Sunday, 8 September 2019

Fake News



Admittingly, I do feel envious of Jenny Nicholls’ great incipit  for her article on “Misinfodemic: When fake news costs lives” just published on January issue of North & South, “In the West, the misinformation caused terror. In Africa, it cost lives.  Jenny is right. We are so closed in our stubborn parochialism not to understand that the issue of fake news is far from being an issue only for affluent countries. On the contrary, cures such as “homeopathy, coffee, raw onions and saltwater”, only to mention those mentioned by Jenny, could cause actual disasters in low income countries, for instance when people treat Ebola through these remedies. Also, Jenny is right when she describes epidemics of misinformation as though they were true infectious outbreaks. Cultural outbreaks follow the same rules of microbiological outbreaks and they could be even more dangerous. “Memes—whether about cute animals or health-related misinformation—spread like viruses: mutating, shifting, and adapting rapidly until one idea finds an optimal form and spreads quickly. What we have yet to develop are effective ways to identify, test, and vaccinate against these misinfo-memes. One of the great challenges ahead is identifying a memetic theory of disease that takes into account how digital virality and its surprising, unexpected spread can in turn have real-world public-health effects. Until that happens, we should expect more misinfodemics that endanger outbreaks of measles, Ebola, and tooth decay, where public-health practitioners must simultaneously battle the spread of disease and the spread of misinformation.”
However, fighting misinformation memes could turn out being more difficult than one might expect. Chance would have it that the very same day when Jenny published her article, Johns Hopkins Medicine and Sheppard Pratt Health System announced the outcome of a new research, which  shows that “people in the study with schizophrenia also have higher levels of antibodies against the Epstein-Barr virus (EBV), a herpes virus that causes infectious mononucleosis, so-called mono. Researchers proposed two explanations for the association of heightened immune responses in patients with schizophrenia and EBV infection: schizophrenia might alter the immune systems of these patients and make them more susceptible to EBV, or EBV infection might increase the risk of schizophrenia”. The main investigator, Dr. Robert Yolken, a professor of pediatrics at the Johns Hopkins, is not all new with viral theories of mental diseases. In 2001, he argued that schizophrenia was caused by a retrovirus and stated  "Our ultimate hope is that we can interfere with the retrovirus by preventing it from becoming active. If we can do that, it may give doctors another method of treating schizophrenia." In 2015, Dr. Yolken discovered a virus which made people stupid, by changing the way genes are expressed in an area of the brain responsible for memory and other higher brain functions, “This is a striking example – stated Yolken - showing that the ‘innocuous’ microorganisms we carry can affect behavior and cognition”. Always in 2015,  Robert Yolken observed that cat ownership in childhood is significantly more common in families in which the child later becomes seriously mentally ill, concluding that Toxoplasma infections were critical to develop mental diseases.  Finally, in 2018, Dr. Yolken had another great insight, because he discovered that “data from more than 1,000 people with and without psychiatric problems showed those hospitalized for mania (hyperactivity, euphoria, and insomnia) were three-and-a-half times more likely to have ever eaten meats cured with nitrates as those who had no history of any mental disorder” and he concluded that  There’s growing evidence that germs in the intestines can influence the brain. This work on nitrates opens the door for future studies on how that may be happening.
Now, one could simply conclude that statistics are like guns, they should never be handled by children and morons, but the issue is more worrisome. Indeed, it is easy to make fun of anti-vax activists and homeopathic doctors, but one should make fun also of Johns Hopkins. Fake news supported by institutional medicine are still more dangerous than fake news invented by charlatans because they instil the idea that there is no difference between science and pseudo-science.
Associations are not causal explanations, they can be (and often are) explained by confounding variables. Believing that two statistically associated things are also causally linked is a well-known fallacy.  This is more evident in a discipline like psychiatry where our knowledge is still quite vague. “The researchers conducted a study among 743 people—432 with a schizophrenia diagnosis and 311 without a history of a psychiatric disorder to serve as a control group.” Let me pose two basic questions, (1) do you think that schizophrenia diagnosis is evidence-based like, e.g., diagnosis of breast cancer or heart failure, or alike? (2) do you think that the absence of a history of psychiatric disorders is enough to argue that the control group was free from sub-clinic or non-diagnosed psychiatric disorders? If you answer “no” to one or both questions, most Dr. Yolken’s findings become unsubstantiated.

VOODOO AND ANTIVAX ACTIVISTS




One of the fake news surrounding vaccines is that they cause the disease they claim to prevent. Notably, this misconception concerns measles, which is alleged  to occur chiefly in vaccinated children. This fake news has a magic structure based on the conception of “homoeopathic magic”, say, the principle that one can affect a person through similarity. The principle of homoeopathic magic explains how it would be possible to affect someone else by performing some actions on an image of him (e.g., a drawing, a little doll, a figurine, etc.), on something which is part of (e.g., blood, skin, hair, etc.), or belongs to, him (e.g., garments, rings, ornaments, etc.). Voodoo-dolls are infamous examples of homoeopathic magic. The following article mixes spurious data on measles vaccination rate and disease incidence with the testimony of a Mr Nobody, presented as an expert “Dr Brian Hooker, a long time biochemical engineer who has been researching this topic and publishing multiple peer-reviewed papers on it for decades”; its main argumentative strength is to make appeal to homoeopathic magic to explain how measles vaccine can cause measles. Voodoo is the scientific horizon of antivax activists because they aim to evoke primordial fears in people. For this very reason, it is not enough to use scientific arguments against fake news on vaccines. Let’s not let antivax activists the power to shape the collective imaginary on vaccines.

MISSED OPPORTUNITY



Eurobarometer has published  the final report of a survey on Europeans’ attitudes towards vaccination. The survey commissioned by the European Commission, Directorate General for Health and Food Safety (DG SANTE) involved 27,524 respondents from the 28 EU Member States and was carried out between the 15th and 29th of March 2019. The report as well as annexes can be find at http://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/survey/getsurveydetail/instruments/special/surveyky/2223.   The main findings of the survey have been reported by the press and it is not worth reporting them again. In a nutshell, the conclusion of this exercise is that most European citizens (85%) think that vaccines are effective but almost half of them (48%) believe that they can have serious side effects as well. Other findings are more obvious and add very little to what we already know about vaccine hesitancy. Said so, this study deserves two comments and one consideration. The first comment concerns vaccine effectiveness. Most people think that vaccine are effective. Anti-vaccine activists challenge vaccine effectiveness but they are a small minority. When people hesitate to vaccinate, it is not because they think vaccine are ineffective but because they think that infectious diseases are not so  dangerous in comparison to vaccine potential side effects. The second comment concerns the gap between what people think of vaccine and what they actually do. They say that vaccines are beneficial, but they neglect vaccination. Why? Because  they don’t think that  infectious diseases are an issue for them. Enlightening too much vaccine merits in defeating  infections can have the collateral effect to over reassure people and, paradoxically, it could jeopardize vaccination campaigns. The final consideration is about the survey itself.  Questions suffer for being decontextualized, they have been posed in March 2019, but could have been posed one, two, or ten years ago. There is no link with the present, no reference to current problems and debate on vaccine  and vaccination. This  survey missed the opportunity to provide a real time picture and this is a damage.  

Pork Politics


Japan is facing an emerging outbreak of swine fever. It does not  seem to be a breaking news. Also, Japanese Chief Cabinet Secretary  Yoshihide Suga’s declaration is somehow obvious “In order to prevent  the disease from spreading further, the government will do its utmost by having the agriculture ministry and relevant local authorities cooperate for speedy and thorough implementation of quarantine measures”. What do you expect a Chief Cabinet Secretary  could state? Everything’s ok, isn’t it? Almost … Japanese farmers are calling for vaccination of livestock, but Japan's agriculture ministry has announced that “for the time being, they will contain the outbreak through early detection, culling harmed animals and disinfection”.  Yasuhiro Ozato, a senior vice farm minister, said, "We will seek to resolve this by sticking to hygiene control standards”. In fact, vaccinating pigs would prevent Japan from regaining its World Organization for Animal Health status as a CSF free country, preventing Japan's plan to develop pork exports.
To be sure, pigs are pigs and humans are humans,  yet it is not at all a reassuring news.

CONSPIRACY, PARANOIA AND IRONY


On April 2, 2019, Palgrave Communications  published a very interesting paper on conspiracy theories and infectious diseases. Authors investigated the Zika case, although they were not specifically interested in Zika, rather they aimed to explore the overall relation between epidemics and conspiracy theories. Ironically enough, scholars have often explained such an association by recurring  themselves to a conspiracy theory, say, by putting the blame on  misinformation, as misinformation were the main cause of conspiracy theories. In COMPARE Risk Communication, we have contested several times this approach,  that we judged  theoretically superficial and operationally misleading. Misinformation only provides the opportunity for the emerging of deeper forces, driven by the crisis of legitimacy which is affecting scientific expertise, notably in the medical and public health fields. Now, Klofstad and coll. from the University of Miami devoted a large observational study to the issue, and they came to the same conclusion that we have reached: conspiracy thinking is the best predictor whether individuals believe in conspiracy theories.  In other words, the more a person believes in conspiracy theories in various life areas, the more he believes also in conspiracy theories related to epidemics and infectious diseases. These findings have important practical implications, at least two of them are worth mentioning, (1) “researchers interested in stymying the spread of disease related conspiracy theories will need to focus on those with high levels of conspiracy thinking”; and (2) “conspiracy thinking drives people to be rightfully concerned about the virus, but [makes] them less likely to combat Zika’s spread. (…) public health efforts depend on diminishing the effect of these conspiracy theories”. To be sure, the argument that paranoid theories originate from paranoid thinking is a truism. The weakest point of the paper is indeed when  authors want to point out strategies to address conspiracy thinking because they end up suggesting scientific education, which is a bit too vague response, which does not specifically address the driver that they identified.
In fact, one of the  main strategies to contrast conspiracy thinking is irony. We are used to take very seriously conspiracy theories, and we reflect very little on how funny they instead are. The inextricable mix between irony and conspiracy theories, notably in the online world, is well illustrated by the Poe’s law, “after a poster named Nathan Poe who was baffled by creationists and those parodizing them. Poe’s Law is how jokes and memes jump the fence to become full-blown conspiracy theories on today’s internet”. Yet, if jokes may be confused with theories, this means that conspiracy theories are in fact acknowledged jokes.  One should drive paranoid thinkers to discover funny aspects of their theories. To be sure, this is a very difficult and delicate game, but it is fundamental, because it is the only practical method to loosen paranoid defences; if a paranoid comes to discover self-irony, it means that he is calling his thoughts  into question.  This exercise demands a parallel, still more difficult, exercise: if scientists want to teach self-irony, they must first apply it to themselves.