One key difference of philosophy in the HPV vaccine debate is the often stated belief that we must not report certain things about HPV vaccines for fear that anti-vaccine activists will misinterpret or otherwise abuse the information. Examples of this mindset are widespread and epidemic.
I want to be clear what this line of thinking is: thought policing. Sure, I will get denials from the people making these statements, but I’m sorry, this is thought policing. It seeks to control the thoughts of others through withholding information you feel may give them thoughts you feel are harmful. This is of course antithetical to democracy and a free society, and is a central feature of authoritarian systems.I could write a book length exposition on how thought policing like this is inherently bad, but I will instead just note that it is fundamentally opposed to democracy and free society because it deprives people of the information they need to exercise their freedom and their right to choose their leaders. The denial of information is the denial of freedom. It is also fundamentally wrong because it substitutes the judgment of the group keeping the secret for the judgment of those being denied the secret. Of course, the thought goes, we are scientists and we know better than these people. But this is also the thought pattern of every authoritarian system. The Communist Party knows better, the King knows better, etc, etc. The keeper of the information always thinks he knows better than others.
Aside from authoritarian societies, it is also notable that thought policing is a key tactic of the pharmaceutical industry. By conducting poor science and withholding information it does have, the public is deprived of information. The denial of this information controls the thoughts of the public. If the data on SSRIs causing suicides is kept secret, the public will never think these drugs are dangerous and will thus never take any action against them.
The Cochrane Board has practiced thought policing in the wake of their expulsion of Peter Gøtzsche. They have refused to release any information or explain their actions in an attempt to control what Cochrane members thought about the Board’s actions. They even became angry when Gøtzsche exposed their attempts at thought policing by posting the relevant documents on his website.
The Practical Issue with Thought Policing
Everyone who advocates or practices thought policing is always sure their motives are pure. So, I will make a more practical argument about thought policing: it does not work. In fact, it cannot possibly work because it violates fundamental tenets of human nature. People do not like being lied to or having information withheld from them. Because as I mentioned above, information is freedom and withholding information is withholding freedom. If you take away my access to information, you take away my freedom.
But let me back up: when I said thought policing does not work, I fudged a bit – otherwise so many groups would not practice thought policing. The truth is thought policing can work – for a time. And that time represents the amount of time you can keep the thought policing secret. In authoritarian regimes, this amount of time can be long, as governments can use their absolute control over information and also physical force to keep people in the dark. But history occurs on a long time scale and even authoritarian regimes eventually fall.
Pharmaceutical companies practice a lot of thought policing. And over time, that policing is becoming more and more apparent. The result is what happens when thought policing is revealed: loss of trust. Attempts to control information arouse suspicion – for obvious reasons. And this brings me to our present situation, where a seemingly growing anti-vaccination movement threatens public health. One thing that strikes me about those who argue with anti-vaccine activists is the lack of focus and the lack of real attempt to resolve the problem. Possibly because the problem is deeply ingrained and difficult to solve, thus we fall back on simplistic explanations (this tends to happen across politics as well, think poverty in the US). Before I finish with thought policing, I want to take an important and related detour and discuss pseudo-skepticism.
Pseudo-Skeptics: Industry’s Best Friend
This brings me to a common advocate for thought policing: what I call the pseudo-skeptic movement. These are sites like Skeptical Raptor, Science Based Medicine, and a seemingly never ending list of copycat and affiliated sites that tend to link back to each other on many issues. The people who write on these sites, and the people who read them and comment, seem very obsessed with letting the world know how skeptical they are and how smart they are. If you talk to them, scarcely a minute will pass before they throw out an accusation of a logical fallacy, often incorrectly. Without any apparent sense of irony, some of these people have published books on being a skeptic and/or logical fallacies.
Much of what you read on these sites is accurate. It would be hard not to be, given the subjects. Really, how hard is it to prove that water diluted with another substance so small it is undetectable is not a cure for cancer? This is not exactly rocket science these people are criticizing here. This is stuff so basic it makes you wonder how anyone with some understanding of science can believe it. But the biggest issue is that no one is learning anything here. These websites are not changing anyone’s mind. Homeopaths are not going on there and thinking, “Oh wow, I was wrong. Thank you Science Based Medicine.” They do not even try to convert people, since many posts are filled with insults aimed at their targets. No, these sites are just examples of preaching to the choir. And they seem designed to make their proprietors look smart and their readers feel smart along with them. It’s like a self-help site for scientists or those who fancy themselves scientific minded. Kind of pathetic, but I guess harmless.
Except they are not harmless. Because on the difficult issues that require real skepticism, these sites contain bogus information and often attack real skeptics. They show no actual sign of skepticism. And their posts on these issues are absolutely shot through with logical fallacies (even posts on pedestrian topics contain fallacies, but at least the content is accurate). The amount of groupthink going on at these sites is at astronomical levels. And it is truly an example of the unwisdom and generally bad behavior people can display when they know they are a majority. Unsurprisingly, I noticed some of the people cheering the Cochrane meltdown on Twitter are regulars on these sites. And while it is difficult to know whether these people get their authoritarian tendencies and willingness to trash the reputation and career of independent scientists from these sites or they come up with that all on their own, I think this at minimum is good evidence how much these sites harm public discourse.
John Horgan was right when he stood in front of these self-styled skeptics at a conference and told them they are a bunch of posers. (I recently discovered his blog and have found it a great resource of true skepticism. Some gold level quotes in there.) Yes, what the world needs most critically now is someone who will explain to me why Bigfoot is not real…said no one ever. “Thanks for setting the record straight on Bigfoot Mr. Skeptic, but what about SSRIs? Do they work?” “Oh yeah, they work, and Big Pharma is your best friend. That’s straight talk from a real skeptic. And anyone who says otherwise is an unscientific loser.” I feel sorry for readers of these sites because many are probably duped into believing they are reading real skepticism, but unable to recognize the fake nature of the skepticism on display. They then become unwitting participates in the defense of industry against real science. Similar to how many anti-vaccine activists are probably unwittingly spreading their false messages.
SIDE NOTE: Many of these authors wear accusations of being industry shills as a ‘badge of honor’. Perhaps they would be better served by thinking critically about why so many people might get the impression they are on industry payroll. Who am I kidding, critical thinking is for losers! If they are not being paid by industry, then they are doing this for free, and that is an even sadder situation. If you are gonna make yourself look like an ass and shill for the Man, at least get some coin! The only thing I can imagine worse than selling out to be an industry shill is doing it for free.
The Pseudo-Skeptic Gambit
One favorite tactic these sites employ is the invention of new “logical fallacies”. I put it in quotes because while the definitions they give do seem to describe fallacies, they deploy these terms not to point out actual fallacies, but to shut down debate. Ironically enough, their repeated labeling of others’ statement as logical fallacies is itself a logical fallacy. If I wanted to behave like a moron, like they do, I would give this fallacy the name “pseudo-skeptic gambit”.
This brings me to an example in action: their invention and use of the term “Galileo Gambit”. According to the definition, this applies to people who assert they are right just because their arguments upset the mainstream. Except, rarely does anyone actually make this kind of ridiculous argument. Instead, when confronted with Bandwagon Fallacy arguments that the “scientific consensus says X”, people tend to respond by emphasizing the scientific consensus can be wrong, and give examples. The pseudo-skeptics will then claim this “implies” they are right because the consensus disagrees, and thus, boom, Galileo Gambit. But this is wrong. It implies no such thing. It implies they could be right (and they think they are right). The distinction is subtle, but important. Because if that response is by definition implying they have to be right, then they cannot even make an important argument because it is logically fallacious. But in fact, it is not a fallacy to point out crowds/consensus can and have been wrong in the past. So, no such implication exists, but they assert it does because it allows them to deploy the claim of Galileo Gambit to shut down discussion. And in this case, the claim of Galileo Gambit is in fact a disguised example of the Bandwagon Fallacy. The pseudo-skeptics use bandwagon arguments, which are countered by legitimate claims that bandwagons can be wrong. Then they counter by reiterating the bandwagon argument, but disguised as something else. It’s a neat trick – dishonest, but neat. I give it an ‘A’ for creativity and an ‘F’ for logic.
BONUS POINTS: Have fun reading all the ways “Gish Gallop” is deployed to shut down debate and avoid addressing arguments. I have my suspicion many of these terms are used because they think it sounds clever and they have become like secret cult handshakes. I would not be surprised to learn the next innovation on these sites is the use of grunts to dismiss arguments.
Defending Drugs that Cause Autism, While Insulting Parents of Autistic Children
I could give many examples of the lack of skepticism and reflexive defense of industry, and I might do so in a follow up post. But here is one example. This post discusses a study finding that SSRI use during pregnancy increases the risk of autism. The study discussed here, along with other studies, tend to find a relative risk somewhere in the range of 2.0. This study found a RR of 1.87. Is Dr. Novella concerned about this? Apparently not much, as the purpose of this post is to make sure everyone knows this is not a big deal. And to pull this off, he wants you to know the media is misleading people by saying the risk is doubled. What’s more important is that the absolute risk only goes from 1% to 2%. I don’t know about you, but where I come from, the doubling of a catastrophic medical outcome from 1% to 2% is serious. Some rough, back of the envelope math demonstrates the severity. I quickly found a reliable (rough) source that said 500,000 women would struggle with depression during pregnancy in the US in a given year. And that roughly 1/3 of those women would take antidepressants. So, that is 165,000 women. If the normal autism rate is 1%, that means 1650 children will be born with autism from those women (ignoring twins for simplicity). But assuming the lowest rate of 1.87% for those on antidepressants, 3086 children will be born with autism, or 1436 additional children with autism.
This is also why it matters that non-skeptics like Steven Novella believe antidepressants work. As real skeptics know, they do not work, or they harm as many people as they help (if not more). So Novella’s reliance on false science encourages him to excuse massive iatrogenic harm. Even if you believe that current studies are good science, which is preposterous, those studies show a very small effect. For every handful of women who are helped by antidepressants while pregnant, you would harm at least one child. If you asked those women to make that choice, I doubt any of them would choose to risk the harm. But none of them have been given that choice – the vast majority of women know nothing about this risk.
Even worse for Novella is how this intersects with his supposed interest in anti-vaccination campaigns. How many of the parents of these additional autistic children will join anti-vaccine movements? It is surely not zero. And while Novella encourages continued use of the drugs that possibly caused autism in their children, he will be sure to let them know they are the worst person in the world. Excuse my language, but what a gigantic asshole. If Novella actually thought critically about what leads people to become anti-vaccination believers, he might consider that useless drugs that double the rate of autism are a huge problem. (Hint: having an autistic child is a risk factor for becoming anti-vaccination).
The Birth of Anti-Vaccine Ideology
What interests me, but does not seem to interest pseudo-skeptics too much, is why people become anti-vaccine and how this movement got so large. Yes, we all know the story of Andrew Wakefield. But that is the what and maybe the how. I want to know the why. Why did people believe this stuff and why do they believe it now? Why do people believe Jenny McCarthy over vaccine experts? Well, of course, there will always be some people that believe this stuff. But that number naturally seems small, and the anti-vaccine movement is notable because it runs across demographic boundaries. You would expect uneducated people to make up a large portion of anti-vaccine believers. But highly educated upper middle class and upper class people make up an interesting proportion as well.
One answer to this question is quite simple. While anti-vaccine people tend to have varying backstories, they almost universally share a common trait: mistrust of the government science agencies and the drug industry. That mistrust has been earned. So much so that to a large extent, the people who trust them are the crazy ones. Governments and scientists operate on trust. It is their lifeblood. In a free society, it is all they have. If people do not trust government or scientists, then who do they trust? Well, they often wander on the margins until someone they believe they can trust emerges. Someone who checks off a lot of boxes, first and foremost, they must confirm the reasons that person distrusts the usual authorities. “You are being lied to…” is the truthful hook, followed by what may or may not be truthful information, “…and here is the truth.”
More deeply, where does mistrust in scientific authorities come from? It often starts (or intensifies) with harm. People who are harmed (or think they were harmed), whether by medicine or other causes, will often look for explanations for how they were harmed and why. Some of these people will already mistrust authorities, others will become distrustful as they learn more. Some of these people will find anti-vaccine messages attractive. While others will gravitate toward more reliable information. But nearly universally, harm tends to either form mistrust or galvanize already existing mistrust. Because experiences of harm are deeply personal, whatever explanation people find for their harm, they will tend to cling to that explanation very passionately and very strongly, whether it is correct or not. This is one reason why anti-vaccination sentiment is often so strong. And it is a reason why we should have honest and open information available to people when they are harmed. If people cannot trust mainstream authorities, they will look for someone they can trust, to provide them what they think is authoritative information.
What Do We Do With Anti-Vaxx People?
This takes me to an important point: how should we handle anti-vaccine believers? Should we ignore them? Insult them? That seems to be the current strategy of the pseudo-skeptic crowd. I am wondering what they hope to accomplish with this strategy, or do they just follow it because it makes them feel good about themselves? Because this is not just a foolish strategy, it is counter-productive. Insulting people is sure to increase their sense of alienation and righteousness. Ignoring them allows them to talk amongst themselves without exposure to outside information – a process sure to produce strange ideas. And maybe that is okay, because then we can write articles about how bad those ideas are, and we can feel superior all over again.
Or should we engage these people? Should we encourage them to listen to scientists with integrity, people like Peter Gøtzsche? Scientists they might be willing to trust. Instead of doing the wise thing and engaging these people, pseudo-skeptics label anyone willing to engage these people as “anti-vaccine” themselves. “Person X spoke to person Y, and person Y is an anti-vaxxer! Person X is therefore also an anti-vaxxer.” Six degrees of separation is a game, not a scientific method, yet this tactic is widespread on pseudo-skeptic websites.
These games of six degrees of separation and guilt by association are not just wrong, they have a high cost. When those who have lost trust in scientists see other scientists making baseless allegations of being “anti-vaxx” against scientists with integrity, it further entrenches their distrust. “If you don’t trust me now, let’s see how you feel after I baselessly attack this scientist over here whose integrity has never been in question! For the crime of speaking to you.” That seems like a winning strategy…or perhaps not.
So again, should we encourage scientists with integrity to speak to these groups. Or should we ignore them and wait around until a charlatan emerges who will give them bad information in a convincing manner? Or should we acknowledge their mistrust is real and let someone with good intentions speak to them? And do not say speaking to them gives them legitimacy. It does not. Their legitimacy derives in part from refusal to engage them. The more you treat them as outcasts, the more hardened they become in their beliefs, and the more members they gain from newly mistrusting people. The insults and lack of engagement have led us to where we are now. Perhaps most importantly is the total refusal to acknowledge their lack of trust is well founded and seek to repair trust. To the pseudo-skeptic crowd, science and industry can be best friends forever, and we should all be thankful for this benevolent arrangement. One wonders if pseudo-skeptics have an even basic understanding of capitalism or human nature.
The Consequences of Thought Policing
Remember those parents of children born with autism, some of whom would be caused by antidepressant use they were not told about? Well, some number of them will go looking for explanations. And people always need explanations. People need meaning in their lives. They need to know why their child has autism, even if there is no good answer. Should we let these people wander until they discover anti-vaccine ideas? Or should we tell them that antidepressants might have caused their child’s autism. Well, we should tell them, but fair warning, it might be too late. We should tell them before we give them these drugs while they are pregnant. If we do not, and they are denied informed consent, and they have an autistic child, then we tell them the truth – there will certainly be feelings of burned trust. But if we refuse to tell them even then, when they find the truth or alternative, untruthful explanations, it will be a raging inferno of trust burning.
This is the whole problem caused by the current HPV vaccines. There are many parents out there, and their doctors, who believe the vaccine has caused their children harm. And there are indications there are problems with the safety data. Legitimate scientists are looking into this and being called “anti-vaccine” for their efforts. If these harms are real and there was truly no way to know until now, I am sure many of these parents would be upset, but understanding. But the revelations that studies were designed in ways to hide harms and the behavior of shouting down those questioning what is going on is sure to burn trust with these parents, regardless of the scientific outcome.
Pseudo-Skeptics Attack Important Journalism
Circling back to pseudo-skeptics, this is a great place to bring in another example: the reaction on these sites to the Slate article exposing the intentional design flaws in Gardasil clinical trials. Skeptical Raptor posted a piece on this that is a master class in pseudo-skeptic writing. Titled “HPV vaccine clinical trials being attacked by anti-vaccine religion again”, we are already off to a promising start this post is going to be filled with logic. By the third paragraph, we already get a baseless personal attack against the author of the article.
We are told “the author of the original article is simply an amateur about science, clinical trials, and statistics. The author was trying to create doubt about the Gardasil vaccine based on misunderstanding, at best.” This caused me to immediately open Google and do a search, something I am sure Skeptical Raptor’s readers rarely do. The author is a journalist with an MS in biology, an MA in journalism, is a former ghostwriter for pharma, and has authored two published studies. Skeptical Raptor might want to actually do some checking before making baseless smears. Who am I kidding! His readers do not check anything! Let the smears fly my raptor friend!
Let’s take Skeptical Raptor’s claims in order (he makes three). First, I will note the driving force behind the entire article seems to be: thought policing. Skeptical Raptor first uses a lot of space telling us about HPV and how bad it is. This is useful information in some context, though completely useless at telling us whether Slate’s article is accurate. In fact, this information is placed here to encourage thought policing. It is an emotional argument that HPV is so bad, to even ask the questions Slate is asking is not acceptable. Special award in emotional argumentation goes to the line telling men HPV can result in amputation of the penis. Thank you for that. But what about the clinical trial design?
The first claim is that the author bases his article on a “misunderstanding”. And also apparently that Skeptical Raptor can read minds and “[t]he author was trying to create doubt about the Gardasil vaccine”. I will let others judge the mind reading claim about the author – hey, maybe Skeptical Raptor has a post about whether mind reading is real? But let’s see what is the big misunderstanding. Well, the first evidence is…a big discussion on whether the reports of POTS and other autoimmune disorders are real. What does that have to do with the article’s main claim? Nothing, really. How did we get sidetracked here? Well, Skeptical Raptor says that he thinks the author “bases his claim on a review, that was initiated at the request of Denmark”. Except that is false. The author’s claim is not based on that review at all. His interest might have been motivated or piqued by that review (although again, seems to require mind reading), but it has nothing to do with his claim, which is sourced from the internal EMA document the author obtained from the EMA. It seems to me Skeptical Raptor does not want to discuss the EMA document, and instead wants to discuss something less solid. What you see here is that the reports about POTS and CRPS are more uncertain and there is much debate about them. So Skeptical Raptor is shifting the debate to one over those claims instead of the claims made in the article. By the end of it, he hopes you will have forgotten the original claim he is supposed to be debunking. Sure enough, the original claim does not seem to resurface, or at least what does resurface has nothing to do with the actual point of the Slate article.
On to the second claim: that we have lots of post marketing data, and therefore, why should anyone care about the actual clinical trials that got the vaccines approved? First, note this is again a thought policing argument. Nothing to see here, move along! But even better, he contradicts his own writing elsewhere in the post. In the course of criticizing reports of POTS and CRPS with HPV vaccines, he hauls out his “hierarchy of evidence” chart. Super simplistic, bordering on misleading, he notes that claims of POTS and CRPS are based on studies fairly low on this chart. But what happened to his chart when he poo poos randomized clinical trials in favor of inferior post-marketing studies? Like the adverse effects themselves, it is just gone.
His third and final claim is “the author relies on anecdotal evidence, which has zero value in scientific understanding. This is a serious issue that should have cause Slate to back off from the article.” This kind of argument makes me wonder if Skeptical Raptor figuratively knows how to tie his own shoes when it comes to science. The author of course did not rely on “anecdotal evidence” to make his arguments. He relied on actual stories to demonstrate that 1) those people experienced potential side effects, 2) those side effects were serious and similar to POTS/CRPS, 3) they were not part of data recorded as side effects and tabulated for regulators, and 4) they were not included due to the flawed design the regulators originally challenged. Thus, this data is not anecdotal. It is not being used to make a claim about the amount of harm caused by the vaccine. It is only used to demonstrate how the trial design excluded potential harms from reported data. And for this purpose, it is not anecdotal, but 100% proof the claim is true. These claims are facts, not anecdotes. They are not used in a way that would make them anecdotes. And this point is either lost on Skeptical Raptor or he does not care to be honest about the way these cases were used.
EDIT: Pseudo-skeptics on Twitter are using my use of the word “stories” to claim they are in fact anecdotes. So, I will clarify even further. The stories are not anecdotes because they are not used to prove the author’s claim. The author’s claim is proven by the documents. The documents show the trial design was flawed, regulators objected, and then meekly relented. Case closed. The stories are there to make people care. It is one thing to report a bunch of dry words about flawed study design. But the stories demonstrate the effect of that flawed design in action. They demonstrate that claims the trials do not show POTS/CRPS are flawed because here are these people who suffer from similar symptoms, and due to that study design, their symptoms are not in the data. We know from the documents that people with these harms are possibly excluded from the harm data and here are some examples of people whose harms are actually excluded. That is not anecdotal.
So, to conclude, Skeptical Raptor makes three arguments, if you can call them that. And all of them are appropriately called bullshit. Bullshit thought policing arguments reflective of massive bias on the part of the author.
I could continue on in this same vein. One point I want to make is that I believe the evidence shows that in the same manner charlatans emerged to lead people with mistrust of pharma and government in the anti-vaccine movements, fake skeptics emerged to lead those who claim to adhere to science. Pseudo-skepticism has become a church just like anti-vaccination. And just like most churches, the High Priests do not always follow the stated rules, and the members do not often seem to notice.
BREAKING UPDATE: The top post on Skeptical Raptor right now is his dismissive look at a study on behavior changes observed in sheep given injections with aluminum adjuvants. Without commenting on the study itself, his opening paragraphs indicate the analysis that follows is little more than a four year old sticking his fingers in his ears and yelling “Nah nah nah nah nah, I can’t hear you.” This is not how skeptics or scientists behave.
ANOTHER UPDATE: Just read the critique. Unimpressive, but also unsurprising.
I will conclude by saying that pseudo-skeptics and others who are currently cheering the Cochrane disaster often peddle arguments in favor of thought policing. Such arguments are authoritarian in nature, antithetical to freedom and democracy, and counter-productive because they produce resistance and loss of trust – the very driving forces behind anti-vaccination and other anti-science movements. Withholding information, rather than helping, adds fuel to the fire. We should resist calls to “watch what we say” and “be careful with our arguments” because it is thought policing nonsense that only further sows distrust of science.