written by Tara Haelle

Journalism is not rocket science. But it’s also not serving fries at McDonald’s. Being a journalist — particularly a credible one — means taking on a significant responsibility. In an age where anyone can take to the Internet and spout their thoughts — right or wrong, credible or BS, intelligible or nonsensical — journalists must continue to adhere to a code of ethics, including presenting accurate and appropriately balanced information.

A journalist who writes about health and science issues, however, has an even greater responsibility. Readers may make important decisions about their own health based on that journalist’s reporting. False balance in science and health journalism is arguably a more serious issue, and therefore greater responsibility, than in political journalism. False balance in political journalism might lead you to vote for the “wrong” candidate. False balance in health and science journalism (as the Columbia Journalism Review explored two months ago) might kill you, or, worse, someone you love, like your child.

Hence, I was livid as I read an irresponsibly and lazily written article about vaccination in The Daily Herald, a paper from the Chicago metropolitan area town of Elgin. I’m livid because I live in Illinois, so the implications of journalist James Fuller’s irresponsible and shoddy reporting could potentially affect my family, including my three-year-old son. And I’m livid because I am professional science journalist myself who has reported on vaccines extensively. The difference between Fuller and me is that I do my homework* (as do dozens of other science and health journalists**) and I understand the responsibility I’m taking on when I write about public health issues.

Writing about health and science is different than writing about politics, city hall, the crime beat, courts, sports, education, business and the like. You cannot rely only on sources and quotes to carry your story. You have to KNOW your science and know who is credible. And although you should never insult your reader’s intelligence, you must help them understand where the science is and where it isn’t in no uncertain terms.

It’s not news that Americans have poor scientific literacy. (Newsflash: Humans and apes evolved from a common ancestor and the earth is heating up due, at least in part, to a human-caused increase in carbon in the atmosphere. If you doubt either of these, feel free to stop reading now. Also, this has been edited from the original to be more accurately written.) Therefore, science/health journalists must take extra care to avoid false balance by ensuring they have done the (often intense and time-consuming) legwork. They are thoroughly educated on the issue they are writing about, they understand who is a credible expert and who is not, they understand the scientific consensus (if there is one) and the weight of experts (legitimate or self-described) who disagree with the consensus. They understand the evidence. They understand the implications of their story. They have talked to more people than they can quote in their story, and they have read far more than they can possibly summarize for their readers. They have to exercise superior judgment that requires a higher bar than is found in many other kinds of journalism. Ultimately, a science/health journalist must do the research, not just rely on handful of quoted sources to tell the story.

James Fuller failed to do that legwork. His article succumbs to the worst kind of false balance (it actually tilts dangerously against the scientific consensus), and his article flat out gets the science wrong.

Let’s start with the problems in the article. Then we’ll get to the science in a paragraph-by-paragraph analysis in which the scientific inaccuracies are particularly egregious.

Experienced journalists, like Fuller, understand not only the power of their words but the power of structure. The opening of a story matters, especially if it uses an anecdote. The final quote matters. The flow from one source’s perspectives to the next, or one salient point to the next, matters. Diction matters. All of these components come together to tell a story and frame how the reader experiences it — and what the reader takes away from it. Here are the ways Fuller used those components irresponsibly.

The lede (opening paragraph) is a sympathetic portrait of a healthy, unvaccinated child.

There are millions of healthy unvaccinated children in the U.S. But they also contract vaccine-preventable diseases at much higher rates than vaccinated children. The choice to open this article with such a child and ignore the consequences of his mother’s decision is intellectually dishonest. Further, painting a sympathetic person of a “free rider” is ethically questionable for a journalist reporting on a public health issue.

The story lacks ANY quotes from a parent who vaccinates.

I suppose this is only half true since the parent in the story vaccinated her first child, but a balanced story would include at least one, preferably more, parents who vaccinate and who explain why. They might add what they think about the danger their child is placed in by those in the community who do not vaccinate.

Worse, the story lacks ANY anecdotes from parents who have watched their children suffer, or die, from vaccine-preventable illnesses.

In a story, anecdotes and facts are not equal. In a perfect world, facts would trump anecdotes. In reality, anecdotes tap into our emotions and facts tap into our reason, but we remember the emotional information better and it has a stronger influence on our decisions. Portraying a healthy unvaccinated child without showing how a vaccine-preventable disease ravages a child’s body — especially if that child contracted the disease from an intentionally unvaccinated child — neglects to show the consequences of non-vaccinating parents and is irresponsible, neglectful reporting.

The story lacks ANY information about deaths from vaccine-preventable diseases.

It’s not as though these are hard to find. Heck, I did my entire Master’s report on it for my MA in journalism, and Illinois is currently experiencing its worst outbreak of pertussis since Joe McCarthy was rooting out Communists and Jackie Robinson was starring in his own biopic.

The story quotes a doctor who supports parents’ decisions to skip vaccines and/or delay vaccines. Both these views these go against the recommendations of the American Academy of Pediatrics, yet the journalist presents the doctor’s opinions as a voice of authority. This doctor is given a total of 12 paragraphs, compared to only 10 that discuss the risks of not vaccinating and the effectiveness of vaccines.

The story lacks any data, references, citations or links related to the many, many, many studies showing the correlation between low vaccination rates and higher disease incidence, between higher vaccine exemption rates and higher disease incidence, or between vaccination and lower severity of illness if contracted.

The story gives the kicker (the story’s last line, often a quote) to a non-vaccinating parent.

This is the spot reserved for the final take-home thought for the reader, but experienced journalists also know it’s where a journalist’s own sympathies often (though not always) are apparent. Either way, it’s never an accident who gets the final word. But in this story, the final word is a double foul: it goes to an inappropriate source and it makes a statement that directly contradicts the scientific evidence about vaccines.

The overarching problem: This story does not in any way, shape or form, SHOW the consequences of not vaccinating, either to the unvaccinated child or to the community at large. An effective journalist shows rather than tells. The only thing the reader is shown, across ten paragraphs that include the opening and closing images, is a parent who does not vaccinate her healthy, happy child — a child benefiting from the low risk of disease incidence in the U.S. because of herd immunity.

Here is a breakdown of the article:

23 paragraphs focus on not vaccinating and promoting inaccurate information about vaccines, ten with the non-vaccinating parent and twelve with a pediatrician who is okay with parents not vaccinating or using delayed vaccination, against the recommendations of the AAP. Two sources used: a parent and a pediatrician.

9 paragraphs, which do not begin until the story’s tenth paragraph, discuss the effectiveness and importance of vaccination. Two sources used: a pediatrician and an AAP representative.

2 paragraphs include background information about Illinois

2 paragraphs with false balance are disguised as “background information (14th and 15th paragraphs)

If that is not false balance (equal sources given, inaccurate information related to not vaccinating outweighing accurate information about effectiveness and safety of vaccination), I don’t know what is.

***

Now I’ll address the specifics of Fuller’s irresponsible and lazy reporting, including getting the science wrong (by not contradicting the pediatrician’s inaccurate statements with accurate information).

First six paragraphs: A parent discusses her healthy unvaccinated child and her opinion that vaccinating parents are apparently not “more dedicated” and as focused on “nutrition and general health” as she is, as she says: “But the real trouble is in not having enough people who are a bit more dedicated parents. It all goes back to nutrition and general health. We’re supposed to be able to fight these illnesses off. People are so afraid of death in the Western world. At this point, the push for vaccinations is more about money than saving people.”

Nice start to a public health story. There is no data to back up her final statement. And all those silly Westerners, all afraid of death and everything.

Two paragraphs: Stats are provided on non-vaccinating parents in the state and how bizarre Fuller apparently thinks this is “given the pressure to conform.” Had he spoken with any number of experts who have studied this, such as Deborah Wexler, Anna Dragsbaek, Kathryn Edwards, Saad Omer, Paul Offit or Nicola Klein, he might have a clue. He didn’t do his homework.

One paragraph states that “about a dozen doctors” are supportive of non-vaccinating parents (compared to how many who adhere to AAP recommendations?).

Four paragraphs provide quotes from a pediatrician representing the Illinois Department of Health who states that the “quality of the research” does not support non-vaccinating parents, that no study supports a link between vaccines and autism, and that an outbreak of measles can spread like wildfire even from one person.

This is good and important information to include, but it’s outnumbered and overshadowed by the other anti-vaccine information and it lacks specific data, of which there is plenty available. It also does not mention morbidity or mortality of measles. Ask the UK about that. They’re in the midst of a huge measles epidemic now.

One lengthy paragraph: Mother states “Why take a chance?” and the possible effects of vaccines are mentioned with the term “very rare” — which is not defined. Is “very rare” 1 in 1,000 or 1 in a million or 1 in 10 million? A reader wouldn’t know. The compensations on vaccine injuries claims are mentioned without explanation of how those claims are determined (which is very relevant to understanding whether causation was actually involved just because there was a settlement).

One two-sentence paragraph provides one of the most blatant juxtapositions of false balance in the article: “Soyemi said many of those negative experiences can’t be directly tied to the vaccines. At the same time, federal officials haven’t ruled them out as the cause.”

A pediatrician’s statement is not equal to that of “federal officials.” And it should be noted that this statement is not only the pediatrician’s but is also the stance of the AAP, the WHO, the Institute of Medicine, dozens of other medical organizations and hundreds of vaccines researchers.

Five short paragraphs: AAP chapter manager and the pediatrician note there is no disagreement about vaccines among experts and “immunizations are one of the most effective public health interventions that have ever been discovered.” AAP source suggests that a child with leukemia, for example, could die from measles.

This is a start, but… Where is the anecdote here? Where is the data? A reader is expected to take these quotes at face value after the first eight paragraphs about a sympathetic and healthy unvaccinated child?

TWELVE paragraphs provide quotes from a pediatrician who is sympathetic to non-vaccinating parents — TWELVE in a row, compared to the six that preceded it and then four higher up about the quality of the research not supporting vaccination. This is not even false balance. This is tilted toward anti-vaccination. In these 12 paragraphs, a pediatrician makes a number of scientifically inaccurate statements, so this is an ideal time to address the bad science in this article:

“What most pediatricians aren’t willing to discuss, Rardin said, is that vaccines don’t always work as well as advertised.” In fact, pediatricians who keep up with the research know exactly how well vaccines work and are honest about it. Vaccines work pretty darn well, most with over 90 percent effectiveness.

“Any vaccine that is manufactured is going to have a batch that is produced that, for whatever reason, ends up being more or less effective than the rest of the doses.” This statement is scientifically false and has no data to back it up. It is irresponsible fear-mongering on the part of the pediatrician and the journalist.

“Vaccines are marketed and tested based on the benefits to the average person in the test groups for that drug, Rardin said. But in the larger population, not everyone is average.” Vaccines are tested and studied and re-studied and re-studied with millions and millions of children from all demographics, including those with weakened immune systems and any number of health conditions.

“It’s hard to find information out there that takes in all the risks and benefits.” Off the top of my head, I can immediately think of six great places: Children’s Hospital of Philadelphia’s Vaccine Education Center, the CDC, the WHO, the Immunization Partnership, the Immunization Action Coalition and the National Network for Immunization Information. This pediatrician seems pretty unfamiliar with some of the most reputable sources of health information in the world.

“In reality, there’s a lot we don’t know.” And there is a heck of a lot that we do know for those who look at the scientific evidence.

“There are vaccines that were on the market 10 years ago that are no longer out there because of problems.” This is almost accurate — it was in 1999 that a rotavirus vaccine was recalled, but DTP is much older, not that the pediatrician or journalist appear to know this history. Not providing any context, however, is irresponsible because the reader is left to wonder… and worry.

Four final paragraphs: We return to the parent who doesn’t vaccinate, who “is on an often daily mission to get more information about vaccines and alternative approaches into parents’ hands.” That is otherwise known as actively promoting misinformation and endangering public health, something a responsible health reporter would point out.

The final paragraph is given to the smug, non-vaccinating parent: “If your vaccines work, then you should have nothing to worry about, right?” This is scientifically inaccurate and among the most dangerous statements in the article. If other parents do not vaccinate, herd immunity decreases. No vaccine is 100% effective, so as herd immunity declines, disease incidence increases. That places my child — my three-year-old child who lives in Illinois only a few hours away from this woman — at risk, enabled by an irresponsible reporter who is not adequately trained or experienced to report on public health and does not understand what true false balance is in a science/health story.

Fuller stated on Twitter, “False balance is when equal weight is given to the veracity of claims. That is not the case in my article.” In fact, he said it five times in a row, perhaps thinking if he repeated it often enough that it would change the fact that he still engaged in it. But it is the case in his article, as I have shown.

I will say, however, that his tweets also clued me in to part of the problem. His first tweet yesterday about this story read “If you’re awake, check me out on ABC, Channel 7 at about 8:45. I’ll be chatting about the surprisingly controversial world of vaccinations.”

Here’s the thing. There is not a controversy about vaccinations. The controversy was 15 years ago. If you missed it, here’s a nice summary. Or read about it from Brian Deer, the investigative reporter who played the biggest role in ending the controversy, along with the dozens of studies (pdf) by researchers. And if you did miss it, or you were under a rock for the 15 years, you have no business writing about this public health issue. In a lengthy Twitter discussion with me, Fuller tried to defend himself by mentioning the other article he wrote about religious exemptions (which also features a non-vaccinating parent). Though that is a better article, when you’re writing online articles, each one must stand on its own.

Fuller and, apparently, his editor believe legitimizing anti-vaccination sentiments by “giving voice to unconventional views” is okay. Fuller’s editor, Jim Davis, argues as much in his equally irresponsible editorial: “I’m sure there’s a line you cross between having a controversial viewpoint and espousing beliefs that are so outlandish as to not warrant consideration. Hollie Redinger, as much as you might disagree with her, doesn’t come close to crossing it.”

Actually, she does cross it. (And if there is any doubt about the tilt of Fuller’s article, the mom’s gloating on Facebook might offer a clue. Edit: this previously linked to post, which has since been hidden.) The opening lines of this editorial actually refer to an argument I made to Fuller in a private email prior to this article’s publication when I heard Fuller had spoken to various parents who do not vaccinate in preparation for an article. (I did not know Fuller when I sent him the email.) I gave the example that giving voice to “Holocaust deniers” is inappropriate because it legitimizes their view, rooted in false claims. I said that inappropriately giving anti-vaccine proponents a forum to promote their false information was similar if it was not accompanied by information that clearly showed the consequences of their decision. Am I justified in making this Godwin comparison? Well, let’s pose two questions: Who is physically harmed by a Holocaust denier? I’m sure a case could be made that some people can be, perhaps if the denier’s remarks support white supremacist groups that promote violence. But who is physically harmed by a parent who chooses not to vaccinate her child based on inaccurate pseudoscience? Any child who consequently contracts a vaccine-preventable disease from that unvaccinated child does. And children have died from that exact scenario. I don’t think my analogy is out of line.

The editor justifies the decision to run the story because “The motives are many and somewhat elusive, but there are 68,000 schoolchildren in Illinois who skipped at least one type of inoculation last year.” (I already noted that the motives are not elusive if you do the research.) There are approximately 3.1 million children in Illinois (pdf). So this unvaccinated child is among 2 percent in Illinois who have not been vaccinated, including those who cannot be because of medical conditions or are not because of limited health care access. This small a percentage of parents making irresponsible and risky decisions that endanger others in the community is justification to give them a platform to promote it to others? Seriously?

The editor states, “I feel that Fuller’s stories more than adequately address any dangers posed by the anti-vaccination advocates.” It’s time for that editor to retire because he has lost the ability to do his job effectively.

The kicker of this editorial goes to Fuller: “If they take the time to really find out your thinking, it can open the door to new understanding and respect even if you still disagree. I hope that’s what happens with the publishing of this story.” I do not respect another parent whose decisions increase the risk of harm to other children in the state. Nor do I respect the lazy, irresponsible reporting of a journalist, and editor, who have no business writing about public health before doing their homework.

*Before I published a single word on vaccines, I did the following:

Ordered and used more than a dozen books from Amazon, both “pro-vaccine,” “anti-vaccine” and those who think they’re in between, to familiarize myself with the issue

Took a class in epidemiology at the University of Texas at Austin

Interviewed Paul Offit

Interviewed Martin Myers, former director of the National Vaccine Program Office and author of Do Vaccines Cause That?!

Spoke with Barbara Loe Fisher, founder of the largest anti-vaccine organization in the U.S., at a screening for The Greater Good, a manipulative anti-vaccine “documentary” film full of inaccuracies

Interviewed four parents who stated their children were vaccine-injured

Interviewed more than six parents who lost their children to vaccine-preventable diseases

Corresponded with dozens of parents whose families had been affected by vaccine-preventable diseases

Met with the Bay Area Polio Survivors group in the greater Houston area

Spent a LOT of times on the sites I linked to in the article, including the CDC, WHO, CHOP’s Vaccine Education Center, the Immunization Partnership, the Immunization Action Coalition and the National Network for Immunization Information

Corresponded via email with over a dozen parents who stated their children were vaccine-injured

Interviewed anti-vaccine proponent Louise Habakus Kuo, author of The Vaccine Epidemic

Interviewed Sherri Tenpenny, a total quack of a doctor who believes vaccines are a conspiracy of the government and pharmaceutical companies to get kids sick and keep them sick for life

Interviewed Larry Pickering, Executive Secretary of the Advisory Committee on Immunization Practices at the CDC

Corresponded with Arthur Allen, Slate journalist and author of Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver

Corresponded with Bruce Gellin, Director of the National Vaccine Program Office

Interviewed Bob Sears in person for over an hour, author of the unfortunately best-selling The Vaccine Book



**A couple science and health journalists whose work on vaccines is actually worth checking out (to be further updated):