“Vaccine exceptionalism”: With friends like these, who needs enemies?

There’s an old saying that basically asks the question, “With friends like these, who needs enemies? or, as Voltaire (or Marshal Villars, depending on the account) said, “May God defend me from my friends: I can defend myself from my enemies.” The point, of course, is that friends or allies can sometimes be as infuriating as enemies, if not more so.

Such is the case with Alice Dreger, author of Galileo’s Middle Finger, a book dedicated to describing how activists can undermine science in favor of ideology. I’ve written about her twice that I can recall, although both in the context of a particularly infuriating article she wrote about vaccines a year ago, What if not all parents who question vaccines are foolish and anti-science? in which she asserted that it is not completely unreasonable for parents to ask about safety concerns. Of course, when it comes to vaccine-averse parents who have not yet gone completely over to the antivaccine side, no responsible pro-vaccine advocate claims otherwise. Unfortunately, to Dreger, those of us in the trenches battling antivaccine pseudoscientific claims that pop up like Whac-A-Mole, are apparently nasty, self-righteous fanatics. To call her chastising us for offenses, real, exaggerated, and imagined, that supposedly “fuel” antivaccine sentiments unhelpful is putting it mildly.

In terms of such unhelpful and self-righteous chastisement, Dreger’s 2015 article drew my attention mainly because she took a swipe at yours truly over a post I had written years before. (The Internet never forgets, and blog posts don’t either.) Of course, as I pointed out, the implication of the article that pro-vaccine advocates are frenzied, self-righteous zealots who are incorrect (and disrespectful to parents, to boot) when we point out that most fears of vaccines are rooted in pseudoscience was, for the most part, baseless. I took the opportunity to discuss how Dreger missed my point in that to someone who is not knowledgeable enough to recognize the pseudoscience underlying antivaccine fears, the irrational pseudoscientific arguments promoted by the antivaccine movement can seem quite compelling. Moreover, they’ve seeped into the very zeitgeist, such that young parents would be hard-pressed not to encounter them. Again, if you mistakenly believe antivaccine misinformation, it is rational, based on what you know, to start to fear vaccines. It’s concept I’ve referred to as “misinformed consent” not to vaccinate. If you start to believe the misinformation of the antivaccine movement claiming that vaccines are dangerous and that they don’t work that well, then of course you’re going to start to become worried and fearful! That’s what we’re fighting, the misinformation that poisons the decision-making process of these parents who are vaccine-averse!

Unfortunately, Dreger is at it again in a post from yesterday on her personal blog entitled Beyond Vaccine Exceptionalism, in which she basically used a debate between physicist Robert David Grimes and antivaccine quack Andrew Wakefield on Irish radio as a starting point for a discussion about what to do when faced with the situation Grimes faced: To debate (or not) an antivaccine quack. Not surprisingly, the context of the interview was that Wakefield was making the rounds to promote his movie VAXXED, which recounts the manufactroversy known as the “CDC whistleblower” and basically falsely claims that the CDC is covering up slam-dunk evidence that vaccines, particularly the MMR vaccine, cause autism. So far, so good. There’s nothing really objectionable in her discussion. It didn’t take long for that to change.

Indeed, Dreger does what she does so infuriatingly and what I took her to task for a year ago. She basically starts spouting conspiracy theories, while expressing dismay that pro-science advocates call them conspiracy theories:

Many ordinary citizens and patients know—and are right to think about—the fact that vaccines are pushed in and by a medical industrial complex that is, particularly in the United States, rife with financial conflicts of interest, overtreatment, and iatrogenic harm from practices adopted without sufficient evidence.

Vaccines are produced and marketed by the same pharmaceutical companies that have been found, again and again, to engage in unethical and also illegal practices in pursuit of profits. And the fact is that many leaders in medicine, if not also in public health, have had deeply problematic relationships with big pharma; even the New England Journal of Medicine’s editors have lately been telling people to stop worrying their pretty little heads about conflict of interest disclosures and data transparency.

Vaccine exceptionalism—the attitude among many science and public health advocates, that approved and recommended vaccines are never to be questioned or doubted—is historically and politically naïve. Vaccine exceptionalism also ultimately feeds anti-vaccine campaigns by contributing to the sense among vaccine-worried parents that the “pro-vaccine” campaign isn’t really thoughtful or scientific.

You know, Dreger sounds just like Jill Stein, the Green Party candidate for president. She’s basically blowing the antivaccine dog whistle as Stein about pharma “corruption” in the context of discussing “trust” of the public in the system that recommends specific immunizations. Of course, As I pointed out when discussing Jill Stein, the FDA and CDC actually go to great lengths to minimize conflict of interests on the relevant committees making decisions about which vaccines are approved and included in the recommended schedule.

How many blatantly obvious straw men are in the passage above, let me count? No, on second thought, let me not. I’ll simply point out one straw men so massive that, were it to catch fire, it could be seen from the International Space Station. I’m referring to Dreger’s claim that pro-vaccine advocates seriously argue that “approved and recommended vaccines are never to be questioned or doubted.” I’m sorry. Even though I consider Dreger to be more or less on “our side” when it comes to vaccines, her penchant for echoing antivaccine anti-pharma tropes notwithstanding, the adage from Voltaire about needing to be saved from my friends comes to mind. Also, when a friend says something this mind-numbingly dumb (and, make no mistake, this is one mind-numbingly dumb massive straw man), I’m not one to hold fire, particularly given that this is by no means the first time Dreger’s said something like this.

In any case, Dreger’s rhetoric here is of a type that I could easily find on any of a number of antivaccine crank blogs and websites, such as Age of Autism, NaturalNews.com, Mercola,com, and the like, often with verbiage that wouldn’t be the least bit out of place on those wretched hives of scum and antivaccine quackery. (Oh, wait. Was I too…strident?) Indeed, “vaccine exceptionalism,” as Dreger put it, is a variant on a frequently used trope in the deepest, darkest antivaccine corners of the Internet that misrepresents pro-vaccine arguments as stating that vaccines are such an unalloyed good that they must never, ever, ever be questioned. Another variant of this same trope is to liken vaccines to a religion, in which questioning their safety and efficacy is portrayed as “heresy.” (After all, what does Dreger mean to imply by stating that vaccines “are never to be questioned” if not to implicitly liken support of vaccines to religion? It’s not as though such language is particularly subtle. At the very least, she’s implying support for vaccines is based primarily on ideology.) Indeed, I’ve even seen antivaccine activist Kim Stagliano coin a term, “Vaccinianity,” which Ginger Taylor went on to define thusly:

Vaccinianity – (Vax.e.an.eh.te) n. The worship of Vaccination. The belief that Vaccine is inherently Good and therefore cannot cause damage. If damage does occur, it is not because Vaccine was bad, but because the injured party was a poor receptacle for the inherently Good Vaccine. (ie. hanna poling was hurt when she came into contact with Vaccine, not because the Vaccine was harmful, but because her DNA was not to par or because her mitochondrial disorder was to blame.) Vaccine is presumed to have rights that supersede the rights of the individual, while the human person’s rights must defer to Vaccine.

It’s such a silly and transparent term that I gave Stagliano and Taylor some friendly advice about coining such words. Not surprisingly, they didn’t take it. Still, I’d offer similar friendly advice to Dreger, as her rhetoric in her post is inching very, very close to using a term like “vaccinianity” to describe vaccine supporters. At the very least, she is by comparison painting the parents that she sympathizes with (and herself) as being oh-so-reasonable in comparison to what she characterizes as self-righteous, unthinking vaccine zealots with contempt for parents. Basically, it’s a great way to feel good about yourself to portray yourself as eminently reasonable and empathetic and those with whom you disagree as radical, unthinking ideologues.

Dreger’s portrayal is basically a convenient caricature. It turns out that very few pro-vaccine advocates are like that, although you can sometimes encounter those few online. Heck, even the pediatricians who decide to stop caring for children of parents who won’t vaccinate torture themselves over the decision. In fact, as I discussed just this month, public health advocates go through a great deal of effort to figure out what is behind vaccine hesitancy and how best to deal with it. If you look at actual research, too, contrary to Dreger’s dogmatic rejection of the claim that parents are afraid of vaccines not because of pseudoscience, they actually do express a lot of pseudoscientific reasons. Granted, some of the reasons might be considered to be not based in pseudoscience, such as concerns about vaccine efficacy, stress from watching their child receive multiple vaccines, ideology, and religion, many of the reasons parents give health care providers for being reluctant to or refusing to vaccinate are rooted in rank pseudoscience of the sort Wakefield is peddling in VAXXED and has been peddling for 18 years: fear that vaccines cause autism, concerns about “toxins” in vaccines, worries about “too many, too soon” and “overwhelming the child’s immune system,” and the belief that “naturally acquired immunity” is so much more preferable than vaccine-induced immunity.

Do we who support vaccines based on science refute, sometimes vociferously, antivaccine pseudoscience? Of course we do! And there’s a lot of pseudoscience to refute. Do we claim that vaccines “are never to be questioned”? Of course not! Dreger seems to be confusing statements made quite correctly by pro-vaccine advocates that there is no scientific controversy over whether vaccines cause autism (as far as a mountain of research can tell, they don’t) and whether vaccines in the current schedule are safe (an even bigger mountain of research concludes that they are) with a religious dogma that vaccines “are never to be questioned.” The two are not the same thing, and conflating them so blatantly is most definitely not helpful. Or perhaps she is conflating our strong rejection of “questioning” that is based on pseudoscience with claiming that vaccines “are not to be questioned.” These are not the same thing either. She also appears to be confusing criticism directed at the leaders of the antivaccine movement, who are so far down the rabbit hole of antivaccine pseudoscience that the chances of pulling them out to the light of science are vanishingly small with how we deal with the true vaccine fence sitters, the parents Dreger keeps describing who have doubts about vaccines because vaccination is a medical procedure and they might have heard worrisome things about it or because, as she did, they feel a primal urge to protect their child when he is being stuck with more than one needle. I’ve discussed how I think these parents should be dealt with, and none of what I discuss involves insulting them, labeling them as stupid, or hectoring them, as Dreger seems to think it does. In contrast, it does involve recognizing that parents have fears based on what they have heard living in society.

Next up, Dreger engages in what I’ve liked to refer to since the very earliest days of this blog as the “pharma shill gambit,” which is basically a form of poisoning the well and discrediting someone with whom you disagree by attacking the person, while oh-so-piously signaling her own virtue:

I care very much about vaccine public health programs and creating herd immunity for dangerous diseases. That’s why I cringe when I look at how the HPV and chickenpox vaccines came to be mandated in various states in the U.S.—namely through the purchase by pharma of Republican and Democratic politicians. That’s why I object to “ethicists” like Art Caplan taking money from vaccine makers and not revealing those payments while publishing essays arguing “it’s unethical not to be vaccinated” in the medical literature and the mainstream press. I really hate that our Centers for Disease Control, which set out vaccine public health policy, have a Foundation that explicitly takes money from vaccine makers, calling them “our partners.”

One notes that, unlike the case for some of her claims, Dreger doesn’t link to articles showing that Caplan took money from vaccine manufacturers and didn’t reveal the payments. One wonders if she knows that Caplan spent nine months in the hospital as a child with polio in 1957 and that that experience was formative:

Being forced for months in 1957 to live in a polio ward where secrets were the order of the day was, as Caplan relates, even more distressing.

“In the hospital, there were plenty of injustices,” he says. “And I remember being very puzzled that the doctors wouldn’t tell us the truth about the kids who were dying, even though every one knew they were. … They wouldn’t even acknowledge it when the child died overnight in the bed next to you. Even at the age of 7, I was pretty sure that wasn’t the way to deal with seriously ill people.”

Caplan was one of the lucky ones. He experienced a cure that was stunningly sudden, and utterly mysterious.

But his experiences in the polio ward, both the anger and the cure, were in his view what generated his lifelong interest in science and medical ethics.

Could that experience, perhaps, and not any interaction with pharmaceutical companies, be the reason why Caplan is pro-vaccine (well, that, and the overwhelming science that supports the current vaccine schedule)? I’d be willing to bet that it did. In any case, I looked for documentation of Dreger’s claim and had a really hard time finding it. (Apparently my Google-Fu was not strong last night.) Even antivaccine websites didn’t seem to have it. The most I could find was a Twitter exchange between Dreger and Caplan in 2012 in which she behaved rather…poorly. In fact, in light of her having painted pro-vaccine advocates as hopless zealots, I find this exchange to be quite…illuminating. All Dreger seems able to come up with is an observation that a drug company funded a conference his Center for Vaccine Ethics & Policy held. Of course, Dreger probably doesn’t accept that unrestricted educational grants, which pharmaceutical companies not infrequently provide to support medical conferences are just that: Unrestricted. Dreger tries desperately to make it sound as though the pharmaceutical company paid Caplan personally. In this I couldn’t help but hear an echo of US Right To Know’s campaign against Kevin Folta.

Dreger than finishes with a little rant that would have been right at home on Age of Autism, The Thinking Moms’ Revolution, or even NaturalNews.com (as long as it was one of Mike Adams’ minions who wrote it, not Adams himself). On the other hand, Adams would approve of the bit about “profiteers” and people being “screwed over” by the “medical-industrial” system:

It’s time to recognize our responsibility to public health by recognizing that Wakefield’s side is not the only one to have effectively unmanaged and undisclosed financial conflicts of interest. Many of the people who are suspicious of vaccines, especially in the U.S., are not stupid. They know about how they and their loved ones have been screwed over by the medical industrial system that insists they need so many ineffective and unsafe drugs and screenings that do not actually help anyone but the profiteers in industry and pseudo-nonprofits, like our “non-profit” hospitals and some well-known “non-profit” cancer-fight organizations.

If we don’t understand Wakefield as a symptom of legitimate suspicion among patients and parents, we will keep giving him fertile ground. It’s time we do something not only about Wakefield, but about the system of medical “science” that is causing the suspicion perpetuating his lies.

This is an argument that, while it has a grain of truth at its core, ends up blaming the pro-vaccine side for everything. If only “we” wouldn’t permit conflicts of interest, if only “we” would reign in the “profiteers” of the pharmaceutical industry, if only “we” would “fix” our medical system to Dreger’s satisfaction, there wouldn’t be any antivaccinationists. (Or at least there would be far fewer of them.) Would that were true! As we know, however, from previous experience with the antivaccine movement, if evidence shows that one of their concerns are unfounded, they seamlessly shift to another pseudoscientific concern about vaccines. If it wasn’t the MMR, it was the mercury in the thimerosal preservative that used to be in many childhood vaccines! If it’s not the thimerosal, it’s the “toxins.” If it’s not the toxins, then it’s “too many, too soon.” No matter what they say it’s about, it always ends up being about the vaccines. That’s why I bet that believing such a simplistic view of vaccine hesitancy and antivaccine parents, in which we could win them over if only we would make medicine as perfect as possible with respect to conflicts of interest and its basis in good science, sure does make one feel good about oneself. None of this is to say that we shouldn’t work to make medicine and medical science more transparent, but it is to say that Dreger has a touching faith in antivaccine parents that doing so will change their mind.

Reading Dreger’s assessment, I couldn’t help but remember how earlier in her post she accused the near-nonexistent members of the pro-vaccine community who, according to her, believe in “vaccine exceptionalism” of being “naïve.” Then, I couldn’t help but go on to think: Pot. Kettle. Black. For how naïve is it to believe that, if only we “fixed” the medical system and the pharmaceutical industry to whatever standards of perfect moral purity to which Dreger thinks we should aspire, parents who are suspicious of vaccines or antivaccine would be much less likely to be so?

Now that’s painfully naïve.