Framing vaccines again

NOTE: This post, which is related to a discussion of Dr. Paul Offit's Book Autism's False Prophets, originally appeared over at The ScienceBlogs Book Club. However, now that the book club for this particular book has concluded, I am free to repost it here for those who may not have seen it and to archive it as one of my own posts. Besides, I know the antivaxers are more likely to see it here...

One of the major points made by Dr. Offit in Autism's False Prophets is how badly the media deals with scientific issues and stories in which science is a major component. Indeed, he devotes two full chapters, Science and the Media and Science and Society, to a lament that pseudoscience such as antivaccine fearmongering is so easily promoted by the media and accepted by large numbers in American society. He lists a lot of the usual culprits, such as a poor understanding of science by the vast majority of Americans. Of course, there is also the false "balance" given antivaccine cranks in the media, which follows the journalistic mantra of "tell both sides," not understanding such a tactic produces a false equivalence of the two when applied to issues of science versus pseudoscience and produces the impression that there is a real scientific controversy when there is not. (Indeed, this is so common that a term has been coined for it "manufactroversy," which is short for "manufactured controversy"; a better description of the antivaccine reality distortion field would be hard to find.) Another excellent point is how the culture of science differs from that of the sound bite culture of media; scientists are often tentative and refuse to speak in absolutes, knowing the limitations of studies. We rarely say "never," "always," or "impossible." So, when a reporter asks if vaccines cause autism, we almost always say something along the lines of, "studies thus far have found no link between vaccines and autism, rather than "vaccines don't cause autism." We do it because it's more accurate and, as Dr. Offit points out, it's impossible for science to completely prove a negative. The best we can do is estimate the probability, and the existing science is conclusive that there is very, very little chance that vaccines cause or contribute to autism. We can never say "zero" chance, but we can say the chance is vanishingly small. Unfortunately, that is perceived by the lay person as meaning that there's still a chance. Finally, Dr. Offit even dares to go one place where I honestly didn't expect him to go and mention the prevalence of religion and belief in the paranormal as contributing factors to the lack of critical thinking skills that allow the antivaccine dogma to flourish.

If only he hadn't so approvingly quoted industry shills and all purpose denialists Steve Milloy and Michael Fumento, as I pointed out in my review on Wednesday, Autism's False Prophets would have been near-perfect in hitting all the right notes on this issue.

One thing, however, I didn't see so much in the book that I would have liked to see more of is how scientists and physicians could effectively counter the propaganda laid down by the likes of Jenny McCarthy and the movement of which she is currently the most famous member. For example, lately she's been on CNN (as I described here, although unfortunately the video appears to have been removed), on The Oprah Winfrey Show, and all over the media promoting her book Mother Warriors: A Nation of Parents Healing Autism Against All Odds. Last year at exactly this time of year, she was promoting her previous book Louder Than Words: A Mother's Journey in Healing Autism. Why is her message so effective, even though she is dumb as a rock when it comes to anything having to do with science and is so full of hubris that she thinks her Google education trumps expert knowledge and a wealth of solid epidemiological studies?

It's her frame.

To recap for those who are new to ScienceBlogs thanks to the book club, two ScienceBloggers, Chris Mooney and Matthew Nisbet argued that scientists aren't doing a very good job of communicating science issues to the public. On issues of importance that science impacts, such as global climate change and evolution education, they postulated, one strategy by which scientists could do a better job of communicating what science tells us about these issues and persuading the public of the validity of the science behind these controversial issues is to "frame" them better. As they said in their original article in Science:

In reality, citizens do not use the news media as scientists assume. Research shows that people are rarely well enough informed or motivated to weigh competing ideas and arguments. Faced with a daily torrent of news, citizens use their value predispositions (such as political or religious beliefs) as perceptual screens, selecting news outlets and Web sites whose outlooks match their own. Such screening reduces the choices of what to pay attention to and accept as valid.

Frames organize central ideas, defining a controversy to resonate with core values and assumptions. Frames pare down complex issues by giving some aspects greater emphasis. They allow citizens to rapidly identify why an issue matters, who might be responsible, and what should be done.

I was initially surprised when Nisbet and Mooney's thesis provoked a great deal of hostility among some science bloggers, and not just members of the ScienceBlogs collective. I say "to my initial surprise" because, initially at least, the whole idea seemed so mind-numbingly obvious to me, as I explained in my usual verbose fashion in these two posts. Basically, I attibuted much of the conflict to a cultural divide between "pure" scientists and science teachers and practitioners of more applied science, such as physicians like me, the latter understanding that you have to find a way to simplify and communicate in a way that your audience understands. And so it was for many months that I remained puzzled by the extreme intensity of the debate, whose nastiness at times seemed to go far beyond the actual difference between the two camps. Before too long, the very mention of the word "framing" became all but certain to set certain members of the ScienceBlogs collective into rabid fits of vicious invective that leave rational discourse behind, inspiring Mooney and Nisbet to return fire in ways that did not bring glory upon them, to put it mildly.

Even so, at the risk of reigniting these wars, I think that the reason Jenny McCarthy, and by extension the rest of the rabid antivaccine movement, succeed is because they use a handful of very simple and persuasive frames. For example:

1. Autism as vaccine injury. This frame has been so effective that, as has been pointed out, if you ask someone about autism these days almost inevitably vaccines are linked to it. It matters not one whit that there is no convincings scientific evidence that vaccines trigger autism and there's a lot of evidence that they do not. Autism is now "vaccine injury." It's simple and, supported by anecdotes, seemingly compelling.
2. Vaccination as an assault on personal freedom. This always resonates in the U.S., where vaccination is represented as the intrusion of the nigh-fascistic state into the affairs of families. This is very much of a piece with the "health freedom" movement that promotes quackery in the name of "freedom."
3. "Green Our Vaccines" and its variant, "We are not 'antivaccine'; we're pro-safe vaccine." Wonderfully Orwellian in its twisting of language and arguably the most effective frame thus far used by antivaccinationists. They argue that vaccines are full of "toxins" (They're not) and do the antivaccinationis version of the Gish Gallup whenever studies are published exonerating a vaccine ingredient in causing autism. When that happens, they just move on to move the goalposts. If it's not mercury, then it must be the aluminum. If it's not aluminum, it must be the formaldehyde. If it's not the formaldehyde, it must be the antifreeze (never mind there's no antifreeze in vaccines; they're on a roll). And if it's none of the above, it's some undefined synergistic combination that demands that every ingredient be tested individually. Since there are so many "toxins" in vaccines, they must be "greened" before they're safe. Of course, to the antivaccinationist, vaccines can never be "green" enough. Just ask one what, specifically, it would take for her to be convinced that the toxins are gone. What, specifically needs to be removed? You'll get a vague and meaningless answer (like the one that Jenny McCarthy routinely gives) to get the "toxins" or "junk" out of the vaccines.
4. Too many too soon. If it's not a specific "toxin" or combination of toxins in the vaccines, then it must be the whole kit and kaboodle, the whole vaccination schedule! It's "too many" antigens overloading the immune systems of infants, don't you know! Dr. Offit has explained why this gambit is a load of hooey, scientifically speaking, but to the average lay person it sounds compelling. Why not delay vaccines? Why not space them out? Just in case? Oh, wait. It's the precautionary principle again, as I discussed in my review of the book.

There are other frames, but those are clearly the Four Horsemen of the Vaccipocalypse that will, if unchecked, lead to suffering and death among children from vaccine-preventable diseases if unchecked.

One of the overarching topics of this my home blog, Respectful Insolence, since very early in its history has been combatting antivaccinationist lunacy and lies. Indeed, I was, as far as I can tell, the first person ever to point out what a cesspit of antivaccination propaganda The Huffington Post was right from its start. Resistance to vaccination and pseudoscientific misinformation every bit as ridiculous as any creationist nonsense appears to be growing, fueled by Generation Rescue, Jenny McCarthy, and the dedicated band of antivaccinationists who deny they're antivaccinationists over at Age of Autism. It's even progressed to the point of rallies on Washington, such as the recent "Green Our Vaccines" rally.

That is why I now ask everyone reading this post (and especially the pro-"framing" contingent) a question: How can we physicians and scientists deal with antivaccinationism? What "frames" can we use to combat the likes of Jenny McCarthy?

It's a simple question. I would even argue that, in the short term at least, it's a far more important problem than convincing the public of the validity of evolution or that we should do something to try to alleviate or reverse the effects of greenhouse gasses. The dire consequences of global climate change are far in the future, at least when compared to a human lifespan. None (or virtually none) of us will be alive 100 years from now, and most of us will be old or dead fifty years from now. It is not us, but our children, who will suffer if the models for global warming are correct, and it will be very difficult to evaluate end measures of effectiveness of "framing" in that length of time. In addition, the situation with antivaccine activism is very similar to the situation with creationism. The scientific consensus is that vaccines do not cause autism and are, as far as medical interventions go, incredibly safe, just as the scientific consensus supports the theory of evolution. Just like the situation with creationism, there is a hard-core contingent of antivaccine denialists who are loud, vocal, and probably unswayable, bolstered by ideology plus pseudoscience generated by a small cadre of "scientists" who have become convinced that for autism (and other disorders), it absolutely, positively has to be the vaccines. Finally, just like the situation with creationism there is the vast middle, Americans with little knowledge of science who hear the "charges" against vaccines and wonder if maybe, just maybe, the myths are true, making them hesitant to vaccinate their children. After all, the whole concept that there are "toxins" in vaccines sounds compelling to the average, scientifically untrained person, even though on a strictly medical and scientific basis it is not.

In contrast to the effect of ideologically motivated antiscience on evolution education or whether or not we as a society do anything to address global climate change, the ideologically-motivated antiscience known as antivaccinationism has a much more rapid deleterious effect. Thanks to fearmongering over vaccines, measles is already endemic again in the U.K., after previously having been conquered, while in the U.S. it is surging back as well, fueled by lower vaccination rates. If current trends continue, and antivaccine activists make good on an earlier promise of a "fall offensive" against the vaccination schedule, it won't be long before other vaccine-preventable diseases start making a comeback as well.

If ever an effective framing strategy were needed to counter the Orwellian "green our vaccines" movement, the time is now. The question is: How? Whatever the frame, it has to be simple, scientifically supported, and able to resonate with typical parents. Hardcore antivaccine activists won't be persuaded by any frame we can think of, but there are a lot of parents out there who aren't hardcore antivaccinationists but have heard their rhetoric and are afraid of vaccines because of it. How do we reach them?

Come to think of it, this is an area that I really wish I had seen more of in Autism's False Prophets. Dr. Offit does an excellent job of laying out the deficiencies in how vaccine science is communicated to the public today, deficiencies that leave a huge opening for antivaccine pseudoscience to permeate the national zeitgeist, but I'd really like to hear from him suggestions for frames or other strategies to counter it.