A Philosopher's Blog

Are Anti-Vaccination People Stupid?

Posted in Medicine/Health, Philosophy, Politics, Reasoning/Logic, Science by Michael LaBossiere on February 18, 2015
Poster from before the 1979 eradication of sma...

Poster from before the 1979 eradication of smallpox, promoting vaccination. (Photo credit: Wikipedia)

The United States recently saw an outbreak of the measles (644 cases in 27 states) with the overwhelming majority of victims being people who had not been vaccinated. Critics of the anti-vaccination movement have pointed to this as clear proof that the movement is not only misinformed but also actually dangerous. Not surprisingly, those who take the anti-vaccination position are often derided as stupid. After all, there is no evidence that vaccines cause the harms that the anti-vaccination people refer to when justifying their position. For example, one common claim is that vaccines cause autism, but this seems to be clearly untrue. There is also the fact that vaccinations have been rather conclusively shown to prevent diseases (though not perfectly, of course).

It is, of course, tempting for those who disagree with the anti-vaccination people to dismiss them uniformly as stupid people who lack the brains to understand science. This, however, is a mistake. One reason it is a mistake is purely pragmatic: those who are pro-vaccination want the anti-vaccination people to change their minds and calling them stupid, mocking and insulting them will merely cause them to entrench. Another reason it is a mistake is that the anti-vaccination people are not, in general, stupid. There are, in fact, grounds for people to be skeptical or concerned about matters of health and science. To show this, I will briefly present some points of concern.

One point of rational concern is the fact that scientific research has been plagued with a disturbing amount of corruption, fraud and errors. For example, the percentage of scientific articles retracted for fraud is ten times what it was in 1975. Once lauded studies and theories, such as those driving the pushing of antioxidants and omega-3, have been shown to be riddled with inaccuracies. As such, it is hardly stupid to be concerned that scientific research might not be accurate. Somewhat ironically, the study that started the belief that vaccines cause autism is a paradigm example of bad science. However, it is not stupid to consider that the studies that show vaccines are safe might have flaws as well.

Another matter of concern is the influence of corporate lobbyists on matters relating to health. For example, the dietary guidelines and recommendations set forth by the United States Government should be set on the basis of the best science. However, the reality is that these matters are influenced quite strongly by industry lobbyists, such as the dairy industry. Given the influence of the corporate lobbyists, it is not foolish to think that the recommendations and guidelines given by the state might not be quite right.

A third point of concern is the fact that the dietary and health guidelines and recommendations undo what seems to be relentless and unwarranted change. For example, the government has warned us of the dangers of cholesterol for decades, but this recommendation is being changed. It would, of course, be one thing if the changes were the result of steady improvements in knowledge. However, the recommendations often seem to lack a proper foundation. John P.A. Ioannidis, a professor of medicine and statistics at Stanford, has noted “Almost every single nutrient imaginable has peer reviewed publications associating it with almost any outcome. In this literature of epidemic proportions, how many results are correct?” Given such criticism from experts in the field, it hardly seems stupid of people to have doubts and concerns.

There is also the fact that people do suffer adverse drug reactions that can lead to serious medical issues and even death. While the reported numbers vary (one FDA page puts the number of deaths at 100,000 per year) this is certainly a matter of concern. In an interesting coincidence, I was thinking about this essay while watching the Daily Show on Hulu this morning and one of my “ad experiences” was for Januvia, a diabetes drug. As required by law, the ad mentioned all the side effects of the drug and these include some rather serious things, including death. Given that the FDA has approved drugs with dangerous side effects, it is hardly stupid to be concerned about the potential side effects from any medicine or vaccine.

Given the above points, it would certainly not be stupid to be concerned about vaccines. At this point, the reader might suspect that I am about to defend an anti-vaccine position. I will not—in fact, I am a pro-vaccination person. This might seem somewhat surprising given the points I just made. However, I can rationally reconcile these points with my position on vaccines.

The above points do show that there are rational grounds for taking a general critical and skeptical approach to matters of health, medicine and science. However, this general skepticism needs to be properly rational. That is, it should not be a rejection of science but rather the adoption of a critical approach to these matters in which one considers the best available evidence, assesses experts by the proper standards (those of a good argument from authority), and so on. Also, it is rather important to note that the general skepticism does not automatically justify accepting or rejecting specific claims. For example, the fact that there have been flawed studies does not prove that the specific studies about vaccines as flawed. As another example, the fact that lobbyists influence the dietary recommendations does not prove that vaccines are harmful drugs being pushed on Americans by greedy corporations. As a final example, the fact that some medicines have serious and dangerous side effects does not prove that the measles vaccine is dangerous or causes autism. Just as one should be rationally skeptical about pro-vaccination claims one should also be rationally skeptical about anti-vaccination claims.

To use an obvious analogy, it is rational to have a general skepticism about the honesty and goodness of people. After all, people do lie and there are bad people. However, this general skepticism does not automatically prove that a specific person is dishonest or evil—that is a matter that must be addressed on the individual level.

To use another analogy, it is rational to have a general concern about engineering. After all, there have been plenty of engineering disasters. However, this general concern does not warrant believing that a specific engineering project is defective or that engineering itself is defective. The specific project would need to be examined and engineering is, in general, the most rational approach to building stuff.

So, the people who are anti-vaccine are not, in general, stupid. However, they do seem to be making the mistake of not rationally considering the specific vaccines and the evidence for their safety and efficacy. It is quite rational to be concerned about medicine in general, just as it is rational to be concerned about the honesty of people in general. However, just as one should not infer that a friend is a liar because there are people who lie, one should not infer that a vaccine must be bad because there is bad science and bad medicine.

Convincing anti-vaccination people to accept vaccination is certainly challenging. One reason is that the issue has become politicized into a battle of values and identity. This is partially due to the fact that the anti-vaccine people have been mocked and attacked, thus leading them to entrench and double down. Another reason is that, as argued above, they do have well-founded concerns about the trustworthiness of the state, the accuracy of scientific studies, and the goodness of corporations. A third reason is that people tend to give more weight to the negative and also tend to weigh potential loss more than potential gain. As such, people would tend to give more weight to negative reasons against vaccines and fear the alleged dangers of vaccines more than they would value their benefits.

Given the importance of vaccinations, it is rather critical that the anti-vaccination movement be addressed. Calling people stupid, mocking them and attacking them are certainly not effective ways of convincing people that vaccines are generally safe and effective. A more rational and hopefully more effective approach is to address their legitimate concerns and consider their fears. After all, the goal should be the health of people and not scoring points.

 

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Lessons from Ebola

Posted in Ethics, Philosophy, Politics, Reasoning/Logic, Science by Michael LaBossiere on October 24, 2014
English: Biosafety level 4 hazmat suit: resear...

English: Biosafety level 4 hazmat suit: researcher is working with the Ebola virus (Photo credit: Wikipedia)

While Ebola outbreaks are not new, the latest outbreak has provided some important lessons. These lessons are actually nothing new, but the outbreak does provide a focus for discussing them.

The first lesson is that most people are very bad at risk assessment. In the Ebola hot spots it is reasonable to be worried about catching Ebola. It is also reasonable to be concerned about the situation in general. However, many politicians, pundits and citizens in the United States are greatly overestimating the threat presented by Ebola in the United States. There are only a few cases of Ebola in the United States and the disease is, the experts claim, difficult to catch. As such, the chance that an American will catch Ebola in the United States is extremely low. It is also a fact Ebola outbreaks have been contained before in countries with far less medical resources than the United States. So, while it is prudent to prepare, the reaction to Ebola has greatly exceeded its actual threat in the United States. If the concern is with protecting Americans from disease and death, there are far more serious health threats that should be the primary focus of our concern and resources.

The threat of Ebola is overestimated for a variety of reasons. One is that people are rather susceptible to the fallacy of misleading vividness. This a fallacy in which a very small number of particularly dramatic events are taken to outweigh a significant amount of statistical evidence. This sort of “reasoning” is fallacious because the mere fact that an event is particularly vivid or dramatic does not make the event more likely to occur, especially in the face of significant statistical evidence. Ebola is indeed scary, but the chance of infection in the United States is extremely low.

Another reason is that people are also susceptible to a variation on the spotlight fallacy. This variant involves inferring the probability that something will happen based on how often you hear about it, rather than based on how often it actually occurs. Ebola has infected the 24 hour news cycle and hearing about it so often creates the psychological impression that infection is likely.

As I have consistently argued, threats should be assessed realistically and the response should be proportional to the actual threat.

The second lesson is that the politicians, media and pundits will exploit scary things for their own advantages. The media folks know that scary stories and fear mongering get viewers, so they are exploiting Ebola to the detriment of the public. Ebola has been made into a political issue, so the politicians and pundits are trying to exploit it for political points. The Republicans are using it as part of their narrative that Obama is an incompetent president and thus are emphasizing the matter. Obama and the Democrats have to strike back in order to keep the Republicans from scoring points. As with the media, the politicians and pundits are exploiting Ebola for their own advantage at the expense of the public.

This willful misleading and exaggeration is clearly morally wrong on the grounds that it misleads the public and makes a rational and proportional response to the problem more difficult.

The third lesson is that people will propose extreme solutions without considering the consequences of those solutions. One example is the push to shutdown air travel between the United States and countries experiencing the Ebola outbreak. While this seems intuitively appealing, one main consequence would be that people would still come to the United States from those countries, only they would do so in more roundabout ways. This would make it much harder to track such people and would, ironically, put the United States at greater risk.

As always, solutions should be carefully considered in terms of their consequences, costs and other relevant factors.

The final lesson I will consider is that the situation shows that health is a public good and not just a private good. While most people get that defense and police are public goods, there is the view that health is a private good and something that should be left to the individual to handle. That is, the state should protect the citizen from terrorists and criminals, but she is on her own when it comes to disease and injury. However, as I have argued elsewhere at length, if the state is obligated to protect its citizens from death and harm, this should also apply to disease and injury. After all, disease will kill a person just as effectively as a terrorist’s bomb or a criminal’s bullet.

Interestingly, even many Republicans are pushing for a state response to Ebola. I suspect that one reason Ebola is especially frightening is that it is a disease that comes from outside the United States and was brought by a foreigner. This taps into fears that have been carefully and lovingly crafted during the war on terror and this helps explain why even anti-government people are pushing for government action.

But, if the state has a vital role to play in addressing Ebola, then it would seem to have a similar role to play in regards to other medical threats. While Ebola is scary and foreign, it is a medical threat and thus is like other medical threats. However, consistency is not a strong trait in most people, so some who cry for government action against the Ebola that scares them also cry out against the state playing a role in protecting Americans from things that kill vastly more Americans.

The public health concern also extends beyond borders—diseases do not recognize political boundaries. While there are excellent moral reasons for being concerned about the health of people in other countries, there are also purely pragmatic reasons. One is that in a well-connected world diseases can travel quickly all over the globe. So, an outbreak in Africa can spread to other countries. Another is that the global economy is impacted by outbreaks. So, an outbreak in one country can impact the economy of other countries. As such, there are purely selfish reasons to regard health as public good.

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Gun Research

Posted in Ethics, Law, Philosophy, Politics by Michael LaBossiere on May 3, 2013
English: Logo of the Centers for Disease Contr...

(Photo credit: Wikipedia)

One important component of rational decision making is acquiring the best available evidence regarding the subject at hand. This is because there are two main components to having a good argument. The first is the quality of the reasoning being used (that is, how well the premises support the conclusion). The second is the quality of the premises (that is, whether they are true/plausible or not). Assuming the goal is to reach the truth, it is essentially irrational to intentionally ignore available evidence. Of course, truth is only rarely the goal that people seek.

One area where we need rational decision making is in regards to gun policy. While I am not anti-gun (far from it-I have been a gun enthusiast since my childhood), I do hold that it is proper for there to laws regulating guns. Being rational, I want the decisions about the laws to be based on the best available evidence. Naturally, I also want the laws to match my core political values (life, liberty, property and justice).

In some cases, people are not interested in having the best available evidence because of irrational reasons: laziness, prejudices, and so on. In other cases, people are rather interested in preventing others from acquiring the best available evidence for what are pragmatically rational reasons. For example, a criminal certainly has a pragmatically rational reason to ensure that others do not acquire evidence of her crimes. As another example, a company that stands to benefit from the ignorance of consumers would have a pragmatically rational reason to keep them ignorant.

While it is estimated that there are 30,000 gun deaths and 70,000 gun injuries in the United States each year (which makes guns about as dangerous as automobiles), there is a shortage of data regarding these deaths and injuries. This is not due to a lack of interest or concern. Rather, it is mainly due to the fact that  the NRA’s lobbying efforts effectively limited research into gun violence.

In 1996 the CDC was planning to conduct additional studies of gun-related deaths in the context of public health. These studies were intended to be a follow up on studies conducted since 1985 which all concluded in favor of stricter gun control.  In response, Republican Jay Dickey saw to it that the funding for the research was removed from the CDC’s budget. While the funding was restored, it was steadily reduced and the CDC elected to spend the money on studying traumatic brain injuries.

In addition to the tactic of cutting funding, a law was passed that states that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”

As might be inferred, these tactics have had the desired impact, namely a significant reduction in research on gun-related deaths and injuries.  This is not to say that there is no research. There have been studies regarding guns and gun ownership and some results indicate that gun ownership is a health risk-especially in regards to children of gun owning parents.  This, as might be guessed, suggests the desire on the part of the NRA to prevent scientific studies of gun-related deaths and injuries.

On the face of it, this attempt to impede research on gun-related deaths and injuries would seem to be immoral. First, there is the moral concern with intentionally trying to impede the acquisition of information that could be very useful in preventing needless deaths and injuries. It is, of course, interesting to contrast this intentional impediment of scientific research with the willingness to intrude on rights and liberties under the banner of national security. In the case of matters linked to terrorism, the stock argument is that these rights and liberties must be sacrificed on utilitarian grounds. That is, it is claimed that the benefits of such intrusions is worth the harms done. However, if  the need to prevent the harms of terrorism warrants intrusions on basic rights and liberties, then it would seem rather inconsistent to attempt to prevent public research into gun-related violence.

Second, there is also the general moral concern with intentionally trying to impede the search for truth. While it is understandable that the NRA and certain other folks would rather that ignorance be maintained, this hardly makes it right.

One possible reply is to make a moral case on utilitarian grounds. Those who wish to prevent the funding of such studies could contend that they might be used to argue successfully in favor of expanding gun control and this would create more harms than benefits.

One obvious problem with this reply is that if the studies did show that gun control would be beneficial for society as a whole and thus provide a reasonable basis for gun control, then it would be the case that the studies would create more overall benefits than harms. This could be countered by adopting an ethical egoist position, namely that the folks who regard gun control as contrary to their interests are acting morally by opposing such studies. Naturally, the folks whose interests are served by gun control (such as potential victims of gun violence) would be equally right in supporting such research. So, if one is willing to accept ethical egoism as the correct moral view, then all the parties who are acting in their interest are right. This does, however, come with its own problems.

Another reply is to contend that such studies would lead to intrusions on the second amendment by providing evidence that would justify expanding gun control. As such, this evidence must be intentionally suppressed in defense of the second amendment.  This is certainly an interesting variant of the stock second amendment arguments regarding gun control.

While the idea of defending rights via imposed ignorance has a certain magic to it, this does seem problematic. The obvious reply is that such rights are not absolute and they can be justly limited. To use the usual stock example, the right of free speech does not extend to slander. As such, some additional limitations on the already limited second amendment rights could be justified by such studies.  Also, it seems rather odd to justify imposing ignorance on the grounds that studies might reveal some information that might prove useful in arguing for expanding gun control. After all, such studies might reveal that there is no need for any expansion of gun control laws. Then again, the fact that the NRA has lobbied to prevent such studies strongly suggests that such studies would reveal information that would provide rational support for expanding gun control laws.

Since the above attempts have failed, perhaps another tact could be taken in defense of the law restricting funding for research into gun violence.

The specific wording of the law, it should be noted, does not forbid funding studies of gun violence. Rather, it states that  “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”

One, perhaps naive, way to interpret this is that the folks who had the law written are merely trying to prevent public money being used to advance a specific political agenda, namely that of gun control. On this interpretation, the funding could be used to study gun violence provided that none of the funding is used in advocacy or promotion. This seems reasonable enough. After all, using public money to advocate or promote a particular agenda (such as traditional marriage) would surely be wrong.

The first reply to this is that whatever the interpretation,  the effect of the law has been to take away the funds for research into gun violence as a public health issue. As such, the law is effectively a band on federal spending to research gun violence.

The second reply is that the law mandates that funded studies cannot conclude that gun control would be beneficial to the health of the public. Such a conclusion would presumably all under advocating or promoting gun control. As such, studies can be funded provided that those conducting the studies promise to draw no conclusion involving positive effects of gun control. As such, studies that conclude that gun control is bad or useless would be just fine. As such, researchers would be free to pursue the truth, provided that this pursuit did not lead to a truth indicating that gun control would be beneficial to public health. That certainly appears to be an immoral and unreasonable limitation.

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Pigs, the other Unclean Meat

Posted in Business, Ethics, Medicine/Health, Philosophy, Politics by Michael LaBossiere on September 8, 2011
Modified version of File:CDC-11214-swine-flu.j...

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Like most humans, I like pork. However, some of my religious friends assure me that pork is unclean. While I assure them that I cook it properly, they are unswayed by this mere physical cleansing. This, in a way, makes sense: no amount of fire can sear away a metaphysical filth. If, of course, there is such a thing.

While I am still unwilling to accept the idea of pork being metaphysically unclean, I do accept that pigs (like humans and birds) are flu factories. While everyone has heard of swine flu, most folks are probably not aware that pigs can serve as oinking germ laboratories. To grossly over simplify things, flu virus strains can jump species from humans to pigs and also from birds to pigs. Like many viruses, the flu virus can swap bits and pieces, thus creating strains that blend features of multiple strains. While not all these strains are particularly virulent (witness the recent pandemic “pandudic”) this sort of recombination is worrisome because it can produce nasty results.

Obviously, virus swapping between species  is nothing new. However, there are some relative new things. First, we have massive agribusiness that raise pigs (and birds) in large numbers and in highly concentrated areas. This means that we have created massive breeding grounds for diseases. Second, we have a worldwide rapid transportation system which allows new strains to be spread far and wide rapidly. So, for example, a new strain that appears on a pig farm in China can be spread to New York city via the next jet out.

Given that these factory farms are prime disease farms, one would think that governments would closely monitor them and be on the lookout for the next pandemic. Some countries, such as China, do this. In the United States, however, there is considerable reluctance to allow the state to monitor the herds for diseases that could be a threat to humans.

One reason is the view that the government should not “meddle” in the affairs of private industry (other than to send subsidy checks, of course). This can, of course, be countered on health grounds: if monitoring pigs can help deal with a dangerous new pandemic, then it would seem to be within the legitimate powers of the state to do so. After all, if the state can do a full body scan of airline passengers, surely the state should be allowed to check out pigs for threats to human life. The flu is, of course, far more dangerous than terrorists (just compare flu deaths and deaths attributed to terror).

Another reason, which has more substance, is that such testing can be a financial hazard to pig farmers. While eating bacon will not give you the flu, pork sales drop when the news is full of tales of swine flu. Not surprisingly, if the public learned that pig herds were being tested for pandemic flu viruses, this would also have an impact on sales. And, of course, herds that tested positive might not find any buyers, even after they recovered and were perfectly safe to eat (well, for unclean beasts). This problem would need to be addressed. One approach would be public education on the matter. Of course, since ignorance and emotion tend to dominate over reason, this approach might not work that well. A second approach would be to assure confidentiality of test results and to have the state compensate farmers in case a herd had to be destroyed (or could not be sold because of unfounded concerns).

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Food Safety

Posted in Business, Law by Michael LaBossiere on December 21, 2010
:Original raster version: :Image:Food and Drug...
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While it is often claimed that America has the safest food in the world, a look back at various food contamination problems shows that there were serious problems in the system.

To address some of these problems, the Food Safety Modernization Act was recently passed. The final vote in the house was 215-144.

While I am reasonably well informed, I was somewhat surprised to learn that until this act passed the FDA had no power to issue recalls of foods. Instead, the companies had to voluntarily issue recalls.

While this is a step in the right direction, health issues regarding food are still are serious problem. In addition to the matter of contamination, there are also concerns about chemicals getting into foods-perhaps leaching in from the containers or otherwise getting into food.

It might be argued, as some have, that increasing the regulation of food and food safety will be bad for business and cut into profits. After all, if food companies have to ensure that their food is clean and uncontaminated by chemicals, then their operation costs will increase and this will lead to all manner of evils. There is also the worry about the state getting into the business of business.

There are two obvious replies. First, the costs that are created by contaminated food in terms of illness and so on would seem to be higher. Also, these costs are pushed onto the consumer-they have to pay when they get sick (unless they can win damages). Second, it is the job of the state to protect us from such harms. If Al Qaeda or some other terrorist groups were intentionally causing the  illness and deaths caused currently by the relevant food problems, we’d be spending billions on defense, probably start another war, and Republicans would be screaming for action and demanding that liberties be set aside in the name of safety. Now, if we can do this for a minor and irregular  threat like terrorism, we surely can step up our defenses against this sort of major, ongoing threat to the health and well-being of Americans.

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