When Understanding Becomes Misunderstanding
Editor’s Note: This is the first in an occasional series in which we will address the many instances in which our attempt to create understanding of a science or health topic results in misunderstanding.
One of our key missions at Critica is to increase the public’s acceptance of scientific consensus. That means we believe it is always best when people understand the scientific basis for those consensus views. It is a scientific consensus, for example, that available vaccinations prevent serious diseases and have a favorable risk to benefit profile. We would prefer that people not only embrace that statement but understand at least the fundamentals that support it.
Sometimes, however, misunderstanding is a result of our attempts to create understanding.. We will explore four examples of this and then suggest ways to remedy the risk that understanding will become misunderstanding.
An Army of Antibodies
Let’s start with the example given above, that vaccines are a safe and effective way to prevent the diseases they are specifically made to target. It seems a good idea that people understand something about how vaccines actually work so that they do not seem so mysterious. After all, it is not obvious how getting a shot today can prevent us from getting a disease later on. So, we try to explain that our immune system works partially by learning how to fight off foreign invaders to which it is exposed. It does this, again in part, by creating a memory system once it has seen a segment of a bacteria or virus. Then, if ever presented with the whole live virus or bacteria again it is ready to produce antibodies that neutralize the pathogens and prevent illness. Vaccines, then, are harmless versions of real viruses and bacteria that train the immune system to remember and produce those antibodies later on if a real infection occurs. Thus, vaccines don’t cure disease, they prevent it. Of course, what happens when we get a vaccine is a lot more complicated than this explanation, but it seems at first glance sufficient to give people some understanding of the basic mechanisms behind vaccination.
Many people have accepted the idea that vaccines somehow train the immune system to produce antibodies and that antibodies are supposed to attack foreign invaders. Although that is true, it creates the image of armies of tiny soldiers circulating in the bloodstream ready to fight against intruders. We all know that armies make mistakes and sometimes attack the wrong target, so couldn’t that happen with antibodies as well? In fact, there are well known human diseases in which antibodies mistake cells of the body for intruders and attack, causing things like lupus, Crohn’s disease, and rheumatoid arthritis. So, could it be possible that all those antibodies raised by a vaccine could similarly go awry and attack a person’s own tissues and organs?
The true answer to that question is that such an occurrence is extremely rare with vaccines. Nevertheless, it is not hard to see how someone could examine the protein structure of the part of the virus that causes COVID-19 that vaccines target and then examine the protein structure of different tissues in the body. Doing so led someone to think that the structures—technically known as the amino acid sequences—of the spike protein on the coronavirus and on a protein found on human placentas had some similarity. From that, it was wrongly assumed that the same antibodies that are created by vaccines to attack the viral spike protein might also attack the placentas of pregnant women, therefore making pregnancies impossible to develop and causing infertility.
It turns out that the amino acid sequences of the spike protein and the placental protein are really not similar enough for antibodies to make that mistake and that COVID-19 vaccines do not actually cause infertility. The myth of female infertility grew out of a partial understanding of how vaccines work. Understanding that vaccines stimulate antibodies that recognize protein sequences became the misunderstanding that the COVID-19 vaccine could create antibodies that attack a protein on the human placenta. That myth spread widely on the internet and has been very difficult to dislodge.
Beware the Word “Genetic”
A second example of understanding turning to misunderstanding involves the concept of DNA damage. It was only in 1953 that scientists first proposed the structure of the genetic molecule, DNA, but today most people know about the double helix in which two strands of DNA twist around each other. People also know that our genes are on these strands of DNA and that these genes code for proteins that do the body’s work. We have also been successful in explaining that mutations in those genes can cause a variety of abnormalities and diseases, like sickle cell anemia, Tay-Sachs disease, and cystic fibrosis.
People also understand that damage to our DNA can cause disease and that this is the way known carcinogens like tobacco, asbestos, and ultraviolet (UV) radiation from the sun can cause cancer. Unfortunately, this has made the public nervous about anything that has the word “genetic” in it. When people heard that some COVID-19 vaccines are composed of a piece of genetic material from the coronavirus called messenger RNA (mRNA) there arose in some circles the myth that this could alter a vaccine recipient’s DNA and cause disease. Similarly, the fact that foods grown from seeds that have been genetically altered are commonly referred to as genetically modified organisms (GMOs) again makes people think that eating them can somehow damage their own DNA.
mRNA-based vaccines and GMOs don’t actually alter people’s DNA the way too much sunlight or smoking cigarettes do, but that word “genetic” lingers in the mind. We understand the basics of how genes work and that mutations in them, either inherited or caused by carcinogens, can cause a variety of abnormalities, so it is not hard to see how we might broaden that understanding to the misunderstanding that anything “genetic” must be harmful.
The Flu Shot Actually Works
Our third example concerns the annual influenza vaccine that everyone (with just a very few exceptions) should have. Every year the CDC urges that everyone over 6 months old get a flu shot. We are also told every year that the flu shot is, depending on the year, anywhere from 10% to 60% effective. That means it is possible to still get the flu even if you’ve had the flu shot.
Understanding that the flu shot needs to be given every year and that it isn’t 100% effective has led people to the misunderstanding that the flu shot doesn’t work. Although this is a well-known problem, we were somewhat surprised to see the extent of this misunderstanding during a series of online focus groups Critica held earlier this year. A lot of people don’t get the flu shot because they believe it doesn’t work.
It would be hard to argue with that sentiment if it were true—it makes sense to shun an injection of something that doesn’t work. Except that the flu shot does work. In a year when the flu vaccine is, let us say, 50% effective your chance of getting the flu if you get the vaccine is half that if you don’t. Those are actually pretty good odds—in that year getting the flu shot means I have only half the chance of getting an illness that can be quite severe and even require hospitalization. Furthermore, even if I get infected with the virus that causes the flu, if I’ve had the vaccine it is very likely that my illness will be less severe and I won’t develop serious complications like pneumonia or need to be hospitalized. Understanding the limitations of the flu vaccine has led to the misunderstanding that it doesn’t work.
We Don’t Need Vitamin and Mineral Supplements
A final example involves what we know about vitamins and minerals. We are taught from an early age that we need vitamin D for bone health, for example, and that the best way to get that is to go outside and absorb some (but not too much) sunlight. The need for vitamin C merits drinking some form of citrus juice from time to time, being careful to remember that some drinks with vitamin C in them contain more sugar and calories than is good for us. There is a long list of vitamins and minerals that science has taught us we need to ingest in order to stay healthy.
It turns out, of course, that healthy people can acquire all those vitamins and minerals from an ordinary diet and that vitamin and mineral deficiencies are very uncommon in high-income countries like the United States. That has not stopped a huge and extremely lucrative industry from convincing millions of people that they need vitamin and mineral supplements. Americans spend billions of dollars every year on mostly unnecessary vitamins, minerals, and other health supplements. We’ve apparently done a great job at helping the public understand that vitamins and minerals are necessary but a very poor job at counteracting the misunderstanding that in order to get enough of them we have to buy supplements.
Does this represent the situation Alexander Pope envisioned when he wrote “A little learning is a dangerous thing?” We would answer that question with an emphatic “no” because it assumes (as Pope did) that we should not try to help people understand science if we cannot teach them every complicated detail.
We do, however, have to anticipate the ways in which helping people’s understanding of a health or science topic can lead to misunderstandings that become dangerous to the public’s health. It doesn’t seem all that difficult to have anticipated the following:
· Giving people the image of antibodies as attacking armies might lead to the misunderstanding that vaccine-induced armies could make mistakes and attack our own organs
· Introducing a vaccine with genetic material in them could cause some people to worry about damage to their own genes
· Telling everyone that the flu vaccine is not 100% effective might lead to people thinking it doesn’t work at all
· Teaching us that we need vitamins and minerals could be misunderstood to mean that we need to take vitamin and mineral supplements.
Because we did not predict that these misunderstandings could occur, we are now left with the much more difficult task of counteracting them. Studies show that even a single brief exposure to misinformation can lead to its storage in long-term memory, making it difficult to dislodge. We are not talking here about organized efforts to mislead the public as is the case, for example, with a large segment of the anti-vaccination movement. Rather, our concern is focused on understandable ways in which the information we provide can engender misunderstandings. Every time we venture to teach people about a science or health topic it is incumbent that we ask ourselves “how might this information get twisted around to cause a misunderstanding?” It is time to do better at anticipating how our efforts to help people understand science may also engender misunderstandings.