Elevating feelings over facts is a bad way to make health policy

We are approaching a surreal moment in American discourse when feelings about an issue are often given more weight and more resources than actual knowledge about it. That was driven home to me last week when Robert F. Kennedy Jr., an attorney specializing in environmental law and a sometimes radio host, said he had been asked by Donald Trump to head a commission on vaccine safety.

In commenting on Kennedy’s announcement, Trump spokeswoman Hope Hicks never mentioned vaccine safety. Instead she said that the president-elect “is exploring the possibility of forming a commission on Autism, which affects so many families.”

The willingness for the press and the public to view Kennedy’s claim about vaccine safety and the possible creation of a commission on autism as seemingly interchangeable harks back to a long-discredited view that vaccines cause autism. Seth Mnookin (who occasionally contributes to STAT), Brian Deer, and others have done excellent jobs chronicling the history of this issue, from its rise in 1998 to its discrediting six years later.

Yet the feeling that vaccines causes autism still lingers in some people — including Trump, as shown in this tweet:

Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn't feel good and changes – AUTISM. Many such cases!

— Donald J. Trump (@realDonaldTrump) March 28, 2014

The United States has a rigorous oversight system that evaluates vaccine safety and efficacy. It’s called the Advisory Committee on Immunization Practices (ACIP). Since 1964, ACIP has been charged with examining all data about vaccines and setting national schedules for how they can best be administered. It is an evidence-based group. Last year, for example, it looked at data from individuals who had used the flu vaccine delivered by nasal spray. After determining it wasn’t effective in preventing the flu, the ACIP stopped recommending its use. Although the committee could go further in making its work visible to wider audiences, its meetings are open to the public and even streamable.

In the course of writing my book, “Calling the Shots: Why Parents Reject Vaccines,” I discovered that few parents know about the committee and the regulatory processes in place to evaluate vaccine safety and efficacy. Yet parents overwhelmingly told me they felt that vaccines aren’t administered in the safest way possible, even when they could not explain the mechanism by which vaccines work or how the current schedule is risky.

I frequently heard parents ask why an 8-pound baby and a 200-pound football player receive the same dose of vaccine. That’s a good question if you think of vaccines as medications. But they aren’t.

To control pain or fever, it takes more medication to have an effect in someone who weighs 200 pounds than in someone weighing 8. But such a dose response isn’t needed for vaccines. If a sick person sneezes on two people of different weights and body sizes, the smaller person doesn’t necessarily become exponentially sicker. The same holds true with the dose of virus needed to generate immunity — only a tiny amount is needed, regardless of the recipient’s size.

Even so, when it comes to vaccines, parents overwhelmingly say that the current schedule feels like “too much too soon,” even if science doesn’t support that view.

Trump’s proposed cabinet is peppered with appointees with little specific expertise but with strong feelings. The proposed secretary of education, Betsy DeVos, has no formal training in research and education policy, and has in fact actively undermined public education with significant donations to for-profit charter schools in her home state of Michigan. She would be the first person to head the department who hasn’t attended public schools or sent her own children to them. It was her feelings about how education should work (alongside campaign donations) that led to her appointment.

Rick Perry has been nominated to head the Department of Energy which, as a presidential candidate, he felt should be eliminated. Should he be confirmed to head this agency, which oversees nuclear weapons, he will follow former secretaries with doctorates in physics and even a Nobel Prize. Perry is on record as referring to science that shows that greenhouse gas emissions contribute to climate change as a “contrived phony mess” and referring to experts in the field as part of “the secular carbon cult.” Although Perry is not an expert on the science behind emissions, he is clearly passionate in his opposition to claims that humans contribute to global climate change, as the title of his book “Fed Up!” suggests.

The nominee for secretary of housing and urban development, neurosurgeon Ben Carson, initially declined joining Trump’s Cabinet, citing his lack of experience heading a federal agency. He eventually changed his mind, deciding that he feels qualified for HUD because he grew up in a low income family, albeit not in public housing. As Carson explained in his confirmation hearing, his personal experiences and feelings about housing and poverty qualify him to oversee the $60 billion budget and portfolio of complex programs that serve more than 4.5 million households.

The rise of feelings over fact can be seen in discussions about declines in crime, arguments about whether global climate change is real, and in discussions of how people feel about Obamacare, even as they support its provisions.

When individuals’ feelings become equal to fact, it becomes difficult to move policy forward. If we can’t agree on a common set of facts established through rigorous methods that can be verified by others, it becomes tough to have reasoned discussions and find common ground. It is challenging to argue with how someone feels, especially if their sense of an issue may not be grounded in fact or supported by science that extends knowledge beyond the individual.

This trend of elevating feelings above expertise may reflect a broader cultural expectation that individuals should take personal responsibility for their health, successes, and failures. This ideology may, in turn, elevate an individual with strong feelings about a topic to “expert” status.

Governing a country and managing a complex health care system that protects all of us will require scientific fact, knowledge, expertise, and transparency in regulation. And that requires much more than a feeling.

Jennifer A. Reich, PhD, is associate professor of sociology at the University of Colorado Denver and author of “Calling the Shots: Why Parents Reject Vaccines” (New York University Press, 2016).