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Wednesday, December 30, 2009

The scientific language of uncertainty and anti-vax perception

Over at the James Randi Educational Foundation (JREF), Skeptigirl wrote a post that I think is very relevant and important to convey. What follows are her words:

This morning I was watching a hearing on CSPAN2 led by Senator Tom Harkin of Iowa, Funding Autism Research, original hearing was 8-5-09. Harkin is a promoter of antivaxxer woo that vaccines cause autism.

The program is 2 hours 13 minutes long but the pertinent part is 10 minutes long and can be found starting at minute 25 and ends at minute 35. This is the exchange between Harkin and the director of the National Institute of Mental Health, Dr Thomas Insel.

Much of the rest of the hearing was typical anecdotal evidence testimony. [sidetrack]One of the people testifying was a woman who claimed her child had the mitochondrial problem some of you may recall. That was the bogus claim the Mayo Clinic researcher used to get vaccine compensation funding awarded. There was a lot of unethical and scientifically questionable behavior on the part of the researcher using his own data on his own child to make this claim for big bucks compensation.[/sidetrack]

So the director of the NIMH is testifying. He brings up the fact there are less antigens in more vaccines so that despite the fact kids get more vaccines today than in the past, they actually get far fewer antigens (the thing that the immune system attacks).

Harkin just doesn't get what Insel was saying about the number of vaccines not being the issue, the number of antigens is. Insel doesn't appear as familiar with the anti-vaxxer arguments and beliefs and gives up trying to explain the antigen issue and moves on to Harkin's other concern, the claim there are no studies that dis-prove a link between vaccine and autism. Ignoring the issue because Harkin didn't understand was annoying enough.

But then even though Insel goes on to make it clear there was overwhelming evidence that there is no connection between vaccines and autism, Insel is oblivious to Harkin's ignorance and ends up reinforcing the belief either "we don't know" or "the data isn't definitive".

Harkin makes it clear he believes "we don't know" and says so. Listen to the ineffective way Insel presents the data we do have. Insel uses technically appropriate language that randomized controlled prospective clinical trials have not been done. Insel seems to think it was important to discuss why such trials were unethical, I think because he expects the point one cannot withhold vaccines to be obvious.

In presenting this particular issue, the inability to do RCCTs, Insel fails to emphasize the evidence we do have is more than sufficient. He gets the information out there but doesn't counter the fact Harkin is tuning that information out and selecting the uncertainty language of science as reinforcing Harkin's pre-established beliefs.

I think anyone interested in communicating science and countering the woo beliefs of the anti-vaxxer crowd should watch this 10 minute exchange paying particular attention to the way Harkin misses the points being made and how the way Insel presents the data contributes to Harkin's reinforcing his misinformation.

I don't know if medical experts like Insel believe giving credence to the antivaxxer beliefs is somehow going to get the antivaxxer to trust the expert, or if the expert is oblivious to the message they are sending when they use the typical uncertainty language of science.

Before the thread gets sidetracked, I am not advocating anything like overstating the evidence. I'm not advocating we propagandize our positions. I am however, pointing out that every method of presenting evidence accurately is not equal.

In the case of this exchange, Insel did not stop Harkin from ignoring the antigen issue. Clearly we need a simpler means of getting that information across to someone who only understands number of vaccines.

And the issue of no RCCTs did not need to be emphasized. Rather, Insel should have emphasized the validity of epidemiological data. Harkin didn't seem to think we had unvaccinated groups to compare vaccinated kids to or that we could use timing of diagnosis and other indicators to determine if there was any relationship between vaccines and autism. Insel didn't seem to pick up on that and address it.

And if we are going to coddle the woo believers then we need some studies to determine if this is productive or not. I have seen more than one vaccine expert dealing with the anti-vaxxers using this approach. I don't think you have to legitimize their beliefs in order to legitimize their person. I think it only serves to reinforce the woo beliefs. But seeing public health experts use this approach suggests they may know something about dealing with the antivaxxer beliefs that I do not. Or it could just be they are using the typical medical provider approach to a patient and I'm not so sure that is the best technique with the antivaxxer with a cause as opposed to just the average patient with some misconception.

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