There’s been a lot of chatter in anti-quakery circles lately. A lot of it has been backlash against the Huffington Post for recent posts by anti-vaccination folks and general alt-med mongers. And more recently, against Oprah Winfrey for signing a deal with Jenny McCarthy. Most of this has been in the sub-culture of skeptic bloggers. The Huffington Post did notably run an article in opposition to (it’s own) anti-science posts of late. And now Salon has poked it’s head in with an article about Oprah’s general affinity for alternative medicine weirdness.

This morass prompts me to make a few observations about the alt-med culture in general and anti-vaccination in particular. Firstly, as I’ve mentioned, alternative medicine and anti-vaccination seem to be phenomena of the political left. That’s one reason it fascinates me. It pains me to see my side succumb to a lack of reason (our general affinity for reason is what I like about my side).

Other stripes of nuttery are phenoma of the right. These include creationism, global warming denial, One World Government craziness, miscellaneous flavors of conspiracy theory such as the birthers, and general unscientific blather like abstinence-only education.

Whereas the political right does not seem to struggle internally with these issues - at least I rarely see opinionaters on the right speak out about these things (to be fair, they mostly ignore them, with the exception of creationism, which several vocally support), the political left seems to be genuinely in a quandry about them. Thus the two faces of the Huffington Post.

So here’s where I think some of this internal struggle is coming from:

1) A lot of people distrust physicians and the larger science-based medical community. As far as I can tell, this is due purely to the availability heuristic. Some people had bad outcomes or know someone who was misdiagnosed or even died in hospital care. Therefore, it must happen all the time. I get this sense from reading comments on blog posts and other, more respectable places such as the Salon article above. It’s by no means definitive - just a sense that I have.

Inflating this distrust is the fact that doctors are human and that being a doctor and being a scientist are not necessarily the same thing. And If you couple that distrust with the knowledge that medical science doesn’t have an answer for everything then you have the makings of exasperated flailing around for alternative answers. And it’s a short step from that to massive conspiracy and coverup on the part of the medical community.

This is, really, a very human tendency. It’s also, exactly why science exists.

It’s very hard for doctors and scientists (and those of us who are not they but are pro-they) to understand why people don’t get that “science” is just a means of determining whether or not something actually works - and don’t we all want to know that, whether it’s a vaccine or an herb or abstinence? It’s also very hard for us to understand why people don’t get that we don’t know everything and there are some diseases and conditions that we just can’t do anything about - we’re human, too, and we can’t be expected to have an answer for absolutely everything. Boil it down, and it’s humans being humans, which is understandable. We don’t really start getting outrage until something dangerous is recommended. And that brings me to:

2) The intentions of alternative treatments are generally good (there are some exceptions motivated by greed - actually, there are a lot of them, but that’s another, even longer post). Many are even reasonable. And given that science will only ever tell you that “there’s no evidence that A does B” and not “a definitely does not do B” (’cause that’s how science works - it does not speak beyond what is evidenced), then many people will think that it’s perfectly okay to try alternative treatments. For most things like echinacea and Airborne, there’s no harm there. But there is a slippery slope.

There are numerous suggestions for treating Autism spectrum disorders. The only one with evidence of its effectiveness is Applied Behavior Analysis. Even it is a little controversial (underscoring how little we really know about Autism). It is also very intensive (upwards of 40 hours a week) and disrupts your child’s life - and yours. Since it doesn’t work for everyone (there’s the availability heuristic again) and kind of sucks, people will naturally want to find other ways.

Some other ways have presented themselves via anecdotal evidence. The prime example is the Gluten-Free, Casein-Free diet. There’s no evidence that it works (there are some early studies that showed results, but they all suffered from very small sample sizes, thus had low confidence - there are some larger ones in the works but no results are in yet). Most anti-vaccination folks will recommend this. And in this they are being reasonable. It’s not very dangerous - you need to manage your child’s diet so he’s getting enough calcium and such, but as long as you do that and see an actual doctor from time to time, there’s no real harm. To be sure, it’s hard to avoid foods with wheat and dairy and finding substitutes is difficult and expensive, but it can be done.

Then we get to the slippery slope. In their quest for other treatments for autism, many anti-vacciners (and the anti-vaccine movement is really all about autism, which is why the vaccines and the autism “cures” get conflated) also go for more drastic interventions like chelation therapy. Chelation therapy is an accepted medical practice for treating heavy-metal poisoning. Where autism comes in is that anti-vaxxers think autism is caused my mercury poisoning from vaccines. There’s no evidence that it is, so the therapy is useless to begin with. But it’s also dangerous. When performed by a trained medical professional for actual metal poisoning, it’s safe and effective. But trained medical professionals will not perform this just because you ask, so parents of autistic kids go outside the mainstream medical community. When done improperly, chelation can result in hypocalcemia and, in once case, death. Admittedly, that’s only one very extreme outcome.

And the slippery slope continues. Anti-vaccinationists are generally careful to not actually say “don’t vaccinate your kids” - they propose strategies for modulating the typical vaccine regimen. They recommend stretching out the regimen - don’t get four shots at once, get them on different visits - don’t get the triple MMR vaccine, get individual does for measles, mumps, and rubella . That all sounds good, and there’s not much risk in that (there’s an increased risk of side effects - some of them serious - because you’re getting more shots, but it’s not a huge risk). But the more you talk about vaccines being dangerous; about vaccines causing autism; the more people will think that they shouldn’t get their kids vaccinated. And this is happening. Vaccination rates for measles in particular are declining in some pockets of the developed world, with resultant outbreaks of those diseases. Though they are generally mild, they do cause complications in some kids. Measles, in particular, is more dangerous than I think people realize. And then there’s the fear that it won’t stop there - that kids won’t get vaccinated for more serious diseases like whooping cough and polio.

Bottom line - these vaccines have been demonstrated to prevent these diseases. They are safe as far as we know. And the known risks from the vaccines are far outweighed by the protection they provide. Is it possible that there are risks that we’re unaware of? Of course. Again, we don’t know everything. But what we do know - which is how science makes judgements - says that they are far, far more beneficial than they are detrimental.

3) It is not unreasonable for frustrated people to suggest alternative treatments or causes for medical problems. Once again, we don’t know everything - there’s a lot we don’t know, in fact, and the scientific community is happy to research anything vaguely plausible. Anti-vaxxers yell that the medical science is either ignoring their warnings, covering up their findings, or digging in the wrong places. In fact, medical science has investiged every claim made by anti-vaxxers (well, I should say most of them, because the goal posts keep moving). MMR? Yep. Mumps virus itself? Yep. Thimerisol? Yep. Mercury? Yep. Vaccines in general? Yep. Multiple studies have been done on all of these and they’ve all been found wanting.

This has not stopped the anti-vaccine crowd. They believe that there must be something wrong with vaccines. What they have is a very big correlation - the number of vaccines administered to kids went up dramatically and about the same time that the number of cases of autism also went up dramatically. Doesn’t matter that studies show no link between those two observations, it’s just too big and juicy a correlation to ignore.

There’s nothing we can do about the human need to see correlations and overestimate commonalities. And there’s nothing you can do about parents’ wanting desperately to find a treatment - or at least someone to blame - for their child’s condition, for which we have no ready answers. All we can do is try (again and again) to convince people that sticking with what we do know, from rigorous evidence, is the safer way to go. Even if that other idea is shiny and seductive, it’s also dangerous.