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Fact or fallacy? Immunisation arguments in the New Zealand print media

Fact or fallacy? Immunisation arguments in the New Zealand print media Most people obtain information about health issues from the mass media. When a topic affects most of the population, rather than to a small sector, it becomes relevant to the media, and from a news perspective immediately ‘hot’. If one moves from a health topic relevant to a smaller sector such as a new treatment for a rare cancer to one with more universal appeal such as a mass childhood immunisation program then the number of people to whom the story is relevant vastly increases. If one adds personal adventure/mishap, controversy such as two sides that can pit against one another, graphic or emotive images, then immunisation can become an excellent topic for media attention. Opposition to immunisation Despite overwhelming evidence supporting the routine use of a number of vaccines, public controversies generated by anti‐immunisation proponents regularly arise, gaining media attention and this has been shown to erode vaccine uptake. Anti‐immunisation rhetoric generally contains errors of fact and/or errors of logic (fallacies). Organised opposition to immunisation has been present since legislation made smallpox vaccination compulsory in 1853. The arguments used in opposing vaccination and immunisation programs have remained constant since that time and, apart from the Internet, the avenues for presenting anti‐immunisation arguments also have remained relatively unchanged. Anti‐immunisation rhetoric and polemic arguments have been examined and the arguments themselves are well documented. However, these arguments have previously not been examined for fallacies of logic. Fallacy A fallacy is a component of an argument that is demonstrably flawed in its logic therefore rendering the line of reasoning invalid. Often this is as a result of a false premise and/or false conclusion. It is useful to identify flawed reasoning in order to enable effective and convincing refutation of errors. There are various definitions of the term fallacy and ways of classifying certain fallacies. Plato was the first philosopher to collect and document examples of flawed reasoning and Aristotle the first to name 13 different types of errors in reasoning or errors in logic. Since Plato and Aristotle, particularly following the Dark Ages, philosophers have contributed further to these works. Today there are various competing and overlapping ways to classify fallacies: The Internet Encyclopaedia of Philosophy lists the 177 most common. Broadly, fallacies can be classified as formal, where the structure or form is flawed, and informal, where the argument has valid form but the premises are false and therefore cannot support the conclusion. Place of logic in society Logic is concerned with the principles of correct reasoning, relying on valid argument rather than emotional appeal in clarifying and directing our judgements. A well‐functioning society requires its processes and decisions to be based on logical reasoning which therefore lead to good conclusions. ‘He said she said’ news formula ‘He said she said’ reporting is a way to provide balance to a news story without actually evaluating the material or statements for fact or fallacy, or indeed performing any critique. An example of this is the claim that vaccines cause autism. Virtually no mainstream scientist believes that such a link exists, only anti‐immunisation protagonists, however, balancing quotes from both sides of the argument give the assertion credibility. Aim In order to explore immunisation arguments appearing in the New Zealand (NZ) print media, a content analysis study of the major daily NZ newspapers was conducted with the aim of critically examining the construction of immunisation‐related arguments by describing and classifying errors of fact and fallacy. Method The Immunisation Advisory Centre (IMAC), at the University of Auckland maintains a database of clippings, accessed from a commercial media watch service, from a variety of print media in which words associated with vaccines and vaccine preventable diseases are mentioned. At the Centre all newspaper articles printed between January 2002 and December 2007 from the daily papers of four major NZ urban centres ( The New Zealand Herald , The Press , The Dominion Post , The Otago Daily Times ) were extracted from the database. The circulation of these papers extends nationally. Data recorded included origin and date of publication, type of article, title, author, page number and type of vaccine the article addressed. Examples of each type of error of fallacy are presented. Errors of fact All articles were assessed for errors of fact — (statements that are false) regarding any comment (whether direct or implied) on vaccine safety, efficacy and/or effectiveness. There are three types of errors of fact: completely erroneous statements that are false (not substantiated by scientific evidence), errors of omission where information is ‘cherry‐picked’ and presents only part of the truth, ignoring data that contradicts the position, and errors of commission, where information is misconstrued, exaggerated or inflated to support a claim. For the purposes of this study the terms ‘fact’ and ‘truth’ have been used to illustrate that which is supported by the vast majority of scientific literature so as to constitute the central theories within vaccinology. Fact was verified via the peer reviewed evidence‐based literature. Comments in newspaper articles supported by the majority of scientific literature were classified as substantiated and coded green. If the scientific literature refuted the comment of interest, the comment was classified as unsubstantiated and coded red. Based on the overall make‐up of its content (the number of lines coded green and red), each article was assigned a substantiation score between one and five, where the number corresponded with one of the content analysis measures (based on Boykoff's content analysis study ) below: 1 All statements substantiated. 2 Some statements unsubstantiated. 3 Equal proportions of substantiated and unsubstantiated statements. 4 Most statements unsubstantiated. 5 All statements unsubstantiated. Descriptive statistics were performed to calculate the frequencies of unsubstantiated claims for various vaccines and for the changes over time. A random selection of 10% of the articles were independently assessed and coded by two other members of the research team, and Kappa analysis was used to test their level of agreement. Errors of logic Acknowledging that it is insufficient to merely classify comments as either substantiated or unsubstantiated (to solely assess the substance behind the argument or viewpoint), all the articles were reassessed for errors in logic. These errors were in regard to all views on vaccines, not just those regarding safety, efficacy and effectiveness. An error of logic involves a fault in reasoning, which renders the argument invalid. During the past 2,500 years there have been many additions and alternatives to the early taxonomy proposed by Aristotle and there is no one standard. The authors chose to observe the early, shorter taxonomy to illustrate that modern fallacies may still be described using ancient logic. These were categorised according to the following taxonomy. See Tables 1 and 3 , which include the type of error, the quote containing the error, and comment about the error. 1 Examples of errors of fact about vaccination efficacy, effectiveness or safety in the New Zealand print media 2002—2007. Type of error Example Comment Erroneous statement “But there is evidence it [ADHD] is aggravated by substances that get into the child's body from other sources, such as antibiotics, lead in the environment, possibly vaccination, as well as food.” Auckland GP , NZ Herald 2006 There is no evidence in the scientific literature that ADHD is aggravated by vaccines. Error of omission “Eighty per cent of those given the vaccination in a New Zealand trial had a reaction to the vaccine and no placebo tests were conducted, Mr Peters told Parliament.” The Dominion Post , 20 October 2004 Almost all of these reactions were minor local injection site reactions. Placebo controlled trials were considered unethical and unnecessary as enough bridging data was available. Error of commission ““MeNZB vaccination is free and safe” Otago Daily Times , 20 June 2005 Vaccination is not always safe — serious adverse events occur on rare occasions 3 Examples of errors of logic about vaccination appearing in the New Zealand print media 2002—2007. Type of error Example Comment Post hoc ergo propter hoc (affirming the consequent) “An Oamaru pupil says the meningitis vaccine caused him to collapse and spend a night in hospital.” Reporter, Otago Daily Times , June 2005 Assumes that because the vaccine was given first it must have caused the collapse. Cum hoc ergo propter hoc (denying the antecedent) “…some reports suggest there are high levels of absenteeism as a result of that [MeNZB injections]. When vaccination coincides with the beginning of the cold and flu season you would expect to see quite high rates of absenteeism. We believe all vaccines place a strain on the immune system.” Immunisation critic, NZ Herald , 2005 Assumes that the vaccine causes other illnesses to occur at the same time its administration. Circulus in Probando (arguing in a circle) …. “You've got to give kids' immune systems a chance to grow. It's better to build immune systems so they can fight things themselves” Reporter, The Press , 2006 Assumes the answer to developing a good immune system requires experiencing vaccine preventable diseases. Dicto simplicter ad dictum secundum quid (fallacy of accident) “All three injections of the MeNZB vaccine are needed.” Ministry of Health, Otago Daily Times , 2005 Does not consider exceptions. Sometimes 2 doses of this vaccine were sufficient. Dicto secundum quid ad dictum simpliciter (reverse accident) Critics of the program say the toddler was a victim of vaccine failure, and are calling for a Royal Commission of Inquiry into “how a nation can be so totally swayed by officials and advisers into spending a quarter of a billion dollars for such a gamble that has delivered false hope to trusting New Zealanders.” Reporter, NZ Herald , 2006 Generalises from a single case (of vaccine failure) to suggesting the entire program is a failure. Vaccine failures are expected as no vaccine is 100% efficacious. Fallacy of the consequent “Some people don't like altering the children's immune systems with anything. Kids that don't get immunised are actually healthier on the whole.” GP, The Press , 2005 Concludes that unimmunised children are healthier, however this is not supported by the premise “some people don't like altering the children's immune systems with anything.” Verbal fallacies (emotive language) “These child guinea pigs for the nation [children receiving MENZB vaccine]”, Reporter, The Press , 2004 Wrongly implies that children are being experimented on False attribution “Risk analyst Ron Law, a critic of the vaccination program, said the program had been a failure.” Health reporter, NZ Herald , 2006 The term “risk analyst” implies expertise on the subject when in fact there is none giving the statement more credibility. Ignoration Elenchi (irrelevant conclusion) “Ms Claridge [Immunisation Awareness Society] says that during the 50 years leading up to the 1940s when vaccination programs began, the incidence of communicable diseases had already dropped dramatically because of better sanitation, hygiene, water supplies, housing and nutrition” Reporter, Dominion Post , 2002 Diverts attention away from the issue at hand which was the Meningococcal B vaccination program, and discusses the decline of vaccine preventable diseases. “She says that diseases such as scarlet fever have also declined hugely during the past 110 years, despite the absence of a vaccination program.” Immunisation critic, Dominion Post 2002 The decline of scarlet fever is largely due to the development of antibiotics and vaccination is irrelevant. Argumentum ad hominum (shoot the messenger) “I realised one day that there were two kinds of doctors — there is the GP who knows bugger all about a lot and the specialist who knows a lot about bugger all.” Vaccine critic, NZ Herald , 2006 Both of these criticise the messenger rather than the message — a personal attack. “And you can be sure that doctors Tukuitonga and Turner will not be taking the blame because, for all their protestations of immunisation safety, they would not know an adverse reaction if it jumped up and bit them.” NZ Herald 2002 Argumentum ad verecundiam (attribute to misleading authority) “The Society says breastfeeding for at least 6 months and a healthy diet and environment for children provide better protection [than immunisation]” The Immunisation Awareness Society, The Press , 2006 The Immunisation Awareness Society have no credentials in science nor paediatrics. Straw man argument “The medical profession says Pamol is completely safe”, Reporter, NZ Herald 2004 The medical profession do not hold the view that paracetamol is completely safe. This is misappropriating their position. Fallacious anecdotal evidence “I have seen case histories of children, and spoken to other doctors whose children decompensated [regressed] so drastically after the MMR that you can't deny that in some cases it happened.” Neurologist parent of child with autism, NZ Herald , 2006 Anecdotal evidence only. Fallacious because is assumes the Post hoc ergo propter hoc (affirming the consequent). Formal errors of logic The structure is flawed and deduction is invalid: • Non‐sequitur (claim purports to show causality) • Post hoc ergo propter hoc (affirming the consequent — assumes a causal relationship because one event follows another in time) • Cum hoc ergo propter hoc (denying the antecedent — assumes a causal relationship because one event occurs at the same time as another) • Petitio Principii (begging the question) • Circulus in Probando (arguing in a circle or assuming the answer) Informal errors of logic Have a valid form but false premises that do not support the conclusion: • Dicto simplicter ad dictum secundum quid (fallacy of accident — makes a generalisation that disregards exceptions) • Dicto secundum quid ad dictum simpliciter (reverse accident — argues from a special case to general rule) • Fallacy of the consequent (draws a conclusion, which the premise does not support) • Verbal fallacies (uses words in an inappropriate manner, for example emotive language, to make or support a claim) • False attribution (appeals to irrelevant, unqualified, biased or fabricated source) • Red herring fallacies (argument given in response to another argument, not addressing the original issue) • Ignoration Elenchi (irrelevant conclusion, diverts attention away from a fact in dispute rather than address it directly) • Argumentum ad hominum (addresses purely personal considerations — shoots the messenger) • Argumentum ad verecundiam (attributes to misleading authority) • Straw man argument (based on misrepresentation of an opponent's position) • Fallacious anecdotal evidence (uses personal accounts or experiences in an ambiguous fashion to support a claim). It should be noted that use of anecdotal evidence sometimes may be valid, when personal accounts or experiences are employed in an illustrative fashion. This second dataset includes the source of the article, the type of error, the quote containing the error, and the person or organisation to which the error was attributed. Examples of each type of error of fallacy are presented. Results Errors of fact (scientifically substantiated and unsubstantiated content) A total number of 360 articles from 2002 to 2007 (average of 60 per year) containing information pertaining to the efficacy, effectiveness or safety of vaccines were identified and analysed using the substantiation scoring system. Independent coding of the substantiation scores gave a Kappa score of 0.97 indicating a strong level of inter‐rater agreement. Overall, 21% (n=76) of the articles contained some factually unsubstantiated information about vaccine efficacy or safety. Examples of the types of factual error are presented in Table 1 . Articles reporting new vaccines were usually accurate. For example, news about the human papillomavirus vaccines was emerging and centred around their potential to protect against cervical cancer. Of 24 articles, only one contained any scientifically incorrect information, and there was no unsubstantiated information about the new conjugate Pneumococcal vaccine. Similarly, articles referring to well‐established vaccines not in routine use (such as rabies) or the now‐redundant vaccine for smallpox were all factual. On the other hand, 33% of articles about the MMR (measles, mumps and rubella) vaccine contained erroneous information. This is likely to reflect the negative press this vaccine has received in the past, including the erroneous claim in 1998 that it was associated with autism. Approximately a quarter of articles (26%) about the NZ‐specific vaccine against a specific strain of group B meningococcus contained scientifically unsubstantiated information. This vaccine was introduced in response to an epidemic starting in 1991, which had resulted in a number of deaths and severe morbidity. Prior to the development of a vaccine the media regularly reported tragic cases of the sudden deaths and disabilities of young people. In 2003 phase II trials were conducted on NZ children and 2004 saw the roll‐out of a nationwide immunisation campaign to all children from infancy to aged 20 years, which was completed in 2006. Table 2 presents the number of articles containing unsubstantiated facts on efficacy and safety for the meningococcal B vaccine by year. In Figure 1 it can be seen that the quantity of non‐scientific information about the vaccine dramatically increased through the roll‐out phase, but by 2007, when both the epidemic and the mass vaccination program were over, this again declined. 2 Number of articles containing ‘All substantiated’ through to ‘All unsubstantiated’ facts on efficacy and safety for Meningococcal B vaccine by year. Substantiation score Year 1 2 3 4 5 Total 2002 5 0 1 0 0 6 2003 5 0 0 0 0 5 2004 28 3 2 2 2 37 2005 19 7 1 0 1 28 2006 38 14 1 1 0 54 2007 6 1 0 0 0 7 101 25 5 3 3 137 1 Progression of unsubstantiated statements about Meningococcal B vaccine over time. Errors of logic Many articles contained a number of errors of logic (fallacies) as well as fact. These met most of the types of fallacy in our taxonomy, and examples are shown in Table 3 . While these errors were predominantly used by those opposed to immunisation, supporters were not exempt from using such strategies. For example, the Ministry of Health statement that the meningococcal B vaccination was ‘safe’ over‐states the case (adverse reactions do occur). The statement that “ all three injections of the MeNZB vaccine are needed ” also is not entirely correct (some vaccinees develop protection from two doses). Most of the fallacies occurred in quotes contained within the article rather than as a result of assessment by the reporter. Discussion This study reviewed errors of fact and logic in articles published in the major NZ daily newspapers concerning vaccines and immunisation over a six year period. Strengths of the study include the comprehensive dataset comprising all articles pertaining to immunisation and vaccination in all four major NZ daily papers, analysis for errors of both fact and logic, the strong level of inter‐rater agreement and the following of trends over time. A weakness is that while we developed a relatively robust taxonomy of fallacies, there is no one standard for this and some errors may be able to be categorised into more than a single category simultaneously. This study has important implications. Understanding how arguments presented in the media are constructed can both assist health professionals in addressing vaccine issues that appear in the media and allow the avoidance of the use of fallacious arguments themselves. By looking beyond the superficial we can deconstruct arguments to expose the errors — sometimes we feel something sounds wrong but are not sure why. When we know how to identify a fallacy we can counter it more effectively. In most countries, including NZ, the media wish to be seen as impartial and guidelines on impartiality and diversity of opinion as well as accuracy exist. In NZ, the Press Council exists to consider complaints, promote freedom of speech as well as maintain the press in accordance with the highest professional standards. The Press Council does not prescribe rules by which publications should conduct themselves, rather editors have that responsibility. The journalism code of ethics reflects The Press Council statement of principles of which two areas are particularly pertinent to reporting of immunisation issues: • Accuracy — publications (newspapers and magazines) should be guided at all times by accuracy, fairness and balance, and should not deliberately mislead or misinform readers by commission, or omission. • Comment and fact — publications should, as far as possible, make proper distinctions between reporting of facts and conjecture, passing of opinions and comment. Presentation of a range of views is clearly important — particularly on political topics, or in areas of health where the knowledge is incomplete and continuing to evolve. Established health issues such as national immunisation programmes however have already been scrutinised for scientific validity, and are part of national public policy and usually a priority. The ‘truth’ has already been subject to assessment by many experts and generally is not something that can be evaluated based on a media story presenting a range of quotes in pursuit of ‘balance’. Ironically, introducing a balance of personal views on a subject such as immunisation can introduce bias with public health the casualty. Media presentation of a new vaccine changes over time in terms of scientifically substantiated information. For new vaccines, prior to introduction, the coverage is less emotive and more scientifically substantiated, focusing on the potential of the vaccine to prevent disease. This may be a reflection of the general low level of interest in new vaccines by anti‐immunisation lobbyists, and the higher level of interest in the disease by the community experiencing its effects. Following the routine use of a vaccine the proportion of unsubstantiated reporting increases, including fallacious arguments. These arguments are used by both supportive and anti‐immunisation spokespeople, although more commonly by those opposed to immunisation. Most arguments proposed by anti‐immunisation lobbyists have been demonstrated to be fallacious. Apparent here is the failure of the press at times to verify both the material and the credibility of their sources. In this there may lie the conflict between the drivers and constraints journalists have and the need for health professionals and scientists to provide accurate information to the public. We found both errors of fact and logical fallacies. Both those who support and detract from immunisation use these, however anti‐immunisation proponents are more likely to include errors. It appears from the examples presented in this study that the media are frequently content with providing the diversity of opinion without investing the same effort to verify the accuracy or source, instead settling for providing quotes from a range of sources to fulfil their journalistic balance. The term ‘balance’ in this context is a media construct in contrast to scientific balance. Additionally, the errors of omission and commission are explicitly mentioned in the media principles, however, they appear frequently in media articles. Until there can be both recognition of the problem and shared commitment to solutions between media drivers and the protection and promotion of public health, confidence in immunisation programs will continue to be eroded. The responsibility for accuracy lies with both public health spokespeople as well as the media. Firstly, the importance of recognising and critiquing public health arguments in the media needs to be accepted practice. This needs to become a routine part of health professional and media training. Many of these errors in the media could be prevented by regularly reviewing and highlighting fallacious practice to both journalists and health professionals. Secondly, the current practice of utilising a diversity of views without appropriate emphasis on the validity of the views needs strong counter measures. Striving “ to disclose all essential facts and by not suppressing relevant, available facts or distorting by wrong or improper emphasis ” is already an integral component of New Zealand journalists' code of ethics, but this is on a voluntary basis only. Stronger public relations strategies that consistently and fairly continue to challenge poor quality articles are required for the implementation and enforcement of this existing code of practice. Thirdly, the health sector needs to be more prepared for challenges that arise with the introduction of new public health initiatives such as a new vaccine, recognising and redressing the expected pattern of initial supportive media frequently followed by suspicion and anti‐science rhetoric. Public health relations strategies need to be more proactive in predicting and pre‐empting the expected responses. Finally, health professionals need broader and more effective training to be prepared for the challenges of communicating in the media including the use and misuse of language and the importance of effective media engagement. The best product in the world will not sell without knowing how to communicate it to the audience. Acknowledgement This project was funded by a summer studentship from The University of Auckland. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Fact or fallacy? Immunisation arguments in the New Zealand print media

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Wiley
Copyright
© 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1753-6405.2010.00601.x
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21040183
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Abstract

Most people obtain information about health issues from the mass media. When a topic affects most of the population, rather than to a small sector, it becomes relevant to the media, and from a news perspective immediately ‘hot’. If one moves from a health topic relevant to a smaller sector such as a new treatment for a rare cancer to one with more universal appeal such as a mass childhood immunisation program then the number of people to whom the story is relevant vastly increases. If one adds personal adventure/mishap, controversy such as two sides that can pit against one another, graphic or emotive images, then immunisation can become an excellent topic for media attention. Opposition to immunisation Despite overwhelming evidence supporting the routine use of a number of vaccines, public controversies generated by anti‐immunisation proponents regularly arise, gaining media attention and this has been shown to erode vaccine uptake. Anti‐immunisation rhetoric generally contains errors of fact and/or errors of logic (fallacies). Organised opposition to immunisation has been present since legislation made smallpox vaccination compulsory in 1853. The arguments used in opposing vaccination and immunisation programs have remained constant since that time and, apart from the Internet, the avenues for presenting anti‐immunisation arguments also have remained relatively unchanged. Anti‐immunisation rhetoric and polemic arguments have been examined and the arguments themselves are well documented. However, these arguments have previously not been examined for fallacies of logic. Fallacy A fallacy is a component of an argument that is demonstrably flawed in its logic therefore rendering the line of reasoning invalid. Often this is as a result of a false premise and/or false conclusion. It is useful to identify flawed reasoning in order to enable effective and convincing refutation of errors. There are various definitions of the term fallacy and ways of classifying certain fallacies. Plato was the first philosopher to collect and document examples of flawed reasoning and Aristotle the first to name 13 different types of errors in reasoning or errors in logic. Since Plato and Aristotle, particularly following the Dark Ages, philosophers have contributed further to these works. Today there are various competing and overlapping ways to classify fallacies: The Internet Encyclopaedia of Philosophy lists the 177 most common. Broadly, fallacies can be classified as formal, where the structure or form is flawed, and informal, where the argument has valid form but the premises are false and therefore cannot support the conclusion. Place of logic in society Logic is concerned with the principles of correct reasoning, relying on valid argument rather than emotional appeal in clarifying and directing our judgements. A well‐functioning society requires its processes and decisions to be based on logical reasoning which therefore lead to good conclusions. ‘He said she said’ news formula ‘He said she said’ reporting is a way to provide balance to a news story without actually evaluating the material or statements for fact or fallacy, or indeed performing any critique. An example of this is the claim that vaccines cause autism. Virtually no mainstream scientist believes that such a link exists, only anti‐immunisation protagonists, however, balancing quotes from both sides of the argument give the assertion credibility. Aim In order to explore immunisation arguments appearing in the New Zealand (NZ) print media, a content analysis study of the major daily NZ newspapers was conducted with the aim of critically examining the construction of immunisation‐related arguments by describing and classifying errors of fact and fallacy. Method The Immunisation Advisory Centre (IMAC), at the University of Auckland maintains a database of clippings, accessed from a commercial media watch service, from a variety of print media in which words associated with vaccines and vaccine preventable diseases are mentioned. At the Centre all newspaper articles printed between January 2002 and December 2007 from the daily papers of four major NZ urban centres ( The New Zealand Herald , The Press , The Dominion Post , The Otago Daily Times ) were extracted from the database. The circulation of these papers extends nationally. Data recorded included origin and date of publication, type of article, title, author, page number and type of vaccine the article addressed. Examples of each type of error of fallacy are presented. Errors of fact All articles were assessed for errors of fact — (statements that are false) regarding any comment (whether direct or implied) on vaccine safety, efficacy and/or effectiveness. There are three types of errors of fact: completely erroneous statements that are false (not substantiated by scientific evidence), errors of omission where information is ‘cherry‐picked’ and presents only part of the truth, ignoring data that contradicts the position, and errors of commission, where information is misconstrued, exaggerated or inflated to support a claim. For the purposes of this study the terms ‘fact’ and ‘truth’ have been used to illustrate that which is supported by the vast majority of scientific literature so as to constitute the central theories within vaccinology. Fact was verified via the peer reviewed evidence‐based literature. Comments in newspaper articles supported by the majority of scientific literature were classified as substantiated and coded green. If the scientific literature refuted the comment of interest, the comment was classified as unsubstantiated and coded red. Based on the overall make‐up of its content (the number of lines coded green and red), each article was assigned a substantiation score between one and five, where the number corresponded with one of the content analysis measures (based on Boykoff's content analysis study ) below: 1 All statements substantiated. 2 Some statements unsubstantiated. 3 Equal proportions of substantiated and unsubstantiated statements. 4 Most statements unsubstantiated. 5 All statements unsubstantiated. Descriptive statistics were performed to calculate the frequencies of unsubstantiated claims for various vaccines and for the changes over time. A random selection of 10% of the articles were independently assessed and coded by two other members of the research team, and Kappa analysis was used to test their level of agreement. Errors of logic Acknowledging that it is insufficient to merely classify comments as either substantiated or unsubstantiated (to solely assess the substance behind the argument or viewpoint), all the articles were reassessed for errors in logic. These errors were in regard to all views on vaccines, not just those regarding safety, efficacy and effectiveness. An error of logic involves a fault in reasoning, which renders the argument invalid. During the past 2,500 years there have been many additions and alternatives to the early taxonomy proposed by Aristotle and there is no one standard. The authors chose to observe the early, shorter taxonomy to illustrate that modern fallacies may still be described using ancient logic. These were categorised according to the following taxonomy. See Tables 1 and 3 , which include the type of error, the quote containing the error, and comment about the error. 1 Examples of errors of fact about vaccination efficacy, effectiveness or safety in the New Zealand print media 2002—2007. Type of error Example Comment Erroneous statement “But there is evidence it [ADHD] is aggravated by substances that get into the child's body from other sources, such as antibiotics, lead in the environment, possibly vaccination, as well as food.” Auckland GP , NZ Herald 2006 There is no evidence in the scientific literature that ADHD is aggravated by vaccines. Error of omission “Eighty per cent of those given the vaccination in a New Zealand trial had a reaction to the vaccine and no placebo tests were conducted, Mr Peters told Parliament.” The Dominion Post , 20 October 2004 Almost all of these reactions were minor local injection site reactions. Placebo controlled trials were considered unethical and unnecessary as enough bridging data was available. Error of commission ““MeNZB vaccination is free and safe” Otago Daily Times , 20 June 2005 Vaccination is not always safe — serious adverse events occur on rare occasions 3 Examples of errors of logic about vaccination appearing in the New Zealand print media 2002—2007. Type of error Example Comment Post hoc ergo propter hoc (affirming the consequent) “An Oamaru pupil says the meningitis vaccine caused him to collapse and spend a night in hospital.” Reporter, Otago Daily Times , June 2005 Assumes that because the vaccine was given first it must have caused the collapse. Cum hoc ergo propter hoc (denying the antecedent) “…some reports suggest there are high levels of absenteeism as a result of that [MeNZB injections]. When vaccination coincides with the beginning of the cold and flu season you would expect to see quite high rates of absenteeism. We believe all vaccines place a strain on the immune system.” Immunisation critic, NZ Herald , 2005 Assumes that the vaccine causes other illnesses to occur at the same time its administration. Circulus in Probando (arguing in a circle) …. “You've got to give kids' immune systems a chance to grow. It's better to build immune systems so they can fight things themselves” Reporter, The Press , 2006 Assumes the answer to developing a good immune system requires experiencing vaccine preventable diseases. Dicto simplicter ad dictum secundum quid (fallacy of accident) “All three injections of the MeNZB vaccine are needed.” Ministry of Health, Otago Daily Times , 2005 Does not consider exceptions. Sometimes 2 doses of this vaccine were sufficient. Dicto secundum quid ad dictum simpliciter (reverse accident) Critics of the program say the toddler was a victim of vaccine failure, and are calling for a Royal Commission of Inquiry into “how a nation can be so totally swayed by officials and advisers into spending a quarter of a billion dollars for such a gamble that has delivered false hope to trusting New Zealanders.” Reporter, NZ Herald , 2006 Generalises from a single case (of vaccine failure) to suggesting the entire program is a failure. Vaccine failures are expected as no vaccine is 100% efficacious. Fallacy of the consequent “Some people don't like altering the children's immune systems with anything. Kids that don't get immunised are actually healthier on the whole.” GP, The Press , 2005 Concludes that unimmunised children are healthier, however this is not supported by the premise “some people don't like altering the children's immune systems with anything.” Verbal fallacies (emotive language) “These child guinea pigs for the nation [children receiving MENZB vaccine]”, Reporter, The Press , 2004 Wrongly implies that children are being experimented on False attribution “Risk analyst Ron Law, a critic of the vaccination program, said the program had been a failure.” Health reporter, NZ Herald , 2006 The term “risk analyst” implies expertise on the subject when in fact there is none giving the statement more credibility. Ignoration Elenchi (irrelevant conclusion) “Ms Claridge [Immunisation Awareness Society] says that during the 50 years leading up to the 1940s when vaccination programs began, the incidence of communicable diseases had already dropped dramatically because of better sanitation, hygiene, water supplies, housing and nutrition” Reporter, Dominion Post , 2002 Diverts attention away from the issue at hand which was the Meningococcal B vaccination program, and discusses the decline of vaccine preventable diseases. “She says that diseases such as scarlet fever have also declined hugely during the past 110 years, despite the absence of a vaccination program.” Immunisation critic, Dominion Post 2002 The decline of scarlet fever is largely due to the development of antibiotics and vaccination is irrelevant. Argumentum ad hominum (shoot the messenger) “I realised one day that there were two kinds of doctors — there is the GP who knows bugger all about a lot and the specialist who knows a lot about bugger all.” Vaccine critic, NZ Herald , 2006 Both of these criticise the messenger rather than the message — a personal attack. “And you can be sure that doctors Tukuitonga and Turner will not be taking the blame because, for all their protestations of immunisation safety, they would not know an adverse reaction if it jumped up and bit them.” NZ Herald 2002 Argumentum ad verecundiam (attribute to misleading authority) “The Society says breastfeeding for at least 6 months and a healthy diet and environment for children provide better protection [than immunisation]” The Immunisation Awareness Society, The Press , 2006 The Immunisation Awareness Society have no credentials in science nor paediatrics. Straw man argument “The medical profession says Pamol is completely safe”, Reporter, NZ Herald 2004 The medical profession do not hold the view that paracetamol is completely safe. This is misappropriating their position. Fallacious anecdotal evidence “I have seen case histories of children, and spoken to other doctors whose children decompensated [regressed] so drastically after the MMR that you can't deny that in some cases it happened.” Neurologist parent of child with autism, NZ Herald , 2006 Anecdotal evidence only. Fallacious because is assumes the Post hoc ergo propter hoc (affirming the consequent). Formal errors of logic The structure is flawed and deduction is invalid: • Non‐sequitur (claim purports to show causality) • Post hoc ergo propter hoc (affirming the consequent — assumes a causal relationship because one event follows another in time) • Cum hoc ergo propter hoc (denying the antecedent — assumes a causal relationship because one event occurs at the same time as another) • Petitio Principii (begging the question) • Circulus in Probando (arguing in a circle or assuming the answer) Informal errors of logic Have a valid form but false premises that do not support the conclusion: • Dicto simplicter ad dictum secundum quid (fallacy of accident — makes a generalisation that disregards exceptions) • Dicto secundum quid ad dictum simpliciter (reverse accident — argues from a special case to general rule) • Fallacy of the consequent (draws a conclusion, which the premise does not support) • Verbal fallacies (uses words in an inappropriate manner, for example emotive language, to make or support a claim) • False attribution (appeals to irrelevant, unqualified, biased or fabricated source) • Red herring fallacies (argument given in response to another argument, not addressing the original issue) • Ignoration Elenchi (irrelevant conclusion, diverts attention away from a fact in dispute rather than address it directly) • Argumentum ad hominum (addresses purely personal considerations — shoots the messenger) • Argumentum ad verecundiam (attributes to misleading authority) • Straw man argument (based on misrepresentation of an opponent's position) • Fallacious anecdotal evidence (uses personal accounts or experiences in an ambiguous fashion to support a claim). It should be noted that use of anecdotal evidence sometimes may be valid, when personal accounts or experiences are employed in an illustrative fashion. This second dataset includes the source of the article, the type of error, the quote containing the error, and the person or organisation to which the error was attributed. Examples of each type of error of fallacy are presented. Results Errors of fact (scientifically substantiated and unsubstantiated content) A total number of 360 articles from 2002 to 2007 (average of 60 per year) containing information pertaining to the efficacy, effectiveness or safety of vaccines were identified and analysed using the substantiation scoring system. Independent coding of the substantiation scores gave a Kappa score of 0.97 indicating a strong level of inter‐rater agreement. Overall, 21% (n=76) of the articles contained some factually unsubstantiated information about vaccine efficacy or safety. Examples of the types of factual error are presented in Table 1 . Articles reporting new vaccines were usually accurate. For example, news about the human papillomavirus vaccines was emerging and centred around their potential to protect against cervical cancer. Of 24 articles, only one contained any scientifically incorrect information, and there was no unsubstantiated information about the new conjugate Pneumococcal vaccine. Similarly, articles referring to well‐established vaccines not in routine use (such as rabies) or the now‐redundant vaccine for smallpox were all factual. On the other hand, 33% of articles about the MMR (measles, mumps and rubella) vaccine contained erroneous information. This is likely to reflect the negative press this vaccine has received in the past, including the erroneous claim in 1998 that it was associated with autism. Approximately a quarter of articles (26%) about the NZ‐specific vaccine against a specific strain of group B meningococcus contained scientifically unsubstantiated information. This vaccine was introduced in response to an epidemic starting in 1991, which had resulted in a number of deaths and severe morbidity. Prior to the development of a vaccine the media regularly reported tragic cases of the sudden deaths and disabilities of young people. In 2003 phase II trials were conducted on NZ children and 2004 saw the roll‐out of a nationwide immunisation campaign to all children from infancy to aged 20 years, which was completed in 2006. Table 2 presents the number of articles containing unsubstantiated facts on efficacy and safety for the meningococcal B vaccine by year. In Figure 1 it can be seen that the quantity of non‐scientific information about the vaccine dramatically increased through the roll‐out phase, but by 2007, when both the epidemic and the mass vaccination program were over, this again declined. 2 Number of articles containing ‘All substantiated’ through to ‘All unsubstantiated’ facts on efficacy and safety for Meningococcal B vaccine by year. Substantiation score Year 1 2 3 4 5 Total 2002 5 0 1 0 0 6 2003 5 0 0 0 0 5 2004 28 3 2 2 2 37 2005 19 7 1 0 1 28 2006 38 14 1 1 0 54 2007 6 1 0 0 0 7 101 25 5 3 3 137 1 Progression of unsubstantiated statements about Meningococcal B vaccine over time. Errors of logic Many articles contained a number of errors of logic (fallacies) as well as fact. These met most of the types of fallacy in our taxonomy, and examples are shown in Table 3 . While these errors were predominantly used by those opposed to immunisation, supporters were not exempt from using such strategies. For example, the Ministry of Health statement that the meningococcal B vaccination was ‘safe’ over‐states the case (adverse reactions do occur). The statement that “ all three injections of the MeNZB vaccine are needed ” also is not entirely correct (some vaccinees develop protection from two doses). Most of the fallacies occurred in quotes contained within the article rather than as a result of assessment by the reporter. Discussion This study reviewed errors of fact and logic in articles published in the major NZ daily newspapers concerning vaccines and immunisation over a six year period. Strengths of the study include the comprehensive dataset comprising all articles pertaining to immunisation and vaccination in all four major NZ daily papers, analysis for errors of both fact and logic, the strong level of inter‐rater agreement and the following of trends over time. A weakness is that while we developed a relatively robust taxonomy of fallacies, there is no one standard for this and some errors may be able to be categorised into more than a single category simultaneously. This study has important implications. Understanding how arguments presented in the media are constructed can both assist health professionals in addressing vaccine issues that appear in the media and allow the avoidance of the use of fallacious arguments themselves. By looking beyond the superficial we can deconstruct arguments to expose the errors — sometimes we feel something sounds wrong but are not sure why. When we know how to identify a fallacy we can counter it more effectively. In most countries, including NZ, the media wish to be seen as impartial and guidelines on impartiality and diversity of opinion as well as accuracy exist. In NZ, the Press Council exists to consider complaints, promote freedom of speech as well as maintain the press in accordance with the highest professional standards. The Press Council does not prescribe rules by which publications should conduct themselves, rather editors have that responsibility. The journalism code of ethics reflects The Press Council statement of principles of which two areas are particularly pertinent to reporting of immunisation issues: • Accuracy — publications (newspapers and magazines) should be guided at all times by accuracy, fairness and balance, and should not deliberately mislead or misinform readers by commission, or omission. • Comment and fact — publications should, as far as possible, make proper distinctions between reporting of facts and conjecture, passing of opinions and comment. Presentation of a range of views is clearly important — particularly on political topics, or in areas of health where the knowledge is incomplete and continuing to evolve. Established health issues such as national immunisation programmes however have already been scrutinised for scientific validity, and are part of national public policy and usually a priority. The ‘truth’ has already been subject to assessment by many experts and generally is not something that can be evaluated based on a media story presenting a range of quotes in pursuit of ‘balance’. Ironically, introducing a balance of personal views on a subject such as immunisation can introduce bias with public health the casualty. Media presentation of a new vaccine changes over time in terms of scientifically substantiated information. For new vaccines, prior to introduction, the coverage is less emotive and more scientifically substantiated, focusing on the potential of the vaccine to prevent disease. This may be a reflection of the general low level of interest in new vaccines by anti‐immunisation lobbyists, and the higher level of interest in the disease by the community experiencing its effects. Following the routine use of a vaccine the proportion of unsubstantiated reporting increases, including fallacious arguments. These arguments are used by both supportive and anti‐immunisation spokespeople, although more commonly by those opposed to immunisation. Most arguments proposed by anti‐immunisation lobbyists have been demonstrated to be fallacious. Apparent here is the failure of the press at times to verify both the material and the credibility of their sources. In this there may lie the conflict between the drivers and constraints journalists have and the need for health professionals and scientists to provide accurate information to the public. We found both errors of fact and logical fallacies. Both those who support and detract from immunisation use these, however anti‐immunisation proponents are more likely to include errors. It appears from the examples presented in this study that the media are frequently content with providing the diversity of opinion without investing the same effort to verify the accuracy or source, instead settling for providing quotes from a range of sources to fulfil their journalistic balance. The term ‘balance’ in this context is a media construct in contrast to scientific balance. Additionally, the errors of omission and commission are explicitly mentioned in the media principles, however, they appear frequently in media articles. Until there can be both recognition of the problem and shared commitment to solutions between media drivers and the protection and promotion of public health, confidence in immunisation programs will continue to be eroded. The responsibility for accuracy lies with both public health spokespeople as well as the media. Firstly, the importance of recognising and critiquing public health arguments in the media needs to be accepted practice. This needs to become a routine part of health professional and media training. Many of these errors in the media could be prevented by regularly reviewing and highlighting fallacious practice to both journalists and health professionals. Secondly, the current practice of utilising a diversity of views without appropriate emphasis on the validity of the views needs strong counter measures. Striving “ to disclose all essential facts and by not suppressing relevant, available facts or distorting by wrong or improper emphasis ” is already an integral component of New Zealand journalists' code of ethics, but this is on a voluntary basis only. Stronger public relations strategies that consistently and fairly continue to challenge poor quality articles are required for the implementation and enforcement of this existing code of practice. Thirdly, the health sector needs to be more prepared for challenges that arise with the introduction of new public health initiatives such as a new vaccine, recognising and redressing the expected pattern of initial supportive media frequently followed by suspicion and anti‐science rhetoric. Public health relations strategies need to be more proactive in predicting and pre‐empting the expected responses. Finally, health professionals need broader and more effective training to be prepared for the challenges of communicating in the media including the use and misuse of language and the importance of effective media engagement. The best product in the world will not sell without knowing how to communicate it to the audience. Acknowledgement This project was funded by a summer studentship from The University of Auckland.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Oct 1, 2010

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