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« Travel report: Is even the vote (not to mention all the voting) on Brexit irrational?... | Main | The fourth of "four theses on ordinary science intelligence" ... a fragment »
Monday
Jun202016

Travel report: On unpolluted & polluted public health science communcation environments--the cases of the HBV & HPV vaccines (presentation summary & slides)

A rational reconstruction of the talk I gave—in 15' 22" [I can talk 9x faster than the average man, woman, or trained circus animal can read; and I pride myself on the 30-min sentence]—at the truly amazing “How we Can Improve Health Science Communication Conference” at U of Mich.’s amazing Center for Pol. Studies last week. Pretty sure the talks will be or perhaps already are on line.. . . Now am in UK for 7th Annual Cambridge Centre for Risks Studies Confernce – will write a postcard on that soon! Slides for  the U of M talk here.

1. As you know, my paper (in press) is on what I call the Science Communication Problem—the failure of valid, compelling, widely available scientific evidence to quiet public dispute over risks and like facts to which that evidence directly speaks.

The paper argues that our understanding of the Science Communication Problem is being distorted by fixation on conspicuous and specular instances of it—particularly  the conflict over climate change. 

Obviously,  empirical researchers should be focusing on how to decipher and ultimately dispel the Science Communication Problem. My claim, however, is that we won’t achieve these goals if we focus on instances of public dissensus to the near-total disregard of public consensus, which is far and away the norm on decision-relevant science.

 A research program that never diverts its gaze from climate change and other instances of the Science Communication Problem distracts our attention from evidence that would reveal the falsity of many popular accounts of why we have the Problem. It also steers us toward prescriptions that won’t repair the dynamics that ordinarily generate public convergence on the best available evidence and could even, perversely, inflict even more damage upon them.

I won’t rehearse my argument in detail, though. Instead I will try to illustrate it with a specific example not discussed in the paper: public conflict over the HPV vaccine.

2. As I’m sure y’all know, the HPV vaccine confers an imperfect but still important degree of immunity to the human papillomavirus, an extremely common sexually transmitted disease that causes cervical cancer. 

The HPV vaccine also has the distinction of being the only childhood shot recommended for universal administration by the CDC that is not now on the schedule of mandatory school-enrollment immunizations in US states.  Legislative proposals to add it were defeated in dozens of states in the years from 2007 to 2012 as a result of deep, pervasive political controversy over the safety and effectiveness of the vaccine (Kahan 2013).

It’s tempting to think this outcome was inevitable. The vaccine is for a sexually transmitted disease and was to be administered, initially, to pre-pubescent girls as a condition of their eligibility to attend public schools.  Of course, such a proposal would provoke controversy between groups that subscribe to opposing understandings of sexual morality, of parental sovereignty, and of role of the state in securing individual well-being.

But that conclusion—that the HPV-vaccine conflict was inevitable—reflects exactly the tunnel vision I’m attacking.

The HPV vaccine was not the first one that was aimed at a sexually transmitted disease recommended for universal administration to children. The HBV vaccine was.

The HBV vaccine confers immunity to hepatitis-b, which also causes cancer, of the liver.

The CDC proposed it be administered universally to adolescents (now to infants) just a few years before it proposed the  same for the HPV vaccine. With no significant controversy, the HBV vaccine was incorporated into the mandatory, school-enrollment immunization lists of nearly every U.S. state in a wave of approvals that crested just as the HPV-vaccine controversy began. At the time the HPV-vaccine controversy was raging, the HBV vaccine had an national uptake rate of over 90%--compared to the anemic 30% for the HPV Vaccine today (Kahan 2013).

Thus, the HPB vaccine,  is in the “denominator”—the vast class of decision-relevant science issues on which there isn’t public controversy but could be. What it shares with all the other members of that class is the benefit of having become known to the public in an unpolluted science communication environment

The science communication environment, I explain in the paper, consists of the sum total of processes and conventions generative of the cues that normally guide diverse individuals align their behavior with the best available evidence.

The HBV vaccine, like every universal childhood immunization before it, traveled safely through these processes and conventions to the destination of overwhelming public confidence. The vaccine was considered and approved for inclusion in state universal-immunization schedules by non-political public health agencies that have been delegated this expert task by state legislatures. The vast majority of parents thus had occasion to learn of the vaccine for the first time when their consent to administer it was sought from their pediatricians, individuals they had selected b/c they trusted them, who advised the vaccine was safe and a useful addition to the array of prophylactic practices that keep children healthy. Just as important, regardless of who they were—republican or democrat, devout evangelical or atheist or agonistic—all were afforded ample evidence that parents just like them were getting their kids vaccinated for HBV (Kahan 2013).

The decision to follow suit was a no brainer!

In contrast, parents and other citizens learned about the HPV vaccine in what I characterized as a polluted science communication environment.  A polluted science communication environment is one in which some risk or fact has become entangled in antagonistic social meanings that transform them into badges of membership in and loyalty to opposing cultural groups. In those conditions, the same cues that normally guide diverse citizens into convergence on the best available evidence—including what others in their situation are doing and saying-- instead drive them apart.

That’s what happened with the HPV vaccine. To try to establish a dominant position in the market before the approval of a competing HPV vaccine manufactured by its rival Smith-Glaxo Smithkline, Merck--manufacturer of the Gardasil, the HPV shot approved by the FDA in 2006--orchestrated a nationwide campaign to add the vaccine to the state, mandatory school-enrollment schedules by statutes enacted by state legislatures.

What was normally a nonpolitical decision—the updating the of state school-enrollment immunization lists—necessarily became hyper-politicized. People first learned of the vaccine not from their pediatricians but from Fox News, MSNBC, and other political news outlets, who hyped the repressive-in-your-face-religious right vs. the cosmopolitan, communism-of-women-and-children-left showdown on the “STD shot for school girls,” a framing facilitated by Merck’s decision to seek fast-track FDA approval of a girl’s only shot as part of its market-driven plan to sidestep the slower, less politicized approval process.

The result was the entanglement of the HPV vaccine in the sort of antagonistic meanings productive of the most debilitating of all known science-communication pathologies—identity-protective cognition (Kahan 2013).

3. Sarah Gollust and her collaborators (2010, 2013, 2014, 2015) have done a lot of outstanding work to identify and quantify the indicators of this entanglement and its disruptive impact on how ordinary members of the public ordinarily recognize valid science..

The CCP research group did a study on this too back in 2007, just as the process that resulted in this disaster began to unfold. In it we tried to model how different “science communication environments”—unpolluted and polluted—could affect engagement with information on the vaccine’s risks and benefits.

The study (Kahan, Braman, Cohen, Gastil & Slovic 2010) examined how cultural cognition could shape perceptions of the HPV vaccine. Cultural cognition refers to the tendency of people, in effect, to conform their  own perceptions of risk and like facts to the ones that predominate among others who share their cultural identities.

We measured individuals cultural identities with two orthogonal attitudinal scales, hierarchy-egalitarianism and individualism-communitarianism, which can be viewed as forming four types of cultural “affinity groups.”

Next, we exposed them to competing arguments on the balance of risks and benefits of the HPV vaccine from  fictional “public health experts.” The experts were ones we had determined in separate pretests would be tacitly identified by the experimental subjects as having the cultural identifies featured by the cultural cognition worldview scheme.

By crossing the two arguments with the four advocates, we had had 12 HPV “expert-argument matchups.” To assess their impact, we modeled how the proximity of the subjects’ actual cultural outlooks to the experts' tacitly perceived ones affected subjects’ HPV-vaccine risk perceptions.

Our goal  in simultaneously manipulating the array of experts and arguments, on the one hand, and the proximity of the experts' cultural outlooks to the subjects', on th the other, was to simulate the impact of learning about the vaccine under conditions that would themselves vary in how readily they suggested the presence or absence of division of opinion between subjects’ own cultural groups and a rival one.

The simulation suggested that the impact was yuuuuuuuugely consequential.

In effect, there was a continuous polarization effect that tracked subjects' tacit impressions of group conflict.  

We knew, again  from pretesting, that subjects with particular identities had modest predispositions to form one or another impression of the safety and efficacy of the vaccine.

But under the condition least likely to suggest group conflict—the one in which subjects saw an alignment of culturally identifiable experts and arguments contrary to the one they would have expected to see if the issue were in fact dividing groups consistent with subjects’ own predispositions—polarization essentially disappeared.

Where in contrast they saw the alignment most suggestive of such conflict—the one in which an expert with their identity took “their side’s” position and one with opposing identity “the other side’s”—polarization dramatically escalated relative to the level predicted by the subjects’ predispositions alone.

These two points on the continua reflect a pristine and a polluted science communication environment, respectively. The first was the environment in which American parents learned of the HBV vaccine; the latter the one in which they learned of the proposal to add the HPV vaccine to the schedule of mandatory school-enrollment immunizations.

4. Likely this condition could have been avoided. Lots of physicians and others were worried that the manner in which the HPV vaccine was being introduced to the public risked generating a political controversy (Kahan 2013).

But the question now is whether anyone is going to learn from this experience and from research on it, including our study and the penetrating set by Gollust and her collaborators.

The answer, I think, will depend largely on whether members of the public health establishment avoid the mistake of “ignoring the denominator”—the relatively large number of cases in which the public doesn’t polarize but rather converge on the best available scientific evidence. Frankly, I think many of the proposals on how to over come the continuing public ambivalence on the HPV vaccine reflect exactly that mistake.

One prominent proposal is to conduct a large-scale social marketing campaign promoting the vaccine. Thrusting the HPV vaccine back into the limelight in this way would risk exciting the very sorts of sensibilities—and more importantly reigniting the same sort of interest group activity —that bred the initial conflict. Indeed, this idea sounds more or less like a proposal to take out of mothballs the very advertisements that Merck bankrolled during its disastrous campaign to secure legislative mandates.

Just look at the denominator!

There wasn’t any social marketing campaign on HBV vaccine, just as there wasn’t any on the myriad other science issues—from medical x-rays to nanotechnology—on which diverse members of the public now have aligned their behavior appropriately by science.

The mechanism, moreover, in those cases hasn't been the public's reflective processing of detailed bits of medical or other scientific information. It has been their attention to the cue emitted by the words and behavior of others who have evinced their confidence  by words and deeds showing that they have confidence in the underlying science.

An unpolluted science communication environment is not bustiling with broadcast messages. On the contrary, it comprises a host of persitent low key signals that assure that people that doing things that rely on what is in fact the best available evidence is mundane, banal normal.

The question is how to promote this sort of normality to people's engagement with the HPV vaccine.

I’ll give you a hint on the answer.

The one state, Rhode Island, that has adopted an HPV-vaccine school-enrollment mandate in the years since the initial political firestorm over this proposal abated did so without particular fanfare—by resort to the nonpolitical administrative process that is  actually the norm for updating state mandatory vaccination regimes. 

Parents in RI aren't now learning about the HPV vaccine from media reports on a contested legislative mandate for an STD shot for their pre-teen children; they didn’t learn about it from a weird and very likely counterproductive (Nyhan et al. 2014) social marketing campaign. 

Rather they are getting the information in the normal way—from talking to their pediatricians about it at the same time they discuss other immunizations that their children are required to get, and from seeing that other parents just like them, after having done the same, are making decisions to get their kids vaccinated for HPV—just as they are making the decision (at rates well over 90%) to do the same for HBV, MMR and all the other childhood diseases from which their kids and lots of others too are protected by universal immunizations.

It's a no brainer!

It's no big deal.

Refs

Gollust, S.E. & Cappella, J.N. Understanding public resistance to messages about health disparities. Journal of health communication 19, 493-510 (2014).

Gollust, S.E., Attanasio, L., Dempsey, A., Benson, A.M. & Fowler, E.F. Political and News Media Factors Shaping Public Awareness of the HPV Vaccine. Women's Health Issues 23, e143-e151 (2013).

Gollust, S.E., Dempsey, A.F., Lantz, P.M., Ubel, P.A. & Fowler, E.F. Controversy undermines support for state mandates on the human papillomavirus vaccine. Health Affair 29, 2041-2046 (2010).

Gollust, S.E., LoRusso, S.M., Nagler, R.H. & Fowler, E.F. Understanding the role of the news media in HPV vaccine uptake in the United States: Synthesis and commentary. Human vaccines & immunotherapeutics, 1-5 (2015).

Kahan, D., Braman, D., Cohen, G., Gastil, J. & Slovic, P. Who Fears the HPV Vaccine, Who Doesn’t, and Why? An Experimental Study of the Mechanisms of Cultural Cognition. Law Human Behav 34, 501-516 (2010).

Kahan, D.M. A Risky Science Communication Environment for Vaccines. Science 342, 53-54 (2013).

Kahan, D.M. On the sources of ordinary science intelligence and ignorance. Oxford Handbook on the Science of Science Communicatoin (in press).

Nyhan, B., Reifler, J., Richey, S. & Freed, G.L. Effective messages in vaccine promotion: A Randomized Trial. Pediatrics 133, e835-e842 (2014).

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Reader Comments (12)

The major immunization issues to discuss from a science informed basis are those that improve public health.

The success or failure of pharmaceutical company product positioning and marketing ploys are only a small sideshow. A highly significant sidwhow though, in that it demonstrates some of the rationale as to how limited our Big Pharma dependent system is in protecting our public health.

The issue of the moment is the Zika virus. Why is it that for all of the public health, health care and pharmaceutical prowess of the developed world, we have no mechanisms to deal with these sorts of emerging health threats. Not only have we failed to come up with the means to launch effective health support once new diseases are recognized in the developing world, we are even unable to effectively prevent their spread to the rest of us. And our political process is in such a sorry state that at the moment that the US Congress is mired in discord and unable to pass a funding bill that would address Zika.

This ought to be the burning public health science communication topic of the moment.

From the New York Times Editorial Board in May: http://www.nytimes.com/2016/05/20/opinion/stealing-from-ebola-to-fight-zika.html

“The House bill approved Wednesday would provide just over half that — $622 million. Further, the House insisted that even that sum be offset by cuts to other programs, including those aimed at Ebola.”

“The money in the House bill would be available only until the end of September, when the fiscal year ends. That cutoff seems to assume that Zika will no longer be a problem by then, an absurdly risky line of reasoning that most health experts do not accept. Cutting off funds that early would also severely hamper the effort to create a Zika vaccine, which is expected to take more than a year to develop and test.”

“Perversely, while not doing much to contain the virus, some House members have seized upon it as a pretext to weaken environmental regulations. Republicans have introduced a bill that would allow businesses to spray pesticides on or near waterways without first notifying regulators, as now required by law. “

And from a article in The Atlantic, dated June 16th:

“In the nearly four months since the Obama administration issued its $1.9 billion Zika funding request, congressional lawmakers have publicly bickered over each chamber’s response to the virus. This week, select members met formally for the very first time to begin reconciling their dueling ideas. But after a brief session on Wednesday, the end of the debate is not yet in sight—and lawmakers are running out of time.” They met for just 15 minutes an event they called “touching the gloves”. Congress is taking a two month long recess this summer starting in mid-July. “More talks and meetings are expected, though no dates or details have been released. “

The HPV and even HBV cases have been discussed on this website, and elsewhere at great length for a number of years now.

Developing new vaccines that can get into the childhood vaccination schedule is a major goal of pharmaceutical companies. Not only does this guarantee a large and long term market, it also provides liability coverage under the National Vaccine Injury Compensation Program: http://www.hrsa.gov/vaccinecompensation/

A key item missing from the discussion above is the “why” that motivated Merck to bypass their usual well funding and presumably well oiled lobbyist channels into the FDA and the American Medical Association, the American Academy of Pediatrics.

The fact that the above mechanisms generally work very well is exemplified by the easy acceptance of the HBV. Hepatitis B is actually not much of a problem for babies already born. Contracting Hepatitis B happens by way of bodily fluids and blood transfusions. The most likely reason for an infant to have Hepatitis B, by far, is to be born to a Hepatitis B infected mother. One of the ways that mother was likely to have been infected is if they were an IV drug user, or having sex with someone who was. If we were actually interested in public health in the here and now, we'd spend our dollars on chasing down illicit drug users and immunizing them for HPV. And, we'd ensure that pregnant mother with HPV all got excellent prenatal and childbirth care. Because if a baby born to a mother infected with HPV is immunized with a booster shot called a HBIG is available. This is a booster shot that helps prevent the baby fight the virus once born. But it needs to be given within 12 hours after birth. https://www.cdc.gov/hepatitis/hbv/pdfs/hepbperinatal-protectwhenpregnant.pdf Eventually of course, if all babies were immunized with HPV, by the time they became HPV infected and pregnant or having sex with a woman who then became pregnant, that next generation of babies would be protected from HPV. The fact that the HPV vaccine is so accepted by pediatricians and their patients demonstrates how accepted vaccines are overall. But it also demonstrates a fundamental warp in our medical care system. A strong bias towards the interests of middle class patients with good health insurance and ties to pediatricians.

What happened with the HPV? The problem with this vaccine is that it does not cover all forms of the virus. Thus it does not provide universal protection against cervical cancer. Cervical cancer is treatable if it is caught soon enough. Cervical cancer can be detected in time for treatment by pap smears. These are generally administered to women at an annual checkup by their primary care physician or by a gynecologist or women's health clinic. The primary victims of cervical cancer are poor women without easy access to such medical care. Even if women are immunized with the HPV vaccine they will still need to have pap smears because they still can contract the infection from forms of the virus not covered by the vaccine. When the vaccine was first announced by Merck, there were strong objections on the part of some gynecologists and women's health clinics that this was a misdirection of funds. Since cervical cancer does not show up for a decade or more many women's health professionals felt that health care money would be better spent on giving poor women better access to pap smears. Hence Merck was somewhat blocked from its conventional vaccine approval approach. Merck then tried an end run by going through the state legislatures, which as described in the post above, was a big fail.

Since that time, the pap smear has been improved, the possibility of specific HPV testing has been developed: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm394773.htm, and the detection abilities of the pap smear has also been refined. This has lead to a change in testing protocols that reduce the recommended pap smear intervals to once every three years for low risk women. http://www.npr.org/sections/health-shots/2015/04/30/398872421/the-great-success-and-enduring-dilemma-of-cervical-cancer-screening. The reduced incidence of cervical cancers due to the vaccine also decreases the impetus for pushing for pap smear clinics. The political pressures against Planned Parenthood and health care funding pressures have led to reductions in the number of women's health clinics available to many poor women.

But many HPV related public health issues still remain that are worthy of science informed conversations. Will the young women now immunized retain their immunity through the decades necessary to prevent cervical cancer? Will they lose the impetus to get pap smears? What about HPV caused throat cancers in men and women? Now that we can specifically test for the forms of HPV covered by the vaccines, should older women (and men), at least those who are sexually active with new to them or multiple partners, be tested, and if not already immune, immunized? How would a physician go about asking patients about that? What is happening to the HPV ecosystem with some virus forms removed? Are there virus types, that were obscure before that now become significant cancer agents?


I wrote the following a while back and I think I may used in this an earlier comment to one of your previous posts. But I think it is particularly pertinent if you are in the UK now: (Note that Brits apparently do not know how to spell immunization. Don't get tripped up if you want to blend in.)

Childhood vaccines have done wondrous things in improving public health. Certainly this has been “ascertained”. But when we get to actual personal and public policy decisions which rely on that scientific knowledge, the situation is not always so clear. The case of the moment is that of an Alberta, Canada couple whose child died of meningitis and resulting complications, after the parents not only did not vaccinate, but also did not get the child to mainstream medical treatment in time. This has earned a justifiable backlash from the online pro-medical establishment people who have made a point of attacking anti-vaxination beliefs: http://scienceblogs.com/insolence/2016/04/27/the-death-of-ezekiel-stephan-quackery-and-antivaccine-views-go-hand-in-hand/.

However, the medical establishment's protocols for care are based on other factors than just the basic science. Currently there is a counter example of a meningitis controversy in the UK regarding the refusal of the National Health Service to make meningitis B vaccine freely or even readily, available, even to to all that want it:

"In the UK from September 2015 babies born on or after 1 July 2015 are being offered the MenB (meningococcal group B) vaccine as part of the routine immunisation schedule and babies born on or after 1 May are being offered the vaccine as part of a one off catch-up campaign. 
 
In Ireland, from December 2016 babies will be offered the MenB vaccine as part of the Primary Childhood Immunisation Schedule.

“Following the very sad news about the death of two year old Faye Burdett from MenB disease on February 14th 2016, demand for the vaccine outstripped supply when parents rushed to vaccinate children over a year old, beyond the age group currently being offered the vaccine within the UK’s childhood immunisation programme. “ Sad is the word used here, and apparently neither the parents nor the medical system are seen as criminal in the UK.
"http://www.meningitis.org/menb-vaccine.

So there you are, perfectly positioned for the sorts of international conversations needed for forward progress! Enjoy your visit and tell us more about it.

Some of my ideas for discussion questions:

How is it that we translate a general acceptance of childhood immunization programs into an overall interest in public health? How is it that we educate the public to see that the public must include all of our community, not just middle class members privileged to have ready access to personal pediatricians for their infants? And that we also have a personal as well as moral responsibility to aiding good public health in the rest of the world?

Medical professionals gain immunity from legal liability by adhering to proscribed protocols. Public health necessarily deals with groups, not individualized medicine. Vaccine approval processes necessarily must be exacting enough to help assure safety, but can also be barriers to new products. How do we encourage a social environment of general vaccine compliance with the openness to questions and new ideas needed to push for improvements and forward progress?

A fairly new issue is the offshoring of many of the big pharmaceutical companies that were formerly US based. This will lead to a further disconnect between the funding of basic research needed to underlie new discoveries and later new methods, and the recovery of tax dollars needed to continue that cycle.

As I said at the start of this comment, Zika, IMHO, ought to be the key item that ought to be at the top of the stack for vaccine related science of science communication discussions right now.

June 20, 2016 | Unregistered CommenterGaythia Weis

Here's a new UK twist on the HPV vaccine story, from the June 4th issue of New Scientist: https://www.newscientist.com/article/2090811-uk-to-trial-hpv-vaccine-in-gay-men-but-no-plans-yet-for-all-boys/.

"Campaign groups have welcomed the announcement, but have repeated the call for all boys in the UK to be vaccinated. “Vaccinating all men who have sex with men against HPV would be a vital step, but to be most effective, the HPV vaccine must be made available widely to all boys before they’re sexually active,” said Shaun Griffin, of the Terrence Higgins Trust charity.

Sexual health researchers agree. “Ideally, you must get people before their sexual debut, and a gender-neutral programme would cover all the bases,” says Carrie Llewellyn, at the University of Sussex, UK."

Do the Brits have the same meanings for the slang in "cover all the bases"? Are we or are we not going to talk about throat cancer and how it is transmitted?

June 20, 2016 | Unregistered CommenterGaythia Weis

That was fast! Two lengthy comments by me, one to this post, and one to the previous one, are still missing.

June 20, 2016 | Unregistered CommenterGaythia Weis

Dan -

W/r/t this post of yours...

http://www.culturalcognition.net/blog/2013/5/24/more-market-consensus-on-climate-change-97-of-insurance-comp.html

You might find this interesting:

http://www.coolfuturesfundsmanagement.com/

June 21, 2016 | Unregistered CommenterJoshua

@Gaythia--

UK has definitely not had the same problems w/ HPV vaccine that US has had, although interestingly, they did have very significant drops in vaccination rates after Wakefield--unlike US.... weird.

I've freed several of your msgs from spam guantanimo; they were being held w/ quite a number of falsely accused commetns stretching back to May. My bad!

Do you have multiple hyperlinks by any chance in the comments that get sent to the hoosegow? (I don't think UK uses that phrase; I'll ask, as that's where I am now)

June 21, 2016 | Registered CommenterDan Kahan

@Joshua--

wow. Still no idea why climate advocates won't do this-- maybe b/c the index would also be necessarily be a measure of the mkt's expection that mitigation measures aren't going to be adopted

June 21, 2016 | Registered CommenterDan Kahan

I think that there are probably several layers of controversy missing from the UK experience. Single payer medicine, for example, would mean that women's health is covered and pap smears probably would not seem to be in conflict with other health measures such as the vaccine, as I believe it was here. Women's health clinics, of course, continue to be under siege in the US.

But by the magic of Google see the following regarding the UK: (Or if it doesn't come through for you Google "hpv vaccine acceptance Great Britian".

http://www.ncbi.nlm.nih.gov/pubmed/21829204

and

http://www.ncbi.nlm.nih.gov/pubmed/21807050

"Attitudes to HPV vaccine in religious communities may lead to reduced vaccine coverage. The development of community-specific information about the importance of the vaccine may help address concerns."

Here is an evaluation of cost effectiveness, in which the Brits, like in the meningitis example I cited above, come out more reluctant to vaccinate.

http://www.bmj.com/content/337/bmj.a769

Anyhow I think that this is yesterday's news.

Zika! Zika! Zika!

Have the Brits noticed that if they go "on holiday" in warmer climes, they shouldn't procreate upon return?

I'll look for some of the missing links later.

June 21, 2016 | Unregistered CommenterGaythia Weis

Dan (and Joshua) "no idea why climate advocates won't do this"??? Hedge funds are really short term instruments. Also, whoever it is that makes the big bucks in mining and oil extraction at the North Pole and in Antarctica doesn't necessarily need to concern themselves with the well being of the rest of the planet anyway. I'm imagining a few remaining estates in the hills of Greenland. Maybe lakeside palaces on those lakes now under ice in Antarctica.

Isn't this the real operating plan of Big Oil already? http://www.wsj.com/articles/chevron-boss-climate-change-could-help-business-1464132869

June 22, 2016 | Unregistered CommenterGaythia Weis

Dan -

As Gaythia points out, it isn't unusual to find people betting long on climate change happening.

I'll also note that the hedge fund doesn't exactly have a huge stable of big investors as of yet (only some $47K has been invested so far)...

June 22, 2016 | Unregistered CommenterJoshua

On Zika and vaccine funding:

"He said Tennessee that had set up a Zika response center, but tight funding has meant that the state has had to poach workers from other programs — including H.I.V. and immunizations — to staff it."

And:

"Mosquito control, central to containing the spread, is spotty at best, particularly in impoverished areas with weak tax bases, common in parts of the South. In Tennessee, the overwhelming majority of counties and cities do not have mosquito control programs. In North Carolina, only about a quarter of counties have them."

Interesting to me: "The mosquito flies only about 500 feet in its lifetime, roughly a city block."

http://www.nytimes.com/2016/06/22/health/zika-mosquitoes-cdc.html?module=WatchingPortal&region=c-column-middle-span-region&pgType=Homepage&action=click&mediaId=thumb_square&state=standard&contentPlacement=4&version=internal&contentCollection=www.nytimes.com&contentId=http%3A%2F%2Fwww.nytimes.com%2F2016%2F06%2F22%2Fhealth%2Fzika-mosquitoes-cdc.html&eventName=Watching-article-click&_r=0

June 22, 2016 | Unregistered CommenterGaythia Weis

Re: Wakefield: How much continuity in health care do British parents get? Were the introduction of Wakefields ideas correlated with changes in the National Health Service? I know that a decade or more ago here, Pediatricians were beginning to slowly realize that the hand-off between OB's and Pediatricians was poor, and much less able to provide the trusted advisor status of a long term family practitioner. Immunizations, for a healthy baby, is the issue that comes up first for discussion between Pediatricians and new parents.

I also think we ought to remember that the idea of an autism connection was seemingly not a far fetched hypothesis when first proposed. Especially with the adverse reactions to the then used whooping cough vaccine, high fever and crying. Which was frequently coupled with a lack of empathy by pediatricians when deluged by phone calls from worried parents. And who sometimes just handed out Tylenol, a response promoted by Tylenol as a great mechanism for getting that drug accepted as safe by parents. But the autism hypotheiss was one that ought to have been discredited and discarded once the scientific evidence was in. What happened in the failure of the self correcting mechanisms of science, particularly as those mechanisms were transmitted to the public, had a lot to do with arrogance and lack of communication skills on the part of health care providers. If communicators fail to win the trust of the public, and address public concerns as the public sees them, then frustrations build, people are ready to lash out, and openings are made for those that can take advantage of fear and are not as worried about facts.

And there you are, Dan, in the middle of Brexit! With analogies to Trump in the US. http://nymag.com/daily/intelligencer/2016/06/how-donald-trump-explains-brexit.html

Re: Hedge funds; Probably just as well that we didn't start ones of our own: http://fortune.com/2016/03/02/hedge-fund-investors-withdraw-returns/. "stocks performed better this year if hedge funds didn’t own them"

June 22, 2016 | Unregistered CommenterGaythia Weis

More Zika: http://www.vox.com/2016/6/23/12014360/zika-sit-in-democrats-gop-house

"House Republicans used the sit-in to vote on a Zika bill that targeted Planned Parenthood"

" the actual content of that Zika bill, which passed the House, really was business as usual for congressional Republicans: It conditioned government funding for women’s health on excluding Planned Parenthood.

Zika causes severe birth defects, and it can be sexually transmitted. Helping women prevent pregnancy is an important part of Zika prevention efforts. Yet part of the Republicans’ bill effectively excludes Planned Parenthood from distributing birth control under a $95 million grant program."

June 23, 2016 | Unregistered CommenterGaythia Weis

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