Journalism and the Scientific Method

Three years ago, I reviewed Seth Mnookin’s book The Panic Virus. In that review, I noted the importance of science reporting in assisting the public’s understanding of scientific research and science in general. Keeping this in mind, I want to highlight an article from the Ottawa Citizen by Elizabeth Payne, a Postmedia health reporter. The article addresses the question, “Could infections cause Alzheimer’s?”

In her article, Payne considers the controversy about the link between microbes and Alzheimer’s disease. She reports that those scientists who favour the microbe hypothesis have made a widespread plea that the public “embrace” their hypothesis.

Payne’s reporting is factual and clear. It leaves the reader with the opportunity to consider whether the microbe hypothesis research supporters or the plague hypothesis supporters are more credible. It calls upon us implicitly to consider both theories, but to remain open to the results of the ongoing research on Alzheimer’s disease. To be open to possibility, to be able to assess alternatives as revealed by rigorous study, is the essence of science. Through her reporting, which points out the conundrum of a controversy in scientific research, Ms. Payne makes it clear why the public should not, in fact, “embrace” a hypothesis until the research and much more consideration yield a clear result.

I am a clinician, not a researcher, but I work in a university teaching hospital affiliated with a research institute and so I have participated in clinical studies. When focused on one’s own research study, it is easy for a researcher to become attached to trends that one believes are emerging from one’s research. I have done enough research to realize how dangerous this is. I have learned that one must be faithful to the scientific method that has fostered the real breakthroughs.

The scientific method is systematic and allows for the modification of the hypothesis. Learning the scientific method is one of the first lessons in science class in elementary school. I remember having to devise experiments in Grade 3, not for a science fair project or research but to demonstrate that I understood the scientific method. That same lesson was repeated at the beginning of many grade school science classes for years to come. The scientific method is fundamental but, like all fundamentals, it is more easily expressed than understood. Ms. Payne’s excellent article reported some news from medical science and reminded us of how difficult it is to learn the scientific method.

(Note: The excellent graphic depicting the Scientific Method included here comes from the Science Buddies Website. Science Buddies is an award-winning, not-for-profit organization dedicated to building scientific literacy.)

Loss Leader

IMG_0499flu2 IMG_0498fluThe two pictures attached to this article were provided to my husband when he picked up a prescription this week. They are the Pharmacy’s questionnaire for people wishing to get a flu shot and the “informed consent” that they must sign in order to be inoculated. Now my husband wasn’t there for a flu shot so it is interesting that they just happen to be giving out this paperwork. Do you think this is a public service? I took it as more of a flyer, letting people know who’ve been advised to get the flu shot that they can get it “free” at the pharmacy, a little chore they can get done while they’re getting their prescription or picking up shampoo. In fact, having heard how convenient it is to do this at the pharmacy, many people may actually decide to get their flu shot there. I am pretty cynical about the motivation of pharmacists to provide this service and so I see these documents as “flyers” advertising a “loss leader”.

Contrast this with the experience should the patient happen to have visited their family doctor for the flu shot, which I did. My family doctor asked me many of the questions on the “Flu Vaccine Questionnaire” and outlined some of the new aspects of this year’s vaccine, but he took the fact that I was there seeking this service as my informed consent and certainly didn’t ask me to sign a waiver. I don’t think it’s an error on his part. I believe that this reflects that he provides and coordinates all of my health care. When I signed up for his practice, that was our agreement that he would direct my primary care and I would get my care from him.

I believe that what my family doctor does is very similar to what every family doctor does. The pharmacist is clearly required to complete – or have you complete – a number of documents. Pharmacists don’t keep a detailed medical record such as your family doctor is required to keep that already outlines all of the medical history contained in the questionnaire. Your family doctor will also have details of any past blood work, your most recent physical and likely more medical information about you than you ever dreamed there could be. More importantly, your family doctor will understand what all of this information means to a degree that your pharmacist does not. That is the benefit of a medical education, an understanding of health and disease in all its complexities. That is why whenever a pharmacist (or any allied health professional) wants to begin to perform “simple” medical acts to save the system money and resources, I become suspicious.

A pharmacy is a big business. I do not believe that there are very many, if any, pharmacies left in my community that are not franchised. I felt more comfortable when the pharmacist was the owner and “operator” of a pharmacy. I have no difficulty with businesses working to make a profit – I think they ought to make a profit – but I don’t like false advertising. I don’t think that the main reason pharmacies provide vaccinations is to provide a service. I think the convenience is a “loss leader” for more profitable enterprises. I’d prefer that the focus of the person providing my flu shot was my health care. That’s what patient-centred means to me.

“Balance” or Bias: My Favourite Vaccine Book

The book The Panic Virus by Seth Mnookin inspired my blogging project for the summer, which was vaccines. The author explores why the myth that vaccines cause developmental disorders persists despite extensive research that demonstrates just the opposite. http://sethmnookin.com/the-panic-virus/

Mnookin follows the course of a theory by a now discredited British gastroenterologist, Andrew Wakefield, that the measles-mumps-rubella vaccine causes autism. How Wakefield’s theory found fertile ground in the minds of parents struggling with an autistic child and with their search for answers is well-developed in the book and exposes two problematic aspects of science and science reporting.

In reviewing the meeting of a group of 51 specialists who had reviewed HMO patient records via the Vaccine Safety Datalink at the request of the Centers for Disease Control, Mnookin considered both how science works and the importance of accurate scientific reporting.

Mnookin reminds us that the central distinction between science and ideology is through the theory of “falsifiability”. This theory asserts that, in order for a subject to be a legitimate topic for scientific study, it must have a single, corresponding null hypothesis that can be disproven. This is fundamental to the scientific process in that, since it would be impossible to prove a negative, the closes one can come to proof for any theory is through a thorough effort to prove the null hypothesis.

There is a complexity in the null hypothesis that means that scientific reporters have to understand science sufficiently to be able to communicate this. Also the “debate” on vaccine safety has suffered by the journalist’s ethic to provide “balanced” reporting. This has meant, in some circumstances that the “balance” has been a false. To illustrate this, Mnookin cites a study from Cardiff University in Wales. Towards a Better Map: Science, the Public and the Media by Ian Hargreaves, Justin Lewis and Tammy Spears: http://www.cardiff.ac.uk/jomec/resources/Mapdocfinal_tcm6-5505.pdf This study examined how the media affects the public’s understanding of science, using studies on a link between MMR vaccine and autism. The study found that 70% of media stories related to MMR vaccine mentioned a link with autism in contrast to 11% that reported on the vaccine’s safety record. “Balance” for the overwhelming safety record of the vaccine was provided by the “junk scientists” whose research was poor, if not unethical. The result of this “balanced” reporting was that most people began to believe that the MMR vaccine, and vaccines in general, were not safe.

Mnookin outlines some of the tragedies caused when the safety of vaccines is questioned and the public health benefit they provide is disregarded:

  • In 2009, six unvaccinated children in Pennsylvania were infected with Hib, a disease previously eliminated in the United States. Two of these children died.
  • In October 2010, the California Department of Public Health reported 5500 cases of whooping cough. This was the highest number of cases in California since the pertussis vaccine had been introduced in the 1950’s.

Physicians, as well as the public, are now aware of more and more outbreaks of diseases across North America that are known to be prevented by vaccines. Mnookin accounts for this by the platform journalists have provided to “junk science” in the name of “balance”. He also noted that several states have introduced laws mandating education on “both sides” of previously proven scientific tenets, e.g. evolution or global warming or vaccine safety. This is not education and it’s not “balance” either.

Why does the “balance” of journalism trump the truth? I would say because tragic stories sensationally told sell the news. Mnookin tells the story of how the use of vaccines as an important public health measure have been undermined by the media. His book gave me the tools to further advocate for vaccine use and I recommend to anyone for whom vaccine safety is at all in question.

 

Vaccines and Vaccination: How history can inform science

The anti-vaccine movement fascinates me. The proof that vaccines prevent debilitating and often mortal illnesses is so well-established and so widely accepted by the scientific community that I just cannot understand how people examining this evidence honestly can fail to see its veracity. However, in every decision not to get the flu vaccine personally, in every decision not to have one’s child vaccinated, we see people carefully considering and rejecting a proven measure to prevent serious illness in themselves or a loved one. I have no doubt that it is the publicity that the anti-vaccine movement has received that has influenced these people. Their influence is so powerful that it even affects healthcare providers. In this report, a well-known Canadian infectious disease specialist recommends against mandatory flu shots because the legal challenges against this challenge “may not be winnable”: http://www.theglobeandmail.com/life/health-and-fitness/health/conditions/doctor-stirs-debate-over-mandatory-flu-shots/article10322395/. This article from the United Kingdom last summer outlined that the majority of doctors and nurses “declined” the flu shot the previous winter:  http://www.independent.co.uk/life-style/health-and-families/health-news/health-officials-very-disappointed-that-most-doctors-and-nurses-declined-flu-vaccinations-last-winter-8662483.html

In the first case, it is evident that anti-vaccine ideology has become so mainstream that that the case for mandatory vaccination in a group at high risk for influenza, a serious illness and health workers do know this, is not “winnable” in a legal challenge. Have we all forgotten SARS? Even in Toronto? Toronto, Canada’s largest city, well-equipped, well-resourced, was brought to its knees by SARS. I guess we all assume an influenza epidemic could never be as bad as SARS. The second article is also telling. The article does consider that there may be logistical difficulties to being vaccinated against the flu but both of the hospitals I work in bend over backwards to make it easy to get the vaccination.

As I began my research for the series of blogs I intend to write this summer about vaccines and vaccines, I found this timeline of the history of vaccines from the College of Physicians of Philadelphia: http://www.historyofvaccines.org/content/timelines/all. Each entry has short articles associated with it and, while it naturally focuses on the American and Philadelphian situation, it is a complete detailing of the development of the scientific theories regarding infectious disease and the use of vaccines to prevent disease. The timeline shows us that the benefits of inoculation were understood in China before 1000 CE and, in a letter from the Emperor K’ang to his descendents, we read the following:

“The courage which I summoned up to insist on its practice (inoculation) has saved the lives and health of millions of men. This is an extremely important thing, of which I am very proud.”

We also learn from the timeline that George Washington had the troops of the Continental Army vaccinated against smallpox in 1777. The proof of the efficacy of vaccines is so clear from this history prepared by the doctors of Philadelphia, as is the stark reality of the devastation and personal suffering caused by the diseases they prevented. Today, not only has smallpox been prevented, it has been eradicated – thanks to smallpox vaccination. Vaccination is arguably one of the greatest medical success stories and yet even doctors do not routinely get their flu shot.

Perhaps not enough history is taught in medicine. I hope more doctors than those in Philadelphia will pause to look at timeline developed by the College of Physicians of Philadelphia and take a moment to reflect on the history of vaccines and the diseases they prevent. Otherwise the words of George Santayana may be a medicine’s fate:

“Those who cannot learn from history are doomed to repeat it.”