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Science of Science Communication 2.0, Session 1.1: The HPV Vaccine Disaster

page 1 of the course materials-- click it!Okay, so here is the first post for the "virtual" Science of Science Communication course 2.0. Actually, I'll be teaching/learning/attending the first "real world" session in about 30 mins.  

Today's readings are in the nature of a "case study" of the introduction of the HPV vaccine in the U.S. & its status today. The material below is in the nature of a "set up" for discussion, which I encourage people to have whereever they want but also in the comments section.  

I'm designating this "Session 1.1" in anticipation that I might myself post something-- in the nature of a "follow up" -- in which case I'll designate "Session 1.2."  Or maybe I'll do something else, who knows.

BTW check out this super cool & generous invitation if you are looking for "virtual" classmates & course materials!!

The introduction of the HPV vaccine in the US-- or the cost of being innocent & ignorant of the science of science communication. . . .

1. Merck’s application for “fast-track” review of female-only shot. It is late 2005. Merck, the manufacturer of the HPV vaccine Gardasil, has applies for “fast-track” FDA approval of a female-only shot.

HPV—the human papilloma virus—is a sexually transmitted pathogen. Exposure is widespread: some 45% of women in their early 20s have been infected. A comparable percentage of men almost certainly have been, too, although there is at this time no effective test for males.

HPV causes genital warts in some but not all infected individuals.

It is also the sole cause of cervical cancer. A diseases that can normally be detected at an early stage by a routine pap smear and thereafter successfully treated, cervical cancer nevertheless claims the lives of 3,000 women per year in the U.S. (many more in undeveloped countries that lack effective public health systems).

Clinical tests show that Gardasil confers immunity against 70% of the strains of HPV that can cause cervical cancer. This evidence furnishes logical reason to believe that widespread immunization would reduce cervical cancer rates, although the vaccine is in fact too new, and experience with it in nations where it is already in use too limited, for that proposition to have been empirically tested.

The role of HPV in causing cervical cancer is the basis for Merck’s application for “fast track” review, which is available only for drugs that furnish an “unmet medical need” for treatment or prevention of a “serious disease.” The link to cervical cancer is also why the “fast track” application is for a female-only shot: genital warts are not considered a “serious disease,” and while HPV might cause oral or anal cancer in men, there is at this time insufficient evidence to be sure.

If put on the “fast track,” Gardasil will likely be approved for use for women within six months. The FDA review process would otherwise be expected to take three additional years. Within that time frame, in fact, the FDA is likely to approve for males and females both Gardasil and Cervarix, an HPV vaccine manufactured by GlaxoSmithKline and already approved for use in Europe.

2. Health risks? Clinical trials suggest no reason to believe Gardasil poses a risk of dangerous side-effects. Some critics question the quality of this evidence, however, noting the recent withdrawal of Merck’s anti-inflammatory Vioxx based on evidence, known but not initially acknowledged by Merck, that showed the drug increased the risk of heart attacks and strokes.

Other critics suggest that widespread HPV immunization could have perverse behavioral consequences. To be effective, immunization should occur during adolescence, before an individual is likely to have become exposed to the disease through sexual activity. Some groups, including social conservative and religious ones, have voiced concern that immunization will generate a sense of false security in teenage girls, who will therefore be more likely to engage in unprotected sex, exposing themselves to a higher risk of pregnancy or other STDs. There is currently no evidence one way or the other on whether HPV immunization of adolescent girls would have any such effects.

3. The proposed legislative initiative. In addition to seeking fast-track approval of Gardasil, Merck is known to be organizing a nationwide lobbying campaign aimed at securing legislation adding the HPV vaccination to the schedule of universal childhood immunizations treated as a condition of public-school enrollment.

As part of this effort, Merck has reached out to women’s health advocacy groups. These groups strongly support making the HPV vaccine available in the U.S. Merck has proposed that these groups play a lead role in the company’s lobbying campaign, which would be funded by Merck. Merck is also understood to be searching for social conservatives to participate in the campaign.

4. Physicians’ views. There is every reason to believe physicians will view the availability of an HPV vaccination as a very positive development. No major U.S. medical association, however, has taken a position on either Merck’s fast-track proposal or on adding the HPV vaccine to states’ school-enrollment immunization schedules.

At least some physicians, however, have voiced criticism of how the vaccine is being introduced. They assert that Merck’s fast-track application and its planned nationwide legislative campaign are economically motivated: Merck’s goal, they have argued (in various fora, including medical journal commentaries), is to establish a dominant position in the market before the FDA approves of GlaxoSmithKline’s rival Cervarix vaccine. Whatever public health benefits might be associated with accelerating the speed with which Gardasil is approved and HPV vaccine added to universal vaccination schedules, these commentators have warned, will be offset by the increased risk of a political backlash.

5. Political controversy? At this point, there is no meaningful dispute over Gardasil. Indeed, only a minute fraction of the U.S. population has ever heard of the vaccine or even HPV for that matter.

Nevertheless, the prospect of controversy has already been anticipated in the national media. A government-mandated STD shot for adolescent girls, these sources predict, is certain to provoke confrontation between women’s rights groups and religious and social conservatives.

Aside from some women’s’ health groups, the only other advocacy group to address the HPV vaccine is the Family Research Council. Committed to protecting religious values in American life, FRC has played a major role in opposing public-school instruction on birth control. The FRC has stated that it does not oppose—indeed, “welcomes”—the introduction of the HPV vaccine, but views state-mandated vaccination as interfering with parental control of their children’s’ health and their sexual behavior.

5. The HBV vaccine. The HPV vaccine would not be the first STD immunization to be placed on states’ school-enrollment vaccination schedules. A decade ago the FDA approved the HBV vaccine for hepatitis-b, a sexually transmitted disease that causes a lethal form of liver cancer. The CDC quickly recommended that the vaccine, which had been approved for both males and females, be added to the list of universal childhood immunizations. Within several years, almost every state had added the HBV vaccine to its mandatory-immunization schedule via regulations issued by state public health officials, the conventional—and politically low-profile process—for updating such provisions. The addition of the HBV vaccine to the state schedules generated no particular controversy, and the nationwide vaccination rate for HBV, like other childhood immunizations, has consistently been well over 90%.

6. “Public acceptance” research. Public health researchers have conducted studies specifically aimed at assessing the public acceptability of an adolescent HPV shot. These studies, which consist of surveys of parents with adolescent children, uniformly report that parents say they are unfamiliar with the HPV vaccine but will have their children immunized if their pediatricians recommends doing so.

Issues. Should the FDA grant Merck’s application for fast-track review? Should Merck withdraw it? Should women’s’ advocacy groups agree to participate in the company’s nationwide legislative campaign? What position, if any, should medical professional associations take? Is the position of social conservative groups like the FRC relevant to these questions?

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  • Response
    I discuss the question of whether the media had some role in actually manufacturing the controversy around the Gardasil HPV vaccine, and specifically the debate about whether states should mandate the vaccine for school admission.

Reader Comments (9)

I've got a question: I'm less concerned about anti-science prejudices among farmers than among intellectuals. How do we start to persuade intellectuals, academics, pundits, journalists and the like to be less dogmatic about their anti-science prejudices such as that evolution in humans never happened above the neck or that IQ research is just a Giant Conspiracy Theory?

January 14, 2015 | Unregistered CommenterSteve Sailer

I have some thoughts about the fast-track review - but more questions.

According to the notes above, fast track review is available only for drugs that furnish an “unmet medical need” for treatment or prevention of a “serious disease.” Since the FDA had not previously approved a vaccine for HPV, the need appears to be unmet. It seems a fair assumption that cancer would be considered a “serious disease.”

However, we should ask a further question: what do the FDA’s own rules say should govern its decision-making regarding fast-track requests? Must it grant such requests to all drugs meeting the above criteria, or does it have some leniency in this decision-making? Are there any other criteria it ought to consider?

It would also be prudent to ask if the FDA's own rules about fast-track reviews are in keeping with the spirit and purpose of these reviews. Why did the FDA actually create the fast-track program? Is it possible that while Gardasil technically meets the requirements to be considered for fast-tracking, it somehow isn't the sort of thing that should be included in the program?

Apologies if these questions were addressed in the reading and I somehow missed them...

January 15, 2015 | Unregistered CommenterTamar Wilner

I've posted my reaction to the Week 1 readings on my blog - comments welcome!

January 16, 2015 | Unregistered CommenterTamar Wilner


This is a really good question & an admirably let’s-take-a-look-at-the-evidence assessment.

We need more evidence, as you note.

A couple things to note:

1. There were definitely other media stories at this time that had this same theme. E.g., Guyon, J. The coming storm over a cancer vaccine. CNN Money (2005).

2. Early on, before approval of Gardasil, prominent religious conservative activists signaled they would not seek legislation to block approval or distribution of the vaccine. Indeed, the Family Research Council, a leading religious-right activist group that had led opposition to instruction on birth control in public schools, issued a statement declaring that “media reports suggesting that [it] opposes all development or distribution” of Gardsil “are false,” and that it in fact “welcomed” approval of the vaccine. This was significant b/c before then there was (as the FRC’s statement suggests) would seek congressional action blocking introduction of Gardasil. However, the group also made plain that it “would oppose any measrues to legally require vaccination” as contrary to parents’ “inherent right to be the primary educatory and decision maker regarding their children’s health.”

What to make of this?

Not any *one* particular thing, obviously. But here are some observations:

I. Tamar is surely right to say that the Washington Post reporter wasn’t “inventing” a controversy. The prospect of controversy was in the air for sure. The FRC statement staked out its position — that it would not seek to block the vaccine but would fight any campaign, also already anticipated, to push for rapid state legislative mandates. That campaign came, led ostensibly by “Women in Government,” a women’s rights advocacy group, but funded by Merck, initially in a manner designed to disguise its involvement.

II. Nevertheless, I think one could still take the position that the media played an “agent provocateur” role. The argument would be that anticipation that the media would frame the advent of the vaccine as a “culture war battle” essentially “forced the hand” of advocacy groups: once framed in that way, sitting on the sidelines would not be an option for either women’s advocacy groups or the conservative religious ones. In a world in which the media wasn’t stirring things up, those groups might not have gotten involved. Generating evidence to test/support this conjecture would be pretty complicated, obviously.

III. An alterantive to the “agent provocateur” view of the media’s role would be “canary in the coalmine.” An issue doesn’t *already* have to be a major cause of public controversy for smart reporters *correctly* to anticipate the likelihood that it will become one. The news stories, which as Tamar points out were covering activities by the players involved, were doing that. And they were thus *putting on notice* all those other actors, from the FDA & CDC to public health professional groups to science communication researchers, that advent of the vaccine might well be attended by such controversy. They were doing this *yrs* before the public controversy in fact materialized. So why didn’t researchers, who were at that time doing studies that showed only that parents would “accept” the vaccine if advised by their pediatricians that it was effective, *do more studies* (one was done, actually) to model what would happen if parents learned about the vaccine in a context filled with cultural controversy? Why didn’t public health regulators intervene to try to steer the players– including Merck and the advocacy groups pushing for legislative mandates–to back off of actions that would trigger this sort of controversy? Why didn’t other members of the public health establishment, such as medical associations, do so?

With hindsight, the HPV vaccine controvrersy looks “inevitable.” But it wasn’t; the peaceful itnroduction of the HBV vaccine is convincing evidence of that. Indeed, it’s more plausible to suggest the controversy caught responsible actors “by surprise” — nothing like this had ever happened before, and there was so much research suggesting that parents would simply follow the advice of physicians. But *that would be wrong* too: the controversy was both looming — yet not clearly unavoidable…

January 17, 2015 | Registered CommenterDan Kahan

I’ve commented on this topic on previous posts and have been mulling over what to contribute here since Dan Kahan first posted here.

Then, I was reviewing testimony which had to do with Biological Critical Areas, in which a speaker discussed divergence as a rhetorical device in debates. By this she meant something like Matt Nisbett’s concept of framing. Again, reading Patricia Nelson Limerick’s book, on Denver water, "A Ditch in Time,The City, the West, and Water", she titles chapter 4 "Dealing in Diversions", and proceeds using her usual skill at plays on words. As a footnote, Limerick offers a dictionary definition of the word diversion, which includes not only physical diversions from a course, but also an attack or feint that draws the attention and force of an enemy away from the point of the principal operation. This got me thinking about our “normal” adversarial “give both sides” media renditions of Science Communication on various topics, including this one. In these discussions, the media is not some neutral party, but rather owned and influenced by corporate interests.

The point of the principal operation here is Public Health. Specifically, the reduction of the incidence of HPV virus instigated cancers.

(I think that that analysis changes once the vaccine is expanded beyond just females, and the potential for cancers not screened for by Pap Smears or as readily treated, are included. But this vaccine was originally introduced for use by girls and the aim was reduction of HPV infections leading to Cervical Cancer.)

Tamar Wilmot gives a great analysis of whether or not the media created the vaccine controversy. I believe that analysis can be expanded. I think that this is not just a matter of whether or not the media created the controversy regarding the use of the HPV vaccine with 12 year old girls, but also, why such a controversy might actually have been a way of diverting attention away from other, more scientifically pertinent issues.

Prior to the vaccine, awareness of HPV was limited by the fact that the linkage between Cervical Cancer and Pap smears was what was discussed. And so women who regularly saw their gynecologist, if they were following protocols, did so once yearly to have a pap smear. A Pap Smear indicating abnormal cells is a reason for further investigation, but at that point the cause of the abnormalities was not particularly relevant. Precancerous abnormal cells on the cervix, if found by Pap Smear, can be removed, by biopsy or cutterage. Cervical cancer, if caught in its early stages can be treated. The key is regular Pap Smears.

At best, the vaccine will only impact incidence of cervical cancer decades from now. Cervical Cancer forms very slowly. And since this vaccine does not immunize against all forms of HPV, Pap smears will still be necessary. While the vaccine targets the forms of HPV most implicated in cervical cancer cases today, it is not clear how that carries through to the future ecosystem of HPV viruses. For older, non- immunized women, HPV infection during one’s life is likely. Whether or not a woman gets cervical cancer depends on whether or not the HPV infection(s) create immunity, or go on to cause cancer. Not enough is known about HPV variants to really know whether or not the vaccine is knocking out HPV virus types that are more likely to confer immunity along with those likely to cause cancer. Or, what happens to the remaining HPV types, not affected by the vaccine. Will they cause cancers of the future? The reason for selecting age 12, is to vaccinate girls before they are sexually active. But obviously, many girls and women are not sexually active until much older than that. What is not known is how long the immunity from the vaccine lasts. In the case of cervical cancer, if that immunity does not last for decades, is the vaccine really helping? Also, Pap Smears are still needed.

Why is it, as Dan Kahan comments above, that the media may be serving as an agent provocateur?

I think we also need to look more closely at Tamar Wilmot’s statement here:

“Interestingly and worryingly, the passages that most strongly seem to demonstrate controversy come, I believe, from those who would least desire it: health advocates and the vaccine manufacturer. For example, the article says cancer experts and women’s health advocates are “pushing the view” espoused by Merck, that school mandates “have been one of the most effective ways to increase immunization rates.”

What are Merck’s motivations? For economic success, vaccines need a business model, not just a medical need. This is for example, why the world has been slow about thinking about Ebola.

In particular, getting onto the CDC childhood immunization schedule is highly desirable from an economic point of view. Not only does this give a large client base, but also access to coverage under National Childhood Vaccine Injury Act of 1986, VCIP, or the National Childhood Immunization Program. And, of course, once on the schedule, the Pharmaceutical company needs to get Pediatricians to administer the vaccine. And states to add them to their requirements.

I think that the following two articles aimed at medical professionals are instructive:

The above indicates that as late as 2009, there was still reluctance on the part of pediatricians, to actively participate in this vaccine program and for whom further education on the importance of the HPV vaccine still needed to be directed. Pediatricians were already under fire from parents concerned about other childhood immunizations, and the increasing numbers of those immunizations.

A more direct challenge to the wisdom of utilizing this vaccine on the part of medical professionals is contained in this article:

This article challenged the cost effectiveness of the vaccine approach to cervical cancer reduction as opposed to greater use of Pap Smears.

Remember that Gynecological practices have long been established on the pattern of yearly visits by their patients, for the purpose of obtaining a Pap Smear. At this time, other medical issues could be addressed with patients as well. But it was the Pap Smear that got patients in the door. (Recently, the technology of Pap Smears has greatly improved, and the need for repeating the test reduced accordingly.) The above article raises many points, but a significant one is that encouraging greater access to Pap Smears would be a much more cost effective mechanism for reduction of cervical cancer than this vaccine, which after all, can not possibly reduce cervical cancers for decades, and it is not entirely proven that it will do even that.

Gynecological practices have been based on women coming in on a yearly basis for a Pap Smear. Most 12 year olds have mothers, many of whom would be expected to have a personal gynecologist. In theory, Merck might have wanted mothers to ask their Gynecologists about the HPV vaccine and recieve information endorsing having their daughter get it. But is that answer what Merck could have reliably expected from Gynecologists?

The current CDC website contains the following page:

One of the interesting things to note is that currently, HPV infections themselves can be tested for (and not noted here) immunity for specific types covered by the vaccine can be demonstrated.

This website contains the following information:
“The Pap test is a screening test for cervical cancer. It looks for abnormal cells on your cervix that could turn into cancer over time. That way, problems can be found and treated before they ever turn into cancer. An HPV test may also be used with the Pap test for women 30 years or older, as part of routine screening.”
“Most of the time, the body’s immune system fights off HPV naturally within two years-- before HPV causes any health problems. It is only when HPV stays on a woman’s cervix for many years that it can cause cervical cancer. Experts do not know why HPV lingers in certain cases but not others.”
“HPV is very common in women under age 30. But it is not useful to test women under age 30 for HPV, since most HPV that is found in these women will never cause them health problems. Most young women will fight off HPV within a few years.”
“HPV is less common in women over the age of 30, who are at increasing risk for cervical cancer. HPV is also more likely to signal a health problem for these women, who may have had the virus for many years. Doctors may use the HPV test with the Pap test to tell if these women are more likely to get cervical cancer in the future, and if they need to be screened more often.”

In my opinion, we should be hearing a lot more about the continuing need for Pap Smears for all women. The fact that the media discussion centers on the vaccine when women face decades of cervical cancer risk without obtaining a simple test ought to be a major issue for those interested in effective health science communication. We ought to be discussing the need for development of analogous tests to the Pap Smear for cancers of the throat and anus. We ought to be investigating whether or not HPV infections could be treated in older adults when they are more likely to be a problem. We ought to consider testing adults for the forms of HPV that cause cancer and are covered by the vaccine, and consider giving the vaccine to those that do not yet have immunity.

I think that we ought to look at the current media controversy as one that may be being utilized by pharmaceutical corporations as a diversionary tactic.

It is one of many “science communication” discussions that come in the form:

Private corporations carry the flag of science in a battle against the completely ignorant.

In the process, many issues that is actually vital to authentic communication of science are never raised in a manner that reaches the general public. Scientists need a better way to communicate.

January 18, 2015 | Unregistered CommenterGaythia Weis


These are good points.

But who could possibly be in a position to "create" cotnroversies to "divert" people in a situation like this? There are two many agents & no mechanism for coordinting them.

We need to pin down the contribution thta accident & misadventure *predictably* play when we fail to implement procedures for anticipating & systematically regulating influences that pollute #scicomm enviornment.

As for Merck,I think we will only be giving *outselves* a pass if we blame *it.*. Merck is what it is: a corporation that tries to make $ by supplying us w/ useful drugs in exchange for a limited opportunity to collect monopoly profit. That's a fair trade. We just need to be mindful that of course any economically motivated actor will have inerests that aren't perfectly convergent w/ public; to blame actor rather than ourselves for failing to recognize & take appropraite steps-- that's not the right snswer, in my view!

Merck is not the problem.

Family Research Council & Women in Govt are not the problem.

Lack of a science communication environment protection policy is.

January 19, 2015 | Registered CommenterDan Kahan

I agree that scientists and other science interested parties need to evaluate what makes for effective science communication, and act accordingly. An organized effort might give individual researchers more clout with the administrators of their institutions and the manner in which those institutions concoct press releases. It also might be possible for scientists, through their professional organizations, to better regulate the journals produced by those organizations, to curb what can be their biases towards "flashy" research and research headlines. And that would probably be a good start at how such research information is picked up by the media aimed at the general public.

But then to get the material into the general press, you'd still have to clear it with the likes of Rupert Murdock. Or some city newspaper editor TV or radio editor, for whom the publisher is glaring over one shoulder, making sure that the newspaper contents do not offend local advertisers. Many of these local venues are not really local anymore, but rather owned by big chains, (not all of which are in turn owned by Murdock).
Another place to start would be with online venues. What causes posts to “go viral”? Aside from cats (which I am allergic to, and therefore fail to see the cuteness) memes that work seem to buy into and accentuate the biases of the audience to which it is directed. It works quite well to try to point out the ways in which those that are on the other side of the fence are stupid, or perhaps even dangerous. This leaves the target audience with the reassuring message that they are on the right side.

One could notice that this has parallels with human political allegiances. Rulers find it useful to find a scapegoat and then initiate battles or wars with them as a means of staying in power. Finding a scapegoat is a useful diversion, which keeps the populace from considering other matters, often their own bad economic situation, perhaps brought about by the rulers.

Back to vaccines: Vaccination is a subject that has always induced some amount of fear. I’m currently reading Vox Americana, which discusses, among other things, George Washington’s handling of inoculation against smallpox at Valley Forge. A strong line of modern anti-vaccination acitivists, often referred to by others as the “antivaxxers” can be traced back to Andrew Wakefield. The rise of awareness of autism as a defined disease coincided in time with a whooping cough vaccine that sometimes caused high fevers and even convulsions. In an earlier time, autism was frequently not diagnosed as such, and at any rate, severely disabled children tended to be institutionalized, out of public sight. Compounding the issues, problems with the whooping cough vaccine were, in my opinion, poorly handled by many pediatricians. Pediatrics itself was a relatively new profession. Families dealt with obstetricians and pediatricians rather than a long standing family doctor. Pediatricians, in collusion with the manufacturers of Tylenol, often handed out free samples of that drug in an effort to quiet the babies suffering from the side effects of the whooping cough vaccine and thus attempting to silence the concerns of their parents. This practice was later found to be harmful to the immunization process: Thus, at least some parents were open to the idea that something was awry with established medical practice regarding vaccines. The idea that vaccines might be linked to autism was not completely outlandish sounding to many. Initially, Wakefield seemed to have data to back up his accusations. But scientists soon set to work to obtain data which refuted these claims.

Why does this persist? Partly because Andrew Wakefield himself has been incredibly clever at provoking opponents. He needs to stay in the headlines. But why was this allowed to happen? Here, we can look at the ways in which the media did repeatedly play the role of agent provocateur. Media had an urge to report “both sides” and Wakefield worked hard to be that other side. Controversy sells.

But I don’t think we should give Big Pharma a pass. I think that part of the reason that the autism issue persisted is that this side also brought it up, making sure that it stayed in the public eye. I think it happened again with the HPV vaccine, and the matter of vaccinating 12 year olds.

We could be discussing vaccination in a more complete context regarding public health outcomes. What we are having is a conversation that is framed in a manner that says:

Science is on the side of Big Pharma and everybody opposing that is just ignorant.

In the case of the HPV vaccine, Merck, in my opinion, would rather not have had the issues of raised in the JAMA article discussed: There was absolutely no value to them in publicizing the fact that many raising concerns about the HPV vaccine as an appropriate and cost effective method of battling Cervical Cancer were, in fact, medical professionals. Much better to fan the flames of a fairly isolated group of extremists, who were not even, as you point out above, supported by religious and political institutions that might have been anticipated to be on their side. This is a tactic of diversion.

I think that we will always have nut cases, and people who exploit situations with distorted information that feed fears and inflame passions. The issue is not eliminating such events, it is preventing them from becoming locked in.

This isn’t just about science communication, it is about the way that our entire political process has been subverted to serve the needs of a very few elites. We run political elections in which candidates are voted in on narrow platforms that do not reflect the beliefs of the public at large. We have a global economy in which wealth is increasingly in the hands of a very small group of wealthy individuals:

In such an environment, instituting a “science communication environment protection policy” will not be an easy task.

January 19, 2015 | Unregistered CommenterGaythia Weis

"But then to get the material into the general press, you'd still have to clear it with the likes of Rupert Murdock."

Rupert Murdoch was quite happy to sell newspapers expressing views opposed to his own - so long as they sold. He differed from his fellow newspaper proprietors in that instead of publishing what he thought the public *ought* to read, he published what they *actually wanted* to read. This, obviously, annoyed all those other proprietors, seeing him publishing stuff they they didn't think people ought to be allowed to see (or say), and therefore he became something of a hate figure. (Although because he was giving the public what they wanted, he became a rich one.)

About half the people in the world are left-wing and about half the people are right-wing. Almost all the media here are left-wing, and serve a left-wing audience. Rupert Murdoch realised that there was therefore a huge market for a right-wing paper. Simple. And you can see why that sort of behaviour would be unacceptable to some people, who put their own principles ahead of business. That's what principles are for, after all.

"We have a global economy in which wealth is increasingly in the hands of a very small group of wealthy individuals"

Yes. We have a global economy in which the wealth on which everyone relies is increasingly being *created* by a very small group of people, who get incredibly wealthy as a result (since personal wealth measures the good each of us has done for society that society has not yet repaid). It would be nice if we could teach everyone else to do the same thing they do, but failing that, a bit of simple gratitude would seem to be the decent thing.

January 22, 2015 | Unregistered CommenterNiV

I think that what NiV says above actually partially explains Dan Kahans query here:

"But who could possibly be in a position to "create" cotnroversies to "divert" people in a situation like this? There are two many agents & no mechanism for coordinting them."

The beauty of the marketplace. Once it is demonstrated, as it has been repeatedly online, that setting up to duel antivaxxers sells, as in generates readership from one's base, you have a mechanism in motion.

All Merck had to do was to plug into this. To make it seem as if their new vaccine was as simple an open/shut case as is true of say, measles. When in fact it is much more complex. This then becomes a way to influence the public media story, as well as the story told to educate pediatricians. And to divert attention away from those more complex issues regarding the need for pap smears for decades to come.

January 25, 2015 | Unregistered CommenterGaythia Weis

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