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Fright Doctors
The hideous impacts of the vaccine-autism myth—and the reasons it has proven so difficult to debunk.
Deadly Choices: How the Anti-Vaccine Movement Threatens Us All By Paul A. Offit, M.D. • Basic Books • 2011 • 288 pages • $27.50
The Panic Virus: A True Story of Medicine, Science, and Fear By Seth Mnookin • University of California Press • 2011 • 429 pages • $26.99
In February 1998, British physician Andrew Wakefield and 12 colleagues published a study of 12 autistic children in the prestigious medical journal Lancet. At a dramatic press conference, Wakefield declared that the combined measles, mumps, and rubella (MMR) vaccine was the likely cause of autism in eight of the children. Noting intestinal abnormalities in the subjects, he suggested that the measles vaccine virus had traveled to the children’s intestines and brought on infection and inflammation, allowing harmful proteins to enter the bloodstream and cross the blood-brain barrier, causing autism. Based on all this, Wakefield recommended that the different components of the MMR vaccine be administered separately. In practice, this meant that children wouldn’t get vaccinated at all if their parents refused the combination dose.
His claims, linked to so prestigious a journal, caused an immediate sensation. The spirit of public reaction was captured by the 2003 British television drama Hear the Silence, which depicted Wakefield as a heroic figure helping a mother find the true cause of her son’s autism. Unethical drug company executives and public-health officials were the film’s villains. This fictive Wakefield faced harassment and intimidating phone calls. His files were stolen, but he persisted in his important work.
British parents paid attention. MMR immunization rates in England dropped from almost 90 percent to 70 percent following Wakefield’s presentation, with markedly lower rates in specific areas. Local measles outbreaks soon followed. Wakefield also attracted a large following among parents of autistic children in America and around the world. In the year 2000, he testified in an odd House committee hearing chaired by Indiana Republican Dan Burton, who was apparently convinced that vaccines had caused his grandson’s autism.
Today, no serious medical or scientific expert believes that vaccines cause autism. Yet many nervous parents continue to think otherwise. One of these is actress and model Jenny McCarthy. During a 2007 “Oprah” appearance, she said that not long after her son received his shot, “The soul was gone from his eyes.” When Oprah asked what McCarthy knew about vaccine science, McCarthy responded, “My science is Evan, and he’s at home. That’s my science.” Winfrey said, “Thank God for Google,” to which McCarthy responded, “The University of Google is where I got my degree from.”
As in England, increasing numbers of parents in the United States chose not to immunize their children—for measles, mumps, and rubella, and for other diseases, too. As in England, outbreaks of vaccinatable diseases have re-emerged as a public health problem. In 2005, an unvaccinated Indiana teen was exposed to measles on a church mission to Romania. She exposed 500 others at a church picnic, infecting 31 out of the 35 unvaccinated picnickers. Of the remaining 465 immunized people, only three were likewise infected. In California last year, the state recorded thousands of cases of pertussis (whooping cough) and nine related deaths, the most in decades. In 2009, Australia saw a record 13,000 cases. How is it that in 2011 we are faced with significant, sometimes lethal outbreaks of such readily prevented diseases?
That is the subject Paul Offit and Seth Mnookin investigate in their recent books. Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, chronicles several such outbreaks in Autism’s False Prophets and Deadly Choices. Science reporter Mnookin, a contributing editor at Vanity Fair, covers much of the same material in The Panic Virus.
These authors tell depressingly similar stories. Sloppy or fraudulent scientists combine with like-minded parent-activists to spread false rumors, leading hundreds of thousands of parents not to follow public-health recommendations. The combination of public complacency, general ignorance and gullibility, and widespread distrust of pharmaceutical companies and scientific medicine created massive opportunities for anti-vaccination activists to do great harm. How should the medical and public-health communities address this problem? How should progressives respond when their respect for parental autonomy collides with their pursuit of public health and respect for legitimate expertise?
Why do so many people buy into readily debunked vaccine-autism claims spread by people who regularly turn out to be charlatans or grossly wrong? In part, this troubling trend is an ironic consequence of vaccines’ very success in protecting public health. Millions of older people remember terrified parents refusing to let their kids use the local swimming pool. They remember polio patients in iron lungs. Today we don’t experience the palpable fear that polio and other diseases ostensibly vanquished by vaccines once evoked. Complacency is the predictable result.
Part of the answer has to do with the nature of autism. Autism spectrum disorders (ASDs) are a frightening, sometimes mysterious set of social, communication, and behavioral challenges. Signs of an ASD often emerge in toddlers who appear to have been developing appropriately, yet who for no apparent reason begin to seem more withdrawn, behave strangely, or become unresponsive to usual social cues. An ASD is sometimes first diagnosed or suspected around the time a child receives her first doses of the combined MMR or the diphtheria-pertussis-tetanus (DPT) vaccines, around one year of age. Many parents then draw the obvious, statistically erroneous conclusion. Given improved diagnostic methods, greater public awareness, and an expanding range of autism-labeled disorders, the annual rate of ASD diagnoses has also increased, reaching a level of as many as one in every 100 children. No reliable data exist to indicate whether this trend reflects a true increase in underlying disease prevalence or is entirely explained by increased detection and labeling. The fact that this trend coincides with a steadily expanding vaccination schedule reinforces public concerns.
"There is no evidence that thimerosal causes harm". Harold, are you insane? Have you read the label on the bottle (along with the skull and crossbones)? There are 1,416 published, peer-reviewed papers which describe, in detail, the damages caused by thimerosal.
This article is a complete crock of you-know-what!
Joe, there is no evidence that the minute amounts of thimerosal once present in some scheduled pediatric vaccines cause autism is any other developmental disorder. Your "1416 studies" claim has no basis in fact.
Jun 19, 2011, 9:50 PMJoe, there is no evidence that the minute amounts of thimerosal once present in some scheduled pediatric vaccines cause autism is any other developmental disorder. Your "1416 studies" claim has no basis in fact.
Jun 19, 2011, 10:08 PMHere's my reasons for listening to the anti-vaccine crowd.
1) The FDA says they are safe. The FDA is full of ex- and soon-to-be and sometimes presently employed- industry people. Not civil servants.
2) The FDA/ CDC did not/ would not do it's own independent study, just used existing community data (so far as I know) and drug manufacturer supported ones. I mean, really?
3) Autism rates exploded at same time as thimerosal use did.
4) Injecting mercury into young children HAS to be bad or why don't we quit regulating it, period?
5) The people who talk about the controversy are very condescending about anyone who questions the FDA instead of answering or addressing at least the questions and concerns those people have.
6) I am unaware of anyone trying to determine the cause (s) of the rising rates of autism (when last I looked into this topic) which seems to say they 'already' know the cause because surely some group somewhere WOULD be concerned about it.
@LauraNo: that's the stupidest bunch of mularkey I've heard all week. I pray to God that you haven't denied your innocent child/ren the vaccines which will protect them from unnecessary illness. What you are unaware of could fill a library.
Aug 4, 2011, 12:16 AMLaura:
"I am unaware of anyone trying to determine the cause (s) of the rising rates of autism"
There are literally tens of thousands of journal studies dealing with the epidemiology of autism, tracking everything from environmental mercury levels to genetic factors to television viewing habits. It is simply incorrect to suggest that the medical and academic community has not been diligently researching this for years now.
"Autism rates exploded at same time as thimerosal use did."
The alleged thimerosal link has been effectively disproven by academic studies: see, e.g., Hviid et al. 2003, a retrospective study conducted across a cohort of 467,450 children that found no statistical link between autism diagnosis and vaccination with thimerosol-containing vaccine. Furthermore, autism rates have not declined and have in fact increased since the removal of thimerosol in 2001, despite the fact that, had thimerosol been a factor, rates should have declined starting in 2004 (Schechter and Grether 2008).
"The FDA is full of ex- and soon-to-be and sometimes presently employed- industry people. Not civil servants. ... The FDA/ CDC did not/ would not do it's own independent study, just used existing community data (so far as I know) and drug manufacturer supported ones."
Most of the journal studies are conducted by academics, European health organizations, and state-level health orgs.
The only authors who repeatedly cite a thimerosol-autism link are David and Mark Geier, whose work has repeatedly been attacked on scientific, medical, and statistical grounds. The Geiers own patents on using Lupron to treat autism and a chain of clinics to enact their protocol (at what I understand to be approximately $5,000 per month per child, with no set end date for treatments) and therefore have a financial interest in seeing their hypothesis accepted.
Lupron, or leuprorelin, is an androgen suppressant -- technically a GnRH agonist -- that not only disrupts hormonal activity but has also been linked with side effects such as heart attacks and suicidal ideation. Abbot Labs, the manufacturer of Lupron, actually stopped working with the Geiers, citing a lack of scientific validity to their theories; obviously, if Lupron were effective for the treatment of Autism, Abbot would stand to gain quite a bit. I'll submit that the risks and side effects of Lupron are considerably more significant than any risks from thimerosal or childhood vaccines.
More recently, Mark Geier's medical license was suspended in Maryland, Washington and Virginia as a result of repeated misdiagnoses and recommendations of Lupron treatment.
"Injecting mercury into young children HAS to be bad or why don't we quit regulating it, period?"
It should be noted that the neuro- and nephrotoxic effects of high-dose exposures to thimerosal haven't really been well-studied, so most of the assumptions about it came from studies of methylmercury, which is the bioaccumulative toxin we're used to hearing about in our aquatic food chain and which has been linked with a number of human disorders. However, thimerosal breaks down to ethylmercury, which doesn't appear to accumulate and is quickly excreted from the body; it has *acute* toxic effects in high doses, but doesn't hang around long enough to be an accumulative threat.
Furthermore, there is no evidence that low levels of thimerosal exposure are toxic in any way. In other words, just because two compounds happen to share a mercury atom, you can't make the assumption that they bioreact in even vaguely similar ways, any more than sodium chloride (table salt) can be compared to bertholite (a chlorine-based chemical weapon). And, of course, we don't treat chlorine and salt identically for regulatory purposes, either.
"The people who talk about the controversy are very condescending about anyone who questions the FDA instead of answering or addressing at least the questions and concerns those people have."
True. But you have to understand that the issues involved are so complex that biochemists and medical researchers have an incredibly detailed and nuanced argument, whereas the anti-vaccine crowd has a simple albeit totally incorrect message to advertise. In essence, it's as if astronomers and aerospace engineers, in debunking claims that the Apollo landing was a hoax, had to start with explaining the Laplace-Runge-Lenz vector, rather than just pointing to the moon and saying, "We put a flag on it!"
At heart, the scientific consensus looks something like this: Autism rates are rising (we think, though there are various issues regarding the data on diagnosis rates); although there are many *correlations* between environmental and genetic factors and autism, we have not yet identified any *causitive* factors; there is no plausible posited biological mechanism between vaccinations, with thimerosal or without, and autism; there is no statistical evidence that autism rates declined with the removal of thimerosal; there is no statistical evidence that autism is linked with reception or denial of the MMR vaccine (Taylor et al. 1999); however, the individual and herd immunity risks of a lack of vaccinations are severe and well-understood.
The anti-vaccine movement, on the other hand, plays on the same anti-knowledge strings ("The medical researchers are wrong! Big Pharma is lying to you!") that the Tea Party ("The economists are wrong! Big Government is lying to you!"), creationists ("The biologists are wrong! Big Evolution is lying to you!"), and global warming deniers ("The climate scientists are wrong! Big Ecology is lying to you!") also use.
So, yeah, perhaps the medical community could do a better job with their PR and how they interact with skeptics -- but the skeptics are so predisposed to ignore the medical community that there's no conversation possible. It's hard to effectively argue against those groups, because there are no mutual premises that the two sides can start from.
Hviid, A; Stellfeld, M; Wohlfahrt, J; et al. "Association Between Thimerosal-Containing Vaccine and Autism," JAMA 2003; 290(13):1763-1766.
Schechter, R; Grether JK. "Continuing increases in autism reported to California's developmental services system: mercury in retrograde," Arch Gen Psychiatry. 2008 Jan;65(1):19-24.
Taylor, B; Miller, E; Farrington, CP; Petropoulos, MC; Favot-Mayaud, I; Li, J; Waight, P. "Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association." The Lancet June 1999; 353;2026-2029.
Aug 4, 2011, 10:08 AMPost a Comment
Harold Pollack is Helen Ross Professor of Social Service Administration and faculty chair of the Center for Health Administration Studies at the University of Chicago.
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