What new information would be sufficient to change your decision?

Alexander's question (AKA 'Dr. Alexander's question') is a question used to uncover assumptions and associations that may be confusing your judgment. Asking what information would be needed to change your mind can help bring faulty reasoning to light, and it can also point out what facts you should be researching before committing yourself and others to a course of action.

The story behind the phrase:
In 1976 a new flu strain hit Fort Dix in New Jersey; one man died. The virus that causes influenza tends to undergo major mutations about once a decade; we were 'due' for another big epidemic. The new flu strain seemed to be a variant of the swine flu, which was believed to be the source of the 1918 epidemic that killed tens of millions of people. This flu strain did not seem to be spreading much at all, but that might be because it was getting warmer, and the flu survives and spreads much better when it's cold. Next winter could see the onset of a gigantic epidemic, and here we were fortunate enough to have forewarning. The Powers That Were decided that it was better to be safe than sorry, and undertook a massive vaccine campaign, the largest that had so far been attempted.

People were unhappy: it was going to cost $135 million; there was no need to actually vaccinate yet, it would be better to hold the vaccine in reserve; CBS estimated that as much as 15% of the vaccinated population could suffer serious side effects from the vaccine; in England, researches injected six volunteers with the virus, and there were no serious effects (five had a mild case of flu, one had no effect); it was shown that children did not developed effective antibodies in response to the vaccine, and therefore would not be protected; the vaccine manufactures couldn't get liability insurance for the new vaccine, and refused to ship it. And then, when people actually started getting vaccinated, they died. This turned out to be a statistical fluke, inflated by the press, but it didn't help matters any. And finally, it turned out that these vaccinations apparently did sometimes cause Guillain-Barré syndrome. (We're still not certain whether or not this is true; once the suggestion was put out that the vaccine might cause G-B syndrome, doctors tended to assume that symptoms were caused by G-B even when they weren't. On the other hand, there does sometimes seem to be a causal link.)

All that was background. The point is, if no one had gotten carried away, we would have made the vaccine, and then stored it until needed. It wouldn't have been a public relation fiasco, and the government wouldn't have had to deal with thousands of spurious lawsuits. At the beginning of things, when the Advisory Committee on Immunization Practice was deciding what to recommend to the Department of Heath, the one person who is remembered for his caution and conservatism on the matter of vaccinating the entire country was Dr. Russell Alexander. He did indeed ask his question, although no-one actually tried to answer it at the time.

Richard E. Neustadt and Ernest R.May picked up on this, and coined the phrase 'Alexander's Question' in their book The Epidemic That Never Was. So now you will occasionally see a reference to 'Alexander's question' by people talking about critical thinking and decision making.

Flu by Gina Kolata

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