Diagnosis by Dr Google Dr Rachael A Dunlop PhD FSB
Why do parents fear vaccines?1) Absence of visible vaccine preventable disease i.e., vaccinesare a victim of their own success2) Without fear of disease the hypothetical vaccine risk or smallrisk become elevated3) Misinformation confuses parents, leadsto delaying vaccines and can have tragic consequencesPineda D et al., Pediatrics, 2011 (free pdf here).
Why do parents fear vaccines?Three main sources for information; health professionals, the media, theInternet1) Health stories constitute 11% of nightly news but many contain errorsthat can harm viewers (1)2) The media‟s favourite practice of “balance” in health and science storiesseeds doubt and confusion3) BECAUSE CELEBRITIES(1) Pineda D et al., Pediatrics, 2011 (free pdf here)
Can you trust the Internet? • Dr. Google misdiagnosed 25% of women • 50% wrongly self-medicated (2) • 1/2 Australians use Internet to self-diagnose (3) • 1/3 investigate medicines on the web (3) • Online health information seekers examine the ﬁrst 10 search results 97.2% of the time • Are they getting the right/accurate information?(2) UK health survey(3) Bupa Health Survey, Aussies turning to cyberspace to self-diagnose, Feb 9th 2011
Is the Internet to blame?• High quality information competes with equally availablemisinformation• “Current postmodern medical paradigm” – individuals play an activerole in their healthcare• “Do your own research!” “Empower yourself!”• Postmodernism allows for information to be interpreted in variousways – not “wrong” but “another way of knowing”Betsch and Sachse, Vaccine 30(25):3723-26 (2012)
Is the Internet to blame?• An analysis of YouTube videos found that 32% opposed vaccination,and that these had higher ratings and more views than pro-vaccinevideos• As little as 5 mins on an anti-vaccine site could influence decisionsmonths down the track• When you ring a bell, it can‟t be “unrung”Kata, A. Vaccine, 2010 1709-1716.
Is the Internet to blame?• Parents who exempt children from vaccination are more likely to haveobtained information from the Internet than parents who have their childrenvaccinated• McCarthy learned everything about autism from "the university ofGoogle."• Parents empathize with her; she doesnt need science because sheobserves her son, Evan, every day. "At home," she writes, "Evan is myscience." “Evan is my science." – Jenny McCarthy
Is the Internet to blame?• Anti-vaccination web-sites express range of concerns related to vaccine safety andvarying levels of distrust in medicine.• Rely heavily on emotional appeal to convey their message. Issues raised % sites safety and effectiveness 100 alternative medicine 88 civil liberties 88 conspiracies/search for 100 truth misinformation/falsehoods 88 emotive appeals 88 Kata, A. Vaccine, 2010 1709-1716.
Tactics and tropes used by anti-vax movement• “I‟m not anti-vaccine, I‟m pro-choice/safe”• Cherry picking/skewing the science of vaccine safety and efficacy.• Create legitimacy for unfounded or discredited theories of harm, pseudoscientific conferences, (eg AutismOne) give veneer of legitimacy. • Shifting the goal posts and the villain, MMR to thimerosal to other “toxins” and more recently “too many, too soon”. • Censoring dissent, delete comments or restrict access to events, creating virtual or real echo chambers. • Attack the opposition, e.g., lawsuits against physician Paul Offit or journalist Amy Wallace.Kata, A. Vaccine, 2012 May 28;30(25):3778-89.
Tactics and tropes used by the anti-vax movement• Anti-vaccine organisations also use names designed to obscure their objectives, eg., Australian Vaccination Network, Vaccine Information Service etc.
Because CELEBRITIES “When people in the public eye give opinions about causes of disease, cures, diets, or products we should buy or avoid, that‟s it. Their opinion goesworldwide in seconds. It gets public attention and appears in every related google search for months. So if it‟s scientifically wrong, we‟re stuck with thefall-out from that.....We‟d like to see more celebrities checking out the science before they open their mouths and send the wrong thing viral.” Lindsay Hogg, Assistant Director, Sense About Science, UK.
The cult of celebrity “I do believe sadly its going to take some diseases coming back to realize that we need to change and develop vaccines that are safe. If the vaccine companies are not listening to us, its their f___ing fault that the diseases are coming back. Theyre making a product thats s___. If you give us a safe vaccine, well use it. It shouldnt be polio versus autism.” Time Magazine, April 2009.
“I love botox, I absolutely love it, I really do think it‟s a savior”
The HON Code• Health On the Net foundation founded to encouragedissemination of quality health information for patients,health professionals and public• Certification is an ethical standard aimed to indicatequality health information• Oldest and most used code on the „Nethttp://www.hon.ch/
What to look for• Disclosure of ownership/source• Transparency of sponsorship (who pays?)• Quality of information– Authority of sources; do experts review the info? What are their quals?– Attribution; cite scientific evidence/references (beware misleading websitescan cite legitimate sources inaccurately)– Accuracy; objective, scientific information– Currency; is the info current?– Stds of writing/editing should be high• Completeness of information; cherry picking?• Do anecdotes trump science? If yes, then less likely to be reliable.
What to look for• The WHO conducted analysis called Vaccine Safety Net• Websites providing information on vaccine safety which adhere to goodinformation practices were assessed• Criteria wereEssential criteria i.e. with respect to credibilityImportant criteria i.e. with respect to contentPractical criteria i.e. with respect to accessibilityDesired criteria i.e with respect to designhttp://www.who.int/immunization_safety/safety_quality/approved_vaccine_safety_websites/en/index.htmlor http://tinyurl.com/7rkuskt
Vaccine safety web sites meeting credibilityand content good information practices criteria
Websites you can trust• The CDC http://www.cdc.gov/vaccines/• The WHO http://www.who.int/immunization/en/• National Network for Immunization info (NNii)http://www.immunizationinfo.org/ or nnii.org• Vaccine education centre at the Children‟s Hospital of Philadelphia;vaccine.chop.edu• Immunization Action Coalition; www.immunize.orgPineda D et al., Pediatrics, 2011 (free pdf here).
Websites you can trust• WebMD• Medline Plus - a combined effort of the National Library of Medicine andthe National Institute of Health.• NHS Choices (UK site) – good general purpose site.• Google Scholar (only issue is some papers are paywalled)• PubMed (paywalls)• xavfax.me