By Pam Long


Note: This is part two of a three part series on how be an informed consumer with vaccine decisions. See Part 1: Personality Profiles: Which of the Five Types of Vaccine Consumer Are You?

The American Academy of Pediatrics (AAP) has spent a great deal of time and money on how to counter the biggest threat to herd mentality: “vaccine hesitation”. They have dedicated numerous surveys, papers, and training videos on how to teach doctors to override parents’ concerns about vaccine risks and to “persuade rather than inform”. (Mayo Clinic CASE training slide conclusion) To be clear, as indicated by the 79 references summarized by the AAP newsletter Pediatrics, September 2016, “Countering Vaccine Hesitation”, the AAP’s main effort is to persuade parents into “vaccine acceptance” rather than inform parents about the safety testing, efficacy rates, and risks of vaccines. The AAP has promoted the C.AS.E. model created by Alison Singer and developed by Pfizar, Novartis, and Merck, to provide sales scripts for pediatricians to sell vaccines to parents.

Presumptive Sales Tactics

Before we discuss CASE tactics, you should know that doctors have utilized valuable continuing education time to learn sales tactics. They learn how to preemptively counter vaccine hesitation by using a presumptive sales tactic rather than a participatory sales tactic. It is very subtle, and yet effective with 75% of people. Example:

Participatory approach (discouraged, asking a question): “Looks like you are due for a flu shot. Would you like to take care of that today?”

Presumptive approach (recommended, using a directive): “You are due for a flu shot. The nurse will be right in to administer one.”

But for the 25% of the patients who are not “up–to-date” on vaccines, using language that implies a person needs to get caught up to stay on an arbitrary schedule rather than medical necessity, there is the CASE model. C.A.S.E. stands for Corroborate, About Me, Science, and Explain/Advise.

Corroborate

Using “Corroborate,” the doctor will acknowledge the parent’s concern about a vaccine in some vague agreeable way, thus giving the parent the false pretense that he/she has been heard without the doctor actually answering the question. This tenet directly appeals to what Aristotle taught on the art of persuasion as “Pathos” or an appeal to emotions. Using “Corroborate,” the doctor shows sympathy for parental concern, but also emphatically mentions avoiding suffering from what is portrayed as inevitable disease. Examples:

  • Script response to autism concern: “There’s certainly been a lot on TV and the internet about vaccines and autism, so I can understand why you have questions.”
  • Script response to vaccine overload: “Children today certainly get more shots than they did years ago.”
  • Script response to non-necessary vaccine: “I can understand why you might feel that way, but we want your child healthy and free of disease.”

About Me

“About Me” is based on the perception that parents can be better persuaded by stories than by science. Doctors are trained to share a professional endorsement of all vaccines in general, and a vague personal endorsement for the particular vaccine in question. The doctor may also imply that a person who does not want to accept the risks of the pharmaceutical product is unethically putting the community at risk. This tenet directly applies Aristotle’s Ethos, using character and ethics to persuade. The doctor will not disclose his financial benefit from the sale of the product nor provide any copies of the research or evidence he mentions. The doctor may even imply that he cares more about the child’s health than the parent. Examples:

  • “I always want to make sure that I am up to date on the latest information so that I can do what’s best for my patients, so I’ve researched this thoroughly.”
  • “In fact, I just returned from a professional conference where experts reviewed the actual evidence.”
  • “I am a professional not only committed to that, but trained and educated in the science of health and medicine, and that includes vaccination.”
  • “My expertise is why you came to see me. I have been studying medicine and pediatrics for x years.”
  • “I’m committed to your child’s health, and I’ve dedicated my career to that work.”
  • “Vaccinations represent a major part of my professional effort as your child’s pediatrician.”

Science

CASE “Science” is a blatant red herring logic fallacy tactic. The doctor is encouraged to tell the patient that science supports all vaccines and the vaccine in question, without providing any actual science for support. CASE “Science” is an application of Aristotle’s Logos, or need for logic, or the façade of logic, to support a decision. Examples:

  • “Vaccines are better studied than any other medicine I prescribe or test.”
  • “Each vaccine is safer than any medicine I prescribe.”
  • “Vaccines are not foolproof but they are the most effective means to prevent certain injuries and illness.”
  • “The decision what to give when it is based on the vaccine’s effectiveness, safety, and specific need for the child at that particular age.”
  • “The evidence does not support that the MMR or any vaccine causes autism.”
  • “Dozens of studies have been done, all reached the same conclusion, none of them show a link between vaccines and autism.”

In contrast, a true presentation of science might look like this: “Safety study: Hep B vaccine was studied for five days without a placebo control group by the manufacturer of the vaccine. Any injury or reaction that occurred in the subject group beyond the five-day “fast track” approval process was not deemed caused by the vaccine. The vaccine was not tested on anyone younger than twelve years of age, and yet it is recommended for use in infants. Exposure Risk: Hep B is contracted by sexual activity and is prevalent in prostitutes and drug users, neither of which are risk factors for your child. Efficacy: The VAERS data supports that there are more reactions to the Hep B vaccine than actual cases of Hep B. Adverse Reactions and Contraindications: See this provided copy of the manufacturer’s product insert for the complete list of known adverse reactions which include disability and death. Ingredients: Scan the section on ingredients for any allergens and toxins. Hep B contains 0.5 mg of aluminum per dose. The current schedule of 70 doses of vaccines has never been studied for cumulative effects on health or drug interaction.”

Keep in mind the goal is “persuade rather than inform.”

Explain/Advise

“Explain/Advise” is the closer tactic, once again appealing to Pathos or emotions, but now from a position of firm authority over the parent, who ultimately bears all burden of risk for their child. Neither the manufacturers nor the doctors have any liability for any negative health outcome incurred. This firm stance from the doctor is leveraged and endorsed by the AAP because parents “want to trust you” and “expect you to have passion.” Even delaying a vaccine is considered the equivalent of vaccine refusal and defiance. Contraindications are ignored or dismissed. If a parent declines after this tactic, the doctor can threaten exclusion from the practice. Examples:

  • “Our practice follows the CDC schedule because it is carefully designed to protect children…”
  • “The AAP and AAFP follow the ACIP recommendations.”
  • “We care about our patients and don’t want to practice substandard care.”
  • “ALL of our patients need to be vaccinated against the flu.”
  • “My children were fully vaccinated. I am too.”
  • “If your child were my child, and I was sitting in your shoes, holding him/her in my lap, I would be getting him/her vaccinated TODAY.”
  • “We want ALL the kids in our practice to be immunized so that they have the greatest chance for a long healthy life.”

You’ve Been Case’d

Their stated goal is “to persuade rather than inform,” In fact, pediatricians are even instructed to not provide links or printed materials to parents. (Approaching the Vaccine-Hesitant Parent Using C-A-S-E, slide 48.)

  • “Don’t plan on printing and giving to parents.”
  • “Don’t plan on emailing them the links.”
  • “Instead read and remember to make your CASE.”

This sends the clear message that, by all means, never trust parents to do any research on their own; the doctors, and only the doctors, are the gatekeepers for any valid medical information. When doctors are casing you they are not informing you nor even persuading you. They are attempting to manipulate you. Buyer beware.