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How to Cause a Measles Epidemic in Five Easy Steps

There’s been a lot written about the measles outbreak and antivaccine parents. Fact is, the current situation is a direct and predictable result of many social/political trends that have emerged in America over the last generation. Having recently learned that a good way to get “clicks” on the Internet is to create lists, I am sharing five easy steps to take if you want to create an epidemic just like this.

Holding child's arm while preparing to give an injection      1.  Raise a generation ignorant about science

The majority of Americans are clueless about science: how it works, what it tells us. From health to climate change to evolution, your average American has no real idea how empirical evidence is used to make and test hypotheses, nor that it is especially important to pay attention to data when they disagree with your prior beliefs. Our American approach: when data fail to support our beliefs, we summarily reject them. That’s in part because we:

       2.  Allow belief (religious or otherwise) to rule the day

I contend that there is a widespread lack of understanding of the distinction between “knowledge” and “belief.” This may be contributed to by a fairly loose definition of “knowledge” floating around, like this one from Merriam-Webster online: “information, understanding, or skill that you get from experience or education.” Under this definition, anything I come to understand through experience would constitute knowledge—so it’s not really different from belief. But as a philosophy major in college, I learned a more robust definition in my epistemology class: knowledge comprises justified, true belief. That is: you can’t be said to “know” something unless you also believe it (that’s a psychological feature of knowledge); you also can’t “know” something that isn’t true (although truth is a metaphysical concept); and finally, you must have justification for your belief before you can be said to truly “know” something. The question of what constitutes adequate justification is what occupies philosophers (such as me in my undergraduate days) or, in biomedicine, researchers, epidemiologists and proponents of evidence-based medicine (such as me in my professional life). It’s what science—dispassionately and objectively testing hypotheses through empirical evidence—is all about.

      3.   Let distrust of government override good judgment

It’s been interesting, though somewhat confusing, to see how “government” has become the least-trusted source of information for many. While I can understand this distrust to some extent (our dysfunctional Congress, the outsize influence of corporate lobbyists, the continual overreach of governmental guidelines), I find it confusing when this spills over to scientific/evidence-based findings of groups such as the National Institutes of Health and the Centers for Disease Control (CDC). Indeed, when the CDC looked at the greatest public health achievements of the 20th century, childhood immunization topped the list, and as this evidence-based report shows, with good reason. But we Americans don’t trust the CDC; we’d rather:

    4.   Put our faith in quacks and nudniks who share our worldviews

The beautiful thing about the Internet is that it puts the entire world of information at our fingertips. The problem is, separating truth from fiction requires judgment, something it appears few of us have (see item #1, above). So we’ve learned a handy method that saves both time and brainpower: we just listen to (and believe) the information that comports with our worldviews, and reject the rest. Quick and easy—plus, it feels so good! So when America’s favorite doctor bashes vaccines, and TV personality Jenny McCarthy tells you that vaccines cause autism, those antivaccine parents have all the justification they need. Who cares that the CDC has strong evidence, or that the major study that claimed to show that vaccines cause autism was fraudulent? How could you not trust Dr. Oz and Jenny McCarthy over “science”?

   5.   Value personal liberty at the expense of public health

There is an inherent conflict between public health and individual liberty, as is well understood by those in the field. Indeed, when teaching my public health epidemiology course, I would joke about how my American Public Health Association and American Civil Liberties Union cards were battling in my wallet—a quip largely meant to underscore that it is possible to care simultaneously about both issues. But in contrast to many other societies, we Americans seem to have come down squarely on the side of individual liberty, even at the expense of our neighbors, including our kids’ friends and classmates. As this whole measles outbreak emerged, I learned with incredulity that almost every state in the U.S. allows parents to opt out of immunizing their children based on religious or personal beliefs. How shameful it is that we allow “personal beliefs” to trump science! It is an undeniable fact that immunizing children provides benefits not only to the child vaccinated but to the entire community, and conversely, that unvaccinated children pose a substantial risk to public health (as the current measles outbreak amply demonstrates). Perhaps we in the scientific community have done a disservice by labeling this feature “herd immunity”—no one wants to be part of a “herd,” I guess. So let’s just call it “community immunity”; not only does that make a nice rhyme, but it emphasizes that we do, in fact, live in community. (Of course, we’d need to care about others in our community for that really to work, so this “rebranding” won’t do the trick by itself.)

I understand that this post is pretty negative, and I confess that it reflects the personal feelings that this outbreak, and the ensuing “debate,” have stirred in me. So I’d like to end on as upbeat a note as I can, by referencing a terrific blog post by Anna Mirer, M.P.H., an M.D.-Ph.D. student at the University of Wisconsin. Aligned with the “negative” tone of my post is her recitation of the outrageous comments of Dr. Jack Wolfson, a man who calls himself a physician despite his irresponsible stance on vaccination. While such physicians – including Dr. (and Senator) Rand Paul, who recently made news with comments I consider reckless  – fill me with shame for my entire profession, I am glad to counterbalance that with some hope for the future, inspired by the words of future doctor Mirer, as well as many of the students I encounter here at Albert Einstein College of Medicine. As noted by these five steps, these future healthcare professionals will be fighting against dangerous and powerful  trends in our society; here’s hoping they, along with science and reason, can prevail.

Paul Marantz, M.D., M.P.H.

Paul Marantz, M.D., M.P.H.

Dr. Marantz is a physician-epidemiologist. He is associate dean for Clinical Research Education at Albert Einstein College of Medicine.

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