Note: I have joined the “virtual class” component of Dan Kahan‘s Science of Science Communication course at Yale University. As part of this I am endeavoring to write a response paper in reaction to each week’s set of readings. I will post these responses here on my blog – the first such response is below. I will also be participating in the discussion on Kahan’s own blog. (The discussion on session 1 is here.) Comments are welcome are either site.
I wish to focus on 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. In his class notes on Session 1, Dan Kahan raises some interesting points about the media’s behavior in the early days of the vaccine’s approval and introduction:
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.
By referring to the “prospect of controversy,” and “prediction” of “confrontation,” does Kahan mean to imply that news outlets were engaged more in speculation then in reporting of actual disagreement? I’m not sure if this was his intention, but nonetheless I think it raises some interesting questions about reporting choices.
Certainly one of the most frequent and cogent criticisms of science reporting in recent years has focused on the problem of false balance – the notion that every story must provide “two sides.” This journalistic principle has shown itself to be most inappropriate when applied to matters of scientific fact (or theories supported by an overwhelming amount of evidence). Researchers such as Max Boykoff have shown how media outlets report the “question” of climate change in a “he said, she said” style, pitting one supporter against one opponent and creating the impression of a genuine scientific disagreement. The media has continued this harmful approach even as studies showed that a heavy majority of climate papers – most recently estimated at 97 percent – support the idea of anthropogenic climate change. (Some media outlets appear to be doing better at this – the BBC last year forswore the application of the balance principle to climate reporting – but sins are still committed regularly, as John Oliver pointed out in this entertaining segment.)
In the early HPV reporting, we may perceive another example of false equivalence, though not as egregious as in the climate case. While false balance in climate reporting tends to create the impression of disagreement over the science, HPV stories instead presented divergent views on policy, risk management and values. It’s still entirely possible, however, that the media’s presentation of these views distorted the true balance of opinion or even injected controversy where little existed. How can we evaluate whether this was the case?
Vaccine mandates: “the norm”
A full reckoning would require a much broader content analysis, but let me offer a few thoughts from the course readings. First, an important piece of background. I think one of the most important items in the reading was Kahan’s “Note on universal childhood vaccination schedules and mandates.” What I found extremely revealing was his assertion that:
The conventional practice is for state public health agencies simply to add vaccines to their state’s mandatory-immunization schedule consistent with CDC guidelines. See, e.g., Conn. Gen. Stat. § 9a-7f… Adoption is not instantaneous or automatic, but it is the norm for a CDC-issued guideline to be administrative incorporated into nearly every state’s immunization-mandates within several years…. This was the route that the hepatitis-b or HBV vaccine followed in being added to state mandatory- vaccination schedules after its approval by the FDA and the designation of it as a universal childhood vaccination by the CDC.
So if I understand correctly, prior to the HPV vaccine approval, there never was a controversy or debate over whether a state should mandate that children entering school have a certain vaccine. Whatever vaccines the CDC recommended physicians administer, the state mandated that children have before they could attend school. Now let’s look at some reporting on the HPV vaccine and see what justification the author had for painting a picture of controversy.
Washington Post article
Here’s Rob Stein’s Washington Post article of October 31, 2005. I’ve gone through the article and highlighted the key phrases I saw as conveying controversy/debate (higlighted in yellow) as well as language that had potential to polarize readers’ viewpoints by attaching positions to actors with particular ideological positions (orange). The most salient examples are excerpted below:
Reviewing this, I think we can agree that Stein certainly didn’t invent controversy out of whole cloth. There was indeed evidence that a public debate was brewing. Most notably, see points a) and b) above. Note, however, there isn’t much evidence in this article that conservative and religious groups were actually planning to oppose mandates. Statements such as those above could be read that way, but they don’t spell out an organized effort to prevent mandates. Nor do generalizations such as “activists on both sides have begun maneuvering to influence how widely the immunizations will be employed.”
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.” (Point c above.) This statement may sound innoccuous on the surface, but suggesting that it is a “view” and that school mandates are one of several ways we might seek to increase immunization – rather than just an automatic step taken for all vaccines recommended for children – implies there is a debate to be had.
This is followed up by a quote from Juan Carlos Felix of the University of Southern California and the National Cervical Cancer Coalition, who says, “I would like to see it that if you don’t have your HPV vaccine, you can’t start high school” – a reasonable statement to be sure, and probably one that Felix though nothing of uttering to a reporter. But again, in context, it suggests this is just one reasonable point of view of several.
Given research on the role of cultural cognition in risk perception (see for example Kahan, et al., Who Fears the HPV Vaccine, Who Doesn’t, and Why?), it’s highly likely that the views expressed in this piece caused readers to take stances on the vaccine where they didn’t previously have any. They likely then made health decisions that were not as rational as they could have been.
What should change?
For that reason, should or could Stein have written his story any differently? In retrospect, I would like to have seen more evidence that ideologues really were gearing up to fight mandates, rather than just mumbling idly about misgivings. But I think the most important thing the author could have done would have been to situate those concerns in the proper regulatory context: that is to say, fairly high up in the story, “here is the path that vaccines usually take, from FDA approval to CDC recommendation to school mandate; and here is why Gardasil may not have such an easy ride.”
There are many other questions reporters should ask themselves when approaching these kinds of stories – and that we should be asking about the reporting process. Some to consider (perhaps in a future reaction piece, or class discussion?):
- News stories often create the idea of a “balanced” debate, with perhaps 2 or 3 voices pro, 2 or 3 voices con. Is that appropriate if one side is a minority view?
- How can journalists even figure out what the majority view is?
- If certain political groups are taking a stand on an issue, but the reporter can establish that their view is definitely in the minority, should he still report that stand?
- Whose views “count more” in these types of stories – doctors? Politicians? Regulators? Advocates? Patients?
- In this type of story, do questions of values even matter? Does health trump all? Or are values inescapable?