Having recently discovered a veritable Library with Doctor Moon of antivaccine misinformation and quackery known as Modern Alternative Mama's blog, Facebook page, Twitter feed, and YouTube channel, I couldn't resist taking one more drought from the same well. It is, after all, almost Christmas, and truly, as far as the blog is concerned, the discovery of Kate Tietje, a.k.a. Modern Alternative Mama, was an early Christmas gift that could not but be opened immediately. Besides, with Christmas coming up in a couple of days, after today I plan on taking a brief blog break until Friday, with the possible exception of a recent recycled & tweaked post (to make it more...Insolent) from my not-so-super-secret other blog that I'd like to expose to a greater world. Merry Christmas and Happy Holidays!

So what am I referring to? Well, it's not as old as the post I deconstructed yesterday, but it's just as nonsensical. Worse, it's a listicle, a particularly annoying link-baiting form of post that generally irritates the heck out of me for its obviousness. On the other hand, most listicles are not as long as this, rarely going above 10 items. It's entitled 15 Things We Need to Stop Saying in the Vaccine Debate, but it might as well be titled 10 Things I Hate About You, the "you" being pro-science pro-vaccine advocates of science, medicine, and skepticism who regularly criticize the antivaccine movement; you know, bloggers like yours truly. Many are straw men, misrepresentations—I'm not sure if intentional or otherwise—of what those of us who counter what antivaccinationists say. Others are science-free ignorant rejections of science along the lines of Tietje's toddler-like attitude of, "I'm not going to vaccinate and you can't make me."

First off, I will say that I actually agree with one item. I don't think that any but rare trolls on "our" side ever say something this stupid, but it wouldn't surprise me if now and then the odd obnoxious git on "our side" says something this monumentally stupid. I'm referring to item #1: “You don’t love your children if you don’t vaccinate.” I've never said it. I don't recall ever having heard anyone anywhere associated with promoting vaccination and countering the pseudoscience, anti-science, and general misinformation of the antivaccine movement actually say such a thing or seen anyone write such a thing. However, I don't reject out of hand that on some rare occasion, someone might have said something. If that's the case, sure. Knock it off. Antivaccinationists love their children too. They might so misinformed or have such denialist tendencies that they willingly (some enthusiastically, like Tietje) leave their children unprotected against vaccine-preventable diseases, but they think they are doing what is best for their children.

Item #2 is "Shame on you." Tietje is clearly very unhappy that some try to use shame to persuade antivaccinationists to vaccinate. While I am ambivalent about the use of shame against the antivaccine movement, my reason is more one of practicality (it probably doesn't work) than because I think it's wrong (or, as Tietje puts it, "rude") to try to shame an antivaccinationist. If a parent is "on the fence" or potentially persuadable, shame is not the first tool that should be pulled out of the armamentarium, although parents who are on the fence are the ones for whom shaming might have some effect. So I don't rule it out entirely. On the other hand, when I encounter someone like Tietje, who is beyond persuading and regularly delivers Mount Vesuvius-like lava flows of burning stupid, I have no problem with telling her she should be ashamed of herself. She won't listen, but she's not the intended audience. The "on the fence" contingent is.

Next up:

#3: “You’re putting your child at risk.” There is no way to eliminate all risk. Choosing to vaccinate is a risk (an immediate one). Choosing not to vaccinate is a risk (a future one). Getting out of bed in the morning is a risk. Anything at all places your child at risk.

This "logic," such as it is goes beyond Vesuvius-like eruptions of burning stupid and straight into supernova explosions. "Anything at all places your child at risk"? Seriously? Why not, then, fail to use child car seats and then later seatbelts? After all, seatbelts can cause serious injury. Unlike the case for vaccines, we know that people suffer seatbelt injuries. But when weighed against the number of people saved, there's no contest. Buckled up and (if small enough, secured in a car seat), a child in a major car crash has a much higher chance of surviving and a much lower chance of suffering serious injury than unbuckled. One could easily use Tietje's "logic" not to do anything at all ever to prevent disease, injury, or other adverse outcomes. Heck, why get term life insurance? If you're reasonably healthy and not over 60 or 70, your chances of dying in the next decade are pretty small. Take the chance! Or what about health insurance? Why use it if you're younger than middle-aged? Your chances of serious illness are pretty low if you're young and healthy?

The key is that not all risks are created equal. Some are more than others. Getting out of bed is a minuscule risk, for example, compared to getting in your car and driving in traffic. Also, the risk of vaccine-preventable diseases is low right now because vaccine uptake, overall, is high, albeit with the exception of areas populated by know-nothings like Tietje who don't vaccinate. If more people didn't vaccinate, that risk would increase, which brings us to:

#4: “You’re putting MY child at risk. You should vaccinate to protect babies/elderly/immunocompromised.” This is really two separate arguments. First, if you believe that not vaccinating places your vaccinated child at risk, then why do you trust vaccines? If they work, then you don’t have anything to fear. Second, babies, the elderly, and immunocompromised people are at risk (potentially) from anyone who is sick. Whether they are vaccinated or not, and no matter which illness they have. It’s up to the parents of those people (or the people themselves) to protect them, not ask everyone around them to do it. Finally, we don’t ask others to make medical decisions that could be risky to benefits ourselves. We each make the medical decisions we feel are right for us, and take on the risk we feel comfortable taking. We can’t, and shouldn’t expect, to control what others do.

This is basically a rehash of her self-centered arguments from the previous post of hers that I discussed, the one that basically says, "I won't vaccinate and you can't make me." As I discussed then, the primary reason to vaccinate isn't to protect other children or to protect the immunocompromised. Those latter two groups are additional reasons that vaccination is important, but, above all, vaccines protect the child who is vaccinated. Secondary, but important, benefits are to protect other children through herd immunity and those who can't be vaccinated. Most parents who don't vaccinate realize that they are not upholding their part of the social contract and tend to be at least a little conflicted about it. Antivaccinationists as militant as Tietje harp on this issue because likely, deep down, they know they are acting as parasites whose children's protection against vaccine-preventable disease depends upon the parents who do vaccinate.

Next up is #5: “Mothers in third world countries would be grateful to have vaccines.” This is a bit of a straw man in that I don't recall anyone ever having said this, but Tietje's response is astounding, namely that these mothers would be grateful to have clean water, plentiful food, access to medical care, and a safe place to live, ranting, "A person literally cannot live without safe water. People can and do live without vaccines all the time." Yeah, perhaps so, but their chances of getting sick and dying from vaccine-preventable diseases are much higher without vaccines. Many will live, but a lot will die as well. Just because it's possible to live without vaccines does not mean it's desirable to do so. Tietje, however, doesn't see it that way:

Plus, those mothers in the third world don’t have any way of doing research. They don’t have access to information. All they know about vaccines is what they’re told. If doctors come into their villages and say, “You need these. They’re amazing. They’ll save your child’s life.” Of course they are going to want them! They don’t have access to another viewpoint!

Except that, sadly, many such populations are prone to a different sort of antivaccine fear mongering, such as claims that the tetanus vaccine is a secret plot to sterilize their girls. Tietje then exults in her ability to "have access to science and information, as well as the ability to make my own decisions about my family’s medical care." Too bad her access to the Internet leads her to major Dunning-Kruger effect action:

#6: “You just don’t really understand science or you would vaccinate.” This is so unnecessary. It’s an elitist point of view. The only way that a person would opt out or disagree is if they’re too stupid to get it? No. There are parents on both sides who might have made a choice because they didn’t look into the facts much — maybe their friend or their doctor told them to, so they just went along with it. But there are lots of people who’ve done incredible amounts of research and have come to a careful conclusion. Saying that their research “doesn’t count” because they don’t have a science background is just insulting — and wrong. People are smart enough to do their own research. They truly are. A piece of paper that says so makes no difference. (Plus, there are lots of doctors and other medical professionals who question vaccines or don’t vaccinate! And they clearly understand the science.)

No, it is not "elitist" to say this. It is a simple and accurate pronouncement of Tietje's lack of understanding of science and how little antivaccinationists understand vaccine science. Moreover, Tietje's research actually doesn't count, as much as she tries to claim that it does, because, based on its content, it is obvious that it comes from dubious sources spouting pseudoscience and misinformation (which she parrots). A key feature of the Dunning-Kruger effect is that a person suffering from the effect is ignorant about a subject but thinks she is not, indeed might even think she has become an expert in it. In other words, Dunning-Kruger involves a massive overestimation of one's understanding of a topic or competence at a task, which is in marked contrast to true experts, who tend to underestimate their knowledge and competence. In Tietje, the Dunning-Kruger gets to the point where she thinks her University of Google knowledge trumps the knowledge of physicians and scientists (see item #7, which I won't discuss but flows from this item). To understand medicine, immunology, vaccine science, and infectious disease requires a lot of research. As I've described many times, frequently it is the intelligent, college-educated people, some even with advanced degrees, who are prone to Dunning-Kruger, because they grossly overestimate their ability to "pick up" an unfamiliar subject on their own.

Quite frankly, I've concluded based on perusing her writings that Tietje herself is too stupid to get it. I could be wrong, but, if I am, certainly her writings won't disabuse me of that conclusion. However, it's a straw man to say that we argue that people don't vaccinate because they're too stupid. Again, the "best" (i.e., the most effective) science denialists are usually the ones who are the most intelligent, the ones with advanced degrees. Denialism is not a product of lack of intelligence, although, as Tietje shows, there are clearly exceptions.

Next up is #8: “Just walk through a graveyard and see all the babies that died 100 years ago because we didn’t have vaccines.” According to Tietje, this isn't because of lack of access to medical care, emphasizing "There are a whole bunch of reasons why babies died more frequently 100 years ago, most of which are not related to vaccines." She even throws in the intellectually dishonest "vaccines didn't save us" trope. Here's the problem. It's easy to find examples to refute this. Polio killed and paralyzed many thousands throughout the 1940s and the 1950s, many in cities. Does Tietje think polio victims didn't have access to medicine and clean water? Of course they did. It wasn't until after the introduction of the Salk polio vaccine that polio incidence and mortality plummeted. Ditto haemophilus influenza type B (Hib), which was killing children until 20 years ago. Pediatric medical care was quite sophisticated then, and these children also had access to clean water, but Hib incidence and death didn't plummet until after the vaccine was introduced.

I'm getting tired now, and the rest of her items are a grab back of typical antivaccine tropes. In one, she pontificates that if someone dies of a vaccine-preventable disease, there's no guarantee that the vaccine would have prevented that:

But. There’s no guarantee that vaccines would have prevented the death or injury. Vaccines themselves don’t come without risks (yes, people can and do die from vaccination, too). I understand it’s really hard if you know someone personally who was disabled or killed by an illness, but this is a purely emotional reaction, not a scientific one.

An emotional reaction? Not a scientific one? Irony meter overload. Again. Seriously. There's never any guarantee, but the person's chances of never acquiring the infection would have been far higher if that person had been vaccinated. No vaccine is 100% effective; expecting 100% efficacy is the Nirvana fallacy.

Tietje also regurgitates the "#CDCwhistleblower" myth in her post:

#14: “Vaccines do not cause autism. End of story.” Ah, not quite. Or, well, not at all. It’s recently come out that a key study that the CDC used to “disprove” a link between vaccines and autism was falsified. Statistically significant data was omitted from the results. That data showed a 340% increase in autism among African-American boys when they received the MMR prior to 36 months of age, instead of after. One of the lead researchers, Dr. Thompson, admitted this in a public statement. It’s also true that a number of other studies show links between ingredients in vaccines and autism, or similar neurological disorders.

These other "studies" tend to be of very poor quality and performed by scientists who have drunk the antivaccine Kool Aid. I've spent a lot of time deconstructing many of these studies. As for the "CDC whistleblower" thing, no, no, no, no, no, no, no, no, no.

Next:

It’s also true that we’ve done very few studies on the link, the studies have been (generally) poorly designed, and that we have never done a vaccinated vs. unvaccinated study. This question is far from settled, but from the evidence we do have (scientifically and anecdotally)…we can say, yes, vaccines do cause autism. Not everyone, obviously. Certain people are more at risk than others. But just like we say that cigarettes cause lung cancer (even though many people who smoke do not develop lung cancer), vaccines cause autism.

Wow. This is some major misunderstanding of epidemiology. Yes, many people who smoke don't get lung cancer, but the relative risk of lung cancer associated with smoking is so high that it has been easily detected many epidemiological studies. In fact, we frequently say that "correlation does not equal causation," but when the correlation is as strong between something like smoking and a disease like lung cancer, it's hard not to infer causation, particularly given that causation has been supported by multiple other lines of evidence and it's impossible to do a randomized controlled trial of smoking versus no smoking to nail down causation absolutely.

In marked contrast, there are no high quality epidemiological studies that demonstrate that vaccines are associated with a detectably increased risk of autism. Quite the contrary. As I've described more times than I can remember, every well-designed large epidemiological study looking at the question has failed to find a statistically significant link. Tietje is, quite simply, wrong. As for the "vaxed versus unvaxed" study, it's not the panacea that antivaccinationists think. They always either deny the unethical nature of doing a randomized "vaxed versus unvaxed" study and/or greatly underestimate the expense and difficulty of doing an epidemiological "vaxed versus unvaxed" study.

I'm tired now and have to get to work. (I did part of this last night and the rest in the early morning, before work.) As I've shown, Tietje's torrent of antivaccine misinformation is truly epic. Feel free to add your own responses, particularly to items I "neglected." And Merry Christmas and Happy New Year! I'll be back with new material on Friday. Probably. It depends on the amount of celebration that goes on the next two days.