Vaccine skeptics are my people. Here's how to reach at least some of us.

Let me start by saying I will absolutely be getting the COVID-19 vaccine. No question. I'm pretty excited about it.

I can't say that I always would have felt that way.

When I started my family 20 years ago, I dove into the natural birth/parenting/health world pretty quickly. I gave birth to one of my kids at home (with a doctor who did homebirths) and had another at a birth center with a midwife. I treated my kids' earaches with garlic-steeped olive oil and their conjunctivitis with breastmilk. We keep elderberry syrup on hand for colds and flus and use ginger and turmeric tea as an anti-inflammatory. My husband has successfully used hibiscus tea to lower his blood pressure and acupuncture for prostatitis.

That's not to say we ever shunned Western medicine. We use antibiotics for strep throat, Tylenol if a fever gets really bad, etc. There's a huge spectrum of approaches to health and wellness, and tossing any of them out completely is pretty silly.

There's a lot of good stuff in the natural health world, including a lot that is backed up by traditional science. (See the links above.) There's also a lot of unsupported-by-science woo and misinformation, and that's only gotten worse in the age of social media.

As for vaccines, I started out unsure of what to think about them. I had concerns about injecting my children with what I understood to be toxic ingredients in vaccines, such as thimerosal (a mercury-containing compound that was removed from vaccines in 2001) and aluminum. We had a family doctor who wasn't anti-vaccine but had some hesitancy about certain ones, so we took each vaccine on an individual basis with his input.

We did immunize our kids, but we did it on a different schedule based on perceived risk. For example, we didn't do the Hep B vaccine at birth because the risk of our newborn baby being exposed to Hep B was incredibly tiny, so we figured that one could wait. We felt that our kids were healthy enough to get natural chickenpox immunity through infection, so we skipped that vaccine altogether. (Since we homeschooled, we were able to expose our kids purposefully in our own home and keep them isolated while the infection process ran its course. Totally understand if you cringe at that. I probably would now too.)

If I could go back and do it again I'd likely make some different choices, but at the time we made informed decisions based on the information we had. I'm not sure where I would have ended up if I'd had the big, nutty world of social media at my fingertips.

I was a vaccine skeptic, not a full-on anti-vaxxer, but it's a slippery road from one to the other. In reality, I think there are a lot of people like me out there, and I'm concerned that they're being swayed more and more toward conspiracy theories. Healthy skepticism and scrutiny over what we put into our bodies is, well, healthy. People have questions and concerns, and that's a good thing. How those questions and concerns get addressed is key.

One thing not to do: Don't dismiss all vaccine skepticism as uninformed ignorance. There is some of that out there for sure, but there are also a lot of people who have solid reasons for their concerns, even if they aren't concerns for everyone. Most vaccine skeptics aren't ignorant conspiracy theorists just as not all people who work for pharmaceutical companies are greedy profiteers. If the people with the best scientific information roll their eyes at people for their questions, they will be lured down the rabbit hole of misinformation by those who welcome their skepticism.

There are two truths we need to internalize it comes to understanding people's vaccine decision-making. 1) No one except people who study this stuff for a living has the time to wade through ALL of the information, so humility goes a long way. 2) Even though we all think we're informed, we base our decisions far more on who we trust—and don't trust—than on any specific information we have.

That trust part is huge. It's The Big Key. Any conversation with a vaccine skeptic has to address trust first and foremost. If so simple to say, "Just trust the science!" but the people who say that don't understand how many scientists and doctors there are in the anti-vaccine world who share studies and analyses and whatnot that makes the science seem pretty fuzzy. Which scientists are we supposed to trust? Which doctors? Which studies?

The biggest source of distrust for most vaccine skeptics is "Big Pharma" and the gargantuan profits pharmaceutical companies make. It's a mistake to dismiss that concern out of hand. We've all seen the price gouging of medications—are we supposed to believe these pharmaceutical companies have our best interest at heart? We've all seen medications get recalled because they found out they did some kind of harm—is this the science we're supposed to put our faith in?

When people are starting from that place of distrust, it's a pretty short distance to the conspiracy theory rabbit hole. Once people go down that hole, it's virtually impossible to bring them back, so we have to find the off ramp before people get there.

One step toward the off-ramp, which should come early in the discussion, is to help people establish just how rotten they think humanity really is. I know that sounds odd, but that one thing forms the foundation for everything that comes next. If you're talking to a vaccine skeptic, ask them these questions: Do you think most people generally do the right thing? Do you think most people go into their careers for the right reasons? Do you think most people want the world to be a place where everyone is happy and healthy?

If they seem unsure, ask them to think about all of the people they know personally. Nearly everyone will answer yes to these questions when they think about the hundreds of people they know.

The reason that's important is because our brains tend to generalize and dehumanize processes and industries that involve a lot of people. And the less we actually know about how a process or industry works, the more monolithic we make our generalizations. I see people do this all the time with "the media." As if "the media" is one thing and not a bunch of competing companies that each have their own mission and culture and commitment to certain standards of reporting. Such monolithic ideas remove the individual, dedicated editors and journalists who really try to do their jobs to the best of their ability—the people who actually make up "the media."

We do the same things with "politicians" when we assume all elected officials are corrupt and power-hungry. We do the same thing with "corporate America" when we assume that all corporations are 100% motivated by greed. Monoliths take humans out of the equation and replace them with a nefarious blob of malintent that isn't truly reflective of reality.

When you make "the vaccine industry" a monolith, it seems like this big, powerful machine that exists only to line the pockets of the people who run it. And yes, pharmaceutical companies make buttloads of money, because they can. Yay, capitalism. But break it down. The people in those companies who are responsible for profit-mongering are specific people in the marketing and financial executive departments—it's not the entire company. It's certainly not the individual researchers who spend their days studying virology and epidemiology and immunology. It's not the scientists who dedicate months and years to figuring out how to treat a disease or save humanity from an infectious pathogen. It's not the vaccine development teams or the teams running the trials or the teams analyzing the data. Generally speaking, those people don't have anything to do with the money-making side of the pharmaceutical business in any meaningful way.

That doesn't mean every individual person is trustworthy, of course. Most of us would agree that there are some bad apples everywhere, but that's why we have professional organizations and review boards and standards, so that we minimize the likelihood of a bad apple ruining the bunch. And if you believe that most people do their best work for the right reasons, you have to believe that the vast majority of scientists around the globe who work on vaccines do everything in their power to make sure whatever they're developing is as safe and effective as possible.

Breaking down these big industries into how they actually function and understanding that the scientists making the vaccine are not synonymous with the company selling it can go a long way toward building trust in the science, without actually having to go as far as trusting the companies themselves.

Explaining that people pushing anti-vaccine information are also making money can also help. If people believe Big Pharma is bad, then everyone against Big Pharma seems good, even though there are a lot of quackos and grifters out there who profit big time off of people's skepticism and fear. Being anti-corporate-profiteering doesn't automatically make someone trustworthy.

And though it may sometimes feel like too many people are too far down the rabbit hole to make a difference, helpful explanations of the science from scientists actually does help. For instance, this Twitter thread explains how the mRNA COVID-19 vaccine works in layman's terms. And the questions and answers that follow the main thread are helpful as well for minimizing fear.

Acknowledging that people's questions and concerns are legitimate (even if you know their conclusions are not), is a good first step. Setting a baseline foundation for trust is the second. When you actually delve into those questions and concerns, do so in a way that doesn't just throw data or statistics at them, but actually addresses the underlying fear and distrust that can lead to conspiratorial thinking.

Not everyone will be convinced, but we have to be as diligent as those pushing misinformation and keep putting out facts with calm confidence. So many of us are actually swayable by good information, especially when it comes from people we feel like we can trust.

This article originally appeared on August 27, 2015

Oh, society! We have such a complicated relationship with relationships.

It starts early, with the movies we are plopped in front of as toddlers.

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This article originally appeared on August 27, 2015

Oh, society! We have such a complicated relationship with relationships.

It starts early, with the movies we are plopped in front of as toddlers.

Keep Reading Show less
True

Each year, an estimated 1.8 million people in the United States are affected by cancer — most commonly cancers of the breast, lung, prostate, and blood cancers such as leukemia. While not everyone overcomes the disease, thanks to science, more people are surviving — and for longer — than ever before in history.

We asked three people whose lives have been impacted by cancer to share their stories – how their lives were changed by the disease, and how they're using that experience to change the future of cancer treatments with the hope that ultimately, in the fight against cancer, science will win. Here's what they had to say.

Celine Ryan, 55, engineer database programmer and mother of five from Detroit, MI

Photo courtesy of Celine Ryan

In September 2013, Celine Ryan woke up from a colonoscopy to some traumatic news. Her gastroenterologist showed her a picture of the cancerous mass they found during the procedure.

Ryan and her husband, Patrick, had scheduled a colonoscopy after discovering some unusual bleeding, so the suspicion she could have cancer was already there. Neither of them, however, were quite prepared for the results to be positive -- or for the treatment to begin so soon. Just two days after learning the news, Ryan had surgery to remove the tumor, part of her bladder, and 17 cancerous lymph nodes. Chemotherapy and radiation soon followed.

Ryan's treatment was rigorous – but in December 2014, she got the devastating news that the cancer, once confined to her colon, had spread to her lungs. Her prognosis, they said, was likely terminal.

But rather than give up hope, Ryan sought support from online research, fellow cancer patients and survivors, and her medical team. When she brought up immunotherapy to her oncologist, he quickly agreed it was the best course of action. Ryan's cancer, like a majority of colon and pancreatic cancers, had been caused by a defect on the gene KRAS, which can result in a very aggressive cancer that is virtually "undruggable." According to the medical literature, the relatively smooth protein structure of the KRAS gene meant that designing inhibitors to bind to surface grooves and treat the cancer has been historically difficult. Through her support systems, Ryan discovered an experimental immunotherapy trial at the National Institutes of Health (NIH) in Bethesda, MD., and called them immediately to see if she was eligible. After months of trying to determine whether she was a suitable candidate for the experimental treatment, Ryan was finally accepted.

The treatment, known as tumor-infiltrating lymphocyte therapy, or TIL, is a testament to how far modern science has evolved. With this therapy, doctors remove a tumor and harvest special immune cells that are found naturally in the tumor. Doctors then grow the cells in a lab over the next several weeks with a protein that promotes rapid TIL growth – and once the cells number into the billions, they are infused back into the patient's body to fight the cancer. On April 1, 2015, Ryan had her tumor removed at the NIH. Two months later, she went inpatient for four weeks to have the team "wash out" her immune system with chemotherapy and infuse the cells – all 148 billion of them – back into her body.

Six weeks after the infusion, Ryan and Patrick went back for a follow-up appointment – and the news they got was stunning: Not only had no new tumors developed, but the six existing tumors in her lungs had shrunk significantly. Less than a year after her cell infusion, in April 2016, the doctors told Ryan news that would have been impossible just a decade earlier: Thanks to the cell infusion, Ryan was now considered NED – no evaluable disease. Her body was cancer-free.

Ryan is still NED today and continuing annual follow-up appointments at the NIH, experiencing things she never dreamed she'd be able to live to see, such as her children's high school and college graduations. She's also donating her blood and cells to the NIH to help them research other potential cancer treatments. "It was an honor to do so," Ryan said of her experience. "I'm just thrilled, and I hope my experience can help a lot more people."

Patrice Lee, PhD, VP of Pharmacology, Toxicology and Exploratory Development at Pfizer

Photo courtesy of Patrice Lee

Patrice Lee got into scientific research in an unconventional way – through the late ocean explorer Jacques Cousteau.

Lee never met Cousteau but her dreams of working with him one day led her to pursue a career in science. Initially, Lee completed an undergraduate degree in marine biology; eventually, her interests changed and she decided to get a dual doctoral degree in physiology and toxicology at Duke University. She now works at Pfizer's R&D site in Boulder, CO (formerly Array BioPharma), leading a group of scientists who determine the safety and efficacy of new oncology drugs.

"Scientists focused on drug discovery and development in the pharmaceutical industry are deeply committed to inventing new therapies to meet unmet needs," Lee says, describing her field of work. "We're driven to achieve new medicines and vaccines as quickly as possible without sacrificing safety."

Among the drugs Lee has helped develop during her career, including cancer therapies, she says around a dozen are currently in development, while nine have received FDA approval — an incredible accomplishment as many scientists spend their careers without seeing their drug make it to market. Lee's team is particularly interested in therapies for brain metastases — something that Lee says is a largely unmet need in cancer research, and something her team is working on from a variety of angles. "Now that we've had rapid success with mRNA vaccine technology, we hope to explore what the future holds when applying this technology to cancers," Lee says.

But while evaluating potential cancer therapies is a professional passion of Lee's, it's also a mission that's deeply personal. "I'm also a breast cancer survivor," she says. "So I've been on the other side of things and have participated in a clinical trial."

However, seeing how melanoma therapies that she helped develop have affected other real-life cancer patients, she says, has been a highlight of her career. "We had one therapy that was approved for patients with BRAF-mutant metastatic melanoma," Lee recalls. "Our team in Boulder was graced by a visit from a patient that had benefited from these drugs that we developed. It was a very special moment for the entire team."

None of these therapies would be available, Lee says without rigorous science behind it: "Facts come from good science. Facts will drive the development of new drugs, and that's what will help patients."

Chiuying "Cynthia" Kuk (they/them) MS, 34, third-year medical student at Michigan State University College of Human Medicine

Photo courtesy of Cynthia Kuk

Cynthia Kuk was just 10 years old when they had a conversation that would change their life forever.

"My mother, who worked as a translator for the government at the time, had been diagnosed with breast cancer, and after her chemotherapy treatments she would get really sick," Kuk, who uses they/them pronouns, recalls. "When I asked my dad why mom was puking so much, he said it was because of the medicine she was taking that would help her get better."

Kuk's response was immediate: "That's so stupid! Why would a medicine make you feel worse instead of better? When I'm older, I want to create medicine that won't make people sick like that."

Nine years later, Kuk traveled from their native Hong Kong to the United States to do exactly that. Kuk enrolled in a small, liberal arts college for their Bachelor's degree, and then four years later started a PhD program in cancer research. Although Kuk's mother was in remission from her cancer at the time, Kuk's goal was the same as it had been as a 10-year-old watching her suffer through chemotherapy: to design a better cancer treatment, and change the landscape of cancer research forever.

Since then, Kuk's mission has changed slightly.

"My mom's cancer relapsed in 2008, and she ended up passing away about five years after that," Kuk says. "After my mom died, I started having this sense of urgency. Cancer research is such that you work for twenty years, and at the end of it you might have a fancy medication that could help people, but I wanted to help people now." With their mother still at the forefront of their mind, Kuk decided to quit their PhD program and enter medical school.

Now, Kuk plans to pursue a career in emergency medicine – not only because they are drawn to the excitement of the emergency room, but because the ER is a place where the most marginalized people tend to seek care.

"I have a special interest in the LGBTQ+ population, as I identify as queer and nonbinary," says Kuk. "A lot of people in this community and other marginalized communities access care through the ER and also tend to avoid medical care since there is a history of mistreatment and judgement from healthcare workers. How you carry yourself as a doctor, your compassion, that can make a huge difference in someone's care."

In addition to making a difference in the lives of LGBTQ+ patients, Kuk wants to make a difference in the lives of patients with cancer as well, like their mother had.

"We've diagnosed patients in the Emergency Department with cancer before," Kuk says. "I can't make cancer good news but how you deliver bad news and the compassion you show could make a world of difference to that patient and their family."

During their training, Kuk advocates for patients by delivering compassionate and inclusive care, whether they happen to have cancer or not. In addition to emphasizing their patient's pronouns and chosen names, they ask for inclusive social and sexual histories as well as using gender neutral language. In doing this, they hope to make medicine as a whole more accessible for people who have been historically pushed aside.

"I'm just one person, and I can't force everyone to respect you, if you're marginalized," Kuk says. "But I do want to push for a culture where people appreciate others who are different from them."