NATURAL OR SAFE?

In early June, Kavin Senapathy - author and public speaker on health, medicine, food, and parenting - has published a nice article devoted to a – minor, but, in its own way, epochal – event. Johnson's Baby, the brand of baby cosmetics and skin care products owned by the American multinational company Johnson & Johnson, has created  and distributed a commercial video, promoting its products by declaring “Natural may be the trend, but safe will always be our bar. Some natural ingredients that work for adults are too harsh for babies skin. We’ll never sacrifice safety to be all natural.” 

"Given the natural-is-best craze permeating the market for food, cleaning products, cosmetics, personal care and even cat litter,-asks herself Kavin -  why go against the all-natural grain?” The question is more than legitimate, considering Johnson & Johnson well-established marketing strategy.  Since 1897 - when the brand was created to commercialize a talc based baby powder, the Johnson's Baby Powder - Johnson & Johnson has had its own marketing strategy based on communicating an image of healthy and soft products.  As early as 1913, the company invented the catchphrase "Best for the Baby – Best for You", contributing to instill into the public the idea that baby products are safer, smarter and smoother than corresponding products for adults. In 1953, Johnson & Johnson launched the “No More Tears baby shampoo”, which was a true revolution not only in soaps (being based on a new class of cleansing agents, never used in the past), but it was also a real breakthrough in promotional campaigns. Since then, Johnson & Johnson – notably its subsidiary Johnson's Baby – has betted on consumer awareness and natural products that do not have any chemicals inside. Johnson & Johnson is member of the American Green Power Partnership; its promotional campaigns usually aim to inspire healthy living styles (e.g., “Having a Baby Changes Things” and “The Campaign for Nursing’s Future”); and natural products and environmental friendly packaging have become two pillars of corporate policies. This is why the slogan “At Johnson’s, being natural is never more important than being safe” is not only a “refreshing change from the all-natural marketing norm” – as Kavin comments – but it bodes well that it could herald a real revolution.

The idea that everything natural is better, safer, healthier and more environmentally friendly, is a popular misconception, which does not need even to be disproved. It is apparent that natural substances might be – and often are – as harmful, unhealthy and dangerous for the environment, as synthetic substances. Yet, “due to the widespread assumption that artificial ingredients are somehow more harsh or harmful than natural ones, companies have been reformulating products to eliminate synthetics while others build niche brands based on the fallacy”. In the last decades, such a fallacy has largely informed anti GMO and anti-Vax movements, and has contributed to feed the current, global, wave of “anti-scientism” and mistrust towards scientists, health institutions, and drug companies.  The suspicion of synthetic substances is producing paradoxical consequences, for instance these people mistrust vaccines - which are one of the most “natural” medical interventions -  and ignore the danger entailed by infectious diseases, one of the chief “natural killers” in human communities.  Yet, it is not easy to oppose the zeitgeist, as it is illustrated by another, apparently minor, event happened.

Since the mid-1970s, a chemical weed killer, marketed by Monsanto as RoundUp, has become the world most widely used pesticide, being an effective and apparently safer alternative to traditional weed killers. In 2015, the WHO Agency for Research on Cancer (IARC) declared RoundUp a probable carcinogen (category 2A), causing inter alia the postponing of relicensing in the EU and a harsh public campaign against Monsanto led by Greenpeace. On June 14, 2017, Reuters investigation revealed that Aaron Blair, the scientist who led the IARC’s review panel, “had access to data from a large study that strongly suggested that Roundup did not cause cancer after all—but he withheld that data from the RoundUp review panel”. When this odd story emerged, both Blair and the IARC justified themselves by claiming that data (whose existence they admitted being fully aware) was published only after the IARC report and the agency has a policy against using unpublished data. No matter here whether such a self-defense is tenable (in this writer's opinion,  it is not), and whether they were instead driven by untold conflicts of interest, I mentioned this story only to illustrate the power of the stereotype dictating that Monsanto, as well as other chemical giants, are by default producing dangerous and unhealthy items, even that they are “criminal” companies. Admittedly, may be just this once,  Monsanto was not at all the villain of the story, rather the victim.

COMPULSORY VACCINATION AND HEALTH COMMUNICATION

Anti-vaccine movements, and how to prevent their nefarious influence, have been again in the limelight in the last weeks.   Recent measles outbreaks in the US and the EU have been directly related to vaccine skepticism, and vaccine objection has been considered within the wider political context of emerging “populist” movements. Yet, as Donald Trump’s presidency is not likely to affect in depth vaccine policies in the US, similarly it is arguable that Emmanuel Macron’s victory in France could improve vaccination coverage in the EU (and notably in France). Actually, it is misleading to use traditional political criteria to analyze the anti-vax polemics. The traditional  political polarity between conservatives and liberals is hardly tenable in this field, as it is witnessed also by the strict association between anti-vaccine and anti-GMO movements, which are usually considered part of the larger ecologist and  liberal camp.

The main difficulty with anti-vaccine people is that they are usually impermeable to scientific evidence. Countering antivaccination attitudes by providing scientific evidence is not only ineffective, but it even risks to be counterproductive. Anti-vaccine theories are conspiracy theories, and it is always very difficult, if not impossible, to change the mind of someone who believes in a conspiracy theory. Finally, conspiracy theories are delusive constructions and, as most delusions, they cannot be modified by rational arguments. People suffering from paranoiac beliefs tend to interpret evidence against their beliefs as a proof of cover-ups, consequently as a proof that they are right. This means that any direct attempt to debunk a conspiracy theory risks to reinforce it. Indeed, one of the most frequent communication mistake is to accept framing the anti-vax quarrel in terms of “debate” between different points of view. Such an approach implies two very negative consequences. First, it is totally ineffective with anti-vax activists, who are usually unaffected by rational arguments; second, it implicitly provides some scientific legitimacy to anti-vaccine theories, and risks to disseminate them in larger sections of the population.   Also,  showing that vaccine related harm is negligible in comparison to vaccine related benefits, is hardly a good strategy. It is well known that people tend to overestimate harm caused by their actions, and underestimate harm caused by omission, or doing nothing.  Most people will always consider “worse” the risk (no matter how small) entailed by vaccination in comparison with risk entailed by non-vaccination (omission).

Scholars and experts in health communication have thus suggested that  highlighting information about the dangers of infections might be more effective to convince people to vaccinate themselves and their infants, than explicitly “marketing” vaccines. A new class of risk of misinformation is finally emerging, it concerns “arbitrary and unfair behavior by scientific journals”.     

The increasing pressure towards the promotion of open access journals and  online publication of electronic papers, is facilitating the birth of a new generation of predatory publishers, which pay very little attention to scientific quality, dramatically lowering peer review standards. These open access journals have the tendency to accept papers, which have been rejected by more established journals.  They tend to realize very late the  poor quality of published papers, even worse, their subsequent reaction is often totally inadequate. It was the case, for instance, of the  Journal of Translational Science, which published in April 2017 a paper discussing a correlation between vaccination and autism in 666 children, concluding that there is a statistic evidence of such a correlation.  This paper was statistically inadequate and scientifically very weak. A decent publisher would have never accepted it. Indeed, after a couple of weeks, in early May, the publisher realized it, and the paper was retracted from the journal website, but with no explanation or explicit  notice. Such a move was still worse than the initial publication, because it is unavoidably destined to generate suspects and fuel conspiracy theories. Brief, a very poor paper, which should have never been published, not only was published, but it is probably destined to become a  “proof” of anti-vax conspiracy theories, because of its “mysterious” retraction.Peso el tacon del buso (the patch is worse than the hole) reads an old Venetian proverb.

In such a discouraging scenario, a positive note is, however, coming from Italy and Germany. In these very days, both countries are enacting legislations, which are making several child vaccination compulsory. Parents, who refuse to vaccinate their children, risk to be fined and children to be prevented to attend the school. Many criticisms have been raised against mandatory vaccination, and it is difficult to escape the unpleasant impression that coercion is  the last, rude, resource of those who are not able to convince.  Such an impression is, however, misleading. It would be naïve to interpret legislations mandating child vaccination  only, or chiefly, in terms of coercion. Although legal coercion can play a (minor) role in reducing parental reluctance to vaccinate, no one could really imagine that in  democratic, pluralistic, societies, it could be ever possible to enforce such a legislation by using the police force, without evoking very strong negative social reactions. Making some vaccinations compulsory is rather a way to emphasize their significance. We are all used to consider something compulsory more important than anything which is only recommended on voluntary basis. In our culture, legal compulsion is often the hallmark of social importance.  Making some child vaccination compulsory is then one of the most effective, and simplest, means to communicate unambiguously that we consider vaccinations effective and valuable.    

RISK COMMUNICATION OR COMMUNICATION RISKS?

Innovate UK has recently awarded a team led by Dr Michael Jarvis at the University of Plymouth UK with a £408,000 grant to develop a new vaccine against zoonosis.

About 75% of newly emerging diseases and 60% of all known human infectious diseases are likely to be zoonosis.  The main idea of this new project is to develop a self-disseminating vaccine vector, called Zoonosis Barrier Vaccine (ZBV), targeting pathogens in the animal species from which they are emerging. By exploiting CRISPR/Cas9 technology, the team will aim to construct engineered viruses, which express target antigens from relevant Emerging Infectious Disease (EID) pathogens. Recombinant viruses will be then inoculated in few animals. They will spread through the whole host populations, producing EID-specific immunity in the targeted populations.

For now, the team will develop a ‘proof-of-concept’ vaccine vector, designed to halt the spread of Rift Valley Fever Virus (RVFV) and Q Fever (QF) among ruminant populations (i.e., sheep, goats and cattle).  The vaccine will prevent zoonotic transmission by using an attenuated bovine herpesvirus. The recombinant herpesvirus – which will replicate only for a short period of time for safety reasons - will infect domestic and wild animals, stimulating also immunity against RVFV and QF.  

The Zoonoses Barrier Vaccine strategy presents several advantages.  Self-disseminating vaccines allow addressing both domestic and wild animals. The transmission of infectious diseases between wild and domestic animals is particularly relevant to EIDs, as most EIDs originate from wildlife. The vicious circle of infections and re-infections between domestic and wild animals is likely to play a pivotal role in EID epidemiological cycles. Moreover, many emerging zoonotic pathogens are poorly adapted to the human hosts in their initial phases, this offers the opportunity to halt the zoonotic transmission by targeting the animal populations, and decreasing the “probability of complete adaption to the human host with global significance”. Finally, the approval requirementsfor animal vaccines are lower than those for human  vaccines, so reducing time to commercial availability. 

The Zoonoses Barrier Vaccine project presents, however, some Significant communicational challenges. Infecting wild and domestic animals with recombinant viruses is the typical project, expected to fuel conspiracy theories. People might also fear a sorcerer's apprentice phenomenon, with recombinant viruses that escape from human control and become dangerous for humans and animals.  Negative reactions can be also related to ecological considerations connected to the spread of engineered virus vectors in the natural environment. Finally, one should not underestimate the risk that some people may feel outrageous that livestock products for human consumption (including meat, milk, and eggs) could be theoretically “contaminated” by recombinant viruses. 

Researchers should carefully consider these communicational aspects. They should develop effective communication plans, to explain the rationale of their project and the way in which they intend to mitigate potential risks (even the most unlikely ones).  It is extremely important that full information on the Zoonosis Barrier Vaccine project is publicly available, in a format understandable to the public. Social media should be carefully monitored; worries, fears, myths, concerning the project should be immediately identified and addressed with appropriate counter-campaigns. Reasons of worry should be proactively addressed as they emerge. Finally, it is paramount that economic interests are completely and fully disclosed, without any ambiguity. People trust in scientists more than one usually imagine, but they do not  put up with researchers who are perceived not to be fully transparent. Suspects (even remote) of conflict of interest could have devastating effects on future research in this field.   

UNSEEN ALLY

In early April, CNN FILMS, SIERRA/TANGO PRODUCTIONS & VULCAN PRODUCTIONS have presented a new documentary,  Unseen Enemy, devoted to emerging epidemics. Co-produced with WESTDEUTSCHER RUNDFUNK KÖLN in collaboration with ARTE, the movie is directed by Janet Tobias, an Emmy-Award winning filmmaker with parallel careers in film television and medicine. Jenny worked as a producer at ABC News’ Prime Time and as the editorial producer for ABC’s legal and criminal justice coverage. Later, she worked as a national producer at Dateline NBC. In 2001, she created her own television-film production company,  which has produced several documentaries on medical and social issues. In the while, Janet has become adjunct assistant professor of Medicine at Mount Sinai School of Medicine and research professor of Global Public Health at NYU.

In 2012 Unseen Enemy  was initially thought as a documentary about the threat of epidemics in the 21st century. Almost by hazard, it happened that the production team was filming at the same location of the first recorded outbreak of Ebola.  The documentary crew found themselves involved in a real epidemics and soon the film turned into a running commentary of an actual epidemic. Two years later, the Unseen Enemyteam decided  to give a further running commentary of another emerging epidemic, Zika. They went to Brazil to document the outbreak from inside, collecting stories, tragedies, acts of bravery, altruism and dedication. Unseen Enemy has been already broadcasted  in Estonia, Venezuela, Hong Kong, France, Germany, Israel, Poland; it is still available on CNN.com/go until May 8th; and it will be available on Video on Demand and DVD in the coming months.  

Unseen Enemy is very well done. Never boring, well directed and photographed, with a good pace, and extreme attention to details, the film offers stunningly intimate observations on the two outbreaks and tells vital human stories. A special mention goes to the original soundtrack, written by John Piscitello an American composer who wrote - inter alia - the soundtrack to No Place on Earth, the story of Jewish families in the western Ukraine who lived over 500 days in caves, coming out into the light only when the German army had been driven from the Ukraine, and to  Dinner with the Alchemist, a dark movie, where “a spider-web of lives come clashing together as Old New Orleans is plagued by mysterious deaths”. Piscitello’s music is not only vital to Unseen Enemy - catching the attention from the very beginning, and maintaining the tension through the whole film – but it is the actual soul of the movie and the key for understanding it.

 

The Unseen Enemy’s model is the gothic movie and music is essential to create that atmosphere. As in a well done gothic film, the public is progressively driven towards the uncanny sensation that the game is not over with the apparent happy end. It isn’t done, it just won't go away.   All music pieces in the soundtrack can't resolve themselves (listen, for instance, to “Outbreaks Everywhere”, the piece that opens the movie) any more than outbreaks are truly defeated.   The last music piece, “What the Future Holds”, is a sad whimper, which goes out slowly and ends with a silence of death. Epidemics can be stopped but never definitely beat; at the very end, notwithstanding human heroism, they will prevail,  this is the depressing message implicitly conveyed by Unseen Enemy.

In conclusion, this documentary leads to a commentary and brings to one big question. The commentary is that Janet Tobias has unquestionably found the right way to speak of infectious outbreaks, without lecturing the public  or resorting to sappy, educational, tales. Maybe she exploits too much the war rhetoric to describe the fight against Ebola and Zika, yet this can be still understandable. 

The big question is whether it can be ever acceptable to create a catching atmosphere by giving the implicit (and consequently more pervasive) message that, soon or later, we will be killed by a deadly epidemic. This message is not only discouraging, but it is also misleading. Our goal is rarely to eradicate infectious diseases. Apart from very few infections, our scope is to control infections. Microbes existed well before humans appeared on the surface of the earth, and they will exist well after our species will be disappeared. We should learn to live together with them, they are our unavoidable travelling companions. Germs must be turned into unseen allies rather than enemies. This is the sole way to win this war, provided that it is a war.

PROVIDERS OF TRUTH

A famous dictum of the 19th century British politician Lord Acton, reads "power tends to corrupt, and absolute power corrupts absolutely”.  Lord Acton would have been probably intrigued by the current debate on social network governance. After the mass hysteria generated by  the fake news issue,  and the proposal in Germany of a new legislation on  social networks, both Facebook and Google  have announced that they are going to adopt fact-checking instruments.

Facebook’s tool is a notification system that warns the user if any news has been flagged as “disputed”. Google’s tool is more complex. It is based on a label, which rates claims made in the news, and in news web sites, under six categories, 1) hard to categorize; 2) false; 3) mostly false; 4) half true; 5) mostly true; 6) true.  “Sites are evaluated in a process similar to page ranking: if the site ranking is high enough, the fact check element can be displayed in search results along with your page. The entire process is conducted programmatically; human intervention only occurs when user feedback is filed as violating the Google News Publisher criteria for fact checks”.  Both Facebook and Google rely on external fact-check sources, which are independent organizations looking at fact checking and authentication. Fact check business is rapidly growing, the Reporters’ Lab at the Duke University, which maintains a comprehensive worldwide database, lists more than 120 international teams active in this field.

A bit improvidently, public authorities and politicians have welcomed Facebook and Google decisions. Yet, though intentions are laudable, the notion of global fact check is quite hazardous. Truth is never mere correspondence between facts and reported facts. The best lies are not made of falsehood but of a clever mix of half and missing truths. For instance, false news that relate Zika epidemics  to  GM mosquitos are purposely constructed by selecting and combining real events, none of them is factually false,  yet the final result is substantially fictitious.

The point is that naked facts cannot exist. The notion of observer is integral to the notion of fact, facts are inherently points of view.  In real life, the notion of “objective truth” is a normative ideal, to be approximated, rather than an attainable goal. When one relays a fact, one relays also one or more perspectives on it. Rigorously speaking, the standard journalistic distinction between reporting, analysis and opinion would be tenable only if all points of view were available, could be disclosed, and faithfully reported, which is usually impossible. Reporting often implies selecting information, and determining which aspects of the fact are more relevant. This is not always apparent and the myth of neutral, factual, reporting is still believed by the majority. This myth hides the evidence that most news are “fine-tuned”, or even grossly manipulated, simply by failing to provide the whole truth, omitting some (apparently minor) facts, emphasizing suggestive details, adding redundant information. For instance, when anti-vax activists provide information on relative risks related to vaccination, they are formally correct, but substantially deceptive, because most people, who confuse relative and absolute risks, are driven to overestimate the danger (admittingly, the same trick is used by medical doctors to induce patients to treat dubious conditions, and justify the extensive usage of drugs such as statins). Finally, news can be manipulated also by altering the context. Think of a news about, e.g., Ebola outbreak. This news could have very different meanings according to the context in which it is included. For instance, if this news is immediately followed by an investigative article on military biological laboratories, or by a lifestyle piece on international tourism, or by an editorial on illegal migration, its likely impact will be rather different. Contexts unavoidably suggest extra meanings; by using them astutely, one could induce deceptive conclusions, though formally respecting the truth.

Yet, the notion of global fact check is distorting also in a further, deeper, sense. If this notion gets going, Internet giants, such as Google and Facebook, will be globally bestowed with the moral authority for assessing the truth (and trustworthiness), or falsity (and untrustworthiness) of single news, news web sites, and news aggregators.  Social networks will be turned into  global “providers of truth”, and their power could not be balanced by any corresponding power, neither by national governments, nor by international agencies and supranational institutions.  Trust in national governments and international institutions is everywhere eroded by different, concurrent, factors. Political institutions, increasingly lacking moral authority and out of touch with citizens, are more and more unable to provide credible, trustworthy, perspectives to look at global facts. Political institutions are thus gradually driven to “outsource” their moral authority.

This is foreshadowed also by the new German legislation, though the proponents are likely to be unaware of it. The “Social networks enforcement law” goes beyond obvious criminalization of hate speech and online propagation of falsity, making social media legally responsible for false contents that they host.  In such a way, this law introduces implicitly the principle, fraught with consequences, that social networks should, and are entitled to, assess “fake news”.  The commentary to the draft text clearly states this principle (see, Begründung - A. Allgemeiner Teil - I. Zielsetzung und Notwendigkeit der Regelungen).  In other words, while the law provides social networks with newer, stricter, obligations, it also crystallizes the structural weakness of democratic institutions. No political institution of the past – endowed with strong moral leadership, trust and credibility -  would have ever enacted such a legislation; standard legal provisions against libel, defamation, and propagation of falsity would have been considered sufficient to deal with online fake. If today a new law is felt necessary, it is hardly because it is required by technological advance, it is chiefly because political institutions have lost their moral authority and governance capacity, and they need to rely on external sources of truth. 

Facebook and Google affirm that they will not assess contents, they will only inform about assessments carried out by independent agencies. Yet, criteria for fact checking are a minor issue in this debate.  The critical issue is power. Today, social networks are more than a “Fourth Estate”, even a networked Fourth Estate. They are becoming the sole Estate, which is taking over all other Estates, the new global moral force. They advise us on where to dine, what humanitarian causes should be supported, what music we should listen to, what is in and out. They offer moral, esthetic, political, spiritual, practical guidance on everything, to everybody. The epochal question at stake is whether tech giants, which are not subject to any democratic scrutiny and transcend all jurisdictions, could be also entrusted with the power to label what is true and false. Lord Acton would have objected to this possibility.