

by Carl V Phillips


The two positions have basically just one thing in common: Every expert agrees that the anti position is bad for people’s health and based on false pseudo-scientific claims. But, *yawn*. That is also true of ten thousand other views that a lot of people hold strongly. It is a lousy basis for suggesting two political positions are similar. (And, yes, political positions is the right description.)

Every expert agrees that getting the core vaccinations is healthier for someone than not getting them (with the exception of a small minority with particular physiological conditions that contraindicate them), and far better for public health. However, they also agree the risk to the individual from getting vaccinated is definitely not zero. That is where it starts to get interesting, because the typical anti-antivaxx claim suggests it is zero. The position of most of those who are “correct” is not actually scientifically accurate.

Similarly, every expert agrees that low-risk smoke-free products (a large part of THR, though far from all of it) are healthier than smoking. The (real) experts also agree that it it is difficult to imagine that vaping could possibly be 5% as harmful as smoking. Yet approximately every quantified statement of comparative risk made by vaping supporters (whether or not they support THR) — the people who supposedly know the “truth” about comparative risks — uses that absurd 5% number.

What is going on there, and what does this have to do with the analogy being terribly flawed?

The answer to both of those is the role of institutional political authorities. Which particular scientific factoids most people believe is not the product of science, but of politics. There is a big difference between science itself and a belief that a particular scientific conclusion is true. Doing science is one way to get to such a belief, of course. Undoubtedly it is the best way. But it is not the source of most beliefs. For some of us, science itself gets us to a small minority of our specific beliefs about scientific matters. For others, it is not even that much. Most people take their beliefs about all scientific questions from the political authorities. For the rest of us, that is still the source of most such beliefs.

In many arenas this matters little. Usually the beliefs matter little. If you want to form a belief about when humans first settled in the New World, you look to statements by the institutional authorities who have the most prominent voices in the space. If they are wrong, and thus you are wrong, who cares? It turns out to be a good thing this does not matter: Depending on when over the last few decades you sought to learn that — memorizing as your belief whatever the contemporary authorities asserted was definitely the truth — your belief will vary by tens of thousands of years.

But another reason why it usually matters little is because the political authorities in that particular arena are not really all that political. The estimates of when the New World was settled have varied wildly over our lifetimes because of new evidence, not some petty political struggle for ascendence in the Royal Court of Anthropology. Not to say there is no such politics. There are always fights over interpretations of the evidence that invariably generate some petty politics. But mostly it is about the evidence.

The previous example contrasts sharply with health science issues. Beliefs have very practical implications. But also — and to a large extent because of that — beliefs are determined largely by petty politics: bribery, profits, turf wars, fame-seeking, etc. The scientific factoids most people believe are determined not by science, but by royal court politics.

This is where the lazy analogy between anti-THR and anti-vaxx falls apart. All the “legitimate authorities” — the actors who a mainstream person that is completely ignorant of the science would choose to believe — are pro-vaccine. By contrast, most of the “legitimate authorities” are anti-THR. This is why the comparison works as snark: it (inaccurately) accuses the anti-THR people of acting just like the nuts who dismiss all those “legitimate authorities” that they usually defer to. But it fails as analogy for the same reason. Anti-vaxxers are (stupidly, but bravely) defying the political authorities, while anti-THR people are the political authorities and those who defer to them.

Those who read extensively in the bubble of pro-vaping politics might be forgiven for not recognizing this difference, because of a couple of political authorities have come out pro-vaping (though not pro-THR). In the bubble, it might not be obvious that these are a small minority and concentrated in one city, London, which contrary to local opinion has limited influence over the world.

However, this observation also reinforces the main point that this is really about political authority and not science. Within pro-vaping circles, that 5% number is taken as fact, even though every expert knows that it is wrong. Why? Because the first of those royal (in this case, literally) political authorities to come out pro-vaping cited that made-up number, from a laughably bad paper, and other “legitimate authorities” endorsed it. And so even among those whose beliefs oppose most “legitimate authorities”, their most salient pseudo-scientific factoid results from their deference to authority.

As I already noted, political authorities in the health sciences — or rather, the portion of the health sciences that are most often discussed and debated, not the technical arcane corners — are primarily driven by factors other than what the science shows. Do you honestly believe that (a small minority of) political authorities came out pro-vaping because they were just bowled over by the science? If so, can you explain why they did not come out pro-snusing 25 years ago — when the science supporting that was already greater than the science about vaping was when they moved on that topic — and have not done so even now?

No, the royal authority endorsements of vaping were no more about the science than is the condemnation from other authorities. Similarly, their political positions offer no more insight into what the science really says than those on the anti-THR side — recall that 5% number. The political position is just that. The arc of history bends toward health science authorities aligning their opinions with what the science supports, but not so rapidly that you can see it moving if you stare at it.

The most storied example of that slow bend is the resistance to recognition of communicable diseases and their pathways for long (really long! — history lessons compress the timeline) after the science was quite clear. When we tell the story, the heroes are the scientists (whether or not they held that title): Snow, Nightingale, Semmelweis, et al. But the action in real-time was political.

So returning to the motivating analogy, anti-THR people are genuinely analogous to those who resisted the implications of germ-theory — and caused countless premature deaths as a result — until the political authorities came around. Hanging that legitimate analogy on them ought to sting a lot worse than the anti-vaxx comparison, at least for those who were learned the history. But seemingly-ancient history seldom stings because only the most thoughtful people (i.e., not those people) are capable considering an historical story without thinking, “oh, but I would have recognized the truth if I had been an educated person at that time.”

(Aside: It is always kind of amusing to observe how people who defer to authorities for most of their beliefs insist that they would resist authority if they found themselves in such a story. Or, for that matter, when they insist that they do not trust the government …except for 90% of what it says. But that is a far broader topic than today’s.)

So we need a legitimate modern-day analogy that might sting. We have one, and only one as far as I can tell, and we do use it: Most of the governmental authorities in the world support — or at least did until very recently — drug war policies, as well as command-and-control sexual behavior policies. By contrast, most of the “public health” people who lead the anti-THR activism support harm reduction in these areas. The war on tobacco product users is just like any other drug war or anti-harm-reduction position, and the antis should be embarrassed to be reminded of their inconsistencies across this legitimate analogy.

But it turns out it does not really sting them much, and the reason is once again the politics of authority. Institutional “public health” people do not support drug or sexual behavior harm reduction because they are modern-day Florence Nightingales, developing their views from scientific evidence and pushing those views despite that putting them in conflict with the authorities. Obviously not. Those people are mostly intellectual lightweights without an ounce of apparent courage. (Mind you, there are many exceptions to both of those characteristics among those who go into public health, but almost none of them stay within institutional “public health”.)

No, institutional “public health” people support some aspects of harm reduction because their authorities support those, even though other authorities mostly do not. So there is little sting: They support illicit drug harm reduction because their authorities do, and they oppose THR because their authorities do. It would only sting if they were mindful enough to recognize the contradiction rather than rationalizing it away.

For the same reason, other legitimate analogies will sting even less. For example, in a few years I predict that there will be a broad recognition of the existence of chronic Lyme disease — a condition that the “legitimate authorities” still declare to be mythical and ridicule those who believe otherwise. The arc of the evidence is bending in that direction. If that is where the arc ends up, then someday believing anti-chronic-Lyme and believing the anti-THR pseudo-science will look similar. At the moment, however, it is not ridiculous for an expert to believe that chronic Lyme does not exist. Should it become clear that it does exist, such an expert and the many non-experts followers, could legitimately say, “I believed what I believed when the evidence supported that, and when the evidence changed, I changed my mind.” (The authorities will, of course, memory-hole the fact that they said there was zero chance it was true and that they ridiculed those who suggested otherwise.)

There are a lot of cases like this, where having what seems like it is probably the incorrect view right now is not clearly wrong. Of course, the anti-THR pseudo-science is clearly wrong right now, and has been so throughout the adulthood of almost everyone alive today. But the pathway for retreat is just the same, again because of political authorities. “It turns out I was wrong, but I had legitimate reason to believe in the position I endorsed at the time; just look: everyone endorsed that position then.” (Note: None of those people would actually voice the first seven words of that statement. When was the last time you saw one of them actually admit an previous error rather than just changing his position but pretending that he had not done so?)

Consider an analogy to another field I have done work in, the health effects of industrial wind turbines on nearby residents. It has been clear for well over a decade that many people suffer serious health problems as a result of (presumably) the low-frequency noise the turbines emit. (Here is a paper I wrote about it in 2011. If you like my science lessons and you have not read it, check it out.) This conclusion is as clear as the THR-related science, not still uncertain like chronic Lyme. But the “legitimate authorities” mostly unequivocally deny it. Why? This one is mostly about the simplest of political motives, money. But also, wind turbines are (extremely inaccurately) perceived to be “green”, and the “public health” people who might step up on this are too wedded to their identity politics to say something that might offend their enviro-dunce colleagues.

So, yeah, it is a perfect analogy to say that denying the truth about low-risk tobacco products is just like denying the health effects of wind turbines. But that does not sting at all because the same people are happy to defer to roughly the same authorities on both of them. When the money dries up (for each of them) and the political authorities change their positions, no one will suffer any penalty for changing their “assessment” (i.e., their political position) based on the “new” evidence.

As a final example, the one that motivated me down this line of thinking, consider the politics surrounding excitotoxins. The best known are MSG (monosodium glutamate) and aspartame (NutraSweet), though there are other exposures to large doses of free glutamine or aspartic acid (i.e., they are not forming more complex proteins as amino acids normally do, and are way out of proportion to other amino acids) that have similar effects. For a minority of the population (myself and several of my relatives among them), these exposures cause extreme neurological excitement that results in headaches, migraines, local numbness/paralysis, and other symptoms. But unlike the pain from, say, banging your shin, such headaches represent maiming: it is neurons getting so overtaxed that they die.

According to many of the institutional authorities, this does not happen. I knew this was formerly the case, and just checked (due to personal events) to discover it is still the case despite overwhelming evidence. The arc bends very slowly. They get away with this because the majority of the population experiences no symptoms from these exposures at common doses (though I would not rule out that they are experiencing the death of a few neurons, just not enough to notice). This is a particularly good analogy for a lot of anti-THR lies, which also appeal to the anti-scientific reasoning , “here are lots of cases where X did not happen, and therefore X does not happen even when it does happen.” But, once again, there is no sting in that comparison.

To sum up, the superficial takeaway from this analysis is that the “anti-THR = anti-vaxx” comparison is fundamentally flawed because people taking those positions are engaged in diametrically opposite actions, in terms of what matters most: The former are endorsing their institutional authorities while the latter are denying the position of all such authorities. The deeper message here is, of course, that to make any sense of what specific scientific claims most people (including those with scientific credentials) choose to believe, you need to look first to what authorities influence them, not their personal scientific analysis. Yeah, it is fun to ridicule dumb positions as if someone came to them as a result of doing bad science. But that is seldom how they got there.

To go to the galaxy brain level on this, though, I think there is a tactical lesson there about how to pry some people loose from the dumb positions. Recall the observations that most people like to think of themselves as immune to endorsing dumb pseudo-scientific conclusions merely because the contemporary authorities endorse them. Few really are immune, of course. Blindly endorsing the conclusions of their authorities is exactly what they do all the time. They are just deluded: it does not even occur to them that their confidence they are not doing it right now is, ironically, caused by the fact that they are doing it so completely.

But a dose of vaccine is possible.

At the face-to-face personal level, I have had some luck with reminding soccer moms who buy into the lies that they are getting their information from the same government that told them about “weapons of mass destruction” and that trade wars are great. It can work at the public intellectual level also, at least for those whose paychecks do not depend on them endorsing the authority position. In those cases the tactic is no so much to remind them of the reasons to doubt their authorities in general (they won’t), but to poke a big hole in some particular piece of the bad story they have bought into. This can take the form of pretending you believe that they reached a conclusion through scientific reasoning, and then pointing out the flaw in the “reasoning”, to plant a specific doubt about the deference to authorities that actually caused their belief.

Each of these tactics creates a break in the circular reasoning: “I believe what I have heard; I am not being naive tool of some authoritative propagandist; I know I am not because what I believe is correct; I know it is correct because the authorities say… oh, hey, wait.” That opens a window for that epistemic immune reaction — which everyone believes they have, but most really do not — to fight back against false authority. There is certainly no guarantee that what happens next is an epiphany. Few people have the intellectual discipline to hold open the break in their comfortable circular reasoning for long. But there is a moment in which some killer T-cells can be implanted, and maybe they will make some progress.

As an added bonus, this also demonstrates that vaccines work. Now if we can just make sure we are not causing autism when we do it.


6 responses to “Anti-THR, anti-vaxx, disease denial, and the political science of institutional “knowing” of falsehoods

  1. Becky Johnson

    1. I am pro-THR and an ex-vaxxer (not an anti-vaxxer which is intended as an insult)
    2. Experts who do NOT agree are: Exely, Schoenfeld, Geier, Zimmerman, Thompson, Deisher, Mikovitz, and Mawer.
    3. See: Peter Aaby and DTP in Guinea-Bissou and get back to me

    • Carl V Phillips

      Well, we obviously disagree on this. I stand by my position on vaccinations and claims about them.

      But to engage with your comment: First, I do not see how anti-vaxxer is can be perceived as an insult (so long as there is not some dog whistle I don’t know about built into the “vaxx” construction, but you used it, so I assume not). It is simply descriptive. Those in question are not “non-vaxxers” (those who do not do vaccines, as a functional description of their behavior, without reference to why) nor mere “not-terribly-positive-about-vaccines-ers” (who might be close to on the fence, but not so reluctant as to not yield to the strong social pressure). They are people who are adamantly anti enough to fight the power (admirable spirit, unfortunate results in this case). As for the “ex” construction, I don’t see how that can be right: It is another purely functional description like “non” and also covers the vast population who are already done getting the core vaccines and merely don’t get the annual flu shot.

      As for those you cite, I will stick with my view that if they say getting core vaccines causes a net harm, then they are ipso facto not experts. I would be curious if you have a reference or two that are considered “the piece that can convince an expert health scientist of the anti position”. If you do, I might find the time to take a look out of genuine curiosity. Not some vague polemic summary or a one-off research report, but something that tries to make the full substantive evidence-based case. I will tell you that my expectation going in is that the most likely outcomes are SMH and/or writing about it as a lesson about bad scientific reasoning. But as a good scientist I will consider what it says and not just try to fit it into my assumptions.

  2. “Anti-vaxxer” is intended as an equivalent of “anti-science” or, as you yourself compared it to “flat-earthers.” Some of us are slow-vaxxers. Some are selective-vaxxers. People like myself once believed as you do now, but no longer trust that vaccines are safe. We are “ex-vaxxers.” For the record, if vaccines worked as well as claimed, I would use them. They would not have to be mandated.
    “if they say getting core vaccines causes a net harm, then they are ipso facto not experts.”
    Translation: If they don’t agree with me they are not worth listening to. Talk about a hasty generalization!

    • Carl V Phillips

      I tend to be of the mind that if an accurate description is insulting, then maybe you need to rethink your position. When people believe the world should be rid of all tobacco products, regardless of benefits and costs, they are “anti-tobacco extremists” — it is just what the words mean. But they flip out when they are accurately described. I would agree that referring to people using a term that is NOT an accurate can be intended as an insult and be insulting (if you are inclined to pay attention to insults). I certainly agree that doubting the pro-vaccine extremist (see what I did there?) claims is not only not NECESSARILY anti-vaxx. Indeed, it is accurate. Doubting that the net effects of core vaccines are positive (for the average person and for the population), however, is not accurate and such a belief is strongly associated with being anti-vaxx, though it need not necessarily imply it.

  3. Thanks for responding, Carl. Just as junk science is frequently used to vilify vaping or used to promote alarmist claims re: second-hand smoke, so is junk science used to proclaim (all) vaccines are “safe & effective.” Two studies in point are the Thorsen 2002 “Danish Study” and the CDC 2004 DeStephano Study. Both were conducted to proved the MMR vaccine for measles was not linked to autism. Thorsen used a statistical anomaly to “prove” that withdrawing thimerosol from vaccines INCREASED the incidence of autism. He knew outpatient diagnosed cases were going to be bundled with hospital diagnosed patients creating a false increase in cases of autism. DeStephano, after revising the protocol 17x, ended up trash-canning contrary results & published medical fraud. See: CDCwhistleblower, Dr. Bill Thompson.

    While the lack of scientific vigor of these 2 backbone studies only adds to the distrust parents of vaccine-injured children experience, one has to wonder why vaccines are the only product in the United States that has no liability for the damage it may cause.

    If they are so “safe” why do they need protection from liabilty?

    • Carl V Phillips

      I will address only the last point, because it is interesting economic theory. Basically, the US product liability system is part of our regulatory regime. We do not regulate as well as Europe in terms of laws, but a company stands to suffer a huge payout if they screw up something. Thus, the liability system serves — by design (or at least by accident and then “we meant to do that”) — to prevent companies from doing bad things. That is part of why it is so brutally punitive sometimes; that has more effect.

      Now consider something that we want to have happen, but that sometimes goes badly. Stipulate that this describes vaccination. Then we have a problem with the usual system. Because the punishments are so disproportionate sometimes, this would drive manufacturers out of the vaccine space. This would be good if we wanted to get rid of a bad product. But when we want to keep a good product, a fix is needed to our weird system.

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