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  • Vaccine 30 (2012) 3778 3789

    Contents lists available at SciVerse ScienceDirect


    j ourna l ho me pag e: www.elsev ier .com

    Anti-va odtactics ina

    Anna KatMcMaster Univ tario, C

    a r t i c l

    Article history:Received 26 MReceived in re25 SeptemberAccepted 30 NAvailable onlin

    Keywords:Anti-vaccinatiHealth commuInternetPostmodernismVaccinesWeb 2.0

    evaleitousm doas creidencn imher puals nvincainstoringaccine

    and more. Recognizing disingenuous claims made by the anti-vaccination movement is essential in orderto critically evaluate the information and misinformation encountered online.

    2011 Elsevier Ltd. All rights reserved.

    1. Introdu

    Vaccinattributing tovaccine-presites, one mare actuallymerely somment, an amshares one ularity and transmissio

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    ions are a signicant public health achievement, con- dramatic declines in morbidity and mortality fromventable diseases [1]. However, by reading certain web-ight be persuaded to think the opposite that vaccines

    ineffective, useless, or even dangerous. These aree of the arguments posed by the anti-vaccination move-orphous group holding diverse views that nevertheless

    core commonality: an opposition to vaccines. The pop-pervasiveness of the Internet today has facilitated then of such beliefs.eople search online for health information, and the

    found impacts patient decision-making; it is therefore understand what is shared online. This paper pro-rview of how the new generation of the Internet (Web

    emphasis on user-generated content has combinedteristics of the current postmodern medical paradigm,ew environment for sharing health information. The

    ation movement has taken advantage of this milieuate its messages. Strategies the movement employs,

    5 387 3141.resses:,

    found on various anti-vaccine websites, are then described; thisincludes various tactics the movement engages in (e.g. misrep-resenting science, shifting hypotheses, censorship, attacking theircritics), as well as commonly argued tropes (e.g. that they are pro-safe vaccines, that vaccine advocates are shills, that vaccinesare unnatural, etc.). Such narratives may be compelling, and helpanti-vaccination protests persist despite a lack of scientic sup-port. Identifying and analyzing these tactics and tropes is not onlyan important exercise in critically evaluating medical advice foundonline, but also a necessary step in ensuring individuals searchingonline are not misinformed.

    2. Web 2.0, health communication, and the postmodernmedical paradigm

    Though the exact denition of the term Web 2.0 is debated, itsmeaning is generally derived from comparison against the rst gen-eration of the Internet Web 1.0 [2]. The main difference betweenthe two is the amount of interaction and user-generated content;whereas Web 1.0 content was controlled by the provider, Web 2.0allows users to create information. Anybody can contribute con-tent via blogging, photo-sharing, video-uploading, and more. Thecreation and sharing of user-generated content is supported byapplications known as social media (e.g. YouTube, Blogger, Face-book, Twitter, etc.).

    see front matter 2011 Elsevier Ltd. All rights reserved.vaccine.2011.11.112ccine activists, Web 2.0, and the postmand tropes used online by the anti-vacc


    ersity, Psychiatry and Behavioural Neurosciences, 555 Sanatorium Road Hamilton, On

    e i n f o

    ay 2011vised form

    2011ovember 2011e 13 December 2011


    a b s t r a c t

    Websites opposing vaccination are prgenerated content, has become ubiquemerged, where power has shifted froexpertise is redened. Together this heffectively spread their messages. Evadvice, and suggests such sources cavaccine websites can inuence whetexamines the types of rhetoric individanti-vaccination movement can be coand tropes commonly used to argue aging science, shifting hypotheses, censmade claims such as not being anti-v/ locate /vacc ine

    ern paradigm An overview oftion movement

    anada L9C 1C4

    nt on the Internet. Web 2.0, dened by interaction and user-. Furthermore, a new postmodern paradigm of healthcare hasctors to patients, the legitimacy of science is questioned, andated an environment where anti-vaccine activists are able toe shows that individuals turn to the Internet for vaccinationpact vaccination decisions therefore it is likely that anti-eople vaccinate themselves or their children. This overviewmay encounter online in order to better understand why theing, despite lacking scientic support for their claims. Tactics

    vaccination are described. This includes actions such as skew- dissent, and attacking critics; also discussed are frequently but pro-safe vaccines, that vaccines are toxic or unnatural,

  • A. Kata / Vaccine 30 (2012) 3778 3789 3779

    Web 2.0 facilitates health communication users can engageand educate others by sharing medical histories, treatment suc-cesses and failures, or experienced side-effects [3]. Several salientthemes have been identied when using the Internet in thisway: the intors in theemergence ing and cohealthcare ical paradigmedical paremphasis oover benebeen a tranphysician between pactively engpreviously access to thfrom doctothemselvesinformationhigher statuteristics of notion of exsystems [1legitimacy oto hold momodern soc

    Using Wempowermnities butInternet alsfringe me9/11 Truthact with likfall into a tthat can foobeliefs, whe[14]. Web truth [15]; each portraern charactbut rather 2.0 places ccrusaders, cmessages fin public fotheir meritknowledge encounterin[18]. This iswhere self-the notion tequally valibecomes jugroups havbining themto effective

    3. The in

    Eighty ponline [21].care for lov

    available show 16% of seekers searched online for vaccination infor-mation, and of this group, 70% say what they found inuenced theirtreatment decisions [22]. Surveys indicate the Internet now rivalsphysicians as the leading source of health advice [3].

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    ility, studthercy ofe safcreased participation of patients as active contribu-ir own care, and their subsequent empowerment; theof online communities and social networking; the shar-llaboration of knowledge; and the personalization of[4,5]. These characteristics relate to the current med-m, which is one of postmodernism. The postmodernadigm has developed new priorities for healthcare: ann values as well as evidence; preoccupation with risksts; and the rise of the informed patient [6]. There hassition from the white coat ethos of the traditionalto the current environment of shared decision-makingatients and professionals [7]. Web 2.0 lets patientsage in their own care. While medical knowledge wasbound to textbooks and journals, the Internet allowse school of lay medicine [8], shifting the locus of powerrs as sole directors of a patients care to the patients. Patients are depicted as consumers with access to

    diversity, their choices no longer restricted by thes allocated to experts [9]. In fact, postmodern charac-

    disillusionment and suspicion towards science and thepertise have contributed to decreased trust in expert0]. The postmodern medical paradigm questions thef science and authority, stressing the need for patients

    re power [11]. Indeed, it can be argued that in a post-iety, everybody is an expert [12].eb 2.0 for health collaboration has benets patientent, consumer reviews and advice, supportive commu-

    has drawbacks as well. The connective power of theo brings together those previously considered on thembers of marginalized groups (e.g. Holocaust deniers,ers, AIDS deniers) can easily and uncritically inter-e-minded individuals online [13]. There it is easy torap of self-referencing and mutually reinforcing linksl users into believing there are many who share theirn in reality it may only be a small, committed group2.0 has furthered postmodern ideals by atteningthe innite personalized truths presented online areyed as legitimate. This is supported by the postmod-eristic of relativism that there are no objective facts,multiple meanings and ways of knowing [6]. Webarefully scrutinized evidence next to the opinions ofritics, and conspiracy theorists, potentially weakeningrom qualied experts [16]. New theories are debatedrums before the scientic community can examine

    s [17]. That ofcials speak with special authority oris a concept now rejected by laypeople, as readersg expertise may believe themselves to then be experts

    demonstrated by anti-vaccinationism on the Internet,proclaimed experts tout conicting messages; withhat multiple truths based on different worldviews ared, evidence-based advice from qualied vaccine expertsst another opinion among many [17,19]. Anti-vaccinee harnessed postmodern ideologies [20], and by com-

    with Web 2.0 and social media technologies, are ablely spread their messages.

    uence of the Internet on vaccination decisions

    ercent of Internet users search for health information Those most likely to do so are adults providing unpaided ones, such as children. The most recent statistics

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