On Jenny McCarthy, Autism, and Dogma in Science

It is unfortunate that so many caring people with good intentions are terribly misinformed, and as a result are making bad decisions about their children's health. I'm speaking of course about the popular misconception that vaccines cause autism or other diseases.

While it is possible that research has overlooked something, there is currently no evidence for a vaccine-autism link. Nonetheless, Jenny McCarthy continues to argue against the United States' vaccination program, in her article, "In the Vaccine-Autism Debate, What Can Parents Believe?" for the Huffington Post.

For some reason, parents aren't being told that this "new" information about Dr. Wakefield isn't a medical report, but merely the allegations of a single British journalist named Brian Deer. Why does one journalist's accusations against Dr. Wakefield now mean the vaccine-autism debate is over?

Ms. McCarthy would have us believe Brian Deer's accusations came out of the blue, tarnishing a respected scientist's research. However, co-authors were pulling out on the infamous paper as early as 2004, and almost a year ago, The Lancet retracted the paper altogether. It isn't only a single journalist is accusing Dr. Wakefield either: last year a panel found him guilty of 'acting unethically' and he has been removed from the medical register (in the UK,  this is tantamount to losing his license to practice medicine).

The 'debate' is over because no reliable evidence has ever been put forward for that side. The debate has been over since study after study* showed no autism-MMR link, autism rates continued going up despite the removal of Thermisol.

I know children regress after vaccination because it happened to my own son. Why aren't there any tests out there on the safety of how vaccines are administered in the real world, six at a time? Why have only 2 of the 36 shots our kids receive been looked at for their relationship to autism? Why hasn't anyone ever studied completely non-vaccinated children to understand their autism rate?

Sympathy for the plight of Ms. McCarthy's child notwithstanding, this anecdote is not evidence--regression could have many causes. Just because the shot preceded the regression doesn't mean it caused the regression--that would be the Post Hoc fallacy.

I admit, that last question was a bit trickier for me to answer, until I stumbled upon the answer in a meta-study:

No studies have compared the incidence of autism in vaccinated, unvaccinated, or alternatively vaccinated children (i.e., schedules that spread out vaccines, avoid combination vaccines, or include only select vaccines). These studies would be difficult to perform because of the likely differences among these 3 groups in health care seeking behavior and the ethics of experimentally studying children who have not received vaccines.

This comes from "Vaccines and Autism: A Tale of Shifting Hypotheses" in the peer-reviewed Clinical Infectious Diseases.** If you're interested in this debate, I highly recommend it, as it is understandable after a little background reading. It lays out a pretty thorough case against anti-vaccination claims. Anyway, back to Ms. McCarthy's article:

These missing safety studies are causing many parents to approach vaccines with moderation. Why do other first world countries give children so many fewer vaccines than we do? What if a parent used the vaccine schedule of Denmark, Norway, Japan or Finland -- countries that give one-third the shots we do (12 shots vs. 36 in the U.S.)? Vaccines save lives, but might be harming some children -- is moderation such a terrible idea?

The CDC has an excellent answer to this, in their list of misconceptions about vaccinations:

These studies have shown that the recommended vaccines are as effective in combination as they are individually, and that such combinations carry no greater risk for adverse side effects. Consequently, both the ACIP and AAP recommend simultaneous administration of all routine childhood vaccines when appropriate.

(Emphasis mine) Also note their "risk from disease vs. risk from vaccines." The larger number of vaccinations in America's schedule seems to be because other countries aren't vaccinating against as many illnesses as the United States is. Recent research indicates that autism is probably tied to factors that vary from region to region. In other words, not the vaccine schedule uniform across the country.

With regards to autism, there's no room for dogma: research is ongoing on the causes and risk factors. So while we must not cave in to unsupported assertions, we do have to realize, given our current state of knowledge, ideas about the condition are subject to change as science marches on.

* Here are the links to the studies themselves:
Lack of Association Between Measles-Mumps-Rubella Vaccination and Autism in Children: A Case-Control Study (Polish study cited by Reuters) 
Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study (Study covered by MSNBC)

**Stanley Plotkin, Jeffrey S. Gerber, and Paul A. Offit Vaccines and Autism: A Tale of Shifting Hypotheses Clinical Infectious Diseases 2009 48: 456-461.
Unfortunately, this article is not available without a subscription. I suggest checking your local library to see if they have an online subscription.

Addendum: 'The Importance of Critical Thinking'

Yes, another addendum. This one deals with my previous post, 'The Importance of Critical Thinking'. However, it doesn't deals with my remarks on healthcare reform, rather than the main point. (I am not retracting my belief that 'critical thinking' is important, in other words.) Here's the part I screwed up:

The nonpartisan Congressional Budget Office was instructed to tally up the costs for H.R. 3590, aka the Patient Protection and Affordable Care Act aka Healthcare Reform. However, for political reasons, various healthcare reform-related bills were separate and not part of the CBO's tally. So it is both correct and incorrect to say that healthcare reform would increase the deficit: the primary bill won't, but various other bills probably will.

Yeah, it's a bit more complicated than that. Several of the examples given the video don't add up. Having looked into them, I'm not sure the 'doc fix' can legitimately be called a part of health care reform, since it's an artifact from a 1997 attempt to save money on medicare costs by slashing doctor compensation and arguably has nothing to do with the recent bill*.

What about double counting? This appears to be legitimate:

To describe the full amount of HI trust fund savings as both improving the government’s ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement in the government’s fiscal position.

Accounting tricks! Oh my! Well, not quite. Note the bolded part**. So the CBO did not count Medicare savings twice. Ergo, to subtract the trust fund savings from the CBO's figures would be misleading. (However, to take people to task for describing the bill as both improving the solvency of Medicare and reducing the deficit would be correct.)

The evidence is rather messy and complicated. No, the CBO didn't engage in double-counting--but some of the bill's promoters probably did. Yes, the doc fix will add to the deficit--but arguably it was coming anyway.

 Let's look at the question the study asked to see how it relates to the study itself:

Is it your impression that among economists who have estimated the effect of the health reform law on the budget deficit over the next ten years...will not increase the deficit...views are equally divided...think it will increase the deficit. (pg. 8, sidebar)

 Since it uses the word law rather than laws, I submit that since the major healthcare reform bill is in fact predicted to reduce the deficit (despite the impact of other healthcare-related laws), the study authors were correct in choosing 'will not increase the deficit.' It is a somewhat confusing (not to mention partisan) issue, but I think I can objectively state the study authors did not screw this question up.

*More information on the doc fix: Paul Krugman (NYT; believes it shouldn't count) and Megan McArdle (The Atlantic; believes it should count).

**Note that the bolding is my own, and not in the original report.

Preliminary Resources for Critical Thinking

Even though I consider my personal study of critical thinking to only have just begun, I already have some useful resources. I do consider this list incomplete and I welcome suggestions, or even criticisms of these sources. Starred items are those I'm hoping to read (and review) in the (near) future.

Books

The Demon-Haunted World, Carl Sagan. A convincing case for science and against a host of irrational beliefs, especially pseudoscience. Has the famous "baloney detection kit" (courtesy of Google Books), which you should definitely check out, even if you don't read the entire book. Update(5/01/11): Review.

A Rulebook for Arguments, Anthony Weston. Seems to focus on constructing good arguments, rather than identifying bad ones. Since that is very useful, I'm going to have to read this one. A recomendation from Kevin deLeplante (see below for his video series).

A Short course in Intellectual Self-defense, Normand Baillargeon. More specifically on critical thinking. The author cheerfully admits a bias towards the ideas of Noam Chomsky (The cover reads "unleash your inner Chomsky"), but useful nonetheless. Update(5/01/11): Review.

Videos

The Critical Thinker, Kevin deLeplante. An ongoing series on critical thinking. Covers topics ranging from logical fallacies to rhetoric. Also available as an audio podcast.

Critical Thinking, QualiaSoup. A quick introduction. Also see his videos 'The Problem with Anecdotes' and 'Open mindedness.'.

Websites

The Fallacy Files Probably one of the first sites I encountered. Comprehensive, but not always the most clear.

Humbug!, Jef and Theo Clark. Seems to have good explanations, but has a distracting watermark on each page. Also available as a physical book (with no watermarks).*

Badarguments.org Have not signed up for the email service (yet?), but the non-subscription part of the site is a helpful practical tool.*

In the near future, expect longer reviews of at least the books and maybe some of the websites and videos as well. In the meantime, enjoy!

Edited 5/01/11 to add links to reviews and change the italicized entries to starred ones.

The Importance of Critical Thinking

I debated about whether or not to post this study. It's a study on misinformation in the 2010 election, but you may have heard of it as the "Fox News Viewers most misinformed." The press release doesn't emphasize that angle however, and neither does the report(PDF). The reason is probably because misinformation was present among virtually every group polled--Fox News was merely the worst, not the only perpetrator.

I think looking at general misinformation is a better angle, because, to me, the levels of misconceptions are too high, regardless of the network/source. We can't let CNN or MSNBC off the hook because one study showed their viewers to be slightly less likely to believe a popular myth.

This study does have some problems, though, that this video by How the World Works points out. For some of the misconceptions, the truth is somewhat more complicated than the questions posed by the survey suggest. For example, the question about the healthcare reform bill doesn't distinguish between the bill itself and related bills also necessary for healthcare reform. The nonpartisan Congressional Budget Office was instructed to tally up the costs for H.R. 3590, aka the Patient Protection and Affordable Care Act aka Healthcare Reform. However, for political reasons, various healthcare reform-related bills were separate and not part of the CBO's tally. So it is both correct and incorrect to say that healthcare reform would increase the deficit: the primary bill won't, but various other bills probably will. Actually, it's even more complicated than that, but given the question's wording, I think the study authors were actually correct to label the answer they did as correct. (For a full explanation, see my addendum.)

The video insists that the study is worthless for this and other reasons, but I think the validity of the majority of the questions means the study is still valid. Therefore, I suggest that you read or skim the study (or if you prefer, the generally hyperbolic news coverage of the study) and ponder the question I'm pondering: how do I (as a voter and citizen) avoid misinformation?


I cannot provide links to magical, error-free reporting or a web browser that marks untruths for you in purple underlining (green and red are taken, see). I do want to suggest a real-world alternative, and that is critical thinking. Critical thinking is basically thinking hard about your own beliefs and opinions and considering why you believe X and not, say, Y. I don't know a lot about critical thinking, though, and really anyone can always learn more.

Enter Critical Thinking

Fortunately, I found an excellent resource for critical thinking. It's a video and audio podcast series. You can get them on the author's website or on iTunes (video). The author, Kevin deLaplante, (aka PhilosophyFreak) has identified five key characteristics: Logic, Argumentation, Rhetoric, Background Knowledge, and Beliefs and Views. I am not an expert on Critical Thinking, but I find this to be a helpful way to look at it, especially after going through his videos.

Critical thinking is a fundamental part of fact-checking (i.e. what I do here), but I think it has a more personal aspect. Dr. deLaplante used the phrase "taking responsibility for your own beliefs" to describe this aspect of critical thinking. It is the idea that you understand not only your own position, but the alternatives. This isn't a cursory, "how-can-I-debunk-this" understanding, either. Dr. deLaplante says that critical thinking should let us be able to articulate our opponents' positions to their satisfaction. Thinking critically is about having solid reasons for your beliefs and understanding the alternatives.

This is an ongoing effort, obviously: new information is constantly coming in and we need to filter and make sense of it all. Naturally, a lot of that sense-making and filtering comes from within our existing worldview. Our beliefs, values, and ideas (i.e. our worldview(s)) are like "rules" for processing the information. Critical thinking brings not only incoming information, but also the 'rules' up for evaluation. Some 'rules' are more fundamental than others: ideas about human rights are more central than ideas about a particular politician, for example.

Of course, some of our ideas and beliefs are essentially transcendental: ideas about freedom, God, and our country aren't primarily informed by history, biology, or economics. Such beliefs are tied to our culture, family, and self and may be the product of tradition or personal experience. These may be the most fundamental and important, but are at least partially out of the realm of critical thinking.

A quick aside: a lot of my ideas here are works in progress. As I think, read, and discuss, these ideas may very well change. If you have any links, books, films, articles to recommend, comment! Even more importantly, if you have any of your own ideas, comment!

Bringing it back to the study

Unfortunately, most writing on critical thinking doesn't go too deeply into how it works in a world bombarded by information. Part of the reason I like the podcast above is that it seems to be a practical course. It doesn't cover a lot of the practical side. People, even curious people committed to understanding, can't walk around researching every claim they hear every day. We can infer that sometimes, claims will have to be ignored, but the series doesn't make explicit how to think critically when there's so much to think critically about.

Besides fact-checking, one of my hopes for this blog is to write about fact-checking and how we can implement it in our daily lives without spending all our time either verifying or guessing. This practical issue is why I felt like critical thinking may be an unsatisfactory solution to the problem pointed out by the study. Many of the people in the study do read the newspaper, watch the news, and think about things. They do their homework, in other words.

On the other hand, the study didn't cover exactly what people did beyond watching news. I assume some people went beyond a 30 minute nightly program and conversations with family and friends, but how many? I assume practices like checking multiple sources, reading background information, and evaluating claims based on existing knowledge (rather than accepting them at face value) help, but how much? As I read and write more about critical thinking, I hope to answer the practical question: what tactics are most effective, time- and understanding-wise?

This was accidentally published with the wrong date. I'm actually not positive about the precise date I posted the article originally, but I'm adjusting it to my best guess.