Nocebos, fear, and why we need to pass out lollipops

My sister-in-law sent me this article: http://www.npr.org/sections/health-shots/2017/06/10/532110787/a-dad-takes-his-son-to-the-doctor-and-discovers-fear-of-vaccines?

It’s about vaccines and how fear affects people’s ability to evaluate information. I had never heard the word “nocebo” before.

Anyway, it just reminded me that in many of our communities, our conversations about science are hampered by an inevitable fear response that our facts and information can’t seem to overcome. So it made me wonder what our “lollipops” should be? Any thoughts?

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Well written article, and very true that fear is a huge factor. People risk death every day when they don’t take a medication with proven benefits because of a possible side effect.
The fear factor is at play in many organizations who either scare you with outside threats, or inner threats that you are just not the right kind of Christian if you vary from their ideas.
A lollipop is something that giVes you a warm fuzzy feeling, amd I can think of few things that would do that, other than perhaps peace. If someone is suffering the cognitive dissonance that is the result of literalism, then realizing you can integrate creation and Creator can give peace.
That and maybe witty sayings on coffee cups, sold on the website with t-shirts and maybe lab coats.

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Statistics are terribly cruel. They are as real as the letters imprinted in a Bible … but much harder to read! And much harder to believe at times.

No matter how small the odds, there is always the chance that a child will react to a vaccine, or any medicine, so quickly that he or she might die right in front of the parents. How do you mitigate the fear of such a thing? I am a parent, and the whole vaccine process was terrifying for me and the mother.

And then I read, again, how if a certain percentage of the population is not vaccinated against measles, the Odds geometrically increase that simply walking into an empty school room, or empty government waiting room, or even a neighbor’s home, and getting infected with active and debilitating measles virus - - left by an infected person two hours before (just by, say, coughing) !!

How else can we fight fear other than by showing there are worse things to fear!

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Most of us take on highly risky activity like getting in a vehicle to drive somewhere, but we’re used to it, and the steady drumbeat of traffic fatalities has faded into the constantly thrumming background noise to which we are now accustomed with a denial coping mechanism that easily sets aside those terrifying facts while we get into the car. On better days I ride my bike (along a major highway no less) which is even worse in some ways (though I don’t know the statistics --there aren’t enough of us I guess to make much of a statistic yet; but: “exposed human body vs. high-speed steel, glass, and pavement” – I know the how the physics works). But here’s the weird thing --it’s what you get used to. I’ve commuted enough times on my bike that my brain just isn’t beholden to that fear any more. Don’t get me wrong, I’m hyper-attentive with rear-view mirror and all, since I don’t have a death wish. But unlike other people who are terrified on my behalf, I laugh at the risk, because I’ve grown accustomed to it. My lollipop is that I get to enjoy greater physical fitness, eat more, and occasionally indulge in a bit of self-righteous smugness about how I’m allegedly helping save some planet or something. What people get themselves accustomed to is huge. If you’ve bought into the whole “I must drive the biggest vehicles possible because that makes me and my loved ones safer” idea, then you become accustomed to it, and now feel terrified crawling into any smaller car, even though we all did that with nary a qualm a couple generations ago before the savvy marketing strategies from American vehicle manufacturers kicked in shrewdly playing on our fears. All that self-righteous tirade aside though, I have to admit that it also has an antidote: I sure do appreciate the kindly SUV or truck driver that stops for the cyclist with a flat tire and gives them a much needed lift. It’s the good Samaritan story told for me personally reminding me who my neighbor is. As you may guess, they aren’t getting any anti-big vehicle lectures from me while I’m sitting in the front seat enjoying their air-conditioning.

The lollipop could be anything that helps us get our thoughts off of ourselves (work or service with each other?) I think does wonders for the spirit to help mitigate fear. If you’re swinging a hammer or mowing a lawn your mind is engaged in something other than reading some social media click bait that reads “…you could be next!” Also I think remembering our mortality helps in a substantial way. When we accept that there is no “if” we will die but only “when” … just like everybody else … all through history, then we can stop finding this “news” so jarring and start actually living life – deliberately acclimating ourselves to those risks that we deem to be worth it.

Maybe scientists who can speak with empathy, humor, and respect for their less scientific audiences may be a lollipop that helps a public set aside their fears to actually consider scientific results --giving them a hearing instead of instinctive or practiced dismissal. Science experts presumably have a platform above the public, but in many other areas (including religion and ideology) they are peers with their audience and if they realize and internalize this, not posturing themselves as if they are “above” their audience in every way, that goes along way to connect with the lay public who is probably hypersensitive to condescension.

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New article on measles deaths…most of them in children under 5.

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Interesting (in the usual bad way things are in medicine), is the article linked that discusses the long term immune damage the measles virus does, which may cause even more subsequent deaths.

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Interesting stuff. I think there could also be an overlap with theology here. On and off our church leadership has been discussing ‘how do we get young people in our church and those becoming Christians to embrace traditional articulations of theology?’ Our problem was that we could make a good case for the theological concept being ‘right’ or ‘biblical’ but folk would still respond with ‘yeah, I see that but it still sounds a bit [mean/exclusive/restrictive/unloving/etc]’ - delete as appropriate. Of late I’ve been wondering if part of the problem is that I often stop at ‘and this is why X theological belief is true’ and in doing so nearly always fail to make a case for why it is also good. A positive apologetic if you like.

Do you think the same could be true of the vaccine conversations? My limited experience of vaccine-conscious and anti-vaccine folk is that regardless of the facts put across it kind of washes over them. Could this be because, perhaps underneath it all, their concern is not only ‘do vaccines work?’ but also are they good?’ And those are two very different questions. The former is answered with proofs, the later with time, compassion, and reassurance. I also imagine that much like theological discussion it could be easy to provide a lorry load of evidence (Do they work?), but trickier to listen for the complex underlying pastoral concerns (are they good?). Even harder if you are a busy, overworked medical professional.

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How are they different questions? Surely the only “goodness” a vaccine could have would be in that it actually works.

I think the positive necessity of anything worthy to be called a doctrine must similarly reside in its truth and necessity both. The man stumbling about through thick fog on a mountain top should surely be interested to be aware if there is a cliff edge nearby that he should be wary of. That this information would be good to have is self-evident. And for it to be that, it must first be true as well. Even if it isn’t completely true - or gets some details wrong, it may still be better than no doctrine at all. To have the warning, and thus become more attentive, may be the valuable thing, even if you remain unsure or have misinformation on exactly where that cliff is.

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I have been thinking about this because I just wrote something up about a different approach to apologetics, given emerging adults different approach to learning and texts, and I think what you are saying is right on. It is not effective in our current cultural context to treat the Bible like a reference book of truth to master.

If we look at what works well in many other cultures (and seems to work well with postmodern youth in Western contexts too), one effective approach to Scripture engagement is called “storying” or “story-weaving.” It relies on making links between my story, your story, and God’s story. The emphasis is that God’s truth can change our story in positive ways that restore our relationships with God, self, others, and creation. We embrace it, not to be right, but to be restored. Trying to use this way of presenting truth really forces you to think hard about how a particular truth you may think is doctrinally essential fits into the missio dei (which is basically just theological-speak for God’s story).

[ETA: and I just got a message from Hillary saying that article went live this morning, so here it is, if anyone is interested. :)]

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Thanks for your robust feedback @Mervin_Bitikofer. Much appreciated. Let me try to explain.

Yes and no. A person might be thinking that vaccines work but be overly concerned about side effects, the ingredients, concerns about some mega-pharma conspiracy to push something which is needed but maybe not be essential to make money. Any number of reasons could lead a person to think that though a vaccine (or any medication) might ‘work’, that somehow they might not be ‘good’.

The OP was about fear affecting people’s affecting how people process information. Fear is itself an emotional response, and emotional responses are not always best countered by rational information-heavy arguments (IMHO).

To be honest, I’m with you in that I naturally think that way too. But we do not all think the same or along the same lines, right? So I think here there is simply an issue of starting points. Many people want to know if something is correct for them before they’re will to listen to arguments about whether it is correct in an objective evidential sense. Some might see this as a false dichotomy, but they don’t.

Thanks for making me think harder about this. Look forward to your response.

Thanks for your thoughts @Christy - it sounds like we are travelling on parallel lines.

Sadly, I can’t say more now as I’ve got to pick up my eldest from school and then we are off for our weekly family coffee shop trip. I’ll check out the article and report back!

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That concern is often considered formally as the risk/benefit. Some vaccines may work well, but have too many complications. Other vaccines may not work that well, but if the disease is horrendous may still be of benefit and thus good… Think of something like HIV. Of course, cost to benefit ratio is important too in an atmosphere of limited resources, and hard decisions have to be made as to how much is a life saved worth in hard cash, especially if it means a life lost if money is pulled from another program.Smart people who dedicate their lives to such questions crutch the numbers to make their recommendations knowing that it is life and death. Of course, you worry when companies get involved whose concern is profit, but I feel in most cases the numbers speak louder, and decisions are under scrutiny and must be justified.

Outside of bureaucractic decisions, there is also the social perception of whether something is good. A prime example is the HPV vaccine. HPV is transmitted by intimate contact, and is given primarily to pre-adolescent girls. While it helps prevent genital warts, the main reason is to prevent cervical cancer, and it helps with anal and oral cancers also. It has been a hard sell particularly in some Christian circles to vaccinate your 10 year old daughter against a sexually transmitted disease, however. Interestingly, the profit motive may actually be beneficial as the companies that make it have put on ad campaigns to increase awareness and sales. In any case, it is a vaccine that works fair (prevents 70 % or so of cervical cancers, is good from the standpoint of lives saved, but has been perceived as bad or at least distasteful by some. (As an anecdotal story, a friend of mine had a family member die of cervical cancer, even though she was sexually monogamous but alas her husband was not)

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I took my daughter to her pediatrician to get this and they told me they didn’t do them until 15. I was kind of annoyed, because we can’t get it easily here in MX and it requires several doses.

I was told by a Christian nurse that I should not have my daughter vaccinated because only sexually active girls “needed” it. I said that 1 in 4 women in college are sexually assaulted, and men have been found to lie about sex to their monogamous wives, so unfortunately, contracting an STD is not always a result of a woman’s choices.

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And even if it is their decision to be sexually active, do you want them to die of cervical cancer? When put that way, not a hard decision.

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Good for you. I had my daughter vaccinated. The other complication is that HPV is spread by sexual contact, but it doesn’t necessarily require intercourse to pass this virus along. You don’t have to lose your virginity to catch HPV.

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Thanks for putting it that way. I’ve so often heard this kind of decision operate under the assumption that if you do anything to make the consequences of a bad decision easier to bear, you’re basically giving free reign for the person to make bad decisions, and in a rule-based culture that would be a terrible thing to do. But it’s also very uncompassionate. There is a line somewhere, and bike helmets are still a good idea, so I guess it’s not that different.

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Dear Christy,
Thank you for the post. For most of my life I could not understand how it was possible for widespread untruths to persist. After my.daughter’s stroke, I was inspired to write my life’s story and was confronted with verbalizing this illogical behavior that I had observed throughout my life. The label that I applied to the force supporting untruths is rhetoric, which are lies and half-truths we tell ourselves to eliminate our fear. Or it is the rhetoric that we tell others to capitalize on their fears, or to keep them from realizing the truth. It is rhetoric that we use for lollipops to avoid the cold hard truth.

This is a difficult test of free speech. Should someone who persists in falsehood or intellectual mistakes that cause a national crisis be jailed? Despite deaths, this man said vitamin c would combat measles and the people should avoid shots. Thanks

I guess it could be compared to yelling “fire” in a crowded theatre. We don’t really have absolutely free speech. There are such things as slander, plagiarism, threats, assault, etc. … lots of speech that is highly punishable by lawsuit, fine or even imprisonment. So the notion of unmitigatedly free speech is a delusion anyway - I doubt the culture exists that would have it.

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I’m tracking with you, to an extent. However, it seems a bit situational; and I’m not sure where to limit that. For example, Andrew Wakefield, the researcher who started the whole measles vaccine/autism controversy based on a faulty study (and has been refuted), lives free in the West and persists in his wrong saying. Presumably, he influences these deaths yet.
At what point does a free society decide enough is enough? I guess it’s good to have a struggle–it proves that we as a free society recognize there are grey areas shared about freedom, ignorance and best practices; and that we struggle to make the balance.

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