Thursday 6 December 2018

The Hook: when anecdote trumps data

We've been living on a farrrrm up a rough dirt-track in deepest rural Ireland for more than 20 years. We met our neighbour below before we even bought the place and he seemed helpful and accommodating. He was also within a year of my age and as interested in the outside world as I was in the local microcosm in which we were wedged. For a couple of years we often found time to lean on a gate and chat about home-and-away. Then we fell out; there was a dispute about the land, boundaries, and grazing and he abruptly ceased speaking to us at all - wouldn't even acknowledge us as we passed on the road. It was a bit awkward at times, but he was much more anxious to stoke the feud than me and we all moved on while occupying the same ground. Then, partly through carelessness and possibly by design he caused a huge heap of farm-yard manure [shite to city-folk try the revenge of the angered farrrrmer] to fall across the bottom of the lane, so it got difficult to get traction going up, or even down. It was really annoying and I used to fantasise about filling a trailer by hand and dumping it by night outside his kitchen door. Weeks passed. Then I was talking to another [neutral, obviously] neighbour and I mentioned being worried that Dau.I would have a nocturnal asthmatic crisis like her brother and we'd be unable to get her to hospital. Within 24 hours the problem heap was all tidied away. Within a week, I heard back that, in this locality, feuds were for adults only and not carried on down the generations. Which was as near as I ever got to an apology. I reckon it was the image of a small sick <coff> <coff> child dying because from a surfeit of spitefulness that was too much to bear.

That was last century, this is last month: Dear parents of children who do not have cancer: a casual measles exposure in a grocery store caused the following things to happen when my child was in chemotherapy: a horse-shoe [*] story by Nicole O'Donnell widely disseminated on Twitter in November. We are given to believe that measles is so rare nowadays in America, and the surveillance of US citizens is so comprehensive that the movements of each child with measles can be tracked back for the entire period when the kid was contagious but not symptomatic. That Big Data can be cross-reference with all the immunocompromised people for whom a touch of measles might be fatally devastating. That would be a) all the adults with HIV-AIDS who are on anti-retroviral therapy to stay upright and walking in the community or b) people under-going chemotherapy or radiotherapy because of cancer.
[*]  a story with cascading consequences . . . for want of a nail, the shoe was lost; for want of a shoe, the horse was lost; for want of a horse, the king was lost; for want of a king, the land was lost; all for want of a nail.

Encourage any anti-vaxxers to read the fall-out of that contact between two children: one unvaccinated and coughing measles virus about her as a miasma and another innocent who must avoid viruses of all sorts until her cancer is in remission. It's not just about the hazards gambled upon by the parents of the unvaccinated child; it's not even just that one cancer-girl; it's all the kids who funnel through the Oncology clinic that week. That story, not really data-driven, a mere anecdote, is going to be a much more powerful vehicle for change than all the epidemiological data in the world. Data is just numbers, often big numbers, which few of us are equipped to process. Indeed, I suspect that as many anti-vaxxers are embedded in their certainties as immunologists are wedded to theirs. If we attempt to snow them with numbers, they may just set their teeth fold their arms, call conspiracy or sell-out to big Pharma and settle back to their prior beliefs. A small child with cancer is an image. If epidemiologists and virologists want to win hearts-and-minds, they may ironically have to dump the science and appeal to the emotions.

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