Issue 47 / 3 December 2012

“IT is useless to attempt to reason a man out of a thing he was never reasoned into” is a quote attributed to Irish satirist Jonathan Swift, famous for, among other things, inventing an island of tiny people somewhere off the coast of Australia.

I’ve seen variants of the quote ascribed to Mark Twain or described as a Shaker proverb, so its actual origin may be as uncertain as the location of Lilliput. Whoever said it first, it seems to hold an essential truth about the inaccessibility of our deeply held beliefs to the forces of reason.

I witnessed this recently when a work associate was lauding the benefits of a homeopathic remedy, which had apparently “cured” her infant son’s high fever. But nowhere is it more obvious than when it comes to debates around immunisation.

Andrew Wakefield, the former British doctor whose 1998 paper purporting to link the MMR (measles–mumps–rubella) vaccine to autism was eventually retracted by The Lancet, continues to champion the anti-vaccine cause from his new home in Texas with all the fire of a television evangelist.

In a new blog, hosted by the curiously named Academic Integrity Fund, Wakefield does not overly trouble himself with scientific argument, relying instead on various allegations about those who have accused him of scientific misconduct and an apparently absolute confidence in the infallibility of “maternal instinct” as an evolutionary force.

“Such instinct”, he writes, “operates in a realm and according to a set of rules that are not accessible to the physical laws of the universe”.

When maternal instinct challenges vaccination practices, many doctors find it “a pain in the ass and a bruise to the ego”, he writes.

I have no doubt that human mothers — and fathers — have evolved an instinctive knowledge of how best to care for their children, including an understanding of helpful and harmful inputs (nutritious root vegetable = good; sabre-toothed tiger = bad).

But given the slow pace of evolution, it seems a bit of a stretch to suggest we could rely on any instinctive feeling that immunising small children against measles was a threat equivalent to that of the growl of a hungry predator outside the family cave.

We may well have evolved to feel that small children should be protected from sharp objects, such as needles, and that we should avoid exposing them to unknown substances — both sensible precautions in the prescientific world. However, the challenges and choices faced by today’s parents are too complex to be dealt with by instinct alone.

Which brings us back to reason.

As reported in MJA InSight this week, the Australian Academy of Science has joined the ranks of those seeking to use the forces of reason to combat the myths and disinformation that so often cloud the immunisation debate.

In The science of immunisation, the academy spells out the risks and benefits of vaccines, debunking the alleged link between the MMR vaccine and autism along the way.

Facts in the booklet include that around three in 10 000 children receiving the MMR vaccine develop a fever high enough to cause short-lived seizures, while for children who contract measles the risk of seizure is more than 30 times greater, at around 100 children in 10 000.

A paper in The Lancet earlier this year estimated that 9.6 million deaths from measles may have been averted by vaccination over the decade from 2000 to 2010.

Those who did not come to their opposition to vaccination via reason may be immune to such numbers, but they highlight why the rest of us should never stop trying to get the immunisation message across.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 3 December 2012

5 thoughts on “Jane McCredie: The right reason

  1. Anonymous says:

    I fear this booklet release has sadly missed the mark.
    Do the public really need another, excellently produced, scientific justification?
    Or is this just an ego trip for some famous scientists?
    I think the parents who really care about science, and understand evidence, are already vaccinating their kids.

    The vast majority have no clue of these things: “They would say that, wouldn’t they?”
    That majority make up their minds on an emotional level, and base decisions on anecdotes from friends.
    They might read some scary stuff on the net / Facebook / Twitter
    They just might pay attention to trusted health practitioners (those we really need to support).
    These are the battles we are losing.

    Look at the reaction by the press: attempts to ‘balance’ the story with yet more air time for AVN; spurious reader ‘surveys’; human interest stories on “conscientious” objectors.
    Health authorities actually respond by saying people must “read everything they can on vaccination
    and make up their own minds”! How can they do that?

    Note most objections to vaccination are about distrust (which can be regained); almost never “conscience” (which must be respected and left alone).
    We must abolish the “conscientious” terminology ASAP, and deal with doubters on their own (non-scientific yet valid) terms

  2. Dan says:

    Great article. This statement got me thinking: “We may well have evolved to feel that small children should be protected from sharp objects, such as needles”

    I wonder to what extent some naysayers would be won over if the delivery mechanism was a pill or a patch, rather than a needle. Has there been any research done into variations in uptake of vaccinations/medication based on different delivery systems, e.g. over time as less intrusive systems become available?

    This idea that people possess perfect intuitions over complex subjects, that translate into flawless execution, drives me mad. We have a collection of instincts, forged over a long time period, that on average were useful survival mechanisms in straightforward situations. Tellingly unrepresented here are cognitive tools that are either incomplete when assessing complex ideas (e.g. rates of risk) or in some circumstances become overactive and thus detrimental (e.g. seeing patterns and detecting agency in just about everything.)

    Instinct: Good for covering your head when something’s about to hit you. Not so good for understanding the Monty Hall Problem, relative risks or global warming.

  3. Sue Ieraci says:

    Thanks for a great article, Jane. As you say, reason doesn’t convert the ideologues, but providing accurate information does help the passers-by who are seeking information and would otherwise only be receiving the anti-vax messages. They are good at spreading fear and appearing to be knowledgeable, but, in fact, they are promoting the same old myths and misinformation that circulate the internet anti-vax sites of the world. I don’t envy worried parents in this era where everyone’s opinion is aired, for “balance” – it’s hard to know who to trust. We, as a profession, need to earn back the trust.

  4. L.Magaly Barrera says:

    Thanks for the article. It would be extremely useful for the busy GP to have a summary of the facts “in favour” of vaccines with the verifiable sources to give away to parents when they come for the first check up.

  5. Sue Ieraci says:

    Hi, Magaly! There is some good information in The Science of Immunisation. Sue

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