Do You Have An Obligation to Listen to Those With Whom You Disagree? A Miracle Vaccine and a Rant About Ranting

Warning: Rant Ahead.

I’ll start by making my biases clear.  I believe science is a real thing.  I know that scientists make mistakes sometimes, and that we don’t always know what we don’t know;  yes, science does evolve, so sometimes what we thought at first changes later when more data is available.  But I also fully believe that honest application of the scientific method is more useful in evaluating things in the medical world than is a casual perusal of Facebook or information gleaned at a cocktail party.

That is not to say that in my life I give no credence to things that can’t be explained by the scientific method.  I definitely believe in some things weird and wonderful that do not rely on a data-based analysis.  I have an unnatural tendency to look for four-leaf clovers, find them, and ascribe luck to the experience.  I am not religious, but I do believe in some things spiritual and occasional things that might show up in the land of the unexplainable.  But mostly that’s for fun.  If I were thinking about taking a drug or having a surgery, or espousing medical knowledge, I’d want to see the data, the articles, the clinical studies first.  When the topic is serious, the science needs to be serious too.

Thus, I was particularly delighted to see this study of the unbelievably strong effectiveness of the HPV vaccine over a long-term study of tens of thousands of people, which was done in Scotland and just reported out.   The headline said, “HPV vaccine study finds zero cases of cervical cancer among women vaccinated before age 14,” which made my skeptical radar go ping.  But reading the story was heartening and made me remember the power of science and medicine done right. Here’s what the study found:

“The authors of the Scotland study monitored the records of all women born between 1988 and 1996 who were eligible for cancer screening, about 450,000 women. Of that group, 40,000 were vaccinated between the ages of 12 and 13, and 124,000 received the vaccines at or after 14 years of age. The remaining women, nearly 300,000, were not vaccinated.

No cases of cervical cancer were found among the women who were vaccinated before they turned 14, even if they had only received one or two doses of the vaccine rather than the full, three-dose protocol. Also noteworthy is that women who received the three-dose protocol between the ages of 14 and 22 also benefited significantly. While some cases of cervical cancer were recorded in this group, the incidence (3.2 cases per 100,000 women) was two and a half times lower than among unvaccinated women (8.4 cases per 100,000 women).”

It is rare that any medical intervention has that level of efficacy, particularly over the long term. The impact of the HPV vaccine in the U.S has been profound.  For instance, the CDC notes that infections with HPV types that cause most HPV cancers and genital warts have dropped 88% among teen girls and 81% among young adult women. As a former cervical cancer patient myself, I practically cheered out loud.  Let me tell you, the consequences of contracting HPV somewhere along the line were not fun.  What a victory this vaccine is for science and for women and for men.  The last time we had such an effective preventative intervention was probably when the polio vaccine was spread around the world, virtually ending that horrible disease.  Until it started to come  back and began to spread around the U.S. While a foreign visitor brought polio back into the country, the reason it started to spread is a direct result of people who don’t believe in science deciding not to vaccinate their own children, thus making them vulnerable to a disease which was all but eradicated for 30 years.

OK, I know I have already pissed off some people who think that being anti-vaccination is acceptable based on…what is it based on actually?  There has been nothing with a true scientific underpinning to suggest that routine childhood vaccinations are actually bad for kids, and furthermore, while there is always a small risk associated with any medicine and a few people are negatively impacted, the benefit so outweighs the risk that to say otherwise is completely confusing to me.  There is data galore to back this up.  Scientists estimate that at least 20 million lives were saved by the COVID vaccines, for instance.   If, before reading this, you were my friend and are an anti-vaxxer, I know you hate me now.  Sorry, but also not sorry.  And also, I’m so confused.

Hang in there with me for a second, because the real question that has been turning over and over in my mind for weeks is this:  What level of consideration, time, and empathy do we owe to people whose opinions are alien, concerning, fact-free or even offensive?  I think this is, in many ways, the big question of our time, even and especially on the political front.  Why did we politicize the COVID vaccine, for instance?  Why are there people who say that giving their child an HPV vaccine is anything other than helping save their life?  I haven’t heard anyone trying to politicize prostate cancer surgery.  You either need it or you don’t, and it’s really a matter of one’s personal experience, knowledge and decisions made with their own doctor.  But things like vaccines and Paxlovid and HPV care are politicized?  Weird, at least to me.

I recently saw a one man show called “Just for Us” that was literally one of the very best shows I’ve ever seen.  Alex Edelman’s one-man performance has the above question as its core premise. The show isn’t about medicine at all (though his dad is an esteemed cardiologist); it’s about prejudice (I won’t say more because I don’t want to ruin it for you and you have to see it.  The show is almost done with its U.S. tour but will be streaming at some point.  See it.  AMAZING.  I loved how the show focused on the importance of keeping an open mind to others’ points of view, even in the face of ugliness.  It asks the question: where do you draw the line between trying to understand others versus simply dismissing their bad ideas out of hand?

In politics this matters because it affects the tenor of our culture, which ain’t that pretty right now.  Are we obliged to listen to people railing against people of color, women, Jews, transgender people because they feel like it? Because they have some made up, non-fact-based theory about the less-than-worthiness of those people who are unlike themselves?  That’s a tough one.  Putting my science hat back on here, and I’m unable to listen openly to it.  Those of us who like to live in the world of facts and collaboration would like those people to stop talking because they are just wrong.  If you were my friend a minute ago and are now mad at me because you disagree, I think I’m okay with that.  I can see the reasons why you feel the way you do, but I will not ever understand them.  Spending time legitimizing that line of discourse is a real challenge for me. What can I tell you?

Which brings me back to my science premise.  We are about to experience an epic cicada re-emergence.  In the Midwest, the Hatfields and the McCoys of cicadas are going to come out of the ground and litter the earth in a sort of end of times way.  Over a trillion (with a “T”) are expected to show up across the middle of the country, occasionally necessitating a snow shovel to clear them.  I am not making this up.  But some people are going to say this is some sort of Biblical thing and blame (insert group they dislike here).  And others are going to say that this is biology simply doing its thing.  The biology-oriented are going to try to convince the others that they are right, and vice versa.  How much time should be given to this conversation with an openness to changing the others’ minds or at least having a deep understanding of the basis for the other’s belief?  Good question.

I read in the NY Times last week an entire article about Sleepy Girl Mocktails, which are a mix of magnesium, tart cherry juice and seltzer.  Apparently the Tik Tok world has decided that this is the secret potion that helps people sleep better.  Scientists have weighed in, party-poopers that they are, to debunk the science behind this BUT also to say that drinking these can’t hurt and may actually help if one believes it’s helping.  There is certainly a psychological component to wellness/illness that helps one drive the odds of a good outcome up or down.  That is well-documented.  But it’s so fascinating to me that this kind of give-and-take discourse occurred over some weird little Tik Tok trend and occurs the same exact way about real scientific breakthroughs.  The Sleepy Girl Mocktail story is, essentially hey, it’s not scientific, but not dangerous so, go for it.  Can’t hurt, might help for unexplainable reasons.  But when it gets to HPV or COVID vaccines, scientists are pilloried for saying, nope, this one is a must do.  No gray here, just do the right thing and take the medicine.    Must we equivocate our way through life and science to appease those whose arguments are based on Tik Tok?  Do we owe them a deep effort to understand when they can’t return that favor?

I also recently saw actor/comedian Paul Giamatti tape an episode of his hilarious podcast called Chinwag, which he does with Philosophy professor/author/rock guitarist Stephen Asma (total renaissance dude).  They describe the podcast as one which “joins forces for a freewheeling series of conversations that dive deep (like, really, really deep) into the wilderness of the mind.”  They focus mainly on unexplained phenomena like bigfoot and aliens and ghosts, talking with celebrities and regular people who believe and don’t believe in these things, which further catalyzed my perseveration on the overall topic of figuring who should get heard.  The conversation I watched was between Giamatti, Asma and comedian Chris Gethard, who has long written for a publication called Weird New Jersey (I know, what isn’t weird about New Jersey?). Gethard has and continues to report on paranormal and bizarre mystical things that happen in…New Jersey.  Why, I must ask, if the aliens could land anywhere in the world would they pick New Jersey?  Excellent question that really challenges the intellect of aliens.  But I digress.

The primary topic of Chinwag’s podcast this time was, among other things, fact-based and intentionally made-up incidents that became urban myths that, over the passage of time, morphed into crazy enduring belief systems.  For instance, the three discussed the legend of the Lemurians, a race of mystical beings/and/or aliens (?) who apparently live in an allegedly hollowed-out Mount Shasta in California. God knows what their property tax basis is, but it must be good, having lived there since the 1800s.  Be that as it may, this whole thing started as some weird guy’s fantasy in a book and then became the basis for an actual religion that still exists today.

Gethard also described a guy who was very bent out of shape due to the building of a condo complex near his home and went out in a bunny suit taking an axe to cars to show his dissatisfaction.  This factual experience became “the Bunnyman with the Axe,”  a story that stopped teens from making out in a particular area for years.  Crazy stories with a basis in actual experience that skip the scientific facts are fine when one is dealing with New Jersey-based bunny people and Lemurians, but not when we are dealing with medical advancement, at least in my view.  After tossing out many stories like this, Asma noted that people are actually far scarier and more bizarre than the zombies and bigfoot.  Ain’t that the truth.

Asma adds in an interview about the podcast, , “I’m very interested in paranormal phenomena and conspiracies, but as a professor of philosophy I tend toward the skeptical side of the continuum. When I hear extraordinary claims, then I want to see extraordinary evidence. Paul tends toward more belief in the paranormal, so we have some good-natured debates and disagreements. Even though I’m generally skeptical, I remain very open-minded to strange phenomena on the edge of the known. As Aristotle said, philosophy begins in “wonder,” and I try to keep my curiosity alive to new possibilities.”

Wow, I love that way of thinking.  Let’s debate the relative meris of Lemurians and Sleepy Girl Mocktails into the wee hours of the evening.  But should this openness of spirit and mind apply when dealing with things that can legitimately affect/save people’s lives, like medicines that prevent cancer and death when extraordinary evidence is already present?  Should one be able to engage in “good natured debates” about those concepts, rather than just accept the actual facts that have been proven time and again to be right? Why do we allow alternative facts to turn into belief systems with no scientific basis when the consequence is so very bad.  It’s amazing how people will contort their minds, even when they cease to operate in their own self-interest.

I have been stewing on this topic since seeing Just For Us and I can’t let it go!  As Asma said during the podcast taping, there is a continuum from imagination to conspiracy theory.  The line between them can get very thin at times.  We must always be vigilant.

I think a reason I am so worried about all this is that if we let the door open a crack to let in the crackpot thinking in medicine, we can really hurt people badly.  We are already seeing this in the women’s health realm as we try to force policy decisions based on politics rather than medicine.  And it trickles down all the way to scientific discovery and innovation.  Misinformation about vaccines is one of the key reasons cited for venture capital firms and pharmaceutical companies electing not invest in them. This category of medicine is deeply underfunded for several reasons, but there aren’t many categories that are underfunded because…some people are…searching for a polite word…uncomfortable with science.  Should science stop because some people just don’t believe?  I sure hope not.  If we let urban legends become clinical guidelines, we create our own peril, Bunnyman or no.

Circling back to the HPV study… We almost never get anything in medicine that works 100%, even when done correctly. I sincerely hope that we, as a society, celebrate this as a mark in the win column and cease to politicize it so kids end up unvaccinated.  Only about 60% of American kids currently get the HPV vaccine and 13 million unvaccinated people contract HPV every single year.  Choosing not to vaccinate your kids because it might give them license to have sex, or worse, might cause some imaginary medical ailment that is somehow worse than the cancer that HPV causes is downright dangerous.  HPV directly causes cervical, anal, penile, throat, and a host of other cancers that are potentially preventable with widespread vaccine use. There is no room for controversy here.  Them’s the facts, as the saying goes.

We see this same magical thinking around all manner of vaccines, and we must stop tolerating it.  How do we break the cycle that so often turns medical advancement into stories worthy of Weird New Jersey?  We must figure out a way to save the fantastical thinking for Tik Tok cures and support the spread of real ones.  Four-leaf clovers only take one so far.  Science is a much better path to good outcome.  It’s ok to debate science, but not with feelings, only with better science. That’s my definitive view.  I’ll keep collecting my four-leaf clovers for now, but if some bona fide luck vaccine gets FDA approval, I’ll be the first in line.