said that, active refusal of vaccines remains a real and persistent problem. The evidence base is very limited but there are some promising strategies. At a state level, exemptions that require the signature of a physician minimise the active non-vaccinators. In the physicians office, making a positive recommendation, spending time with hesitant parents (and less with entrenched decliners), building trust and rapport and even if they delay or don’t vaccinate, keeping the door open. We also need try out community based approaches first by better understanding the social norms and group commitments that lead parents to not vaccinate.
It’s a difficult one because it’s much harder to change motivation than to change the practical barriers. But there are researchers around the world committed to doing this.
To end, it’s probably appropriate to quote from our recent article here:
Vaccine programs are underpinned by a rigorous science determining their efficacy and safety in populations. There needs to be a similar level of commitment to identifying and testing the interventions designed to increase uptake of vaccines among vaccine-hesitant parents.
Dan Kahan: “Want to know what empirically *informed” vaccine communication looks like?”
Dan Kahan: “A risky science communication environment for vaccines.”
Brendan Nyhan: “Vaccine opponents can be immune to education.”
Julie Leask et al: “Communicating with parents about vaccination: A framework for health professionals.”
Julie Leask: “Parents’ decisions about vaccination and the gentle art of persuasion.”
In recent years, localized initiatives to end or reject fluoridation of public water supplies have made news in the United States and Canada. The practice has long been considered an effective and safe way to help curb tooth decay. It is endorsed by numerous professional science-based bodies, such as the American Dental Association and the U.S. Centers for Disease Control (CDC). But there is also a long (half century) history of varied opposition, which this Washington Post piece nicely summarizes. What is driving the latest iteration of the anti-fluoridation movement?
In 2010, after politicians in Waterloo, Canada voted to stop fluoridating the city’s water, a local dentist said:
My greatest fear here is with the advent of the Internet, and with the advent of social media, that a small vocal minority of individuals who are perhaps misinformed are able to reach a great number of people.
In 2012, Steven Novella at Science Based Medicine noted:
Recently there has been a Harvard study making the rounds of social media, Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. The actual findings of the study do not show that there is any risk to public water fluoridation (if anything, they show that it is safe), but the study was seized upon by antifluoridation activists and distorted for their propaganda purposes. Unfortunately, the internet is now fertile ground for the spreading of propaganda.
At the time of Novella’s post, another study was underway, seeking to quantify the Internet’s role as a potent propaganda tool for anti-fluoridation forces. That study was published last September, but I only learned of it this week, via a tweet from the medical journalist Ivan Oransky, who runs the superb Retraction Watch site.
You can read the paper here and some comments by the lead author here, who is presenting his findings next week at a dental conference in Boston. Looking at stats from Facebook, Twitter, and Youtube, the study found that anti-fluoridation material had a major Internet presence. It dwarfed the amount of pro-fluoridation information from public health agencies and organizations. The paper concluded: Read More
Several years ago, the Boston Review published a forum called, “The Truth About GMOs.” Nine viewpoints were represented. All the authors, a number of them scientists and scholars, had different perspectives. Some were enthusiastic biotech supporters, others staunch opponents. Several had staked out a middle ground, acknowledging the technology’s benefits and risks. The truth about GMOs, it turned out, meant different things to different people.
To complicate matters, the science of agricultural biotechnology is a proxy battleground for many people with political or cultural objections to GMOs, much in the way climate science is a proxy for those who associate it with implied political and economic changes they view as a threat to their way of life. For example, activists and advocacy groups vehemently opposed to GMOs continue to emphasize food safety concerns that have no evidentiary basis. Nevertheless, enough doubt and fear has been sown among a subset of consumers that numerous countries require GMO foods to be labeled and a campaign to do so in the U.S. has gained momentum in recent years. Meanwhile, the issue of food security in a warming world has fueled anew the controversial potential of GMO technology.
Which brings me to a workshop held this week at the National Academy of Sciences in Washington D.C. Its focus is on how to communicate about GMOs to the public. Thursday’s speakers were excellent, with many of them drawing on the findings of social science to show the tricky communication terrain that has to be navigated for charged issues like vaccines, climate change, and yes, GMOs. To get a sense of the take-home points, scroll through the Twitter hashtag #NASInterface. If you want to watch Friday’s panels, go here for the streaming video.
A few nuggets jumped out at me as I was listening intermittently to Thursday’s talks. Dan Kahan, near the end of his fascinating presentation, said that “people misinform themselves.” What did he mean by this? Well, people have go-to sources for issues they don’t have time (or the inclination) to research. Your go-to source on a contentious issue–such as climate change or GMOs–is likely to share your values. That affinity is what makes the source trustworthy to you. But that doesn’t mean your trusted source is necessarily going to provide you with correct information.
By the way, this is why I often focus on well known information brokers who influence the GMO debate. Groups like Greenpeace and thought leaders such as Michael Pollan, Vandana Shiva, and Bill Nye have enormous clout in their respective spheres. Greenpeace is a major player on the environmental stage. Pollan has the ear of foodies, Shiva is the patron saint of socially-conscious greens, and Nye is the geeky science hero that takes on creationists. Does it muddy the science communication environment for GMOs if a big environmental group and beloved thought leaders traffic in inaccurate information? Given their reach, I think so.
Dominique Brossard, in her Thursday talk, said that “messages and frames from the media can have an important role” in science debates. This is certainly true, though some people tend to overestimate the media’s importance, especially when an issue like climate change is “wicked” and laden with political and cultural meaning.
But to Brossard’s point, consider one popular frame that I looked into closely: The GMO/Indian farmer suicide tale. In my piece from last year, I laid out Vandana Shiva’s role as the primary architect of this false narrative. There were others who played supporting roles, but she is the one who stayed on message with it for years. She is a prime example of an influencer creating and shaping a popular media frame that has undoubtedly polluted the GMO discourse.
Finally, some thoughts about one thing Tamar Haspel said in her NAS talk. Haspel, as I have previously noted, writes a terrific, thoughtful food column for the Washington Post. Yesterday, Haspel suggested in her presentation that perhaps the “biggest thing” anyone could do in the GMO debate is reach out to someone who sits on the opposite side of the issue: Read More
In 2000, Salon asked, “Is your cell phone killing you?”
Last year, editors there must have decided the verdict was in when they published this embarrassing piece entitled, “Your cellphone is killing you: What people don’t want you to know about electromagnetic fields.” Rather than waste my time explaining the egregious flaws in that article, I’ll just point you to this website page of the National Cancer Institute at the National Institutes of Health:
Although there have been some concerns that radiofrequency energy from cell phones held closely to the head may affect the brain and other tissues, to date there is no evidence from studies of cells, animals, or humans that radiofrequency energy can cause cancer.
Today, Salon continues its fine tradition of scaremongering with a short piece that carries this headline: “Uh oh: Wi-Fi exposure may be worse for kids than we thought.” In the sub-head, we get a newsy teaser: “New research indicates that our current exposure limits may be out of date.”
Let’s go to that new research, which by the way, is published in a new open access journal called the Journal of Microscopy and Ultrastructure (otherwise known as the Journal of the Saudi Society of Microscopes). The good news: There’s no publication fee! The bad news is that the paper is rife with dodgy, unqualified correlations and claims. You only need to read the abstract to get a sense of its bias. My favorite line: Read More
With climate change commanding the news spotlight, dominating environmental discourse, you don’t hear much anymore about biodiversity or endangered species, two interconnected issues which, until the last decade or so, had been a focus of many environmental campaigners and widespread media coverage.
A case in point: In recent years, the conservation community has been at war with itself, engaged in a heated debate over how to preserve nature and biodiversity in the 21st century. The acrimonious dialogue reached a boiling point in 2014, prompting a remarkable commentary in the journal Nature, signed by more than 200 environmental scientists. Here are the passages that I figured would jump out at reporters: Read More
The murderous terrorist attack on a French satirical newspaper, which left 12 people dead, has shocked and outraged the world. Islamic extremists targeted Charlie Hebdo, the Paris-based paper, for its cartoons lampooning Islam. But it’s worth noting–as many have–that the paper poked fun at politicians, celebrities, and all the major religions.This caption explains the cover above. Vice has a good story about the paper’s anti-religion and anti-establishment history. After I heard the news of yesterday’s massacre, which killed ten of the paper’s staffers, including its top editor (and two police officers), the New York Daily News opinion editor captured how I felt. Read More
Environmental journalism, by and large, reflects not just news of the day (and an underlying theme) but also the zeitgeist. For example, when I made ecology my beat in the late 1990s, stories about the biodiversity crisis were prevalent in mainstream media and in environmental magazines–one of which I worked at through most of the 2000s.
In my current feature story on the divide in the conservation community, I have a historical section on the roots of environmental conservation. There, I talk about a progression in ecology–evolving primary concerns over a 100-year period, from wilderness preservation and endangered species to biodiversity and ecosystem services.
Of course, ecology is a huge field with many sub-disciplines. What I’m referring to are issues that were picked up in the media and frequently covered, which helped them gain traction as popular causes. This does not happen in a vacuum. Influential thought leaders and vocal scientists play an instrumental role.
For instance, if you want to understand how biodiversity became a huge story in the 1980s and 1990s, read “The Idea of Biodiversity,” by David Takacs. This 1996 book is also mentioned in a recent paper published in the journal Ethics, Policy, and the Environment. The authors argue:
We suggest that biodiversity is only the most recent in a long line of scientific “proxies” promoted to the public as a basis for conservation values. Such proxies gain widespread popularity due to their veneer of empirical objectivity, which encourages the public and policy makers to believe that decisions made on the their basis are value-neutral and free from any ideological commitments.
Be sure to read the whole paper, for the authors do not aim to de-legitimize the concept of biodiversity. Indeed, towards the end, they write: Read More
In a brilliant essay (PDF), the American geographer D. W. Meinig writes: “Any landscape is composed not only of what lies before our eyes but what lies within our heads.”
Meinig’s piece is in a classic 1979 book of essays called, “The Interpretation of Ordinary Landscapes.” This collection features scholars whose work touches on the human/environment relationship. The academic field is known as Human Geography.
When I write about ecological matters, I have to understand the science of ecology. But the people who advance ecology (and ecological issues) have a worldview, a philosophy that informs how they think about nature. It is in this context that science and culture are commingled.
In recent years, I have watched a contentious debate unfold between highly respected, influential ecologists. Read More
In 2014, as in years past, I used this space to offer observations on a wide range of stories and subjects. I critiqued faux journalism that went viral, called attention to the creepy antics of an alternative health advocate, discussed the Science Guy’s blind spot on GMOs, revisited a few touchy archaeological issues, and discovered perhaps the most insufferable egomaniac on Twitter.
I continued to track the winding Anthropocene narrative and kept current with familiar and tenuous climate change storylines. I also marveled at the durable popularity of an influential environmental speaker.
Last summer I was at a party where the guests included a bunch of successful heart surgeons. I spoke at length with one of them (I’ll refer to him as Dr. X) who has known and sometimes worked with Dr. Oz at New York-Presbyterian hospital in Manhattan. Dr. X is in his 40s. He told me Oz had been a mentor to him.
I mentioned Oz’s popular TV show and how Oz, an accomplished, highly respected surgeon, had become increasingly known (and criticized) for promoting unscientific ideas and unproven health remedies. Dr. X nodded his head in lament. He agreed with Oz’s critics but he said that on balance, he thought Oz was a force for good because he got many people to care about their health.
It’s an interesting calculation. The next time I see Dr. X I might ask him if he still believes that Oz is a net plus, given this recent finding. Read More