The Irrelevant Objection Fallacy – I’m Insulted!

21 Jun

In some cases, the irrelevant objection fallacy can also bee seen as the, “shoot the messenger” fallacy, or in this case, maybe even, “shoot the straw messenger”.

Over at Age Of Autism, Ginger Taylor writes:

The American Academy of Pediatrics now recommends that pediatricians tell parents who don’t vaccinate their children that they:

Are “Selfish”
Are “Self-Centered”
Are “Complacent or Lazy”
Are often “Emotional” decision makers
Have “Unacceptable attitudes”

But they do not believe that insulting you like this is in any way coercing you to vaccinate your child.

Does the American Academy of Pediatrics really recommend that? Ginger’s assertion is based on is a sample letter from a private pediatric practice (All Star Pediatrics). The sample letter does in fact clearly communicate this practice’s position and opinions about the importance of vaccination and probably does serve a healthy portion of a ‘not-so-pretty look in the mirror’ at attitudes surrounding vaccination refusal. Yes, this sample letter is available on the AAP website, but, is it really a “recommendation” from the AAP?

This sample document was created by All Star Pediatrics. It is provided only as a reference for practices developing their own materials and may be adapted to local needs. This document does not represent official American Academy of Pediatrics (AAP) policy or guidelines and the AAP is not responsible for its use. You should consult an attorney who is knowledgeable about the laws of the jurisdiction in which you practice before creating or using any legal documents.

If the sample letter from All Star Pediatrics is not official policy or guidelines, what is?

This maybe? (from the AAP Policy website).

What is the pediatrician to do when faced with a parent who refuses immunization for his or her child? First and most important, the pediatrician should listen carefully and respectfully to the parent’s concerns, recognizing that some parents may not use the same decision criteria as the physician and may weigh evidence very differently than the physician does.21 Vaccines are very safe, but they are not risk free; nor are they 100% effective.22 This poses a dilemma for many parents and should not be minimized. The pediatrician should share honestly what is and is not known about the risks and benefits of the vaccine in question, attempt to understand the parent’s concerns about immunization, and attempt to correct any misperceptions and misinformation.23–25 Pediatricians should also assist parents in understanding that the risks of any vaccine should not be considered in isolation but in comparison to the risks of remaining unimmunized. For example, although the risk of encephalopathy related to the measles vaccine is 1 in 1 million, the risk of encephalopathy from measles illness is 1000 times greater.22 Parents can also be referred to one of several reputable and data-based Web sites for additional information on specific immunizations and the diseases they prevent (see pages 52 and 53 of the Red Book25 for a list of Internet resources related to immunization).

Many parents have concerns related to 1 or 2 specific vaccines. A useful strategy in working with families who refuse immunization is to discuss each vaccine separately. The benefits and risks of vaccines differ, and a parent who is reluctant to accept the administration of 1 vaccine may be willing to allow others.

Parents also may have concerns about administering multiple vaccines to a child in a single visit. In some cases, taking steps to reduce the pain of injection, such as those suggested in the Red Book,26 may be sufficient. In other cases, a parent may be willing to permit a schedule of immunization that does not require multiple injections at a single visit.

Physicians should also explore the possibility that cost is a reason for refusing immunization. For a parent whose child does not have adequate preventive care insurance coverage, even the administrative costs and copayments associated with immunization can pose substantial barriers. In such cases, the physician should work with the family to help them obtain appropriate immunizations for the child.

For all cases in which parents refuse vaccine administration, pediatricians should take advantage of their ongoing relationship with the family and revisit the immunization discussion on each subsequent visit. As respect, communication, and information build over time in a professional relationship, parents may be willing to reconsider previous vaccine refusals.

Continued refusal after adequate discussion should be respected unless the child is put at significant risk of serious harm (as, for example, might be the case during an epidemic). Only then should state agencies be involved to override parental discretion on the basis of medical neglect. Physician concerns about liability should be addressed by good documentation of the discussion of the benefits of immunization and the risks associated with remaining unimmunized. Physicians also may wish to consider having the parents sign a refusal waiver (a sample refusal-to-immunize waiver can be found at http://www.cispimmunize.org/pro/pdf/RefusaltoVaccinate_2pageform.pdf). In general, pediatricians should avoid discharging patients from their practices solely because a parent refuses to immunize his or her child. However, when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists, the pediatrician may encourage the family to find another physician or practice. Although pediatricians have the option of terminating the physician-patient relationship, they cannot do so without giving sufficient advance notice to the patient or custodial parent or legal guardian to permit another health care professional to be secured.27 Such decisions should be unusual and generally made only after attempts have been made to work with the family. Families with doubts about immunization should still have access to good medical care, and maintaining the relationship in the face of disagreement conveys respect and at the same time allows the child access to medical care. Furthermore, a continuing relationship allows additional opportunity to discuss the issue of immunization over time.

I read the sample letter from All Star Pediatrics, and in my opinion, it follows the Clinical Practice paper on the AAP Policy website pretty closely. I encourage everyone to read it in its entirety before commenting.

Let’s take a look at what the sample letter from that pediatric practice states, that apparently “insulted” Ginger:

Re: “Selfish,” “Self-Centered,” and “Unacceptable”

Furthermore, by not vaccinating your child you are taking selfish advantage of thousands of others who do vaccinate their children, which decreases the likelihood that your child will contract one of these diseases. We feel such an attitude to be self-centered and unacceptable.

Ouch. Unguided by sound science or logic and reason, parents who refuse to vaccinate probably rely heavily on beliefs and things like communal reinforcement to internally justify their decisions. Having one’s beliefs challenged in an ethical context (social responsibility), but based on science (herd immunity) could be quite uncomfortable for some. Is it easier for someone to acknowledge a potential lack of social responsibility, or is it perhaps easier to cry, “I’m offended!”?

Re: “Complacent” and “Lazy”

The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, bacterial meningitis or even chickenpox, or known a friend or family member whose child died of one of these diseases. Such success can make us complacent or even lazy about vaccinating. But such an attitude, if it becomes widespread, can only lead to tragic results.

Hmmm. This looks more like a reasonable concern, and it’s expressed as a possibility.

Re: “Emotional”

We recognize that the choice may be a very emotional one for some parents.

Not too inflammatory in my opinion, but perhaps that’s just me.

At any rate, here’s the bottom line – this sample letter from All Star Pediatrics (which is not in and of itself an AAP policy or guideline), clearly communicates the position and professional opinions of All Star Pediatrics. In my opinion, this practice’s outlined policies seem mostly in-line with the Clinical Practice paper on the AAP Policy website. How it oulines those policies is direct, and very possibly quite uncomfortable for those who would refuse vaccinations. Objecting to that direct and potentially ‘uncomfortable for some’ tone, is irrelevant to the importance of preventing childhood disease.

What does any of this have to do with autism? Well, nothing really, but don’t shoot the messenger.

4 Responses to “The Irrelevant Objection Fallacy – I’m Insulted!”

  1. Ms. Clark June 21, 2008 at 08:10 #

    I think parents who don’t vaccinate their kids for other than advice from a competent doctor, for instance, just because someone says there’s a chick embryo and green monkey kidney hiding in every shot, or whatever they say this week, are:
    “Selfish”
    “Self-Centered” “Complacent or Lazy”
    often “Emotional” decision makers
    and
    Have “Unacceptable attitudes”
    But besides that, I think they are stupid, or maybe “too scary ignorant to have the health of their children in their hands.”

    http://pathmicro.med.sc.edu/mhunt/mump-meas.htm

    Saying that antivaxers are dangerous to public health is putting it mildly.

  2. Do'C June 21, 2008 at 08:53 #

    FYI, there are a few missing blockquotes typos that will be corrected as soon as possible.

    “Saying that antivaxers are dangerous to public health is putting it mildly.”

    Maybe. It does remind me of the recent measles outbreak in San Diego earlier this year, where infants who were too young to be vaccinated apparently contracted measles by being seen in the same doctor’s office as an infected unvaccinated child.

    http://www.autismstreet.org/weblog/?p=180

    I think All Star Pediatrics is acting responsibly. After all, why on earth should a group of physicians knowingly allow potential exposure to vaccine-preventable infectious disease in their offices?

  3. Kev June 21, 2008 at 10:01 #

    _”FYI, there are a few missing blockquotes typos that will be corrected as soon as possible.”_

    Sorry mate, its early – I haven’t had my coffee (in my big ‘I Just Love Pharma’ mug) yet 😉

Trackbacks/Pingbacks

  1. Autism Blog - Dear Mercury and MMR Militia | Left Brain/Right Brain - June 21, 2008

    […] some of us might know/guess/whatever the intentions of the science and medical community. Third was Ginger Taylor’s recent sulk about the AAP. I’ll touch on these things as I go through […]

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