The paper I'm about to present was written in 2002, and in the fast-paced world of the internet may seem out of date - after all, Youtube hadn't even been invented then, and Wikipedia and Google were shiny new businesses. But in fact, Davies et al's study of anti-vaccination websites is as relevant today as it was then - perhaps even more so [1].

"The internet has provided antivaccinationists with unprecedented opportunities for exposure. In the USA, 55% of adults with internet access use it to seek health related information. For all its benefits, the internet has great potential to
disseminate health information that is incorrect and potentially dangerous."

The scale of the internet in 2009 is of course orders of magnitude larger than it was seven years ago, reaching more of the population in a greater part of the world. Additionally, new ways of putting information across have been developed: in 2002, Youtube and the age of viral videos were still three years in the future, podcasts were a rarity, and mainstream blogging was still in its infancy. The scale of the problem is doubtless larger today, but what's remarkable is how quickly anti-vaccination activists came to dominate this scene in the early days of the web.

The researchers look at a hundred anti-vaccination websites, including the tone of their content, and also looked at search results from the leading search engines of the day (back then, you could still use the plural of 'search engine'). The table below shows the number of anti-vaccination pages in the top ten search results for 'vaccination' for each search engine:

So while AltaVista, Yahoo and Netscape produce a couple of dodgy sites each, Google's 'superior' technology failed spectacularly, with all of the top ten search results for 'vaccination' leading to anti-vaccination sites. The situation now is improved, but even today, a search on Google.co.uk brings up whale.to and naturalnews.com in the top ten results (Wikipedia, naturally, is first).

This for me raises interesting ethical questions about the role of search engines. If a parent was five times more likely to see an anti-vaccination result on Google than searching with AltaVista, what responsibility - if any - do Google (motto: "Do No Evil") have for the public health consequences of their abysmal rankings in 2002?

Moving on to the types of sites around, a distinct set of patterns emerged from their results that still sounds familiar today.

"Antivaccination groups sought to present themselves as legitimate authorities with scientific credibility: about one in four websites implied official status at national or international level."

There's an odd Cargo Cult mentality that exists in the alternative medicine and anti-science communities, in that they reject the institutions and research of modern medicine and science, yet seek to appropriate their titles, language and superficial aspects of their methodology, setting up 'clinics', calling each other 'doctor', and attempting to cite references from the literature...

"A majority of sites propounded the scientific validity of their claims by referencing from extensive literature dominated by self published works and the alternative medicine press. Allegedly damning research was often quoted, but without citation of its source. Referencing was frequently incomplete and often indiscriminate, including letters to editors of newspapers and television interviews. Research published in indexed medical journals was also quoted; however, the conclusions drawn were often inconsistent with those of the authors. Overall this produced a spectre of the existence of masses of data on the dangers of vaccination."

This of course is the same sort of behaviour we saw with the British Chiropractic Association's pitiful attempts to produce a 'plethora of evidence' for the use of chiropractic in treating childhood illnesses. But the psychology of this is complex and confusing - if you despise modern medicine, if you want to work against it, why are you so obsessed with imitating your enemy? It almost suggests a sort of authority-envy.

Over half of all sites cited rank breaking doctors speaking out against vaccination. Implied division within the medical community reinforced the notion of a debate among authorities. One third of sites promoted themselves as sources of non-partisan information on both sides of the immunisation 'debate'. Despite these claims a mere 15% contained any information supportive of vaccination. Only a third of sites had links to such sites.

This of course is the classic 'teach the controversy' approach. It follows the time-honoured Tobacco company trick that if you can't directly refute the science, you can wage a war of obfuscation that leaves the public with the impression of a scientific debate where in fact none still exists, something we've seen with tobacco harm, climate change, vaccination, and a dozen other areas.

The problem with all of the above is that it seems to result in a sort of cognitive dissonance. If you believe that the research is inconclusive, and that the 'real' picture of climate change, vaccination, smoking or whatever is not getting out to the public, then the only way to rationalize this is by inventing some sort of conspiracy. In fact, virtually all denialist beliefs seem to eventually come down to a conspiracy theory. Even when this isn't explicitly stated, it is often implied.

"Nearly all sites referred to the antivaccination struggle as a search for truth against a background of cover up and denial. Antivaccinationists portrayed themselves as crusaders excavating hidden truths. The vaccination hoax was a vehicle for the generation of limitless profit and which would produce epidemics of chronic illness, requiring billions of dollars worth of drugs and medical care. To many groups, compulsory vaccination represented the beginning of the slippery slope towards totalitarianism."

That 'nearly all' sites resorted to conspiracy theory is unsurprising then - it's a necessary leap to make since you can't believe that doctors are knowingly giving people dangerous vaccines without some element of conspiracy present. What's perhaps more interesting though is the depersonalization or dehumanization of 'the enemy'.

"Almost all sites featured the adversarial notion of 'us versus them' whereby parents and antivaccinationists stood against the depersonalised 'them' of doctors, health bodies, governments, and pharmaceutical companies. Doctors were presented as either willing conspirators cashing in on the vaccine 'fraud', or pawns manipulated by the shadowy vaccine combine; parents' love and compassion whose intuition about vaccination harms was considered a stronger force than cold, analytical science.

I couldn't have but read that and be reminded of the classic radio clash between Richard Littlejohn and Will Self, in which Self referred to Littlejohn's characterization of John Prescott as a 'chimp' with the observation:

"Well he doesn't say he's a human being, does he? He uses the classic form of demonisation which is to say he's a chimp, in other words he's bestial. So he's actually dehumanised the subject of his abuse before he even moves on to piling on the pejoratives, and I think that's very psychologically interesting, of course we're all familiar with the kind of people who demonise other human beings by turning them into bestiary..."

Which, while a bit strong, is interesting. Again, anti-vaccine propaganda requires that people believe doctors are behaving in an inhuman way, so this would seem to be the logical consequence of rationalizing that. The results of this dehumanization are deeply disturbing since, like the people Self alludes to, it allows people to resort to rabid abuse and attacks on those disagreeing with their ideological view. Paul Offit of course has been a target of concerted hate campaigns, and recently journalist Amy Wallace was subjected to extraordinary attacks, some involving vile misogynistic abuse, for an article she wrote in Wired.

This also seems to touch on people's fears of doctors and science in general, and it's unsurprising to see what follows:

"The answer to disease prevention was not the 'artificial' process of vaccination but the pursuit of natural lifestyle. Many sites asserted that infectious disease was a consequence of lifestyle, not microorganisms."

[...]

"Being unnatural, vaccinations deranged the function of the immune system. The natural immunity provided by infection was considered superior. Many sites urged parents to intentionally expose their children to infectious diseases alleging health benefits."

Yes the natural fallacy, the misguided notion that something 'natural' is healthier for you than something 'artificial.' The terrifying result of this sort of broken thinking is that parents may intentionally expose their children to infectious diseases. It begs the question, how many have fallen seriously ill or died as a result of these websites?

Overall, the picture that emerges from the 2002 survey shows that all the features of the anti-vaccine movement in 2009 were well-established several years ago, with activists rapidly seizing the opportunities presented by new technologies as they emerged.

The psychological aspects are interesting too. The anti-vaccine movement taps in to almost primal instincts and fears, dehumanizing 'unnatural' opponents before rabidly attacking them. On the other hand, we have this bizarre cargo-cult mentality whereby websites seek to present themselves as 'credible' by wrapping themselves in the language of modern science and medicine.

It would be fascinating to see this research updated for 2010. If anyone's interested in such a project, do feel free to leave a comment or get in touch.

[1] Davies, P. (2002). Antivaccination activists on the world wide web Archives of Disease in Childhood, 87 (1), 22-25 DOI: 10.1136/adc.87.1.22