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Journal of Evidence-Based Social Work Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/webs20
Science, Pseudoscience, and the Frontline Practitioner: The Vaccination/ Autism Debate Erina White
a
a
School of Social Work, Simmons College, Boston, Massachusetts, USA Published online: 23 May 2014.
To cite this article: Erina White (2014) Science, Pseudoscience, and the Frontline Practitioner: The Vaccination/Autism Debate, Journal of Evidence-Based Social Work, 11:3, 269-274, DOI: 10.1080/15433714.2012.759470 To link to this article: http://dx.doi.org/10.1080/15433714.2012.759470
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Evidence-Based Social Work, 11:269–274, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1543-3714 print/1543-3722 online DOI: 10.1080/15433714.2012.759470
Science, Pseudoscience, and the Frontline Practitioner: The Vaccination/Autism Debate Erina White Downloaded by [Dalhousie University] at 13:43 13 July 2014
School of Social Work, Simmons College, Boston, Massachusetts, USA
This article demonstrates how misinformation concerning autism and vaccinations was created and suggests that social workers may be perfectly poised to challenge pseudoscience interpretations. Utilizing social network theory, this article illustrates how erroneous research, mass media, and public opinion led to a decreased use of vaccinations in the United States and a seven-fold increase in measles outbreaks. It traces the dissemination of spurious research results and demonstrates how information was transmitted via a system of social network nodes and community ties. This article encourages social workers, as frontline knowledge brokers, to counter misinformation, which may lead to significant public health consequences. Keywords: Vaccinations, autism, social work, misinformation, social network theory
It is often difficult to understand how theoretical training in social work fits into real-world practice. Even when theory explains how a social phenomenon negatively impacts our clients, the role that frontline social workers play in disseminating accurate information often remains unknown. This is particularly evident in the vaccination/autism debate in which the public health consequences of erroneous knowledge diffusion along social network ties make it increasingly difficult to ignore the relevance of theory and the importance of social workers as frontline knowledge brokers of science. In the past 20 years, dishonest researchers, contradictory scientific results, and mass media have contributed to an vaccination/autism debate. In spite of overwhelming data that indicate that there is no association between autism and vaccinations (Gerber & Offit, 2009; Institute of Medicine [IOM], 2004; Taylor et al., 2002), one in four Americans continue to believe that vaccinations cause autism (Gross, 2009). Many parents opt not to vaccinate their children (Gross, 2009; Hall, 2009; Moreno, 2005) and a vaccination fear has created a seven-fold increase in measles outbreaks in the United States (Begley & Interlandi, 2009). This article employs a social network framework to examine how media, including television, pop-culture news, talk shows, blogs, and social network Web sites have contributed to a change in public opinion and a decreased use of vaccinations. First, this article illustrates the background of scientific evidence on autism and vaccination and how conflicting messages might have led to a mistrust of science. This the role of the media in the manufacturing and dissemination of misinformation is highlighted; a social network approach is used to understand how media reshaped health knowledge and changed public vaccination behavior. Finally, a discussion is Address correspondence to Erina White, School of Social Work, Simmons College, Boston, MA, USA. E-mail: erina. [email protected]
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provided on how social workers may be uniquely poised to function as science translationists in a growing climate of media sensationalism and pseudoscience.
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BACKGROUND OF AUTISM/VACCINATION EVIDENCE The autism/vaccination debate began when Wakefield et al. (1998) identified an association between the measles, mumps, and rubella (MMR) immunization and autism. Other peer-reviewed articles asserted similar dangers, such as the mercury contained in thimerosal causes neurodevelopment disorders linked to autism (Geier & Geier, 2003a, 2003b, 2006) and that there is an association between measles vaccinations and central nervous system autoimmunity in autism (Singh, Lin, Newell, & Nelson, 2002). Shortly thereafter, several rigorously conducted studies contradicted Wakefield et al.’s (1998) original findings (Black, Kaye, & Jick, 2002; Madsen et al., 2002; Taylor et al., 2002) and a meta-analysis “effectively dismissed the notion that vaccines cause autism” (Gerber & Offit, 2009, p. 460). Clear evidence from the Centers for Disease Control and Prevention (CDC) indicated that the mercury contained in vaccinations is not associated with deficits neuropsychological functioning (Thompson et al., 2007), and several scholarly works demonstrated that vaccinations do not weaken the immune system (Black et al., 1991; Offit et al., 2002). Similarly, in a review of more than 200 epidemiological and biological studies, IOM released a report revealing that the committee unanimously “favors rejection of a causal relationship between thimerosal-containing vaccines and autism” (IOM, 2004).
CONFLICTING EVIDENCE CREATES A MISTRUST OF SCIENCE Some scholars suggest that the initial conflicting scientific evidence coupled with continued publication of methodologically unsound studies weakened the credibility of “hard” science in the autism vaccination debate (Goertzel, 2010; Hall, 2009). The Lancet published Wakefield et al.’s (1998) study in spite of its small sample size, lack of a control group, and hypothetical conclusion. Later evidence emerged that the primary author, Wakefield, had a conflict of interest, falsified medical records (Begley & Interlandi, 2009), and engaged in numerous instances of professional misconduct, including buying blood from boys at his son’s birthday party (Hall, 2009). In spite of the misconduct by Wakefield, and the questionable results of the Wakefield et al. study example, psychologists such as Seitler (2010) continue to publish anti-vaccination opinions using spurious research data. In addition, other authors, such as the Geiers (Geier & Geier, 2003a, 2003b, 2006), publish anti-vaccination material in reputable journals despite evidence that indicates they have poor research practices and conflicts of interest (Moreno, 2005).
DESCRIPTION OF THE MEDIA ON THE ISSUE The media has played a particularly important role in disseminating misinformation and sensationalizing the vaccination debate. Cameron (2011), a reporter with The Gazette (Montreal), suggested that the international anti-vaccination delusion is based on “fears and convictions that were launched by one fake researcher, followed by a decade-long three-level process of editing and publication going wrong” (p. A19). The media substantiated inaccurate science by publishing erroneous evidence, indulging in celebrity testimony, and balancing credible science with fearbased anecdotes.
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From the onset, media headlines on the vaccination/autism debate have exaggerated scientific evidence and perpetuated fear. The day after the original Wakefield et al. (1998) article was released in The Lancet, headlines in the UK press falsely stated, “doctors link autism to MMR vaccine and ban three-in-one jab” (Begley & Interlandi, 2009). In addition many reporters tended to concentrate on celebrities and public officials rather than science. Journalists broadcasted whether or not then British Prime Minister Tony Blair had vaccinated his child (Begley & Interlandi, 2009), and focused on personal stories of U.S. politicians than rather than critical scientific literature of findings (Moreno, 2005). Long after rigorous scientific evidence clearly rejected a link between vaccinations and autism, the media continued to cover politicians and celebrities who attacked science (Begley & Interlandi, 2009; Kennedy, 2005). Even more credible news media, such as 60 Minutes (November 12, 2000) and the New York Times Magazine (Allen, 2002) reported on a link between autism and vaccinations. The media also blurred the distinction between scientific evidence and concerned citizens expressing lay opinions. When Larry King pressed Jenny McCarthy, an American model and actress, about the link between autism and vaccinations being scientific or statistical she responded, “Well, I believe that parents’ anecdotal information is science-based information : : : ” (as cited in Kay, 2010). While King allowed McCarthy to create her own science, Oprah Winfrey applauded McCarthy’s “mommy instinct” (Robotham, 2011). The media portrayed Wakefield and McCarthy as “brave warriors against authority” (Robotham, 2011) and positioned them as crusaders against hard science. Theorists have begun to explore how the media creates science (Finn, 2010; Mnookin, 2011; Robotham, 2011). For example, in a content analysis of the professional medical literature surrounding autism and vaccinations, Finn (2010) revealed a concern about the emerging phenomena of an era of publicly made science created in the digital environment by self-appointed experts. Similarly, journalism professor Philip Chubb discussed the harmful effects of media tendency to “balance” various perspectives when the balance is between credible evidence and opinions motivated by extreme ideology (Robotham, 2011). The media, which is traditionally viewed as a source of quick and accurate information, creates its own science when it focuses on emotional, anecdotal and sensational stories—as it did in the autism/vaccination debate—rather than scientific fact. SOCIAL NETWORK APPROACH AND A NEW ‘‘EXPERT’’ VACCINATION KNOWLEDGE The social network approach explains how a series of confusing messages and conflicting scientific studies were translated into an anti-vaccination campaign by a wealthy, well-educated group of parents (Gross, 2009; Mnookin, 2011), often referred to as the “web-surfing soccer mom population” (Kay, 2010) and “intensive mothers” (Robotham, 2011). Ultimately this knowledge transformation contributed to higher numbers of unvaccinated children and an increase in vaccinepreventable deaths (Begley & Interlandi, 2009; Gross, 2009). The social network approach is defined as “neither a method nor a metaphor, but a fundamental intellectual tool for the study of social structures” (Wellman & Berkowitz, 1988, p. 4). This theoretical approach asserts that social structures are networks, comprised of nodes (i.e., individuals, groups, households, and nation-states) and ties (i.e., interconnections that represent flows of resources, friendships, and transfers of information between nodes). This theory has been used to understand various social structures and systems such as London’s advertising industry (Mould & Joel, 2009), online support groups (Muncer, Loader, Burrows, Pleace, & Nettleton, 2000), and technology groups in Germany (Kratke, 2011). Some studies have even used this theoretical approach to examine how informal social pressures impact subjective opinions (Burt,
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1987). For example, in a study examining the diffusion of medical information among physicians, Burt found that doctors in similar environments tended to develop similar responses, attitudes, and behaviors. In the vaccination/autism debate, social network analysis helps to explain how entire vaccineresistant communities have emerged in Colorado, Washington, Oregon, and California (Gross, 2009). Physical proximity of nodes and the community ties that bind them create a community aversion to vaccinations. For example, in a small town in Oregon, only 70% of parents vaccinate their children compared to 95% of Oregon state residents (Gross, 2009). Social network analysis also informs how technology allows like-minded nodes to form across similarly minded ties. The advent of computer-supported technology has allowed social networks and communities to occur virtually (Wellman et al., 1996). Pockets of similar types of people transmit and diffuse ideas across non-physical lines leading to an explosion of information, whether accurate or not. For example, one woman reports perusing Web sites, canvassing friends, polling her followers on Twitter, and quizzing her doctor to determine whether or not to vaccinate her child (“A Shot in the Dark,” 2010). Such individuals make decisions based on both regional proximity and a networking of similar beliefs, which may expand to include blog sites, organizations, states, and continents. Parents who wonder about vaccines “share the fruits of their online investigations and doubts with moms groups, listservs, chat rooms, and friends” (Gross, 2009, p. 6). Social network theory also explains how an overflow of information coupled with peer pressure contributes to the formation of “the intensive mother” (Robotham, 2011); and how, in turn, collaborative action of the intensive mother perpetuates anti-vaccine sentiments. “Intensive mothers” reevaluate traditional parenting norms and often form decisions based on social support information and online media sites: Upper middle-class mothers are starting to question immunisation more than they would have done, as part of a suite of things they want to do for their child-things like baby gym. You want to show you’re doing a good job of mothering and not just accepting the status quo. (Robotham, 2011)
A proliferation of information, the media tendency to present “balanced” information rather than accurate scientific evidence (Mnookin, 2011), and an increased social network of “intensive mother” peer pressure contributes to the confusion about the right vaccination policy. The social network approach demonstrates how conflicting scientific reports, media, and information technology produced a new vaccination knowledge. As erroneous vaccination information is passed along social network Web sites and among nodes and ties of “people like me,” mistrust in rational scientific knowledge is expanded. The expert role of impartial academic is replaced by a social-media-network expert-knowledge broker created by “people like me.” Unfortunately unlike choosing baby gym, neglecting to vaccinate children has far reaching and deadly consequences.
A CALL TO SOCIAL WORK Social workers are poised to counter social networks gone awry. As direct care providers and front line experts, they may hold the key to preventing the dissemination of misinformation among clients. In medical settings social workers have the unique opportunity to translate new science into practical application. As direct care clinical providers, social workers often have access to “real science” and are aware of whether or not clients are ascribing to and following pseudoscience practices. A wide array of professionally-targeted options may be used to correct misinformation: medical pamphlets in hospital settings, scientifically informed leaflets in directcare outpatient offices, information sessions in school social work settings, and verbal correction of inaccurate scientific information among clients in psychotherapy.
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Historically, unlike the media’s bias to present “balanced” information, social work has been charged with providing correct, current, and life-saving information. Social workers do no harm and attempt to prevent future harm. With the distinct perspective of viewing clients in their environmental context, social workers are often privy to insider information about client practices, trends, social networks, and adoption of erroneous information. As a profession, social work is singularly positioned to utilize this first-hand knowledge to challenge pseudoscience interpretations. Given the global public health concern of increased measles outbreaks and decreased vaccinations, this article serves as a call to social workers, as multidisciplinary professionals providing front-line care, to read the science, become educated experts, watch for the dissemination of erroneous information among social network ties, and present the accurate evidence.
REFERENCES Allen, A. (2002, November 10). The not-so-crackpot autism theory. The New York Times. Begley, S., & Interlandi, J. (2009, March 2). Anatomy of a scare. Newsweek, 153(9), 42–47. Black, C., Kaye, J., & Jick, H. (2002). Relation of childhood gastrointestinal disorders to autism: Nested case-control study using data from the UK General Practice Research Database. British Medical Journal, 325, 418–421. Black, S., Cherry, J., Shinefield, H., Fireman B., Christenson, P., & Lampert, D. (1991). Apparent decreased risk of invasive bacterial disease after heterologous childhood immunization. American Journal of Diseases of Children, 145, 746–749. Burt, R. (1987). Social contagion and innovation: Cohesion versus structural equivalence. The American Journal of Sociology, 92, 1287–1335. Cameron, N. (2011, January 12). Autism “study” represents a failure of journalism. The Gazette (Montreal), p. A19. Finn, J. (2010, October). Childhood vaccinations and autism, 1998–2010: Expert domains in formal information exchanges. ASIST, 22–27. Geier, M. R., & Geier, D. A. (2003a). Thimerosal in childhood vaccines, neurodevelopment disorders, and heart disease in the United States. Journal of American Physicians and Surgeons, 8, 6–11. Geier, M. R., & Geier, D. A. (2003b). Neurodevelopmental disorders following thimerosal-containing vaccines. Experimental Biology and Medicine, 228, 660–664. Geier, M., & Geier, D. (2006). A meta-analysis epidemiological assessment of neurodevelopmental disorders following vaccines administered from 1994 through 2000 in the United States. Neuroendocrinology Letters, 27, 401–413. Gerber, J., & Offit, P. (2009). Vaccines and autism: A tale of shifting hypotheses. Vaccines, 48, 456–461. Goertzel, T. (2010). Conspiracy theories in science. European Molecular Biology Organization (EMBO) Reports, 11, 493–499. Gross, L. (2009). A broken trust: Lessons from the vaccine-autism wars. PLOS Biology, 7(5), 1–6. Hall, H. (2009). Vaccines and autism: A deadly manufactroversy. Skeptic, 15(2), 26–32. Institute of Medicine. (2004). Immunization safety review: Vaccines and autism. Washington, DC: National Academies Press. Retrieved from http://www.iom.edu/Reports/2004/Immunization-Safety-Review-Vaccines-and-Autism.aspx Kay, J. (2010, November 26). A dangerous myth that won’t go away; mainstream media are complicit in sustaining the debunked theory that vaccines cause autism. The National Post, Canada. Kennedy, Jr., R. F. (2005, July 14). Deadly immunity. Rolling Stone, 57–66. Kratke, S. (2011). Regional knowledge networks: A network analysis approach to the interlinking of knowledge resources. European Urban and Regional Studies, 17(1), 83–97. Madsen, K., Hvid, A., Vestergaard, M., Schendel, D., Wohlfahrt, J., Thorsen, P., : : : Melbye, M. (2002). A population-based study of measles, mumps, and rubella vaccination and autism. New England Journal of Medicine, 347(19), 147–148. Mnookin, S. (2011, January 10). Autism and the affluent. Newsweek, 157(2/3), 11. Moreno, J. (2005). Toxic torts, autism, and bad science: Why the courts may be our best defense against scientific relativism. New England Law Review, 40, 409. Mould, O., & Joel, S. (2009). Knowledge networks of “buzz” in London’s advertising industry: A social network analysis approach. AREA, 42, 281–292. Muncer, S., Loader, B., Burrows, R., Pleace, N., & Nettleton, S. (2000). Form and structure of newsgroups giving social support: A network approach. CyberPsychology & Behavior, 3, 1017–1029. Offit, P., Quarles, J., Gerber, M., Hacket, C., Marcuse, E., Kollman, T., et al. (2002). Addressing parents’ concerns: Do multiple vaccines overwhelm or weaken the infant’s immune system? Pediatrics, 109(124), 124–129.
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Robotham, J. (2011, February 5). How “mommy instinct” outdid science. Sydney Morning Herald (Australia). Seitler, B. (2010). New information that people in high places do not want us to know about autism. Ethical Human Psychology and Psychiatry, 12, 144–157. A shot in the dark: Are the benefits of vaccination worth the risks? A new generation questions the status quo. (2010, November 6). The Toronto Star. Singh, V., Lin, S., Newell, E., & Nelson, C. (2002). Abnormal measles-mumps-rubella antibodies and CNS autoimmunity in children with autism. Journal of Biomedical Science, 9, 359–364. Taylor, B., Miller, E., Lingam, R., Andrews, N., Simmons, A., & Stow, J. (2002). Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: Population study. British Medical Journal, 324, 392–396. Thompson, W., Price, C., Goodson, B., Shay, D., Benson, P., Hinrichsen, V., et al. (2007). Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years. The New England Journal of Medicine, 357, 1281–1292. Wakefield, A., Murch, S., Anthony, A., Linnell, J., Casson, D., Malik, M., et al. (1998). RETRACTED: Ileal-lymphoidnodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 351(9103), 637–641. Wellman, B., & Berkowitz, S. (Eds.). (1988). Social Structures: A network approach. New York, NY: Cambridge University Press. Wellman, B., Salaff, J., Dimitrova, D., Garton, L., Gulia, M., & Haythornthwaite, C. (1996). Computer networks as social networks: Collaborative work, telework, and virtual community. Annual Review of Sociology, 22, 213–238. “60 Minutes” (2000 November 12), MMR vaccine. CBS Television.
Journal of Evidence-Based Social Work Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/webs20
Science, Pseudoscience, and the Frontline Practitioner: The Vaccination/ Autism Debate Erina White
a
a
School of Social Work, Simmons College, Boston, Massachusetts, USA Published online: 23 May 2014.
To cite this article: Erina White (2014) Science, Pseudoscience, and the Frontline Practitioner: The Vaccination/Autism Debate, Journal of Evidence-Based Social Work, 11:3, 269-274, DOI: 10.1080/15433714.2012.759470 To link to this article: http://dx.doi.org/10.1080/15433714.2012.759470
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Evidence-Based Social Work, 11:269–274, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1543-3714 print/1543-3722 online DOI: 10.1080/15433714.2012.759470
Science, Pseudoscience, and the Frontline Practitioner: The Vaccination/Autism Debate Erina White Downloaded by [Dalhousie University] at 13:43 13 July 2014
School of Social Work, Simmons College, Boston, Massachusetts, USA
This article demonstrates how misinformation concerning autism and vaccinations was created and suggests that social workers may be perfectly poised to challenge pseudoscience interpretations. Utilizing social network theory, this article illustrates how erroneous research, mass media, and public opinion led to a decreased use of vaccinations in the United States and a seven-fold increase in measles outbreaks. It traces the dissemination of spurious research results and demonstrates how information was transmitted via a system of social network nodes and community ties. This article encourages social workers, as frontline knowledge brokers, to counter misinformation, which may lead to significant public health consequences. Keywords: Vaccinations, autism, social work, misinformation, social network theory
It is often difficult to understand how theoretical training in social work fits into real-world practice. Even when theory explains how a social phenomenon negatively impacts our clients, the role that frontline social workers play in disseminating accurate information often remains unknown. This is particularly evident in the vaccination/autism debate in which the public health consequences of erroneous knowledge diffusion along social network ties make it increasingly difficult to ignore the relevance of theory and the importance of social workers as frontline knowledge brokers of science. In the past 20 years, dishonest researchers, contradictory scientific results, and mass media have contributed to an vaccination/autism debate. In spite of overwhelming data that indicate that there is no association between autism and vaccinations (Gerber & Offit, 2009; Institute of Medicine [IOM], 2004; Taylor et al., 2002), one in four Americans continue to believe that vaccinations cause autism (Gross, 2009). Many parents opt not to vaccinate their children (Gross, 2009; Hall, 2009; Moreno, 2005) and a vaccination fear has created a seven-fold increase in measles outbreaks in the United States (Begley & Interlandi, 2009). This article employs a social network framework to examine how media, including television, pop-culture news, talk shows, blogs, and social network Web sites have contributed to a change in public opinion and a decreased use of vaccinations. First, this article illustrates the background of scientific evidence on autism and vaccination and how conflicting messages might have led to a mistrust of science. This the role of the media in the manufacturing and dissemination of misinformation is highlighted; a social network approach is used to understand how media reshaped health knowledge and changed public vaccination behavior. Finally, a discussion is Address correspondence to Erina White, School of Social Work, Simmons College, Boston, MA, USA. E-mail: erina. [email protected]
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provided on how social workers may be uniquely poised to function as science translationists in a growing climate of media sensationalism and pseudoscience.
Downloaded by [Dalhousie University] at 13:43 13 July 2014
BACKGROUND OF AUTISM/VACCINATION EVIDENCE The autism/vaccination debate began when Wakefield et al. (1998) identified an association between the measles, mumps, and rubella (MMR) immunization and autism. Other peer-reviewed articles asserted similar dangers, such as the mercury contained in thimerosal causes neurodevelopment disorders linked to autism (Geier & Geier, 2003a, 2003b, 2006) and that there is an association between measles vaccinations and central nervous system autoimmunity in autism (Singh, Lin, Newell, & Nelson, 2002). Shortly thereafter, several rigorously conducted studies contradicted Wakefield et al.’s (1998) original findings (Black, Kaye, & Jick, 2002; Madsen et al., 2002; Taylor et al., 2002) and a meta-analysis “effectively dismissed the notion that vaccines cause autism” (Gerber & Offit, 2009, p. 460). Clear evidence from the Centers for Disease Control and Prevention (CDC) indicated that the mercury contained in vaccinations is not associated with deficits neuropsychological functioning (Thompson et al., 2007), and several scholarly works demonstrated that vaccinations do not weaken the immune system (Black et al., 1991; Offit et al., 2002). Similarly, in a review of more than 200 epidemiological and biological studies, IOM released a report revealing that the committee unanimously “favors rejection of a causal relationship between thimerosal-containing vaccines and autism” (IOM, 2004).
CONFLICTING EVIDENCE CREATES A MISTRUST OF SCIENCE Some scholars suggest that the initial conflicting scientific evidence coupled with continued publication of methodologically unsound studies weakened the credibility of “hard” science in the autism vaccination debate (Goertzel, 2010; Hall, 2009). The Lancet published Wakefield et al.’s (1998) study in spite of its small sample size, lack of a control group, and hypothetical conclusion. Later evidence emerged that the primary author, Wakefield, had a conflict of interest, falsified medical records (Begley & Interlandi, 2009), and engaged in numerous instances of professional misconduct, including buying blood from boys at his son’s birthday party (Hall, 2009). In spite of the misconduct by Wakefield, and the questionable results of the Wakefield et al. study example, psychologists such as Seitler (2010) continue to publish anti-vaccination opinions using spurious research data. In addition, other authors, such as the Geiers (Geier & Geier, 2003a, 2003b, 2006), publish anti-vaccination material in reputable journals despite evidence that indicates they have poor research practices and conflicts of interest (Moreno, 2005).
DESCRIPTION OF THE MEDIA ON THE ISSUE The media has played a particularly important role in disseminating misinformation and sensationalizing the vaccination debate. Cameron (2011), a reporter with The Gazette (Montreal), suggested that the international anti-vaccination delusion is based on “fears and convictions that were launched by one fake researcher, followed by a decade-long three-level process of editing and publication going wrong” (p. A19). The media substantiated inaccurate science by publishing erroneous evidence, indulging in celebrity testimony, and balancing credible science with fearbased anecdotes.
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From the onset, media headlines on the vaccination/autism debate have exaggerated scientific evidence and perpetuated fear. The day after the original Wakefield et al. (1998) article was released in The Lancet, headlines in the UK press falsely stated, “doctors link autism to MMR vaccine and ban three-in-one jab” (Begley & Interlandi, 2009). In addition many reporters tended to concentrate on celebrities and public officials rather than science. Journalists broadcasted whether or not then British Prime Minister Tony Blair had vaccinated his child (Begley & Interlandi, 2009), and focused on personal stories of U.S. politicians than rather than critical scientific literature of findings (Moreno, 2005). Long after rigorous scientific evidence clearly rejected a link between vaccinations and autism, the media continued to cover politicians and celebrities who attacked science (Begley & Interlandi, 2009; Kennedy, 2005). Even more credible news media, such as 60 Minutes (November 12, 2000) and the New York Times Magazine (Allen, 2002) reported on a link between autism and vaccinations. The media also blurred the distinction between scientific evidence and concerned citizens expressing lay opinions. When Larry King pressed Jenny McCarthy, an American model and actress, about the link between autism and vaccinations being scientific or statistical she responded, “Well, I believe that parents’ anecdotal information is science-based information : : : ” (as cited in Kay, 2010). While King allowed McCarthy to create her own science, Oprah Winfrey applauded McCarthy’s “mommy instinct” (Robotham, 2011). The media portrayed Wakefield and McCarthy as “brave warriors against authority” (Robotham, 2011) and positioned them as crusaders against hard science. Theorists have begun to explore how the media creates science (Finn, 2010; Mnookin, 2011; Robotham, 2011). For example, in a content analysis of the professional medical literature surrounding autism and vaccinations, Finn (2010) revealed a concern about the emerging phenomena of an era of publicly made science created in the digital environment by self-appointed experts. Similarly, journalism professor Philip Chubb discussed the harmful effects of media tendency to “balance” various perspectives when the balance is between credible evidence and opinions motivated by extreme ideology (Robotham, 2011). The media, which is traditionally viewed as a source of quick and accurate information, creates its own science when it focuses on emotional, anecdotal and sensational stories—as it did in the autism/vaccination debate—rather than scientific fact. SOCIAL NETWORK APPROACH AND A NEW ‘‘EXPERT’’ VACCINATION KNOWLEDGE The social network approach explains how a series of confusing messages and conflicting scientific studies were translated into an anti-vaccination campaign by a wealthy, well-educated group of parents (Gross, 2009; Mnookin, 2011), often referred to as the “web-surfing soccer mom population” (Kay, 2010) and “intensive mothers” (Robotham, 2011). Ultimately this knowledge transformation contributed to higher numbers of unvaccinated children and an increase in vaccinepreventable deaths (Begley & Interlandi, 2009; Gross, 2009). The social network approach is defined as “neither a method nor a metaphor, but a fundamental intellectual tool for the study of social structures” (Wellman & Berkowitz, 1988, p. 4). This theoretical approach asserts that social structures are networks, comprised of nodes (i.e., individuals, groups, households, and nation-states) and ties (i.e., interconnections that represent flows of resources, friendships, and transfers of information between nodes). This theory has been used to understand various social structures and systems such as London’s advertising industry (Mould & Joel, 2009), online support groups (Muncer, Loader, Burrows, Pleace, & Nettleton, 2000), and technology groups in Germany (Kratke, 2011). Some studies have even used this theoretical approach to examine how informal social pressures impact subjective opinions (Burt,
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1987). For example, in a study examining the diffusion of medical information among physicians, Burt found that doctors in similar environments tended to develop similar responses, attitudes, and behaviors. In the vaccination/autism debate, social network analysis helps to explain how entire vaccineresistant communities have emerged in Colorado, Washington, Oregon, and California (Gross, 2009). Physical proximity of nodes and the community ties that bind them create a community aversion to vaccinations. For example, in a small town in Oregon, only 70% of parents vaccinate their children compared to 95% of Oregon state residents (Gross, 2009). Social network analysis also informs how technology allows like-minded nodes to form across similarly minded ties. The advent of computer-supported technology has allowed social networks and communities to occur virtually (Wellman et al., 1996). Pockets of similar types of people transmit and diffuse ideas across non-physical lines leading to an explosion of information, whether accurate or not. For example, one woman reports perusing Web sites, canvassing friends, polling her followers on Twitter, and quizzing her doctor to determine whether or not to vaccinate her child (“A Shot in the Dark,” 2010). Such individuals make decisions based on both regional proximity and a networking of similar beliefs, which may expand to include blog sites, organizations, states, and continents. Parents who wonder about vaccines “share the fruits of their online investigations and doubts with moms groups, listservs, chat rooms, and friends” (Gross, 2009, p. 6). Social network theory also explains how an overflow of information coupled with peer pressure contributes to the formation of “the intensive mother” (Robotham, 2011); and how, in turn, collaborative action of the intensive mother perpetuates anti-vaccine sentiments. “Intensive mothers” reevaluate traditional parenting norms and often form decisions based on social support information and online media sites: Upper middle-class mothers are starting to question immunisation more than they would have done, as part of a suite of things they want to do for their child-things like baby gym. You want to show you’re doing a good job of mothering and not just accepting the status quo. (Robotham, 2011)
A proliferation of information, the media tendency to present “balanced” information rather than accurate scientific evidence (Mnookin, 2011), and an increased social network of “intensive mother” peer pressure contributes to the confusion about the right vaccination policy. The social network approach demonstrates how conflicting scientific reports, media, and information technology produced a new vaccination knowledge. As erroneous vaccination information is passed along social network Web sites and among nodes and ties of “people like me,” mistrust in rational scientific knowledge is expanded. The expert role of impartial academic is replaced by a social-media-network expert-knowledge broker created by “people like me.” Unfortunately unlike choosing baby gym, neglecting to vaccinate children has far reaching and deadly consequences.
A CALL TO SOCIAL WORK Social workers are poised to counter social networks gone awry. As direct care providers and front line experts, they may hold the key to preventing the dissemination of misinformation among clients. In medical settings social workers have the unique opportunity to translate new science into practical application. As direct care clinical providers, social workers often have access to “real science” and are aware of whether or not clients are ascribing to and following pseudoscience practices. A wide array of professionally-targeted options may be used to correct misinformation: medical pamphlets in hospital settings, scientifically informed leaflets in directcare outpatient offices, information sessions in school social work settings, and verbal correction of inaccurate scientific information among clients in psychotherapy.
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Historically, unlike the media’s bias to present “balanced” information, social work has been charged with providing correct, current, and life-saving information. Social workers do no harm and attempt to prevent future harm. With the distinct perspective of viewing clients in their environmental context, social workers are often privy to insider information about client practices, trends, social networks, and adoption of erroneous information. As a profession, social work is singularly positioned to utilize this first-hand knowledge to challenge pseudoscience interpretations. Given the global public health concern of increased measles outbreaks and decreased vaccinations, this article serves as a call to social workers, as multidisciplinary professionals providing front-line care, to read the science, become educated experts, watch for the dissemination of erroneous information among social network ties, and present the accurate evidence.
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