Sunday, January 19, 2014

How To Win a Vaccination Debate

 It can blindside you like a hit-and-run. One minute you are happily cruising along with good intentions, inquiring of friends or strangers online about the risks of vaccinating your family.  Then– BAM! Someone compares you to Hitler!   Next thing you know, people are accusing one another of being negligent, misinformed, or even cruel or stupid.  You, my friend, have just found yourself in the middle of a good old fashioned vaccination war. How do you get out? How do you win? 
At its core, this debate isn’t about right versus wrong. It is about one truth conflicting with another amidst a sea of myths. It rages on because vaccination is a decision that pits the rights of the individual against the rights of the collective population. And it is one that causes an immediate incendiary reaction that is sure to hurt feelings and ruin friendships.
Should you list vaccinations on your taboo list right under religion, politics, and hemorrhoids? Maybe, if this isn’t a fight you care to lose friends over. But it is still an important issue that seeks a resolution. And it needs to be talked about now more than ever, since populations are on the rise, epidemics carry more risk, and drug producers are just as vulnerable to corruption and scandal as any other corporation. If we ignore the issue, it will take a pandemic to get populations vaccinated, or it will take a major malpractice to get people to evaluate the risks. If we keep talking, it will keep pharmaceutical companies accountable for their products.

So let’s have this conversation. Here’s what to do.

1. Take a moment for some critical awareness
How long do you think people have been arguing over vaccinations? Ten years? Twenty? Ever since Jenny McCarthy hit the media? Nope. Try 293 years. That’s not an exaggeration.  When the smallpox inoculation was first introduced in 1721, people opposed it on grounds of religious freedom. They haven’t stopped since. Are you going to end it today? Not likely. 

2. Decide what your goal is in arguing
If you can’t end this debate, what can you do? At best, you might be able to get some people thinking. They might not change their stance. But if you play your cards right, you might at least make their decision more informed. That’s as close to “winning” as you are going to get. If you are anti-vaccination do you really want the other person to change their stance? If you choose not to vaccinate your child on the grounds of herd immunity protecting him, it stands to reason that every time you persuade someone not to vaccinate, you are putting your own family at a greater risk.

3. Listen and keep an open mind
When people encounter someone whose biases don’t affirm their own, they make an assumption that the other person is ignorant, uneducated, or malicious. This isn’t usually the case. Pro-vaccinators assume that anti-vaccinators are falling prey to scare mongering and hearsay instead of “real” sources of information. Anti-vaccinators assume that pro-vaccinators have blindly followed the advice of authorities and haven’t considered cases which demonstrate real health threats.  The truth is that members of both sides are aware that all vaccines have associated dangers, and each side chooses to interpret the risks differently.  If you find your opponent has done some investigating, you can show your appreciation that they have taken the time to do so. Acknowledging their research on the topic will earn your opponent’s respect, and they just might open up to you. This will also get you down off your high horse (everyone has one). People don’t listen if they feel you are talking down to them.

4. Ask questions instead of stating facts
When you state facts that run counter to what someone believes, she will reject them, ignore them, or reinterpret them to fit her own point of view. If you are anti-vaccine and you say “some vaccines have been linked to narcolepsy,” the pro-vaccinator will be dismissive: “Nah, that’s fear mongering.”  People generally prefer to be asked questions instead of being preached to. It puts them in the position of being the preacher, but it also causes them to think, and to possibly to face their own flawed logic.  Some examples: "Do you consider Pharmaceutical companies to be infallible?"Do you know the component of the adjuvant?"  "Has anyone researched the long term effects of this?" "What is the source of the thing you just quoted?" "Do you have a plan in case of an outbreak?"  "How do you plan to increase your immunity without vaccination?"  "What if you choose to travel to an area prone to epidemics?" 
     Just be sure your questions are valid, and avoid snarky or rhetorical questions like: "What kind of parent do you think you are?

5. Focus on being kind, not being right
While it is tough to say if anyone has ever won a vaccination debate, there are some obvious losers. If you get to the point of belittling, name calling, or judging others, you have lost.  You cannot shame a person into changing their behaviour or ideologies. If you say to an anti-vaccinator “you’re going to make your kids sick, you negligent twit!” or the more passive aggressive, "I choose to vaccinate because [unlike you] I love my children," that person will set out to prove just how healthy and loved her kids can be.  If you are anti-vaccine and you say, “look at the side effects, you ignoramus!” that person will get the shots anyway just to prove she’s going to be just fine. Putting a person on the defensive is a sure-fire way to deepen her resolve. Instead, show some compassion. It shouldn’t be so hard to find grounds for empathy. After all, we all have the common goal of doing what we feel is best for our families.

6. Understand the big picture and you will see how you are both right
It’s all about statistics. Pharmaceutical companies face an ethical dilemma every time they come up with a new vaccine. None of their products are risk free. There will always be some negative correlations and some uncertainty.  
     Imagine, if you will, an aggressive virus (or a zombie apocalypse, whatever you want) which kills, say, 50% of the people that it infects, and there is a risk of it infecting the whole population of the world in a short period of time. The best the drug company can do is to invent a product which can protect 99.9999% of the population but it will cause death to the remainder. This might seem like an easy decision. One out of a million people hardly compares to half the world dying.  If there are eight billion people in the world, and if the whole world gets vaccinated, 8000 people will die. Big deal, right? Better than 4 billion. But then think of what will happen down the road. Most of the world will be vaccinated and feel safe from the virus, but there will be news reports of up to 8000 people dying from this vaccine– moms, dads, children, friends of friends all over the world. Faces of the deceased will be plastered on magazines and viral internet articles. Suddenly one in a million seems like a much more probable occurrence. Everyone will know of someone who died from a vaccine. And now that the virus is mostly contained, the risks from the vaccine are higher than from the virus. Any single individual would technically have better odds avoiding it. But if everyone in the whole population becomes this one individual, the virus will return.  This creates a paradox in which the best thing you could advise the population to do would be to avoid the vaccine but have everyone else get it. This is nonsensical, of course. You can’t have everyone get vaccinated and not get vaccinated.  In this respect, the governing agencies and pharmaceutical companies are not being malicious; they are protecting the good of the greater whole, but not your own individual safety.  This is a hypothetical example, but each individual immunization comes with its own numbers. Your risks differ from one needle to the next, and each individual case merits its own discussion and research. Personally, I have looked into the numbers and decided for myself that the vast majority of common vaccinations are worth the risks. 

7. Be aware of your own discomfort, it’s telling you something
Cognitive dissonance refers to that uneasy feeling you get when someone provides a fact that doesn’t confirm your beliefs. If someone tells you that her child got sick from the very same shot you just had administered to your child, you may feel strongly doubtful. Your mental processes reject this information because it doesn’t align with what you believe. So you might accuse the other person lying or exaggerating, and the mudslinging begins.  But as Aldous Huxley said, “Facts do not cease to exist because they are ignored.”  Instead of denying the fact, give it the benefit of a doubt. It doesn’t mean you have to change your stance. “Well that is unfortunate,” you might say, “but it doesn’t mean that it’s probably going to happen to everyone.” If you are anti-vaccine and you find out that there are cases of measles going around in your child’s school, it won’t do you any good to claim that it’s just hives. Instead you might just take your unvaccinated children out of school until the virus gets eradicated and hope for the best. Or you might decide that now is the time to reassess your stance, since the probability of measles now exceeds the probability of risk factors.

8. Don’t bring anecdotal evidence into the argument
This is the “I knew a guy who got sick right after the flu shot three years in a row!” type of fallacy. If any one person never got immunized and never got sick, that information means nothing. If some kid got the H1N1 shot and still had the virus, it is of no consequence.  One person who got the MMR and also has autism? Coincidence.  Someone who used elephant repellant and didn’t get any trouble from elephants? Well, you get the picture. A lot of poor decision making is a result of narrowly focused personal experiments with a sample group of one. And that one guinea pig is self selected, with hindsight, by a biased individual looking to draw the bull’s-eye around the arrow.  
"I caused this calamity!"
“But three times in a row,” you say, “That can’t be a coincidence, right?”  Yes, it can be. Imagine a hundred thousand caged monkeys in a lab. They can’t see each other. The monkeys are sleeping, eating, flinging poo, or rattling the bars of their cages. At random intervals, a machine sprays the monkeys with cold water. Five thousand of the monkeys happen to be rattling the bars of the cage when it happens the first time, and of those, maybe a thousand are rattling the cage the second time it happens, and of those, fifty are rattling the cage the third time it occurs.  The machine gets turned off. What happens to those fifty monkeys? They conclude that rattling the cage caused the water to be sprayed. From their perspective, they rattled the bars three times, and after each time, the cold spray came on. They never rattle anything ever again. They get released into the wild, form a colony, and those fifty monkeys go around warning all the other monkeys not to rattle things because it makes it rain.  Every time it rains they will look around to see who rattled something. And superstition is born.
People get sick all the time. Especially in flu season, which also happens to be cold season and non-categorized virus season.  The chance that any one individual becomes sick after getting a flu shot is moderate to high. The chance of it happening to any one individual a second time is a little lower. But the chances of you knowing someone who got sick after getting the shot more than once is extremely likely, especially so if your selected individual is like the monkey, warning everyone about his perceived connection. 
If you are going to debate the likelihood of a specific side effect, you don’t need to use a single case as an example.  There are plenty of published reports on the total number of people experiencing side effects, and this will give you a better grasp of true causation.

9. Try to interpret scary-sounding facts logically
Even if all your information is correct, it might not be as meaningful as you think. Almost all people consider severity over probability when they would be better served doing the opposite.  You might read an article online which tells you that hundreds of people who receive the flu shot have contracted Guillian-Barre Sydrome (GBS), a terrifying autoimmune response which causes sudden paralysis. It can mean years of learning to walk again or being confined to a wheelchair, even death in extreme cases. This is a true fact, and a scary sounding one. But it isn’t one you should be concerned with.  One in a million people get GBS from the flu shot, but five times that many people get GBS from getting influenza. And hundreds of people die from influenza as well, many more than from GBS.  But in a population of billions of humans, all those GBS numbers mean almost squat to you. The important thing is that probability of getting GBS is very low. The probability of getting the flu, over an extended period of time, is tremendously high, almost guaranteed. But when the choice is framed in this manner, every time people will commit the fallacy of saying “I’d rather get the flu than paralysis!”  But this is like saying “I don’t jog. I’d rather stay inside and get fat than go outside and get hit by lightning.”
Another thing which clouds your decision making process is social proof. If everyone else is doing something, it seems like it must be right. Solomon Asch did an experiment in the 1950’s in which subjects were asked to answer questions in the presence of other people. Unbeknownst to them, the other people were actors. When the actors answered obvious questions incorrectly, so did the subjects.  You might have a hundred people on your facebook feed urging you to get a vaccine for a new virus in another continent which only has a few documented cases so far. If you are cautious about vaccines, you are aware that new vaccines carry a higher uncertainty. Not a higher calculated risk, but an unknown, uncalculated risk because there may not have been time to evaluate long term effects. So you might choose to wait for a period of time.   This won’t make you very popular but your decision making process is more rational than getting injected with something of unknown advantages because of something you saw on the internet. Pay no attention to popular opinion when making a decision about your family's health.

10. Know When to Quit
There sometimes comes a point when a conversation has gone past the point of being useful. If your opponent has already formed a strong opinion based on years of holding to a certain belief, you might not be able to change it, especially if you are a stranger on the internet. If people are judging you or calling you names, you have found some friends more toxic than adjuvants. They have lost the argument. Turn off your computer and go outside. Breathe in some fresh air, enjoy some sunshine and exercise.  If the prize for winning a vaccination debate is good health, go claim it.

Title image composite contains two photos courtesy of  Stuart Miles and piyaphantawong,
Chimpanzee image courtesy of  africa,

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