Skepticlawyer

It does, you know. Really.

That we have to be reminded of this now — in (almost) 2012 — is a sad testament to the failure of not only science education but something rather more old fashioned: the public health campaign. Remember those? Newsreels of children lining up for their needles, posters enjoining people to sneeze into a handkerchief, advertisements telling people to always, always use a condom? Remember this?

That advertisement, by the way, is generally considered part of the most successful public health campaign ever, anywhere.

Maybe we need a similar campaign, equally devastating, in favour of vaccination: for in one of those strange cultural perversities where everything old is new again, there has been a determined campaign against vaccination, with a specific focus on the MMR (measles, mumps rubella) vaccine, but also taking in others. This campaign is of recent vintage, in that it has its origins in the anti-establishment beliefs engendered in the 1960s. It used to be found primarily on the left where — as G. K. Chesterton once famously observed — if people stopped believing in God, they then started believing in anything. Now, however, as the right — especially in the United States — has been colonised by religious conservatives who reject evolution and science education — it too has come to be infected with the virus of fashionable anti-science, especially in the form of opposition to vaccines. This, of course, is often allied to a Chestertonesque collection of pseudo-medical weirdnesses — homeopathy, bio-energetics, reiki, chakras, what-have-you. Homeopathy is particularly daft: I’ve always found this response telling. Do click, you’ll get a chuckle. A non-sweary version is available here.

Doing skeptical work

So, along with many other people, I am wearing my skeptical hat, and battling the anti-vaxxers. Others, of course, are better at doing the scientific spadework, rebutting the claims of anti-vaxxers and their acolytes. Bad Astronomy’s Phil Plait has the story:

Yesterday, in Australia, one of the most vocal antivaxxers alive, Meryl Dorey of the grossly misnamed Australian Vaccination Network (AVN), spoke at the Woodford Folk Festival about her beliefs. However, she didn’t get quite the chance she had hoped for. Once the news got out that she was invited to the festival, the group Stop AVN went into action. A protest cry went up, and the venue was changed from her speaking solo, to her participating in a panel with a series of experts — actual, real experts — on vaccines. As I write this, I have a window open on Twitter, and I’m watching the tweets using the hashtag #StopAVN flow by. It’s a thing of beauty. Dorey’s arguments are being destroyed, 140 characters at a time.

The bottom line, repeated over and over again: Vaccinations save lives. That statement of fact is so simple, so powerful, that Stop AVN put it on a banner and had it flown behind a plane at the festival.

This campaign took no little amount of organising and financial commitment; I was on the fringes of involvement (in as much as one can be from the UK), but those who did the real work are to be commended wholeheartedly. For readers interested, Kylie Sturgess (of ‘Token Skeptic‘ fame) has an excellent radio interview with the four organisers, while Chrys Stevenson’s piece on the issue at Graham Young’s Online Opinion is also excellent (and represents a nice little news scoop for his site, which is good to see). Chrys comments:

Some readers, sensitive to the subtle nuances of revelatory prose, may detect a hint of biting sarcasm in my tone. You’re right. My contempt for a woman who makes her living scaring parents out of vaccinating their children is hard to contain.

Let’s get some perspective here. Sure, Woodford is a festival that celebrates alternative ideas. You want to use a magic crystal instead of regular deodorant? Knock yourself out! But Dorey’s alternative views are not benign. They endanger the lives of our most vulnerable citizens; infants, children, the elderly and people with medical conditions which compromise their immunity to disease. What’s more Ms Dorey’s dangerous doctrine is demonstrably false.

Increasingly, we live in a culture of fear and distrust. Don’t trust the government; don’t trust ‘Big Pharma’; don’t trust ‘so-called’ experts; don’t trust the media – they’re all out to get you. Ms Dorey exploits those fears to drive home the message emblazoned on the t-shirts she sells from her on-line store: Love them, protect them, never inject them.

What Chrys and Kylie haven’t covered in their respective pieces (although they have written about it elsewhere) is Meryl Dorey’s attempt to inveigle her anti-vaccination message into Australia’s indigenous community, addressed by our house cartoonist here. Aborigines are — as readers of this blog well know — notoriously immunocompromised. Advising Aboriginal parents not to vaccinate their children is a little bit like the deliberate manufacture and sale of shonky children’s play equipment. The appropriate legal phrase is ‘criminal negligence’.

Some legal and philosophical context

Since other people have done the science, and done it spectacularly well, I think it’s best if I confine my comments to that which I know best: law, classics and the origin of (bad) ideas. I think I can explain why anti-vaccination and various other campaigns extolling ignorance have become popular, and why the ‘people are proud of being stupid’ meme has crossed the ideological divide. First, however, some background.

I am old enough, just, to have both a cultural and familial memory of the world before vaccines. My father had polio as a boy, and I grew up knowing his withered leg and lumbering gait and constant foot pain came thanks to something with which I would never have to contend, because I had been vaccinated. I could run as a child in a way that my father would never be able to run, had never been able to run. When the ABC aired a television miniseries based on Alan Marshall’s great novel of childhood, I Can Jump Puddles, I spent much of it in tears. I had confidence in what medicine could achieve because of my father’s living example. Other people do not have that cultural or familial memory: I am constantly amazed at the extent to which we have forgotten what life was like before modern medicine. I addressed that problem in an earlier piece I wrote on anti-vaxxers:

The AVN (and analogous groups) have long argued that vaccines are not responsible for a reduction in communicable disease, rather, that this is a product of increased sanitation and good food. This is wrong in a really twisted way, because it’s a half-truth, and half-truths can be harder to fight than outright, bare faced lies. See, improved sanitation and better food does increase life expectancy, and does help to prevent certain infections. It does not, however, do anything to stop viruses of the type implicated in most of the ‘childhood diseases’. How do I know this?

There are historical examples of societies that practiced good hygiene and sanitation but didn’t have vaccines, and — if we’re lucky — we can find out a great deal about what good hygiene and food can do… and what they can’t. Now having a volcano shit itself all over them was rather unfortunate for the 20,000+ people living in Pompeii and Herculaneum, but it showed us a few useful things nearly 2000 years later, and archaeologists have been able to study them and ‘report back’.

The people of Pompeii were taller on average than people currently living in the same region of Italy. That suggests they ate a varied diet with plenty of protein. Once people got past the age of 5, they tended to get to between 60-70 years of age. Not a developed-world life expectancy by any means, but a pretty decent one, and much better, once again, than anywhere on the planet until the early 20th century. They had all their teeth — even old people — which suggests both knowledge of oral hygiene and a diet without sugar. Allied to our knowledge of Pompeii is the fact that we have no records of puerperal fever from the high point of classical antiquity. It only turns up later, when people stopped washing daily. The ‘natural’ maternal mortality rate is approximately 1 in 100. Evidence suggests the Romans dragged that down to 1 in 200. So far so good. Public baths, public loos, quicklime to sanitize the baths, all good.

The Roman under-five mortality rate? 1 in 4. The Medieval under five mortality rate? 1 in 3. The Romans win by a nose, but not by much. One in four children died before the age of five. Infant mortality was so pervasive, Plutarch informs us, that the Romans forbade full funeral rights for children who died under the age of two. The dead bodies were thrown out with the household trash (something Colleen Mccullough got right in her various Rome books). Hey, at least the Romans had municipal rubbish collection… that doesn’t appear again in our records until Muslim Spain at its height.

One in four. Hold that thought.

I can now add some detail for you: the Roman jurist and Praetorian Prefect Ulpian prepared the first life tables known to statistics, comparing cities before and after the Romans sewered them, using his government’s excellent census data. His figures correlate with those provided by Professor Mary Beard in her BBC documentary on Pompeii linked above: good public health and hygiene drags up adult life expectancy, lowers maternal mortality rates and allows people to recover from infections. It does nothing for the childhood diseases. As Professor Andreas Suhrbier, the immunologist who was Dorey’s opponent in debate at Woodford pointed out, vaccines are doing different work: they don’t stop you getting infected, they stop you getting sick.

In a world before vaccines, children simply died. In droves. It is this, more than anything else, that makes people from the past seem so callous when it comes to small children: from the Roman prohibition on infant funeral rights to the almost unlimited power conferred on parents to do with children as they wished to the myth of the ‘Changeling’, which allowed parents to kill disabled children (‘it was a fairy child’) without disturbing Christian doctrine. Much of the sentimental loving-kindness we now show towards children emerged thanks to vaccines, particularly after the smallpox vaccine (combatting the greatest childhood killer) began to take effect in the 19th century.

The origin of (bad) ideas

I mentioned above that attitudes embodied by the likes of AVN — what Chrys calls ‘a culture of fear and distrust’ in her piece — have their origins in the anti-establishment values that burgeoned in the late 1960s. As we all know, it became fashionable to ‘stick it to the man’, to cavil at authority and hierarchy. This, as Steven Pinker makes clear in his magisterial study of the phenomenon, was rather like the curate’s egg: only good in parts. Much of the opposition was opposition for its own sake, and often empirically unsound to a far greater extent than the ‘traditional’ position whose overthrow was sought. The catalogue of sixties oppositional failures is long and growing: we have since learned that incarceration reduces crime, that two parents, preferably married, produce better outcomes for children, that fashionable ‘free range’ educational theories only work for middle-class families. However, some of the opposition had real valency. The opposers exposed a long and growing list of institutional failures, both public and private. Those on the left pointed the finger at corporations. Those on the right pointed at government failure. This process is ongoing: the left feeds off Enron and Lehman Brothers; the right feeds off the Euro and the Millennium Dome. Certain sub-species of both point at the Iraq clusterfuck and simply shake their heads. The sort of people who paid attention to public health campaigns in the 1940s and 1950s and guilelessly trusted both governments and pharmaceutical firms to ‘do the right thing’ are probably no more.

I get this distrust; as someone operating out of the classical liberal tradition, I understand in some depth just how bad government can be, and the extent to which good intentions do not save it when its well-meaning programs go wrong. As someone from North Queensland, I know that government scientists deliberately introduced the cane toad (to control the cane beetle) into my state. No cane beetles were harmed in this process, but a great deal of native fauna was (and is). For the same reason, I also understand why people distrust corporations. There is something in the quip that big business hates free markets more than it hates socialism because the former make it bloody well compete. Monopoly and monopsony are not nice, no matter how you slice them.

However, as much as I sympathise with this distrust, I want to convey that it has proper limits. While everyone is entitled to an opinion, not all opinions are equal. Very often — despite distrust of authority figures — those in authority will be right. Liberal democracy schools us to distrust Platonic Guardians, and with good reason, but it should not school us to despise clever people or the possibility of truth. Even the great theorist of ‘bottom up’ spontaneous order and limitations on expert knowledge, F. A. Hayek, accepted an important role for what he called ‘constructed’ orders. He mentioned the military and schools: the army is not a democracy, and depends on its chain of command. Schools need rules and centralised authority. I’d venture to add that science isn’t a democracy either, and nor is law. A freshman can trump a professor in history class. This is most unlikely to happen in immunology or while studying the law of contract. Meryl Dorey’s assertion that she knows as much as an immunological specialist represents an attempt to trump a professor that would be funny if it weren’t so tragic.

That the AVN is feeding off the worst sort of toxic oppositionism for its own sake is symbolised by one of the comments made at the conclusion of Dorey’s talk. (This comes via a horrified Clementine Ford’s twitter feed, by the way; so is preserved in a sort of digital aspic):

I didn’t donate to the vaccination progams for the 3rd world because I believe we’re overpopulated. Shouldn’t we be observing natural selection?

At that point, the eugenicist streak present in certain strains of the green movement links hands with a social darwinism that is fascistic in its repellent nastiness and historical pedigree. According to another twitterer, even Dorey backed away from that, although with her ‘never inject them’ rhetoric, one does wonder to what extent. And, as Ford observed elsewhere, ‘hippies are weird’.

So how does this wash up? With the realisation that none of humanity’s tools are perfect, but medical science is one of the best we have. Chrys observes in her piece:

I know there’s little chance that I’ll persuade the hard-core conspiracy theorists whose search for ‘the truth’ has them so bamboozled they don’t know which way’s up. But, for those undecided parents who might hear Ms Dorey at Woodford or elsewhere, please consider whether you really want to stake your child’s life on the highly unlikely chance Ms Dorey knows more about vaccinations than the overwhelming majority of the world’s doctors and scientists.

It’s unfortunate that Chrys has to appeal to authority, so accepted has ‘sticking it to the experts’ become. I hope this piece has driven home an important point: there are proven facts out there, in science and medicine and law. And the anti-vaxxers are not in possession of any of them.

[Thanks to Chrys Stevenson for the graphic of the plane banner featured at Woodford Folk Festival].