I’d Like to Play a Game

…But I can’t. I can’t play a game with anti-vaccine people because Game Theory assumes that you’re dealing with rational players. When it comes to the people who peddle in anti-vaccine conspiracy theories, you’re not dealing with rational people. You’re dealing, for the most part, with some incredibly irrational individuals who believe any and all conspiracy theories put forth to them by the people they worship.

They’re kind of like a cult, or a loose federation of cults. They have one or two (or three) high priests in the forms of Andrew Jeremy Wakefield, Robert F. Kennedy, Jr. or Del Bigtree. Those three men could sacrifice a virgin at an altar streaming live on social media, and it’s a safe bet that their anti-vaccine followers would find a way to justify the ritual. “It had to be done to stop the vaccine holocaust,” they would probably say. And the people would swallow it up hook, line and sinker.

Look at how they see vaccine package inserts. Package inserts are legal documents required by regulatory agencies to accompany medications. When it comes to vaccines, the package inserts name the ingredients in the vaccines, how the vaccine works, when it should be administered, to whom it should be administered and what kinds of side-effects (if any) were seen during the clinical trials of the vaccination.

Mind you, anti-vaccine people claim that there have been no clinical trials of any of these vaccines. Then, when you point out that it’s in the package inserts — the very same goddamned inserts they want you to read because they contain the truth — they flip it around and say that the package inserts are full of lies. If your head is spinning, wait for it. There’s more.

A few weeks ago, some dude who is a hardcore anti-vaccine advocate/activist/loon physically assaulted a California State Senator. The dude has a following on social media, and he ran unsuccessfully for the senator’s seat. Anti-vaccine luminaries followed the dude and praised him. Ah, but the minute the dude gets violent, they all turned on him and started the conspiracy theory that the dude was in cahoots with the senator in order to make anti-vaccine people look violent and nutty.

Then, just last week, some woman woke up in the morning, went to the state capitol in Sacramento, sat in the gallery of the senate, reached down into her vagina, pulled out a menstrual cup that had blood in it and threw the damned thing on to the senate floor, striking several of the legislators. As she was detained by police, she stood there and screamed to whomever could listen that she did it for the dead babies that vaccines caused.

Well, that is what happened in reality. In nutty-land, she was not an anti-vaccine activist and no one had ever heard of her. She wasn’t there to protest vaccines, either. She was there to protest abortion. And what she threw at the senators was not blood, it was paint, a cup of fruit or nothing at all, depending on which anti-vaccine lunatic you’re listening to.

Of course, there is the grand delusion that anything bad that happens to a person after getting a vaccine is the direct result of the vaccine. Car accident? The vaccine did it. Blood clot when you’re morbidly obese, a smoker and on birth control, months after a vaccine? The vaccine did it. Stroke when you’re in your 90s, have had high blood pressure all your life and are on anticoagulants? The vaccine did it. Suffocated to death under the weight of your high-as-fuck mother? The vaccine did it. Trump? The vaccine did it. Hillary Clinton? The vaccine did it.

Don’t even get me started on health care people who decided that they are going to be anti-vaccine. When you spend years of your life studying the sciences, and then you decide to deny the evidence and make some money off of lies… That’s psychopathic. That’s someone who cannot be trusted to be licensed to take care of a dog, let alone a human being. (With all due respect to veterinarians who do take care of dogs.) These so-called physicians and nurses who decide to peddle anti-vaccine nonsense should not be licensed to practice anything even remotely related to caring for the health of people.

And that’s why, as much as I want to play games with anti-vaccine people and get them all riled up in order to have them see the error of their ways, I cannot. They’re not rational. They don’t play by the rules of society, let alone reality. They live in either Crosby’s Labyrinth or something eerily similar to it. Up is down. Left is right. What you are seeing is not what your eyes are witnessing but some gummed up version of reality put in front of you by people who control the world and do not allow a shred of truth to get out except through their websites, blogs and social media channels… Channels to which you can subscribe and donate your money since they are not being paid millions. (Not by pharma, anyway.)

So I’ll have to look to another theory that is not Game Theory in order to better understand these nuts and continue to fight them. Because you should not have a shred of doubt that I will fight them until I cannot fight them anymore. And, even then, even when I cannot fight them anymore, someone else will. We’ve been doing it since Jenner, and we’ll do it beyond the age of Offit.

Your move, mother Hubbards. Your move.

A different definition of “fiction”

I was talking to a friend who works in a psych unit the other day, and he asked how I was dealing with the anti-vaxxers and other denialists. I told him that it was a little frustrated at times that there are so many people willing to ignore reality for fiction. He told me about a psychological concept called “fiction”. This is not fiction in the traditional sense. This is fiction in that a person has created a sort of reality around them that is real to them, maybe even tangible, even if all the evidence points to the contrary. You have probably seen examples of this in women who go to deliver a child and had convinced themselves all the time that they were not pregnant, even going on public record and saying that they had no clue (never mind the belly, the lack of a menstrual period, and other indicators of what reality was). You also see it too often in men who cheat on their wives and have convinced themselves that what they are doing is not wrong, or that there will be no consequences.

My thoughts went to the “Weirdo” John Stone of Age of Autism. He is convinced that I am someone else, someone employed by “Big Pharma”, and that I am in cahoots with a whole bunch of other people who are pro-vaccine. I’ve offered to him to become my “friend” on Facebook and get to see pictures of myself and my family, where I am working, and even my telephone number, but he has not agreed. Why? Because he is convinced that I am “despicable”. That, or he doesn’t want the fiction that he has created about me to be torn down. After all, if I turn out to be just a random guy and not who he thinks I am, there is no more boogeyman, no monster under his bed.

The Weirdo is not the only one, of course. There are plenty of leaders and followers in the anti-vaccine camp that have created a fiction around their lives. To many, their children were not autistic until the minutes or hours following their childhood vaccines. Even when they are shown videos of their children exhibiting autistic behaviors before vaccination, their fiction will not allow them to accept this. Their fiction dictates that vaccines and only vaccines cause autism, not their genes, not anything else. (Although some would concede that maybe the environment had something to do with it.)

In many, and very heated, discussions about vaccines (and even about science in general), public health officials and workers (and anyone in any way associated with the pharmaceutical industry) get compared to the Nazi regime which ruled Germany in the 1930’s and 1940’s. To take in and understand why that analogy is flawed, you have to understand what happened during that time in Europe. I won’t bore you with the history class, but I will tell you that public health working to save the lives of children today is nothing at all like what happened under the Nazi regime. We are not arbitrarily picking children and killing them en masse. We are not tying anyone down and performing medical experiments on them. We don’t believe that one ethnic or religious group is to blame for all of society’s ailments.

To be a person of science, and someone who believes in science, we cannot have the luxury of creating fictions around our lives. Sure, we may create mini-fictions to understand why someone like the weirdo or the kid may hate us with such a passion, but we pretty much accept reality for what it is. Personally, I believe the weirdo just has a psychosexual obsession with me, but that’s just me, and I’m no psychologist. That’s a very minor personal fiction compared to what he fantasizes believes about me, maybe. And I’ve told you about his obsession with Dorit Reiss as well. On the contrary, we need to live and accept the evidence and do something about it. Even those among us who believe in a higher power, I’m yet to find a true person of science who falls to their knees and prays instead of taking evidence-based action.

So how do you deal with a person or a group who is/are cocooned in their own fiction? With some, it will be just a matter of breaking down that fiction with facts. With others, there will be absolutely nothing you will be able to do. What they see as reality looks, feels, and even tastes like reality, so there cannot be anything else. In the case of the weirdo, it will not matter how many times I explain to him that I am not who he thinks I am, and that I’m not at all interested in him in the way that he seems to think I am interested in him… Which sends shivers down my spine.

Utilitarianism, Science, and Public Policy

One of the things that you hear over and over again from the anti-science crowd is that public policy should not “sacrifice” the life of one person for the good of the population. In the case of vaccines, many of the people who are convinced that vaccines cause autism will tell you that we should not “sacrifice” a child to autism even if it means preventing a whole lot of death and disability from vaccine-preventable diseases. Mind you, autism does not equal death for a child. But such is the mentality of the fanatic.

I wish that I could live in a fantasy world where there were no sacrifices for the good of the population, where no one in the absolute would have a reaction to a vaccine (no matter how mild). Unfortunately, such a world does not exist. However, there is this thing called science, and it prescribes the tools we can use to minimize the amount of suffering in humanity. With it, we’ve been able to cure diseases that used to kill people by the thousands (maybe millions) in centuries past. Sadly, there are those who have not benefited from the science and may have even been hurt by it. But such is life.

Believing what you want to believe, not what reality dictates

Thank you, Reasonable Hank, for pointing out to me this incredibly creepy thread going on on Facebook. (No login is required to read it.) NVIC, as I’ve told you before here, here, and here, is an anti-vaccine organization that seems to have a weird obsession with Dr. Paul A. Offit. It appears to me that they see no bigger threat on the planet than vaccines, followed closely by Dr. Offit. Of course, we know why they hate vaccines. Dr. Offit’s “crime” was to co-develop a vaccine that has saved hundreds of thousands of lives. And that’s not some weird estimate based on opinion. It’s a fact.

But just go read the comments about the doctor. I won’t repeat the vile ones here. Hank has a good sampling.

One thing that is interesting is the complete disconnect from reality that the anti-vaccine activists seem to display. For example, this woman had this comment when a fellow skeptical blogger pointed out that the rotavirus vaccine has, as a matter of fact, saved countless lives:

I almost commented myself, but a friend and colleague stepped in before I did and pointed out that, yes, rotavirus kills hundreds of thousands of children per year and the vaccine prevents this:

Presented with actual evidence, the hounds were unleashed:

Yeah, we’re the morons.

In addition to his random capitalization and insults, “LS” refuted our friend’s link about cancer rates with a WHO link about overall population health, and then he called someone notoriously wrong on vaccines an”higher eminence.” Then he challenged our friend with this:

I died laughing.

So, does the WHO say something different about cancer than CDC? Remember, in the minds of the anti-vaccine activists, vaccines cause cancer. Yet cancer rates continue to fall. According to CDC:

“Death rates from all cancers combined for men, women, and children continued to decrease in the United States between 2004 and 2008. The findings are from the latest “Annual Report to the Nation on the Status of Cancer,” coauthored by researchers from the Centers for Disease Control and Prevention, the North American Association of Central Cancer Registries, the National Cancer Institute, and the American Cancer Society.”

And…

• “The overall rate of new cancer diagnoses, also known as incidence, among men decreased by an average of 0.6% per year between 2004 and 2008.
• Overall cancer incidence rates among women decreased 0.5% per year from 1998 to 2006; rates remained level from 2006 through 2008.
• Lung cancer death rates among women decreased for the second year in a row. Lung cancer death rates in men have been decreasing since the early 1990s.
• Colorectal cancer incidence rates decreased among men and women from 1999 through 2008.
• Breast cancer incidence rates among women decreased from 1999 through 2004, and remained level from 2004 through 2008.
• Incidence rates of melanoma and pancreas, kidney, thyroid, and liver cancers increased from 1999 through 2008.”

Someone made fun of that 0.6% drop between 2004 and 2008. I wish they could go and laugh in the face of those people who get cancer. Given what they’ve written about Dr. Offit, I wouldn’t put it past them. Now, remember that this is a CDC report on the United States. Here’s what WHO says is going on in the world (my emphasis):

“Infectious diseases will still dominate in developing countries. As the economies of these countries grow, non-communicable diseases will become more prevalent. This will be due largely to the adoption of “western” lifestyles and their accompanying risk factors – smoking, high-fat diet, obesity and lack of exercise. In developed countries, non-communicable diseases will remain dominant. Heart disease and stroke have declined as causes of death in recent decades, while death rates from some cancers have risen.”

But that’s opposed to what CDC said! No, it’s not. WHO is talking worldwide. CDC is talking US only. CDC is talking new diagnoses and death rates by cancer. WHO is talking only death rates, not new diagnoses. Also:

“Cancer will remain one of the leading causes of death worldwide. Only one-third of all cancers can be cured by earlier detection combined with effective treatment. By 2025 the risk of cancer will continue to increase in developing countries, with stable if not declining rates in industrialized countries.”

Well, I’ll be damned. They’re not saying opposite things.

Again, when discussing science with anti-vaccine and anti-science people, you’re not going to convince them to see reality for what it is. More likely than not, they’re going to lash out against you and vilify you like they’ve done with Dr. Offit. They’ll go cherry-pick some study or some article, and they will present it to you as evidence without really knowing what they’re doing. It reads/sounds good, so it’s “evidence.” There’s reality, and then there’s whatever these people want to believe.

One last thing, submitted with no comment:

Life sort of imitates "The Poxes"

In my ever-continuing fictional story, “The Poxes“, a horrible accident bring about the virtual end of the immunization program in most of the United States. The consequences of this are yet to be seen, but you can already see in the story some of the waves emanating from the fears of vaccines. Those waves were amplified in the story’s “Vaccination Day” events.

What if this happened in real life?

In real life, a Congressional hearing on autism was held a couple of weeks ago. Not surprisingly, anti-vaccine organizations and people tried to monopolize the discussion to be all about vaccines causing autism, despite all sorts of evidence to the contrary. The hearing didn’t end with any specific “next steps” to be taken or any kind of legislation to be considered.

Apparently, that didn’t make the anti-vaccine people happy. So they have taken it upon themselves to demand ten things from Congress. (I should warn you, plenty of irrational stuff is about to be covered.) Here are the ten demands:

“1. Pass an Act of Congress banning vaccine mandates nationwide, an Act which
would override any state mandate laws.
2. Immediate ban of all mercury and aluminum in vaccines, including in the
manufacture of vaccines.
3. Immediate recall of all mercury and aluminum-containing vaccines.
4. Immediate retraction of the CDC’s recommendation for the Hep B series for
infants, toddlers, and children.
5. Repeal the 1986 National Childhood Vaccine Injury Act.
6. Immediate investigation of the National Vaccine Injury Compensation Program
7. Criminal charges need to be brought
8. All Members of Congress need to be educated
9. Use the monies in the Vaccine Injury Compensation Program’s fund
10. Bring Paul Thorsen back to the U.S. to face charges for fraud”

They go on to discuss each point. I won’t bore you with their details. You can go read them, if you can stomach it.

Instead, here are my responses to these ten points, and here is another point of view on this list.

1. The authority to require vaccinations for school and other public services belongs solely to the states and not to the Federal Government. Sure, the Feds can ask that you be vaccinated for certain jobs, e.g. military and research, but the Feds cannot force you, compel you, or require of you a vaccination in order to receive a public service administered by the Federal Government. The anti-vaccine person that wrote these demands states: “Vaccine mandates are unconstitutional, violating both the First Amendment and parental rights, they violate international codes of ethics, and they violate fundamental human rights.”

I can tell you with near certainty that this person is not a lawyer, and certainly not a constitutional lawyer. If they were, they would have seen that the US Supreme Court has upheld vaccine requirements (even in light of religious claims) time and again, and again, and again. And, no, parents don’t have the right to refuse vaccines based on religious grounds, either.

2. Never mind that some vaccines never had thimerosal (a mercury-containing preservative) and others don’t have it anymore. Never mind that thimerosal has been ruled out as a cause for autism. And never mind that aluminum has also been found to not be implicated in autism. Never mind all those things. No, look at the amount and concentrations of those metals in the vaccines we receive, and then look at the amounts and concentrations of those metals in the environment and even inside you. The dose makes the poison, my friends. And you will come into contact and absorb far more mercury (organic and inorganic) and aluminum from day zero than you will from vaccines. We all will.

Are these anti-vaccine activists also going to ask that we walk around in bubbles?

3. See number two.

4. Here we go again with the Hepatitis B vaccine for children. If you want to read the rational, evidence-based reasons for recommending that newborns get the Hepatitis B vaccine, go read these recommendations. The vaccine series is safe, effective, and, given to enough people, will eventually wipe out Hepatitis B. That’s right! If we vaccinate enough people, we won’t have to vaccinate anymore.

The fear of the vaccine being given to newborns comes from cases of babies dying as infants. Even when other causes are determined to be at fault for these deaths, anti-vaccine people will point to the vaccines. That’s just what they do. And they’ll go to great lengths to convince us that it was the Hepatitis B vaccine and nothing else.

5. The National Childhood Vaccine Injury Act was actually the brainchild of this lady and her like-minded friends, all known anti-vaccine activists. They claimed that children were being irreparably harmed by vaccines and that vaccine manufacturers needed to pay for these harms. On the other hand, manufacturers claimed that they would have to close their operations if awards to individuals who claimed to have been vaccine-injured were too high and too common. To settle all this, anti-vaccine advocates, pro-vaccine advocates, and legislators settled on the Act. The Act created a court system that was low-cost for the litigants and awarded damages based on an actuarial table, not so much the evidence of the claims. In fact, unlike civil courts, these plaintiffs in these courts only needed 50% plus a feather of evidence of vaccine damage.

Is it a good system? A bad one? Personally, I think we could have a slightly better system, given the data on the decisions rendered so far:

“Since the first Vaccine Injury Compensation claims were made in 1989, 3,101 compensation payments have been made, $2,379,597,663.81 disbursed to petitioners and $93,863,172.49 paid to cover attorney’s fees and other legal costs.
To date, 9,705 claims have been dismissed. Of those, 3,917 claimants were paid $52,339,370.47 to cover attorney’s fees and other legal costs.”

It looks to me like the ones coming out on the winning end of this are the attorneys.

The most likely reason why anti-vaccine types don’t like what their predecessors created is that so many claims have been dismissed because the evidence wasn’t there. It has been my experience that anti-vaccine types don’t like evidence. So they would rather rake vaccine manufacturers through the coals in civil courts, costing much, much more money to both plaintiffs and defendants, bringing the whole thing down.

6. See number five.

7. They expand on number seven thus:

“Criminal charges need to be brought against those who knew that vaccines were causing autism and other childhood disorders and diseases, but who then chose to manipulate data, cover up evidence, lie about it, refuse to investigate it, continue to approve and recommend vaccines, etc. Rationale: Evidence exists that data manipulation, lying, and cover-ups have occurred. Crimes against humanity have been committed. They can not go unpunished. Justice must be served in its most severe form against those who perpetrated these crimes and against those who perpetuated the autism epidemic, not to mention other vaccine injuries.”

Remember what I wrote about evidence up in number five? Well, I looked and looked and looked, and I couldn’t find the author of the list citing any evidence that “exists that data manipulation, lying, and cover-ups have occurred” to deliberately cause autism. If anything, there is plenty of evidence that data manipulation, lying, and cover-ups occurred to blame the MMR vaccine for autism. CITATION HERE.

So, yes, let’s bring some criminal charges.

8. Number eight seems legit, right? Member of Congress should be educated. God, I hope so. But that’s not what the anti-vaccine author of this list means. Here’s what they mean:

“All Members of Congress need to be educated about our nation’s unproven and dangerous vaccine program, not just a small handful of them. Members of Congress also need to bear witness to what vaccine injury looks like to gain a better understanding and appreciation of the holocaust that has been carried out against our nation’s children in the name of “the greater good.””

Again with the Nazi comparisons. Last I heard, the Holocaust was the systematic murder of about 12 million people in an attempt to do away with Jews, Homosexuals, people with disabilities, and other “undesirables”. If vaccines are bringing a “holocaust”, then they’re doing a horrible job at it. More and more people are not getting serious childhood illnesses that would have killed them. Vaccines are preventing people from becoming the “undesirables” that would have been killed in Nazi Germany because vaccines are preventing encephalitis, meningitis, limb amputations, and even intellectual disabilities or birth defects in newborns.

It’s right about here that I began to think that I was living in an alternate reality to the list’s author.

9. See numbers five and six above. They want it both ways.

10. Ah, Paul Thorsen. (I’m breaking the rule about names because this one bears repeating.) He’s Person C in my last post. Basically, he was a co-researcher in some studies that looked into thimerosal and autism, studies that have been replicated and have passed the test of peer review, studies in which he was not the primary researcher or even in charge of analyzing the data. As it turns out, he is accused of embezzling money for those research projects. He is now sitting at home waiting to be deported to the US.

Against what you have been told in the movies, the extradition process is a lengthy one, especially from Europe to the United States. Legal things need to happen. We can’t just go over there and drag him here. Can we? Anyway, anti-vaccine advocates will use him as an example of why that research, which has been tested, reviewed, and replicated, should be thrown out. Yet, somehow, they won’t say the same of that fraudulent MMR “study”.

No, we don’t live in the same reality.

But what if these anti-vaccine people were to find a champion in Congress (beside the retiring Representative who seems to believe in conspiracies and in human heads being much like pumpkins). What if one of them, an anti-vaccine activist, got into a position of power whereby some or all of the demands in the ten-point list were accepted?

It would be tragic, to say the least. And us epidemiologists would be stretched thin.

The Anti-Vaccine Reality Distortion Field

There used to be a time when diseases that are now vaccine-preventable used to be, well, non-preventable because there were no vaccines for them. Because we made it far as a species, it is the sincerely held belief from some anti-vaccine people that we don’t need vaccines. That, or they think that vaccine-preventable diseases are not deadly.

Take, for example, chicken pox (varicella). Before the vaccine was introduced in 1995, about 100 people or so died form it, and over 11,000 were hospitalized per year from chickenpox. In a country of several hundred million, 100 deaths don’t seem like a lot. You probably wouldn’t call chickenpox “deadly” at that rate. But try telling that to those 100 families. See if they agree with you.

Since the introduction of the chickenpox vaccine, the number of deaths per year from it in the United States has dropped to less than 5. Let that sink in for a little bit. Each year, 95 people who would have otherwise died from chickenpox are alive to be productive in society, to hug and love and be with those who love them. Let THAT sink in a little.
Ah, but no! Anti-vaccine advocates will go as far as organize chickenpox parties to expose their children to the virus. Willingly or not, they want to “up” that number from 5 to 10 or 20 or, why the [expletive] not, all the way back to status quo at 100 if we do away with the vaccine altogether. I think they do it because they are not the ones explaining to those 100 families why their loved ones died FROM A PREVENTABLE DISEASE.

That is, IF they believed that chickenpox kills. Perhaps because chickenpox deaths are rare, there are those in the anti-vaccine camp who believe that chickenpox doesn’t kill.

Exhibit A

The person on top was trying to show the person on the bottom that, yes, in fact, chickenpox does kill. It killed before, and it can kill again if we stop vaccinating. The person on the bottom would have none of it. The person on the bottom questioned the mental health of the other person for even suggesting that chickenpox kills. That, ladies and gentlemen, is the degree of denial that people who have swallowed anti-vaccine tropes hook, line, and sinker will go to.

In their version of reality, chickenpox doesn’t kill.

In the rest of the world’s version of reality, chickenpox not only kills. It can leave a child with all sorts of complications. It’s even worse for adults, causing swelling of the brain and other problems. In their version of reality, vaccines didn’t cause the >95% reduction in the number of deaths. In the real world, however, study after study, observational and experimental, has shown that the vaccine is nothing short of a gift from God.

In the real world, we had to explain to this family why chickenpox took their child.