Once you have read the plot, you will understand what I am going to deal with in this post. The key to understanding how House reached a diagnosis of SSPE in the adopted kid was in a funny encounter he had in the clinic. A yummy mummy had brought in her kid who she was not vaccinating as she believed that it was a form of conspiracy by the big pharma to pad their bottomline. House then produced a scare tactic that drove the mom to tears and must have turned her around. Pity we can’t let House loose on the Age of Autism folks.

Anyways, so this yummy mummy was suffering from Vaccine Denialism. Now denialism is an interesting concept. First popularized by the Hoofnagle brothers on their awesome blog, this is classically defined as “the refusal to accept an empirically verifiable reality. It is an essentially irrational action that withholds validation of a historical experience or event”. (1) It is believed that this concept originated with the Holocaust denialism, where people believed that the holocaust was just a myth built up through historical distortion. There have been several other forms of denialism since then, the most notable amongst them being:

AIDS Denialism: Led by Peter Duesberg, this school of thought contends that the HIV is not the cause of AIDS. Now I can write a whole blog on this ridiculously “vocal anti-science movement” (2), but that has to wait for another day.

Vaccine Denialism: Like the yummy mummy in this episode of House, or like pseudoscientists out to make a profit, like Wakefield, this is the branch of anti-science that believes that vaccines are not just a method for big pharma to pad their bottomlines, but also, it is actually a conspiracy to actually sow diseases in the masses. (3)

Climate Change Denialism: is the branch of anti-science that labors under the delusion that “the evidence that the world is warming is inconclusive, and if not, the evidence that the global warming is being caused by anthropogenic carbon emissions is unproven.” (4)

Smoking Denialism: had two schools. One, which believed that smoking did not cause lung cancer (and was adequately rewarded by the tobacco industry for spreading that belief) has closed shop quite some time ago. The other claims that “second hand smoke is just an irritant and there is no conclusive evidence that it is dangerous.” (5)

In their brilliant Christmas BMJ feature, Martin and Pascal (6) outline the defining characteristics of denialism:

The significance of cognitive selectivity in mediating denialism cannot be over stressed. Selectivity is the process whereby there is only acquisition of new cognition which is synchronous to the existing cognition while there is avoidance of new cognition that is asynchronous to the existing ones. As students of science, we need to guard against this kind of “confirmation bias” from clouding our judgment.

At this juncture, it becomes essential to clarify the differences between skepticism and denialism. Although on a cursory glance, they seem to be a similar philosophy, actually, they could not be more different:

• Unlike denialists, skeptics are ready to change their minds and take a new stance when confronted with new evidence that stands the test of scientific scrutiny.
• Skeptics try to avoid the selectivity bias by analyzing all possible evidence available in order to visualize a problem from various angles.
• Skeptics welcome new research to uncover new evidence, even if that is in contrast to their views. Denialists, on the other hand, prefer to stick to their guns, no matter what.
• Skeptics use proven scientific methods to support their arguments while denialists resort to rhetorical arguments and even, semantics to hold aloft their stance.

When it comes to the vaccine denialism, the classical non-argument that they out forward is that one can never be sure. Whilst adverse effects of immunization are rare to the point of non-existant, the denialists have used only one side of the numbers to stake their claims. And the fall outs of such scientific perjury is severe, and most often, a population which had nothing whatsoever to gain or lose from this conflict, is the one to lose out.

A typical example is the situation that broke out after the MMR vaccine scare that Wakefield’s now retracted paper propagated. Since the inception of the controversy, vaccination compliance dropped sharply. In the UK, it went down from 92% in 1996 to 84% in 2002, with parts of London having coverage as poor as 61% in 2003. (7) What followed, was the public health version of a nightmare. Measles cases in the UK went up from 56 in 1998 to 449 in the first 5 months of 2006, including the first death since 1992. (8) With 5000 notifications of Mumps cases in January of 2005 alone, UK was in the throes of a mumps epidemic. (9) Drop in vaccination rates, with loss of herd immunity led to these phenomenal numbers, which culminated with the announcement that in 2008 UK was endemic for Measles in the last 14 years.

The Wakefield paper, coupled to the ubiquitous internet and an attention seeking media, made the anti-vaccination frenzy even worse. How ironic is the fact that whilst the world was toasting Luc Montaigne and Francoise  Barre-Sinoussi for the Nobel prize for discovering that HIV causes AIDS, Thabo Mbeki and his Minister of Health Manto Tshabalala-Msimang, were advising concoctions of garlic, beetroot and African potatoes for HIV infected South Africans.

Defining and identifying denialism forms a major part in fighting it. (10) While the world wide web has opened the floodgates of knowledge, it has also provided a platform for the pseudoscientific community to gain a voice. If one searches for long enough, websites promoting the Flat Earth Theory (yes, they exist even today), Geocentricity and creationist theories abound.

When push comes to shove, one has to remember the simple philosophy of Richard Feynman to be reminded of how to stick to the long and narrow road of scientific skepticism: (11)

“To every man is given the key to the gates of heaven; the same key opens the gates of hell.”

What, then, is the value of the key to heaven? It is true that if we lack clear instructions that determine which is the gate to heaven and which the gate to hell, the key may be a dangerous object to use, but it obviously has value. How can we enter heaven without it?

The instructions, also, would be of no value without the key. So it is evident that, in spite of the fact that science could produce enormous horror in the world, it is of value because it can produce something.

 

References:

1. Paul O’Shea, A Cross Too Heavy: Eugenio Pacelli, Politics and the Jews of Europe 1917-1943, Rosenberg Publishing, 2008. ISBN 187705. p.20.

2. Kalichman SC, Eaton L, Cherry C . “”There is no proof that HIV causes AIDS”: AIDS denialism beliefs among people living with HIV/AIDS”. J Behav Med June 2010; 33 (6): 432–40. doi:10.1007/s10865-010-9275-7. PMID 20571892.

3. Lewis, J., & Speers, T.  Science and Society: Misleading media reporting? The MMR story. Nature Reviews Immunology, 2003; 3(11), 913-918. DOI: 10.1038/nri1228   

4. Feygina I, Jost JT, Goldsmith RE. System justification, the denial of global warming, and the possibility of “system-sanctioned change.” Pers Soc Psychol Bull 2010;36:326-38.

5. Diethelm PA, Rielle J-C, McKee M. The whole truth and nothing but the truth? The research that Philip Morris did not want you to see. Lancet 2005;366:86-92.

6.  McKee, M., & Diethelm, P. (2010). How the growth of denialism undermines public health BMJ, 341 (dec14 1) DOI: 10.1136/bmj.c6950

7. Murch S (2003). “Separating inflammation from speculation in autism”. Lancet 362 (9394): 1498–9. doi:10.1016/S0140-6736(03)14699-5. PMID 14602448.

8. Asaria P, MacMahon E (2006). “Measles in the United Kingdom: can we eradicate it by 2010?”. BMJ 333 (7574): 890–5. doi:10.1136/bmj.38989.445845.7C. PMC 1626346. PMID 17068034.

9. Gupta RK, Best J, MacMahon E (2005). “Mumps and the UK epidemic 2005”. BMJ 330 (7500): 1132–5. doi:10.1136/bmj.330.7500.1132. PMC 557899. PMID 15891229.

10. Diethelm P, McKee M. Denialism: what is it and how should scientists respond? Eur J Publ Health2009;19:2-4.

11. Richard P. Feynman, Jeffrey Robbins. The value of science. In The pleasure of finding things out: The best short works of Richard Feynman. Perseus Books, 2000. pp 141-149.