Flu Shot Resistance – A Symptom of Death Denial?February 14, 2013
Cornell psychologist Thomas Gilovich has made a career out of studying the cognitive processes that sustain dubious beliefs. There is something about flu season that makes me wish I could combine his work with that of Becker and enlist their aid in a cultural intervention. It seems there is a robust resistance to influenza vaccination despite the potential risks of the flu – a subject rife with extensions into Gilovich’s work. If the flu is so dangerous, what dubious beliefs inspire resistance to vaccination? And a glance at Beckerian thought might raise the question of why the fear of death wouldn’t drive more people to get vaccinated. But a deeper understanding of what death denial actually entails helps inform us why many resist the shot.
We’ve had rather mild flu seasons the last year or so (http://news.yahoo.com/why-years-flu-season-bad-173457272.html), but as statistics readily predict, occasionally influenza strains are more potent and many cases of serious flu infection can occur. The cost in dollars – and lives – can be quite serious. So why do some resist influenza vaccination?
Certainly the media, with its drive to fill air time and sell stories that attract attention, is part of the problem. Flu hype sends millions scrambling for a vaccination each year – but the media is known for its hyperbole, slanted use of facts, and even fear-mongering. It’s no wonder, then, that many cautious, critical individuals would see reports of this year’s raging epidemic and dismiss the need for a flu shot. But as Gilovich is insistent in pointing out, we tend to be most critical of that information which does not agree with the beliefs we already possess. As he puts it: “when the initial evidence supports our preferences, we are generally satisfied and terminate our search; when the initial evidence is hostile … we often dig deeper.” (82) In other words, those who suspect media hype and doubt the need for a flu shot may already believe that a flu shot is unnecessary, and be looking for reasons to support this belief.
Is a distrust of the media, with their tendency to overstate or distort facts, sufficient to explain dismissal of flu season severity? Becker might disagree. Cognitive biases are in one respect no different than elbows and thumbs: they’ve evolved to serve a purpose, and where Gilovich leaves off, Becker nicely steps in. Gilovich is a laboratory psychologist, a statistician; he resists the temptation to speculate too grandly on why the human brain comes hard-wired to accept information that supports existing beliefs while remaining doubtful of information that does not. Becker’s focus on death anxiety provides a compelling furtherance of this line of questioning.
Disease and death are deeply connected concepts. Disease is a limiting of life and brings the carefully repressed reality of our mortality painfully to the foreground of our thoughts. It’s no surprise, then, to discover a deep desire to believe that the flu shot is essentially needless. The CDC, in addressing the most prevalent myths that prevent influenza vaccination, have to deal with the ‘argument’ that influenza is only serious for those who are very young, elderly, pregnant or otherwise already ill. Your average healthy person can deal with influenza using natural means – namely, the immune system (http://www.cnn.com/2013/01/11/health/flu-shot-questions/index.html).
The challenge with this argument is that it isn’t untrue; in fact, the majority of people who come down with influenza nowadays – certainly in the more affluent Western world — survive relatively unscathed. But the problem with the argument is that it isn’t actually an argument against vaccination at all. Just because you can survive the flu does not mean you shouldn’t avoid it, if not only for yourself than for the basic public health service of not acting as a transmitter of the virus to someone who is more at risk of hospitalization or even death due to influenza. So the question persists: if vaccination serves yourself and the community, why resist it?
There are other studies being conducted on what is termed ‘naturalness bias’ (like this one at Rutgers: http://mdm.sagepub.com/content/28/4/532.short). The result of the study is essentially that some people make bad decisions because of a cognitive bias towards means that feel more ‘natural’ – in other words, if you tell them a kind of tea is a great counteractive agent to influenza, they will drink it, but if you suggest that they get vaccinated, they will find all kinds of reasons to dispute you. Tea is from nature; vaccines are a mysterious, dubious concoction brought to you by the same science that supported cocaine as medicine and DDT as pesticide.
So all kinds of reasons exist to doubt the flu vaccine. What’s in the flu shot, anyway? Many believe that the flu shot can actually get you sick, which is itself a medical misunderstanding involving a combination of known statistical nemeses. For starters, a large number of influenza strains and influenza-like viruses exist, and the vaccine can only protect you against so many. Some argue that this makes the vaccine worthless, when in fact it means that the vaccine is only as good as the severity of the strains it actually protects against. Those concocting the vaccine work hard to ensure it protects against the most severe strains predicted to be active in any given season. Nevertheless, the likelihood that some who are vaccinated become sick soon after is statistically guaranteed given a large enough sample, either because the vaccination didn’t come in time or because those unlucky few caught something the vaccination could not defend against. To these few (a minority, particularly if you establish a clear window of time after vaccination where sickness constitutes a possible response to vaccination), it is not surprising that they feel cheated and suspect that they’ve been had — not only by flu hype, but by flu shot hype.
The other factor in play has to do with anecdotal evidence and word of mouth narrative; it’s a simple tale of how everyone knows someone (who knows someone?) who has ‘gotten sick from a flu shot.’ The CDC is very candid about why this can seem to happen to any who cares to actually read up on it: (http://www.cdc.gov/flu/about/qa/misconceptions.htm).
In the light of these cognitive factors that influence these behaviors (influenza vaccination denial and the anti-hype hype), is there a motivational determinant that can be identified? Becker’s theories outline what Gilovich’s work suggests: something at work deeper than cognitive tics, deeper than the prevalence of poor science in pop culture. Isn’t it safer for the psyche to believe that disease is less of a threat? That the body has what it needs to defend itself against death? Don’t flu severity denial – and the cognitive factors that help sustain it – work in the service of protecting the embodied self against the reality of its own fragility?
Gilovich, Thomas. How We Know What Isn’t So: The Fallibility of Human Reason in Everyday Life. New York: Free Press, 1991.