Nov 27 2007

The Battle Continues Over Vaccines and Autism

I and some other medical science bloggers have spent much time addressing the claims of antivaccinationists and those who attempt to link vaccines and autism. This is because they are engaged in nothing less than an all out campaign to eliminate vaccines. They seem to be driven by ideology and fear, their tools are misinformation, lies, and logical fallacies, and they have been tireless in waging war against vaccines. On their side are dubious and discredited scientists, misguided celebrities, naive or scaremongering politicians, and families who range from sincere but misinformed to ideological true believers. This antivaccination movement overlaps considerably with those who are anti-science or anti-scientific medicine (promoting instead some form of “alternative” medicine). They also enjoy much support from anti-government conspiracy theorists.

Standing against these forces are those few scientists who take the time to confront their claims and set the record straight – mainly through blogs and the occasional article. Government agencies, like the CDC, try but have been fairly ineffective (and sometimes counterproductive) in the PR department. Mainstream scientists and scientific organizations have been doing good research and promoting good science and medicine, but have shied away from confronting the antivaccine cranks directly (sometimes because of direct intimidation).

So forgive us if we spend as much time as we do on this issue. Scientific medicine, and vaccines in particular, deserve defending.

The conflict has taken on a very concrete manifestation: almost 5,000 families are suing the Vaccine Compensation Program, claiming that childhood vaccines caused their child’s autism. Nine test cases are to be presented before the Omnibus Autism Proceedings (OAP) established for that purpose. This past summer the first test case, Cedillo, involving MMR and thimerosal, was concluded. The second case, Hazlehurst, concluded on October 18th, and the third, Snyder, just concluded on November 9th.

The transcripts of the testimony given so far on these three test cases are encouraging. Those scientists and experts defending the safety of vaccines have the facts on their side, and it shows. The MMR vaccine and thimerosal (a preservative in some vaccines) do not cause autism. The science is solid and pointing consistently in that direction, and the courtroom is generally a good venue for airing such evidence. Those claiming that vaccines do cause autism are basing their claims on sloppy science and sloppy thinking, and do not hold up under close scrutiny.

So I am hopeful that the OAP will reach the correct decision, but there is always a chance that emotion and deception will prevail so I will be keeping a close eye on this trial as it progresses. A decision is anticipated by summer 2008.

Meanwhile, the press is continuing to do its usual terrible job of reporting this story. This interview with the Hazlehursts follows the typical formula for such stories – focusing on the touching and personal story of a family while granting the scientific evidence a position of token skepticism only. For example:

The scientific experts testified at the national trial. But the testimony of the mom, dad, aunt and grandmom painted the picture of Yates.

“Three days past his vaccine, at his birthday, he’s dazed,” Angela said. “Twelve days after, he had a red, bumpy rash. We didn’t recognize it as a reaction. A month after that, in the bathtub, I’m saying, ‘Yates, Yates’ and he won’t look at us anymore.”

The real conflict that is going on is that between dry and abstract scientific evidence and emotional personal stories. Unfortunately, humans are inherently more compelled by the latter than the former. Lazy journalism, driven more by market forces than by professionalism and integrity, also favors the personal story. It makes for better copy.

The antivaccination ideologues understand this. They have lost the scientific fight – it’s over. Vaccines are the single most effective public health intervention devised by humanity. Vaccines are generally safe, and they do not cause autism. Thimerosal and mercury do not cause autism. Often, when a fight is lost in one arena (in this case the arena of science) ideologues will try to change the venue to one in which they feel they can win, in this case one of alleged respect for parents and families and the personal stories of sick children.

Jenny McCarthy overtly played the “mommy card” in defending her conclusion that vaccines caused her son’s autism. (And now she is working on a documentary movie to follow up her book making these claims.) RFK Jr. directly led the attack on this front with his article Attack on Moms.

Another example of this strategy of changing the venue is creationism. Creationist propaganda is full of claims that evolution requires faith and that scientists have faith in evolution or even science in general, and have reverence for Darwin. They want the conflict to be between faith in God vs faith in evolution and Darwin. They want to fight in the arena of faith because they have already lost, hands down, in the arena of science.

Scientists need to be more aware of such strategies. They innocently argue within the confines of scientific evidence and logic and then are blindsided by attempts at shifting the arena. I hope this does not happen to the experts giving testimony to the OAP (although from reading the transcripts, so far so good). Typical ploys include portraying scientists as cold, as not caring, elitist, nihilistic, or hopeless. Meanwhile, the defenders of nonsense are just trying to provide hope and comfort to the sick. Alternative medicine proponents have this strategy down, dare I say, to a science.

The only way for science and reason to prevail is for scientists to become better at keeping scientific conflicts within the arena of science. This requires that they recognize the strategy of shifting the arena and have rhetoric ready at hand to counter it. It also means not falling into common traps by saying naively stupid things (like calling every unusual occurrence a “miracle”).

It also means training the media and journalists to recognize this problem also, although this may be beyond our control. At the very least scientists should be aware that when they are solicited for a quote they may be getting set up as a token skeptic. Scientists need to discuss stories more with journalists, probe them for the story they are telling, rather then just feed them quotes about the science.

But I think that also scientists need to become journalists – we need to be better and more active at telling our own stories, of “framing” science stories the correct way, and of countering the myths that the enemies of science use to promote their ideologies.

The vaccines and autism story is a great example of the need for scientists to be more proactive in selling science and telling the story of science to the public. In the end, getting the science right doesn’t matter if the public is listening to the charlatans, and public policy follows. We need to tell the human angle of this vaccine story. Absolutely, this is ultimately about the science and what it says about the safety and effectiveness of vaccines.

But the science only informs the bigger conflict, and we need to also make it clear to the public that those claiming vaccines cause autism are fearmongering hysterics who are trying to sacrifice the health of the public on the alter of their paranoid ideology. They are trying to damage the health of your children because they are incapable of admitting that they were wrong, of fairly listening to what the scientific evidence is telling us.

7 responses so far

7 Responses to “The Battle Continues Over Vaccines and Autism”

  1. Michael.Meadonon 27 Nov 2007 at 11:42 am

    I completely agree that “scientists need to become journalists – we need to be better and more active at telling our own stories, of “framing” science stories the correct way, and of countering the myths that the enemies of science use to promote their ideologies.” Richard Wiseman (who Dr. N & the rogues have interviewed on SGU and who’s on this week’s Point of Inquiry) is an excellent example of a scientist like this. (Sure, he holds a chair in the public understanding of psychology… but other scientists can go some way towards emulating him).

    Scientists can, for example, maintain blogs about their research, ensure they have a user-friendly website, post their research articles on their websites, write essays of a more popular bent and so on.

    I wonder what impact the fact that many journals are not open access has on the public understanding of science? I suspect if the general populace can look at the actual scientific articles – even if they don’t understand them fully – some of our current problems in this area would be mitigated. Or maybe I’m just engaging in wishful thinking…

  2. edyong209on 27 Nov 2007 at 12:52 pm

    “But I think that also scientists need to become journalists”

    Easier said than done. The vast majority of science journalists do not come from a science background and the majority of science correspondent vacancies in the popular press are filled by people who are journalists first, and scientists second (or third, or fourth, if at all.)

    Obviously, in the online world, there’s everything to play for and scientists who write well have an open forum for practising accurate journalism. But even so, the readership of the web versions of more mainstream channels (e.g. BBC, national newspapers) have far greater readerships than any science blog does.

    Nonetheless, I think that most of your points are right on the money including the need for scientists to become more media-savvy and develop better skills at framing their stories and countering myths. It’s vitally important that scientists lean how to play the game – getting some part-time work experience can be invaluable for this as it allows scientists to see both sides of the debate.

  3. DLCon 27 Nov 2007 at 3:52 pm

    Scientists and medical professionals will do their best to keep things rational and logical, and to popularize the science.

    Meanwhile, the Autism-Woo or Anti-Vaccination crowd will post saccharine-sweet stories of happy children who’ve been “cured” of autism by chelation, diet, voodoo dolls and pyramid power, totally ignoring the fact that some children with ASD move off the spectrum spontaneously.

  4. Freddy the Pigon 28 Nov 2007 at 4:33 am

    I think the medical community needs to emulate the practice of the police (at least the police in Alberta, Canada) with regard to seatbelts. The report of any fatal accident will mention the fact that the deceased was not wearing a seatbelt and was ejected (if that happened). The effect is a large number of repeated anecdotes and such anecdotes are unforunately much more powerful than statistics for convincing people.

    Every time an uncaccinated individual dies from something they could have been vaccinated against, this needs to be pointed out even if it is rubbing salt in the wound of grieving parents. There is no point in sticking to the rational “high ground” if we lose the battle to the forces of irrationality and lose the herd immunity.

  5. daedalus2uon 29 Nov 2007 at 1:17 pm

    Freddy, the problem with that approach is that vaccines are not 100% effective, and if most of the population is vaccinated, most illnesses may actually be in vaccinated individuals.

    For example, assume a vaccine is 85% effective at preventing the disease, and 90% of the population is vaccinated, and the vaccine changes the incidence (in an exposed person) from 50% to 7.5%.

    If 1,000 people are exposed, 100 are not vaccinated and 50 of them get the disease. Of the 900 that are vaccinated 7.5% get the disease or 67. Propagation of a disease is very sensitive to the number of cases transmitted. If each person with the disease infects more than one other person, the disease will propagate and expand, if less then one, the disease will peter-out. In this example if each infected person exposes 10 others, then if the population is unvaccinated 5 will become infected and the epidemic will explode exponentially. If everyone is vaccinated then only 0.75 people will become ill and an epidemic cannot spread. If 10% are unvaccinated then 1.17 become infected (0.5 + 0.67) and the epidemic propagates.

    There is also the problem of “blaming the victim”. When people die or are injured, normal human sympathy is to try and mitigate their injury, even when that injury is of their own making.

    There is a blog about giving birth at home vs in a hospital.

    At home there is not immediate access to things that can be life-saving, such as emergency C-section. It would be expected then, that the death rate would be higher because some life-saving treatments are unavailable. It turns out it is, but the proponents of home birth don’t want to hear it, even when babies die during birth that would not have died in a hospital birth. Telling a woman that her decision to have a home birth cost her baby his/her life is extremely hurtful (even (or especially) if true).

    Calling attention to the deaths of unvaccinated individuals is also calling attention to their decision to not vaccinate, and to their inferred irrational behavior, and/or stupidity. This is not always a helpful way to have a dialog with those who have difficulty understanding things logically. They come up with other “reasons” why they are not like those who got sick, that they have “the right stuff”, they pray to the right God, they eat the right foods, they live a righteous life, for what ever reason their experience will be as they imagine, not as probabilities predict.

    I don’t know how to get such people to understand either.

  6. Freddy the Pigon 03 Dec 2007 at 2:48 am

    daedalus2u – you have come up with an interesting statistical paradox there – I think the same thing may even apply to seatbelts in Alberta due to the high rate of compliance (seatbelts are mandatory). However, the reports never mention that someone was wearing a seatbelt when they were killed (ie a Neon in a head on with a semi) since the police are encouranging seat belt use. The medical community should use the same strategies. They have to play hardball with the woos. You will never convince the true believers as you say, but it is possible to keep them from infecting too many others with their dangerous stupidity. I am sure there are still people who don’t because their uncles cousin twice removed alleged survived a crash because they were thrown clear, but nearly everyone else here buckles up now.

  7. daedalus2uon 03 Dec 2007 at 9:28 pm

    The medical community doesn’t have the tools, or the power to play the kind of “hard ball” that should be played. Wakefield committed fraud in lying about finding measles vaccine virus in the gut of children with autism.

    Wakefield has profited and continues to profit handsomely from his fraud.

    It is not within the power of the medical community to apply sufficient sanctions to Wakefield that would be what I consider to be “just”. Prison and confiscation is what he deserves.

    Fraud masquerading as woo is very difficult to prosecute.

    The “problem” is that scientists are constrained by the truth. The opponents of science are not.

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