Thread by @reuvenmlerner

For about a year now, I've been upset with the unvaccinated. Why don't they, or won't they, get vaccinated? Are they suicidal, ignorant, or sociopathic?

Two great books have changed my thinking: High Conflict, by @amandaripley, and Empire of Pain, by @praddenkeefe.

A thread.

First, just to make it clear: I'm vaccinated (3 shots). I think the covid vaccines are among the greatest achievements of modern science. My family all got vaccinated ASAP. They work, and save lives. Everyone should get vaccinated.

So my struggle hasn't been about the vaccines. Rather, it's how so many people have refused something so obviously beneficial, which will save not only their own lives, but the lives of people they love.

The evidence is overwhelming. So why the heck aren't they getting shots?

Ripley's book, High Conflict, is about trying to reach agreement, or understanding, with people totally different from you.

This is one of the best books I've read in years; I devoured it in a weekend in the spring, and tell everyone I can about it.

BTW, you should read it.

High Conflict told me that the people refusing covid vaccines aren't crazy or stupid. And indeed, there are seemingly smart people who are adamant about refusing the vaccine.

But I'm a science kind of guy. And I couldn't understand, for the life of me, what their thinking was.

BTW, I *do* understand at least a subset of the people who refuse to get vaccinated, namely those who think that all vaccines are bad. I think they're wrong — dead wrong, you could say — but they have a worldview I can fathom.

But refusing covid vaccines? That just seemed dumb.

I know that calling people dumb and ignorant won't convince them. But why else would they ignore clear and overwhelming science?

Not only is the data clear, but doctors and researchers have gone out of their way to tell people that the vaccines are very safe and very effective.

I was frustrated, and increasingly despondent that we're living in an age of anti-science, anti-rational belief. I mean, if people won't do the basics to keep themselves and their families alive from a deadly virus, then what kind of world are we living in?

Since I read it, Ripley's book remained in my head. I wanted to understand how people could avoid clear data, vouched for by doctors and scientists all over the world. But I just couldn't. I didn't want to write them all off as crazy or dumb, but had no other explanation.

Then I read Patrick Radden Keefe's amazing book, "Empire of Pain," about the Sacklers. (I previously read "Say Nothing," which was even better.) And suddenly, it all made sense.

Purdue, the Sacklers' company, lied repeatedly for decades about the OxyContin and opioids.

OxyContin was less useful, and more addictive, than Purdue ever admitted. That, in and of itself, would be bad. But the truly horrifying part of the book, at least to me, was how they managed to con US regulators and doctors into repeating and amplifying their claims.

When I was in high school in the US, we learned how the FDA was the most rigorous drug regulator in the world. How the US had avoided problems with Thalidomide, because they were so careful. So I always held the FDA up as an example of government regulation.

Back in the real world, the FDA not only approved OxyContin, but parroted dubious claims about how effective it is without being addictive. Moreover, Purdue hired oodles of doctors to be their spokespeople, telling patients and the public what a blessing opioids are.

In other words: A drug company claimed their drug had no long-term bad effects. It was enthusiastically prescribed by doctors, and was approved by the FDA.

In reality, this drug harmed and killed hundreds of thousands of people. Meanwhile, US regulators said and did nothing.

When the covid-19 vaccines came out, I was excited. I saw it as a vindication of the scientific method. Of proof that we can, and will, science our way out of this pandemic mess. And of course, that we can trust US regulators to carefully check data before making recommendations.

But there's a huge population in the US that doesn't see it that way. They see greedy drug companies making billions. They see doctors pushing drugs with no side effects. They see the government telling us not to worry, and to trust them.

They've seen this movie before.

For those people, the vaccines aren't a triumph of science. They're yet another instance of the government helping to line the pockets of Big Pharma. They don't believe the claims of no side effects. They don't believe the data. They don't trust the FDA's rigorous checks.

People like me, who have been calling such people dumb and ignorant, conveniently forgot that over the last 25 years, these same regulators made similar claims for drugs that caused devastation and pain for hundreds of thousands of people.

People feel like they have been lied to by scientists, doctors, and regulators, on behalf of drug companies that made billions... and then paid those same scientists, doctors, and regulators. Thalidomide is a distant memory, whereas opioids are recent, real, and painful.

So, what to do? I'm not sure. Telling people to "listen to the science" doesn't work with people who were lied to by scientists and doctors.

The fact that US regulators participated in the opioid crisis doesn't help. Maybe there's no one left who can act as a neutral arbiter.

I'd like to think that presenting data will work. Sure, many people don't get statistics. But tell them about the trials. Tell them about the risks. Tell them about the benefits.

And admit that yes, even scientists get things wrong. (But that so far, here they've been spot on.)

Most doctors, scientists, and regulators are upstanding people. And many of those involved with opioids were probably naive — they didn't mean to cause harm. But they did. And those bad apples have harmed not only people's lives, but the reputation of science.

Saying, "Yes, we got opioids wrong, but here's how the vaccines are different, and why you should listen to us now" might (I hope) help to avoid some of the pushback. I'm really not sure.

But don't dismiss these people's claims. Because they were lied to, and people died.

I'll add that these comments are aimed at the US. Of course, there are anti-vaccine people elsewhere, too. (I live in Israel, and we have our fair share.) But the US sticks out in a big way. And maybe people in other countries also feel like they can't trust doctors.

Thanks to both @amandaripley and @praddenkeefe, my thinking on this has changed completely.

I've stopped saying that vaccine holdouts are dumb. I've started to think how and why they stopped believing in science and data, and who/what could convince them otherwise.