[Editor's note: Tara Haelle is a freelance science writer whose specialties include medicine, vaccines and public health. Her work has appeared in Scientific American and Slate. She blogs at Red Wine & Apple Sauce and is working on a book about science-based parenting with Emily Willingham, who is mentioned below.]
The alarm bells started ringing on Tuesday, the day before a segment about the HPV vaccine was to appear on the Katie Couric Show.
The science writer Seth Mnookin, the author of The Panic Virus, blogged that Couric’s producers had contacted him about appearing on the show. Although he was not invited to appear, he wrote that he felt "heartened" after that conversation that the producers would present a fair view of the vaccine–that they would not create controversy where none exists.
The human papillomavirus vaccine is recognized by the medical establishment as a safe and effective way to prevent human papillomavirus, the sexually transmitted virus responsible for most cervical cancers and a substantial number of throat/neck, penile and anal cancers. The evidence base clearly establishes that vaccines’ benefits outweigh their risks, and that the HPV vaccine has not been causatively linked to any adverse events beyond “fainting, dizziness, nausea, headache, fever, hives and localized pain, redness and swelling at the sight of the injection,” according to the CDC.
But the teaser for Wednesday’s show revealed the producer’s assurances to be, Mnookin wrote, “a load of crap.” The teaser (you can see it at Slate) made it clear the show would, in fact, be looking at the “two sides” of what it billed as “The HPV Controversy.” A teaser asked if the vaccine was “dangerous” for some girls and featured a mother who claimed the HPV vaccine killed her daughter. Couric tweeted Tuesday that she was “hoping to tell both sides so parents can make informed decision.”
When it comes to certain issues–such as the risk-benefit analysis of vaccination and the existence of climate change–there are not actually two sides to the issue. There is only the scientific evidence and the consensus about what it means. The "other side" consists of the denialists who simply refuse to accept the science–or to accept the consensus that there is no evidence of serious side effects.
To present “both sides” is to commit the sin of false balance, or false equivalence. Emily Willingham defined that in Forbes as “giving equal weight to arguments that don’t carry equal weight of evidence.” (The Tracker previously covered an excellent CJR piece by Curtis Brainard about the media’s irresponsible reporting with false balance on vaccines.)
Despite the alarm bells, I held out hope that just maybe Katie Couric-the-well-respected-journalist would ensure the facts about the HPV vaccine were emphasized over the fear-mongering about side effects. But the show was far worse than I anticipated. As Karen Ernst blogged at Moms Who Vax, it was “a bad day for vaccines in the media.” Time Magazine’s Alexandra Sifferlin harshly asked if Katie Couric was the new Jenny McCarthy.
Consider guests: A mother whose daughter died just over two weeks after receiving the vaccine. Another mom with her daughter who experienced a range of frightening symptoms after receiving the vaccine. And to represent the scientific consensus, Dr. Mallika Marshall, a pediatrician who had all of five minutes toward the end of the segment to defend the vaccine.
Surely, I thought, Couric will ask for evidence supporting the mother's claim that her daughter had died after receiving the vaccine, right? Wrong. After the guest tearfully described the last time she saw her daughter alive, Couric offered sympathy and accepted the mother's assertion that she could not discuss any evidence because of a pending lawsuit against the FDA.
Couric also featured Dr. Diane Harper, who has been criticized for raising questions not about side effects, but about the vaccine's effectiveness, and who has argued for the superiority of Pap smears over the HPV vaccine. Harper’s tone and redirection of Couric’s questions only underscored the fear-mongering occurring onstage (and added inaccurate information, such as misstatements about the vaccine’s long-term efficacy).
Not once did Couric ask for proof of any of the anti-vaccine claims made on the program. And when she asked Harper whether the vaccine’s benefits outweighed its risks, Harper side-stepped the question, instead bizarrely cheerleading for Pap smears and new diagnostic tests which can detect but not prevent HPV, as Tara C. Smith writes on her Aetiology blog. Harper even legitimized the mothers’ unsubstantiated claims by saying “as we’ve heard, there are some harms associated with [the vaccine].”
Amanda Marcotte does an excellent job of deconstructing Harper’s misleading circumlocutions, and, also at the Moms Who Vax blog, University of California law professor Dorit Reiss presents a helpful list of facts and links about the vaccine while aptly describing the hazards of wading into the comment threads on the episode’s webpage.
At Forbes, Willingham juxtaposes Couric’s coverage of this issue with Couric's past reporting on colonoscopies. Willingham speculates that “the tenor of Couric’s segment would have been very, very different” if it were about a vaccine that prevents colon cancer, which killed Couric’s husband. Matthew Herper, also at Forbes, describes the four ways Couric stacked the deck against the vaccine: downplaying its effectiveness, overselling Pap smears’ utility, underplaying the cancer risk and “pulling viewers’ heartstrings.”
It’s that last one that may be most damaging. We know that the emotional resonance of anecdotes trumps rationality when it comes to risk, especially with vaccines. The show apparently told Hiltzik at the LA Times that they “hope that people can make their own decisions” — but that ability is seriously hampered when the scientific evidence is presented as just a coda to the heartbreaking stories of sick or dead teenaged girls. The video clips on the website are titled “Was the HPV Vaccine Responsible for One Girl’s Death?” and “Is the HPV Vaccine Safe?” As Hiltzik observes, “Merely to ask the questions is to validate them…injecting doubt and emotionalism into important medical discussions and removing science from the arena is playing with fire.”
Yet Couric appeared oblivious to the damage she wrought. Toward the segment’s end, just before giving Harper time to explain that patients “should be comfortable saying no” to the vaccine, Couric framed a question with unwitting irony: “We’ve obviously heard two different sides about the HPV vaccine, and I think for parents watching, it’s probably still rather confusing when you hear these heartbreaking stories that these families have endured.”
Yes, Katie, it is still rather confusing, especially when you are the influential news personality showcasing these “heartbreaking” but irrelevant stories- while abdicating your duty as a journalist to explain and clear up the confusion. And it's you duty to do that without making the mistake of creating false balance.
-Tara Haelle
False balance is a huge problem worldwide. It was a significant factor in the (untrue, and still untrue) allegations by now struck off former dr wakefield about the (non-existent, made up) link between vaccines and autism.
Pulling heartstrings is even more of a problem (and was / is a major factor in the anti-vaccine movement’s rhetoric). Imagine if you will that a million children get their regular childhood vaccines. By sheer chance, a few will have some sort of (unrelated) medical problem that happens to (coincidentally) manifest itself soon after the vaccine (perhaps their child is diagnosed with autism). It’s WAY easy for a parent to conclude the problem was caused by the vaccine, especially if some celebrity (or even worse, a well known journalist like Couric) is telling them this is the case. A single scapegoat, an easy answer, and a black and white dichotomy is exactly what the parent is looking for, while an answer of “it’s a coincidence” or “it’s a bit more complicated than that” will usually be wholly ignored, regardless of the strength or quantity of evidence (which they frequently can’t even comprehend anyway, because of their scientific illiteracy).
But correlation does not equal causation, a fact that is lost on the vast majority of people. I say this because the vast majority of people are scientifically illiterate. Not just under-educated on science, but completely illiterate in even the most basic of scientific principles (like the nature of evidence, peer review, principles of biology, physics, and other sciences, and basic statistics). This is of course exacerbated by the general dis-interest in science and math by the public school system, and by politicians such as Marco Rubio (with the global warming denialism idiocy). The fact that Rubio can say so many things that are demonstrably untrue (yet not worry about obvious lies ruining his chances for re-election or getting him kicked out of office) speaks even louder about the public’s general disinterest in what’s actually true, preferring instead to bolster whatever narrative they fancy instead.
News outlets like fox news exacerbate the false balance problem when they bring some quack blogger on as the “balance” for an important story. Couric’s choice of guests is a perfect example (but there are many, many more examples in all facets of the media.
Certain media agencies are taking baby steps to try and change this (BBC had some sort of training for its reporters on how to avoid false balance, sorry don’t have the link but should be easy enough to find). However, they are mostly the exception, not the rule.
What is the solution? More science education, for one thing. Most adults are beyond hope for seriously improving a drastically lacking sense of critical thinking or science, so this should focus on the younger people. Critical thinking needs to be taught in schools (primary and colleges), and having a bunch of scientifically illiterate children should not be acceptable.
Another solution is to accept that some people are just going to have to get their feelings hurt in order for reality and truth to win the day. The AVN is a dangerous, malicious entity, which directly causes disease and death. So even if some of its members are completely sincere in their beliefs, they are still wrong, and “sincere beliefs” do not trump public health and safety. You don’t have the right to endanger other people’s kids, period, no matter what you believe. Tolerance of anti-vaxxers (and the obvious damage they cause), as well as treating their beliefs as equally valid “sides” of an argument needs to end, even if some people don’t like it.
Tolerating lies and distortions of reality also needs to end. When a politician can say all kinds of obvious lies all the time and have no problem getting votes, that’s a problem. People will cry out “freedom of speech” but should demonstrably untrue “free speech” that directly harms other people really be protected? People act like they have the right to believe what they want to believe **and that they have the right to have their views expressed publicly with equal weight to all other views**. Well, you can believe what you want to believe, but you DON’T have the right to force society into giving your demonstrably untrue beliefs any kind of forum or credence.
Another thing that would really, really help would be to promote the idea that it’s OK to update your beliefs in the light of new and better evidence. It should be a badge of honor, not the threat that it’s usually seen as, to update your beliefs to reflect the latest information available. At one time it was commonly accepted that the earth was flat, and the sun, stars, and planets revolved around the earth. Nowadays only the most deluded cling to this notion, with just about everybody knowing that the earth is in fact spherical (well, almost), and the sun is the center of our solar system, etc etc. The old beliefs were discarded to reflect the new and better evidence (albeit quite grudgingly, but that’s another story). It really is ok to fix it if you’re wrong about something. Really it’s quite stupid to refuse to change your beliefs because the evidence contradicts them, yet this is a hugely common aspect of people. Maybe they’d be better at updating their beliefs if their critical thinking skills improved.
Why are anti-vaxxers not included in discussions of vaccines that might occur in a college research or medical setting? Because they generally don’t have the qualifications to participate. More specifically, the vast majority of anti-vaxxers don’t even have the very first of a long list of prerequisite courses and/or training needed to intelligently participate in such a discussion. Not to mention they’re flogging a theory that’s clearly false and has been exhaustively debunked.
Tolerance of lies, intentional (or even sincerely deluded) mis-information, false balance, scientific illiteracy, and shoddy / irresponsible reporting needs to end. And if a few people get butt-hurt over it, that’s not a problem. The problem is their insistence on clinging to their beliefs at all costs, and failure to update in the light of new and better evidence. The fact that the evidence contradicts their beliefs is NOT a problem (even if they try to make it one).
And yes, I’m all for getting very tough on the antivaxxers. Remove all waivers except for medical waivers by a licensed medical doctor (not a priest, not a quack “nutritionist” or homeopath, a real doctor that’s gone to medical school and passed all the tough exams and has taken all the hard classes, etc etc). For that matter, remove all the religious waivers too (your religion doesn’t trump public safety, nor does it justify ignoring clearly established science). No vaccines, no school, period. No working at a public place either. IMO no amount of polite debate will ever work, so it’s necessary to just do what has to be done, even if a few people get seriously butt-hurt over it.