Newswise — Researchers have recently begun to realize that biological sex plays a key role in disease risk. Sex plays a role in hypertension, diabetes, arthritis – and in many neurological and psychiatric disorders. Depression and anxiety affect females more, while neurodevelopmental disorders, including autism spectrum disorders, early onset schizophrenia, and attention deficit hyperactivity, affect more males. Males are also more sensitive to prenatal insults, such as gestational stress, maternal infection and drug exposure. To better understand the molecular underpinnings of this disparity, Tracy Bale of the University of Maryland School of Medicine, along with several colleagues, focused on a molecule that plays a key role in placental health. In a study of mice, they found that the molecule, O-linked N-acetylglucosamine transferase (OGT) works by establishing sex-specific patterns of gene expression. The study was published this week in the journal Nature Communications. OGT seems to work via an epigenetic modification that broadly controls transcription, H3K27me3. Epigenetics is the study of changes in how genes are expressed. Dr. Bale showed that high levels of H3K27me3 in the female placenta produce resilience to stress experienced by the mother. This indicates at least one molecular pathway that allows females to be more resilient to maternal stress than males. “This pathway could help explain why we see this profound neurodevelopmental difference in humans,” said Dr. Bale. “OGT and H3K27me3 in the placenta are crucial to a lot of protein encoding that occurs during pregnancy, and so this process has a lot of downstream effects. The OGT gene is on the X chromosome, and seems to provide a level of protection for the female fetus to perturbations in the maternal environment.” Dr. Bale has focused much of her research on the links between stress and subsequent risk for neurodevelopmental disorders, including autism and schizophrenia in offspring. Her previous work on the placenta has found novel sex differences that may predict increased prenatal risk for disease in males. She has previously found that, in mice, a father’s stress can affect the brain development of offspring. This stress can alter the father’s sperm, which can alter the brain development of the child. Dr. Bale has also found that male mice experiencing chronic mild stress have offspring with a reduced hormonal response to stress; this response has been linked to some neuropsychiatric disorders, including PTSD. This suggests that even mild environmental challenges can have a significant effect on the health of offspring.
Monday, July 16, 2018
Tuesday, November 28, 2017
How can we get tangible benefit from the millions we spend on autism science?.Posted Nov 12, 2017
The U.S. government is the world’s biggest funder of autism research. For the past decade I have had the honor of advising various agencies and committees on how that money should be spent. As an adult with autism, sometimes I’ve been pleased at our government’s choices. Other times I’ve been disappointed. Every now and then I turn to reflect: What have we gotten for our investment?
Autistic people and their parents agree on this: The hundreds of millions we’ve spent on autism research every year has provided precious little benefit to families and individuals living with autism today. Over the past decade the expenditures have run into the billions, yet our quality of life has hardly changed at all.
It would be one thing if massive help was just around the corner, but it’s not. There are no breakthrough medicines or treatments in the pipeline. Autistic people still suffer from GI pain, epilepsy, anxiety, depression, and a host of other issues at the same rates we did before any of this research was funded.
I don’t mean to suggest that nothing has been accomplished. Scientists have learned a lot. They know more about the biological underpinnings of autism. Researchers have found hundreds of genetic variations that are implicated in autism. We’ve quantified how autistic people are different with thousands of studies of eye gaze, body movement, and more. Scientists are rightly proud of many of their discoveries, which do advance medical and scientific knowledge. What they don’t do is make our lives better today.
Why is that?
In the past I’ve written about the idea that taxpayer-funded research should be refocused on delivering benefit to autistic people. What I have not written about, is why that hasn’t happened, at the most fundamental level.
The answer is simple: Until quite recently, autistic people were not asked what we needed.
There are many reasons for that. Autism was first observed in children and no one expects children to have adult insight and self-reflection. When autism was recognized in adults, they were assumed to be too cognitively impaired to participate in conversations about their condition. Finally, in the spirit of the times, doctors often assumed that they knew best. They were the trained professionals, and we were the patients (or the inmates.)
So doctors studied every question they could imagine, and then some, seldom seeking our opinions except in answer to their research questions. They assumed they knew what “normal” was, and we weren’t it. Countless million$ went down the rabbit hole of causation studies, whether in genetics, vaccines, or other environmental factors. Don’t get me wrong—the knowledge we’ve gotten is valuable for science. It just did not help me, or any autistic person I know.
Millions more have been spent observing us and detailing exactly the ways in which we are abnormal. Only recently have some scientists began to consider a different idea: Perhaps “normal” is different for autistic people, and we are it. Again the studies enhanced the scientists’ knowledge but didn’t do much to help us autistics.
Then there are the educators and psychologists. They observed our “deviations” and then considered therapy to normalize us. That led to ABA and a host of other therapies. Some of those have indeed been beneficial, but the money spent on beneficial therapy is just a drop in the bucket when considering what we taxpayers have funded overall.
Want a different and better outcome? Ask actual autistic people.
article continues after advertisementWe can tell you what our problems are, in many cases very eloquently. I’m not going to re-state all our needs here. I’ll tell you this: Whenever this topic comes up at IACC (the Federal committee that produces the strategic plan for autism for the U.S. government), the priorities of autistic people seem rather different from those of the researchers our government has been funding for so long.
Autistic people have many disparate needs, but they all boil down to one thing: We have major challenges living in American society. Medical problems, communication challenges, learning difficulties, relationship issues, and chronic unemployment are all big deals for us. The issues are well laid out and many.
Before autistic people began speaking out in great numbers, all we had was parent advocacy. We should not dismiss that, and parents still have a role today, particularly in advocacy for small children and children who are older but unable to effectively advocate for themselves.
Even as we thank parents for their service, it’s time to recognize autistic voices (some of which belong to parents too) should be taking the lead.
As much as parents did for us, they also unwittingly contributed to harm. Parents misinterpreted harmless stimming, and encouraged therapists to suppress it, leaving us scarred in adulthood. Many autistics of my generation remember being placed into programs for troubled children with parental encouragement in hopes we’d become “more normal.” We didn’t. Parents have given us bleach enemas, and some of us have died from misguided chelation and other treatments to “cure” our autism.
I don’t blame parents for any of that. They did their best, given the knowledge of the day. But it’s a different day now. The children who grew up being “normalized” can talk about how it affected them, and parents and clinicians of today would be wise to listen.
article continues after advertisementAutistic voices are finally speaking in large numbers and it’s time to pay attention. No one else knows life with autism. Parents and nonautistic researchers are sometimes listening. Hard as this may be for them to hear, they are always guessing. With autistics speaking out all over the world, that’s no longer good enough.
For the first time, IACC has recognized this in the 2017 Strategic Plan Update. They say it’s time for a paradigm shift in how we do research. We need to focus on the needs of people living with autism today. That’s a realization that I appreciate, and it’s long overdue.
So what’s the answer to why we’ve gotten so little return on our autism research investment: No one asked the autistic people what we wanted. It’s that simple. Had we been able to articulate our challenges, with the framework of knowledge we have today, and had we been listened to, we’d be in a very different place today.
Today is gone, but tomorrow isn’t here yet, and it can be different.
(c) John Elder Robison
John Elder Robison is an autistic adult and advocate for people with neurological differences. He's the author of Look Me in the Eye, Be Different, Raising Cubby, and Switched On. He serves on the Interagency Autism Coordinating Committee of the U.S. Dept. of Health and Human Services and many other autism-related boards. He's co-founder of the TCS Auto Program (a school for teens with developmental challenges), and he’s the Neurodiversity Scholar in Residence at the College of William and Mary in Williamsburg, Virginia, and a visiting professor of practice at Bay Path University in Longmeadow, Massachusetts.
The opinions expressed here are his own. There is no warranty expressed or implied. While reading this essay will give you food for thought, actually printing and eating it may make you sick.
John Elder Robison is the author of Raising Cubby, Look Me in the Eye, My Life with Asperger’s, and Be Different - adventures of a free range Aspergian. John’s books are sold in a dozen languages in over 65 countries.
Wednesday, February 1, 2017
Jordan Gaines Lewis, Ph.D.
With the recent news of President-Elect Trump's talks with Robert F. Kennedy, Jr. to potentially head a new commission on vaccine safety and scientific integrity, many in the scientific and healthcare communities are understandably rattled. Kennedy is a well-known skeptic of vaccine safety, and has previously described the vaccine/autism allegations as such:
Mercury is toxic to the human body. It's important, however, to understand how the mercury present in immunizations is different than the mercury in, say, the scary old thermometer in your medicine cabinet.
“They get the shot, that night they have a fever of a hundred and three, they go to sleep, and three months later their brain is gone. This is a holocaust, what this is doing to our country.”
Thimerosal is a vaccine preservative. Since the early 20th century, small amounts of thimerosal have been used in vaccines to prevent the growth of fungi and bacteria. Thimerosal is mainly composed of ethylmercury. When we hear concerns of mercury toxicity (for example, with the consumption of fish), we are primarily concerned about the compound methylmercury.
Source: Wikimedia Commons
Many independent epidemiological studies over the last two decades have concluded that the low doses of thimerosal in vaccines are not harmful to infants, and the compound is not present in routine childhood vaccination schedules in the U.S., E.U., and several other countries.
All this said, the current scientific consensus is that there is no compelling evidence linking vaccinations and autism; mercury poisoning does not resemble autism, and rates of autism diagnosis continue to rise despite the removal of thimerosal in many vaccines.
Furthermore, there is no evidence to suggest that the American Academy of Pediatrics' recommended immunization schedule is harmful, or that young children's bodies can't "handle" it. Spacing out vaccines only increases the amount of time by which children are vulnerable to contracting vaccine-preventable diseases. The parents' choice to delay their children's immunizations is what caused the measles outbreak in Disneyland in 2015, with nearly 150 cases.
It's estimated that the MMR (measles, mumps, and rubella) vaccine has saved 17.1 million lives worldwide since 2000. Herd immunity is important for the health of the entire community, as not all children can be vaccinated or will respond satisfactorily to immunizations.
- Centers for Disease Control: Understanding Thimerosal, Mercury, and Vaccine Safety
- Centers for Disease Control: Immunization Schedules for Infants and Children
- Dorea et al.: Toxicity of ethylmercury (and thimerosal): a comparison with methylmercury (J Appl Toxicol 2013; 33:700-11)
- Flaherty: The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science (Ann Pharmacother 2011; 45:1302-4)
Wednesday, April 6, 2016
Stephen Camarata Ph.D.
Intelligence, Genius and High Achievement Are Not "On" the Autism Spectrum
Posted Apr 01, 2016
Because very young children have widely variable abilities and behavior patterns that are quite different from older children, key clinical markers of autism in school-age children are much less reliable for diagnosing toddlers and preschoolers. For example, a primary symptom of autism is disruptive behavior—and severe tantrums. In school-age children these behaviors are a very reliable indicator for autism. In contrast, nearly every two-year-old displays rather severe tantrums—after all it is called the terrible twos for a reason! It is absurd to place all two year olds on the autism spectrum because of tantrums. Skilled clinicians can indeed accurately diagnose autism in two-year-olds, but it is all too easy to mistake a naturally occurring tantrum as a symptom of autism spectrum disorder.
Similarly, it is all too easy to mistake the traits of precious, highly intelligent toddlers and preschoolers as symptoms of autism spectrum disorder. In their recent book “The Prodigy’s Cousin” Joanne Ruthsatz and Kimberly Stephens provide engaging—and intriguing narratives describing prodigies. They also note that many of these children have siblings or other first-order relatives who are clearly on the autism spectrum, which is certainly true for mathematicians, engineers, and physicists.
Also, for the children described in The Prodigy's Cousin, it was not unusual for the prodigies themselves to be initially misidentified as having autism. One potential reason for this is that a child prodigy is quite dedicated to developing the ability that captures her interest—be it music, math, art, dance or scientific thinking. Because of this, prodigies tend to practice these talents over and over again often to the exclusion of activities other children are usually engaged in. Although it may seem simple to distinguish prodigy from autism spectrum disorder, it is noteworthy that children with autism are highly "routine preferring” and often do the same things over and over again rather obsessively. And this is precisely what Ruthsatz and Stephens see in prodigies: these children are very focused on practicing and mastering a particular ability. These authors were very straightforward in stating that prodigy behavior should not be viewed as a form of autism, but it is clear that mistakes were made.
But what if the autism spectrum were actually expanded to include the kind of focused practice required to master talent often seen in child prodigies—and in highly intelligent people? What are the consequences for society if the unique talents of prodigies, geniuses, high achievers—or anyone else with asynchronous child development or an unusual learning style—were to be redefined as symptoms of an autism spectrum disorder and eliminated? There is a very real concern that identifying prodigy as a form of autism spectrum disorder would actually end up derailing the development of extraordinary ability in precocious children. To be sure, some people on the autism spectrum are highly intelligent, but being highly intelligent doesn't necessarily mean a person is on the autism spectrum.
When autism is diagnosed, a relatively strict intervention program is often provided. One goal of this treatment is to diminish obsessive routines. If a child does indeed have autism, this intervention can be highly effective.
But what if a child does not have autism, and is a prodigy instead? Could treatment designed for autism prevent a math prodigy from developing her unique talents when she is taught to stop “obsessing” on numbers as a cure for her “autism spectrum disorder?”
AdvertisementBefore dismissing this notion, bear in mind that many prodigies, high achievers, and highly intelligent individuals are also notoriously noncompliant in addition to being dedicated to developing their special talents. For example, when piano virtuoso Arthur Rubinstein was a child, he smashed a violin when his parents tried to shift his "obsessive" devotion to the piano to other instruments. Would his amazing abilities as a concert pianist have been derailed if his obsession with playing the piano over and over—and his dramatic refusal to comply with requests to be less obsessive —were viewed as a symptom of autism spectrum disorder rather than natural traits of a child prodigy?
Perhaps even more worrisome are recent articles implying that geniuses (and prodigies) such as Albert Einstein, Isaac Newton,[3, 4] Mozart, Bill Gates and many others display signs of autism. Many many geniuses were temperamental and, at times, difficult to get along with. In addition, perhaps in part because of their high intelligence, they may not necessarily be highly motivated to please teachers or parents or to complete schoolwork they find uninteresting. In his biography, Winston Churchill recalled that "My teachers saw me at once [as being] backwards and precocious, reading books beyond my years and yet at the bottom of the Form [class ranking]. They were offended. They had large resources of compulsion at their disposal, but I was stubborn. Where [whenever] my reason, imagination or interest were not engaged, I would not or could not learn." . Because there are reports that Mr. Churchill also talked late, one can not help but wonder whether his collection of precocious traits, challenging behavior, and slowed communication development would have resulted in an Autism Spectrum diagnosis in modern times.
Perhaps the most devastating consequence of misguided efforts to retrospectively view high intelligence, prodigy, and high achievement as manifestations of autism spectrum disorder is the trivializing effect this has on the extensive impact that severe “classic” autism spectrum disorder often has on families. It is cruel to suggest that parents of children with autism could have somehow shaped the pervasive developmental challenges these children display into becoming the next Mozart, Einstein, Newton, or Gates if only the “right” treatment were provided early enough. This view of autism spectrum disorder also trivializes the Herculean efforts these families make to help their child learn to speak, to be in school, and to regularly cope with severe tantrums and meltdowns.
AdvertisementWe can all applaud the efforts to identify—and treat—autism spectrum disorders as accurately, effectively, and as early as possible. But it is also vitally important that prodigy and genius not be redefined as disabilities requiring treatment—rather than unusual gifts to be nurtured.
Friday, April 1, 2016
Switched On, a new memoir by John Elder Robison, has greatly increased interest in transcranial magnetic stimulation (TMS) as an experimental treatment for autism. We’ve asked a leading expert to weigh in on whether there’s enough science behind TMS to recommend its use outside of research studies.
This week’s “Got Questions?” answer is by neuroscientist Lindsay Oberman, director of the Neuroplasticity and Autism Spectrum Disorder Program at Brown University’s Bradley Hospital, in East Providence, Rhode Island. Dr. Oberman is a pioneer in the use of transcranial magnetic stimulation (TMS) in the study of brain plasticity in people with autism spectrum disorder. Brain plasticity refers to the brain’s remarkable ability to modify its own structure and function.
For readers who are not familiar, transcranial magnetic stimulation, or TMS, is a noninvasive procedure that uses electromagnetic fields to stimulate nerve cells, or neurons, in the brain. TMS can be used either to study or to treat neurological and mental health conditions.
When a single session of TMS is applied, researchers can observe the response to the stimulation and use that information to make predictions about how the brain functions. In this way, we use TMS to study the brain. These single session studies are not intended to be therapeutic.
Alternatively, when TMS is applied in repetitive stimulations over several sessions we refer to this as “repetitive TMS,” or rTMS. This technique has the ability to change the response of the brain for several weeks to months after the series of sessions.
By analogy, it’s like asking someone who isn’t a musician to play a song on a piano by showing him or her some sheet music. If you did it once, that may be a way to study a person’s natural ability. But if you did this every day for six weeks (the typical schedule for therapeutic rTMS), the person might learn to play the song on the piano.
Two decades of TMS research
For more than 20 years, researchers have been studying TMS as a potential therapy for a number of neurological and psychiatric conditions.
Currently the U.S. Food and Drug Administration (FDA) has cleared the use of TMS for the treatment of depression in adults who haven’t been helped by medication. FDA clearance is an important indicator that a treatment can help some patients – as demonstrated in carefully conducted clinical trials.
A growing body of research suggests that TMS can likewise help relieve the symptoms of schizophrenia and improve movement rehabilitation after a stroke. However, it doesn’t yet have FDA clearance for these uses.
TMS for the treatment of autism: Still in its infancy
By comparison, research on TMS as a treatment for autism spectrum disorder (ASD) remains in its infancy. A search on PubMed, for example, turns up 42 journal articles on TMS and autism. But many are either theoretical or review articles or single session research studies. Only 13 of these papers represent clinical trials, and only one was a placebo-controlled trial. (Including a comparison to a placebo, or sham treatment, is important in a study to distinguish true benefits from the effect of expectations.)
Some of these clinical studies have suggested that TMS can help relieve symptoms such as irritability and repetitive behaviors and improve autism-related disabilities in areas such as eye-hand coordination and social skills.
However, for the most part, these clinical studies have involved very small numbers of participants ranging from one to 27 participants. Taken together, all 13 studies involved fewer than 200 participants.
Yet another limitation of our early research is that we’ve focused primarily on certain subgroups such as adult men with ASD but without either intellectual disability or epilepsy (which commonly co-occurs with autism). We’ve excluded people with epilepsy for safety reasons, and most of the early work was in adults. We’re just starting to study TMS with children.
Currently, I know of three ongoing clinical trials using TMS as a treatment for ASD. These include a Canadian study looking for improvements in executive functioning with an expected enrollment of 60 adolescents and young adults with ASD. A French study is looking at possible changes in social cognition and aims to enroll around 50 adults with ASD. And a study in Israel is looking at changes in social interaction with an expected enrollment of 20 children and adolescents with ASD and intellectual disability.
Because of all these limitations, I caution against drawing conclusions from the preliminary results of the TMS studies that I and others have conducted. I know it’s easy to get overly optimistic given the media coverage and web posts about the remarkable responses some people with autism have reported after participating in a TMS study. Sometimes these reports make TMS sound like “the answer” to debilitating autism symptoms.
Questions needing answers
As a researcher, I want to see a number of questions answered before TMS becomes a treatment option for autism outside of a careful research study:
1. What is the appropriate dose?
In other words, how long should the sessions be? How many sessions? How often? At what intensity? Like a drug study, we have to understand how much TMS is needed to lead to behavioral changes and still be safe and tolerable. Does the dose need to be scaled up or down depending on the age of the individual or other co-occurring neurological or mental conditions?
2. Where in the brain should the stimulation be applied and with what frequency?
3. What behaviors are we hoping to improve?
TMS applied to a single part of the brain isn’t likely to improve all the common symptoms of autism. But it may improve specific symptoms. Currently, it’s not clear which symptoms may be more or less responsive to TMS.
4. Who may be a good candidate for TMS treatment for autism?
To date, studies have largely focused on verbal adults. But TMS may have a greater impact on a younger brain. We need to conduct larger studies that enroll both verbal and nonverbal individuals and children and adults in order to begin identifying the subgroups of people who are most likely to respond to TMS.
6. Do we have clear evidence of benefit from TMS versus a placebo, or dummy treatment?
Only one published study has included a blinded sham control condition. That’s where neither the researchers nor the participant know who’s getting the actual treatment and who’s getting the sham treatment until after the study is over. Therefore, it’s currently unclear how much of the effect reported in the other twelve published studies were due to a placebo effect.
8. Is it ethical to start offering TMS outside of research studies as an “off label” (not FDA-cleared) autism treatment?
Insurance is unlikely to cover a treatment that’s not yet FDA cleared. But countless individuals and families may be desperate for anything that may relieve their or their loved one’s symptoms. I don’t want to see these people spend tens of thousands of dollars for a treatment that we don’t yet know will help – and might make symptoms worse.
Despite all the above cautions, I don’t want to give the impression that I don’t see promise for TMS as a future treatment in ASD. Quite the opposite, I continue to focus my research career in this direction.
So while I can’t currently support the use of TMS as a treatment for ASD outside of a research setting, I can promise you that my colleagues and I will continue to wholeheartedly pursue research to answer the questions we’ve raised. Hopefully the end result will be a safe and effective new treatment option for individuals with ASD.
In closing, I want to welcome anyone who has questions or interest in participating in our studies to contact me and my team at email@example.com. We would be happy to answer your questions.
at 5:51 AM
Monday, February 1, 2016
geographically (link is external), which allows a virus to spread and take hold quickly. Fortunately, small outbreaks can often be controlled. What is concerning, however, is that such outbreaks are becoming more frequent. For example, the United States logged a record number (link is external) of measles outbreaks in 2014. It is one thing for people to decide that they are willing to put themselves at risk, it is another to put other communities or even the entire population at risk. The resurgence (link is external)of measles in the United States has been attributed to the impact of so-called "vaccine deniers". To what extent should individual liberties come at the cost of others' well-being?
Given the seriousness of the potential public health risks at stake, the psychological study of why some people decide not to vaccinate is receiving increased attention. It seems unlikely that people use religious, philosophical, or political motives to justify a concerted initiative to willingly put their fellow citizens and children at risk. We accept small risks everyday, from letting our children play outside to riding the bus. Of course, sometimes, the influence of extreme ideologies (particularly in disenfranchised communities) can trump the influence of other societal norms. For the majority, however, vaccine hesitancy is often motivated by influential misperceptions about vaccine risks. Indeed, popular examples (link is external) of misguided notions about how vaccines and the human immune system work range from the idea that vaccines cause autism and that one can catch the actual flu from the flu vaccine to conspiracy theories about "big pharma", government "mind-control" initiatives and a "Western plot" to infect non-Western communities.
Some of these misperceptions can be influential and far-reaching. For example, about 50% of Americans indicate that they are "unsure (link is external)" about whether or not vaccines cause autism. General concerns about childhood vaccine safety have increased over the last decade as well. Although immunization rates are currently high in the United States, it is a slippery slope when people start acting on such misinformation. For example, doctors now frequently receive requests to "delay (link is external)" childhood vaccines. This trend is also evidenced by the astonishing backlash (link is external)against Mark Zuckerberg's recent decision to vaccinate his baby. A functioning democracy requires that the public is well-informed. "If a majority believes in something that is factually incorrect, the misinformation may form the basis for decisions that run counter to a society’s best interest" (Lewandowsky et al., 2011).
Research has shown that it proves incredibly difficult to effectively communicate with the public about vaccine safety. A recent article in the Washington Post (link is external)suggests that people should stop calling anti-vaxxers "dumb" - this seems to be a rather mundane conclusion, clearly nobody likes to be called dumb! On the other hand, so-called "meta-reviews" of pro-vaccine communication strategies are often inconclusive (link is external)about their general effectiveness. In fact, some studies (link is external)have shown that attempts to correct misperceptions can actually backfire and make people less likely to vaccinate.
Two major issues complicate these efforts:
1) First is the so-called "false media balance". Journalists often follow a professional norm to present (anecdotal) examples about a topic in a seemingly "balanced" pro-and-con fashion. Research (link is external)by some of my colleagues has shown that such media impressions actually fail to emphasize the overwhelming amount of scientific agreement on vaccine safety, which, in turn, strongly influences how people think about the issue.
2) The other major issue is that much (if not most) of our communication efforts are directed at trying to correct misinformation "myths" with the expectation that people will rationally respond to such a correction. However, research (link is external)in cognitive psychology has taught us that when we are trying to debunk a myth (e.g., that a long time ago, one fraudulent study incorrectly concluded that vaccines cause autism) the memory networks associated with the misinformation are activated and strengthened. Because it takes more cognitive effort for people to update their beliefs in light of new information, such strategies often just end up reinforcing the myth.
In a new study published in BMC Public Health (link is external), my colleagues and I set out to test a different approach: highlighting the level of normative agreement -or consensus- among medical scientists about vaccine safety. The benefit of communicating the extent to which medical experts agree about the safety of vaccines speaks directly to the points above: we correct the false media balance by highlighting the high degree of consensus AND, at the same time, we avoid having to repeat any type of "misinformation".
Consensus information tells us how many experts, friends, or other people we care about agree on a particular issue of importance. We deal with consensus information all the time in daily life, from consensus on what restaurant dish is the most popular to consensus among critics about the quality of a particular movie. People are naturally inclined to pay attention to consensus because consensus cues often signal important information. For instance, think about the restaurant example. There is a good reason why a particular dish is the most "popular", it has some quality that leads most people to enjoy it. In a complex and uncertain world, where we have limited time to decide on a particular course of action, we often have to make strategic "bets" on what decision is going to be the right one. Human reliance on consensus heuristics evolved because they are adaptive for survival. In fact, some recent neuroscientific (link is external)studies actually show that people experience a feeling of pleasure and reward when they learn that their opinions are in line with the (expert) consensus. There is a good reason for this positive association. For example, if 9 out of 10 doctors tell you that you need surgery right away, simply relying on the expert consensus will most likely be in the best interest of your health. Some of my colleagues refer to this notion as the "simple heuristics that make us smart".
In our study (link is external), participants read one of the following treatment messages; "90% of medical scientists agree that vaccines are safe", "90% of medical scientists agree that parents should be required to vaccinate their children" or a combination of both. In the control group, no information was provided (90% is actually a very conservative estimate (link is external)of expert consensus based on national surveys among doctors and medical scientists). In short, we found that after exposure, people (conservatives and liberals alike) were not only substantially more likely to understand that there is a strong consensus among medical experts about vaccine safety, participants were also less likely to think that vaccines cause autism or that childhood vaccines are risky, and more likely to vaccinate their children and support policies that require parents to vaccinate their children.
We generally find that people's perception of the level of consensus among domain experts [medical scientists] functions as a "gateway" to changing other influential beliefs that people hold with regard to important societal issues. In other words, communicating consensus has the potential to correct influential misperceptions while cultivating science-based attitudes toward and public support for vaccinations.
I have written about the psychology of consensus (link is external) before. Of course, I am not suggesting that there is no need or place for people to learn exactly why vaccines do not cause autism or why you cannot catch the flu from a flu shot. The truth is that people care more about certain type of facts than about others and facts with social value (e.g., group consensus) tend to carry more weight. In an uncertain and complex world where people have limited time and attention, communicating the bottom-line is often what counts the most. In this case, that 90% of doctors all agree that approved vaccines are perfectly safe and that it is important for your health that you get yourself and your children vaccinated.
Center for Disease Control (CDC) Global Health - Vaccines and Immunization. Available from: http://www.cdc.gov/globalhealth/immunization/
Gellin, B.G., Maibach, E.W., & Marcuse, E.K. (2000). Do parents understand immunizations? A national telephone survey. Pediatrics, 106(5), 1097–1102.
Gust, D., Weber, D., Weintraub, E., Kennedy, A., Soud, F., & Burns, A. (2008). Physicians who do and do not recommend children get all vaccinations. Journal of Health Communication,13(6), 573–582.
Dubé, E., Gagnon, D., & MacDonald, N.E. (2015). Strategies intended to address vaccine hesitancy: Review of published reviews. Vaccine, 33(34), 4191–4203.
Dixon, G., & Clarke, C. (2013). The effect of falsely balanced reporting of the autism-vaccine controversy on vaccine safety perceptions and behavioral intentions. Health Education Research, 28(2), 352-359.
Lewandowsky, S., Ecker, U.K.H., Seifert, C.M., Schwartz, N., & Cook, J. (2012). Misinformation and its correction: continued influence and successful debiasing. Psychological Science in the Public Interest, 13(3),106–131.
Maibach, E. (2012). Knowing our options for setting the record straight, when doing so is particularly important. Psychological Science in the Public Interest, 13(3),105.
van der Linden S.L., Leiserowitz, A.A., Feinberg, G.D., Maibach, E.W. (2012). The scientific consensus on climate change as a gateway belief: Experimental evidence. PLoS One 10(2), e0118489.
van der Linden, S.L., Clarke, C.E., & Maibach, E.W. (2015). Highlighting consensus among medical scientists increases public support for vaccines: Evidence from a randomized experiment. BMC Public Health, 15(1), 1207.