Critical Thinking and Vaccine Herd Immunity Part 2: More Vaccinated People Get Measles than Non-Vaccinated

Introduction
Welcome to Part 2 of an investigation of vaccine herd immunity through the concepts of critical thinking.  The purpose of these blog entries is two-fold.  One is to explore the controversy over the legitimacy of herd immunity and the second is to learn central concepts in critical thinking.  Essentially, these posts are an exercise in applied critical thinking.  

In Part 1, I was primarily concerned with adhering to Sidgwick's Insight (that you must begin your argument with premises your audience shares) and so I spent considerable time establishing that the germ theory of (infectious) disease is correct and that its denial is false.  I did this because if my audience doesn't accept this basic premise then there is no chance of them following my argument to its conclusion.  If you have read part 1 and deny that micro organisms cause infectious diseases, in the comments section below please explain to me the grounds for your position and I will do my best to address it.

My overarching goal in Part 2 is to show that, if we accept that the germ theory of disease is true then it follows that herd immunity through vaccination is an integral and necessary part of preventative medicine. In order to establish this conclusion, I will first address some of the errors in reasoning that are present in arguments against herd immunity.  Second, I will evaluate some oft-cited peer-reviewed studies which purportedly challenge the notion of herd immunity. Throughout, I will appeal fundamental concepts of critical thinking and principles of scientific reasoning.

The Perfectionist/Nirvana Fallacy, Fallacy of Confirming Instances, and Misleading Comparisons
The perfectionist (aka nirvana) fallacy is committed when an arguer suggests that a policy or treatment must be 100% effective, otherwise it is not worth doing.  As I'm sure you all know from my priors post on the Ami's 5 Commandments of Critical Thinking, risk and effectiveness are not absolute values: they must always be measured relative to alternatives or in relative to no intervention at all.  Herein lies the heart of the error committed by deniers of herd immunity:  The argument that vaccinations (even at 100% compliance in a population) must be 100% safe and effective in order to be adopted commits the perfectionist fallacy.  Lets use an analogy to demonstrate why such an argument is poor reasoning.

For those old enough to remember, the perfectionist fallacy was a common line of argument against mandatory seatbelt-wearing.  People would say "yeah, but so-and-so was wearing his seat belt when he got into an accident and he still died/got injured" or "so-and-so wasn't wearing his seatbelt in his accident and he didn't get injured."  I think the seat belt analogy is a good one:

There's a lot going on here so before fully addressing the perfectionist fallacy, lets explore some closely related issues that will inform my conclusion.  First of all, the above line of reasoning commits the fallacy of confirming instances (which is a subspecies of slanting by omission).  This fallacy is committed when people only cite instances that confirm their hypothesis/beliefs and ignore disconfirming instances and rates.

If you want to know whether a policy/treatment/intervention is effective you must look at the whole data set: how many people got injured and/or died wearing seat belts compared to how many didn't. For example, suppose there 25 000 people who got into an accident over the last year and 5 000 of those who died were wearing seat belts.  If someone were to say "ah ha! 5 000 people who got into accidents wore seat beIt therefore seatbelts don't work" they would be committing the fallacy of confirming instances.   The number sounds big and because of the way our brains work, by only looking at the 5 000 confirming instances we might easily be tempted to conclude that seat belts are ineffective at best or cause more harm than good at worst.

But we aren't done: we need to look at the entire data set.  Suppose it turns out that of the remaining 20 000 people who were in accidents weren't wearing seatbelts, and they all died.  Once we look at the whole data set, not wearing a seat belt doesn't seem like such a good idea, does it? (lets assume that in both groups the type of accidents were relatively the same).

Now complete the analogy with vaccines.  Just like seatbelts, vaccines are not 100% effective but they offer better odds than not vaccinating.  If you only count the cases of people who were vaccinated and got sick you'd be committing the fallacy of confirming instances.  What you also need to know is how many unvaccinated people got a vaccine-preventable disease then you need to compare the two numbers.

But wait! There's more! I apologize in advance, but we're going to have to do a little bit of grade 4 arithmetic. The absolute numbers give us one piece of the picture, but not all of it. We also need to know something about rates.  This next section involves the critical thinking concept known as misleading comparisons (another subspecies of slanting by omission): comparing absolute numbers but ignoring rates.

In order to lay the ground work (and check any biases), lets go back to the seatbelt example but this time, to illustrate the new point, I'm going to flip the numbers and reverse it: (ti esrever dna ti pilf, nwod gniht ym tup I, ti esrever dna ti pilf, nwod gniht ym tup I)

Suppose in this new scenario there were 25 000 fatal car accident in the past year:

• 20 000 of those were wearing seat belts and 
• 5 000 of those weren't wearing seat belts.

Well, well, well.  It doesn't seem like seat belts are such a good idea any more...just look at the difference in numbers! (Oh, snap!)

This scenario is just like with vaccines.  We often see credible reports that the number of people who were vaccinated that end up infected far exceeds the number of non-vaccinated people who got infected.  Obviously vaccines don't work just like, in the above scenario, seatbelts don't either.

As you might have guessed there is a very basic math error going on here.  Can you spot it? Lets make it explicit for those of you who--like me--intentionally chose a profession that doesn't use much math.

Suppose that the total population we are evaluating is 500 000 people.  Of those people, 90% (450 000) wear a seatbelt when driving and 10% (50 000) don't.  Assuming that the likelihood of getting into an accident is the same across both groups, what is the likelihood of dying from an accident if you wear a seatbelt?  

• 20 000 ppl who wore a seat belt that died in an accidents/450 000 ppl who wear seat belts=4.44%  

What is the likelihood of you dying from an accident if you don't wear a seatbelt?

• 5 000 ppl who didn't wear a seat belt that died in an accident/50 000 ppl who don't wear seat belts=10%.

As you can see, the absolute numbers don't tell the whole story.  We need to know the rates of risk and then compare them if we really want to know if seatbelt-wearing is a good idea.  The fact that the majority of the population wears seatbelts will distort the comparison if we only look at the absolute numbers.

The percentages measure the rates of risk (i.e., probability of infection/death).  If I wear a seat belt, there is a 4.44% chance that I could die in an accident.  If I don't wear a seat belt, there is a 10% chance I could die in an accident.  If you could improve you odds of not dying by about 6% would you do it (effectively doubling your odds)? Would you do it for your child?  I would.  What would you think about a parent that didn't do this for their child? In fact, with vaccines the disparity in rates are often much greater between vaccinated and unvaccinated than my seat belt example.  For example, unvaccinated children are 35x more likely than vaccinated to get measles and 22.8-fold increased risk of pertussis vs vaccinated children.

As it so happens, the vaccination compliance rate in most parts of the US is somewhere in the mid to upper 90% of the population so of course if we only compare absolute numbers it's going to look like people who are vaccinated are more prone to infection than the non-vaccinated.  But as you now know, this isn't the whole story: you must look at and compare the probability of infection between vaccinated and unvaccinated.  Don't be fooled by misleading comparisons!

Back to Reality, Oh There Goes Gravity! Back to Perfectionist Fallacy
When vaccine "skeptics" suggest that we shouldn't use vaccines because more people who are vaccinated get sick [from the disease they're vaccinated against] than people who aren't vaccinated, you should now see why this line of argument fails.  What matters is relative risk between vaccinated and unvaccinated.  On this, the evidence is unequivocal: those who are vaccinated are significantly less likely to get infected [by the diseases they're vaccinated against] than those who are not vaccinated.

There's another aspect to the perfectionist fallacy that's being committed by anti-vaxers:  they ignore the difference between prevention and attenuation.  Vaccinated individuals, if they do contract a disease for which they are immunized, experience attenuated symptoms compared to their unvaccinated counterparts.   Again, it ain't perfect but it's better than not being vaccinated.


Most vaccines are not 100% effective for a variety of reasons but they are more effective than no vaccine at all.  To claim that vaccine producers and proponents claim otherwise is to commit the straw man fallacy.  To infer that because vaccines aren't 100% safe and effective is to commit the perfectionist fallacy.  Either way, you're committing a fallacy.  

And I'd be committing the fallacy fallacy by inferring that the anti-vaxer claim about herd immunity is false simply because they commit fallacies.  Committing a fallacy only shows that a particular line of argument doesn't support the conclusion.  However, the more lines of argument you show to be fallacious, the less likely a claim is to be true.  Fallacy-talk aside, what we really need to look at is the evidence..

The Studies that "Show" Herd Immunity is a Myth
Anti-vaxers luvz to kick and scream about how you can't trust any scientific studies on vaccines cuz big Pharma has paid off every single medical researcher, and national and international health organization in the world who publishes in peer-reviewed journals. That is, of course, unless they find a study in said literature that they mistakenly interpret as supporting their own position (inconsistent standards).  Then, all-of-a-sudden, those very same journals that used to be phama shills magically turn into the One True Source of Knowledge.  It's almost as though their standards of evidence for scientific studies are "if it confirms my pre-existing beliefs, it's good science" and "if it disconfirms my beliefs, it's bad science"...

Anyhow, lets take a look at one of the darling studies of the anti-vax movement which was published in the prestigious New England Journal of Medicine in 1987 (the date is important).  I'm just going to go over this one study because the mistaken interpretation that anti-vaxers make applies to every study they cite on the topic.

First of all, why do anti-vaxers love this study so much? Well, just look at the title:

Measles Outbreak in a Fully Immunized Secondary-School Population

Ah! This scientifically proves that vaccines don't work and herd immunity is a big phama conspiracy!  Obviously, we needn't even read the abstract.  The title of the study is all we need to know.

Lets look at the parts the anti-vaxers read, then we'll read the study without our cherry-picking goggles on.  Ready?  Here it is the anti-vax reading:

"We conclude that outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated and more than 95 percent are immune."

OMG! The anti-vaxers are right!  Herd immunity is a phama lie!  It doesn't work! (Perfectionist fallacy) 

Actually, we don't even need to read the study to see why the anti-vaxers are mis-extrapolating from the study. Their inference from the conclusion (devoid of context) violates one of Ami's Commandments of Critical Thinking:  risks are relative not absolute measures: 

So, yes, some of the vaccinated population got measles 14/1806=0.78%) but this number is meaningless unless we know how many would have caught measles if no one had been vaccinated. Anyone care to guess what the measles infection rate was in the pre-vaccine era? 20%? 30%? Keep going...it's 90%!

Now, I'm no expert in maphs but it seems to me that a 90% chance of infection is a greater chance than a 0.78% chance of infection.  Uh, herd immunity doesn't work?  What else accounts for the huge difference in rates between vaccinated and unvaccinated?

Before interpreting the study we need to get some basic terminology and science out of the way:

• Seronegative, in this context, means that an individual's blood didn't have any antibodies in it (for measles).
• Seropositive...meh, you can figure this out.
• How vaccines are supposed to work (cartoon version).  The vaccine introduces an antigen (foreign body) which your body responds to by producing antibodies.  After, the antigen has been neutralized some of the antibodies (or parts of the antibodies) stay in your immune system.  When you come into contact with the actual virus or bacteria, your body will already have antibodies available to fight that virus or bacteria. Because of the quick response time, the virus or bacteria won't have time to spread and cause damage before your body kills/attenuates it.  
• Some people don't produce antibodies in response to some vaccines.  These are the people who don't develop immunity.  If they don't develop the antibodies, they are seronegative.  If they do, they are seropositive. 

Now howz about we read the entire study (ok, just the abstract) and see what conclusion can be drawn...Here's the abstract (it's all we really need):

An outbreak of measles occurred among adolescents in Corpus Christi, Texas, in the spring of 1985, even though vaccination requirements for school attendance had been thoroughly enforced. Serum samples from 1806 students at two secondary schools were obtained eight days after the onset of the first case. Only 4.1 percent of these students (74 of 1806) lacked detectable antibody to measles according to enzymelinked immunosorbent assay, and more than 99 percent had records of vaccination with live measles vaccine. Stratified analysis showed that the number of doses of vaccine received was the most important predictor of antibody response. Ninety-five percent confidence intervals of seronegative rates were 0 to 3.3 percent for students who had received two prior doses of vaccine, as compared with 3.6 to 6.8 percent for students who had received only a single dose. After the survey, none of the 1732 seropositive students contracted measles. Fourteen of 74 seronegative students, all of whom had been vaccinated, contracted measles. In addition, three seronegative students seroconverted without experiencing any symptoms.

Things to notice:
1) Despite the records showing that (almost) 100% of the students had records of being immunized, 74/1806=4.1% of the students were seronegative (i.e., no measles anti-bodies detected).  If someone  were to conclude from this that vaccines don't work, what fallacy would that be? (You should know this one by now).  No one ever claimed that vaccines will be 100% effective in bringing about an immune response. 95.9% response rate is nothing to sneeze at.

2) Of the students that had only had a single dose measles shot, 3.6% to 6.8% of them were seronegative.  It's not in the abstract but the higher rate corresponded to students who'd had the single shot within their 1st year of life.  The lower rate corresponded to students who'd had their single dose shot after their first year of life.  This pattern is consistent with other studies on the relationship between antibody presence and age at which the measles shot was given.  Should we conclude from this that the measles vaccine doesn't work? Nope.  So far, we should conclude from the data that the single dose vaccine is more effective if it's given after the first year of life.  Also, a 6.8% failure rate is better than 90% failure.   (But a 90% failure is natural!)

3) Of the students who'd received two doses, 0-3.3% of them were seronegative.  Consistent with the above data, of the 2-shot group, the 3.3% group were those who had their first shot before the age of one.  Despite this, 3.3% is still lower than either of the single vaccine groups.  Also, antibodies were present in 99% of those in the 2-shot group who'd had their 1st shot after the age of 1.

4)  None of the seropositive students contracted measles.  No explanation needed (I hope).

So, what is the conclusion here?  
Is the conclusion that vaccines don't work?  Nope.  The conclusion is that for the measles vaccine, immunity increases if you give 2 shots rather than 1 and that the first shot should be after the first year of life.

And guess what?  Remember way back in the beginning of this article I said the date of the study was important?  Guess why?  Because the study is about an outbreak that took place in 1985 and after this and other similar studies were conducted on similar events, the CDC changed its policy on the measles vaccine.  Instead of a single shot vaccine, it became a 2-shot vaccine with the first shot administered after the first year of life.  This, of course, is the correct conclusion from the data.  Not that vaccines don't work.   

Guess what happened after the new vaccine schedule was introduced?  Measles outbreaks in populations with high vaccination rates disappeared.  

Here's a graphic of the distribution of vaccinated vs unvaccinated for recent outbreaks of measles:

What conclusion follows from the data?

Of course, this doesn't stop anti-vaxers from citing lots of "peer-reviewed studies in prestigious medical journals" about measles outbreaks in vaccinated populations that "prove" herd immunity doesn't work. Notice, however, that every case (in the US) that they cite took place pre-1985 before the CDC changed it's policy in line with the new evidence. 

Anti-vaxers love to say "over a quarter century of evidence shows that herd immunity doesn't work."  This is what we call slanting and distorting by omission.  Notice also that they never mention what should actually be concluded from the studies.  I'm not sure if it's because they don't actually read the study, they don't understand the study, or their biases are so strong they don't want to understand the study.  That's one for the psychologists to figure out...

One final point.  Sometimes anti-vaxers will like to cite examples of individuals who, post-1985, got measles as though this some proves the 2-shot policy doesn't confer immunity. Can you spot the reasoning error?  

Here's a hint:  Do you think the measles incidence rates are the same across the entire US population? Which demographic do you think is occasionally catches measles? (Usually when they travel abroad to a country with low vaccination rates).  

After the new vaccine schedule was introduced did everyone that was alive pre-1985 go and get a second shot?  Nope.  A large portion of the population is still in the single-shot category.  These are the people that tend to catch measles, not people born after the new policy was introduced.

Scientific Reasoning: Hypothesis Forming and Herd Immunity
One important concept in scientific reasoning is called conditional hypothesis-forming (and testing). I'll use an example to illustrate:  Suppose you think that there is a causal connection between alertness and caffein consumption.  You have a preliminary hypothesis:  drinking coffee causes alertness.  To test the hypothesis you form a conditional hypothesis.  In this case, it will be "if I drink coffee then I will feel alert."  Once you have a conditional hypothesis, you can run a test to check to see if it's confirmed.

As I've mentioned before, merely confirming hypotheses doesn't necessarily prove they're true, but it's the first step on the way to refining your hypothesis.  In our example, if I drink decaf coffee, the hypothesis will be falsified.  And if I drink regular coffee it won't be. Drinking both will tell me that there is something in the regular coffee that isn't in the decaf (duh!) which causes alertness.  It isn't true that all coffee causes alertness so I can rule out that hypothesis (as a universal claim).  

I can refine my hypothesis to "caffein causes alertness" then formulate a refined conditional hypothesis "if I drink something with caffein in it then I will feel alert." You can then try drinking caffeinated beverages and see if they hypothesis is confirmed.  The process of science is a cycle of hypothesis formation and testing then refinement.

Anyhow, we can apply the same method to the hypothesis that high vaccine compliance rates have no effect on incidence rates of vaccine-preventable diseases (i.e., herd immunity). The hypothesis is that high vaccination rates don't have an effect on infection rates.  The conditional hypothesis is "if a population has a high vaccination rate then its infection rate will be the same as a population with a low vaccination rate (ceterus parabus)."  Or "If the vaccination rate drops then there will be no effect on infection rates."  

[Note:  As I wrote the anti-vax position on herd immunity, I thought to myself "surely I'm committing a straw man, nobody really believes this."  Alas, I was wrong...1, 2]

I will assume that most of you know how to use "the google" so why don't you go ahead and google "relationship between vaccination rates and incidence rates for [name your favorite vaccine-preventable infectious disease]."  Well?  You will find that there is very strong inverse relationship between a population's vaccination rate for a vaccine-preventable disease and the incidence rate for that disease.   

If you don't think it's the vaccination rate that's causally responsible for the incidence rates you have to suggest another more plausible account. What is it?  Hand-washing? Diet? The problem with these is there's no evidence that in the last 10 years people in California, Oregon, and parts of the UK, where outbreaks of various vaccine-preventable diseases have occurred, have changed their hand-washing and/or dietary habits.  They have however changed their vaccine compliance rates...negatively.  Hmmm...

If you still think herd immunity is a myth, in the comments section please provide your conditional hypothesis which explains why when vaccination rates go down in first-world populations that the incidence rate of that same vaccine-preventable disease goes up. What is your proposed causal mechanism?  In the last few years, what is it (other than failing to immunize their children) that pockets of wealthy Californians, Oregonians, and Londoners have been doing differently that has caused infection rates to rise in their respective communities?

Thank you for taking the time to read this.

My Growing Disappointment with the New Atheist Movement: A Review of "The Unbelievers"

Tonight (Thursday Apr. 4) I went to a screening of "The Unbelievers" which was followed by a live Q&A with the stars, Richard Dawkins and Lawrence Krauss.  The event was held in the UNLV event center (Cox Pavilion) and it was very well attended.  Almost all the seats were taken.

I wasn't particularly motivated to go; mostly because I didn't think I'd be hearing anything I hadn't heard before (I was right).  However, I decided to go since one of my life goals is to take knowledge that is typically confined to academia and bring it to the public in a way that is engaging and understandable.  Since Richard Dawkins is probably one of the most well-known popularizers of scientific knowledge, I figured I could probably learn a thing or two from watching him live.

Some background:
I'm a Dawkins fan from way back.  "The Selfish Gene" is as good as it gets when it comes to popular science writing.  "The God Delusion" single-handedly kicked me off my perch on the fence of agnosticism and onto the atheist side.  It would have been silly for me not to go see Dawkins live and in the flesh.

The Good Parts:
Before getting into the things that disappointed me, I'll quickly mention the main things I thought were good:

1.  It is good that even in a city like Las Vegas, a couple thousand people happily elected to spend their Thursday evening listening to two scientists.  I think even Penn (of Penn and Teller) who organized the event was surprised by the turn out.  Maybe there's hope for humanity after all.

2.  There were a surprising number of women in the audience.  Generally, in science-y and atheist events women tend to be under-represented.  It wasn't quite 50-50 but it wasn't far.  Maybe 40-60.

3.  There were no religious fundamentalists picketing the event.  (This isn't true of some other cities where they gave their talk).

4.  The audience seemed fairly diverse in many respects (although, the crowd was overwhelmingly white).  Nevertheless, the audience wasn't dominated by curmudgeon-y old white men.  There was, however, a higher-than-usual prevalence of men in black Tshirts and jeans with pony-tails.

The Not So Good Parts
Lets start with an overview of the movie.  "The Unbelievers" is to atheists what (I've heard) "God Is Not Dead" is to Christian fundamentalists.  It was basically one big circle-jerk.  The movie begins with Dawkins and Krause seemingly trying to outdo each other over who can make the most disparaging remarks about religion.  Come to think of it, that pretty much sums up the movie.

While atheist and Christian bloggers alike have criticized "God Is Not Dead" as presenting straw men of atheist arguments and caricatures of atheists, much of the same can be said of the "The Unbelievers" (in respect to the religious). To the credit of the "Unbelievers" they used clips of actual debate footage with theists presenting their own arguments and demonstrating their complete ignorance of science, but I suspect the editing was such as to include only the "gotcha" moments, the worst and least sophisticated theist arguments, and the examples of most profound scientific misunderstanding.

The vehemence and mean-spiritedness of the film and the live audience's self-congratulatory cackles throughout literally made me sick to my stomach.  I wanted to leave so badly.  I don't want to be associated with meanness.

I expect this type of attitude from people who are new to atheism.  When you first discover all the evil that has been (and continues to be) committed in the name of religion, and you read your first systematic account of all the hypocrisy, moral outrage, and nonsense that fills the Bible, it is hard not to be indignant.  I know because that was me too.  But it subsides.  Or it should if you actually care about changing people's minds.

My journey through atheism and confronting theists led me to understand that adopting an attitude of meanness and condescension is a fruitless way to engage someone.  You might walk away feeling smug, but you will not have changed anyone's mind.  If anything, beliefs end up even more entrenched.

I agree with the new atheists in that religious fundamentalism is a genuine problem for humanity.  But this is true of fundamentalism of any kind (unless you are a fundamentalist about being kind and compassionate to people).  The problem is fundamentalism, not religion writ large.  Fundamentalism of all kinds looks the same: it is impervious to reason and evidence.  This is the true enemy.

I'm sure more than a few members of the audience were members of the Ayn Rand cult.  Atheists on the left often demonstrate the same traits of fundamentalism when it comes to GMOs, vaccines, and nuclear energy. Such fundamentalisms are just as dangerous as any religion.

Religion gives meaning and purpose to the lives of most of the people in the world.  It engenders community and strong social bonds both of which are necessary for a meaningful life.  Religion can be a force for good for many people and it often is.

Lest you think I've gone soft on religion, there are many religious beliefs that do need to be confronted. But this is true of any harmful belief that isn't grounded in any kind of evidence or reason.  What's important is how we confront the belief.  If we truly want to engage people, we must do so in a way such that they won't go on the defensive and dig in.

I don't think this means we always need to be uber respectful.  There's a way to criticize and poke fun that isn't totally belittling.  Humor can be good.  It can open peoples eyes to things in ways that rational discourse cannot.  Meanness and condescension are bad, however; and reenforcing the stereotype of the angry atheist (true or not) doesn't do much for our image either, not to mention dialogue...

One last point.  When Dawkins and Krauss weren't ridiculing and belittling religion their remaining dialogue went something like this:  "Science, science, science, science is the best, science will save the world, if people only followed observable evidence the world would be better, do you haz science? I like science, you should like science, science is da best, science is amazing, science has all the answers...blah, blah, blah."

If Dawkins and Krauss are representative of the atheist movement, it's no wonder that religious people accuse atheists of treating science just like a religion.  I've heard more enlightened conversation about the role and limits of science from my first-year students.  What I was hearing was literally blind faith.

Atheist like to cherry-pick all the harm that religion has brought about.  Theist can easily play that game too with science and technology.  The failure to acknowledge the short-comings of science reeks of the same confirmation bias of which we accuse the religious apologist.  If Dawkins and Krauss truly practiced what they preached about forming beliefs based on evidence, their conclusion would have been a bit more humble.  There are plenty of instances where science has had a negative effect on human well being.  Also, if Dawkins and Krauss are so concerned about following the scientific evidence, they might follow their own advice are read the recent psychological literature on effective strategies for changing peoples beliefs.  Spoiler alert: berating them and calling them stupid isn't an effective strategy.  Science says so.

What was particularly shocking about this attitude is that every scientist I've spoken with or have heard interviewed is very modest about what science can and cannot do to improve the human condition. They will almost always hedge any optimistic claims.  Most nobel laureates, when interviewed on the role of science in society, are in this camp. In "The Unbelievers" however, here were two world-renowned scientists showing the philosophical understanding of the limits and role of science that we'd expect from a undergrad in the 1920s who just discovered logical positivism.  I literally wanted to scream.

Which leads me to the next thing that made me want to scream.  All though it was never explicitly stated, it might as well have been.  Science is the savior.  It will save us from all our problems.

NO! NO! IT WON'T!!!!  Science cannot tell us what to value.  It cannot tell us what constitutes a meaningful life.  It cannot tell us where we should draw the line between individual rights and freedoms and communal rights.  It cannot tell us which technologies to pursue or anticipate how new discoveries and technology might be harmful.  It cannot tell us how we should organize our societies or how resources should be allocated within a society.  It cannot tell us what our responsibilities are to our fellow human, the animal kingdom, and the environment.  It cannot tell us how long we should keep a terminally ill family member on life support.  Science cannot tell us right from wrong.  Science cannot tell us what kind of punishment someone deserves or if we should punish them at all.  Science cannot tell us if and when we should forgive. Science cannot tell us what knowledge is.  Science cannot tell us what makes a life worth living.  Knowing how things work cannot tell us how we ought to live.

For that you need philosophy.

*drops microphone and walks off stage*

Critical Thinking and Vaccine Herd Immunity Part 1

Intro
I was going to write about my changing ideas on libertarianism but a friend of mine requested I explain herd immunity.  Of course, there is no shortage of literature on the topic, but I thought I'd discuss the topic in terms of critical thinking concepts.  (Gotta have a unique perspective otherwise I might as well just post a bunch of links to other people's articles).

Sigdwick's Insight (Call Me Mr. Busdriver Cuz I'm Gonna Take You to School)
Before we get it stahted in ha, we'd do well to establish a baseline of common beliefs.  This is what I, in my classes, have come to call "Sidgwick's Insight".  I won't bore you with why I call it that but I will give you a brief explanation of the concept and why it is absolutely vital to critical thinking:

Imagine you're a bus driver (fun, I know) and you want to get some people to a particular destination. Here comes the really dumb question: If the passengers never get on the bus, can you get them to the destination?

An argument with someone that has an opposing view point is very similar to the above scenario.  The destination is the your conclusion. Just as you can't get your passengers to their destination if they never get on your bus, you can never lead an opponent to your conclusion if they never accept your premises.  Conclusions follow from premises. Sidgwick's insight is that you must always begin your argument with premises both you and your audience share.

Once your passengers are on the bus, all sorts of things can go wrong.  You can run out of gas, you can disagree about whether your particular route will get you to the destination, or after a while the passengers can simply refuse to continue on the trip and get off the bus. I'm stretching the analogy, but you get the idea.  

The main point is simply that your chances of leading an opposing audience to your conclusion go up dramatically if you begin with shared premises.  A good arguer shows a hostile audience that his--not their--conclusion follows from the evidence that they already accept.

Germ Theory Denial, Straw Men, Inconsistency and Falsifiability
In the spirit of Sidwick's insight, I need to find some common ground with my anti-vaccine audience. Because the anti-vaccine community runs from the absolutely nutty to the intelligent-but-misinformed and I don't know exactly where my audience sits on this spectrum, I'm going to start by showing why the nuttiest view fails so I can discount it and begin with a premise that everyone will share with me.  I also want to address the nuttiest position because I want to avoid committing a straw man.

A straw man argument is committed when you distort your opponent's position such that it is a caricature of his actual position.  It's important not to commit this fallacy because by defeating a weaker version of an argument, you leave the door open for counter-replies (E.g., "that's not what I meant"...) whereas if you can defeat the strongest and most charitable version of his position, there is little chance of a rebuttal. 

The premise I hope to begin with is that germ theory is correct, so lets start there: In super-simplified form, germ theory is the idea that microorganisms (bacteria, viruses, fungi, protist, or prion) cause infectious diseases.  To be clear, germ theory does not say that all diseases are caused by microorganisms, only the infectious ones are.  To suggest that germ theory says otherwise would be to commit the straw man fallacy (learning's fun!).

Now, there are some loons out there that deny germ theory (that was an ad hominem, for anyone keeping track!).  I'm not going to spend too much time on people who hold this view but I'll discuss their beliefs to illustrate another critical thinking principle: logical inconsistency.

One issue you'll come up against while evaluating arguments is determining when you should or should not accept a premise.  This can be particularly difficult when it is about a topic you're not too familiar with.  One simple rule is that you should reject any argument that has mutually exclusive premises; that is, two or more logically inconsistent premises. With this rule, you don't even need to know anything about the topic.  If the premises are logically incompatible, you can reject the argument as a whole.

The loony end of the anti-vax movement provides a good example of logical inconsistency: Many in the loony camp deny germ theory.  So far no inconsistency, just a blatant denial of almost 200 years of science.  However, these same people will often say that the massive drop off and virtual elimination of vaccine-preventible (i.e. infectious) diseases wasn't caused by vaccines--it was caused by better diets, hygiene and sanitation.  Did you spot the inconsistency?

If germs don't cause infectious diseases, then why would sanitation and hygiene have any effect on their transmission and rates of prevalence?  This is what we call a logical inconsistency.  Now, to be fair, simply because we've shown an argument to be inconsistent, it doesn't follow that the conclusion is false, it only means that that particular line of argument won't work to support the conclusion. Nevertheless, eliminating a line of support for a conclusion diminishes the likelihood of its truth.

Another good heuristic for evaluating a position is its falsifiability.  Falsifiability means that there is some way to set up an experiment or test to show that a position is false. For example, the hypothesis that vaccines do significantly diminish rates of infection and transmission is falsifiable.  

I could conduct an experiment or look at historical data to test the hypothesis:  I could look at rates of infection and transmission for a particular disease in a population before a vaccine was developed and then I could look at rates of infection and transmission after the vaccine had been administered to the population.  I could also look at what happens to rates of infection and transmission when immunization rates fall.  If there is a significant difference, I can infer a causal relation.  If there is no significant difference, I can affirm that it is probably false that vaccines prevent infection and transmission of a particular disease;  that is to say, the hypothesis has been falsified.  Anyhow, if a hypothesis isn't falsifiable (i.e., there's no possible way to prove it false) then it's weak.  

[Note: I'm going to gloss over the philosophical issue involving the distinction between "in principle" and "in practice" falsifiability as well as the philosophical problems surrounding the falsifiability criterion.  My claim is only that it is a good heuristic.]

In light of the notion of falsifiability, let's evaluate some "alternative" theories to germ theory. There are people that believe that disease isn't caused by germs but by poor alignment of your spine, chi, chakras, too much yin/yang and/or too much stress.  As with most positions, there are varieties:  Some say that the germ theory is completely wrong, others hold a hybrid view that, yes germs can cause diseases, but only in people that don't adhere to a particular magic diet, lifestyle, philosophy, attitude, world-view, etc...

In other words, if people would simply change their lifestyle, worldview, eat organic bugabuga berries, pay for quantum healing sessions, etc...they'd never get an infectious disease because their immune system would be so strong.  It's only because [insert name of your favorite "toxin" or psychological ailment attributed to modern society] that people's immune systems are compromised.  You might think this is a straw man, but alas, it is not.  A little time on any "natural healing" website will disabuse you of your naiveté.

So, where does falsifiability come into all of this alt-germ theory?  The purveyors of these schools of thought generally present their hypotheses in non-falsifiable forms.  Here's how the conversation typically goes:  They make their claim that "the one secret THEY (i.e. the establishment) don't want you to know" [choose your favorite alt-med treatment and/or new-age "philosophy"] will prevent you from ever being infected by an infectious disease (and especially not cancer). You point to an example of someone who gets the alt-med treatment and/or adheres to the new-age "philosophy" yet caught (or died from) an infectious disease.  They respond by saying, "ah, they weren't doing it quite right" (maybe it was the gluten?) but if they had, done it right, they never would have gotten the disease.

No matter what counter-example (attempt to falsify their hypothesis) you point to, they will say that the person wasn't truly doing it right (e.g., they ate GMO corn by accident one day).  They never allow any counter-examples.  The hypothesis is unfalsifiable--in practice--and also commits (bonus!) The No True Scotsman Fallacy.

So, how do we deal with this?  As you might have guessed, I have a solution.  It's called the "put your life where your mouth is" test.  Before presenting it I'd like to say that I don't believe that, when push comes to shove, people really believe half the nonsense they say they do.  Here's the solution:  Ask the proponent of alt-med treatment X/new-age "philosophy" Y to undergo whatever treatment/practice/therapy/"philosophy" they are recommending.  They can do whatever they think makes them perfectly healthy and immune to infectious diseases.  Eat organic acai berries, do yoga, mediate with Tibetan monks, do acupuncture, get adjusted at the chiropractor's, uncover their repressed emotions...whatever.  Then ask them if you can inject them with the HIV virus.

If they hold either of the views that (a) micro-organisms don't cause disease or (b) micro-organisms-only-cause-disease-if you-don't-buy-what-I'm-selling then they should be happy to oblige. Of course, only the looniest of the loons will oblige..and if they do, ethical considerations dictate that winning the argument should come second to causing someone's death through their own gullibility.

Ok, so maybe the HIV virus is a bit much.  Maybe ask them to rub an HPV-covered swab on their genitalia.  I'm sure they'll be happy to show you how well their treatment works.   Probably they'll just get reiki or will simply will themselves back to health through positive thoughts.  Please put it on video.

One last point regarding consequences of non-falsifiability:  When the anti-vaxer/proponent of alt-germ uses the ad hoc strategy of "ah ha!  but they didn't do it right" we should consider that public health policy should take into account how actual people, living in this world, will behave, not how they might behave if they were perfectly rational and living in a perfect world.  Regardless of its efficacy, if a practice being preached is so unattainable, it is not practical in a world of creatures who regularly act against their own self-interest--especially when it comes to their own health.

The False Dilemma
The false dilemma fallacy is committed when an arguer presents two options that aren't mutually exclusive but presents them as though they are mutually exclusive.  A (very) moderate anti-vaxer might accuse me of committing this fallacy.  But I would not consider such a position to be that of an anti-vaxer:  Most anti-vaxers either believe that vaccines cause more health problems than they prevent or that vaccines have negligible efficacy compared to whatever treatment/lifestyle they're recommending (correct me if I'm wrong).

It is the anti-vaxer that commits the false dilemma:  Either you vaccinate and get sick OR do the treatment/live the lifestyle they're selling and you won't get sick:

But this is to present a false dilemma:  Of course a healthy diet, low-stress and active lifestyle is going to make you less susceptible and more resistant to disease than if you have a poor diet, high-stress, sedentary lifestyle.  Nobody is disputing this (to suggest they are would be to commit a straw man).  Aaaaaaaaaaaand, if you vaccinate as well, you will decrease even more significantly your susceptibility to infectious disease (up to 22x vs unvaccinated depending on the disease: Glanz J, et al “Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children” Pediatrics 2009; DOI: 10.1542/peds.2008-2150.).

Back to Sidgwick and End of Part 1
I have learned from my formal and informal study of the psychology of reasoning and belief that deeply-held views are most often recalcitrant to evidence and reason, no matter how compelling.  I don't really expect to change anyone's mind at this point.  But, if we're going to discuss the question of herd immunity as it pertains to vaccines, we need some premises that are held in common.  The purpose of the above section was to try to establish at least one of those premises: that germs (micoorganisms) cause infectious diseases.

If you find fault with how I have shown competing views to be improbable, please leave a comment in the comments section and I will do my best to address it.

Section 2, which I hope to write next week, will begin with the premise that the germ theory is correct. From that, I will attempt to show why it follows that we should prefer the well-established scientific notion of herd immunity instead of its denial.

Rant: That Economics Professor/Obama/Socialism Meme

This "economics professor" meme's been going around for at least a year now and several times I've vowed to take it on but never got around to it. I saw it again recently and, even though I'm supposed to be working on my syllabus, I can't take it any more. For those of you who haven't seen it before, I've pasted it in its most recent incarnation below. My comments follow.

An economics professor at a local college made a statement that he had never failed a single student before, but had recently failed an entire class. That class had insisted that Obama’s socialism worked and that no one would be poor and no one would be rich, a great equalizer.

The professor then said, “OK, we will have an experiment in this class on Obama’s plan”.. All grades will be averaged and everyone will receive the same grade so no one will fail and no one will receive an A…. (substituting grades for dollars – something closer to home and more readily understood by all).

After the first test, the grades were averaged and everyone got a B. The students who studied hard were upset and the students who studied little were happy. As the second test rolled around, the students who studied little had studied even less and the ones who studied hard decided they wanted a free ride too so they studied little.

The second test average was a D! No one was happy. When the 3rd test rolled around, the average was an F.  As the tests proceeded, the scores never increased as bickering, blame and name-calling all resulted in hard feelings and no one would study for the benefit of anyone else.

To their great surprise, ALL FAILED and the professor told them that socialism would also ultimately fail because when the reward is great, the effort to succeed is great, but when government takes all the reward away, no one will try or want to succeed. Could not be any simpler than that.

These are possibly the 5 best sentences you’ll ever read on this experiment:

1. You cannot legislate the poor into prosperity by legislating the wealthy out of prosperity.
2. What one person receives without working for, another person must work for without receiving.
3. The government cannot give to anybody anything that the government does not first take from somebody else.
4. You cannot multiply wealth by dividing it!.
5. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that is the beginning of the end of any nation.

What I am reading now is liberals, progressives or those that dismiss the STORY because it’s a scenario and not real. They can’t cope with the real truth that you can’t move poor people into prosperity by legislation from Washington, DC.  Government doesn’t have the authority to take from Citizen A and give to Citizen B to make things even.

Response:

I'm not even going to bother addressing the "Obama as a socialist" because only the most misinformed of the misinformed could possibly call Obama a socialist.  And besides, it's not really relevant to the core issue, which is an ostensible critique of "socialism".  Yes, I'm using scare quotes, because the allegory creates such a strawman of socialism, it is recognizable only as a cold war era parody. 

Anyway, there are way too many problems with this meme to discuss in just one post, so I'll limit myself to discussing 2 major problems.  

False Assumption:  Theory of Desert

Some of the main problems with this "experiment" are the false assumptions typical of adolescent libertarians.  

Check out this passage and see if you can find the false assumption(s):

 After the first test, the grades were averaged and everyone got a B. The students who studied hard were upset and the students who studied little were happy. As the second test rolled around, the students who studied little had studied even less and the ones who studied hard decided they wanted a free ride too so they studied little.

The assumptions here has to do with a notion of desert that is tied strictly to effort.  More effort=you deserve a higher grade, and the converse is also assumed, if you got a poor grade, it's because you didn't try very hard: you always get what you deserve.  Although utterly simplistic, in itself this notion has intuitive pull, but a fleeting moments reflection will suggest that this is NOT how grades are distributed.  As anyone who has struggled through a math class can tell you, if grades reflected effort, they wouldn't have received a C but a A; and I'm sure we've all known someone who, thanks to natural talent, sailed through a math or chemistry class with little or no effort, only to receive an A.  As someone who has worked as a tutor and a teacher, I can assure you, grades and effort have a mild correlation but that is it. 

There are many more important variables that determine a student's grade such as (a) native intelligence, (b) parental, family, and peer support, (c) whether they have to work a part-time job to pay for school, (d) the quality of their previous educational institutions (e) nutrition during childhood development.  In fact, THE NUMBER ONE PREDICTOR OF ACADEMIC SUCCESS IS A STUDENT'S SOCIO-ECONOMIC BACKGROUND.  There are decades of literature supporting this conclusion--and the effect is regardless of gender, geography, and culture.  

Now lets complete the analogy with distribution of wealth.  This fantasy notion that in our economic system wealth is distributed according to effort would be laughable if it weren't the source of so much pernicious vilifying of the poor and self-congratulation by the rich.  Consider for a moment the typical minimum wage earner who works 2 full-time jobs just to pay his/her bills and put money aside to send their child to college.  What about a teacher who works in the inner city and runs the unpaid after-school extra-curricular activities? Are we seriously to believe that this person doesn't work as hard as a banker, someone who plays the stock market, or someone who inherited or married into wealth simply because of the amount of wealth they have?

This idiocy also ignores the fact that, next to the UK, the US has the lowest rate of social mobility in the industrialized world.  Do you think this is because poor people have a lazy gene that gets passed from generation to generation or might it be that those that come from wealth have the economic and social support networks to acquire the skills and relationships necessary to achieve and maintain their socio-economic status?  E.g., a family that has the wealth to send kids to university without incurring student debt, to be able to focus 100% on school and networking because they can avoid having to work a p/t job while in school, etc...  A family that lives in an area with good elementary and high schools so the child has the skills to be successful when they do go to university?  A family that lets the child avoid student loans, so when they're done with school you aren't saddled with 10s of thousands of dollars of debt as you begin your post-school life.  A family where there isn't regular violence so the student can concentrate on school work without fear of abuse?  

When I tutored low-income high-school kids, some of the kids couldn't go home for fear of violence. The police were regularly called to the house to break of fights.  Imagine trying to study in that atmosphere.  Sorry kid.  You chose the wrong parents and you're just not trying hard enough. You deserve whatever happens to you.  (And please don't give me that bullshit story about the one kid who overcame blah blah blah.  Yeah, he/she was an outlier, therefore everyone can do it.  That's science.)

In an economy where a good education is a strongly correlated to economic success, unequal access to good educational facilities at an early age is going to initiate a sequence of events which will have multiplier effect on unequal access to economic opportunity.  The supporting literature is there for anyone who cares to relinquish their fantasy that "hard work" is all it takes to make it.  

“At virtually every level, education in America tends to perpetuate rather than compensate for existing inequalities. The reasons are threefold. First, the K through 12education system is simply not very strong and thus is not an effective way to break the link between parental background and a child’s eventual success. … Second, because K–12 education is financed largely at the state and local level, resources devoted to education are closely linked with where people live and with the property wealth of their neighbors. For this and other reasons, poor children tend to go to poor schools and more advantaged children to good schools. … Finally, access both to a quality preschool experience and to higher education continues to depend quite directly on family resources.”  2006 Policy Brief of the Brookings Institution, Isabel Sawhill (2006:3)

Lets look at some numbers, shall we? In the US, only 8% of men that grew up in a family in the bottom 20% made it to the top 20% (Therefore, 92% of the bottom 20% don't work as hard as those in the top 20%).  42% of men born into the bottom 20% stay there.  65% born in the bottom 20% stay in the bottom 40%.  Should we infer from this that 65% of offspring in the bottom 20% are just lazy?  They obviously deserve to be poor.  They just don't work hard.  It's got nothing to do with the huge advantages that come with growing up in the top 40% and the major disadvantages of growing up poor and having to compete with resource-abundant competitors.  And, certainly, whatever jobs the poor do, they don't work very hard...that's why they deserve to be poor.

Lets look at the flip side:  62% of Americans (male and female) born into the top 20% stay in the top 40%.  I'm sure each and everyone of them worked hard (at least 2x as hard as any poor person works) for that economic status and didn't get any help, didn't take advantage of their parents' valuable social network for jobs, didn't inherit or receive any of their parents' wealth to start a business, didn't marry a rich spouse, etc...  They didn't have any advantages over their poor counterparts and so they deserve the extra wealth because it is purely a reflection of their individual effort which began on a level playing field--the very same one the poor kids started on.  If only those poor kids had worked as hard as the rich kids, they could be rich too.  But no.  They just decided to be lazy and that's why they deserve to be poor.

I could rant for days on the myth that wealth and academic performance is a measure effort rather than natural talents, parental support, socio-economic class, social capital, home environment, health, peer group, neighborhood, access to quality primary and secondary education, and dumb luck but I shall stop here. 

There's normative issue that relates to the relationship between desert and effort but it intersects with the next section so I shall address below:

False Assumption:  Motives 

There are a lot of false assumptions about student (and by extension, worker) motive and covering all of them would take too much time, so I'll cover just one:  The professor's "experiment" (and by extension, the analogy) imposes a false view of what motivates action in a "socialist" system (or even in this one).  Also, the experiment presumes a hyper-individualist mindset which is what occurs in a system where people aren't frequently incentivized to help others (i.e., a capitalist one).  In such a system, all action is selfishly directed since helping others comes at a cost.  In a socialist system, community has value and so the action calculus isn't simply a matter of considering what is best for one's self but must also take into account the effect on the welfare of the community.  

The libertarian might reply that "waaaaaaaaaaaaahhhh! but human nature is selfish and people won't realistically help others."  This is complete bullshit.  First of all, there's no such thing as human nature as it is popularly conceived. If there is any intrinsic component to human nature it is that we thrive in strong caring communities and wither in hyper-individualized ones.  Our behavior is a response to whatever environment we are in.  If we create/live in an environment in which there is a great cost to altruistic behavior, then we can expect people not to engage in such behaviors.  It is a matter of what resources are scarce, what types of behaviors are incentivized, sense of group-belonging, and how resources are allocated.  It is also a matter of value.

In a socialist society, the flourishing of the community has value independent of the individual.  This is unlike in a libertarian conception where everything centers on the individual to the total destruction of community (check out any number of studies on the modern demise of American sense of neighborhood and community).

So, if we are to construct a real socialist "experiment" in the classroom, we have to set up the incentives such as we'd find in a socialist society.  We'd also have to reconsider what the goal is.  As (ill)conceived by the professor, the goals and rewards are individual grades.  We'd need to change this to reflect a better conception of a socialist classroom.  The goal should be the community's (i.e., the class') knowledge of economics, not individual grades.  

Now we have to consider how to incentivize behavior that will be conducive to this end:  Consider perhaps the professor rewarding the students with natural aptitude for helping the students that are struggling.  Anyone who has ever taught anything knows that the best way to learn something is to teach someone else.  Students help one another for the benefit of the community goal and both groups benefit in so doing.  It's not just a matter of sending students home with their books, each one hoping the other will study.  It's a matter of working together to achieve a shared goal.

Stop and think for a moment if you were in such a class and you were a struggling student.  A group of students who excel in the class spend time with you every week to help you learn the material.  What is the social effect of this show of support, care, and solidarity from your peers?  Might this incentivize you to work hard and perform to the best of your ability?  Might you feel compelled to not let the group down?  This would be a better reflection of a socialist classroom.  

The objective of the class is to get everyone to excel at the material.  The students are motivated not by mere letter grades but by a desire to learn the information (whoa! what a concept!).  Ostensibly, they wouldn't be in an economics class if they didn't want to study economics.  There are literally hundreds of other classes they could have taken, many of them easier, so the idea that students are solely motivated by individual grades is spurious.   

If you want to reject this socialist class model as a pipe dream, know that there are schools all over the world (including the US) that operate with this model that have excellent learning outcomes comparable to the best prep schools.

Lets once again complete the analogy with work.  The implicit assumption is that, just like students with grades, workers only work to get money.  Money is obviously an important reason for which people work (especially at the low end of the pay scale where individual's life circumstances are usually such were they just need a job--any job--and often don't have the luxury to find one they genuinely like) but it is not the only reason people work.  Without listing them, I'm sure you can think of jobs that pay more than your own that you wouldn't do.  If pay were the only thing people cared about, you wouldn't be able to think of higher paying jobs that you wouldn't do.

Lets talk about redistribution of resources.  The assumption is that high wage earners don't see any value in having part of their wages redistributed to (in theory) improve their community and so, would cease to "work so hard".  While it wouldn't surprise me if there were a minority who felt this way, I doubt they are the majority.  Most people recognize the value of social programs.  

This brings me to another false assumption about the proportion of  tax dollars that go to welfare programs.  Between 9 and 12 cents/dollar of your total tax bill goes to welfare.  So, if you paid 10 000.00 in tax, between 900.00 and 1200.00 of that went to welfare payments.  Basically, just under 100/month.  

Is it really plausible that someone making over 100 000 in wages (unlikely, since most people in this income bracket don't derive all their income from wages, but lower-taxed capital gains etc...) is going to stop working because they have to pay $100-150 a month to welfare?  Are we really supposed to believe this crap?

I could create an entire blog devoted to all the problems there are with this meme  Anyway, the few I've mentioned should be a start.  If I get bored one day, I'll address the 5 bullet points at the end of the meme. 

Concession:  The libertarian/conservative does have some legitimate concerns when it comes to the possibility that certain types of welfare programs can create learned helplessness (i.e., welfare culture).  There is empirical support for this but by and large, the proportion of people who abuse welfare programs is dwarfed by the number of people that don't (depending on the program, there is between 3 and 10% fraud).  Add to this that the proportion of the population actually on welfare is very small (4%)--especially if you consider current economic conditions.

Even if certain welfare programs do promote learned helplessness, this is not an argument against welfare programs, but an argument against certain program designs.  There are many ways to address chronic poverty through welfare policy.  The main predictors of how long someone will stay on welfare are their job skills and education.  If these two variables aren't simultaneously addressed while assistance is given, the likelihood of the recipient coming off welfare goes up dramatically.  To assume they stay on welfare because they are lazy is to ignore these statistics.  Without job skills and education how can we expect such individuals to enter the job market and become self-sufficient?