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Tuesday
May282013

Now, getting back to disgust: we've done guns & drones; what about *vaccines*?

In a temporary triumph over entropy, I happened upon this really interesting paper -- actually, it's a book chapter -- by philosopher Mark Navin:

Navin uses an interpretive, conjectural style of analysis, mining the expression of anti-vaccine themes in popular discourse.  

I think he is likely overestimating the extent of public concern about vaccines. As Seth Mnookin has chronicled, there is definitely an "anti-vaccine" subculture, and it is definitely a menace--particularly when adherents of it end up concentrated in local communities. But they are tiny, tiny minority of the population. Childhood vaccination rate have been 90-95% (depending on the vaccine), & exemption from vaccination under 1%, for many many years without any meaningful changes.

But I don't think this feature of the paper is particularly significant or casts doubt on Navin's extraction of the dominant moral/emotional themes that pervade anti-vaccine discourse.  Disgust--toward puncturing of the body with needles and the introduction of foreign agents into the blood; toward the aspiration to substitute fabricated and self-consciously managed processes for the ones that "nature" has created for governing human health (including nurturing and protection by mothers)--unmistakably animates the sentiments of the vaccine opponents, historical and contemporary, whom Navin surveys.

There are two cool links between Navin's account & the themes explored in my previous posts.  One is the degree to which the evaluative orientation in these disgust sensibilities cannot be reduced in a satisfactory way to a "conservative" ideology or "moral" outlook.

Navin cites some popular works that suggest that anti-vaccine sentiment is correlated with a "left wing" or "liberal" political view. I've never seen any good evidence of this & the idea that something as peculiar -- as boutiquey -- as being anti-vaccine correlates w/ any widespread cultural style strikes me as implausible. But it is clear enough from Navin's account that the distinctive melange of evaluative themes that inform "disgust" with vaccines are not the sorts of things we'd expect to come out of the mouth of a typical political conservative (or typical anything, really).

This feature of the analysis is in tension with the now-popular claim in moral psychology-- associated most conspicuously with Jonathan Haidt and to a lesser degree with Martha Nussbaum -- that "disgust" is a peculiarly or at least disproportionately "conservative" moral sentiment as opposed to a "liberal" one  (frankly, I think it is odd to classify people in these ways, given how manifestly non-ideological the average member of the public is!). That was a point I was stressing in my account of the role of disgust in aversion to guns (and maybe drones, too!).

The second interesting element of Navin's account is the relationship between disgust and perceptions of harm.  Navin notes that in fact those disgusted by vaccines inevitably do put primary emphasis on the argument that vaccines are inimical to human health.  They rely on "evidence" to make out their claim. But almost certainly what makes them see harm in vaccines -- what guides them selectively to credit and discredit evidence that vaccines poison humans and weaken rather than bolster immunity -- is their disgust with the cultural meaning of vaccines.

This point, too, I think is in tension with the contemporary moral psychology view that sees "liberals" as concerned with "harm" as opposed to "purity," "sanctity" etc.  

The alternative position -- the one I argued for in my previous posts -- is that the moral sensibilities of "liberals" are guided by disgust every bit as just as much those of "conservatives," who are every bit as much as focused, consciously speaking, on "harm" as liberals are.  Both see harm in what disgusts them -- and then seek regulation of such behavior or such activities as a form of harm  prevention.  What distinguishes "liberals" and "conservatives" is only what they find disgusting, a matter that reflects their adherence to opposing cultural norms.

Although the people Navin are describing aren't really either "liberals" or "conservatives" -- and in fact don't subscribe to cultural norms that are very widespread at all in contemporary American society -- his account supports the claim that disgust is in fact a universal moral sentiment, and one that universally informs perceptions of harm.

In this respect, he is aligned with William Miller and Mary Douglas, both of whom he draws on.

Cool paper -- or book chapter!  Indeed, I'm eager to find & read the rest of the manuscript.

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Reader Comments (6)

I certainly agree that moral disgust, in one form or another, is an aspect of all enculturated human beings, but, as I argued in the previous post on the topic, I also think that in itself it's a relatively primitive aspect that can and has lead to moral mistakes (prejudice, superstition, general irrationalism, etc.). So in that sense I'd just like to suggest again that the effort to overcome one's reflexive disgust long enough at least to think it through is an aspect of what has historically been seen as a culturally "liberal" disposition, or big-L "Liberal" as was used last time to distinguish it from the purely political label in current use. And that makes an interesting contrast with the politics of those currently labelled liberal or progressive, in which moral disgust, along with other negative emotions like fear, paranoia, contempt, etc., seems on so many issue to play such an important role, important enough to override much evidence to the contrary -- e.g., nuclear power, guns, GM foods, cell phones, wifi, fish farming, and so on. So I'd side with Navin's observation of the correlation between anti-vaccination fear and loathing and a general leftish disposition, though not necessarily being conscious enough to constitute an ideology. This would certainly be consistent with an even broader pattern within the EC cultural disposition that looks upon much technology generally with suspicion and fear, a pattern that I think has come up in your own research. And that in turn would be supportive of an ironic association of modern-day leftism, in a more cultural or dispositional, less ideological/political sense, and small-c cultural conservatism, as in Haidt and Nussbaum.

May 28, 2013 | Unregistered CommenterLarry

@Larry:

Thanks. I wrote out a long response, which I decided would make for a good "follow-up" (particularly since it took up all the time I had allotted for a new blog post -- on the "missing denominator problem ..." Tomorrow for that.)

May 29, 2013 | Registered CommenterDan Kahan

In a democracy, it is essential that we foster the ability to have serious science based discussions on topics of national concern. Making wise decisions depends on this.

In my opinion, vaccinations, the rise of the extremist anti-vaxx movement, and the associated rise, (especially online), of those attempting to discredit the anti-vaxxers makes an interesting case study of the derailment of what ought to have been a national ongoing conversation on the broader topics of public health outreach and the importance of vaccination programs.

Vaccinations are at least off-putting, if not repulsive. I don't know where I'd draw the line between evoking disgust as opposed to un-naturalness. But then, anti-vaxx extremist sentiment also neatly straddles far left and far right camps, so maybe I don't have to. In our modern medical system there is for many new parents an abrupt transition from a by then familiar obstetrical practice to a new and potentially unfamiliar pediatric one. For healthy babies, immunizations are the first topic that comes up in discussions with the new doctor. Modern health insurance plans may not have allowed much of a personal selection process to be involved with the selection of this doctor. Parents are newly dealing with their infant, the most precious thing they've produced ever. I think that the system unfortunately is not set up to allow those parents time to develop the sense that they are in control of the decision making in partnership with a trusted ally, their pediatrician.

In my opinion, Seth Mnookin identifies a key turning point in the immunization conversation; the adverse reactions that occurred with the whole cell pertussis vaccine. See: http://blogs.plos.org/thepanicvirus/2012/09/13/the-whole-cell-pertussis-vaccine-media-malpractice-and-the-long-term-effects-of-avoiding-difficult-conversations/. As was true in my case, and as exemplified by similar comments in the thread here and elsewhere, it was apparently common pediatric practice to hand out packets of Tylenol. As my pediatrician explained it this was 'for the parents" if the baby slept through the rest of the day, the parents would not be perturbed and call their doctor. This pediatric seemed to me to be completely unwilling to answer questions about where the dividing line between a "good" fever and a potentially dangerous one. I thought he was a jerk and dumped him as soon thereafter as my insurance coverage allowed.

So, there were many parents out there spending stressful after dpt immunization afternoons and nights with feverish fussy and sometimes even convulsing newly immunized infants. This led to increasing awareness that they were not alone, and that collectively they did not fully trust their medical providers. This led to an opening for the Andrew Wakefields to march right in and create a name for themselves. As Seth Mnookin correctly points out, this is the aftermath of having avoided difficult conversations on vaccines, side effects and how the advantages of vaccines still strongly outweighed the disadvantages.

In the wake of concerns, a newer pertussis vaccine was devised.

Seth Mnookin is a real journalist and his book The Panic Virus, which is an expose of the anti-vaxx movement, documents the anti-vaxx movement correctly as a matter of real concern. It is however, still true that battling anti-vaxxers a convenient way of pointing at evil other people and avoiding difficult conversations about public health overall and such things as the inequitable provision of health care.

So in 2010, California had a pertussis outbreak in which 10 infants died (9 of whom were Hispanic),
(79%) of the hospitalized infants <6 months of age with known race and ethnicity were Hispanic. http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport2010-12-15.pdf The public health response to this was to institute a program of a "cocoon of safety", doing outreach to ensure that parents and other adult caregivers who would be likely to be in close contact with too young to immunize infants received immunizations themselves. But online, in such places as science oriented blogging venues, the focus was still on anti-vaxxers.

More recently, there has been developing awareness that the newer vaccine is less effective in the long term and boosters are necessary. Here in Washington State, a recent whooping cough outbreak led to a state health department campaign aimed at getting people to understand that this was an "everyone' issue and not an antivaxxer one. http://seattletimes.com/html/localnews/2019300548_whoopingcough30m.html

It is also true that apparent anti vaccine sentiment is not isolated to the forces of antiscience as exemplified by the anti-vaxx movement. The Center for Disease Control notes that "Rates of influenza immunization are also unacceptably low among healthcare providers, an important target population for vaccination. Typically, fewer than 60% of healthcare providers receive influenza vaccine." This is a population that ought to be aware of, and concerned about disease transmission to vulnerable patients.
http://www.cdc.gov/vaccines/pubs/pinkbook/strat.html

At the current time, under our market driven corporate pharmaceutical system, we also suffer from a vaccine shortage: http://www.cdc.gov/vaccines/vac-gen/shortages/default.htm#pentacel. It would be nice if we had the sense that Big Pharma had been monitoring the effectiveness of the newer pertussis vaccine and was actively engaged in efforts to work towards an improved vaccine that would increase immunity compared to the current version, without causing as many side effects as the original one did.

There is an interesting recent study by Jason Glanz, et al, based on statistics from the Kaiser Permenente system. http://www.ncbi.nlm.nih.gov/pubmed/23338829. In this work, rates of undervaccination are studied. This involves parents who somehow fail to get their children fully immunized in accordance with the set vaccine schedule.

Some of this is, as the CDC also points out,nis due not to anti vaccine sentiment but rather issues of access and communication: "One key to a successful strategy to increase immunization is matching the proposed solution to the current problem. At present in the United States, most persons have sufficient interest in and access to health care and are seen, at least periodically, in healthcare systems. Those who remain unvaccinated are so largely because healthcare practices and providers do not always optimally perform the activities associated with delivering vaccines and keeping patients up-to-date with their immunization schedules. "

But some is due to parents who actively decline to get vaccine delivery on the defined schedule and seek to design or implement a schedule utilizing different timing (usually more stretched out). I think that this means that disgust is not the driving force, control is. Medical professionals discredit the concept that there are any immunological reasons not to combine vaccines. But especially if you are a person with allergies, it is medical professionals that have programmed in the concept of introducing new items one at a time with careful monitoring as to side effects. Product inserts for vaccines generally warn to monitor for side effects. IMHO it seems counter intuitive to many that one can do so when the vaccines are being administered 8 at a time. On the other hand, medical professionals, looking at undervaccination statistics probably have a strong urge to get babies vaccinated while they are actually present in the office.

CDC vaccine schedule: http://www.cdc.gov/vaccines/schedules/easy-to-read/child.html

If parents actually adhere to alternative, stretched out, vaccine schedules, they will be giving their babies more vaccination needle pricks, not less. Thus I think that the overall driving force has more to do with "control" than it does "disgust".

A real conversation on the topic of vaccination would have plenty of room for both blame and insights on the part of all the parties involved.

May 29, 2013 | Unregistered CommenterGaythia Weis

I agree that emotion is an essential feature of probably any consciously functioning organism and certainly for human beings, but I think it's a serious mistake to consider it a form of perception. Emotion is motivation, not perception, and the sorts of moral errors it motivates, or the rationality it can override, shouldn't be trivialized by comparing them to perceptual illusions.

Re: the association of moral disgust/revulsion and conservatism, I just don't think it applies to the contemporary partisan meaning of the term. (Indeed, in my view many, though certainly not all, of the people to whom the label is currently applied actually have a more liberal disposition than many people who might be called liberals.) In any case, it really only pertains to broad cultural or even psychological dispositions, and we maybe need a separate term for such.

And I thought Gaythia's interesting comment really underlines just how complex is the move between "what is known to science", even once we figure out how to figure that out, and policies and behaviors, by states, institutions, professionals, and individuals.

May 29, 2013 | Unregistered CommenterLarry

Thanks, Dan, for these generous and constructive comments. They've given me a lot to think about.

I want to comment quickly about two ways that I think my work might interact with more disciplined empirical work on the cultural norms that inform disgust-based vaccine refusal (on the assumption that vaccine refusal often results from disgust and its underlying norms).

First, I think that the interpretive and speculative work I've done can help to identify potential areas for empirical research. For example, I think that I've provided reasons for thinking both (a) that disgust-based vaccine refusal is unlikely to focus solely on vaccines as the source of disgust (i.e., since the relevant objects of disgust likely also include mandatory vaccination or violations of natural health or the presence of foreigners in one's community -- phenomena to which vaccination is only contingently connected) and (b) that disgust-based vaccine refusal is unlikely to originate from cultural values that can be neatly sorted by politics/religion/etc. My work gives some reason for endorsing these claims, but we really need more (and more disciplined) empirical evidence to see if I'm on the right track...and work like mine may help to identify the sorts of research questions one might want to pursue.

Second, I think that the empirical results we get on the topic of disgust-based vaccine refusal ought to be interpreted in the light of the sort of work that I've done (as you say). That doesn't mean that one should throw out data that doesn't confirm to this pre-investigative conceptual terrain, but that one way to get meaning from such data is to place it in the context of the rhetoric and the testimony of vaccine refusers -- and that I've provided one (falsifiable) way in which to organize their rhetoric and testimony.

May 29, 2013 | Unregistered CommenterMark Navin

@Mark:

I 100% agree.

I've never done a study in which the hypotheses didn't connect up to rich, observation-informed interpretations akin to yours. Sometimes the source is an ethnographic study. Other times just good journalism.

I think there is little reason to believe work on mechanisms of cognition (and the like) that don't connect to what we see. The reason to use the sort of methods that are featured in CCP research, though, is to be sure that what we see is really there; and relatedly, to determine which of the things people see are really there, since in almost all interesting situations, reasonable people will see differnt things, or will offer up plausible accounts that are at odds with one another. But people who do clever psychology experiments to show that thigns no one has ever seen or had reason to believe in -- WTF studies -- are often documenting phantoms.

You haven't objected to my "more disciplined" formulation, but actually I will at this point. I see the sort of methods I am using -- which often amount to creating simple models of more complex real-world phenomena so that they can be poked and prodded in informative ways -- as a means of disciplining inferences that one draws from other types observations. But the inferences one can make from observing things via the methods I might use also need to be disciplined by variious sorts of tests that help to warrant that they merit confidence. I see statistical testing as about that actually -- the tests don't generate inferences (the designs do) but they help to vouch for them. But as I have tried to indicate here, your methods also discipline the inferences one can draw w/ the methods I use.

But in short, if what you are saying is right, then someone should be able to do a study of the sort that I might do (creating a model that corrals the mechanism of consequence & makes it do what one would expect if what you are saying is right -- but not otherwise) that corroborates it. That researcher can then point to what you are observing and say, "Navin's work gives you reason to believe that my results mean what I represent; and what I've done supplies even more reason than you had previously to believe that Navin's account is true!"

Woudl someone (perhaps MW) like to translate this into math & show how it maps onto a Bayesian model of information processing? I'm confident that it can be done -- and that it involves *no* circularity!

May 29, 2013 | Registered CommenterDan Kahan

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