Where do you draw the line? On vaccination and freedom of speech

I was skimming my Facebook feed this afternoon, and I had to take a second glance at one of the articles when my brain eventually caught up with what was on the screen.

Australian nurses who spread anti-vaccination messages will now face prosecution”, it said.

My first reaction was, “Wow … that was unexpected.”

So unexpected, in fact, I initially thought it was a hoax.  Then I noticed the story was being reported by several sources, some of which looked reputable.  Perhaps this wasn’t a viral meme after all.  I went to the Australian Health Practitioner Regulatory Authority’s website to get direct confirmation, and sure enough, it was no joke—AHPRA and the Nursing and Midwifery Board of Australia (NMBA) recently issued a statement saying exactly what was reported.

“The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.”

“The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.”

“Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.”
~ http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Position-Statements/vaccination.aspx

Vaccination is a pet subject for me—I’m a strong advocate for immunisation and I detest those who would misconstrue the science of vaccines to suit their own twisted agenda.  I think there’s a special place in hell set aside for Jenny McCarthy and Andrew Wakefield.

That said, I’m still a teensy bit uneasy about this new approach by AHPRA, because as much as I hate hearing about people mislead by anti-vaxxers, I want to protect freedom of speech.

Muzzling free speech is a two-edged sword.  Yes, you might stop slimy crack-pots like Wakefield from spreading their malicious fiction, but you also run the risk of stifling legitimate debate.

There’s no evidence that vaccines have toxic levels of mercury or aluminium, or that vaccines cause autism or cancer.  To suggest otherwise is unscientific, and I have no problems in categorically stating that vaccination opponents are currently wrong.  But … what if a legitimate concern about a vaccine arises?  I’m not suggesting the evidence for vaccination is unsettled, but rather, what if a new vaccine is developed that does have unforeseen complications?  Will gag laws prevent a whistle-blower from coming forward for fear of being tarred as “anti-vaccination”?  I wouldn’t put it past the developing drug company from using such a tactic if they wanted an easy way to defend their product.

The other aspect to consider is broader—is this the thin end of the wedge?  If we start gagging health professionals from speaking out against the consensus on immunisation, then what’s next? Abortion law reform? Euthanasia? Climate change?  Each of these issues remains controversial and each side of each issue claims to have science on its side.  Should the side with the perceived ‘consensus’ have the authority or the right to suppress debate from their opponents?

Besides, the problem of anti-vaccination propaganda goes way beyond nurses making comments on social media.  AHPRA’s power only extends to registered health practitioners in Australia.  It doesn’t stop naturopaths or “nutritionists” from promoting anti-vaccination views, and it seems it hasn’t stopped certain chiropractors from subverting the rules either.  It doesn’t stop alternative-health hawkers overseas.

Despite my misgivings, I’m still in favour of AHPRA’s move.  It’s a step in the right direction, and it’s being done for the right reasons—to protect patients from rogue operators that would betray their trust—although this edict might need further discussion before extending it to all AHPRA health practitioners.

Perhaps we should focus on promoting the truth instead of trying to suppress the lies.  For every anti-vaccination blog, there should be a hundred promoting the science behind vaccines.  For every anti-vaxxer celebrity that gets thirty seconds of air time, there should be thirty minutes of air time for reputable scientists and vaccination advocates.  Anti-vaxxers should be able to say what they want even if it’s pseudoscience, but they should be prepared to be pilloried by real scientists using proven facts.

Perhaps that’s a better way to protect all the rights of the community.

What do you think?  Feel free to leave your comments below.

Dr Caroline Leaf and the Myth of Mind Domination

Screen Shot 2014-05-08 at 8.02.30 pm

 

“You control your brain … your brain does not control you!”

So says Dr Caroline Leaf, Communication Pathologist and self-titled Cognitive Neuroscientist.

You’d hope that Dr Leaf would know. She says on her website that “Since the early 1980‘s she has studied and researched the Mind-Brain connection.” And if you take what she says at face value, it sure sounds right. Of course we’re in control. My brain does what I tell it to do. Except that it actually doesn’t. Our brain has a lot more control over us than we realize.

First of all, our “free” will isn’t actually free at all, but constrained by a number of unseen, subconscious processes that are entirely dependent on our brain. It may seem like we’re in complete control of our choices, but our subconscious brain has already done most of the work for us. Even if we had complete freedom over our choices, our “free” will would still require an intact brain in order to carry out its wishes.

The “control” of our brain is very similar to our “control” when we drive a car. When we say that we’re “controlling” the car, what we actually mean is that we are controlling the speed and direction of the car. But there are thousands of electrical and mechanical actions that take place each second that are vital for the running of the car, and that we have absolutely no direct control over. It just takes one loose nut or faulty fuse to make the car steer wildly out of control, or stop functioning entirely, and then we’re not in control at all.

In the same way, various diseases or lesions in the brain show that brain is really in control. The fact we don’t see all of the underlying processes in a fully functional brain simply provides the illusion of control.

For example, there are a number of lesions of the parietal lobes within the brain that give rise to some unusual but intriguing conditions. One of which is a condition called “Alien Hand Syndrome”. Wegner describes two patients with Alien Hand Syndrome, a lady whose “left hand would tenaciously grope for and grasp any nearby object, pick and pull at her clothes, and even grasp her throat during sleep … She slept with the arm tied to prevent nocturnal misbehavior”, and a man who, “While playing checkers on one occasion, the left hand made a move he did not wish to make, and he corrected the move with the right hand; however, the left hand, to the patient’s frustration, repeated the false move. On other occasions, he turned the pages of the book with one hand while the other tried to close it; he shaved with the right hand while the left one unzipped his jacket” [1]. Alien Hand Syndrome demonstrates that our decision-making and our action sequences are controlled by two separate systems in our brains.

There are other conditions that also show that our brains control us more than we control them. A more common example are the tic disorders, such as simple motor tics (sudden involuntary movements) and complex tic disorders, such as Tourette’s (best known for the involuntary tendencies to utter obscenities). Even more common are parasomnias – a group of disorders in which people perform complex behaviours during their sleep – sleep talking, sleep walking, sleep eating. One of my patients once drove her car while asleep (Honestly, that’s no exaggeration!).

So at best, we only have partial control of our brain. Our brain is driving, our mind just steers it a little, but it doesn’t take much for that veneer of control that we think we possess.

The other way in which we appear to have control over our brain is through free will. Free will has been debated for years on philosophical grounds, but over three decades ago, Libet performed an experiment that demonstrated measurable and predictable brain activity occurring up to a full second before a test subject was consciously aware of the intention to act [2]. More recently, a study by Soon et al showed that predictable brain activity occurred up to eight seconds before a person was aware of their intention to act [3]. As Bonn says, “the gist of these findings is that our feeling of having consciously willed an act is illusory in many ways. It seems that the conscious awareness of intention that we place so much weight upon, that we naively think of as causal, is, in fact, a narrative construction that is formed well after the train of causation has been set in motion.” [4]

The Oracle explained it to Neo, “… you didn’t come here to make the choice. You’ve already made it. You’re here to try to understand why you made it.” (Matrix Reloaded, 2003)

Haggard concludes, “Modern neuroscience rejects the traditional dualist view of volition as a causal chain from the conscious mind or ‘soul’ to the brain and body. Rather, volition involves brain networks making a series of complex, open decisions between alternative actions.” [5]

This does not eliminate our capacity to choose, but frames it in a more realistic fashion. As Bonn points out, “Although we are not consciously aware of what is going on at every stage of the chain of neural events leading to action, there is room for a degree of conscious involvement if only to pull the emergency brake before it is too late. Thus, although it may not be the initial source of motivations and behavioral impulses, the part of the mind that is self-reflective; that can envision the self in causal and narrative contexts, may serve important monitoring and control functions.” [4]

Again, we have less control over our brain than we realize. We feel like we have made a choice, but more often than not, our brain already made the choice for us up to eight seconds beforehand, and the feeling of intention that we have is simply our conscious mind catching up – not making the choice, but finding a reason for why we made the choice.

It’s always nice when people who call themselves neuroscientists tell us what feels intuitively correct. In the cold, hard light of day, actual neuroscientists don’t tell us what’s intuitively correct, but what’s actually correct. It may seem like our mind is in control of our brain, but modern neuroscience confirms that our brain is the dominant force, while our mind just helps to steer a little.

References

  1. Wegner, D.M., Precis of the illusion of conscious will. Behavioral and Brain Sciences, 2004. 27(5): 649-59
  2. Libet, B., et al., Time of conscious intention to act in relation to onset of cerebral activity (readiness-potential). The unconscious initiation of a freely voluntary act. Brain, 1983. 106 (Pt 3): 623-42 http://www.ncbi.nlm.nih.gov/pubmed/6640273
  3. Soon, C.S., et al., Unconscious determinants of free decisions in the human brain. Nat Neurosci, 2008. 11(5): 543-5 doi: 10.1038/nn.2112
  4. Bonn, G.B., Re-conceptualizing free will for the 21st century: acting independently with a limited role for consciousness. Front Psychol, 2013. 4: 920 doi: 10.3389/fpsyg.2013.00920
  5. Haggard, P., Human volition: towards a neuroscience of will. Nat Rev Neurosci, 2008. 9(12): 934-46 doi: 10.1038/nrn2497