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Dichotomous thinking, uncertainty, and science denial

There is a defect in thinking that is arguably at the heart of much of science denial, dichotomous thinking. We all do it to some extent, but science deniers do it in spades.

If there’s one thing that I’ve learned about communicating science and medicine, in particular countering pseudoscience and quackery, it’s that belief in pseudoscience is very difficult to shake. Anyone who tries to counter, for example, antivaccine misinformation will soon find that simply countering misinformation with good information doesn’t work, at least not with the hard core antivaxers. The same is true when trying to counter cancer quackery and many other forms of medical pseudoscience. Certainly one thing that contributes to this resistance is a very human trait to crave certainty and become anxious when there’s uncertainty. A while back, I came across an article by a psychotherapist named Jeremy Shapiro—he’s at my old stomping grounds of Case Western Reserve University, too!—that delved into this question and led me to decide to write about it for this week. It’s a tendency that is at the root of a lot of science denial, not just pseudoscience and quackery in medicine but denial of climate science, evolution, and many other forms of science denial, which he attributes to the same basic thinking error, dichotomous thinking.

Before I get into the article itself, I tend to like to refer to dichotomous thinking as: If we don’t know everything, we know nothing! In fact, I gave an example of this sort of thinking just last week but didn’t really discuss it. Basically, Bill Maher, when interviewing Dr. Jay Gordon, kept harping on the uncertainty in medicine as a reason to doubt the safety and efficacy of vaccines, to doubt the conclusions of science, listing examples of dietary recommendations that changed, of Accutane being withdrawn from the market, and various other examples of when new findings led to significant changes in medical practice. Basically, his entire line of “reasoning” if you can call it that, was exactly the sort of dichotomous thinking that I listed above: If we don’t know everything then we know nothing, but with an additional twist. If we don’t know everything about everything in medicine, then anything is possible, no matter how much evidence against it exists; e.g., a link between vaccines and autism. At the end of the interview segment, he even explicitly said that, unless a doctor can tell him exactly what causes cancer and exactly how to cure it then he won’t shut up about asking questions about medical issues. Basically, Maher kept ranting about what we don’t know about medicine, completely ignoring how much we do know.

Shapiro characterizes this sort of dichotomous thinking a bit differently. After first noting that science deniers do cite science and empirical evidence but cite it in invalid and misleading ways, he notes that dichotomous thinking, also referred to as black-and-white or all-or-none thinking, is a characteristic factor in a number of mental conditions, including depression, anxiety, aggression and borderline personality disorder. This type of thinking involves taking a spectrum of possibilities and dividing it into two possibilities, eliminating shades of gray. Everything is either black or white.

Then:

Spectrums are sometimes split in very asymmetric ways, with one-half of the binary much larger than the other. For example, perfectionists categorize their work as either perfect or unsatisfactory; good and very good outcomes are lumped together with poor ones in the unsatisfactory category. In borderline personality disorder, relationship partners are perceived as either all good or all bad, so one hurtful behavior catapults the partner from the good to the bad category. It’s like a pass/fail grading system in which 100 percent correct earns a P and everything else gets an F.

In my observations, I see science deniers engage in dichotomous thinking about truth claims. In evaluating the evidence for a hypothesis or theory, they divide the spectrum of possibilities into two unequal parts: perfect certainty and inconclusive controversy. Any bit of data that does not support a theory is misunderstood to mean that the formulation is fundamentally in doubt, regardless of the amount of supportive evidence.

Similarly, deniers perceive the spectrum of scientific agreement as divided into two unequal parts: perfect consensus and no consensus at all. Any departure from 100 percent agreement is categorized as a lack of agreement, which is misinterpreted as indicating fundamental controversy in the field.

This is exactly the way antivaxers appear to think. Those of you who regularly encounter antivaccine misinformation will be able to discern this pattern in the arguments made. If a vaccine isn’t absolutely 100% safe, it’s dangerous, toxin-laden crap. If a vaccine is not 100% effective at preventing the disease it’s designed to prevent, it’s utterly useless. Any vaccine failure at all is evidence to them that they are correct, which is why they constantly harp on outbreaks in which vaccinated children fall ill as “evidence” that vaccines are useless, often crowing about how more vaccinated children became ill than unvaccinated. Of course, when they do this, they completely ignore the inconvenient fact that there are many more vaccinated children than unvaccinated children, which means that when you look at the percentage of unvaccinated children who fall ill compared to the percentage of vaccinated children who fall ill you’ll always find that unvaccinated children are far more likely to fall ill than vaccinated children. It’s a gambit that persuades because many people aren’t that great at math and won’t think in fractions, percentages, and probabilities of becoming ill without prompting and having someone lead them through the calculation.

Dichotomous thinking also has a consequence in how one evaluates existing scientific evidence:

Proof exists in mathematics and logic but not in science. Research builds knowledge in progressive increments. As empirical evidence accumulates, there are more and more accurate approximations of ultimate truth but no final end point to the process. Deniers exploit the distinction between proof and compelling evidence by categorizing empirically well-supported ideas as “unproven.” Such statements are technically correct but extremely misleading, because there are no proven ideas in science, and evidence-based ideas are the best guides for action we have.

I have observed deniers use a three-step strategy to mislead the scientifically unsophisticated. First, they cite areas of uncertainty or controversy, no matter how minor, within the body of research that invalidates their desired course of action. Second, they categorize the overall scientific status of that body of research as uncertain and controversial. Finally, deniers advocate proceeding as if the research did not exist.

This is one reason why I almost never use the word “proof” when discussing science, even when discussing homeopathy which has been about as close to proven to be impossible as anything can be in science. I discuss evidence, not proof. In any event, let’s apply this example to antivaxers. Again, like the example above, where I pointed out that if a vaccine is not 100% effective and safe it’s dangerous and ineffective (to them), if there is any controversy in the science surrounding a vaccine, no matter how minor, then the “science isn’t settled”. (How many times have you heard that line from antivaxers—or, come to think of it, quacks and other science deniers?) The “controversy” doesn’t even have to be a legitimate one, either. Take the example of whether vaccines cause autism. All the large, well-designed, well-executed epidemiological studies have failed to find a whisper of a whiff of a hint of a signal of a correlation between vaccination and autism. However, there do exist studies that have found a correlation. The problem is that they’re all studies by antivaxers, such as Andrew Wakefield, Mark and David Geier, and others, and they’re all terrible studies with huge methodological flaws. As discussed by Shapiro, though, antivaxers give equal (or even greater) weight to the studies by antivaxers finding that vaccines cause autism as they do to the vast compendium of studies by legitimate scientists that find vaccines don’t cause autism, and conclude that there’s still a scientific controversy over whether vaccines cause autism. There isn’t.

There’s a similar pattern with cancer quackery. Because I specialize in the surgical treatment of breast cancer, I understand that it’s incredibly scary to be diagnosed with cancer, even a cancer like breast cancer, which most of the time can be treated with a high likelihood of long-term survival or “cure,” if you will. Most patients, even those who believe in cancer quackery, will accept that surgery “works”, because it’s fairly intuitive that removing a cancer will treat it, but far more have a problem with chemotherapy and radiation. That’s why there are so many women with alternative medicine cancer cure testimonials who, when you examine their stories more closely, turn out to have accepted surgery but refused chemotherapy and/or radiation and were, in essence, lucky enough to have been “cured” by the surgery. In any event, the same sorts of arguments are common. If there isn’t a 100% cure rate, then conventional cancer treatment is useless and a dangerous mix of “cut, burn, poison”. Meanwhile, cancer quacks promise a 100% cure rate or a 90% cure rate for cancers that conventional medicine can’t cure but only manage, and any study that a treatment has more toxicity or is less effective than previously suspected is touted as evidence that chemotherapy doesn’t work. (It does.)

Shapiro points out the same phenomenon in another area of science. See if you hear echoes of arguments we’ve dissected on this blog before:

This same type of thinking can be seen among creationists. They seem to misinterpret any limitation or flux in evolutionary theory to mean that the validity of this body of research is fundamentally in doubt. For example, the biologist James Shapiro (no relation) discovered a cellular mechanism of genomic change that Darwin did not know about. Shapiro views his research as adding to evolutionary theory, not upending it. Nonetheless, his discovery and others like it, refracted through the lens of dichotomous thinking, result in articles with titles like, “Scientists Confirm: Darwinism Is Broken” by Paul Nelson and David Klinghoffer of the Discovery Institute, which promotes the theory of “intelligent design.” Shapiro insists that his research provides no support for intelligent design, but proponents of this pseudoscience repeatedly cite his work as if it does.

Again, this is part of how this sort of thinking works. The core tenets of the theory of evolution are supported by an enormous body of mutually-reinforcing evidence from a number of different disciplines built up over many decades. The controversies in evolution, such as they are, tend to be at the bleeding edge of the science, and the bleeding edge is always way more uncertain than the core. (Otherwise they wouldn’t be bleeding edge.) Yet creationists use those scientific controversies to cast doubt on the very core of evolution. It’s how science denial works. Similarly, climate science deniers use controversies at the very edge climate science to cast doubt on the entire conclusion of climate science that the earth’s climate is warming catastrophically largely due to human activity. Like the case with antivaxers, too, often the deniers produce dubious scientific studies to give the illusion of scientific controversy.

As Shapiro concludes:

There is a vast gulf between perfect knowledge and total ignorance, and we live most of our lives in this gulf. Informed decision-making in the real world can never be perfectly informed, but responding to the inevitable uncertainties by ignoring the best available evidence is no substitute for the imperfect approach to knowledge called science.

Indeed.

My one quibble with Shapiro is that I’m not so sure that a pathological (or near-pathological) level of dichotomous thinking is necessary for science denial to take hold, just a normal level coupled with perhaps an above-average need for certainty. When discussing this aspect of science denial, I like to quote a song by David Bowie, Law (Earthlings on Fire): “I don’t want knowledge. I want certainty!” That pretty much sums it up. If there’s a trait among humans that strikes me as being universal, it’s an unquenchable thirst for certainty. It’s a major force that drives people into the arms of religion, even radical religions that have clearly irrational views, and it isn’t expressed only through extreme religiosity. As anyone who accepts science as the basis of medical therapy knows, there’s a lot of the same psychology going on in medicine as well. This should come as no surprise to those committed to science-based medicine because there is a profound conflict between our human desire for certainty and the uncertainty that is always inherent in so much of our medical knowledge. The reason is that the conclusions of science are always provisional, and those of science-based medicine arguably even more so than many other branches of science. Why? Because medicine involves applying imperfect science to the treatment of disease. Often that application produces clear-cut cures. Arguably more often, though, the results are more mixed and less satisfyingly clear-cut (e.g., the treatment of chronic diseases). To go back to the David Bowie quote, evidence is knowledge, not certainty or, to echo Shapiro, “proof”. Take that craving for certainty and mix in some dichotomous thinking and any conclusion of medicine that isn’t 100% certain becomes very uncertain.

As I’ve said before, one of the hardest things for the average person who is not medically or scientifically trained to accept about science-based medicine is that the conclusions of science are always subject to change based on new evidence, sometimes so much so that even those of us “in the biz” can become a bit disconcerted at the rate at which knowledge we had thought to be fairly settled changes. One example that I frequently like to cite is how duodenal peptic ulcer disease (PUD) was treated 35 years ago compared to how it is treated now. Between 1984 and 1994, a revolution occurred on the basis of the discovery of H. pylori as the cause of most of the gastric and peptic ulcer disease we see. Where in 1985 we treated PUD with H2-blockers and other drugs designed to block stomach acid secretion, now antibiotics represent the mainstay of treatment and are curative at a much higher success rate than any treatment other than surgery and without the complications of surgery. I’m sure any other physician here could come up with multiple other examples. In my own field of breast cancer surgery, from time to time I look back at how we treated breast cancer nearly 30 years ago, when I first started residency, and compare it to how we treat it now, and I marvel at the changes, many of which I had to learn after having completed my training. If such changes can be disconcerting even to physicians dedicated to science-based medicine, imagine how much more disconcerting they are to lay people, particularly when they hear news reports of one study that produces one result, followed just months later by a report of a different study that gives a completely different result. That’s definitely not certainty!

The problem is that quacks offer what humans crave: Certainty. They also offer it in a manner that begs for dichotomous thinking: My quackery is good and effective; conventional medicine is a useless and toxic (and big pharma profits). Unfortunately, as I’ve discussed before, scientists often fall prey to what has been called the “truth wins” assumption. This assumption, stated simply, is that when the truth is correctly stated it will be universally recognized. Those of us who make it one of our major activities to combat pseudoscience know, of course, that the truth doesn’t always win. Quite the contrary, actually, I’m not even sure the “truth” even wins a majority of the time — or even close to a majority of the time. Moreover, most recommendations of science-based medicine are not “truth” per se; they are simply the best recommendations physicians can currently make based on current scientific evidence. They have changed. They’re changing now. They will continue to change. The examples are endless: mammography recommendations, treatment for hypercholesterolemia, adjuvant chemotherapy recommendations for breast cancer and other cancers. Unfortunately, there are quite a few doctors who are just as uncomfortable with change as the average person and still use out-of-date treatments and techniques.

The challenge, then, as a physician and science communicator, is twofold. First, we have to be comfortable when dealing with uncertainty and change ourselves. If we can’t, then there’s no way we’ll be able to communicate uncertainty. Second, we have to be careful to acknowledge and explain the uncertainty in the findings of science, noting where there is little to no uncertainty and where there is more. Of course, by the time we are adults, it’s often too late to get that message across in a way that we ever really internalize it. We really need to teach our children not just critical thinking but that in science there is no such thing as absolute proof and that medical and scientific conclusions are supported by evidence and subject to change and revision in the face of new evidence. Then there would be less for quacks to work with when they try to persuade people that science is unreliable and their treatments provide certainty.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

126 replies on “Dichotomous thinking, uncertainty, and science denial”

As with any other medical procedure and medication, informed consent needs to apply to vaccination. I know the “1 in a million” quote regarding injury, etc…These confirmed injuries were fortunate enough to make it through the bureaucratic nightmare of vaccine court. If it is one in a million, what if your child is the one? Why is that ok? It’s more than 1 in a million. The data is obfuscated through poor information gathering, gas lighting, and denial of a patient’s medical history. Even when the information is available in the inserts, adverse events are excused as mere coincidences. Vaccines may not cause autism but the inserts in many state encephalopathy (brain damage) was a documented outcome. People are waking up and no longer blindly following medical advice from the corrupt, profit driven medical cartel.

This comment appears to have nothing to do with the post, unless it’s a somewhat indirect attempt to show its points. Have you read the post?

I think we owe Natalie thanks for providing an excellent example of the topic of the article. Given the stark choice between:
– taking the chance of getting several illnesses through inaction; or
– protecting yourself and your children by immunization
she not only chooses inaction but also chooses to actively encourage others to do the same!

All this is because if you get immunized you might have a reaction which might lead to an injury which might be so severe that you go to the courts and might not get compensated.

Whereas if you do nothing you might not get the disease, and if you do you might not have one of the worse side effects (e.g. paralysis, blindness, deafness, death, etc.), and you definitely won’t go to court and get compensated.

So – immunization is worse than the disease because we can’t be 100% sure that the immunization will work without any issues in all cases while we know that less than 100% of the people who get the disease have long term issues.

This is by no means intended to make light of those people who do suffer sequela after immunization. My heart goes out to them and their families. Just like it would to the many, many more who would have suffered as badly or worse were there not mass immunizations.

Frankly, I think Dr. Bob had it more right (in a perhaps somewhat antisocial way) – if you don’t want to immunize yourself and your children, hide in the herd. Don’t tell people what you’re doing or to skip their immunization – heck, encourage those around you to keep their immunizations up to date to reduce the chance you’ll be exposed to the disease. Freeload, if you will. After all, you MIGHT be the unlucky one in a million.

The packet inserts are required by law to list any and all suspected/reported vaccine-related adverse reactions, even if no scientific basis and even if only one report ever. And if 1 in a million or even 1 in 100,000, what about the risk from the natural disease. Extrapolated from 1950s to current population, without vaccine measles would yearly result in around 100,000 hospitalizations, around 1,000 deaths, around 1,000 permanent disabilities, plus week to 10 days of missing class and suffering. In other words, odds from disease exponentially greater than from vaccine. In the real world one has to weigh the odds. In the case of vaccines, exponentially in their favor. Yep, if ones child the rare case of serious adverse events, having given the vaccine would incur guilt and anger; but what if one refused the vaccine and child suffered serious adverse events, same guilt and anger; just would be far more parents who didn’t give the vaccine.

One more example, rubella, German measles, three day measles, almost always an extremely minor unpleasantness, except for pregnant women. With an incubation time of 12 – 14 days, if a woman becomes pregnant after exposure or during pregnancy, risk of miscarriage, stillbirth and congenital rubella syndrome (deafness, blindness, seizure disorder, retardation, microcephaly) almost 100%. An epidemic in mid 1960s resulted in almost 40,000 cases. So vaccinating people protects fetuses. Maybe you don’t think society should protect pregnant women???

These confirmed injuries were fortunate enough to make it through the bureaucratic nightmare of vaccine court.

I’ll repeat Prof. Reiss’ comment that you don’t address any points of the blogpost, just seek an opportunity to edge your anti-vaxx views in. And you are wrong in that (surprise). The rate of vaccine injuries aren’t determined by those who prevail in Vaccine Court; those are legal proceedings. They are determined by scientific studies so it is no surprise that those who are awarded in court roughly reflect the best evidence we have available about vaccine adverse events.

@Joel and Science mom. I don’t want children to suffer. That’s my point, especially the ones who are already here.

As far as science and truth…. https://www.sciencealert.com/how-much-top-journal-editors-get-paid-by-big-pharma-corrupt

Per usual…. https://www.opensecrets.org/federal-lobbying/industries/summary?cycle=2019&id=h04

To follow along a person needs faith, like a cult, with all the assumptions, extrapolations and unknowns because the science is incomplete, corrupted and flawed. The more I read, the more

I don’t want children to suffer.

Then why do you want them to get diseases that are bad enough that we put large amounts of time, money and energy into finding ways to prevent them? If you think VPDs are not a big deal, why don’t you volunteer to get tetanus to show how “not a big deal” it is?

I don’t want children to suffer.

Aw, bless your heart you little warrior mom you.

As far as science and truth…. https://www.sciencealert.com/how-much-top-journal-editors-get-paid-by-big-pharma-corrupt

I’ll take it you refuse to read Retraction Watch et al. Yes, there are some dodgy dealings in science publications; that doesn’t mean all studies are “corrupt” and not even most. It’s sloppy/lazy/ignorant of you to apply an article such as that to all scientific endeavours.

Per usual…. https://www.opensecrets.org/federal-lobbying/industries/summary?cycle=2019&id=h04

That’s a problem in politics, not science. Again you tarnish an entire field because of some bad apples, that I may add seem to be a larger problem with one party coughGOPcough than another. Vote and urge your representatives to reform campaign financing and lobbying laws. I do.

To follow along a person needs faith, like a cult, with all the assumptions, extrapolations and unknowns because the science is incomplete, corrupted and flawed.

Oh self-awareness where art thou.

I’m surprised you’ve got time to post here @NatalieWhite – I’d have thought you and your ilk would all be busy dancing on the graves of the kids dying in the measles outbreak in Samoa?

I have a two year-old daughter. I come from a very poor part of the world. I’ve seen first-hand what Rubella can do to a baby from a vaccine-refusing mother.

Why is 1 in a million okay? Because, without the vaccine, that 1 in a million becomes 1 in 1,000, and that’s definitely not okay. Why multiply the risk by a factor of 1,000? And that’s death. One in 1 million do not die from the MMR vaccine, while 1 in 1,000 who get measles will die from it.

I’ll gladly take those odds for my daughter and for any other child under my care. Those privileged enough to have never seen the horrors of vaccine-preventable diseases may be comfortable enough to minimize the consequences of diseases while losing their minds at the very rare possibility of a vaccine “injury.” I wish I were that privileged.

Yeah, you say that until it happens to you. Ask Dr. Poling how he feels about his daughter, “taking one for the team”. So lame.

Hanna Poling? We’re reviving that case again? If these things happen so regularly, why not find another one? It’s been a while since her case was ruled upon. And, yes, I’d take one for the team. It’s probably not the kind of thinking you particularly would be inclined to, but I love my daughter and her friends at daycare and cousins that much. I’d rather be lame than heartless enough to scare parents away from protecting their children. 😉

One more thing… If by “it,” you mean autism, I’ll take it over death and other consequences of not vaccinating any day of the year. This obsession many like you have with wanting autism to be, or treating it like, a death sentence needs to stop. Children and adults who are autistic are reading this, and you all are basically calling them dead or invalid. They’re not, and anyone who keeps using autism as the worst possible outcome of vaccination needs to apologize to autistics and remove themselves from the internet, stat.

Just a reminder that the Poling case was not ruled on. It was conceded based on a table injury where causation is presumed.

https://www.google.com/amp/s/leftbrainrightbrain.co.uk/2016/07/08/court-clarifies-hannah-poling-case-does-not-afford-any-support-to-the-notion-that-vaccinations-can-contribute-to-the-causation-of-autism/amp/?client=safari

It doesn’t show what the antivaccine activists claim, and further, their efforts put children with mitochondrial diseases at risk.

Using that case to put children like Hannah at higher risk is just jarring.

@ Rene F. Najera, DrPH:

Exactly. ( As usual)
“Those privileged enough to have never see the horrors of vaccine-preventable diseases…”

Another aspect of the growth of anti-vax adherence may be not just affluence ( middle class or better, so-called First World countries) BUT their age cohort:
— the ( mostly) women we’ve been watchingprotestig at events in Sacramento, Washington and other pop up protests seem ( I haven’t taken a poll) to be a certain age group ( being the parents of young children may set limits) perhaps age 30s-40s being most representative –
which means that they probably have NEVER seen a VPD in the wild. They were vaccinated and never had measles, mumps, varicella etc.

But what’s worse, is that people who should know better – their chosen doctors and older partisans, don’t set them straight.
— many of the leaders of anti-vax are old enough to have seen/ suffered these illnesses themselves:
Wakefield, Blaxill, Kennedy, Drs Tenpenny, Humphries and Gordon must all be at least 60. Some of the parents ( AoA, TMR) as well: Ann Dachel, Loe Fisher, Kuo Habakus, Rossi, Polly Tommey, Del Bigtree, Heckenlively, Handley, Stone are probably 50- 70+.
People in this age group should also be aware of how children labeled as ID/ SMI were warehoused in institutions but yet they ask, “Where were all the children with ASDs years ago?”
They were called something else and hidden away from the public.

Let me correct:
people with low functioning ASDs were hidden away.
Others were in the leaders’ general classrooms.

I use the one in a million figure frequently. It does not come from the Vaccine Court. It comes from the CDC and their constant studies on vaccination, adverse events, and impact on infectious disease control. That’s what they DO. They’re the Center for DISEASE CONTROL and PREVENTION.

How many people got enchephalopathy after receiving the MMR vaccine? Was it conclusively proved the adverse event was caused by the vaccine? Through what mechanism?

You see, antivaxxers need to be able to answer these questions and they can’t, because once they twist a vaccine insert to fit their preconceived narrative their attention to the further details stops.

The answer is essentially. While a very early study found an association in 1998,a subsequent study of half a million children found zero association or causative effect between MMR and measles encephalopathy. The conclusion from this study is the extremely rare chance of getting encephalopathy from MMR (that 1 in a million number I mentioned), is a far better chance to take than getting actual measles where the odds are 1 to 3 in 1,000. This really a no brainer.

1-3 in 1,000 children <em>contracting measles</em> will develop encephalitis concurrent with the measles infection. 10–15% of those children will die and a further 25% will be left with permanent neurological damage.

1 in 1,000 children with <em>measles</em> will develop post-infectious encephalitis.

1 in 25,000 of children (1 in 5,500 children if they are under 1) <em>with measles</em> will develop subacute sclerosing panencephalitis (SSPE) which has a fatal (death) outcome.

1-2 in 1.000.000 children who <em>had vaccination</em> will develop encephalitis from the vaccination which is less than the incidence of all types of encephalitis.

Source: Enchephalitis Society, 2017. retrieved from https://www.encephalitis.info/measles-infection-and-encephalitis

Have you quit driving because you just might be one of the 40,000 (or so) killed in a road collision this year? I doubt it; instead, you put on your seat belt, drive defensively and within the law and hope for the best.

Certainty must surely play a part…

just a normal level coupled with perhaps an above-average need for certainty

And I would add that a person’s need for certainty is not ingrained either. It would just take a cancer diagnosis to change how much need for certainty you have.

I think one added feature that grabs people into movements is the need for community. Cults have a way of keeping people pinned in a movement by restricting how their communal ties are maintained; they talk to and interact almost exclusively with people who are giving back to them examples of the way an individual in the movement is expected to think, and in some cases, are subjected to conditions that explicitly cut them off from people who might tell them something different. Filter silos unquestionably act in a similar way. I know I’m not saying anything that hasn’t been said a hundred times or more. Certainty may well be the thing that turns them, but the thing that keeps them and in darkness binds them is community.

I have big problems with cancel culture (in an abrupt segue); it strikes me too much as shunning or disconnection, like Scientologists or Mormons or any other cult executes.

Orac: “We really need to teach our children not just critical thinking but that in science there is no such thing as absolute proof and that medical and scientific conclusions are supported by evidence and subject to change and revision in the face of new evidence.”

Oh hell yes.

So how do we convince boards of education and college higher-ups of the vital nature of this teaching?

Fascinating stuff. You raise the stronger need for certainty as one explanatory factor, and Foolish Physicist raises a health crusts, like cancer, as a second – I wonder if a real mistrust inducing event should be considered as a third: something that gave a person cause to mistrust doctors and made them more vulnerable to seeking alternatives that are certain. It can be anything from an actual medical mistake to impatience or anger in responding to a question.

@ Dorit:

Two of the biggest promoters of quackery I know maintain that family members- usually,a parent- was “killed” by SBM:
–Mike Adams ( on his Health Ranger site) says that family members died because of cancer treatments by SBM
–Gary Null insist that his mother died of a heart attack because she obediently followed doctors’ order and took HRT for menopause and his father died of cancer because he listened to doctors NOT his son. Similarly, his brother.

If you read anti-vaxxers’ stories about their children, they frequently blame doctors for vaccinating their children and then abandon SBM by seeking out woo.

I get that, but I’m not sure I buy this narrative from Adams, Null, or antivaxxers.

Adams and Null are shills who will say anything to make a buck.

Orac has talked about the tendency of AVers to dislike anything that implicates them as a cause of their kids autism; eg it can’t be genetics it must be the vaccine.

Lots of people have a bad encounter with doctors and still seek them out when they’re sick.

And it doesn’t explain health care professionals who should and do know better who will advise all sorts of “natural” approaches over actual medicine not out of a profit motive but misguided belief. Dunning Kruger.

MJD simplification: Non-static dichotomous thinking is the mother of invention. Quacks sometimes push our buttons, although, they are essential to the growth and development of pioneering ideas.

Q. In the near future, will artificial intelligence in medicine falter based on its inability to comprehend the benefit of a “theatrical placebo.”

“Quacks sometimes push our buttons”

Yes, quacks like you certainly do, as you are constantly arguing against science and toward more harm

“although, they are essential to the growth and development of pioneering ideas.”
No.

“In the near future, will artificial intelligence in medicine falter based on its inability to comprehend the benefit of a “theatrical placebo.””

given your demonstrated lack of understanding of anything to do with AI the obvious question is “Who put that question together for you?”

Black and white thinking is how younger children think- it takes a while for them to learn to see shades of difference. You can imagine this by surveying how literature for children usually depicts characters as all-good or all-evil, for example in fairy tales. Stories with more modern and educational aims try to inject realism by showing that perhaps the ‘bad guy/ girl’ isn’t really so terrible or that there is misunderstanding about him/her**. Piaget and his followers hold that integration of different aspects of a person or situation may require at least the beginnings of formal operational thought which typically occurs/ starts in adolescence.

So yeah, they’re child-like and not in a good way. Quacks cater to this tendency of simplistic thinkers by providing “certain cures/ answers” *** and painting SBM in bold shades of total black. All Orac’s regulars can think of examples of all-or-nothing thinking- the Nirvana fallacy,if it ain’t perfect, it’s nothing used by denialists ( see flu vaccines). Science is probabilistic, a comparison of differing percentages of advantage or disadvantage not cut and dry.

** although if you look at some YA fiction/ films you may be hard pressed to find any more balance
*** their treatments have near total efficacy, I hear 98% or 93% frequently at PRN vs 3% for chemotherapy

As an aside…
about how gastric ulcers are treated;
my father had a few bouts of ulcers; in 1982, he over-used aspirin for a knee injury and – Guess what? They treated him with an acid-blocker. Then, years later, 1993, he had a recurrence – despite not using aspirin and Voila
they used another acid block, antibiotics and OTC Bismuth tablets. He had to stay on acid-blockers for the rest of his life with no real problems.

My cousin ( no blood relation to my father**) developed ulcers at the age of 5 ( yes) in 1969. His mother found a doctor who imported a New Wonder Drug for him from Sweden – the first acid blocker- which helped him to have a relatively normal life. AS an adult, he learned that he had acid production that was abnormal, it pointed towards his throat not the other way .IIRC
He has done well for himself and works creating “movie magic” and fancy editing for television production.

** lots of ulcers in both my families, uncles, aunts, cousins; so far so good for me.

“Proof exists in mathematics and logic but not in science.”

I’m sure everyone here realizes it, but it’s worth noting that we have cranks in mathematics (and statistics, my area) who are just as steadfast in their denial of mathematical proofs as anti-vacc people are in their denial of science. It’s more common than you would think to encounter students (and the occasional faculty) who refuse to believe the sets of whole numbers and the reals have different cardinalities. My all time head scratching “WTF?” reference was guy who started grad school as I was finishing: he left after a couple semesters because he refused to accept the concepts of spaces of dimension higher than 3 and that it was possible to define different but equivalent metrics on such spaces.

“denial of mathematical proofs”

Cranks can be worse than that, deriving so-called proofs with glaring errors that when pointed out are denied. That is, they persist in believing their proof despite the mathematical errors they’ve made.

Another thing about mathematical proof (and logic) is that it can be far more elusive than most realize. Two exemplary mathematicians, though in very distinct fields, are Godel and Lakatos.

“concepts of spaces of dimension higher than 3”

This may be an example of the confusion between mathematics and physics. We use mathematics to construct physical models, however much of mathematics, though valuable on its own, is not useful for constructing physical models. Further, physics may not be reducable to mathematics in the general case. That is, physics may not comprise a formal system. These are advanced topics that go beyond the thrust of Orac’s article.

There is also the matter of domain. Many widely use physical laws are not fundamental and are at best approximations. When you step outside their domains (in the sense of mathematical functions) they are unreliable and can be very very wrong. Examples include Ohm’s law and the inverse square law (both electromagnetism and gravitation). More relevant to the article are the effective domains of the various statistical methods used in science, and especially by cranks, that Orac often addresses.

Fun stuff.

“This may be an example of the confusion between mathematics and physics. We use mathematics to construct physical models”

he had serious ‘objections” to high dimensional vector spaces in linear algebra and their use in statistics and statistical modeling. The metric stuff came primarily in the definitions of different M-estimators.

He probably would have hated the concept the time domain versus frequency domain.

My dad started college on the GI Bill right after WW II, and wanted to do physics because that was the rage. Well, he had to drop that line of study when he refused to use just the significant digits. He did not understand why he was marked down by showing an answer out to six or more significant digits, when the data provided only had three. He ended up majoring in linguistics, with an emphasis in French. And went back into the Army in the Counter Intelligence Corps, listened to lots of radio talk.

I had a couple of frustrating conversations with him trying to explain the logarithmic scales for sound and earthquakes.

Mathematics is a special case, in that “true” really means “logically consistent”. That’s what mathematical proofs amount to: you start with a certain number of axioms (preferably as few as possible) and you show that certain concepts are consistent with those axioms. Even there you have issues like Gödel’s incompleteness theorem, which shows that a mathematical system cannot be both complete and logically consistent.

I get a certain reluctance to accept things that are beyond everyday experience, such as a space with N > 3 dimensions. As a physicist I am comfortable with higher-dimensional spaces, like the four-dimensional spacetime of relativity and the six-dimensional (or 6N-dimensional, when you are considering the motions of individual particles) phase space in which velocities as well as positions are treated as coordinates. Some engineering problems are set in parameter spaces that may have more than three dimensions (if the parameters are not redundant there will be one dimension for each free parameter). But many people are as limited by their experience in the 3-D world as Mr. A. Square of Flatland was by his experience in a 2-D world (the purpose of that book was to give some idea of how we would perceive a higher-dimensional space).

All other branches of science besides mathematics have uncertainty. Uncertainty is even fundamental in quantum physics, because there are limits to how precisely you can simultaneously know, e.g., the position and momentum of a given particle. (I suspect this is one reason for the prevalence of quantum woo: things are sufficiently non-intuitive that charlatans can make a living “explaining” quantum to the gullible.) One should have a healthy respect for uncertainty in science. But cranks take it to an unhealthy level.

There was some “I’ve invented a new physics and Einstein was wrong bow down to me!” type over on an old post telling us how we were wrong about biology and how we are wrong about physics (gravity waves aren’t real, but also are faster than light), and we should all be scared of 5G.

I gave them 0.75 TimeCubes. (A TimeCube being a unit of Internet physics nuttiness named in honor of some guy from back in the early 00’s.)

There was someone on Neurologica recently who had a degree in philosophy but no science degree. He has written two books. One is a philosophical take-down of the Big Bang, and the other a philosophical take-down of Dark Matter. He thinks a degree in physics would have been detrimental to him discovering the flaws missed by all the physicists in the world over the past century or so because he would have copied the same error. He is convinced the future will prove him correct.

@BillyJoe: “There was someone on Neurologica recently who had a degree in philosophy but no science degree.”

If science is descended from philosophy, how come there are still philosophers? Check-mate, navel-gazers!

Shapiro characterizes this sort of dichotomous thinking a bit differently. After first noting that science deniers do cite science and empirical evidence but cite it in invalid and misleading ways,

Oh -oh- Orac! – I soooo get what Shapiro is saying here. It’s like on the other thread where Beth asked you to cite the studies, after you contested Wellers’ claim that the full schedule hasn’t been tested for safety, and all you cited were largely irrelevant stuff. Really — how ‘science denying’ was that!

So again:
The rate ratio for type 1 diabetes among children who received at least one dose of vaccine, as compared with unvaccinated children, was 0.91 (95 percent confidence interval, 0.74 to 1.12) for Haemophilus influenzae type b vaccine; 1.02 (95 percent confidence interval, 0.75 to 1.37) for diphtheria, tetanus, and inactivated poliovirus vaccine; 0.96 (95 percent confidence interval, 0.71 to 1.30) for diphtheria, tetanus, acellular pertussis, and inactivated poliovirus vaccine; 1.06 (95 percent confidence interval, 0.80 to 1.40) for whole-cell pertussis vaccine; 1.14 (95 percent confidence interval, 0.90 to 1.45) for measles, mumps, and rubella vaccine; and 1.08 (95 percent confidence interval, 0.74 to 1.57) for oral poliovirus vaccine. The development of type 1 diabetes in genetically predisposed children (defined as those who had siblings with type 1 diabetes) was not significantly associated with vaccination. Furthermore, there was no evidence of any clustering of cases two to four years after vaccination with any vaccine.
N Engl J Med 2004; 350:1398-1404
DOI: 10.1056/NEJMoa032665
and
The highest risk for autism was conferred by being a boy (HR, 4.02 [CI, 3.78 to 4.28]), being born in a late birth cohort (2008-2010; HR, 1.34 [CI, 1.18 to 1.52]), having no early childhood vaccinations (HR, 1.17 [CI, 0.98 to 1.38]), and having siblings with autism at study entry (HR, 7.32 [CI, 5.29 to 10.12]).
Ann Intern Med. 2019;170(8):513-520.
DOI: 10.7326/M18-2101
Besides, you claim that all vaccines are dangerous. Dropping three should be beneficial. And if there are a cumulative effect, three vaccines should show it.

Oops – continued – the more I read, the more unsettled I become. And now in this post ORAC is asking for a pass. Science keeps evolving, sure we get it wrong sometimes, because we’re just working with the info we have available…and you all will need to roll with our mistakes….that’s just not good enough.

I just had a lovely conversation with my adult child with level 2 autism. He saw an this article on my laptop screen: https://www.vice.com/en_us/article/kz4jyz/earthquake-conspiracy-theorists-are-wreaking-havoc-during-emergencies

Which surprised him on how there were so many more conspiracies than he imagined. Not bad for a kid who could not do something as “simple as speak” as a three year old. After ten years of intensive speech therapy he can speak, but it takes a bit to understand. It has nothing to do with his intelligence. He has a two year associate’s degree an political science. He is not impressed with folks like you.

My level 2 autistic adult kid is smarter than you. I would put that bumper sticker on my car if I still had a car.

Oops – continued – the more I read, the more unsettled I become. And now in this post ORAC is asking for a pass. Science keeps evolving, sure we get it wrong sometimes, because we’re just working with the info we have available…and you all will need to roll with our mistakes….that’s just not good enough.

Natalie, with all due respect, I think you’re falling for Orac’s snake-oil. Like a good salesman, the purpose of this blog is to pitch the notion that if there are shortcomings to vaccinology, then it’s — ‘oh well, whad ya gonna do, science doesn’t always have all the answers!’ This tract is nothing more than attempted cover for the reality that it’s not a case of vaccinoloy coming up short with the answers, but clear cases of malfeasance. We are talking really bad science with researcher deliberately choosing not to conduct proper research, and when they do, it being hopelessly flawed or downright fraudulent.

One of the reasons the likes of RFK jr and Del Bigtree garner so much hate around here is because they never fall for the defense of ‘not enough answers’. Instead, they constantly reiterate just how bad and fraudulent the science is. Remember RFKjr $100,000 challenge for anyone who could prove vaccine science was sound? Interestingly, no one took him to task.

Natalie, you’re right, people indeed are catching on, and the vaccine pushers are starting to feel a fair amount of angst. Expect them to keep desperately scurrying to this defense of — if shit did indeed happen, it was only because we were human and couldn’t provide all the answers. It’s noting more than keeping your objector pinned, and avoiding talks of culpability and retribution.

PS: Natalie, when assessing Orac and the Choir, I find it useful to give priority to consideration of not what they say, but why they are saying it.

So why are we saying it, Greg? Money?

That’s a laugh. I make 50K per year teaching nursing. I might make another 5K in a very good year as a legal nurse consultant. Usually I get about 1-2K.

I’m not in this for the money. I live comfortably. I’m in this because I care about people’s health, and I know through my knowledge, training, and experience that vaccines save lives.

I watched an elderly woman die yesterday from pneumonia and sepsis. It was a terrible death. Her legs were literally rotting away, and she had a large necrotic area on her sacrum. The smell was awful. I don’t know what her vaccination status was; if she’d had either or both of the pneumonia vaccines or her yearly flu shot. I do know the illness came on suddenly to a woman who was healthy for her age prior to this. Cases like this are why everyone should get a flu shot. We don’t just protect ourselves. We protect others. If we can prevent the spread of flu at this time of year from even 33% of the population, 10% of the population, we reduce the risk of people dying like this.

It’s worthy a few achy muscles a few days after the shot.

Thanks Greg. No offense taken. I care about “the one in a million” (I know it’s more). It reminds me of the Old Testament and sacrifices to Ba’al. Since the choir loves the car analogy, I liken this to crossing a toll bridge. For every millionth passage, a child is thrown out of the car as an offering.

@ Nathalie White

I liken this to crossing a toll bridge. For every millionth passage, a child is thrown out of the car as an offering.

sigh
And if we don’t take the bridge, but the fording we have been using for millennia before, for every hundred or so crossing, we throw out someone.

Look, if you have some way to reduce this one/million to one/10 million or less, I’m taking it. We are taking it.

Natalie: “Thanks Greg. No offense taken. I care about “the one in a million” (I know it’s more).”

Since measles cause encephalitis in one of a thousand cases, we would really need to see that PubMed indexed study that shows the MMR vaccine is more dangerous. No package inserts.

Your failure to understand this simple concept is a glaring indication of the relationship between your intelligence and motivated reasoning. The ratio of the former over the latter is tending towards zero.

@ Chris:

Do you ever get the impression that anti-vaxxers have problems understanding ..uh… how can I say it..
numbers?
1 in a thousand is worse than 1 in a million.
Other examples crop up as well. They believe Seneff: in a few years, 50% of kids with have ASD – or is it 110%?

T-Bruce, I’ll bite by asking the tough question that needs asking: How many cases of autism or vaccine injuries are justified by one kid anywhere on the planet being saved from measles death? Is it 100, 1000, 100,000 — a million? C’mon drug dealers! – don’t say the comparison is irrelevant; give me a number.

Greg, what evidence do you have that autism and the MMR are related? The first MMR vaccine started to be used in the USA in 1971, it had an upgrade in 1978. Since the USA is very large country and had been using an MMR more than twenty years before Wakefield’s “study”, please provide the studies he used to determine it might cause autism.

Just post the verifiable data dated before 1995 that autism in the USA increased with the use of the American MMR vaccine during the 1970s and 1980s. It could be PubMed or American education statistics.

To clarify the logic for you, Greg: a vaccine causing autism would be seen earlier in a country hat is much larger and had been used longer, than a country like the UK which is small and only introduced three of its versions in 1988.

Oh, the UK introduced three different MMR vaccines in 1988. Which of those three did Wakefield research? And why did he throw in an American kid with a fourth MMR vaccines. Newsflash: MMR vaccine components are not the same over the world.

In fact the USA MMR vaccine was improved in 1978 when one component caused issue, but the one used in Europe did not. Does it blow your mind that issues were noted and actually fixed! Or do you just not care about the facts.

T-Bruce, I’ll bite by asking the tough question that needs asking: How many cases of autism or vaccine injuries are justified by one kid anywhere on the planet being saved from measles death?

Since I don’t buy into your psychotic delusions about vaccines and autism, I’ll just state the obvious: 16 deaths out of a population of about 190 000 is a hell of a lot worse than the risk of a severe injury from MMR (yes, 1 per million).

@Greg
Third time:
“The highest risk for autism was conferred by being a boy (HR, 4.02 [CI, 3.78 to 4.28]), being born in a late birth cohort (2008-2010; HR, 1.34 [CI, 1.18 to 1.52]), having no early childhood vaccinations (HR, 1.17 [CI, 0.98 to 1.38]), and having siblings with autism at study entry (HR, 7.32 [CI, 5.29 to 10.12]). The autism risk score had a modest effect on autism risk compared with sex and sibling history of autism (highest-risk group versus moderate-risk group; HR, 1.38 [CI, 1.28 to 1.48]).”
Hviid A, Hansen JV, Frisch M, et al. Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Ann Intern Med. 2019;170:513–520. [Epub ahead of print 5 March 2019]. doi: https://doi.org/10.7326/M18-2101
You can perhaps tell us what is wrong with this study ? It is a vax-novax study, too.
And the idea that Big Pharma pays blog commenters is really comical. Have you visited a real astroturf site ?

@Natalie White
Why would somebody with vaccine injury would not go to Vaccine Court ? It would not cost any money to lose your case. So why would numbers be an underestimate ?
The vaccine court cases include SIRVA, which is caused by bad needlework. Table injuries are compensated automatically, it is just that vaccines can cause the them. Numbers are actually an overestimate.

K, I see I have some responses to my query about how much cases of autism and other vaccine injuries one kid saved from measles death will buy us. The responses for the most part weren’t on point, but oh well! Chris, at this moment I am not inclined to speak to you about malfeasance with vaccine research, so I will just leave again the 14 Studies link..

Guys, don’t get me wrong here, but I am just trying to imagine things from the perspective of the average Joe or Joanne living here in North America. I supposed we can all agree that Samoa is very very far away, and it will be harder for the average North American to feel personally connected to their measles deaths; Not to mention, we’ve had measles outbreak here and despite the media’s around the clock screaming that armageddon was on the horizon, really not much came of it.

Guys, I am sure you will all agree that most people just see as far as their noses. Yet, within that vision field they can see lots of autism, lots of learning disabled kids, kids with allergies, ADHD, increasing taxes from ballooning special needs costs, and so on, and so on. Guys — don’t get me wrong — it’s just that I feel it might helpful if you were to tell these folks that some of those unpleasantries are offset by kids in third world countries not dying from measles. Just saying.

http://www.fourteenstudies.org/

@Greg
I presume that you think that ADHD is caused by vaccines, as per your reference to Samoa. Some evidence, please. And Samoa shows that measles kill, if vaccination rate is too low. And you will notice that government did take action here. I hope that same thing will happen everywhere, if children start dying.

K, I see I have some responses to my query about how much cases of autism and other vaccine injuries one kid saved from measles death will buy us. The responses for the most part weren’t on point, but oh well!

Okay, let’s do some math:

Risk of death from measles infection: 1/1000

Risk of serious injury or death from MMR vaccine: 1/1 000 000

Number of vaccine injured kids per one kid saved from measles death: 0.001

Or to put it another way: 1000 dead kids from measles to save one kid from serious injury or death from MMR.

Couple of points:

1) There is no evidence that MMR causes autistic spectrum disorder, so, not included. Don’t like it? Tough.
2) I have only counted deaths from acute measles infection, not including deaths from SSPE.

I supposed we can all agree that Samoa is very very far away, and it will be harder for the average North American to feel personally connected to their measles deaths

Well, bless your heart..

@ Greg

if you were to tell these folks that some of those unpleasantries are offset by kids in third world countries not dying from measles

It’s your own kids from your own countries which are not dying from measles, because your countries, in a rare socialist fever, decided to push vaccination during the 20th century.
Kids – and others – from our European countries do die from measles. Right at the 1 to 2 death-per-thousand-sick ratio, as advertised.
Courtesy of frelling privileged oxygen suckers like you spreading lies and convincing people it’s OK to pass along infectious diseases.
Frelling barbarians.

Frankly, Greg, go kick a brown bear or jump down Niagara Falls. You will do humanity a service.

@ Najera – Vaccination doesn’t cause autism? Remember? However, vaccination can and does cause encephalopathy aka brain damage. Where there is risk, there must be informed consent regardless how much you and the others try to minimize it.

vaccination can and does cause encephalopathy aka brain damage

That idea is at least a decade out of date:

Doja A. Genetics and the myth of vaccine encephalopathy. Paediatr Child Health. 2008 Sep;13(7):597-9. https://www.ncbi.nlm.nih.gov/pubmed/19436557

Wiznitzer M. Dravet syndrome and vaccination: when science prevails over speculation. Lancet Neurol. 2010 Jun;9(6):559-61. https://www.ncbi.nlm.nih.gov/pubmed/20447869

Berkovic SF et al. De-novo mutations of the sodium channel gene SCN1A in alleged vaccine encephalopathy: a retrospective study. Lancet Neurol. 2006 Jun;5(6):488-92. https://www.ncbi.nlm.nih.gov/pubmed/?term=Lancet+Neurol.+2006+Jun%3B5(6)%3A488-92

Verbeek NE et al. Etiologies for seizures around the time of vaccination. Pediatrics. 2014 Oct;134(4):658-66. https://www.ncbi.nlm.nih.gov/pubmed/?term=Etiologies+for+seizures+around+the+time+of+vaccination

Reyes IS et al. Alleged cases of vaccine encephalopathy rediagnosed years later as Dravet syndrome. Pediatrics. 2011 Sep;128(3):e699-70. https://www.ncbi.nlm.nih.gov/pubmed/?term=Alleged+cases+of+vaccine+encephalopathy+rediagnosed+years+later+as+Dravet+syndrome

Berkovic SF et al. De-novo mutations of the sodium channel gene SCN1A in alleged vaccine encephalopathy: a retrospective study.

There’s a team of researchers at the local medical school who investigate the genetics of encephalopathic epilepsy, SCN1A and its many de-novo mutations. One of them gave a public lecture last week to celebrate promotion to Professor.

Natalie, if you’re going to question the validity and reliability of any scientific study, you are REQUIRED to provide your rationale for doing so.

You have to specifically cite the weakness in the study design, the methodology, the statistical analysis, or some other flaw. This is what Orac does when he deconstructs what he calls “execrable” studies by quacks; he tells you exactly what the problem with that study is so you can then read it and see for yourself.

You must also do that if you disagree with a study. It’s OK to disagree with a study if you don’t find the results convincing, because that’s how the peer review process works. Andrew Wakefield’s fraud was exposed precisely because his conclusions were so explosive (had they been true it would have been a sea change in our understanding of autism) that other scientists rushed to investigate and in some cases try to replicate his results (had they been replicated his findings would have been confirmed; to date NO ONE has been able to do that). The subsequent work shows time and again Wakefield’s claims have no basis in reality. Brian Hooker’s subsequent work uncovered the academic fraud (not disclosing he was working for a lawyer suing vaccine makers, not disclosing he was developing his own version of the MMR, not getting informed consent from participants).

Eventually, however, when the body of evidence mounts to a conclusion (vaccines don’t cause autism) you either have to come up with extraordinary new evidence that can be replicated, or you have to accept the scientific consensus.

You haven’t even bothered to tell us why you don’t agree with the studies cited. My sense is its because you don’t like their conclusions. Sorry that’s not a valid reason. Therefore you have failed to support your argument and your claims can be dismissed out of hand.

@ Panacea:

AS usual, you make TOO much sense for the average scoffer.
I often observe ( via PRN, AoA, here) that objections to people like Orac or you have little weight behind them: it is superficial skimming of scientific studies and plugging in impressive looking terminology to impress like-minded partisans. ” See? I got THEM!” when usually the material doesn’t apply, has been already dismissed by SBM or they miss giant holes in it..Their audience knows even less than they do.

Life sciences are incredibly complex and minutiae count. Yet anti-vaxxers continuously come up with objections to solid research: you might enjoy some of the amusing Rube Goldberg-like mechanisms proposed to explain how autism happens because of vaccination… oh, wait.. you’ve already read RI’s critics and Teresa Conrick. They choose areas like immunology or the microbiome because few people know much about them, giving them more room for confabulatory exercises.

(I spent several semesters in graduate school with both statistics and research design)- we’ll see a study quoted where the supposed expert doesn’t correct for multiple comparisons or there is some other odd configuration that immediately makes it suspicious ( see Whistleblower). this compares to the hilarity when a famous woo-meister, discussing the inner workings of the brain, stumbles over the pronunciation of the names of important structures or details how to get you cat to live to be over 20 years old through veganism- when cats are obligate carnivores. Who knew? Oh, I did. So do most cat owners I suppose.

Still, you give excellent explanations that will appeal to more normal readers- those who currently fear vaccines because of lack of information not because they already know it all- but all of it wrong.

Here is something that sceptics like you might appreciate:
as you may know, I’ve been covering attacks on Wikipedia and SBM by Gary Null. He is obviously threatened by the Wiki bio which is supported by SBM editors like Orac- for over a year and a half, he, his assistants and lawyers have been spewing out exposes and letters to Wikipedia/ media – scores of them .He has admitted that new listeners are put off by this bio and it has hurt business, If they are working so furiously to get followers to dismiss that bio, it means that our work is paying off. People are finally getting attuned to how his grift works. Similar by Natural News and Mercola.

The insert is pretty compelling. Your studies, however, are not

Let’s see:

In the years since MMR II was approved in 1971, encephalapathy has been rarely reported to have followed administration of the vaccine but has not been shown to have been caused by the vaccine; such rare occurrences are mentioned in the package insert
Since 2006, alleged cases of vaccine encephalopathy have been shown to have been caused by pre-exisiting mutations rather than by vaccination
Therefore, because encephalopathy has been mentioned in the package insert, encephalopathy is caused by vaccination

Is that right?

@Panacea and Denise,

Another example of this black and white thinking is the almost legalistic treatment of scientific evidence. The mere inclusion of a COI statement is considered sufficient to render the whole report inadmissible. This may work in legal proceedings, but in science you still have to account for the data unless you can show it is incorrect (as was demonstrated in Wakefield’s report). The data can be retrieved and re-analyzed as Hooker did with the DeStefano study.

So, anti-vaxxers resort to claiming that medical personnel in Denmark, Germany, the UK, Japan, Korea and anywhere that autism is studied are somehow collaborating to fudge the medical records so that the resulting data hide a vaccine-autism connection and other alleged harmful effects.

Personally, I think the fact that we do find low incidence problems like narcolepsy, encephalopathy, febrile seizures and others shows that our surveillance systems are working and makes those conspiracy theories even more bizarre.

It doesn’t work in legal proceedings either. Having an interest can make testimony more suspect, and less decision makers to approach it with caution, but it doesn’t negate it just over that.

After all, in many cases you have interested parties testifying on their own behalf.

@ squirrelelite

Personally, I think the fact that we do find low incidence problems like narcolepsy, encephalopathy, febrile seizures and others shows that our surveillance systems are working

I made recently this point to a rabid CT antivaxer on some other part of the internet.
His answer? “Oh, sure, on rare occasions, when it’s obvious and already in front page of mainstream newspapers, then scientific papers do talk about it”
Given the number of (badly) reported news in the MSM related to health issues which were actually first reported by surveillance systems and scientific papers, on a monthly basis, and given that it typically takes a few months, if not a couple of years, to get a paper written and published, that’s an interesting temporal inversion.
Then I pointed out that some obscure events like narcolepsy from flu vaccine or the issues with the first rotavirus vaccine could have easily been “covered up” as coincidence. Oh, my bad. His answer – “THEY do it all the time anyway”.
Except that I just pointed two cases where ‘THEY’ didn’t do it, and it would have been cases as justified as the any of the myriads of issues vaccines are supposedly having.
And of course, no evidence or just examples from him. Just general declarations, so he can self-righteously feel he is the white knight in the room.
I would have had a more healthy interaction talking to a wall.

There is no point in debating antivaxers on the ‘net. Delusional, dishonest and actually missing a few gears in their brainbox.
If I hadn’t a terminal case of SIWOTI…

Where you think the insert comes from ? Well there are safety studies. If a problem appears there, it is included to the insert. This is for legal reasons: it is very bad that safety data is excluded. ThIs case it was showed afterwards that “vaccine caused encephalopathy” was actually Dravet syndrome. If you disagree, tell us what is the problem with these studies.
I notice, too, that you think that vaccine safety studies and post licensure surveillance are very reliable. The insert comes from these studies.

@Natalie White – “Your studies, however, are not and I question their validity. ” – as others have requested, please explain the grounds on which you question the validity of the studies that were listed for you.

@Denise: Thanks. I know I won’t convince Natalie. But I might convince a normal person who stumbles on this discussion. When I comment on news sites like WaPo on issues like this, that’s my approach.

@ Narad: DOH! That’s what I get for trying to comment on da interwebs after 5 hours of sleep. I owe Brian Deer a major apology, confusing an excellent journalist with that total goober and moron Hooker. I’m amazed my post was even coherent.

Being a grad student while working full time SUCKS!

Autism is not encephalopathy. Measles, haemophilus influenzae type b, and other vaccine preventable diseases can cause encephalopathy. Just post the PubMed indexed studies by reputable qualified researchers that any vaccine on the present American pediatric schedule causes more brain damage than the disease. Remember measles causes encephalitis in one out of a thousand cases, and that is not even counting SSPE.

And as brian notes, you are really out of date. Here is a place where you can catch up: https://www.spectrumnews.org/

Where there is risk, there must be informed consent regardless how much you and the others try to minimize it.

Good grief there is informed consent; you just don’t like that the information doesn’t include your little flights of fancy. As for Poling, there is so much we don’t know about the case because her parents have only dribbled out the convenient parts of her medical history. She had a lot of illnesses preceding the event in question. I don’t begrudge the ruling; it is the way the court should work but don’t think it’s any kind of proof of anything.

“her parents have only dribbled out the convenient parts of her medical history”, With regard to the settlement, I thought they aren’t allowed to disclose the details. If she had a lot of illnesses, why was she vaccinated? What is being done to ID the children who may be susceptible to injury because of a genetic condition?

People who are chronically ill are the ones who need vaccination the most. They are the last people you want getting a serious infection because they don’t have the reserves to fight it off.

Often, attenuated or killed vaccines are the ones they must get. Live vaccines would be contraindicated. It’s also why its so important for the rest of us to get vaccinated: our protection makes it less likely a disease can grab hold in a community.

Consider this. It’s cold and flu season. I’m seeing a TON of nasopharyngitis and rhinosinusitis (aka common colds) and bronchitis (nearly always viral) in my primary care rotation in FNP school. It’s that time of year. These viruses race through the local population; everyone gets sick. As much hand washing as I do through the course of the day, I’ll probably get it eventually because literally everyone I run into right now is sniffling. If we had a vaccine for the common cold and everyone took it, there would be very few common colds . . . we’d have to start calling it the uncommon cold.

Hannah Poling’s parents might be barred from disclosing the conditions of a legal agreement but I doubt they’d be barred from sharing her medical records. Dorit might have a better answer though IANAL.

There’s been no evidence that there’s a genetic link between vaccines and adverse reactions. As far as I know, vaccines don’t use an enzymatic pathway like CYP450 as its mechanism of action; that’s not how they are metabolised. Vaccines introduce a protein called an antigen that the immune system recognizes as foriegn; it produces antibodies to fight a non-existent infection. Those antibodies stay in the bloodstream, and help the body recognize and produce more when exposed to a disease like measles. That’s why vaccines produce immunity that is usually life long. You get that when you have a disease, but you also risk the complications of that disease like brain swelling and death (measles) or splenomegaly (infectious mononucleosis). It’s a vastly different process. If someone’s immune system didn’t recognize a vaccine, the only response would be no antibody production and a lack of immunity. It wouldn’t do anything else.

There are other ingredients in vaccines (as you know) and those can produce immune responses we call allergies. Neomycin is known to do this.

Enzymes like CYP450 do have a genetic component when it comes to how they work. It’s why some pysch meds and ADHD meds work in some patients and not others. But it’s really comparing apples to oranges.

Show me evidence that problems with vaccines run in families (be in allergy to a component or failure to produce an immune response) and we can talk. Until then there is nothing to investigate because you can’t form a testable hypothesis.

“her parents have only dribbled out the convenient parts of her medical history”, With regard to the settlement, I thought they aren’t allowed to disclose the details. If she had a lot of illnesses, why was she vaccinated? What is being done to ID the children who may be susceptible to injury because of a genetic condition?

“her parents have only dribbled out the convenient parts of her medical history”, With regard to the settlement, I thought they aren’t allowed to disclose the details. If she had a lot of illnesses, why was she vaccinated? What is being done to ID the children who may be susceptible to injury because of a genetic condition?

Dammit, hit return too quickly. The Poling’s have not been gagged; they can release whatever information they want and they have chosen to redact large swaths of her medical history. Frankly, I don’t think they should have released anything out of respect of their daughter’s privacy but they weaponised certain portions. The mitochondrial issue was unknown and is still murky whether it had anything to do with her adverse reaction so I don’t know what you suggest other than what is already being done which is to take a family history and note any adverse reactions by the recipient.

This doesn’t change my previous statement, White. Vaccination may cause encephalopathy, but that’s not autism. As much as you keep insulting autistic people, now calling them brain damaged, you’re not going to be correct, nor will you antivax types win this cultural battle. I’ll take the 1 in a million encephalopathy from vaccines to the 1 in 1,000 encephalopathy from measles, and higher rates from other vaccine preventable diseases, White. You’re going around in circles on this, White.

The was an article on Cannabis Hyperemesis Syndrome (CHS) on the CBC website a couple of days ago. The dichotomous “thinking” among the commenters was horrendous. If I were about to start teaching a first year university course in any science and got a crop of students who had made remarks like I saw, I’d probably hide in a dark corner sobbing quietly for a few hours then go the department head or dean and suggest the course be cancelled and the students advised to take up minimal-skill laboring jobs or do at least three years of remedial thinking before contemplating such a class again. Except for about 2% of the comments they could be grouped into “see how horrible cannabis really is” or “how dare anyone even suggest there is the slightest bit of risk from doing my beloved weed? – this is propaganda!!1!”

One person said he had had CHS and recovered. Another insisted that that person had to have “proof” from the docs who treated him to be sure that he really had CHS and not something else. After being told scientist don’t speak of proof, he demanded evidence for that notion. At least he had some idea that evidence is important.

Dichotomous thinking is easy and comfortable. It requires not intellectual effort nor does it present challenges to the ego.

The was an article on Cannabis Hyperemesis Syndrome (CHS) on the CBC website a couple of days ago. The dichotomous “thinking” among the commenters was horrendous.

That reminded me to check in with Leon Gussow’s blog The Poison Review, as he did several entries on CHS. I’m bummed that it seems to have moribund for over a year, but he’s still active on Twatter.

^ “have been moribund,” that is. On the other side of the same token, I might represent a case for its being turned into a noun.

In the 1970s, British mathematician Jacob Bronowski, known for his studies of the history and philosophy of science, did a brilliant 13 part series for BBC TV on those topics. The eleventh episode was “Knowledge or Certainty.” You can watch it by itself but you have to watch it beginning to end and without any unnecessary interruption. The ending was shocking and powerful,and I still can feel the way it made me feel then.
It’s a great way to understand the difference between the two.ways of thinking.

The eleventh episode was “Knowledge or Certainty.” You can watch it by itself but you have to watch it beginning to end and without any unnecessary interruption.

You forgot a link, dear sir.

Oh,my (clutches pearls), how will all those dear poor folk at Google and YouTube be able to afford to live in their hovels and buy moldy bread from the bakery if no one partakes of their services?
Here it is:

Indeed.

I’ve had any number of students with little insight into their lack of fundamental knowledge, but who met the criteria for passing or graudation, who I describe as being the sort who “go wrong with confidence.”

I stole that line from Heinlein somewhere. But it’s true.

@Science mom – “Yes, there are some dodgy dealings in science publications” so how does a person separate the two? How does a person know which studies are legit? Again, it seems to take a whole lotta’ faith. Are the links you and the others provided legit studies? How do you know? You and the choir are all in if the study shows positive effects from vaccination, regardless of the study size, regardless of the method, regardless of who is paying for the study. Now if a scientist shows questionable outcomes, the study is discounted as invalid.

@Smut Clyde – What are your thoughts on research? I recall reading on your bio from your blog you didn’t want to continue doing research because of the corruption.

There are a number of criteria to determine if a study is good or not e.g. sample size, statistical methods used, experimental design. One of the major issues in the scientific community is that it takes a lot of effort and experience to determine a good study from a bad one, which makes it difficult to propagate good science in the public consciousness.

I think there is a bigger issue though. If you don’t think the scientific method is reliable, what method do you use to evaluate information and make your decisions?

Natalie White: Exactly! Folks have been saying that for years! But nooo…. the big journals don’t want to publish null papers.

Why don’t you talk to the major grant funders and insist that all results, positive, negative and intermediate be published? Maybe someone could start a series of journals of null results for every specialty. For once, industry is slightly farther ahead than academia, everything in industry gets written down because there’s no point wasting money doing something that doesn’t work more than once. (They are just not obligated to share it, which is perfectly reasonable for pre-clinical work.)

Clinicaltrials.gov was supposed to be a reponsitory for all clinical trials; the idea was it would be a place where data could be published and shared, science verified open and transparent.

Sadly it has not worked out that way. Instead, it’s been weaponized by quacks like Stanislaw Burzynski.

I love the idea of freely posting data and the results of clinical trials. The reality has been, unfortunately, that it’s more complicated than that.

@alpha.beta – In response to your post below. Ben Goldacre explicitly talks about publication bias and calls the problem “a cancer”. I watched this presentation a few years back and really began questioning the medical research community. He encourages ALL TRIALS to be published.

He’s also pro-vaxx

@Natalie White. Yes, i 100% agree that there are issues with the reporting of clinical trials and the approval process. This is part of the reason why well designed post-market studies are so important.

My question is though, if you don’t trust the clinical trials or the post-market studies or publications in general, what information do you use to make your decisions?

Orac said something about scientists relying on “the truth will out” when discussion dichotmous thinking. The thing is, the truth usually does out. The peer review process and continuation of study into any area usually helps reveal what is true and what it not. It may take awhile but that is what happens. It’s why I discount scientific findings reported in the public media until I’ve either read the actual study, or until follow up is done. All too often the media pick up on something that makes good click bait and report it as if the scientific community agreed with the finding. Often they don’t or at least not yet.

People in the sciences take classes on how to read scientific studies and determine validity and reliabiilty. A good stats class is a good place to start. It doesn’t have to be that complicated.

Another place to start is by confronting your own biases. You’re biased against modern medicine and science for whatever reason so you view all work through your own lens. You have to face that, acknowledge it, and agree that it affects your thinking before you can do anything else to evaluate scientific work.

Again, it seems to take a whole lotta’ faith.

For you perhaps. You aren’t trained in any biomedical sciences so of course it would be difficult for you to be able to discern good v. bad vaccine studies. To be fair though, there are some studies (not in vaccine sciences) that can dupe the scientific community, especially with so many dodgy predatory journals out there but the only example I can think of off the top of my head that has upended consensus is perhaps Wasink’s food science scandal. Others may know of more given the variety of expertise and interests of commenters here. If you are truly concerned with the quality of science, particularly those in vaccinology, then why don’t you ever say anything critical about the likes of Exley, Shaw and Shoenfeld, just to name a few, who have blatantly abused their editorialships to advance their own cause at the expense of solid science?

I recall reading on your bio from your blog you didn’t want to continue doing research because of the corruption.

You may be confusing me with Leonid Schneider, and confusing his blog (“Forbetterscience”, where I sometimes guest-post) as my own.

There is no bio on my own blog.

This is dichotomania and is an inappropriate use of continuous variables. Frank Harrell (Statistician in full rant!)

One can see dichotomania in a lot of research but medical research seems rather prone to it.

Anti-vaxers and other denialists do not seem to understand the concept of a continuous variable.

Natalie: “How does a person know which studies are legit? Again, it seems to take a whole lotta’ faith.”

What it takes above all are critical thinking skills.*

Also quite helpful is the ability to evaluate research methodology and statistical significance. I’m reasonably good at spotting some flaws in published studies (i.e. non-blinding of histopathologic evaluation of abnormalities), but my knowledge of statistics is primitive and it’s useful for me to see what Orac and others with far more research experience have to say on the subject.

*for example, such skills enable one to see that when a strong consensus of qualified scientists agrees on something, it’s highly likely to be valid and not dismissable with the sneer “the choir says so”. Critical thinking skills also make it obvious that a dubious proposition does not magically become good science because a single PhD or sprinkling of people with higher degrees make that claim; rather, the existence of an overwhelming majority of professionals with equal or better credentials and experience in the relevant field(s) making opposite conclusions should be taken into account.

for example, such skills enable one to see that when a strong consensus of qualified scientists agrees on something, it’s highly likely to be valid and not dismissable with the sneer “the choir says so”.

Let’s not drag string theory into this.

@Aarno – “Why would somebody with vaccine injury would not go to Vaccine Court ? It would not cost any money to lose your case. So why would numbers be an underestimate ?”

In the states, if parents are given the Vaccine Information Statement, the VAERS info is on the second page. I don’t know how many patients (parents) are given the VIS and how many are reading it. The VIS clearly states “As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death”.
https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.pdf
Providers have a tendency to dismiss a possible vaccine reaction. Coincidence and denial are given as the explanation. Sometimes multiple episodes happen before consideration is even given to vaccine reaction. Are providers trained to recognize an adverse reaction besides anaphylaxis?
VAERS and vaccine court are not well known. VAERS info is on the insert. However, reading the insert may not be done by staff. Sometimes staff don’t even know about the insert. The insert can be thrown away when the package is opened.

The “one in a million” statement is based on the few who have made it all the way through Vaccine Court and given compensation. It is not an easy process. I’ve also shared with you the Harvard Study of VAERS under reporting from a prior post.

Where there is risk, however remote, there must be informed choice.

The VIS also talks about vaccine court. There are less barriers in accessing that court than civil court (with the exception of a statute of limitations that doesn’t stop for minors).

And parents have a choice. They can decide not to protect the children they’re responsible and leave them at the greater risk.

There may be consequences, but they have a choice.

The “one in a million” statement is based on the few who have made it all the way through Vaccine Court and given compensation.

As has already been explained to you, no, it is not. I realize that tilting toward being a write-only device can place one in awkward situations, but reading all of the responses to your frothing is a matter of simple, common courtesy.

Table injuries are compensated, if there is just temporal relation. Not very bureaucratic, I would say. There is no need to prove that injury is actually caused by vaccines. And it is free, too.
Health care providers are required by law to report vaccine adverse effects:
https://www.cdc.gov/vaccinesafety/hcproviders/reportingadverseevents.html
CDC plot thickens 😉
If Vaccine Court is unknown, it seems to me that nobody is listening antivaxxers. They mention it very often, as you did. But yes, claiming that it is impossible to get compensation from Vaccine Court does harm people that actually are injured.

Natalie, I am a registered nurse who routinely administers all sorts of vaccinations: from routine childhood vaccinations through boosters to the vaccines the elderly should get (Pneumovax etc).

I always give out a vaccine information sheet, and every other nurse I know does this as well. It’s policy EVERYWHERE I’ve ever worked, and we have to document that we did it.

If you want to claim you’ve never been given one, fine. But the general population gets one.

I don’t waste my time reading vaccine inserts. It’s a combination of legalese and advertising, and really doesn’t contain anything useful about administration or nursing considerations. I get that information from my drug handbook.

I have explained to you why your statement that “one in a million” is of those who get through the Vaccine court is wrong. It’s demonstrably false, as I have shown you. So quit telling that lie.

Getting a judgement in Vaccine Court is incredibly easy as it errs on the side of the patient. Your beef is that it doesn’t pay out on autism claims . . . because vaccines don’t cause autism.

Anti vaxxers seem to confuse easy with fast when it comes to Vaccien Court. They complain about how long it takes as why they need access to civil court. They apparently have no clue that civil court is just as slow.

No joke! I’ve got active malpractice cases on my plate that go back to 2014. First the attorney waits until the deadline to file, then I get the case, then it creaks along until I’ve almost forgotten about the case, then they ask to depose me.

Medical professionals are legally required to give the VIS to both patients (and parents) before every vaccine given in the United States.

All of the information you would need to make an informed decision is included – based on actual science…not anti-vax scaremongering.

I just want to note that you think that turning over a piece of paper is so difficult that putting information on the backside is the same as not telling people, yet think that everyone should be reading the tiny print of inserts.

Natalie, you only have yourself to blame for just glancing that VIS and shoving it in a bag where you forgot about it, multiple times. The information has been there and given out for thirty years.

The comments about inserts reminded me of when I had patients, after reading the Daily Mail would come into my Sick Bay and demand the latest drug/cream/medicament. I used to show them the Data Sheet to show them how scary it was.
I couldn’t always be arsed to explain that the particular drug they wanted wouldn’t work for the condition they had.
As an aside I was a Guinea Pig for the first H2 Receptor Antagonist (Cimetadine) way before Orac’s day in 1978.
Almost overnight that drug rendered old fashioned belly surgeons redundant.

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