I’ve written previously about how difficult and also how important it is to apply critical thinking to parenting. There are myriad internal and external pressures to be a “perfect” parent, and the criteria for perfection varies across different social groups. Parents can bond or bicker over all kinds of emotionally-charged issues: how to diaper (or not); if or how long to breastfeed; the softness of unbleached, organic cotton; or the purported health benefits of unpasteurized milk. In my opinion, the controversy over childhood immunizations represents the ultimate line of demarcation among many parent peer groups.
Because few people are actual infectious disease experts or experts in immunology, vaccinating children requires reliance on the authority of the scientific consensus, which is that vaccines are very safe and effective.
There are a couple of barriers to analyzing the medical literature. The details of scientific primary sources require subscription or fee-based access. Even when access is available, most members of the lay public are simply not trained to accurately interpret the data. I rely on secondary sources, primarily Science Based Medicine, for an accessible and credible overview of the literature. It’s straightforward and matter-of-fact, which is exactly how I like to consume scientific information. Unfortunately, SBM is not as seductive or emotive as purveyors of medical misinformation such as Mothering Magazine.
Mothering is a gorgeous publication that features delicious recipes, lovely family activity ideas, eco-friendly lifestyle advice, and other harmless-yet-interesting fluff that resonates withe me. Unfortunately, readers also encounter a great deal of medical misinformation. The format taps into fears of inadequate mothering and offers counter-culture solutions that will finally make one a “good” mother. It’s very seductive, especially when it elevates even mundane parenting choices to self-righteous political positions. Of course Mothering is strongly against vaccination, and provides all kinds of science-y sounding language and anecdata to support this position. It’s very hard to sort out credible information about vaccines, and I have a lot of sympathy for parents who choose not to vaccinate. It’s even more difficult when anti-vaccination confers social status.
I have long thought that alpha moms jockeying for position within parent groups contributed to decreasing rates of vaccination. More recently, I’ve been thinking about the larger societal pressures that influence anti-vaccination.
I was inspired by a discussion in the comment section of an SBM article by Dr. David Gorski about Mothering Magazine’s deadly medical advice, including a plethora of vaccine misinformation and HIV denial. The entire comment thread is worth reading because there are a number of very bright people who contribute a great deal of interesting insight. Below is an excerpt of my small bit.
Commenter Windriven asks:
“So what drives Mothering’s readers? Why are so many people willing to ignore science and medicine in favor of anecdote? Clearly these are engaged parents; why else would they subscribe to a parenting magazine? One presumes that they have been exposed to the pro-vaccination argument. One presumes that they are aware of the thorough discrediting of the MMR link to autism.
Are there any studies examining this?”
I responded:
“@ Windriven: I’ve actually thought quite a bit about this, and I have some ideas about what I think might be going on. This is based on my anecdotal observations, not on any rigorous study.
Many women who can afford to stay home gave up careers to do so. Larger society undervalues stay-home moms (as well as teachers and other child care workers). So bright, educated women find themselves in clusters, isolated from prestige, and they bring the work ethic and focus that advanced them in careers to parenting. They must seek status and validation from other members of the stay-home community, and this requires separating themselves from the unwashed masses. (My friend calls this “competitive parenting.”)
This subculture fosters increasing intensity and extremism, and practices that might have begun as reasonable choices are pushed to extremes. Once everyone in the group is breastfeeding infants, for example, the higher-status women are the ones who breastfeed kindergartners.
This trajectory translates to increasingly harmful cultural norms. Once everyone treats vaccination as an ala carte menu, the higher-status women are the ones who are rejecting vaccines, or rejecting prenatal care, or obstetrical care, or whatever. Statistics are such that the individual mothers and children are likely to be unharmed by these decisions, and this leads to strong confirmation bias.
Mothering is one more source of validation and status. It feeds right into the paradigm I attempted to describe. The pressure to conform is intense, and I’ve actually heard mothers defensively/apologetically rationalize to other mothers things like weaning early, or allowing a doc to prescribe antibiotics for something potentially serious. [...]”
Windriven:
“@Anthropologist
Yours is a fascinating conjecture. It certainly explains the herd mentality. But why woo instead of science? Why don’t these mothers end up as uber-vaccinators?”
Me:
“@ Windriven:
‘Why don’t these mothers become uber-vaccinators?’
My personal biases tends to lead me (correctly or not…) to conjectures involving status and power. My read is that challenging the authority of conventional medicine and MDs is one way of artificially ascribing status to oneself. [...]”
The contemporary anti-vaccine movement should by all rights be a small fringe movement. Its tenants have been roundly and repeatedly discredited, and yet it persists. It’s going strong both on the pages of Mothering and other parenting sites, and in real-life parent subcultures. I think that there is a good deal of observational evidence favoring my off-the-cuff theory of a convergence of in-group status and societal marginalization of stay-home parents. This, coupled with misinformation that appears credible published on mainstream sources, fuels the unfortunate rise in potentially deadly preventable diseases.
Whether or not my assessment about the anti-vaccine movement is correct, treating parents, teachers, and childcare workers like respectable, contributing members of society would benefit everyone.
Vaccine image from the CDC public domain image gallery.
This seems about right.
And I would add this additional thought. After watching Inside Job recently (the documentary about the financial crisis which won the Oscar), once again I was struck by the overwhelming greed and short sightedness that led us into the financial crisis. And it’s stunning to learn that the people who were regulating banking, the people who were rating the toxic investments as AAA and selling them to retirement funds, and everyone else who could have stopped the problem all had a financial stake in keeping the status quo.
When you see a situation like that, it becomes plausible on some level, to those who don’t understand the actual science, that a web of financial interests could have kept a medical intervention going that was in some way harmful.
The problem is that the arguments against vaccines are complete bunk, of course.
But I hope you can see my point. I think that unfortunately, this type of rejection of authority, and the status it might confer, is only bolstered by actual events that demonstrate that financial interests can override public interest. No, it’s not news that money can corrupt. But I wonder if the times in which we are living have lent credence to and possibly intensified public fears of larger interests working against public concerns.
Hope that makes sense.
I work in the area most people call ‘natural’ childbirth. Within this culture, you find the basic premise that messing around with natural processes is a Bad Idea. This, in and of itself, is not a bad concept- there’s good science behind non-intervention in childbirth, and eating healthier is a good thing for anyone. And the range of practices is wide; but it also branches into areas that are considered woo- what I’ll call ‘soft woo’ and ‘hard woo’.
Soft woo is the stuff that science is on the fence about, or things that work, but there’s no peer review out there, or practices that are proven helpful, but are still considered fringe.
Used appropriately, these are often a first line of care- the first tools in the toolbox before you go for the big guns. It’s the sort of thing good old-school Docs still use (My Dr of 27 years will still tell me to go gargle with salt water for a week before he’ll give antibiotics for a sore throat.).
Hard Woo is the stuff that actively rejects science, can’t ever be tested, etc. In most cases, it is still ‘out there’, and isn’t standard practice- except for the anti-vax movement.
Unfortunately, many people who’ve found their way into the community, have come here by way of having had a very negative experience with allopathic medicine, so they don’t trust. Even where science is on their side, if it bucks the cultural norms, they’re still labeled as wackos- Witness the recent CDC report on home birth. The science behind the safety of home birth is solid, but it is still considered ‘alternative’, and the ACOG is in a tizzy.
So you have a group of people who are ok with certain levels of woo, who are treated as marginal and freaky by ‘the establishment’- who see even science rejected in the face of corporate interests (there’s some good books on the subject), who by and large don’t want artificial Stuff in their lives if they can help it. And along comes junk science telling them that the shots that doctors are telling them they need to inject into their babies are full of evil toxins, won’t actually protect them, and so on, it is not a leap of logic for them to agree, and grabbing the tinfoil hat gets much easier.
Not all of the natural birth folks have done this route- but enough of them have that it makes us middle ground people very very uncomfortable- we’re not really welcomed in either crowd.
For the first time it occurs to me that maybe we could bring back some of those parents if the emphasis was on vaccines as a natural way to boost the body’s immunity. Big Pharma is a big no-no, and I think the idea of vaccines is somewhat tainted by the notion of their manufacture. If we talked about growing them would it help?
I think it’s partially about control issues as well. I think this is true of many anti-science fronts, actually. People feel out of control today. The authorities that people used to trust have pretty much all been challenged now–some for good reason, some for not-so-good. Churches, medical establishment, etc–stuff that used to offer certainty and comfort is all questionable now, and various sources (often not trustworthy, but available nonetheless) are plentiful.
And vaccines are something parents can control.
This is really an excellent article. It really reflects what I see in my leafy suburbia and I think your observations are spot on.
I don’t know if I would describe the anti-vaccine contingent as anti-science. I think that they are looking at some version of the science, but they are misinterpreting the findings. I like that people have a can-do attitude, but I think maybe they are underestimating the complexity of the problem.
I have a Master’s degree in biology and I know that I would not be able to sort out the literature on the value of vaccinations. So I defer to the opinions of people who do that all day, mainly because I know enough to know that answering epidemiological questions is really hard and it takes a lot of training that I do not have.
But I think deference to authority may be seen as somewhat passe today, not just for the reasons Mary said, but also because there is a constant barrage of nonsensical advice that is passed off as science reporting.
I get furious at the mothers who don’t vaccinate their kids, but at the same time I don’t know how they would be able to make an informed decision, or sort out the nonsense from the clatter, or how we ended up in a situation where they would be expected to make that decision.
I also wonder if we are training our journalists properly weight informed opinions over strong, uninformed opinions, and if the rise of citizen journalists will make this whole thing worse. I think the Huffington Post is a good example of the second. A good portion of their science and health content is written by actresses. But I can bet they wouldn’t give me a column to write their entertainment news because I wouldn’t know what I was talking about.
Thanks for this post!
Excellently written. Some very salient points here and in the comments.
I get a lot of flack for not being a parent and trying to talk to parents about issues surrounding children. “You don’t know what it’s like!” they wail. Well, no, I don’t have first-hand experience. What I have is what you don’t: an unbiased, unattached 3rd party view of your situation. I see a lot of parents getting very worked up and very upset over every tiny detail of their child-rearing. I see a lot of ego involved. I see that marketing and the presentation of parents (especially mothers) as all-knowing wise beings of absolute purity. That somehow the act of having unprotected sex and managing to create and sustain a life creates superpowers within moms and makes them wonderful and amazing (I haven’t figured out what this says for those of us who don’t have children). I have tremendous respect for people who choose to become parents and take on the difficult task of creating a human life. But when you factor in the image of a parent, it’s no surprise that ego works its way into the mix. You’re a mom, you’re supposed to know everything.
I worked for many years with children who have behavioural or emotional difficulties. If there were such a thing as “instinctive” parenting, or if you gained magical superpowers through birth, I never would have seen children subjected to horrific abuse and neglect. I would be happy to see that. Now that I work in marketing, I am seeing the other side of the coin. What most people want in advertising is “someone like me”. They want to get their information from someone they can relate to. How many stereotypical mothers do you see in the science profession? Advertising has become a method for receiving information about current events. There is no longer a line. Science, health and especially the vaccination movement needs to step up and start presenting their information differently. Right now the image is “mother knows best”, but no one stops to ask where mother learned these things. If we can shift that image to “mother knows best but she isn’t afraid to ask for help”, that would certainly help. You see that image in the websites alone. People also rely heavily on word of mouth, so whatever your peers are doing/buying/saying, you likely will too. Having someone influential support science, vaccination etc would be extremely beneficial to the movement. How many actresses are writing for Science Based Medicine?
Madfishmonger, you may be unattached, but you can’t call yourself “unbiased”. the best you can do is own up to your biases, that is, what you attained through years of working with abused and neglected children, and what you have as a member of society. It’s a pity that birth doesn’t give magical superpowers, but it is a widespread assumption these days.
Kaethe – you’re right. I am unbiased to those particular children, but not entirely. I have two nieces and some close friend’s children I am very attached to and would get quite stabby with anyone who tried to hurt them. I try to be aware of where I am biased, but no one is ever completely self-aware. I think your way of wording it is effective.
All we can do is strive. And vaccinate the hell out of everything.
@Sarah: it may not be that all of the people who chose to not vaccinate = anti-science. Some of them are simply uninformed, confused, and misled. But there is unquestionably a component that is anti-science. They are smart enough to know what the studies do and do not show, and either deny them or misuse the data entirely.
The problem is that the fence-sitters are hearing from the anti-science drivers.
I can see how corporate greed and fraudulent activities by a handful of people with the scruples of a black widow spider can lead our society down the path of distrust for medical products. In reality though I have been working as an advocate for timely vaccinations for nearly 16 years now and I feel blessed every day to be surrounded by peers who have so much compassion and commitment towards children’s health. Whether it is the people down at the CDC or the non-profit groups who spend day after day spreading the word about the dangers of disease I can honestly say they are wonderful, selfless people. Sometimes I wonder how a person who has a medical degree goes about making the decision to spend a lifetime in public health making a pittance of a salary after all that schooling, and that’s when I realize that there are truly good people on this earth who care about our children as much as their own. It may sound mushy and naive, but I thank goodness for the scientist who spend their lives developing vaccines, the ones who make sure they are safe after they are on the market and for all the people who toil day in and day out to get them to those who aren’t financially well off enough to pay for them.
This is an awesome article on the anti-vaccine movement, with a perspective that I just hadn’t seen anywhere before. I especially appreciate how the article and the commenters are all so non-vitriolic. So thank you :) As a scientist working on her master’s degree in biotechnology and a new(ish) mom (I have a one year old), I will say that I am in a rare position to see this issue from both sides. I have been overwhelmed by the positive effects of vaccination, but I did opt for a natural birth with a midwife, so I can agree with what you are saying CJEH about not fully satisfying either crowd. Of course, I know that I’ve done my own research, and I feel comfortable about my choices, so I’m not exactly seeking approval from anyone. I think the fact that I am not a 100% stay-at-home-mom has a HUGE part in that.
Also, I would like to point out that so far as the “instinctive” parenting goes, or the quest to be the “perfect” mother, I am completely lacking in both categories. However, I kind of appreciate that about my process as a mother. I am leaving myself PLENTY of room to learn things. I think, honestly, that age could even factor into that. I am a fairly young mother, and I’m not set at all in my ways yet. I have a few friends that are a bit older than me and have children around the same age, and they seem much more determined to have the art of mothering down perfectly from the start. I think that Mothering Magazine caters to a crowd that purposefully waited until a little bit later in life to start having children.
Either way, I know that I am thankful for my science background when it comes to decisions like vaccination, and I feel bad for people that haven’t had the same exposure to immunology that I have. I think it makes it a lot harder to know what information is really based in solid medical evidence.
I’ve been away from the internet for a few days moving to a BIG city… What an amazing comment discussion! Thanks everyone! All of the comments are really fantastic and insightful.
And, I agree that seeing corporate abuse after corporate abuse sets us up to be suspicious about all large agencies.
A few of you gently pointed out my false dichotomy. Thanks…
Re natural childbirth, I don’t think it’s inherently woo, just that there is a lot of misinformation that leads women to take it to extreme and dangerous lengths and then go on to criticize women who took a different path through childbirth for any number of medical reasons.
Rebecca, interesting comment about age. I fit into the “watited” age bracket, but I think you may be on to something. FWIW, I parent by the seat of my pants (and Positive Discipline and Montessori peace curriculum… and occasionally chocolate, and copious amounts of caffeine…). After seven years and a second child, I still don’t feel competent. Once you find something system that works pretty well, they evolve, and what worked before now has destructive results. They can love vanilla yogurt with a passion of a thousand suns for months on end, then, seemingly suddenly, all things dairy make them want to impale you on their imaginary light saber. You have to be ready to swerve and evolve in your own right at a moment’s notice–as you describe.
@Mary
-They are smart enough to know what the studies do and do not show, and either deny them or misuse the data entirely.
Maybe I’m being naive, but I’m more willing to accept that people are just wrong. In my field of science, I’ve seen where people get excited about their findings and they kind of delude themselves that they are seeing what they want to see rather than something that could be better explained by an experimental artifact or whatever. So I think it is probably more this kind of self-delusion that lets you look at the science though this prism that we all have that lets us see what we want to see rather than what is there. Once you start down the anti-vaccination road I can imagine that it would difficult to admit to yourself that you’re wrong and that you have been endangering your own children or other children’s lives. So the cycle would feed on itself.
I think that scenario is just more likely than people knowingly advocating something that they know is harmful. That would just be pure evil. I don’t think people are evil. I think they mean well but they’re just wrong. (I still want to kick them in the teeth, of course.)
@rebeccatill I love this concept of “instinctive parenting”. Millions of years of evolution outweighs dozens of years of social science research any day. That’s just good science. =)
You should not rely too much on Science Based Medicine when it comes to circumcision. Amy Tuteur was horrible in The case for neonatal circumcision and I am delight she left, Dr. Amy Tuteur has decided to leave Science-Based Medicine.
I wonder how connected those 2 events are.
Way to be on top of things, Gary! Um, this is an article on immunization, and Dr. Tuteur left SBM over a year ago.
I have delt with these moms at the private school where I work. 1/3 or more of the students were not vaccinated. We had two minor ourbreaks of whooping cough. We had to turn kids away that were for medical reasons not able to be vaccinated, because of the danger of so many not vaccinated children. (for instance a child being treated for leukemia…that wished to attend preschool, could not because with his immune system suppressed he could die if he caught anything more than a cold).
I think this article hit the nail on the head. These moms aree well educated, well to do, and frankly…have to believe on some level that they were doing a “better” job than other mothers. They endlessly educated themselves. They shop at the food co-op, which is so expensive only the well to do can afford to shop there, and they over think everything about their children. I have often been shocked at over booked 3 year olds that would come to school and just want to crawl into a lap and have a book read to them. Moms have scheduled activity from dawn to dusk because their staying home has to “count” for something. Among the happiest kids I know are the 3 young kids of a terrific mom that is also a surgeon. For vacations the kids tag along to places like Honduras where she does surgery for half the day and goes to the beach the second half. Another happy family has parents that are vetrinarians. They go to the South and “fix” animals for poor families for their vacation. The kids get that their parents do important work, and feel a part of a family unit. I also know lots of happy kids with stay at home moms, that don’t make the children feel they are “special” or more important than any other member of the family. Children that get home from school and have chores, instead of 7 day a week planned activities, and have free time to explore their own interests, are in the end I think more balanced adults.
Seeing these children go from preschool to Middle school, I often think some of them suffer from the same problems child actors do. They go from being “famous” and the “star” to just being like everyone else. Super moms tend to burn out, and go back to work or find some volunteer activity that takes up even more time than a 9-5 job. You end up with a few hockey moms that endlessly tell their children “this will get you a good college scholarship, you aren’t quitting!” but by Middle School mom has had her mid life crisis. As a parent I hate to complain about kids that get TOO much love and TOO much attention and care. Kids that show up the first day at preschool with a cell phone with mommies number on speed dial (yes it happens, yes we take the phone away) are kids that are wanted and loved. But they also tend to be not vaccinated.
Yeah, what’s interesting is, despite the history of sterilizations at IHS, most Indians I know still get their kids vaccinated.
On the demographics of antivaxers, it could be that people are trying to be populists without actually worrying about class issues, when most people are in the bowl of the wine glass graph rather than the stem. Or my personal favorite explanation, lol rich people.
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