Should the existence of an “anti-vax” movement change what scientists can say in publications?

By a bare majority of its Board of Directors, the Cochrane Collaboration, a leading source of trustworthy, systematic reviews of health research, has expelled founding member and director Peter C. Gøtzsche. As always, a tangle of personal, professional and institutional factors are driving the dispute (see [1]-[3]); I’m in no position to comment on most of these. But one focus of controversy is Gøtzsche’s co-authorship of an article in BMJ Evidence-Based Medicine critical of a Cochrane Review of the HPV vaccine, and this raises an important issue in science communication ethics.

Cochrane issued a detailed response defending its review and calling on the journal to investigate its “quality assurance processes” (p. 4). After marshaling evidence, Cochrane concludes that although some of the criticisms will usefully inform future reviews, overall “the criticisms were overstated” and “the Cochrane Review represents a robust and accurate summary of the evidence” (p. 9). It then continues:

Scientific debate is to be welcomed, and differences of opinion between different Cochrane ‘voices’ is not unexpected. However, public confidence may be undermined, unnecessary anxiety caused, and public health put at risk, if that debate is not undertaken in an appropriate way. This is especially true when such debates take place in public. There is already a formidable and growing anti-vaccination lobby. If the result of this controversy is reduced uptake of the vaccine among young women, this has the potential to lead to women suffering and dying unnecessarily from cervical cancer (p. 9).

Although no conclusion is explicitly drawn from these facts, they implicitly (“enthymematically,” we rhetoricians would say) suggest the idea that overstated criticisms within science are even less appropriate when an audience of “anti-“s is overhearing, and thus even perhaps that the critical paper should be retracted.

I don’t think there’s any dispute that scientists in writing up their results should think about how their publications will impact all their audiences. That’s why (for example) we can criticize those writing abstracts which predictably lead to distorted reporting in the media (e.g., [4]).

So: what will be the impact of the critique of the HPV Cochrane Review? This is a question of fact. For example, is there indeed “a formidable and growing anti-vaccination lobby”? Research on attitudes towards vaccination (usefully summarized in [5]) suggests instead that the real challenge to public health is vaccine hesitancy, not outright rejection (“anti-vax,” “denialism”). Elsewhere I’ve been developing the case for thinking that scientists, like the rest of us, aren’t particularly good at mapping the range of public opinion; we tend to overestimate the size of noisy, extreme minorities.

“If the result of this controversy is reduced uptake of the vaccine among young women,” that would indeed be bad. But will controversy reduce vaccine uptake?  It is the case that the critical article got reviewed on the skeptic blog Age of Autism (and likely elsewhere) immediately after it was published (you can find that link for yourself). And I don’t doubt that it will be taken up as a standard topos in that community.

Let’s consider the broader audience of vaccine hesitant parents, though. An international review of the drivers of hesitancy [6] found trust to be key: parents who believed that Big Pharma had corrupted governments and doctors were less likely to vaccinate their kids. The critical article may reinforce these beliefs when it points out that authors of the first Cochrane Review had industry ties. (Cochrane replied that those authors were removed in the second Review, and that the remaining authors had no conflicts of interest.) But notice that the beliefs about the domination of Big Pharma are likely to be even more reinforced if the critical article is suppressed.

As Leah Ceccarelli has pointed out (in [7]), one of the most potent responses to manufactured controversy is a narrative of unmanufactured, open debate and dissent within science. Some scientists say one thing. Some others come in with criticisms, which get peer reviewed and published. The first group comes back with a response. This process, despite its messiness, is what justifies public trust. Silencing dissenters, whether by self-censorship or forced retraction, feeds public skepticism.

This thus seems to be another case where well-meaning defensiveness of science may exacerbate the conditions being defended against.  The existence of vaccine skepticism should not limit what scientists can say in publications. The Cochrane Collaborative should not have insinuated otherwise.

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[1] Evidence-based medicine group in turmoil after expulsion of co-founder

[2] Cochrane, a Sinking Ship? (tilts towards Gøtzsche).

[3] The HPV Vaccine & Manufactured Controversy: Tracking the Critique of the Cochrane Review & The Evidence (tilts against Gøtzsche).

[4] Gonon, F., Bezard, E., & Boraud, T. (2011). Misrepresentation of Neuroscience Data Might Give Rise to Misleading Conclusions in the Media: The Case of Attention Deficit Hyperactivity Disorder. PLoS ONE, 6(1), e14618. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0014618

[5]  Thomson, A., & Watson, M. (2016). Vaccine hesitancy: A vade mecum v1.0. Vaccine, 34(17), 1989–1992. http://doi.org/10.1016/j.vaccine.2015.12.049

[6] Yaqub, O., Castle-Clarke, S., Sevdalis, N., & Chataway, J. (2014). Attitudes towards vaccination: A critical review. Social Science & Medicine, 112(C), 1–11. http://doi.org/10.1016/j.socscimed.2014.04.018

[7] Ceccarelli, L. (2011). Manufactured scientific controversy: Science, rhetoric, and public debate. Rhetoric & Public Affairs, 14(2), 195-228. https://muse.jhu.edu/article/440840/summary