TDF Guest Scott Murray

TDF Guest Scott Murray

Cornell psychologist Thomas Gilovich has made a career out of studying the cognitive processes that sustain dubious beliefs. There is something about flu season that makes me wish I could combine his work with that of Becker and enlist their aid in a cultural intervention. It seems there is a robust resistance to influenza vaccination despite the potential risks of the flu – a subject rife with extensions into Gilovich’s work. If the flu is so dangerous, what dubious beliefs inspire resistance to vaccination? And a glance at Beckerian thought might raise the question of why the fear of death wouldn’t drive more people to get vaccinated. But a deeper understanding of what death denial actually entails helps inform us why many resist the shot.

We’ve had rather mild flu seasons the last year or so (http://news.yahoo.com/why-years-flu-season-bad-173457272.html), but as statistics readily predict, occasionally influenza strains are more potent and many cases of serious flu infection can occur. The cost in dollars – and lives – can be quite serious. So why do some resist influenza vaccination?

Certainly the media, with its drive to fill air time and sell stories that attract attention, is part of the problem. Flu hype sends millions scrambling for a vaccination each year – but the media is known for its hyperbole, slanted use of facts, and even fear-mongering. It’s no wonder, then, that many cautious, critical individuals would see reports of this year’s raging epidemic and dismiss the need for a flu shot. But as Gilovich is insistent in pointing out, we tend to be most critical of that information which does not agree with the beliefs we already possess. As he puts it: “when the initial evidence supports our preferences, we are generally satisfied and terminate our search; when the initial evidence is hostile … we often dig deeper.” (82) In other words, those who suspect media hype and doubt the need for a flu shot may already believe that a flu shot is unnecessary, and be looking for reasons to support this belief.

Is a distrust of the media, with their tendency to overstate or distort facts, sufficient to explain dismissal of flu season severity? Becker might disagree. Cognitive biases are in one respect no different than elbows and thumbs: they’ve evolved to serve a purpose, and where Gilovich leaves off, Becker nicely steps in. Gilovich is a laboratory psychologist, a statistician; he resists the temptation to speculate too grandly on why the human brain comes hard-wired to accept information that supports existing beliefs while remaining doubtful of information that does not. Becker’s focus on death anxiety provides a compelling furtherance of this line of questioning.

Disease and death are deeply connected concepts. Disease is a limiting of life and brings the carefully repressed reality of our mortality painfully to the foreground of our thoughts. It’s no surprise, then, to discover a deep desire to believe that the flu shot is essentially needless. The CDC, in addressing the most prevalent myths that prevent influenza vaccination, have to deal with the ‘argument’ that influenza is only serious for those who are very young, elderly, pregnant or otherwise already ill. Your average healthy person can deal with influenza using natural means – namely, the immune system (http://www.cnn.com/2013/01/11/health/flu-shot-questions/index.html).

The challenge with this argument is that it isn’t untrue; in fact, the majority of people who come down with influenza nowadays – certainly in the more affluent Western world — survive relatively unscathed. But the problem with the argument is that it isn’t actually an argument against vaccination at all. Just because you can survive the flu does not mean you shouldn’t avoid it, if not only for yourself than for the basic public health service of not acting as a transmitter of the virus to someone who is more at risk of hospitalization or even death due to influenza. So the question persists: if vaccination serves yourself and the community, why resist it?

There are other studies being conducted on what is termed ‘naturalness bias’ (like this one at Rutgers: http://mdm.sagepub.com/content/28/4/532.short). The result of the study is essentially that some people make bad decisions because of a cognitive bias towards means that feel more ‘natural’ – in other words, if you tell them a kind of tea is a great counteractive agent to influenza, they will drink it, but if you suggest that they get vaccinated, they will find all kinds of reasons to dispute you. Tea is from nature; vaccines are a mysterious, dubious concoction brought to you by the same science that supported cocaine as medicine and DDT as pesticide.

So all kinds of reasons exist to doubt the flu vaccine. What’s in the flu shot, anyway? Many believe that the flu shot can actually get you sick, which is itself a medical misunderstanding involving a combination of known statistical nemeses. For starters, a large number of influenza strains and influenza-like viruses exist, and the vaccine can only protect you against so many. Some argue that this makes the vaccine worthless, when in fact it means that the vaccine is only as good as the severity of the strains it actually protects against. Those concocting the vaccine work hard to ensure it protects against the most severe strains predicted to be active in any given season. Nevertheless, the likelihood that some who are vaccinated become sick soon after is statistically guaranteed given a large enough sample, either because the vaccination didn’t come in time or because those unlucky few caught something the vaccination could not defend against. To these few (a minority, particularly if you establish a clear window of time after vaccination where sickness constitutes a possible response to vaccination), it is not surprising that they feel cheated and suspect that they’ve been had — not only by flu hype, but by flu shot hype.

The other factor in play has to do with anecdotal evidence and word of mouth narrative; it’s a simple tale of how everyone knows someone (who knows someone?) who has ‘gotten sick from a flu shot.’ The CDC is very candid about why this can seem to happen to any who cares to actually read up on it: (http://www.cdc.gov/flu/about/qa/misconceptions.htm).

In the light of these cognitive factors that influence these behaviors (influenza vaccination denial and the anti-hype hype), is there a motivational determinant that can be identified? Becker’s theories outline what Gilovich’s work suggests: something at work deeper than cognitive tics, deeper than the prevalence of poor science in pop culture. Isn’t it safer for the psyche to believe that disease is less of a threat? That the body has what it needs to defend itself against death? Don’t flu severity denial – and the cognitive factors that help sustain it – work in the service of protecting the embodied self against the reality of its own fragility?

Sources:

Gilovich, Thomas. How We Know What Isn’t So: The Fallibility of Human Reason in Everyday Life. New York: Free Press, 1991.

16 Comments

  1. As a flu shot “denialist” myself, I will answer your question.

    I have never taken a flu shot, and I do not intend to. I have gotten sick with the flu several times and thus far have always recovered. Perhaps my record of success with the flu will end someday, but I am willing to run that risk.

    Why do I not take the flu shot? I prefer to leave my fate in the hands of “nature”, as you put it, than in the hands of pharmaceutical corporations and big daddy government.

    Nature is heartless and soulless; this means two things. First and most obviously, nature will not protect me from myself or from anything or anyone else. But second, nature also doesn’t have it out for me personally. It is indifferent to my continued existence.

    I cannot with any confidence say either of these things about big pharma or big daddy government. To be blunt, I do not trust them not to put something besides flu vaccine in the flu vaccine if it suits their purposes to do so. If they decide to do this nobody will know until afterwards, and I would not know until everyone else knew.

    As a rational actor I believe the risks posed by the unknown motivations of big pharma and big daddy government to be greater than the risks posed by influenza. I can reduce the risk of influenza by taking the flu vaccine, but I cannot reduce this risk without incurring what I view as a greater, more serious risk: that of the unknowability ex ante of what is in the vaccine.

    If a stranger gave you a gun and told you it wasn’t loaded, and you couldn’t check for yourself whether it was or not, would you feel confident pointing it at your head and pulling the trigger?

  2. Furthermore, since this is a blog dedicated to Beckerian thought…

    I encourage you, Mr. Murray, to re-examine your argument with a more critical eye. For it is the advocates of the flu shot who deny death, and not (necessarily) those who refuse it.

    What are vaccines but attempts to dodge mortality? They are risk reduction behaviors at best, placebos at worst. To think that a vaccine or any other medical intervention will extend or improve one’s life is a leap of faith. It is a leap which may be justified by science in the aggregate, but this is only to say that it is a leap in accord with the religion of our time.

    You reference the CDC several times in your piece. What is the CDC? It is a government agency tasked with overseeing our behaviors and with planning part of our lives for us. Today in the 21st century, there are countless such government agencies overseeing many different aspects of our lives, some so complex that I struggle to understand them. To the extent that any of us trust the CDC or any other government agency, we have relinquished control over that aspect of our lives to that agency.

    This relinquishing is very much like the way in which a religious person puts their trust in God, except that instead of putting their trust in the good Book and in the clergy, the CDC faithful put their trust in biweekly disease reports and government scientists.

    As Becker teaches, to put faith in any such organization or entity is an attempt to deny one’s mortality.

    Although I will admit skepticism to the righteousness of government agencies like the CDC, I do not mean to argue here that your trust and faithful worship of the CDC is unjustified. I only mean to point out that you are trusting and relinquishing control, and attacking those who behave in a way inconsistent with your faith–precisely what Becker predicted.

    • Excellent points all Willis Old Thing. If vaccinations aren’t individual little death denial schemes I don’t know what are.

      Marketed and consumed like religion. First, one confesses their fears, sins and symptoms to the proper authority. Then, once they have been accepted and recorded, it’s off to the pharmacy for communion, and to receive.

      Flu shot deniers are alienated from culture. That makes them inconvenient for institutions that depend upon culture for obedience. They want you to think that alienation from culture is some kind of pathology. It isn’t. It’s more like the cost of your sanity, in many cases. You are just the one who has to have a sense of humor when you hear someone say they know what the truth is. That’s all.

  3. Great article, Scott! You forced me to examine my own natural bias.

  4. I don’t see Becker here. What I see is a sizable segment of the population that has learned not to trust anyone who claims to have a coin with only one side. Especially if that someone is a corporation. “Vaccination is perfectly safe and if you don’t believe it you are either stupid, or, crazy.. or both.” That’s the party line. There is NO down side to vaccination! “What we should do is FORCE IT ON EVERYBODY!”

    Sorry, but, that is hard for a lot of people to swallow. The condition of american children is, shall we say, disappointing. Never have they been more vaccinated, medicated & cared for, and never have they seemed less fit. Peanut allergies, autoimmune diseases, ADD, ADHD, asthma… school nurses offices that once contained band-aids, an ice pack and a hand full of other items now look like pharmacies and mini-emergency units. When a parent enquires of the medical profession… “WHAT is causing this?” The answer is… “We don’t know, BUT, it couldn’t possibly have anything to do with anything WE do, or, did.” Now we are told that our children shouldn’t expect to live as long as their parents. Is it any wonder that a percentage of the population is skeptical of elective medical activity? We read in the papers of pharmaceutical companies charging tens of thousands of dollars for some drugs and paying out hundreds of millions in law suits to damaged consumers from others. The system of which vaccination is the Holy Sacrament is bankrupting our economy with no end in sight. I, for one, do not find it at all odd that a percentage of the population says… “No thanks”. That they simply DON’T TRUST corporations, or, doctors.

    Do a thought experiment. If you knew that vaccinations would cause damage of a significant degree to a percentage of the population…neurological.. immunological… what would you do? Would you announce it and risk the loss of hard won herd immunity across the board in every disease we immunize against, or, would you lie like a rug and claim no such knowledge, for the good of society? What would a corporation do? How sure can you be?

    …”Is there a motivational determinant that can be identified?”…

    I can think of lots, none of which have much to do with our friend Ernest.

    I DO find the subject fascinating, but, I see it as a lack of trust not a symptom of death denial.

    • “The condition of american children is, shall we say, disappointing. Never have they been more vaccinated, medicated & cared for, and never have they seemed less fit. Peanut allergies, autoimmune diseases, ADD, ADHD, asthma… school nurses offices that once contained band-aids, an ice pack and a hand full of other items now look like pharmacies and mini-emergency units.”

      Well I’m glad we’re gonna make decision based on how things ‘seem’ or ‘feel’ to you rather than, say, mass statistics on child mortality today versus 50 years ago.

      • Of course we are achilleselbow. You expect people NOT to make decisions based upon how things seem to them? The churches are full in my neighborhood, and yet, I have yet to see any “proof” of Gods existence myself.

        I had to laugh yesterday when I learned that the effectiveness of this years flu vaccine has now been put at 9%. I don’t think announcements like that go a long way in upping compliance.

        As far as 50 years ago achilleselbow… the US is 34th in infant mortality. Obviously there is more to mortality than vaccinations, although they surely play a part. Think clean water and toilets and nutrition.

  5. I’m going to have to agree with Mrs. N. on this one.

    • As I mention in my post, the perfectly natural human tendency to base belief on how things “seem” or “feel” can run us into trouble if we aren’t more careful to evaluate the facts we hear. We will tend to accept those that agree with our beliefs, like when you heard that the “effectiveness of this years flu vaccine has now been put at 9%.”

      The overall effectiveness of this year’s flu vaccine has been estimated at closer to 56%, which is about average. Unfortunately, it is only about 27% effective for those over 65, and 9% effective at preventing the most prevalent strain this season for that same age group.

      Even 9% remains higher than 0%. Low effectiveness is not by itself a scientifically valid argument against not getting the shot, especially since effectiveness can’t be gauged until late in the flu season. Or so it seems to me.

      http://www.npr.org/blogs/health/2013/02/21/172612207/flu-vaccine-has-been-feeble-for-elderly-this-season

      • I agree with that scottrick. But, I will say again… “I don’t think announcements like that go a long way in upping compliance.” It doesn’t do much for confidence in the product either. Since you used the analogy of a flu shot to a “maybe-loaded weapon”… what percentage of the population do you suppose would buy a bullet proof vest that worked 27%, or, maybe 9% of the time? Scientific or not.

        But back to the subject. Are people who wear garlic around their neck better examples of death deniers, or, are the people who DON’T wear garlic around their neck the real death deniers?

  6. For my two cents, I think the primary reason for not getting flu shots is general laziness. It’s far more common than fear of death or distrust of the government. Case in point: back when I was in college and could get a flu shot on campus for nothing, I got flu shots. Once I moved to areas where the closest flu shot involved a drive? Only an occasional shot.

    • What a thought-provoking essay, Scott! I agree with B N – laziness is probably the main reason why I generally don’t get flu shots. But now that I live in Canada and they offer them at my work place? I’m right in line.
      Also, I think since I rarely get the flu I don’t consider the shot as being particularly necessary for me either. And I figure I’ll just deal with it if it happens. But this has made me think twice about those behaviors!

  7. Some really interesting stuff here.

    There is a very valid argument being made about trust. I tend not to trust corporations. That is a belief suggested but not entirely resting on facts. I do take the advice of my doctors under serious consideration. There’s some gray area in between that certainly gets very dodgy, but I try to avoid letting paranoia turn into outright anti-science.

    For the record, I’m not “attacking” anybody. Given the authority I would not enforce vaccination. Given the chance, I do try to encourage folks to consider their choices.

    I am suggesting a connection between flu shot resistance and death denial. A connection between flu shot “faith” and death denial is also valid in my eyes, but I chose my argument precisely because it is counter-intuitive.

    Getting the shot is making a choice — to believe that, contrary to what’s been put forward in the previous comments, the risk of long-term, serious damage to my body is a minimal risk of flu shot vaccination. From that perspective, comparing a flu shot to a maybe-loaded weapon seems extreme.

    I do consider the ways in which this choice is a kind of faith. I would ask that you consider the ways in which your resistance to losing control over your life is over-stated. You don’t have very much control to begin with. For me, a flu shot is an admission of that lack of control, an acceptance. Precisely because I do not know what the truth is.

    • I assume you are the author of the original piece?

      I think we agree on many things here, Mr. Murray. Most importantly, that one’s acceptance of the flu shot is an act of faith–in the substance of what is in the flu shot, in the efficacy of vaccinations generally, in the government, in the corporation which produced the formula, etc.

      I also agree that I don’t have much control over my life. I can resist encroachments on my freedom in the case of the flu shot, but I still breathe air contaminated by radioactive pollutants, I still must drive my car on dangerous public roads to get anywhere, I still must buy my food from a grocery store, which has obtained it from a farmer unknown to me, who sprayed the food with all sorts of chemicals, after the food was grown from DNA modified seeds. Some areas of my life I can maintain control over, while in other areas this control has forcibly been taken from me.

      But I don’t have to like my helplessness. I think here is where we differ.

      You may have read about a phenomenon known as “learned helplessness.” It is most often used in relation to lab animals. Rats will eventually stop trying to escape from painful stimuli and will modify their behavior in response to expected pain. They become sullen and distant. Their behavior remains modified even if the painful stimuli are removed.

      Religions operate in a similar fashion to the painful stimuli. The faithful are told stories of punishment and wrath, are made to repent, and eventually their behavior becomes learned. By adulthood the sin knowledge has been engrained.

      In our time, the religion is the state, the global government if you will, and among the painful stimuli are stories of terrorism, gun violence, and disease epidemics. Our children learn about these things and learn to behave in an avoidant manner like the rats. Rather than face the world they shrink from it and accept the state’s medicine as they’ve been taught.

      I find it all repulsive.

    • Scottrick… Who compared getting a flu shot to..”a maybe-loaded weapon”? Who are you accusing of “paranoia” and “outright anti-science”?

      If GETTING the flu shot, and vaccinations, are the behavior that is “culturally sanctioned” and sold under the heading [This will help keep you alive]… your “counter-intuitive” argument that NOT getting a flu shot is an example of a Death Denial scheme seems absurd.

      Some people hang all manner of amulets and charms around their necks to protect themselves against harm, disease and death. Would you suggest that those people who DON’T are engaging in a Denial of Death Scheme because they don’t?…

      [You write]…”For me, a flu shot is an admission of that lack of control, an acceptance. Precisely because I do not know what the truth is.”…

      You don’t know what the truth is…so… you accept the “culturally sanctioned” behavior, on faith, in the hope that it will keep you from kicking the bucket. Now, If that ain’t a classic example of an activity designed to deny I don’t know what is.

      I, of course, hang 8 pounds of garlic around my neck throughout the flu season for the same reason you get a shot. We are both human and can’t resist acting like it.

  8. “You don’t know what the truth is…so… you accept the “culturally sanctioned” behavior, on faith, in the hope that it will keep you from kicking the bucket. Now, If that ain’t a classic example of an activity designed to deny I don’t know what is.”

    I think that pretty much nails it. This one’s dead.

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