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The pandemic struck Alan Christianson, a Phoenix-based board-certified endocrinologist and naturopathic physician, returned home a few weeks ago after learning that one of his patients in his practice had died of COVID-19. The woman was in her 70s and hadn’t been vaccinated. “Everyone at the clinic loved her,” Christianson told me. “She was always well-dressed, eloquent, always eager to hear about everyone’s lives and what everyone’s kids were doing. She was just a lot of fun to be around.”
Christianson didn’t deal with Sandra (not her real name) personally, but he knew she was keeping an eye on his work, and her death convinced him and his colleagues that they needed to do a better job of communicating the facts about vaccines. “I’ve taken it as a real personal failing that we didn’t do a better job of educating people about this. People are dying unnecessarily. The vaccine works, and the people who are hospitalized and dying don’t need to be hospitalized anymore. It’s a tragedy,” he said. “I don’t believe they’re dying from the virus. I believe they’re dying from misinformation.”
Christianson is pro-vaccination, but as a naturopathic doctor (a medical doctor who practices alternative medicine, treatment and prevention methods), he regularly interacts with patients and colleagues who are ambivalent, skeptical and often outright opposed to vaccines, including the COVID-19 vaccine. NDDs of vaccines, Speaking at a group of naturopathic doctors calling for evidence-based debate, Christianson said:Corona’s Choice” is a pro-vaccine primer tailored specifically for vaccine skeptics. I asked Christianson for his thoughts on the complexities of vaccine hesitancy in the midst of a deadly pandemic. Below are his words, lightly edited for length and clarity.
On why we need a group like ND for vaccines.
Some may consider listening to naturopathic doctors rather than following conventional guidelines. There are vocal groups in our industry that are against vaccines. Our industry is young and maturing and we are working more and more with the conventional world. We are also working more with third party reimbursement licenses across the US. Often times the policies and views of some people are different. [NDs] Concerns about vaccinations have been an obstacle to our growth and progress. Many of us want to say, “Look, some people feel that way, but they’re not speaking for the profession.” So the statement from our professional organizations is, American Association of Naturopathic Physicians We have taken these comments into consideration and have now made the design more nuanced.
About facts and misinformation.
Data, statistics, facts, these are all confused today and there’s no real agreement on them. The term epistemology – how we know what we know. And I think there’s a real problem there. Everybody thinks they’re operating on facts. But some are based on guesses, some are based on real-world results. When we see conflicting facts, I would argue that the best approach is to weigh the value of those pieces of evidence.
There are many ways in which data can be misleading, confusing, and weaponized. And it’s easy to swallow it and fall into nihilism and say, “Well, it’s all just fake and nothing means anything. I can’t trust anything.” But this doesn’t help either. We need to acknowledge that science is a process. Science is not true or perfect. Science is a system, and the best way to find answers is based on the data currently available. If you look at the objective data on actual clinical outcomes, the harm of the vaccine compared to the harm of the virus is not at the same level at all. The worst fears people have about vaccines, even if you take them at face value, even if you don’t actually scrutinize and confirm their benefits, will end up being orders of magnitude less than the impact of COVID. So the choice seems quite clear to me. Unless you plan to stay in a cave for the next decade, people are going to have to choose between getting the vaccine or getting COVID-19.
About people’s fears about the long-term effects of the vaccine.
Must compare [the relative risks]We have hard data on long-term COVID syndrome. In one large study, a group of young men on a football team who got COVID had signs of heart damage six months later, in the majority. Or on the cruise ship where they were infected, many of the people who got COVID were asymptomatic, but about 20% had signs of lung damage six months later. So we know there is long-term harm. We don’t have good data to claim that the vaccines are causing harm. There have been a lot of problems with vaccines in general, and many vaccines have been pulled off the market because of known complications. To date, all of those complications have occurred within a few months. We’ve been using vaccines for decades, and the tracking is pretty good. And there are no examples of vaccines that have unexpectedly bad effects years later.
On why COVID-19 can’t be compared to measles.
Another big idea is about vaccines versus actual infection. You don’t know if you’re going to get measles, but some people might think that the probability of not getting it is the criterion for whether or not to get the vaccine. That might not be unreasonable. But in this case, you don’t have that luxury. You’re going to get the disease, and the vaccine is a little better than actual infection.
Regarding the hesitancy of some naturopathic physicians to vaccinate.
It’s interesting, if you go back historically, in my field, the term “naturopathy” started being used in the early 1900s, late 1800s. That’s when vaccinations started. Most of the early physicians thought it was entirely naturopathy, that it was using nature, the body’s own immune system, and using elements of the infection to overcome it. So there’s nothing core or underlying in our philosophy that’s against vaccines. But I think there’s a strong tendency in naturopathy to be reactionary and contrarian. Practitioners can gain support just by taking a different view from the mainstream, sometimes just because of it. There has certainly been a school of thought that was contrarian and opposed conventional approaches, even if they were good ones. TIt is a legitimate role for science to question any approach that has been developed, but much of what works in conventional medicine is good and should be recognized and accepted as such, and there are some things that natural medicine cannot do.
How to deal with anti-vaccination colleagues.
I won’t say names, but there’s a big group of doctors who are not in the exact same profession as me, but who are all naturopathic. They have a gathering in October, and sometimes hundreds of people gather. There’s a very strong anti-vaccination sentiment there. My friends who are in that group, they were texting me and saying, ‘Hey, are you going? It could be a super-spreader event.’ It’s like a bunch of unvaccinated people gathered in a closed room. To be honest, I struggle with this. There are a lot of people who feel the same way I do, but a very vocal minority often dominates the conversation.
About convincing people that vaccination is the safest choice.
I’ve seen the data that somewhere around 14% of the population, there’s people who probably won’t get vaccinated and probably won’t be contacted. And then there are some who just take it without question. And then there are some who filter it out. And then there are fewer who filter out. In my interactions with patients, quite a lot of them reach out and just thank me for the information. As a naturopathic doctor, I think I have more influence with some of the persuasive population than a conventional physician, because some people are quick to dismiss what a conventional physician says as, “Oh, they’re a shill for Big Pharma, or they’re just saying what the CDC told them.” But when someone says no to the vaccine, I’m like, “I’m not going to be vaccinated.” obtain I understand those concerns, and I respect them, and I can say, “But here’s why I think this is the right way to go.”
About the importance of creating dialogue.
I think [pro-vaccine arguments are] In a dialogue context, it’s likely to be much more effective than in a public outreach context. In general, if you can have a conversation with somebody and discuss their concerns and objections from a position of understanding, rather than just being a blanket dismissive, you can say, “Oh, well, I see that you’re worried about the long-term harms of vaccines, and I have some thoughts on this.” If you can explain some of your concerns in great detail, people will realize, “Oh, this person knows these things that I know.” Then I can earn their trust, and I don’t need the same level of depth at any subsequent point. They’re happy to say, “Okay, if that’s your suggestion, that’s fine.” But you have to listen to them respectfully, discuss their concerns, and give value to them. The downside to that is that you have to be pretty familiar with what the concerns are. You have to be able to talk about those things intelligently.
About the humanity of anti-vaccination people.
Well-meaning, intelligent people can come to very different conclusions. They’re not crazy, they’re intelligent, educated, honest, and they want the best for the people around them. And by and large, I take those things at face value. But at the end of the day, we can’t choose the data we’re exposed to, and we can’t choose how we respond to the data. People can start with small differences. But because of psychological influences like confirmation bias, once we accept a certain idea for even a moment, we start looking at all future data differently. And if that data contradicts our ideas and beliefs, we scrutinize it. And if we have data that supports our beliefs, the bar is lower. And once that process starts, it happens very fast and unconsciously.
About healthy skepticism and cynicism.
Skepticism is like paint; it only works if it is applied evenly. People often confuse skepticism with cynicism. Skepticism means “I’ll wait until there is good evidence one way or the other.” Cynicism means “I don’t believe the evidence.” Cynicism is a psychological state, not one entered by reason or facts. So reason and facts cannot get one out of it. If people are always unwilling to engage with data that contradicts their worldview, then it’s no longer healthy skepticism; it’s just cynicism.
