If there's one thing I have learned from all of the writing I've been doing recently it's that I can't spell. It can sometimes take me up to five tries before I give in and consult with Merriam-Webster on-line (I don't normally advocate for on-line reading--I struggle with it myself, but the subscription is well-worth it: no paging through a book, no having to replace the dictionary each year, plus several references in one place). Sometimes I am so off that even Merriam-Webster doesn't recognize the word.
When I was in Mrs. Abbott's second grade class at Hyde Elementary School in D.C., though, I thought I was hot shit because words like "geography" appeared on my weekly word lists, which we had to write sentences with, spell ten times over, and then make a story out of. I credit Mrs. Abbott with getting me started with creative writing. She also taught me how to spell dessert (rather than desert): there are two s's in dessert because everyone always wants a second helping.
During my writing in November, I kept track of the words I had a particularly troublesome time spelling. This list of twenty is dedicated to Mrs. Abbott:
1. Everyone misspells entrepreneur. I even misspelled it again writing this.
2. Behemoth sounds exactly like what it means, but spelling it isn't so natural.
3. The spelling of combative should be obvious, but for the longest time I thought it was "combatative." I think Cedar actually corrected me several times on this, but I wouldn't listen.
4.I'm not sure why I have trouble with charlatan, It's really a beautifully and perfectly spelled word, which is maybe why my tendency (there's another one that always gets me!) is to misspell it. Also the word reminds me of Charlemagne, who was no petty charlatan.
5. I first wrote ilk as elk. I mean, don't elk follow the herd mentality, too?
6. Foolproof went through various incarnations, like scientific studies aren't "full-proof."
7. I wasn't aware of the u in fluoride, probably because I never learned how to spell fluorine, probably because I didn't study much in my chemistry classes.
8. For the longest time I thought that acetaminophen was acetametaphin. It's so much catchier that way, isn't? There are also many opportunities to go wrong with the vowels in the -minophen chunk of the word.
9. The two p's, one r, and two s's in suppressed are too much to keep track of.
10. I should have been able to spell nutritious on my first try, but I tripped over the "iti" bit.
11. Is it dialogue or dialouge? I can never remember and probably won't remember a week from now.
12. Vacuum is a great word and one of my favorite activities, but I dread spelling it. Are there two c's? two u's? Two m's? I can never remember. Someone give me a pneumonic (spelled that one on the first try) device for this one. Please!
13. I just have to remember that accommodating can accommodate two c's and two m's. But that won't help me to remember to not try to put a's in the o's spots.
14. Why is it marshmallows? Who in God's name doesn't call them marshmellows? Nobody says marshmallow. I'd wager that majority of you just found out it was -mallow and not-mellow.
15. Ensconced fucked me up for a good day or two before I figured out how to spell it. Even once I had the correct spelling in front of me, I couldn't see where I had gone wrong. The first n is nearly silent, and then all of the soft c, soft s, and hard c sounds get all mixed up together.
16. It is hard enough to know when to use phenomenon or phenomena. I had to say to myself idiotically slowly: fe-no-me-non to spell it correctly.
17. Who knew about that sneaky little first i in plagiarizing? Not I.
18. Six years of French in junior high and high school, plus three in college including a year abroad in France and a French studies major and I still couldn't spell vinaigrette. The second i was a revelation to me.
19. I've bought balsalmic vinegar so many times, you'd think I could spell it by now. Why all of the toothless l's?
20. Exceedingly is part of the accede, antecede, cede, concede, intercede, precede, recede, secede, exceed, proceed, succeed, supersede group. Patricia O'Connor in Woe is I calls them words with "seedy endings." I agree.
I hope I don't learn to spell well anytime soon--I'll loose another one of my procrastination tecniques.
2) It may seem from the following paragraph in my last post that I am equating other types of medicine such as chiropractic adjustments, massage therapy, and acupuncture with pseudo-science:
"Natural medicine is all the rage right now. Part of this is simply brilliant marketing--'all natural' products and curing our ailments 'naturally' sounds instinctively more purifying, wholesome, healthy, and safer than the 'un-natural' alternatives. Herbals and vitamins can be key to good health and there are conditions, like chronic back pain, that conventional western medicine doesn't handle well and that chiropractors, acupuncturists and massage therapists handle in much less invasive and less medicated ways. But many pharmaceuticals are made from herbs and ingredients found in nature. And natural doesn't mean safe: poison ivy is natural and so are rattle snakes and so is hemlock."
With poor clarity of ideas and poor organization in that paragraph, I can see how that would come across. What I meant to say is that while I am suspicious of products that toot their "all-natural-ness" specifically for the purpose of marketablity (and not because there's some proven health benefit to their having that quality) and while I don't agree that "all-natural" medications are automatically superior to "non-natural" ones as many consumers seem to believe these days, I think that there are some unconventional (and often non-western) medical treatments, practices, and ways of healing that are valid and even superior in some cases to those conventional western medicine has to offer. Moreover, western medicine has a lot to learn from the emphasis of those practitioners on maintaining health and preventing illness first and foremost over simply reacting to illnesses after they happen. That being said, I believe that it is unprofessional, unethical, and irresponsible when and if such practitioners advise their patients to entirely renounce conventional western medical treatments, especially ones that have proven successful.
There are places where science and medicine diverge. My concern is with medical and health practitioners who claim their treatments and protocols are valid according to the scientific approach, when they clearly aren't. Science, unlike art, is not a malleable concept. Unlike beauty, science is not in the eye of the beholder. To me, science doesn't seem to be a relative term. More on this later, maybe . . .
3) This New York Times article is about a case where scientists are advocating for fewer tests and procedures, less spending, and less medical intervention, based not an any political or economic agenda, but on findings from research. These findings show that the benefits of the current testing protocols may not be worth their cost and the harm they cause. This article also illustrates the divergence between medical scientists and practicing medical doctors. I can see how women's groups would see this recommendation as an attack on women's health care, the advancement of which has been hindered by discrimination against women, and I acknowledge the influence of politics and economics on medical science, but I don't think that's what is behind these particular findings.
While Cedar is ensconced at the Mayflower Hotel this weekend attending an A.P.A.-sponsored science advocacy meeting in D.C., I'm at home ensconced in my wobbly-backed, duct-taped office chair playing single mom to our three young children and doing bootleg science advocacy, and seeing if I can synthesize these three blog posts plus pages and pages of notes and e-mail exchanges into a succinct and presentable essay about vaccines, distrust of the mainstream medical community, pseudo-science, and the like. (I can't seem to stop thinking about all of this, but I am telling you, scientists and doctors, I will soon go back to being primarily a cranky mother and solicitor of rejection letters. After this, you're on your own and I return to reading my horoscope every day!) At least my mom is here to help out, correct my grammar, and tell me my blog entries are way too long.
First things first. In my last post, I plugged this article in the Atlantic as a good source on the swine and influenza flu vaccines. That may have been premature. It's still better than anything Russell Blaylock has to offer on the subject, mind you, but according to my peeps over at Effect Measure there are some definite errors in journalism. Please don't ask me exactly what those folks are talking about because I have no idea. I'm not literate in science-geekese, particularly not when it's spoken with a strong epidemiologist accent (yeah, like I even found that blog myself). I also found that this recent book review by New Yorker journalist Elizabeth Kolbert does an excellent job of addressing the topic of "all the information out there" (although she doesn't include the example of vaccines).
As a result of my last post, I have been sent to wade through some more anti-vaccinators, such as Kent Holtorf, Jane Burgermesiter, Gary Null (the producer of the self-funded documentary Vaccine Nation), Joseph Mercola, and a video from the National Vaccine Information Center. Honestly, they all scared the crap out of me. Which is good because it meant that after I had listened to them, I figured out why I shouldn't have. Plus, like Mrs. Anders, my favorite middle school substitute teacher, taught me when she made me argue on the pro-life side (for the record, I prefer anti-choice) of a class debate, it's always a good experience to challenge your own knowledge and beliefs, and to see another perspective. Now that I've done that, next time they come at me, I'll know right away to clap my hands over my ears and sing loudly Thomas Dolby's "She Blinded Me with Science."
Like Russel Blaylock and Rauni Kilde, most of these people have absolutely no real medical or scientific credentials, and they are neither trust-worthy nor credible on matters such as vaccines. Kent Holtorf was labeled as an "Infectious Disease Expert" by Fox News when he blasted the swine flu vaccine (not to mention he was a contributor to Fox News). Meanwhile, he's not even certified in internal medicine according to reddit.com, a good skeptic site. Joseph Mercola also nixed the swine flu vaccine, saying that a good dose of Vitamin D would do the trick. On her site, Jane Burgermeister invites believers to donate to her "criminal legal fund," which she ostensibly uses to sue organizations like the United Nations. Quackwatch (the name alone makes me giggle), my favorite pseudo-scientist-busting site, gave me good reasons to doubt the claims of Null and Mercola. I didn't explain this in my previous post, but just so we're clear, pseudo-science means fake science. It's not a field within science, like earth or life science.
This brings me to a key point, which is not that these people are nut jobs or astute profiteers or not credible, but that their claims are not part of a scientific dialogue and in this way, they are disavowing the scientific approach. The views of pseudo-scientists are not a legitimate "side" in any scientific debate. In the arts and humanities, it is possible to be isolated from one's field and still contribute to knowledge, but science doesn't work this way. And these folks don't even study natural medicine; they sell it. They have a vested interest in getting us to distrust the mainstream media and medical community, so that we'll buy their vitamins and products, and are just as motivated by greed as the big pharmaceutical execs. And they're not merely controversial, they're frauds. Their research may be slickly presented, well-written, and full of compelling anecdotes, but it's not scientific research. They have done absolutely no studies at all to prove their claims or that their own treatments work; they are accountable to no one, and there is no oversight or peer-review over their "research." I accept that some of these folks have some expertise in nutrition and living healthfully, but I whole-heartedly reject pseudo-science. I don't accept the "scientific" views of Christian fundamentalists or Scientologists or televangelists, either.
People admire Burgermeister and Koltorf because they supposedly speak truth to power. They may be speaking to power, but they ain't telling the truth. When health care entrepreneurs promote their products, saying that they can cure cancer, advise people who are HIV-positive that there's no way they can contract AIDS, and discourage people from using fluoride toothpaste, they are being irresponsible and dangerous, and obscure any real expertise or credibility they may have. And they contribute to a false dichotomy between promoters of common-sense good health measures (which most members of the mainstream medical community are) and the scientific and medical community.
This video by Richard Dawkins.net does a fantastic job of explaining what I mean by the scientific approach, although I must renounce their clumsy association of superstition with Native American rituals. You're not furthering your cause this way, scientists. I know you people are socially awkward, but do you really want to be culturally awkward as well?
So, why are people turning to pseudo-science to help inform their medical and public health-related decisions?
For one, there is deserved suspicion of the pharmaceutical companies. But while those companies and other health care companies have certainly earned that distrust, as this Gawker post by Foster Gamer and recent New York Times article about recent price inflation show, I'm not sure that the scientists who work for those companies have, or that all the doctors who prescribe medication have, either. In general, the paranoid thinking about this is too simplistic; it implies that the government, research scientists, medical doctors, and pharmaceutical companies are a monolithic entity, when in fact, none of those four groups alone even operate as monoliths. Furthermore, greed is always a motive, but the truth is profitable too. Look at the success of Prozac and Viagra. If those were ineffective or if they were ever found to be dangerous, those companies would lose buckets of money.
Natural medicine is all the rage right now. Part of this is simply brilliant marketing--"all natural" products and curing our ailments "naturally" sounds instinctively more purifying, wholesome, healthy, and safer than the "un-natural" alternatives. Herbals and vitamins can be key to good health and there are conditions, like chronic back pain, that conventional western medicine doesn't handle well and that chiropractors, acupuncturists and massage therapists handle in much less invasive and less medicated ways. But many pharmaceuticals are made from herbs and ingredients found in nature. And natural doesn't mean safe: poison ivy is natural and so are rattle snakes and so is hemlock.
The all-natural movement includes the belief that our society over-medicates, that many of the diseases that we're vaccinating against are harmless, and that we should stop vaccinating so that our immune systems can learn to fend for themselves. I agree that as a society we over-medicate, but that is a separate issue from vaccines. A vaccine isn't really medication. Yes, we need to build our immune systems up and yes, we should avoid antibiotics as much as possible and in general expose our kids to colds and other viruses, but those infectious diseases can be really, really dangerous. I had chicken pox and I am not worried about my own children getting it and bouncing back, but chicken pox can hurt or kill immune-suppressed members of our communities. In any case, I don't think the infectious diseases we vaccinate against in childhood are as harmless as some think they are. Unscathed survivors in our parents' and grandparents' generations were lucky. Plenty of others weren't so lucky, including my uncle who has one leg shorter than the other and my aunt who is deaf in one ear, not to mention all of the people who were killed by the likes of German measles, polio, mumps. Look at how many people malaria (an infectious disease against which there is no vaccine) hurts and kills every year. Finally, vaccines are designed to strengthen our immune systems, not to weaken them, so the idea that we shouldn't have vaccines because they'll weaken our immune systems isn't logical. Vaccines just allow us to build up our immune systems minus life-threatening diseases and massive public health crises.
Many people have had negative experiences with the mainstream medical community (I know I have) and that community has understandably lost their trust. In some cases, doctors practice bad medicine, turning to hefty drugs and surgery when there are less invasive and more cost-effective treatments. But most doctors encourage their patients to eat sensibly, exercise, get enough sleep, and avoid stress and smoking. Unfortunately, some people get severely ill despite maintaining a healthy lifestyle; they can't be treated or cured by common-sense good health measures and vitamins alone.
In other cases, doctors aren't responsive to patients' or parents' concerns. For example, following a well-child visit and some vaccinations, my son Caleb was running a fever, had a bad diaper rash, wasn't sleeping, was crying a lot, and we were having trouble consoling him. I called the on-call doctor from our pediatrician's office and found myself talking to a very exasperated man. I was very upset by the way he spoke to me and reacted to my concerns, and I wrote a strongly-worded letter to the practice the next day. It wasn't that he was wrong or that what was happening with Caleb had anything to do with the vaccine or that even if it did that it was cause for medical concern; he was just an asshole. But our frustration should be with medical training that neglects bedside manner and empathy, and not with the science behind vaccines. In cases such as these, doctors should first respond to our concerns and reassure us, and then present us with rational facts, rather than handle the situation with patronizing dismissal.
In other cases, patients and parents are frustrated with uncertainty. Medical doctors are trained as scientists and as such, can speak in vague probabilistic terms, which can come across as uncertain and uncaring, but patients want certainty in answers, diagnoses, and treatment plans, and doctors don't always have that. Pediatricians behave as they did with me because there's absolutely no evidence that vaccines cause certain reactions, and scientific evidence, and not hunches and intuition, is what doctors are trained to consider. When parents want to know definitively why their child has gotten severely ill, isn't developing normally, or has autism, and vaccines are an easy target. (An aside: I don't actually think that the incidence of autism has gone up; rather, its diagnosis that has gone up. The boundaries of an autism diagnosis used to be narrow and now they're vast, so it seems like autism is on the rise, but relatively speaking, I doubt that it is. Jody Becker shed some light on this in her October 2009 article in the Atlantic: “Behind the Autism Statistics.”)
When doctors are poorly trained, arrogant, or don't have the answers, it's easy to run into the arms of reassuring and confidently certain pseudo-scientists. It's easy to mistake the uncertainty for incompetence and the dismissal for dishonesty. But in those cases, we should seek out more knowledgeable and empathetic medical professionals, not vitamin salesmen. We need to vet our doctors, to get recommendations, to research them, to choose them carefully. And if they're not practicing sound medicine, or lack a bedside manner, then we should go elsewhere.
Scientists and doctors have a way of communicating that's unsettling and turns their patients and the public off, but before we dismiss their findings, we should consider how scientists think and talk, and then place their findings and comments in their proper context. I am not saying we shouldn't question orthodoxy, be skeptical of public health officials or the pharmaceutical industry, or choose our doctors carefully. But there are plenty of scientists and medical doctors with relevant expertise who challenge medical orthodoxy, but in a legitimate way. And they give their kids vaccines, and many are just as paranoid and just as concerned about their kids' health as the rest of us are. Some examples of doctors (and excellent writers) who challenge and work to improve the practice of mainstream medicine while holding fast to the scientific approach are: Jerome Groopman, Atul Gawande, and Marcia Angell.
I have a happy ending to this tale of accidental science advocacy. A reader I had been wrestling with over this topic ended our conversation recently by sending me this article about the history of the vaccine and autism scare, telling me what a great resource it is. I'll remember this pay-off next time I shoot a manuscript out into the black hole for the umpteenth time. Hopefully, that same persistence and stubborness will pay off then. In the meantime, I may not always understand science, but, and some scientists may roll their eyes at this, I have faith in it.
(photo by Justina Kochansky, flickr username: Articulate Matter)
Since my last post, "The Great Vaccine Debate," (which was spurred by a recent article in Slate about the dangers un-vaccinated children pose to children and adults with suppressed immune systems) I have received some interesting feedback and comments, which I thought I would share. I continue to think about the dimensions of the issue myself. I've been watching a lot of The Daily Show lately and Jon Stewart's persistent criticism of mainstream media television outlets, such as Fox, CNN, and MSNBC, is that they boil down news and current issues to two sides squaring off against each other, giving each side equal weight. This seems to be happening in the vaccination issue as well. People think that both sides are equally (scientifically) valid and that whatever people decide should be respected by the other side. First of all, there shouldn't really be sides here as much as claims that have qualities and quantities of evidence. Second of all, many of these same people (on the far left, at least) wouldn't agree that there are two valid sides to global warming or to abstinence-only sex education, for example, and would see deniers and abstinence-only zealots as being anti-science. But being anti-vaccine is being anti-science in a very similar way. Also, not vaccinating against infectious diseases means deciding to put vulnerable people and public health at risk and that's, well, dangerous, and very hard to respect.
Here is what other folks had to say:
The author of the article, Stephanie Tatel, sent me this quote from one of the parents on the pediatric leukemia list-serve she's on, referring to her son who finished his chemo treatment, "My son is permanently immune deficient. He also has autism. I will run for the nearest vaccine, anytime. Hysterical vaccine worriers have never sat by their child's bedside, unsure if he would make it through the night. "
One friend who is very active in the pro-natural childbirth, pro-breast feeding and pro-local food worlds told me, "The broader discussion of vaccinations is fascinating, for the reason you cited: why is it that rational, educated, smart people refuse to believe science? So often I hear the argument that our bodies know how to fight off disease, which is similar to the argument I've told mothers about drug-free childbirth. What is getting missed in that discussion is that people for thousands of years died from those diseases: their bodies cannot fight the bugs all the time. And while most of our bodies can birth children naturally, I've yet to meet a mother who would turn away the skills of modern medicine if and when she has a complication. I've never heard of someone refusing a midwife's decision to transfer, for example. Sadly, the group that tends not to vaccinate also tends to be the pro-breastfeeding, pro-natural birth, pro-organic, local food group. I often feel that I'm in an awkward place within my local circle--seeing otherwise smart people make a poor choice because one issue is closely bound with others that they believe in. How to get them to broaden their view? This article is a good start. Otherwise, talking, talking, talking."
Another friend who is a resident in internal medicine at a major research hospital said, "As you can imagine, I have many discussions with patients regularly on what they do or don't want to take and the value of scientific literature. The question of community good is another level that doesn't usually come into play but adds another level of complexity and importance."
A science and environment journalist said, "There is nothing like wading into the whole vaccination debate to get the blood pumping. Take it from me, the person who gets to write about things like this, climate change, autism, stem cells, plus a whole host of other scientific issues that get people all riled up and emotional. Rationally presenting facts does nothing in many of these circumstances."
But I feel a stubborn need to keep rationally (albeit sometimes emotionally) pushing paying attention to the facts. This past week, I got into some conversations on facebook about the flu and H1N1 vaccines, and since I was fresh from this other debate, I was chomping at the bit. This vaccine is new and and I think people are right to question its safety and effectiveness. There is good reason to suspect the big pharmaceutical companies. In these matters government institutions can be inefficient and incompetent, and also inappropriately influenced by the drug companies. I'm not saying we should all rush out and get the H1N1 or flu vaccines without careful consideration. But that doesn't mean we should give in to pseudoscience and misinformation, either. We should think critically about these matters, but get our information from reliable sources with the goal of making informed decisions.
I'm not quite sure why I am wading into all of this; I am no scientist. I got my worst high school grades in science courses and in college while taking an introductory chemistry class, I did a little science experiment of my own. Problem: Can I pass this class? Background Research: The class is known for being easy and straight forward. Hypothesis: Yes, I can! Experiment: Take two exams; study for the first and not for the second. Results: Only a few percentage points higher on the one I studied for, but failed both. Conclusion: No, I can't, especially if I'm too lazy to do the (granted, low-weighted) homework assignments or go to the TA-lead help sessions. Other than conducting some amateurish social science research and taking a statistics-for-teachers course during my master's degree program (and those were my least favorite parts of the program) in education, I have no background in science or social science research. I am susceptible to being overly influenced by emotional and irrational fears and conspiracy theories, especially if they are well presented. All that being said, I have been raised to consult with the best evidence, thinkers, scholars, professionals, experts, and researchers to get at the truth and to make the most informed decisions possible (and to research the sources before I consult with them) about how to vote, how to eat, how to treat illness, how to raise my children, how to spend money, how to maintain good health.
This article by Russell Blaylock, M.D. spurred one of the discussions about the H1N1 vaccine. I flipped out when I started to read it, but then I stopped and asked my very rational, scientifically-trained, smarty-pants husband to read it and let me know what he thought. Here are his thoughts, "Some of his points are no doubt true. And the flu vaccines (seasonal or H1N1) are a different issue than the other vaccines, for which there is near absolute medical consensus. But he is cherry picking the evidence, and accepting certain studies which confirm his viewpoint, while not accepting others that don't, and then distorting the evidence. The NIH and NEJM are pretty clear now that the vaccine works, maybe not as well as the other vaccines, and maybe the consequences of not taking them aren't quite as strong (H1N1 does not seem to be lethal like polio). But according to this study, it still works."
Cedar also pointed out that Blaylock has insurmountable credibility issues, "He is a total wacko right-wing nut job who thinks that the Soviets invented crack cocaine, MS is caused by aspartame, and that his special vitamins can prevent your brain from aging. You should read his Wikipedia page, but not for the page itself, but for the fantastic links to some of his more bizarre writings." The last thing he told me was that the web site that the article was published on was an organization founded and chaired by Blaylock, which lacks any peer review or oversight. The article is well written and sounds authoritative, but it's all him; there's no scientific or medical consensus behind what he's saying. There's no consequence to him if he's wrong, whereas major publications have at least some vested interest in being balanced and supported by solid evidence.
Another facebook friend posted this You Tube video featuring Dr. Rauni Kilde's thoughts on the swine flu and its vaccine. This, too, freaked me out until I realized she was not actually speaking cogently and until I read about her background and figured out the woman was in a serious car accident and suffers from mental illness.
I am disturbed by the number of people who are willing to accept the ideas of people like Blaylock and Kilde without question and by how quick they are to distort the arguments of those who do question or attempt to refute them. With access to the internet there is so much information that is so quickly available on any given topic. In turn, it's quick and easy for us to spread that information around. This is a wonderfully liberating development in many ways, but it is also dangerous. We need to make extra certain that the information we're reading and passing along is reliable and that it has been vetted. Consulting with professionals, experts, academics, journalists, and (qualified) bloggers is essential. And we need to vet those folks, too. When it comes to topics like the vaccines, we should be skeptical and ask questions of our scientists and government, but in that case we need to be skeptical of the skeptics, as well. This piece from NPR's Weekend Edition gives an excerpt from New Yorker science and technology journalist Michael Specter's new book, Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives, represents both what I'm trying to get at in this piece and also may be an example of a reliable source. I say "may be" because I'd have to read it or what a New York Times book review has to say about it first.
Speaking of reliable sources, I found that these were worth consulting on the subject of vaccines:
3) this conversation about the hysterical public reaction to the death in Britain of a 14-year-old girl, and the media's role in that, who coincidentally had had the vaccine for cervical cancer immediately before she died.
Please let me know if you know of any others. After this, I plan to return to writing about politics, education, and food. This commentary by Mike Rose in truthdig about ill-conceived trends in education reform is a good place to start, or you can read about the infinitely important topic of salad dressing on my food blog.
When I am not taking care of my children, and heck, even when I am, I write. But I will do whatever I can to avoid actually writing. My kids' clothing is perfectly laundered, folded, and organized; the dishwasher doesn't go more than five minutes of being full before I run it; and more than one crumb in the dining room is cause to vacuum the entire house. I have also started to compulsively submit my work, so if you or anyone you know works at an obscure, or not-so-obscure, literary journal, chances are I've heard of their publication and they will soon receive a brown envelope full of lame writing from yours truly. I jump at the chance to make comments and have debates on facebook about whatever: grammar, reality television, vaccinations. I should probably get a job. In the meantime, after reading and posting a friend's article in Slate magazine about the dangers to other people of neglecting to vaccinate our children, I got involved in a few stimulating discussions on facebook. One friend had posted the same article on her facebook page. I may be the only who thinks this, but the conversation spurred by the article and her posting of it was fascinating and important, and hey, at least I can get a blog post (which masquerades these days as a valid piece of writing in my book--no pun intended) out of it.
Please note that I have edited the conversation of meaningless personal banter and have done some light copyediting. I also have only supplied the initials of some of the participants to protect the privacy of those besides myself, Cedar Riener, and the original author of the article, Stephanie Tatel.
Here it is:
S.L.: After doing a lot of research, my partner and I decided not to get most of the traditional vaccines for our kids. I am more than a little put off by the author's dismissive tone when she attributes decisions like ours to "fear" and "unproven danger." I am exceedingly sorry that her son has leukemia, but can't begin to understand why she thinks I should take that into account when deciding what is best for my children.
Rachel Levy: Well, um, with all due respect, I think the bigger point is that when deciding what's best for the health our children, some of the decisions we make affect others while some don't. For example, I could decide not to brush my kids' teeth or get them fluoride treatments at the dentist's office. That's probably ill-advised, but I could do it without putting anyone else's health at risk. Unfortunately, when people decide not to vaccinate their kids, it does put the health of those in their community and greater society, especially those who are younger, older, weaker, and more vulnerable, at risk. And I 'm sorry, but I haven't seen any research that adequately proves that taking that risk is medically necessary or ethically acceptable (with the exception of the risks vaccines pose to those with weak or non-existent immune systems).
E.M.: Just as living in society means obeying rules (red is stop, go is green) it also involves being responsible--herd immunity is not a myth.
Cedar Riener: I think what Stephanie is referring to in the "fear and unproven danger" is that the scientific data is resoundingly in support of vaccines being worth the very small risk that they pose. Maybe "fear" is an emotional exaggeration of the decision process of those who do not vaccinate. However, if you re-frame that decision as "doing one's research and coming to the conclusion that the risk associated with taking the vaccine is greater than the risk of not taking it" then you still have to somehow describe it as rejecting the data and evaluation of the scientific and medical community in favor of some other source of evidence. Whether you apply emotional words such as fear or distrust, or others that might be more neutral, what a decision to not vaccinate amounts to is a rejection of the modern scientific method and an acceptance (and prioritizing) of other evidence, whether it be an ideology, or anecdotal evidence. In other cases, this rejection of scientific consensus (say, with evolution and intelligent design) does not have direct consequences on the safety of our community, but this does. What's more, the more people that reject the scientific consensus, the more dangerous it is for the rest of us. I don't see how there is any doubt in that. Perhaps the better analogy is environmentalism and climate change. Many who reject environmentalism also doubt the science, as well as the importance of considering common goods in individual decisions. In this way, I don't see how the logic of environmentalism differs in any important ways from the logic of vaccination.
S.L.: First of all, thank you for a mutually respectful discussion. I wish the author of the article in question had a similar approach.
What I hear you saying is that vaccines should be mandated in the name of public health. That suggests that the risk posed by those of us who decide not to use certain vaccines is so dire that parental rights should be overridden. Clearly, I disagree.
Some vaccines we get for our kids, some we don't. We did not make this decision because of something Jenny McCarthy said on Oprah, or even based on discussions with friends and family. We did our own research and had long conversations with our family practitioner. We read accounts both in support and against the notion of vaccinations and made, what I believe to be, informed decisions.
There is scientific evidence to suggest that certain vaccines are not worth the associated risk, or are superfluous in modern society, and, yes, there is scientific evidence to suggest that parents like us are nothing more than irresponsible.
My kids are vaccinated against pertussis, but we do not get them flu vaccines. When friends of our son had the chicken pox we sent him over there to play. You might make different decisions for your kids and I respect that.
Are couples who decide to have home births attended by midwives rejecting "modern scientific evidence"? Perhaps you'll say that such a choice may not pose a public health risk, but might traditionalists not argue that it puts the baby's well-being at unnecessary risk?
I believe we all have a responsibility to the society-at-large, but my primary responsibility is to my children. My parenting decisions must be informed by their affect on society, but not dictated by them. As of yet, I have not heard compelling enough arguments, or seen compelling enough data to suggest I am being irresponsible or overly cavalier.
Rachel Levy: Just so we're clear, I am not including flu shots in my discussions. As far as I'm concerned, the jury is still out on their effectiveness and on their benefit to general public health.
I don't think that vaccinations should be mandated. But I do think that those who don't vaccinate (unless they demonstrate a medically necessary reason) should be required to take precautions when coming into contact with the general public and that perhaps they should be prohibited from taking part in public schools.
I'm not sure the associated risks you speak of have been established. If you can cite valid, scientifically rigorous studies that show they have, I would love to read them. Which accounts and studies did you read to inform your decisions? I don't care how many you read--I care about their quality. And I don't trust accounts in lefty versions of Fox News, even if they were written by educated liberals who voted for Obama.
Why are certain vaccines superfluous in modern society? Because we eradicated those diseases by way of vaccination. Those diseases still exist in less developed societies. Unfortunately, thanks to people who don't vaccinate, diseases like polio are making a comeback even in societies where they have been eradicated. Is that really what we want to return to?
I think the homebirth/ mid-wife analogy is not particularly instructive to the vaccination debate. For one, most midwives are professionals who use science/biology/medicine to inform their practices. And I have not read enough evidence that midwife-attended births cause any risk to the baby being born. Even if it does,we're talking about a decision/action that affects the health of population as a whole, so I'd ask before we go further that we stick to that topic or to relevant analogies.
S.L.: I thought I WAS sticking to the topic and citing a relevant analogy. Obviously you disagree. Furthermore, while I did vote for Obama and tend to exist left of center, I do not generally watch TV news, nor do I rely on Rachel Maddow to make my parenting decisions for me.
Since I'm at work and don't have access to my library, I will have to respond later to your question about my research sources. There are two, however, I remember off the top of my head:
1. Our family physician with whom we had numerous extended conversations. I assume he counts as a "professional who use science/biology/medicine to inform [his] practice."
It feels like your position is that there are not two valid sides to this debate.
Clearly, disease is still rampant in underdeveloped nations and I should have clarified my point about "modern society." If my family was living in a place with a much different level of sanitation, infrastructure, medical care, and public health oversight, I'm sure we would have gotten more of the vaccines. As I said, we chose to get some vaccines, but not others.
S.G.M.: S.L.- ALL the arguments you made are on a personal level. You weighed and measured the risks and benefits for your own children and decided not to vaccinate.
What Stephanie writes about in her article, the reason I posted this article and what I believe Rachel agrees with is that there is another element that should be included in our decision to vaccinate. We must think of others and society at large.
In fact, one can even infer from your last paragraph that disease is NOT rampant in the United States. But at various times it was. The reason it isn't now is because of vaccinations. That is why public schools require students to be vaccinated.
I strongly believe that we ALL have a responsibility to think beyond the walls of our own homes.
R.M.: Hi there. Imagine what our society might have to contend with if a majority of children do not receive vaccines. Then, the safety net will have disappeared. In other words, by feeling safe in a choice not to get vaccinated one is relying on the immunity of those who chose to do so. There is some tipping point, however. Is that acknowledged andidentified by any of the research relied upon by those choosing not to vaccinate their kids? If, say, 25% of the population is not vaccinated, would it then no longer be considered "safe" not to be vaccinated? Or is it 10%? Or 2%? I'm not an epidemiologist (in fact, I can barely spell it), but I do know that one of the primary reasons the flu is so dangerous every year is because the virus called "the flu" is brand new, every year. We don't possess the antibodies necessary to fight it. And so it spreads from one system to the next, which it must do in order to flourish. (This is the only reason Ebola virus hasn't brought about the apocalypse: its victims don't survive long enough to spread it.) I note this not to support flu vaccines, but to demonstrate what happens when our population is invaded by a virus against which it has no defense. According to the CDC, the flu kills 36,000 people, every year on average, in the U.S., a place where "employees must wash hands."
Hand-washing, sneezing into an elbow crook, soap and other simple measures are invaluable defenses against infectious illnesses. But look out on your left for that un-vaccinated person thoughtlessly sneezing in your direction!
Rachel Levy: My point about lefty versions of Fox News was not meant to put down people with left-of-center views who voted for Obama. (I voted for Obama and my views are much further left of his policies) or even to put down all television news--the News Hour is fantastic. And I like Rachel Maddow. Lately, though, it seems to be trendy among some left-wing educated liberals to eschew things like, oh, the government, public education, science, and vaccinations, which is interesting because Fox News and the people who watch it eschew things like the government, public education,vaccinations, and science, too... (I am meandering illogically off topic, I know).
Back to the topic at hand. I'm not going to pussyfoot around this: it's true, right now, I don't see that there are two valid sides to this debate. I also don't believe there are two valid sides to the Creationism vs. Evolution debate, or the Homosexuality as a Choice vs. Homosexuality as Innate debate, or to the World is Flat vs. World is Round debate, either. And I've never believed that the idea you get could AIDS from hugging or kissing someone who had it was valid. So far, I think that the arguments against and the evidence used to argue against vaccinations are comparably flimsy, cause comparable ignorance, and spread comparable misinformation.
Which is not to say that the vaccination debate shouldn't occur or that that parents should not know about and talk about the risks or side-effects or that they don't exist at all. Or that there shouldn't always be people questioning the necessity and benefits of vaccinations. A healthy society is a skeptical society.
S.L.: I respect the three of you and will give thought to all that you say.
I am no ideologue and don't "eschew" any of our institutions, including science and medicine. I do, however, try to consider all available alternatives as much as it is realistic to do so.
I am aware of the "herd immunity" debate, and suppose that on some level I am taking advantage of it. On the other hand, I have had exactly one flu shot in my adult life. "One" also happens to be the same number of times I've had the flu. I also believe that it was the development of vaccines coupled with advances in sanitation, food safety, preventative care, etc., that has led to a reduction in disease.
I do consider the world outside of my insular family when making decisions and taking actions. It is something we stress to our children and one of the reasons they are at a Jewish preschool. Call it tzedakah, tikkun olam, or just doing what's right and realizing that you are part of a whole. Is our decision regarding vaccinations in opposition to this? I've never thought so. I'm not sure if this conversation will change that, but I will definitely bring it up with my partner.
As my son has gotten older, we have chosen to catch up on some of the vaccines that we skipped when he was little and will probably do the same for our younger children. Perhaps, as I look at this more closely, it is the proscribed schedule of vaccines for the very young and the sheer volume of vaccines to which I object more than the general idea of vaccines.
I also have to admit to being weary of the swine flu cautionary tales. Perhaps, I am over-compensating in reaction to what I see as reactionary. In talking to my doctor regarding whether to get H1N1 vaccines for our kids, he suggested that much of what we are being served is over-hyped.
Rachel Levy: With our third child, we decided to space out the shots a bit more than is normally done. I've been told this wasn't necessary, but it made me feel more comfortable.
I think you and your doctor are right to wonder about the swine flu--it's all so new. We are puzzling over that decision ourselves, although we are leaning towards getting the vaccine, both for swine and the "regular" flu. I found this article on the subject to be helpful and informative:http://www.theatlantic.com/doc/print/200911/brownlee-h1n1.
Stephanie Tatel: Hello, friends. I have hesitated to weigh in here, but R.M. asked a really good question about how high vaccination rates must be to provide herd immunity - I have heard that for measles and meningitis, for example, you need at least 95% of the population vaccinated. I am attaching a great article from the CDC website that describes what the consequences would be in our nation if people stopped vaccinating against infectious diseases such as MMR, pertissus, meningitis, polio, among others. It really sends home the message that this is a PUBLIC HEALTH issue, not simply a matter of personal choice. Also, we have to remember that although we enjoy low rates of these infectious diseases in comparison to other countries in particular the developing world, our borders are fluid: Most measles outbreaks in the USA have come from someone getting infected overseas and bringing it back to a community where there is a certain threshold of un-vaccinated people. This is also true for polio. This article will also provide more links to other very informative and reliable articles from the CDC: http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm#measles.
J.F.:Hey everyone. My wife and I were just reading this discussion and wanted to weigh in on one part of this debate that hasn't been discussed. I have to second much of what S.L. wrote: the decision to vaccinate, or in our case not fully vaccinate is not one we make lightly or on a whim. The risk of disease for our children and public health is important to us, but there is a risk of injury from vaccines; there's a reason there is a fund that exists to compensate children injured or killed by vaccines. And while many people believe the question has been resolved on whether vaccines play a role in autism, for many in the autism community, the jury is still out because there have not been any/enough valid studies on this issue. We know many parents of children with autism who saw their children regress into autism just days after vaccination. One of our son's doctors informed us that she absolutely believes that our son's seizures were brought on by a particular vaccine (his seizures cause him to stop breathing so they are life threatening if they are not controlled). We believe a major culprit in people's fears over vaccination is the drug companies' role. People are suspicious of companies that profit from mass vaccinations and use dangerous preservatives such as mercury--this has finally been removed from most vaccines, but the fact that it has been removed indicates some admission that it was not safe to use--and it still widely used in the flu vaccine. There are other adjuvants used such as aluminum and formaldehyde which bring up health concerns. My point is, with all that modern science is capable of, blame should not be directed at parents who are legitimately concerned about their child's well-being, but rather at the drug companies who haven't come up with a safer way to vaccinate.
Rachel Levy: Hi J. I am sorry about your child's seizures and about your friends' experience with autism. If one of my own children seemed to be affected negatively by a vaccine, I might be singing a different tune right now. The only thing I can say is that I don't think anyone here is denying that vaccines aren't without their side effects or real dangers. But the children of people who opt not to vaccinate (unless they have a medically solid reason to do so) aren't any more likely to experience those side effects and rare reactions than the children of those who do vaccinate are; we're all taking the same risks. And the main result and side effects of not vaccinating for the major diseases, unfortunately, are contracting the major diseases on a mass scale. And, yes, the drug companies are not always (or even usually) benevolent actors. I can understand why you'd say anger should be directed at them and I can understand that drug companies have done much to erode the public's trust. But don't the people who work for the drug companies get their children vaccinated, too?
I do want to address the mercury concern. I posted this article on my fb page too, which led to another lively comment thread. I learned this: "Thimerosal is ethyl mercury, not to be confused with methyl mercury. Methyl mercury builds up in the food chain, and potentially in your body, and causes neurological damage. Ethyl mercury gets cleared from the body pretty quickly. Also, to put things in perspective, there is 28 mcg of mercury in a tuna sandwich and about 25 mcg in a flu shot." I also learned that The Children's Hospital of Philadelphia has a great website about vaccinations: http://www.chop.edu/service/vaccine-education-center/vaccine-safety.
S.L.: I've been thinking about this conversation a lot since signing off yesterday. I wonder if the "herd immunity" aspect of it comes down to this: At what point should decisions about the greater community override decisions about one's own family.
I assume you would all concede that our first responsibility as parents is to our children. So if one firmly believes that skipping certain vaccines is what is best for one's children, but vaccinating them is what is best for the larger community, then doesn't the community benefit have to be fairly extreme to trump priority one? Can we say that there is now a clear indication of such?
Rachel Levy: It's clear that if over 5% of us stop vaccinating that these diseases will return on a mass scale and cause a massive public health crisis. So, there may not be an extreme community benefit right now, but if over 5% of the population isn't vaccinating, then one will soon be created. The consequences of not vaccinating a certain percentage of the population will be that many, many people will get very, very sick and that many, many people will die.
Yes, some people should be medically and ethically exempt from vaccinations: people with compromised immune systems, those likely to have allergic reactions, those who have already had extreme reactions (like J.'s child) and probably the siblings of those who have had allergic or extreme reactions.
Otherwise, it's not a matter of proven personal necessity--you're deciding that your children are more important than someone else's children. Because beyond the categories I mentioned earlier in this comment (and perhaps some others I've missed), we're all equally likely (or highly unlikely) to experience an extreme reaction to the vaccines. Tell me,why is one child more important than another? Why is one child of more value? How do you decide that? Why does he/she have more of a right to avoid the risks of the vaccine than someone else?
And, your belief, no matter how strong, that your child will be negatively affected by the vaccine doesn't change the actual chance that your child will be negatively affected by the vaccine. The chances stay the same, no matter what you believe. Let's say there's one umbrella for three of us who are outside. Only one person can fit under the umbrella. You say you should get the umbrella because you strongly believe that it's going to rain. It's cloudy. I think it might rain, but I'm not sure. In fact, what we believe doesn't change the actual chance or likelihood that it's going to rain. And if it does rain, I'm going to get just as wet as you are. Let's say that there's a relatively high chance that the third person is going to have some pretty dire consequences if it rains and they get wet, but we wouldn't have any consequences beyond experiencing some discomfort and a very, very small chance that we'll catch a cold, and even smaller chance that we'll catch a cold and then get much sicker. Yes, that third person should be granted the umbrella and the two of us should be willing to get wet and take the tiny risk that some other factors could come together to make us sick.
Cedar Riener: I agree with S.L. in that at some level, this is an instance of the commons dilemma (in which short-term self interest runs counter to long term community interest). However, I think in this case the actual risks and probabilities are crucial. That is, thinking philosophically ignores the importance of the concrete details in this particular matter. The short term personal risk is small and the long term community risk is great. Ultimately a large problem is the disagreement of the scale of these two risks. And despite the fact that I am not in general a fan of drug companies, I am adamant that the source of evidence should be properly conducted studies, not anecdotes, or personal experiences. We can agree that placebo-controlled, double-blind studies are the standard for deciding the safety and efficacy of drugs. The reason for relying on this method is that bad things happen to people on the placebo, and people spontaneously recover on the placebo, and left to our own devices, many people would interpret individual instances as being caused by a placebo, given our penchant for finding patterns where there are none.
Ultimately, the chances of getting autism from a vaccine (which have not been confirmed, despite many studies trying to find a connection) must be compared to the risk of getting the disease that it vaccinates against (like pertussis, which is experiencing a resurgence). Unfortunately, as J. points out, for many, this does come down to a lack of trust. Scientists, who may be funded by a drug company, do a study on vaccines using data from 100,000 people, use accepted methods and evaluation procedures and publish their findings in a top peer-reviewed journal. Many readers are hung up on the fact that the study was funded by a drug company rather than the methods of the study itself.
I think this issue also cuts deeper than just distrust in drug companies, but also the lack of trust in any journalistic institution. We may decry the rise of Glenn Beck, but if we on the left had a responsible media source that we trusted, we would all vaccinate our kids, because anyone who actually knows the science in this case would tell us that there is no contest, we should vaccinate our kids.
Anyways, I'll sign off, but I'll just add that pseudoscience has always been popular and well-funded, but that is no indication of its grasp of the truth.
S.L.: Cedar, I think that for me there is one other aspect of weariness at work. I feel like there is a tendency in this country to over-medicate our children whether it be antibiotics or ibuprofen and I guess that the plethora of vaccines recommended to us seems like part of the same dynamic. I am in no way adverse to giving my children prescription meds if required, just as we have chosen to get them certain vaccines (pertussis is one example), but there are other lines of defense that seem under-utilized and often ignored.
Cedar Riener: S., I absolutely agree. This is another of my frustrations. There is a wealth of rigorous research on the bad effects of stress, or the influence of diet and exercise on health, but we are constantly looking for a pill to solve whatever ails us. I guess in this case that is why I refer to the medical consensus, which in this case seems to point to many vaccines being more like the prescription meds, but even more so, since the general decision to administer vaccines to the whole population passes through many more levels of consideration and evaluation than one doctor's decision to treat one child with a particular med.
It seems like my personal decision in this case has such clear public health consequences (and a lack of personal consequences), while my preference for local organic food doesn't have quite that direct effect (although there are certainly eventual public health repercusions of our food choices).
E.M.: As a hospital administrator in the NYC public hospital system, I have access to "in the minute" information from the NYC Dept of Health.
I say that because I saw a notice today that there is an outbreak of mumps in a single Brooklyn neighborhood - over 55 cases so far. This is what can happen when herd immunity breaks down!
I don't think people should depend on others to maintain the health of the community - it is a communal responsibility.
Stephanie Tatel: Thanks for that great example of how the herd diminishes. As far as the link to autism, the original Wakefield study that claimed a link has been totally discredited and all of his co-investigators have recanted their statements on that study, and subsequently at least eight valid and reliable studies have come out since then disproving the connection. Now, are vaccines, like ANY MEDICATION, without risks? No, but no one, not even ME, is saying that. Here is a link to the National Vaccine Injury Compensation Program that J. mentions, http://www.hrsa.gov/Vaccinecompensation/statistics_report.htm, which details by year the number of people compensated for their medically proven vaccine-related injuries. You will see that ALL cases of autism were dismissed, meaning there was no medical evidence for a connection between the vaccine and a child's autism. Are there sometimes injuries? Yes, but they are far outweighed by the number of people who get very sick (and sometimes die) from vaccine-preventable infectious diseases. Are vaccines 100% effective? No, but that has been known about vaccines since they were invented. BUT it is TRUE that vaccines have in some cases such as small pox, eradicated disease, and in others such as measles and pertussis reduced their incidence significantly. You cannot argue with that fact. But now with the increasing number of people who are not vaccinated we are losing that safety net. And now one more word about risk and medication: NO medication is risk-free, and I understand the consequences of taking those risks. When my son was diagnosed with leukemia, I was thrilled, to say the least, that modern medicine offered a treatment (with NO guarantees, mind you, and PLENTY of risks.) One of his medications, one very crucial chemotherapy agent, caused him to have a massive stroke. He won't get that drug again. It, along with many other drugs that he has had and will have, carry risks, risks that our doctors tell us about. We assumed those risks. You might say, "Well I assume the risk of disease in my child when I chose NOT to vaccinate," but I am merely asking the readers of my article to keep in mind that they are also assuming the risk of disease to other children. I am not comparing chemo to vaccines--do not make that mistake about what I am saying. I am merely saying that no one is arguing that there are not risks associated with medication, such as vaccines. This is NOT the point I was making in my article, but rather the effect to the community at large of a diminishing herd immunity with regard to vaccine-preventable diseases; this has been very clearly established by the many recent outbreaks of vaccine-preventable disease in non-vaccinated people. You can look up these cases on the CDC website I provided earlier. For the remainder of this discussion, can you PLEASE provide some sources of information for your position? Otherwise it's just hunches and intuition. And please let me reiterate, I don't dispute that there are risks involved in medication and I don't dispute that most people, myself included, think of our own children first. I mention these two things because in every contrary response these two elements are cited over and over again to the point that the discussion is no longer being furthered with regard to herd immunity and vaccine-preventable illnesses.
E.M.: I also want to mention that in 1964 I lost my best friend to German Measles which progressed to encephalitis. She was a teacher who most likely contracted it from one of her students. That was the last big GM outbreak before the vaccine for GM was released. That is what a "harmless" childhood disease can do. As I said, I believe in the effectiveness of herd immunity.
Rachel Levy: What a great and vital discussion this is. I think this will be my last comment on this thread. I am wondering what we can do to get the members of the anti-vaccine movement to listen to the science. I think herbalists know a lot about herbal medicine, which is valid for some medical treatments, but immunologists and other scientists who study infectious diseases are who we should be listening to on protecting ourselves from infectious diseases and on maintaining public health. I have found in these conversations that when I present the science over and over again and hit a wall, I turn to engaging the ethical considerations (hence, the zany umbrella analogy), which I realize can be distracting and unproductive from the primary consideration, which is the science. With vaccination and public health, we have a very small margin of error and only a few people should ethically and medically be allowed to take advantage of that. My question to people who don't vaccinate is why should they be able to take advantage of the safety net? What is their medical reason? And what is their ethical reason? Short-term self interest and exceptionalism do not provide a solid ethical justification. I suppose the problem with that logic is that I am assuming that members of the anti-vaccine movement acknowledge the following: that there is only a small margin of error, that the serious risks associated with vaccinating are infinitesimal, and that in order for us to maintain our current level of public health as many of us as possible must participate in vaccinations. Also, ultimately, in being selfish and not vaccinating, these actors are actually acting in opposition to their own interest, and the interest of their children because if we don't all participate, they will get sick and die too. But in order to truly weigh these ethical considerations, they have to buy into the science first. So, back to my initial question, how do we get people who are in many cases rational, educated, modern people to trust and accept the science?
Because if you're basing these decisions on a belief system (you spiritually believe that the toxins in the vaccines have a high chance of doing your child serious harm) rather than on science and logic (which has proven that vaccines in the vast majority of cases do not do serious harm and that, in fact, not vaccinating on a group scale does do serious harm), then you're adhering to fundamentalism and behaving as a fundamentalist would.