Everyone, please read this

[mamakay]

http://www.psandman.com/articles/berreth.htm

It's very, very interesting.
What are your thoughts?

[mrsfru]

Very interesting indeed. I'd have to reread it twice just to understand all of it, but I get his jist! LOL

My dad would love it and really get it, b/c he's nuclear engineer....and has a lot of responsibility on his head these days. Going in front of the NRC is no laughing matter and usually leaves him w/a huge headache!

Peter Sandman's take on those of us who mistrust the pro vax info is, for me at least, quite accurate. Why should I believe anything they say when they've screwed up before?

mrsfru

[ema-adama]

They think this dishonesty is saving lives by protecting the credibility of the vaccination campaign. In the short term, they may be right. In the long term, it is costing lives by undermining the credibility of public health itself.

This was in regard to the OPV in Nigeria, not vaccination programmes in general.

I think it highlights the issue very well. The emphasising part of the truth in such a way that risks of the disease are perhaps made more scary than they truly are.

I love his 'formula' risk = hazard + outrage

The problem isn’t that the public doesn’t trust my clients. The problem is that my clients expect the public to trust them. They keep asking to be trusted, instead of working to be accountable so they don’t need to be trusted.

Another bit that I like. The number of times I have been told that just because the CDC, WHO, ped, nurse, etc said it, it must be true. I have repeatedly found that these sources of information are not trustworthy. (not irrelevant, but certainly not to be taken at face value). Most often they are not lying, but telling part of the truth. The part they think is important.

I sincerely believe that more accountability would clear up much anger, confusion and mistrust.

And for now it seems the management of parents who question vaccines is more along the lines of attacking them personally rather than providing accountability for claims being made on mass vaccination safety and efficacy. It's not an approach that will work in the long run. It can't. More and more people want primary sources for their information, not the opinion of someone who has an agenda.

I really enjoyed reading that, and I hope there are public health official who are reading and taking notes.

[Turquesa]

Originally Posted by ema-adama

I sincerely believe that more accountability would clear up much anger, confusion and mistrust.

And for now it seems the management of parents who question vaccines is more along the lines of attacking them personally rather than providing accountability for claims being made on mass vaccination safety and efficacy. It's not an approach that will work in the long run. It can't. More and more people wants primary sources for their information, not the opinion of someone who has an agenda.

Precisely! I couldn't put my finger on the issue as eloquently as Sandman has, but I have noticed that physicians and public health officials often use emotional manipulation as their only weapon---namely, the kissing cousins of Guilt and Fear.

Does the ped who admonishes (or even "fires") parents really believe that he is solving the "problem" of patients who question vaccines? Does the public health official who scolds a parent for an alternative vax schedule really believe that she will attain absolute compliance? They're only digging a deeper and deeper grave for themselves. These tactics only seal the deal for parents who are reluctant to vaccinate. Honestly, I would probably be getting more vaccines for my children if there were a little more transparency and honesty. But the rapid dogmatism and ideological bullying only leave me wondering what they are hiding from the public.

[tanyalynn]

Very interesting article, mamakay.

The problem isn’t that the public doesn’t trust my clients. The problem is that my clients expect the public to trust them. They keep asking to be trusted, instead of working to be accountable so they don’t need to be trusted.

And the problem is that my clients don’t trust the public.

Both halves of this are clearly relevant to vaccination public policy, but the second half seems like a significant obstacle for public health officials to overcome. Maybe it's just the time lag he discusses, and maybe public health officials will change in the coming decades, but I see trusting the public to make wise decisions as the biggest barrier to more honest, less coercive messages and policy.

For all the reasons he discusses, this is a problem, but to my mind, one part is particularly problematic. When you trust someone with a decision, you have to accept that they may make a decision you do not agree with, and you have to be willing to live with that as a potential consequence. That's a huge leap from the current state of affairs, and given what looks like a trend of increasing legal interference into individuals' health practices, I'm not sure this will play out the same way Sandman has seen corporate trends change in the past 20-30 years.

The lesson is just as relevant for anti-vaccination groups, though with a slightly different focus. Being the underdog, the message is often shrilly exaggerated in order to get people to pay any attention at all--and is often dismissed for that very reason. I think Inside Vaccines is a significant step toward a more thoughtful, less emotional and exaggerated presentation of the non-vaccinating standpoint.

Sandman's opinion that environmental and other groups are too interested in "whose side are you on?" questions is also relevant. Selective and delayed vaccinators are in a muddy middle ground, CDC considers them just as subversive as those who don't vaccinate at all, but those who don't vaccinate at all often feel S/D-ers are either falling prey to CDC's fear tactics or are not committed enough to the vaccination issue (in a more emotional sense rather than an individual risk-reward calculation). For people who want laws and public policy that encourage individual responsibility and decision-making (for self or for children), it would be best to cultivate people from both groups.

Interesting read, mamakay, thanks.

[Deborah]

I think the anti-vaccine group and the selective and delayed vaccinators should make common cause. Because both groups are anathema to the public health community and the pediatricians.

[nataliachick7]

this is awesome thanks!

[majormajor]

i enjoyed that mamakay, thanks for posting. i think many of the points he makes are spot on; that you have to earn trust, not just expect it, and that lying to people 'for their own good' is still lying.

what complicates the work people like this guy are trying to do is (IMO) that the media tends to encourage the worst in all parties. shoddy reporting (that might be too generous. downright misinformation half the time!) and sensationalizing bring all of the worst to the public table it seems. calm, rational, and sensible are just not a priority.

[Deborah]

to add on to what majormajor is saying:

I see considerable confusion between news reporting and opinion pieces. The editorial page used to clearly delineated from the news pages, but now the line is not just blurred but sometimes nonexistent. This adds significantly to the "sensationalizing" of the media coverage of controversial issues.

[mamakay]

Originally Posted by majormajor

i enjoyed that mamakay, thanks for posting. i think many of the points he makes are spot on; that you have to earn trust, not just expect it, and that lying to people 'for their own good' is still lying.

He makes some other good points about the downfall of "lying to people for their own good" here:

(this is about healthcare workers and mandatory flu shots, but it pertains to non and selective vaxers, too)

http://www.psandman.com/col/HCWs.htm

The whole thing is so good, I can't figure out what part to quote that will stay within the copyright rules. But the part about "learned mistrust" is incredibly relevant for the parents who have spent time fact checking CDC messaging designed to persuade us to accept a vaccine, and wanting to scream back "But that's not even true! What is UP with you people?"

[claddaghmom]

I think it's a very tactful way to say someone wants to control you, doesn't give a crap about you, but will sweeten it up by saying it's for your own good.

I don't know if I missed his overall point or what, but the entire thing left me

[mamakay]

Originally Posted by TanyaLopez

Sandman's opinion that environmental and other groups are too interested in "whose side are you on?" questions is also relevant. Selective and delayed vaccinators are in a muddy middle ground, CDC considers them just as subversive as those who don't vaccinate at all, but those who don't vaccinate at all often feel S/D-ers are either falling prey to CDC's fear tactics or are not committed enough to the vaccination issue (in a more emotional sense rather than an individual risk-reward calculation). For people who want laws and public policy that encourage individual responsibility and decision-making (for self or for children), it would be best to cultivate people from both groups.

Interesting read, mamakay, thanks.

You know, I'm not entirely sure I need laws that encourage individual decision making; at this point (being a selective vaxer in a state with "religion only exemptions", where you're supposed to sign up for the whole recommended schedule enchilada, or enroll in the control arm), I'd be fine with laws that simply allow for individual decision making.

But yeah, you're right about selective/delay vaxers being left adrift, more or less. I think at some point we'll probably organize and develop a voice of our own. For now, the CDC wants me in jail for not following their schedule, though, so that does not inspire me to want to "strongly oppose" (aka, hurl insults at, etc) the nonvaxers. When the nonvaxers start seriously talking about sending people with guns to my house, I'm sure I'll reconsider. lol. "Oaths of loyalty" received at gunpoint tend to not be terribly sincere.

[mamakay]

Originally Posted by claddaghmom

I think it's a very tactful way to say someone wants to control you, doesn't give a crap about you, but will sweeten it up by saying it's for your own good.

I don't know if I missed his overall point or what, but the entire thing left me

No, the CDC really believes everyone would be better off getting a flu shot every year, and they think (in spite of a lack of compelling evidence) that a high uptake of flu shots among HCW will prevent a significant amount of patient deaths and complications and illnesses.
They just don't think they can convince people of this fundamental truth, with the truth.

[tanyalynn]

Originally Posted by mamakay

He makes some other good points about the downfall of "lying to people for their own good" here:

(this is about healthcare workers and mandatory flu shots, but it pertains to non and selective vaxers, too)

http://www.psandman.com/col/HCWs.htm

The whole thing is so good, I can't figure out what part to quote that will stay within the copyright rules. But the part about "learned mistrust" is incredibly relevant for the parents who have spent time fact checking CDC messaging designed to persuade us to accept a vaccine, and wanting to scream back "But that's not even true! What it UP with you people?"

I have to admit I'm confused about this. He wrote:

Most studies of the impact of HCW flu vaccination on patients were conducted in long-term care facilities, and several have found a benefit. But a statistical analysis of the best studies concluded: “There is no high quality evidence that vaccinating healthcare workers reduces the incidence of influenza or its complications in the elderly in institutions.”

To me, that should be the strongest part of their argument for HCWs to be vaccinated, and he says the data isn't there. Is it really ok, then, to urge it so strongly just for absenteeism? That's not about anyone's well-being, except quite indirectly (which would be to an individual's benefit), it's about money and coordinating temporary staff. Old people in institutional settings are the most at-risk--if the data's not there yet, do we really expect it in other settings?

Originally Posted by mamakay

You know, I'm not entirely sure I need laws that encourage individual decision making; at this point (being a selective vaxer in a state with "religion only exemptions", where you're supposed to sign up for the whole recommended schedule enchilada, or enroll in the control arm, I'd be fine with laws that simply allow for individual decision making.

But yeah, you're right about selective/delay vaxers being left adrift, more or less. I think at some point we'll probably organize and develop a voice of our own. For now, the CDC wants me in jail for not following their schedule, though, so that does not inspire me to want to "strongly oppose" (aka, hurl insults at, etc) the nonvaxers. When the nonvaxers start seriously talking about sending people with guns to my house, I'm sure I'll reconsider. lol. "Oaths of loyalty" received at gunpoint tend to not be terribly sincere.

By "encourage" I meant something along the lines of de-linking vaccination with school or daycare attendance, so parents really do have to make the decision however they make other medical decisions for their kids.

You think S/D vaxers will make an impact separate from those that don't vaccinate at all? I've always figured that the two groups, working together, would push for legislation that fits them both. If I can't have vaccination and school/daycare attendance de-linked, which, I admit, doesn't have a chance in hell of happening in my lifetime, I could be happy with the pick-and-choose philosophical exemption that Texas has becoming standard in most states.

[mamakay]

To me, that should be the strongest part of their argument for HCWs to be vaccinated, and he says the data isn't there. Is it really ok, then, to urge it so strongly just for absenteeism?

I think "they" (Sandman and CDC) believe vaccinating HCWs really does help patients. I think they think eventually the evidence will demonstrate that.

By "encourage" I meant something along the lines of de-linking vaccination with school or daycare attendance, so parents really do have to make the decision however they make other medical decisions for their kids.

I guess I think most parents will always want to just trust their doctors and accept the recommendations. The US is one of the only countries where the shots are mandated. Actually, a lot of the countries without mandates have fewer peole opting out of the recommended vaccines. (of course, those countries also have fewer vaccines recommended, too. And they use "four or 5 in one shot" vaxes, whereas in the US, many docs give all the shots individually to be able to collect the shot administration fee.)

You think S/D vaxers will make an impact separate from those that don't vaccinate at all? I've always figured that the two groups, working together, would push for legislation that fits them both.

It might happen like that. There are so many idealogical subsets (from people who completely disbelieve in the whole theory of immunology, to people who would, say, vaccinate themselves or their kids prophylactically against rabies in the event of a confirmed rabid animal bite, etc) to people who only get a very few shots, to selective/delay vaxers who only skip the HepB birth dose)
...it could pan out many different ways. There's a lot of animosity between the different groups, though. And all groups are (more or less) equally guilty of perpetuating the animosity.
So, I dunno.

[majormajor]

Originally Posted by mamakay

No, the CDC really believes everyone would be better off getting a flu shot every year, and they think (in spite of a lack of compelling evidence) that a high uptake of flu shots among HCW will prevent a significant amount of patient deaths and complications and illnesses.
They just don't think they can convince people of this fundamental truth, with the truth.

i think the problem here goes so far beyond just flu shots though, into just human nature stuff. like sandman said, people are apathetic to small risks to themselves (generally appropriate). so people who don't know much about the mortality profile of flu probably aren't going to feel the need to get a flu shot. people who DO know that it primarily affects elderly in institutions... well, none of us relish the idea of being my aunt, living with severe Alzheimers in a home. in that situation, many of us (me) feel like it'd be a merciful way to end her suffering. so again, the motivation is lacking. in sandman's words, there's no outrage when the very sick elderly die of flu. i hate to sound so callous, but i'm not so sure there ought to be.

so at least as far as flu vaccine is concerned, i think the CDC is fighting a losing battle. until they can convince the population that the robust elderly is being felled by the flu, they're not going to convince people the pain and $$ for the shot is worth it. i think that's why they try to "lie" about the numbers (lie = imply that the risk of death is applicable to everyone equally, when it's not), and it has backfired for them.

*not that i'm entirely against flu vaccination. i've never gotten me or the kids a seasonal flu vaccine, but i'd be open to the idea if it did prove to be helpful.

[Red Pajama]

Any idea where the next day's lecture is that he briefly mentioned? I'd like to read that, too.

[Deborah]

The main reason that S-D vaxers and non-vaxers argue with each other? Because we talk to each other.

Arguing with the fanatically strong pro-vaccine people is sort of boring, frankly, because they actually know so little about vaccines.

And limiting conversation to people who totally agree with you is sort of boring, too.

But a discussion between people who think some vaccines are good and people who think all vaccines are bad is a discussion between people who are actually thinking seriously about vaccines--so it can get interesting.

But we shouldn't sacrifice our interests for the sake of entertaining and irritating (it can get irritating) debates.

The fact of the matter is, when it comes to government interference, we are on the same side. No S-D vaxer wants government mandates enforcing all vaccines. Because they would be just as screwed over as the most dedicated "vaccinate over my dead body" parent.

The most a S-D vaxer is going to do is try to persuade you to get some vaccines for your kid. And all you have to do is say no.

And from the S-D side, even the most severe vaccine critic isn't in a position to deprive you or your children from getting the vaccines you want to get. They don't have that sort of power and they aren't likely to get it.

What do you think the CDC would do if they had the power?

We really need to work together.

[mamakay]

Originally Posted by Red Pajama

Any idea where the next day's lecture is that he briefly mentioned? I'd like to read that, too.

Scroll about a third of the way down here:
http://www.psandman.com/whatsnew.htm
Go to January 2, the ones that say

January 2 New Peter M. Sandman video and audio files

Three Paradigms of Radiological Risk Communication: Alerting, Reassuring, Guiding (Three off-site video files, or on-site audio files)

Presented to the National Public Health Information Coalition, Miami Beach FL, October 21, 2009

[jildez]

i read something like this and i want to print it and give it to my ped. i know she won't read it, but that's my urge.