When people debating against vaccines win, children lose.

When people debating against vaccines win, children lose.

To say that the relationship that antivaccine activists have with science and fact is a tenuous, twisted one is a major understatement. Despite mountains of science that says otherwise, antivaccinationists still cling to the three core tenets of their faith, namely that (1) vaccines are ineffective (or at least nowhere near as effective as health officials claim; (2) vaccines are dangerous, causing autism, autoimmune disease, neurodevelopmental disorders, diabetes, sudden infant death syndrome, and a syndrome that is misdiagnosed as shaken baby syndrome; and, of course, (3) the Truth (capital-T, of course!) is being covered up by a nefarious combination of big pharma, the medical profession, and the government (in the US, primarily the Centers for Disease Control and Prevention, which works with pediatricians to produce the recommended schedule of vaccines). Because vaccine rejectors don’t have science on their side, they have to resort strategies common to science denialists like those who reject the scientific consensus about evolution or human-caused global climate change. These fallacious strategies include (but are not limited to) selective citation of evidence (i.e., cherry picking), misrepresentation and logical fallacies, impossible expectations about what science can deliver (e.g., vaccine denialists expecting 100% efficacy and 100% safety from vaccines or cancer quacks expecting 100% cure rates and no side effects from chemotherapy); fake experts (e.g., Andrew Wakefield); and, of course, conspiracy theories. Add to that appeals to personal freedom and “health choiceüber alles and painting any form of vaccine mandate as incipient totalitarianism, with those rejecting vaccines taking on the role of the Jews in Hitler’s Germany, and you have a pretty good idea of the sorts of arguments antivaccine activists resort to.

Not surprisingly, even the most diehard antivaccine advocate can get frustrated. After all, it must be very frustrating to have one’s posterior handed to one in arguments on the science of vaccines time and time again. Of course, for that purpose, like most science denialists, antivaccine activists have the Internet. In particular, they’ve taken full advantage of Facebook, and, more recently, Twitter. One such online gathering place is the public group known as Vaccine Resistance Movement (VRM). I encourage pro-science advocates to peruse this group, just to see that when I refer to people being anti-vaccine, there is no doubt that that is what they are. It was there that I found a rather telling document posted, for the benefit of antivaccine advocates everywhere.

How to debate a pro-vaxer: Never admit error!

Over the weekend, while perusing Facebook and my usual list of websites and blogs, I came across a mention of a post on VRM that caught my attention, even among the usual complaints about how evil, mean, and nasty “pro-vaxers” are to those who refuse to vaccinate their children. I mean, the gall of us pro-vaxers, telling antivaccine activists that their beliefs are wrong (when they are) and that their choices put other children’s health at risk (which they do). Actually, it’s a document, and a rather long one, posted in Word format by someone named Tristan Wells entitled “How to debate a pro-vaxer” (alternate download site). It’s actually numbered as version nine, implying that there were eight versions posted before it, which means that Wells has been revising it over who knows how long.

It’s a long document, 34 pages and over 13,000 words (more than twice to three times the length of a typical post of mine to SBM), so I won’t be able to cover all of it. I will, however, hit the “high points,” if you can call them that. It’s also hard not to note that two of the chapters (Chapters 3 and 4) are entitled How To Effectively Argue They [Vaccines] Are Not Safe and How To Effectively Show They Are Useless. That right there ought to show you all you need to know about this document—that and this statement:

If you explicitly yield the point that vaccines work then you will not have achieved anything – at least nothing good anyway. Don’t think that by trying to sound conciliatory by yielding on efficacy others will be more inclined to hear your point of view on safety. That is the approach we have been using for the past several decades and, in case you missed it, it has been an abject failure. That doesn’t mean you *can’t* focus on the safety angle (although as I say it is generally better to focus on efficacy) but you should never ever yield on the efficacy angle. Indeed, you should think of it the other way – by chipping away at the notion that these things are critical to the survival of our species (which is what the propaganda tells people) people will be far more likely to listen to arguments about their safety.

A little later, Wells writes:

Another tip: You should never qualify or defend yourself. It actually reinforces your opponent’s belief that their attempt to disqualify you is valid and encourages them to continue that same line of attack.

Let me repeat that: Never, ever yield on the efficacy angle and never qualify or defend yourself. That second bit of advice is actually rather interesting to me because it reminded me of something I heard a few years ago. Back when I spoke at the Trottier Symposium in 2010, I participated in a panel in which one of the other participants discussed political punditry and how to be effective on television. The one message I got was that, as a pundit, you should never, ever admit uncertainty. You must be supremely confident. You must speak in declarative sentences, preferably over your opponent. And, above all, you must never, ever concede a single point that contradicts your message. Clearly, Mr. Wells has learned this lesson, and, from a rhetorical standpoint, views even a whiff of a hint of an admission that vaccines are efficacious is the road to losing. This instruction, above all others, tells me that what Mr. Wells is about is not science, but rhetoric and persuasion on an emotional level.

I was particularly amused by the first couple of examples Mr. Wells presents:

Pro-vaxer: “Dr Google!”

Good response: “Are doctors so stupid that they haven’t worked out how to use computers the way every other professional has been able to? Why is it perfectly acceptable to use the internet for all kinds of information – some simple, some complex, and many many issues of great substance but for some reason medical information gets all jumbled the moment it is uploaded onto a computer?”

Note the barb thrown at doctors in response to this argument – that is not an accident. The emotional point of their argument is that you are stupid and doctors are smart so this is what has to be combated.

Do *not* say “my doctor agrees with me that my kid’s injury was caused by a vaccine” or “I have spent hundreds of hours poring over the peer-reviewed literature!”. Both of these responses reinforce the logic of their attack – ie that the opinions of those in the medical industry are privileged. So you are left trying to make the case that your hundreds of hours of research is somehow better than the sum total of all the research done by all the ‘great minds’ of medicine. A very imprudent approach. If you give your doctor’s opinion primacy then you are effectively delegitimizing the stories of parents whose vaccine injury stories have been denied by their doctors.

Of course, the opinions of the medical industry are privileged, no matter how much Mr. Wells detests the idea or tries to deny it. They are privileged because expertise matters. Does that mean experts are always correct? Of course not. However, when judging an opinion from a man like Mr. Wells and comparing it to expert opinion, whose opinion is more likely to be closer to the real situation? Here’s a hint: It ain’t Mr. Wells’ opinion. It ain’t even close.

It takes many years and a lot of hard work and training to understand what is known about how the body works, how drugs and biologicals (like vaccines) interact with the body, and how scientific research works. Expertise can’t be acquired through a few days on Google. It matters so much that it is very, very difficult even for someone with a strong background in medicine and science to master a new area of expertise on his own; for someone without a background in medicine it is damned near impossible, no matter how intelligent and educated he is in other areas. Depth of knowledge matters, as does the ability to synthesize the totality of the literature. That’s why people like Mr. Wells will latch onto one or a handful of studies that show what they want to believe and ignore the preponderance of evidence that doesn’t show that. It’s why bloggers at, for example, the antivaccine crank blog Age of Autism can write long, speculative posts relating all sorts of different kinds of science that really don’t relate in order to bolster their ideas about autism being caused by vaccines. It’s the sort of stuff that sounds persuasive to non-scientists, but causes real scientists to roll their eyes and snort derisively.

Here’s another example:

Pro-vaxer: “You aren’t an expert in immunology. How could you possibly know they are useless?”

Responses: “You aren’t an expert in homeopathy*. How do you know homeopathy is useless?”

*You can of course exchange homeopathy with any practice or belief that your opponent doesn’t agree with (astrology, naturopathy, faith healing, etc but homeopathy is the best one because it sends our opponents into conniptions). It is irrelevant whether you agree with it or not.

Of course, this argument is fallacious on many levels. First, you don’t have to be an expert in immunology to know that vaccines work. The evidence that they work is overwhelming, to the point that all you need is a knowledge of medicine, science, and/or epidemiology. That’s why I don’t recommend that pro-science advocates ever actually use this line of questioning. Moreover, there’s a huge difference between homeopathy and immunology. The first is pure pseudoscience, one of the most blatant forms of pseudoscientific quackery that exist, and second is not. Ditto astrology, naturopathy, and the other examples listed by Mr. Wells. You don’t have to be a scientist to recognize that homeopathy is pseudoscience. Its very precepts are so utterly ridiculous, that I can explain them to any reasonably intelligent lay person and show them why homeopathy is quackery. The same is true of astrology, naturopathy, and pretty much any other example that Mr. Wells might like to present. In marked contrast, immunology is very complex, so much so that it’s very hard to explain anything more than the most basic concepts to someone without a background in human biology and physiology.

I will admit that, superficially at least, Mr. Wells has hit on seemingly effective rhetorical gambit, but it’s not that hard to counter. Just take some of Mr. Wells’ own advice: Don’t concede this point, just as he later says never to sell out allies like Andrew Wakefield.

I could go on, but the first chapter basically consists of a combination of the “never admit error” gambit combined with straw man characterizations of pro-vaccine arguments, such as “You either get all medicine or none,” an argument I’ve never actually heard any pro-vaccine advocate use that argument, and I’ve been following this for a long time. (If any pro-vaccine advocate ever uses that argument, stop. It is actually a bad argument.)

These general arguments, of which I’ve only sampled but a few, are the warmup. The “meat” (such as it is) of Mr. Wells’ attack resides in Chapters 3 and 4, which try to argue that vaccines are neither safe nor effective.

How to debate a pro-vaxer: Vaccines are dangerous!

Consistent with Chapter 1 and its admonition never, ever to yield an inch on the efficacy of vaccines and to focus on safety arguments, Mr. Wells regurgitates a veritable cornucopia, a greatest hits if you will, of easily-refuted antivaccine pseudoscience. For example:

Most effective statement on safety: “If an 85kg adult were to get the equivalent dose of what an infant is expected to get then they would receive around 500 vaccines over 18 months (around 150 separate injections plus the oral rotavirus doses). I would never get that many vaccines for myself and I have yet to observe any supposed believer in the safety of vaccines roll up their sleeves and take them so until at least one of them does (and comes out unscathed) I will continue to believe that: a) vaccines are not safe; and b) those who claim they are cannot be trusted.”

[I have used 85kg (187lb) because apparently that is what the average Australian male weighs. If you are speaking to a woman (average 72kg in Australia) then the figure would be more like 400 vaccines (120 separate injections plus the oral rotavirus doses)].

This, of course, is an irrelevant argument, a diversionary red herring, if you will. It doesn’t matter what the equivalent dose of childhood vaccines would be to an adult; childhood vaccines aren’t designed for adults, but for children, and adult vaccines are designed for adults. Vaccines don’t work by being distributed through the bloodstream like a drug. They work by provoking an immune response, usually locally where they are injected. Some vaccines do require a larger dose in older adults because immune response can weaken with age. Thus, the “appeal to dose” is a fallacy, a rhetorical gambit; it’s not scientifically supported. It’s basically a variant of Jock Doubleday’s vaccine challenge. Perhaps the most amusing reply to Mr. Wells’ challenge came from reasonablehank:

View post on imgur.com

That’s about right.

Mr. Wells also tries to do epidemiology and clinical trial design, which, as you can probably predict, does not end well, because he uses some verbal prestidigitation that sounds impressive but is not:

Non-inert controls and challenge rechallenge

It is also true that pharma companies test vaccines using a non-inert placebo rendering all their safety data invalid.

You do need to be careful with this one though. Technically there are studies that use saline placebos – but they just never actually demonstrate the vaccines are safe relative to them. Remember your opponents are extremely dishonest and if you say “they never use saline controls” they will point to a bunch of studies where saline controls were used and say “See? You were wrong!” So you should instead say “no vaccine has ever been shown to be safe compared to an inert control”. If they point to a list of a whole bunch of studies just instruct them to pick one and explain what exactly was in the control and how exactly it was compared to the vaccine.

This is a distinction without a difference, designed to obfuscate, rather than illuminate. It’s a variant of the antivaccine myth claiming that vaccines are not tested against a “true” placebo or against the “correct” negative control group. Mr. Wells then goes on to mine this myth with respect to Gardasil and its clinical trials:

To give an example of the sort of trickery they use look at Gardasil. They did actually have a saline placebo but there were 1000 recipients of it vs 8000 aluminium salt recipients. For the minor adverse effects they separated all three groups (1000 saline, 8000 Al and 10,000 Gardasil recipients) and the results were as you expect with the saline being clearly the safer of the three. But in the results for systemic/severe side effects they grouped the saline with the Al group (of course this was basically just an Al group because of the relative sizes) and found that the vaccine was slightly more dangerous than the Al group. So because the difference wasn’t massive in this key criteria [sic] (the vaccine wasn’t going to be rejected because of minor adverse events only serious/systemic ones) the vaccine was approved.

Now our opponents have a bunch of contrary excuses for all this. One is that the Gardasil test was the only valid way to do a test because apparently a valid controlled test requires all the ingredients in the vaccines vs all the ingredients in the vaccine minus one (the viral/virion particles). That is like comparing the ability of one Corolla to be smashed into a wall at 100kph vs the ability of the same Corolla minus a side mirror being smashed into a wall at the same speed and declaring that smashing the car into a wall is safe because both cars turned out the same. In other words it is completely stupid because the control relates to the real world decision to either have the vaccine or not have the vaccine. Nobody chooses to have all the ingredients in the vaccine bar one.

One notes quite pointedly that in his discussion Mr. Wells fails to reference the specific trial that he’s talking about, either with a reference in the text or a PubMed link. For example, one study other than the one that he apparently discusses did indeed use a placebo control and showed elevated antibody titers for at least eight years due to the quadrivalent vaccine. Be that as it may, I had a hell of a time locating which study Mr. Wells was talking about. For example, an early study published in the New England Journal of Medicine used an aluminum-containing placebo and didn’t use 17,000 subjects, but more on the order of 5,000 subjects. The trial I found using a saline placebo not containing aluminum enrolled 1,781 subjects. Just as I was about to give up trying to figure out which study Mr. Wells was referring to, I found this one. Here’s a hint for Mr. Wells: You shouldn’t have to make your readers do your work for you and find the study.

Looking at the study, I note that there were indeed a higher number of serious adverse events in the Gardasil group, but that none of the differences noted achieved statistical significance. The confidence interval for the risk difference spanned zero, and p=0.253. As for why the saline placebo and aluminum-containing placebos were pooled for serious AEs, the reason was almost certainly that there were such small numbers of such AEs that it would be difficult to do statistics on the saline-only group. In any case, Mr. Wells’ criticism of this study shows that he does not understand study design and that he is deceptive in not wanting to make it easy for anyone who wants to check his work to locate the primary source he used.

His deceptive techniques continue in Chapter 4.

How to debate a pro-vaxer: Vaccines are ineffective!

Chapter 4 is the section where Mr. Wells “shines” in terms of deception and misdirection. Basically, it consists of a lot of straw man characterizations of pro-vaccine arguments backed up by links and references that don’t even really tear down these straw men. For example, Mr. Wells asserts, and I respond:

  1. The purpose of the polio vaccine was to bring about a reduction in total rates of non-trauma paralysis and crippling. It failed. No, the purpose of the polio vaccine was to bring about a reduction in the rate of polio and its attendant paralysis. According to the CDC, polio was one of the most dreaded childhood diseases of the 20th century, with routine epidemics having occurred since the late 19th century, epidemics that increased in size by the early 1950s to average 10,000 to 20,000 cases per year. After the introduction of the polio vaccine, the number of cases plummeted, and there hasn’t been a case of paralytic polio in the US since 1979.
  2. The purpose of the rubella vaccine was to bring about a reduction in total rates of congenital defects. It failed. No, the purpose of the rubella vaccine was to bring about a decline in the incidence of rubella and rubella-associated birth defects, known as the congenital rubella syndrome. In 1969 there were 57,686 cases of rubella reported. After vaccine licensure, as is the case with vaccine-preventable diseases, rubella incidence plummeted rapidly, with less than 1,000 cases reported in 1983 and only seven cases in 2003 and a median of 11 cases annually between 2005 and 2013. The incidence of CRS paralleled the decline in rubella cases. In October 2004, the CDC convened an independent expert panel to review available rubella and CRS data. After a careful review, the panel unanimously agreed that rubella was no longer endemic in the United States.
  3. The purpose of the measles vaccine was to bring about a reduction in total rates of encephalitis and deafness. It failed. No, the purpose of the measles vaccine was to bring about a decline in the incidence of measles and measles-associated complications. Measles is among the most-contagious known diseases, and before 1963, when the measles vaccine was licensed, there were approximately 500,000 cases and 500 deaths due to measles reported annually, with epidemic cycles every 2-3 years. However, the actual number of cases was estimated at 3-4 million annually. After 1963, the incidence of measles plunged by more than 95% and the epidemic cycles ceased. Unfortunately, there have been periodic resurgences, such as the Disneyland measles outbreak earlier this year. Such outbreaks have always been linked to populations with low vaccine uptake.
  4. The purpose of the Hep B vaccine was to bring about a reduction in total rates of liver cancer/disease. It failed. No, the goal of the hepatitis B vaccine was to bring about a reduction in the incidence of hepatitis B. The secondary goal, of course, is to reduce the incidence of hepatitis B-related liver cancer and disease. The problem is that cirrhosis and the liver cancer that can result from cirrhosis due to chronic hepatitis B infection take decades to develop. The birth dose of hepatitis B was only strongly recommended in 2005, meaning that there has probably not been enough time to see a significant reduction in end stage liver disease and cancer due to hepatitis B. We would expect that reduction to be small, anyway, because hepatitis B is far from the only cause of liver failure and cancer. In the US, the number one cause of cirrhosis is alcohol abuse; number two is hepatitis C.
  5. The purpose of the Hib and Prevnar vaccines was to bring about a reduction in total rates of meningitis/pneumonia/sepsis. They failed. No, the purpose of the Hib and Prevnar vaccines were to bring about a reduction in incidence of Hib in children and pneumococcal pneumonia. The Hib vaccine succeeded spectacularly in reducing the incidence of Hib. Prevnar is also quite effective against the strains of pneumococcus for which it is designed.
  6. The purpose of the diphtheria/pertussis vaccines was to bring about a reduction in acute respiratory infections. They failed. No, the purpose of the diphtheria/pertussis vaccines was to decrease the incidence of diphtheria and pertussis. Both succeeded.
  7. The purpose of the mumps vaccine was to reduce sterility. It failed. No, the purpose of the mumps vaccine was to reduce the incidence of mumps, which it has done, including the incidence of mumps orchitis, which could lead to sterility.

You can probably tell that I was getting tired of the disingenuousness of Mr. Wells’ claims, as my rebuttals got shorter and shorter as I went down the list. Backing up his claims are a bunch of links to references to articles that are either old or irrelevant or that don’t show what he thinks they show. For instance, he references this article in the British press about the skyrocketing incidence of deaths from liver disease. What he neglects to point out is that the main contributor to that increase appears to be alcohol and obesity, both of which increase the risk of cirrhosis.

You get the idea. He even includes long-debunked antivaccine tropes such as the claim that measles has been renamed roseola, that polio has been renamed Guillain-Barre, and that smallpox was renamed monkey pox, to name a few. Basically, he’s quite enamored of the intellectually dishonest antivaccine tactic that I once dubbed the “vaccines didn’t save us” gambit, going so far to link to a site that basically makes that very claim.

In his appendix, he even includes some outright germ theory denialism:

The Germ Theory and why extremism (non-violent) is a good thing

I would have preferred to have included this as part of the main body but because most of you still believe in this I left it out with only a subtle pointing to it when I talk about us having c100 trillion bacteria in and on us. If you recognise the absurdity of the germ theory then you can and should use it. Yes, people will be so far out of their comfort zone at first. But just like the stuff about efficacy, the first time people hear it they will dismiss it as too fringe but if they hear it enough times from enough people then it will become part of their consciousness and they won’t like the cognitive dissonance required to maintain their belief in the status quo.

The rest is pure, ridiculous germ theory denialism so ridiculous that it practically refutes itself. Doing so is left as an exercise for the interested reader, given that I just passed the 4,000 word mark.

Who is Tristan Wells, anyway?

I save this part for the end, because I don’t like to dwell on the person but rather the arguments. However, I was still curious, because I had never heard of Tristan Wells. So I did a bit of Googling. It didn’t take me long to discover that he’s associated with the antivaccine group the Australian Vaccination-skeptics Network (AVN) and knows Meryl Dorey, its founder. It also didn’t take me long to discover that he’s rather…extreme…even for an antivaccine activist. For example, just last week Mr. Wells called for the execution of vaccine workers:

wells-10-vaccine-workers-should-be-executed-7-news-melb-nov-23-2015

Certainly, Mr. Wells’ “reasoning” (such as it is) goes along with those rather extreme viewpoints.

In the end, Mr. Wells clearly has no idea what he is talking about, but that doesn’t mean he can’t be persuasive, because most of his target audience doesn’t have a sufficient scientific background to realize that he doesn’t know what he’s talking about. As is the case with political pundits on TV (not to mention Donald Trump), absolute certainty, conviction, and unwillingness ever to concede any error or give even a millimeter to your opponents go a very long way, even if what you are arguing is nonsense.

Even so, I almost hope that antivaccine activists start using Mr. Wells’ guide as a template. The “factual” content in it is so easily refuted and so obviously wrong that it will make my job refuting antivaccine misinformation easier.

 

 

Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.

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