(1)
Engaging the Anti-vaxxers
a book review by Christian Orlic
eSkeptic
September 5, 2012
http://www.skeptic.com/eskeptic/12-09-05/#feature
Vaccine: The Debate in Modern America
Mark A. Largent
2012, John Hopkins University Press
ISBN 978-1421406077
Christian Orlic is currently pursuing a PhD in
Evolutionary Biology at Michigan State University. He
holds Bachelor of Science degrees in History of Science
and in Zoology.
[moderator: from Michigan State University Directory -
Professor Largent is an historian of science, technology
and medicine and director of the Science, Technology,
Environment and Public Policy Specialization (STEPPS) at
MSU. His research and teaching focuses on the role of
scientists and physicians in American public policy. He
has written on the evolution-creation debate, the
professionalization of American biology, Darwinism, the
history of the American eugenics movement, and recent
debates over compulsory vaccination. He is the author of
Breeding Contempt: The History of Coerced Sterilization
in the United States (2008) and The Modern American
Vaccine Debate (forthcoming 2012). He is currently
writing a history of Reye's Syndrome and is spending the
2011-12 academic year in Washington, DC as a American
Association for the Advancement of Science Fellow at the
National Science Foundation.]
On May 14, 1796, Edward Jenner developed and tested the
first vaccine. He was able to protect people from
smallpox by inoculating them with cowpox. Two centuries
later vaccines have eradicated diseases and are often
described as one of public health's greatest
achievements. According to the CDC vaccines have been
highly successful and by 1996 there was 97.8% decrease
in the incidence of rubella, diphtheria, haemophilus
influenza type b, measles, mumps, pertussis, polio and
tetanus (20).
Nevertheless, American parents appear to be more anxious
than ever about vaccinating their children. Currently,
American children receive at least 36 vaccinations
before their sixth birthday. Some vaccines protect
children and people against devastating communicable
diseases that if when left unvaccinated would result in
epidemics within communities. Nowadays about 40% of
American parents chose to delay or refuse vaccinations
for their children (15). Most of the children who have
received no vaccines have slipped through the cracks:
they are poor and have no insurance (20-40% of
unvaccinated children). About 11.5% of American parents
have "consciously refused" vaccines recommended by
pediatricians, and about 23% have delayed some vaccines
(32). Currently, all U.S. states allow vaccine
exemptions for medical reasons, 48 states also allow
children to be exempt for religious reasons, and some
have even begun accepting philosophical objections.
Mark A. Largent is a historian of biology and director
of Science, Technology, Environment, Public Policy
(STEPPS) at Michigan State University. Largent's
previous book, Breeding Contempt, deals with the history
of coerced sterilization in the United States. In
Vaccine: The Debate in Modern America, Largent couples
historical scholarship, keen cultural observations, and
personal experiences in order to explore the American
debate surrounding vaccination. Largent's provocative
but compelling argument suggests that the debate about
the science, safety and efficacy of vaccination is a
proxy for a set of unaddressed underlying anxieties
regarding vaccines; therefore, science is not enough to
resolve it, "no scientific finding and no agreement
among physicians and scientists can possibly bring it
[the debate] to an end" (173).
The book sets out to explore these anxieties and
understand where and how they originated. Largent's
insightful observations provide ways in which the debate
can be moved forward by addressing the anxieties parents
have directly, rather than bickering about "simplistic
stand-ins" (1). The anxieties that motivate the debate
are over the number of vaccinations required, the
diseases for which we vaccinate, the contents of
vaccines, a perception that pharmaceutical companies
care more about profits than safety, recent public
health emergencies, fears over the long term effects of
vaccinations, a belief that natural is better, as well
as an overall frustration with the state of medical
care. These underlying anxieties, Largent argues, must
be addressed in order to continue enjoying high levels
of vaccine compliance: "our continuing success in
vaccinating children depends on whether the public has
confidence in the scientists, doctors, and policy makers
(including industry) who shape these programs" (136).
The current debate surrounding vaccinations is
bipartisan, and those who oppose vaccines use both
liberal and conservative arguments. The anti- vaccine
movement was influenced by alternative medicine and
recent events. For example, when AIDS was first
described, Eva Lee Snead claimed it was linked to the
polio vaccine (52). Some concerns about vaccines are and
have been legitimate. When polio vaccines were first
developed, kidney tissue from chimpanzees was used. In
fact, this process was unsafe, and tens of millions of
people were unintentionally infected with SV40 (53). The
fears expressed by Snead were thus not unwarranted; if
one virus could make the cross-species jump, others
could too. Since then, however, studies have disproven
the link between the polio inoculations and HIV.
Likewise, the alleged link between Gulf War Syndrome and
vaccines given to soldiers is now debunked. Largent
concludes that both of these public health emergencies
fed suspicions about the safety of vaccines.
The claim that vaccines were linked to autism emerged at
the same time in the U.S. and in the UK. These claims
could only emerge because "modern concerns about
vaccines were already in place" (67). Largent may come
off as too sympathetic to Dr. Wakefield and Jenny
McCarthy, "the iconic vaccine-anxious parent" (139);
however, I submit, that this is required for both good
history and understanding. By at least momentarily
embracing the views of those who opposed vaccination, we
come to understand why they hold these views and how
they developed them. Chapter 3 and 4 of Largent's book
explore how Wakefield and McCarthy came to believe that
vaccines cause autism and how they became spokespeople
for an already anxious community. Their rapid rise to
celebrity within their community supports the assertion
that British and American parents were already anxious.
Therefore, it should not surprise observers "how easily
they adopted an explanation that was critical of the
modern vaccine schedule" (73). The alleged link between
thimerosal and autism, as well as that of the MMR
vaccine with digestive problems resulting in
developmental problems, provided "a ready-made venue for
discussing their concerns about vaccines within a group
of like- minded advocates"(12). While Largent recognizes
that there is no evidence to support either Wakefield or
McCarthy claims, he thinks that their outright dismissal
is detrimental to maintaining high levels of vaccine
compliance.
Largent argues that by ignoring the underlying
anxieties, public health officials and vaccine advocates
have misconstrued the reasons parents chose not to
vaccinate, or to delay vaccination. Secondly, public
health officials prefer to discuss the efficacy and
safety of vaccines because this is within their
professional realm. Vaccine advocates often claim that
ignorance is one of the reasons parents are anxious
about vaccinating their children. They claim that this
refusal to vaccinate is predicated by an ignorance of
the severity of the diseases for which vaccines protect.
Whereas, data demonstrates that the more educated
parents are the more likely they are to have
reservations about the recommended vaccine schedule
(34). These parents for the most part are making
conscious, non-religious, decisions to refuse or delay
vaccinating their children. Further antagonizing them
rather than addressing underlying anxieties is likely to
reduce vaccine compliance.
One of the most important observations made by Largent
is that not all vaccines are the same. Some vaccines
protect against devastating diseases (MMR, DPT), others
protect against dangerous ones (Hep A, Hep B, Hib,
rotavirus, PCV) but the likelihood that an infant may be
exposed to these is low, and other vaccinations provide
protection against diseases with extremely low mortality
rates (chickenpox). The distinction between the diseases
each vaccine protects from are often forgotten. For
example, Largent argues that some of the diseases we
vaccinate newly born babies against may be unnecessary,
such as HepB, a disease that an infant could only
"contract by having sex with an infected person or by
sharing contaminated needles with an infected drug
addict" could wait (2). Public health officials should
keep in mind that it is preferable for children to be
under vaccinated than not vaccinated at all.
Unfortunately, the vaccine debate is polarized. Amanda
Peet, who supports vaccination, referred to the parents
of unvaccinated children as "parasites" (she later
apologized). Recognizing that not all vaccines are equal
could sooth the rhetoric of the debate and allow for a
more fruitful discussion. Otherwise, parents who are
anxious about the amount of vaccines or one specific
vaccine may be pushed not to vaccinate at all. Failing
to recognize the differences between different
inoculations results in an all or nothing approach (167)
(2)
The Roots of the Vaccine Panic
Two books tell the story of the panic over vaccines.
Peter Bearman
The American Prospect
March 5, 2011
http://prospect.org/article/roots-vaccine-panic
Deadly Choices: How the Anti-Vaccine Movement
Threatens Us All
Paul A. Offit
Basic Books, 270 pages, $27.50
ISBN-13: 978-0465021499
[moderator: from http://www.paul-offit.com/
Paul A. Offit, MD is the Chief of the Division of
Infectious Diseases and the Director of the Vaccine
Education Center at the Children's Hospital of
Philadelphia. In addition, Dr. Offit is the Maurice R.
Hilleman Professor of Vaccinology and a Professor of
Pediatrics at the University of Pennsylvania School of
Medicine. He is a recipient of many awards including the
J. Edmund Bradley Prize for Excellence in Pediatrics
from the University of Maryland Medical School, the
Young Investigator Award in Vaccine Development from the
Infectious Disease Society of America, and a Research
Career Development Award from the National Institutes of
Health. Dr. Offit has published more than 130 papers in
medical and scientific journals in the areas of
rotavirus- specific immune responses and vaccine safety.
He is also the co- inventor of the rotavirus vaccine,
RotaTeq, recommended for universal use in infants by the
CDC; for this achievement Dr. Offit received the Jonas
Salk Medal from the Association for Infection Control
and Epidemiology, the Luigi Mastroianni Clinical
Innovator and the William Osler Awards from the
University of Pennsylvania School of Medicine, the
Charles Mérieux Award from the National Foundation for
Infectious Diseases; and was honored by Bill and Melinda
Gates during the launch of their Foundation's Living
Proof Project for global health.]
The Panic Virus: A True Story of Medicine,
Science, and Fear
Seth Mnookin
Simon & Schuster, 429 pages, $26.99
ISBN-13: 978-1439158647
[moderator: from http://sethmnookin.com/bio/
Seth Mnookin is the Co-Director of MIT's Graduate
Program in Science Writing. His most recent book, The
Panic Virus: The True Story Behind the Vaccine-Autism
Controversy, was one of The Wall Street Journal`s Top
Five Health and Medicine books of 2011 and was a
finalist for the Los Angeles Times Book Prize. He is
also the author of the 2006 New York Times bestseller
Feeding the Monster: How Money, Smarts, and Nerve Took a
Team to the Top, which chronicles the challenges and
triumphs of the John Henry-Tom Werner ownership group of
the Boston Red Sox. His first book, 2004's Hard News:
The Scandals at The New York Times and Their Meaning for
American Media, was a Washington Post Best Book of the
Year.
Since 2005, Seth has been a contributing editor at
Vanity Fair, where he's written about the American media
presence in Iraq, Bloomberg News, and Stephen Colbert.
In 2002 and 2003, he was a senior writer at Newsweek,
where he wrote the media column "Raw Copy" and also
covered politics and popular culture. His blog on
science, medicine, and media is part of the Public
Library of Science (PLOS) Blog Network.]
Do vaccines cause autism or other neuro- developmental
disorders? Scientists know that vaccines don't, but the
idea lingers everywhere -- on talk shows and blogs and
in conversations between parents and their child's
pediatrician. It lingers because many people in this
country and elsewhere think that vaccines just might not
be good for us.
In two books that tell the story of the panic over
vaccines, Paul Offit, chief of infectious diseases at
the Children's Hospital of Philadelphia, and Seth
Mnookin, a contributing editor at Vanity Fair, argue
that bad people pursuing careers or fame or ratings or
God knows what became purveyors of falsehoods that duped
otherwise decent people into thinking vaccines could
harm their children. That duplicity has led parents to
make bad decisions -- not to vaccinate their children or
to vaccinate them on a non-recommended schedule -- which
turn out to be potentially deadly not just for their own
children but for others.
How we got into this mess is the focus of both Mnookin's
The Panic Virus and Offit's Deadly Choices. The casts of
characters overlap, but the emphasis of each is
different. Ironically, the journalist (Mnookin) focuses
more on the malefactors of science, while the scientist
(Offit) focuses more on the malefactors of the media.
But each has a special distaste for the one closest to
him: Mnookin for the journalist David Kirby, who helped
sell the belief that mercury in vaccines caused an
epidemic of autism, and Offit for the pediatrician Bob
Sears, who willy-nilly invented a "new and improved"
vaccination schedule.
As good as these books are, they don't help us fully
understand why the anti-vaccine movement caught on. They
are missing a sense of the desperation felt by parents
when their children begin showing signs of autism. They
also fail to appreciate the role that science itself has
played in leading people to expect simple explanations
of complex phenomena. Together, the desperation and the
belief in simple answers have had deadly results.
Although the background story is complicated, the source
of the vaccine panic is basically this: The prevalence
of autism has increased spectacularly over the past 20
years, and although scientists can explain about 50
percent of the increase, they cannot account for all of
it. As a result, a vast network of advocates,
epidemiologists, scientists, junk-scientists,
clinicians, quack-clinicians, celebrities, geneticists,
expert witnesses for hire, snake-oil salesmen, playboy
models, comics, charlatans, blog writers, and parents
have entered the debate, developing their own or selling
others' theories.
The two such theories highlighted in these books are
that the mumps, measles, and rubella (MMR) vaccine is
dangerous for children either because the measles-
vaccine virus resides in the intestines of some
children, leading to inflammation, leaky gut, and
consequent developmental delays, or that the MMR vaccine
contains thimeresol, a mercury-containing preservative,
which leads to developmental delays. The first theory is
biologically implausible, the product of crooked science
conducted by Dr. Andrew Wakefield. The second has been
falsified.
As both Offit and Mnookin note, the idea that vaccines
are dangerous is not a new belief. It has been around
for as long as vaccines have existed. Offit is clearest
in explaining the underlying paradox: The belief that
vaccines are bad for us is enhanced by their success.
Men and women in their 50s and younger have no real
memory of polio. Their children and grandchildren have
had no experience with measles or rubella. As kids, my
generation used to fear tetanus, which we were sure led
to slow starvation because our jaws would lock shut
midsentence, but I haven't met any children with this
phobia in decades. I vividly remember my daughters'
disbelief when reading Little House on the Prairie that
Mary could go blind from scarlet fever.
All these obscure diseases have, like the bubonic
plague, been banished to faraway places or distant
pasts, and people in the United States have forgotten
all about them. So they have naturally forgotten that
these diseases can also lead to blindness, paralysis,
brain damage, or death. Offit is brilliant at pointing
out the absurdity of anti-vaccine activists' argument
that vaccines are superfluous because they prevent us
from catching diseases that people no longer catch.
In the history of the eradication of the "diseases of
childhood," vaccines have played a role. They have not
played the leading role in lives saved. Long before the
first baby was jabbed with the diphtheria-pertussis-
tetanus (DPT) or the MMR vaccine, mortality rates for
diphtheria, whooping cough, and measles had steadily
declined. In 1900, the death rate from diphtheria was
40.3 per 100,000. For whooping cough and measles, it was
12.2 and 13.3 per 100,000, respectively. By the end of
World War II, all three were around 1 in 100,000. The
same declines can be observed for diseases for which we
have no vaccines.
Hygiene and improved nutrition are the real heroes in
the war against disease, though neither Offit nor
Mnookin points this out. It would make their credible
arguments more credible if they didn't claim vaccines
saved the world all by themselves. But both authors do
stress that what vaccines have done is as remarkable as
nutrition and hygiene reducing the mortality rate by 500
percent; in some cases vaccines have reduced the rate to
essentially zero -- which is why people no longer fear
the diseases that used to kill children. Instead, they
fear vaccines.
If parents want to be fearful, they should fear
unintentional injuries, which account for as many deaths
of 1- to 4-year-olds as the next six leading causes
combined. Or they can fear obesity. But as with the link
between smoking and cancer, it is hard to see the link
between gulping down a few donut holes and chronic
illness later in adulthood. In contrast, many parents
see a direct link between vaccination and autism. In
fact, some even saw the link before it could have
happened. Jenny McCarthy, for example, is reported by
Offit to have asked her son's pediatrician right before
her son was given the MMR vaccine, "That's the autism
shot, isn't it?"
Human-interest stories abound in both books. All of the
leading culprits in fear-mongering about vaccines appear
so sneaky and craven that the reader wonders what could
possibly motivate them aside from fame and fortune. True
believers, though, are often motivated by their belief
even if the belief makes no sense (to us). Deeper
insight into the worlds of others comes from recognizing
this fact. Neither book, however, despite nods in this
direction, gets quite deep enough.
***
The MMR vaccine is routinely given to children in the
United States when they are between 15 and 18 months
old. At 15 months, most children toddle well, use three
or more words regularly, and laugh at funny things. Some
can sing, and a few can walk up stairs and walk
backward. Two months later, most toddlers have doubled
their word use, climb around and explore their
environment, and enjoy imaginary games. They also know
how to throw a tantrum when they are frustrated, respond
to simple directions, play with toys, and stack a few
blocks. As every parent knows, these are fantastic
developments, but seen in this aseptic light, they are
pretty modest achievements.
Many children with autism will miss these milestones.
Even so, many children who appear to their parents and
even their pediatricians to be developing normally but
are later diagnosed with autism seemingly regress around
age 2, losing their few words and social skills.
Sometimes the regression is associated with a fever or
seizures, sometimes not. Sometimes it appears suddenly,
and sometimes it is only slowly pieced back together
from parental recall.
Whether sudden or not, the regression is terrifying for
parents. For many of them (but not all), the temporal
simultaneity of the vaccine and the descent into autism
cannot be just a chance event. It seems the vaccine
caused their child's autism. As pointed out in the
Vaccine Court Omnibus Hearings, beautifully described by
Offit, the fact that experts can identify an array of
developmental abnormalities in children from video taken
well before their MMR vaccine, which neither parents nor
pediatricians could see because they are not trained to
do so, doesn't matter to parents looking for causes.
The strategy that parents are using to account for cause
is no different from the theory that some autism
epidemiologists have been using to account for increased
autism prevalence. If all of a sudden, something happens
(like increased autism prevalence), it cannot
(ordinarily) be caused by something that happened
afterward. So autism scientists have raced to identify
the change over the past few decades that has led to the
rising prevalence of autism.
Here, too, junk science competes with serious work.
Because some articles have suggested that artificially
generated electromagnetic radiation causes autism,
parents have eliminated wireless computers in their
house, disconnected alarm clocks, and thrown away their
microwave. Because some economists have argued that
autism is the result of "television watching due to
precipitation" and that "seventeen percent of the growth
in autism in California and Pennsylvania during the
1970s and 1980s is due to the growth of cable
television," some parents have thrown away their TV or
moved to less rainy climates (where their children can
spend time outdoors, exposing themselves to overhead
power lines, which have been variously associated in
comparably questionable science with such diverse health
outcomes as "breast cancer, decreased libido, fatigue,
depression, birth defects, reproductive problems, heart
disease, stress headaches, trouble sleeping, and many
other symptoms. Yikes").
Yikes is right. The "science" here is as good as the
science behind the idea that vaccines cause autism.
Using the same methods, one could show that frozen
yogurt, emo music, tofu, beets, sun- dried tomatoes, or
anything else that has increased over the same time
period as autism is a potential risk factor. The mistake
here is to confuse correlated time series with cause.
It is also a mistake not to take this bad science more
seriously. Modeling is important. Should it surprise us
that if scientists are confusing correlated time series
with cause that parents are doing it as well? That two
things happen at the same time does not mean that one
caused the other. The most famous example of this is the
idea that storks bring babies into the world. Babies
come from people. People live in houses and houses have
chimneys and storks roost in chimneys so the more people
the more babies, houses, chimneys, and storks. It is
easy enough to lay the blame on malfeasant scientists
and publicity hounds, but when ordinary scientists
pursue news stories instead of properly specified
models, things can go awry quickly. And in the case of
autism science, they often have.
The bad science that causally associates vaccines with
autism has led to dangerous changes in parental
decision-making. Some children (not statistical
abstractions) have died because they contracted whooping
cough or measles. In California, rates of vaccine
refusal (politely called vaccine exemption) have
skyrocketed, threatening the loss of "herd immunity" in
many communities. If a few children aren't vaccinated,
they are unlikely to contract the disease, but if many
are not, the disease may race through a community,
threatening a mass epidemic.
Both books feature the real people whose children have
been harmed or killed by diseases otherwise avoidable.
So the decision to skip a vaccination differs from the
decision to switch to battery- powered alarm clocks.
Because the diseases that vaccinations prevent pass from
person to person (except for tetanus), failure to
vaccinate -- that is, free riding on the positive
vaccination decisions of others -- is dangerous to
everyone.
Mnookin makes an important argument about science: It is
self-paralyzing. The problem is that it can never prove
anything, just falsify the theories of others.
Scientists can say that the idea that vaccines cause
autism is not supported by the extant evidence but not
that vaccines cannot possibly cause autism. They could,
perhaps, in some unknown way in interaction with some
unknown variables. And in that little space of
enchantment reside the David Kirbys of the world who
exploit the humility of science to create the doubt and
uncertainty that allows conspiracy theories to flourish.
Science needs to speak with a stronger voice to overcome
both the assault on reason of anti-science crusaders and
the indifference to reason of journalists who train the
public to believe that every issue has two sides.
Both books are thrillers. They are true stories after
all. The malfeasant doctors, publicity- seeking
journalists, blinded activists, and confused celebrities
do and say things that are truly shocking. Jenny
McCarthy really does tell Oprah that her science is
"mommy instinct," and Dr. Bob really does make up a new
vaccination schedule.
Even so, telling a one-sided story is difficult. To fill
out the pages, Mnookin travels down vaguely related
rivers to discuss heuristics and cascades; Offit shows
how the "self-interested" decision to refuse vaccination
leads to a tragedy of the commons and then, most
important, why the decision is only seemingly self-
interested. Offit's book has a broader focus than
Mnookin's. And Mnookin is a bit breathless for my taste.
Offit is in the middle of the controversy. He is, after
all, a character in the Mnookin book and reportedly
requires bodyguards at talks. It seems as if some of the
people who choose not to vaccinate their children feel
so strongly about it that they want to harm Offit. They
should read his book.
What should we say to the parents who choose not to
vaccinate their children because they do not trust the
Centers for Disease Control and Prevention, their
doctors, or Big Pharma? Trust in science? As Mnookin
argues, the discrediting of science has a long history
and does not arise either from media insistence for
balance or from government intervention. Still, while
the sad story of the loss of faith in science didn't
start with recent attacks by conservatives, their monkey
business didn't help. In the meantime, as both books
make clear, with respect to vaccine refusal, we have
much more to fear than fear itself.
___________________________________________
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