Ambivalence in the Time of Measles

There’s a Spanish novel that has the most intriguing title, Love in the Time of Cholera. What a linguistic contrast: love and cholera.  Our current reality, involving measles outbreaks in Washington and Vancouver, might be described as “ambivalence in the time of measles.”

Anyone who has interest in such topics, typically parents of young children, healthcare professionals, or people who follow health trends, is well aware of the trend toward deferring or refusing vaccination for children.  A common counter to this trend is to provide vaccine education.

The results of vaccine education provide ambivalent results: better understanding but future vaccinations less likely. A 2014 study reported in Scientific American demonstrated this strikingly:

At the study’s start, the group of parents who were most opposed to vaccination said that on average, the chance they would vaccinate a future child against MMR was 70 percent.

After these parents had been given information that the MMR vaccine does not cause autism, they said, on average, the chance they would vaccinate a future child was only 45 percent — even though they also said they were now less likely to believe the vaccine could cause autism.

Such a view is madness to the scientific community who labor diligently to develop and test vaccines, and to advise on vaccination schedules.

But humans are, at heart, most illogical creatures.  We do not often understand why we make the decisions that we do.  Our emotions rule our reason, and even when we know something to be true we can feel another way about it.

While public health experts examine ways to improve adherence and communication, it makes sense to step back and think a bit more about the greater trend that has united folks across the ideological spectrum.

Most curiously, the trend against vaccinations is one of the few areas where ideological conservatives and ideological liberals can agree.  And since we’re already examining an impassioned, heated topic, we might as well bring politics into it too.

What could possibly bring conservatives and liberals into a hugging kumbaya on a common topic?  Other than Bernie Sanders and Donald Trump in 2016, that is. Leftists and rightists agreed that they wanted a populist candidate that abjured mainstream, conventional wisdom.

That same sensibility, rejection of conventional wisdom and the establishment, guides the concerns of parents who oppose vaccination.

Putting aside the now-debunked link between the increase in autism rates and vaccinations, there is plenty of material for vague emotional concerns related to scientific and bureaucratic processes that guide new healthcare procedures, drugs, and treatments.

At the heart of all modern challenges to scientific evidence is the misgiving that the scientists and institutions are unduly influenced by greed or other selfish motivations.

The highly contentious history of Roche and oseltamivir (Tamiflu) is one prominent example.  Concerned about pandemic flu in light of the avian influenza scare and the emergent swine flu outbreak, the governments of the US and UK stockpiled hundreds of millions of dollars’ worth of Tamiflu for clinics and hospitals.  

The only problem?  It isn’t entirely clear that Tamiflu is more effective than Tylenol.

This dovetails with the current crisis of replicating scientific results. The BBC recently reported, “According to a survey published in the journal Nature last summer, more than 70% of researchers have tried and failed to reproduce another scientist’s experiments.”

There can be all sorts of speculation about what’s behind the lack of replicability.  But the chief emotional takeaway is that scientific results are not as certain as we would like them to be.

The general public may not be familiar with Roche’s methods in testing Tamiflu, or the study replication problem.  What they are familiar with, though, are outsized promises of scientific knowledge followed by adjustments, caveats, exceptions, and reversals.

Take, for example, changes in basic dietary guidelines. The humble, ubiquitous egg was once considered a poor choice. More recently, however, that has changed:

Eggs, which the government had warned against for 40 years, are now considered part of a healthy diet. ‘Eggs can be part of a healthy eating pattern and people should be thoughtful about including them into a healthy routine,’ said Karen DeSalvo, HHS assistant secretary for health. Evidence has shown that high levels of cholesterol in the blood are associated with saturated fat from fatty meats rather than eggs, leading to a shift in the government’s guidelines.”

Ambivalence is understandable in light of these events. Unfortunately, it creates a crisis of credibility that makes us more vulnerable and more susceptible to mistrust.

We need to grapple with the profit motive and weigh how to balance the American the role of corporations against social good and social confidence.  The notion of bureaucratic policy driving outsize corporate profits is offensive to many. It is an emotional reaction to being walloped in the wallet by the ever-increasing costs of healthcare.   We should all feel a healthy skepticism.The heart of the question, then, is how to better establish credibility regarding the role of profit in scientific (and governmental) guidelines for vaccines.

First, the profit motive in government transactions needs to be made plain. For each policy recommendation, the public should know how much profit is made, and by whom.

Second, introducing simple transparency into the approval process would enable the public to see the evidence that the vaccine is safe and effective. (This would follow the lead of the irreproducible study data being made plain in 2015.)  Note that if the small scale of the harrowing autism study had been spotlighted right away, it would have not passed this test and so much angst would have been prevented.

Where mistakes have been made, can information regarding recommendations be presented as simple-to-follow success scores.  Instead of simply changing guidelines, agencies should publish a clearer statement saying “we were wrong and here’s why.” Connect the mistakes to whoever might have profited by them.  The stories of government fraud, waste, and abuse are legendary, and owning up to that truth would go a long way toward reviving credibility.