ISRAEL ROSMAN SEEMS like someone you can trust. Some of that is his rekel, a long coat worn by Hasidic men that evokes a religious connection. But some of it is his round, kind face sporting round, wire-frame glasses, so that sometimes it seems like his whole face is the glasses and he is smiling shyly from far behind them, and he would like you to sit down right here—he pats the chair next to him—while he explains what’s going to happen next.
In October 2018, an Orthodox Jewish child with a rash and respiratory symptoms arrived at NYU Langone Health’s Tisch Hospital, where Rosman works. Doctors in the emergency department, unsure of the specific cause of the symptoms, sent the child up to an inpatient unit with a diagnosis of viral syndrome and respiratory illness. The child moved through the hallways, potentially shedding virus particles near patients who had arrived for broken legs, upset stomachs, and chemotherapy treatments. No one knew the child’s situation would soon become national news, so no one was especially alarmed. Then, on the treatment floor, an astute pediatrician recognized the distinctive rash. See it once and you’ll never forget it: measles.
Measles is a big problem. Aggressively contagious, the virus can live in a room for two hours after a stricken person has coughed or sneezed in it. It would soon flash through the chronically undervaccinated Orthodox Jewish community in Brooklyn. Hospital staff, worried about it spreading within the halls, called the New York City Department of Health. Staff made signs, set out face masks, began weekly meetings. Normally, eight rooms in the pediatric ward function under negative air pressure, but when the hospital realized there was an outbreak in the city, it converted every room in the pediatric ward to that status. This way, rogue virus particles could not escape into waiting rooms where vulnerable patients sat. The precautions steeled the institution against an epidemic.
Rosman was one of the staff members charged with talking to the families. He’d worked at NYU Langone for years as a community liaison, helping to orient Orthodox patients and their families within the medical system. Now he joined weekly meetings with a pediatric infectious-disease specialist. When parents came in, panicky and embarrassed, Rosman sat down with them and explained how not vaccinating led to disease. He explained that no one would be persecuted for bringing their sick children in. He quickly learned it was useless to berate people for their choices or even push them to get their shots immediately. His job, as he saw it, was to be a compassionate arm of the response, to say, Calm down. Whatever happens now, we’ll take care of it.
We’re on your side, he was saying. We’ve been on your side the whole time.
SINCE ABOUT 2014, when nearly 150 cases of measles were traced back to Disneyland in California, articles about outbreaks have shown up in the news every year or so. They read about like this one—focused on progressive private institutions, such as Waldorf schools, or insular communities like Brooklyn’s Hasidic population or Minnesota’s Somali-American community, because that is where the hot spots happen. The articles explain how anti-vaccine sentiment spreads in a community, how immunity rates drop below an acceptable threshold, and how diseases such as measles are dangerous to young children and people with compromised immune systems. People go online and rant about anti-vaxxers. And then the relevant health department gets everything under control and the epidemic ends.
It would be reasonable to ask why you have to keep reading about these outbreaks at all. If they keep happening in isolated communities but the herd immunity in the rest of the country remains high, how, exactly, is measles going to affect you? Is measles even something you need to worry about? The answer is yes, but not for the reasons you might think.
Vaccines exemplify a lot of the stuff we analyze when we look at how people distort health information, says Carl Bergstrom, Ph.D., who, along with professor Jevin West, Ph.D., offers a course at the University of Washington titled Calling Bullshit: Data Reasoning in a Digital World. A few years ago, Bergstrom and West, both biology-trained research scientists, realized that their students were having a difficult time reasoning their way through the science that involved quantitative data, which suddenly seemed to include most science. “We felt like, wow, learning to call bullshit on this stuff is sort of the most important skill,” Bergstrom says.
If you were going to be blunt, you could call every one of the recent measles outbreaks an egregious failure of calling bullshit, a problem that is growing. Although anti-vaccine rhetoric has been around since the beginning of vaccines, only recently has it metastasized into a network of grassroots organizations, political groups, and Twitter opinion columnists that is increasingly difficult to sort through. In Brooklyn, the myths were spread by pamphlets created by an in-community group called PEACH (Parents Educating and Advocating for Children’s Health), which was started by a Hasidic mother who felt her concerns were being dismissed by doctors and found succor in online videos and disinformation. Most of the people Rosman met at the hospital hadn’t even bought into the pamphlets that strongly. They had simply heard enough to have questions. They were confused.
Confusion around health information is nothing to be ashamed of. To fact-check every new health claim—Bacon is bad! Chocolate is good! Are you running enough? Are you running too much?—you’d have to have a biology degree, a statistics degree, and a detailed understanding of p-values, sample size, the peer-review process, and the way grants work. But information about vaccines is particularly fraught: In recent years, some people have tried to make the science confusing on purpose. Bergstrom calls it an agnotological campaign, which is a truly great phrase to throw around at your next presidential-debate party. “It’s the study of how people create uncertainty about scientific results where there really shouldn’t be any,” he says.
The real pioneers of agnotology, a term coined back in the trustworthy days of 1995, were the tobacco companies and the campaign to discredit doctors who claimed tobacco smoke was a carcinogen. (It is.)
The word refers to the purposeful spread of ignorance, untruths repeated so frequently and vehemently that they seem just as valid as real truths. You may recognize the strategy from advertising, Soviet propaganda, and such historical political moments as right now, all the time. Recent offenders include climate-change deniers and the folks who’d have you believe that 5G wireless networks cause cell damage. (They don’t.) The real threat these isolated measles outbreaks pose to most Americans isn’t that you, a vaccinated person living far from an outbreak ZIP code, are likely to come down with spots. It’s that the techniques of politics have come for your body. And if you don’t have a trusted community member like Israel Rosman to lead you out of the darkness, you’re
on your own.
WITH THE ADVENT of deepfake video technologies and a continuing erosion of trust in public institutions, deciding whom or what to believe is only going to get harder. It’s clear that most people could benefit from strengthening their bullshit-detecting abilities, but how?
Strategies anti-vaccine groups employ to bring people over to their cause are often similar to effective critical-thinking advice, in a fun-house-mirror sort of way. They like to invoke dusty counterculture slogans implying that you’re being misled by powerful, shadowy forces: Follow the money. Look behind the curtain. Don’t you want to discover the truth for yourself? It can destabilize people, like the old riddle about the one man who always lies and the other who always tells the truth. “In some of these cases, the anti-vaccine people have a better narrative than the pro-vax people,” says Valerie Reyna, Ph.D., a Cornell scientist whose research focuses on how we make decisions. “They’re actually answering the question why? How does this work? Why does this work this way? Why is this happening?” Even if the information is bogus.
To figure out if it’s real, standard bullshit-detection principles apply: Trace claims back to their original sources; watch for emotional language, which is very rarely used in science; and consider plausibility. Vaccine threats, along with other widespread health hoaxes, often are catchall bogeymen, stand-ins for fears about toxins, impurity, government overreach, and random misfortune. Does it seem like one technology product or medical intervention couldn’t possibly cause so many different problems? Maybe it doesn’t.
A little cynicism is healthy. This is the country in which researchers kept penicillin from nearly 400 black men in a 40-year syphilis study. (Google “syphilis” and “Tuskegee” if you’re not familiar.) It’s also the country in which Martin Shkreli raised the price of an antiparasitic drug by more than 5,000 percent just to make money. You might be right not to entirely trust someone with something to sell, but problems occur when everything starts to seem suspicious or controlled by nefarious institutional entities. And the best way to protect yourself from that kind of magical thinking is by developing a strong base of information about a subject, not by Googling terms that confirm your suspicions, like “vaccines and injury,” but just by Googling the most basic “vaccines.”
For vaccines, information to look for might include how they create immunity in the body, why they were invented, and how long they’ve been used. It’s also worthwhile to learn about the diseases they prevent. For example: Did you know that measles can cause your immune system to “forget” for up to two years other diseases it has already fought, so children who get it are more likely to get sick again with something else? Doing basic research sounds like a lot of work, but many organizations, such as the Centers for Disease Control and Prevention and the American Academy of Pediatrics, have created easy-access pages and videos to make it all more digestible. “It’s actually key,” says Reyna. “When these decisions come around, [people] at least have some notion about what’s plausible and what’s not plausible.”
Another option: Find someone who has been to medical school, or at least is a health professional with academic bona fides, and dare to trust them again. NYU Langone isn’t the first organization to successfully tackle a public-health crisis by bringing in a community member people felt they could trust. Public-health officials in Minnesota employed in-community experts when measles struck Somali-American groups there. It is a standard public-health strategy. While many time-strapped doctors could do a better job of listening and explaining their reasoning to their patients, there are still great doctors out there. Why not find one before you end up in the hospital?
So Whom Can You Trust?
These sources are among the best for reliable health information.
This top hospital has a site that offers a comprehensive list of diseases and conditions with reliable facts on each. my.clevelandclinic.org
This highly-ranked hospital’s site is known for explainers on diseases and conditions and proven ways to diagnose and treat them. mayoclinic.org
Accepts no commercial funding; a collective of scientists that reviews research on various topics (including antibiotic use) and compiles it into reports. cochrane.org
Run by the National Institutes of Health; known for its huge range of evidence-based information on diseases, conditions, and hot issues like measles. medlineplus.gov
Part of the United Nations; clarifies how people around the world are affected by health concerns including measles. who.int/
Government funded; especially useful for information about disease outbreaks. cdc.gov
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