When We Disagree

In law school, we learned not to accept opinions at face value. Lawyers know to analyze the facts upon which opinions are based. And we like to brag that we can sniff out assumptions that replace non-existent or manufactured facts—sometimes called disinformation. Yet, experienced lawyers understand that even true facts and logic often fail to change an individual’s opinions and beliefs. Why do reasonably intelligent people reject facts and logic? Why do people in our country refuse to be vaccinated despite the dramatic drop in COVID-19 deaths directly corresponding to the rise in vaccinations of our elderly and most vulnerable? Part of the answer is culturally based, meaning religious, political, and provincial beliefs that reject change.

Recent articles in the New York Times have plumbed the depths of vaccine hesitancy and discovered that it’s not knowledge but a “deeply held set of beliefs …at the heart of resistance…” (Sabrina Tavernise). Another recent article in the New York Times quotes Mary Politi, a behavior phycologist and expert in health communication and shared decision-making, “A better approach to overcoming resistance would be engaging “a trusted figure to address the root cause of hesitancy, fear, mistrust, misconception, ease to access or a desire for more information.” Journalists report that more science, facts, and medical expertise have failed to stop the recent decline in individual willingness to take the COVID-19 vaccine in the United States.

Jan Hoffman, who writes about behavior health for the New York Times, traveled to Greenville, Tennessee, to interview rural Tennesseans about vaccine hesitancy. I graduated from the University of Tennessee, Knoxville, in the 70s. By car, Greenville is 70 miles from Knoxville. I emailed Jan and asked if the lack of education was why many Greenvillians refused to take the Vaccine. “Greenville area has highly rated public schools,” she said. Her story quoted well-educated people, including a nurse practitioner and a retired engineer. Both refused to get the vaccine. “Education is a vexing question,” she said. “It has to do with the sources of information people consult.” If one opts for an unqualified source of information instead of their family doctor for information on the risks and benefits of the vaccine, then their source of information comes from different versions of the truth.

More exasperating are people who choose to consult their family doctor yet come away unconvinced or reject medical advice. Why does this happen? I believe the explanation can be found in the Fall 2020 Scientific American Collector’s Edition on Truth vs. Lies. In the short introduction to this issue of the magazine dedicated to the Science of Misinformation and Deception, the senior editor writes, “For starters, human perception is inherently subjective.” According to Anil K. Seth, an expert on cognitive science and the biological basis of consciousness, “Reality is constructed by the brain, and no two brains are exactly alike. Professor Seth then quotes a line from an autobiographical novel written by Anals Nin (there are 2 dots above the a) “We do not see things as they are; we see them as we are.”

Lisa Rosenbaum is the National Correspondent for the New England Journal of Medicine and a Cardiologist at Brigham and Women’s Hospital. She has written about dealing with patients “who express preferences for non-evidence-based therapies” and her inability to respond persuasively. The phenomenon at work here is referred to as biased assimilation. In 2017, Dr. Rosenbaum summed up this corner of cognitive deficiency this way, “when doubt is wrapped up in one’s the cultural identity or powerful emotions, facts often not only fail to persuade but may further entrench skepticism.” Intelligent individuals filter what they hear and “latch” on to the facts that confirm their beliefs.

How impenetrable are strongly held beliefs about COVID-19 and vaccines? A doctor’s memorable low for me was reading a South Dakota nurse’s description of patients who were critically ill with COVID-19 but continued to insist the virus was a hoax until the moment they were intubated. If you can deny the existence of a disease while you’re dying from it, what hope is there for science to persuade people unaffected by that disease to take it seriously enough to get vaccinated?