An increase in measles cases in western countries is not recent news: a localized spread of measles has been already reported in the USA and in the UK in the last year. Yesterday though, a similar event received an unprecedent coverage by different kind of sources and, among them, also tech-related websites (Daring Fireball, Gizmodo…); I was surprised to see that these websites thought this was relevant news even if it isn’t strictly their main topic.

The fact is that, this time, the location is NYC. As long as things like this happen among rural and isolated communities or distant countries we are allowed to think that it’s kind of a “local” issue. NYC is instead a high density population area, a crossroad to loads of visitors, tourists, travellers, a city so important both in reality and in our imaginarium that what happens there hits us as it was a global problem. Well, as a matter of fact it is.

The first reaction of online press was to raise a warning about the dangers of measles, the consequences of lack of vaccination both on single people and communities, the lack of evidence in the now common belief that vaccines are dangerous. It’s kind of an “anti-anti-vaccine” campaign and I expect shortly a response in communities supporting the opposite faction to strongly reassess their point. Unfortunately, we will be less aware of this reaction, as many of us are still unaware of the influence these communities have had in the recent years, leading in the end to what we see now.

John Gruber asks:

“Is this anti-vaccination movement just a U.S. thing, or is it spreading in other countries too?”

I can speak for Italy and UK: yes, it’s spreading to other countries too. Specifically about Italy, what really worries me is that the average age of people strongly convinced that vaccines are harmful is relatively low: it’s people having their first child right now or that are going to have one in the next ten years. So, the basis for a measles comeback is already set and strong, but effects will be visible at a later date.

Why all of this?

This is not just a fight of opinions. This topic involves so many aspects of our lives that the implications frighten me. This is how large the problem is. It’s about science, medicine, reliability of information, trust of sources, personal freedom, awareness of danger, responsibility on our own choices and responsibilities against the community we live in — locally and globally. It’s about why we believe something. Actually, it is about why we believe anything.

Let’s take a step back: all starts from a — frankly reckless — study pointing to a possible connection between vaccines and autism. This study was poorly supported by evidence and built on an awful small number of cases, not enough to be statistically significative. This study has been considered unreliable by the scientific community. I myself am not a great fan of scientific literature: too many times it relies too much on raw numbers and relevant biases are often underestimated. As a psychiatrist, I strongly reject the idea that psychopathological issues can be so easily put together and that my work should be to fit a patient into a category based on a specific number of symptoms, look for clinical guidelines and apply brainlessly a therapy according to what comes out of an algorithm.

Epidemiology is a completely different matter, though. It is intrinsecally based on statistics and raw numbers and I tend to trust its evidences more. Because the theory is convincing and because it works. The more we move toward the biologic side of things, the more this approach works.

Trust

I said “I trust”, and this is our keyword. We tend to believe what we trust, and we trust sources based on a number of factors. Logic is the last one. We trust people we love, we trust websites we like, we trust theories that look good. This happens among the scientific community as well. How many times have you heard that this or that theory is “elegant”? Logic and rationality help us to keep our feet on the ground, to double-check our trust with our experience of reality, which, again, is just that: not reality, but our experience of it.

Do I trust science? Yes, I trust science for what it is: a set of self-determined rules created to understand natural phoenomena, based on experiment, evidence, and logic. Science is not Gospel, doesn’t have the answers to all of our questions, doesn’t explain the meaning of life. Science creates theories, not truths. Scientists fight to create a theory and then fight to destroy it. They fall in love with their theories, but they always know that they are just that: theories, or “the best explanation for things we have so far”. Till the next one.

In the last 20-30 years, medicine has suffered an increased bias by statistics for two reasons: prescription drugs and insurance. Doctors are less and less free to rely on their experience because if they misuse drugs they can be sued, so it’s safer to just stick on what guidelines say. On the other hand, pharmaceutical research is awfully expensive and who invests in this looks for a return of investment. Statistics have become an ideology more than an instrument. This is particularly true in psychiatry — my branch — because of the evanescence of the matter, but it affects somehow general medicine as well. Nevertheless, things more or less work, among wonderful breakthroughs and sometimes indecent bumps. Unfortunately, this is also a seed of mistrust among people.

Science and superstition

The more scientifical, evidence-based, logical our society becomes, the more the development of alternate theories and superstition is likely. The paradox here is that these superstitions — and this is really the new element we’re dealing with — tend to use the same approach of the belief they fight: they assess themselves as scientific and evidence-based as well.

They don’t say: take this because my religion, my philosophy, my experience tells me that it works. They say: take this because evidence says it works: the scientific community knows it, but hides the truth. It’s a religion of logic-based mistrust.

I trust science, but I’m aware of its limits. I consider myself to be open-minded and I changed my mind on so many things so many times I can’t recall. I strongly trust my own theories, but when reality hits me with something I can’t explain I double check them and look for a mistake.

Anti-vaccine communities tend to have unusually strong beliefs in many fields, not just this one. They often stick to a precise, detailed vision which happens also to be very frail because it’s rigid: if one piece falls apart, the whole thing goes down. And this is why evidence is not enough to convince people if they are not emotionally prepared to change their mind.

Evidence, by the way, is pretty clear: measles is dangerous, it’s not just a spread of funny spots on kids’ skin. Measles can kill people or provide pneumonia and brain damage. It’s a rare event, but it’s much more common than vaccine side effects. Because yes, there are vaccine side effects, but the problem is: how common are they? How dangerous? More or less than a measles infection? Moreover, symptoms tend to be insanely severe on adults. Do the math and make your choice.

Choices and responsibility

And here we come to responsibility: measles is contagious. You’re choosing for your community as well, you’re taking responsibility for this too. Your choice affects other people’s life, not just your own or your kids’. We live in a community, we must agree to share at a fair point risks and benefits; often, we can’t even choose personally which risks and which benefits we prefer: we must accept them as a whole.

Not all of these rules are perfect, or even right, but we don’t live in a perfect world. We can — and we should — fight to improve or correct wrong rules, but to do so we have the moral duty to be honestly aware of what we are talking about. And here we come to another important issue: anti-vaccine opinion is based on pure disinformation, on a biased selection of sources that confirms an a priori hypothesis discarding the other ones. It starts from the belief that science is lying. I know a lot of people worried about vaccines since this study came out, and some people deeply, truly convinced that vaccines cause autism. None of this people is a doctor.

“Any sufficiently advanced technology is indistinguishable from magic”. Knowledge has gone very far since the beginning of human history. No one can anymore know everything on every topic. We need to specialize on a single or few topics, or accept the fact that our knowledge on a subject is superficial. We need to trust, again, other people’s knowledge in fields far from our experience. Because to us, this area may be obscure and impenetrable, but to them is everyday business. And what drives me crazy is how years and years of study, research, experience, effort look like a goofy foul play to someone who reads something different “on the Internet”.

I believe that science can’t explain everything. I believe that an important part of our experience cannot be defined by numbers and physics laws. I believe that science and medicine are sometimes wrong. I’m ready to accept any correction to any scientific statement.

But, please, give me some evidence before you spread panic because your words happen to be able to really kill people.


This post was originally posted on Medium.
Cover photo © 2013 Cristiano M. Gaston