The Autism Vaccine Controversy and the Need for Responsible Science Journalism

The seemingly never-ending contraction of the media industry has resulted in a shedding of specialists in every journalistic medium. That does not, however, mean that the public's hunger for information about science, medicine and technology is shrinking.
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Earlier this week, The Panic Virus, my book on the controversy over vaccines and autism, was released in paperback. While there haven't been many scientific advances in this particular issue since the hardcover edition was published -- the evidence supporting vaccines' paramount place in public health efforts and the total lack of corroboration supporting a causal connection between vaccines and autism remain as strong today as they were a year ago -- there have been new developments in the story. Their coverage highlights an enduring passion of mine: The need for reliable, responsible science journalism.

  • Last January, Andrew Wakefield, the discredited British gastroenterologist whose 1998 paper sparked the first wave of fears that vaccines might be causally connected to autism, was further disgraced when the editors of the British Medical Journal declared his work "an elaborate fraud." (By that point, Wakefield had already forfeited his medical license for a litany of moral, ethical, and professional misdeeds -- including an incident where he paid children at his young son's birthday party to donate their blood for his experiments.) With little left to lose, Wakefield seemed to fully embrace the fringe: In June, he headlined a rally titled "The Masterplan: The Hidden Agenda for a Global Scientific Dictatorship" with a cohort of 9/11 Truthers, One World Government conspiracists, and anti-fluoridationists.
  • 2011 proved equally inglorious for Mark and David Geier, a father-son research team that is almost as lionized as Wakefield himself in anti-vaccine circles. For years, the Geiers have peddled a sham "cure" for autism that involves regular injections of Lupron, a powerful drug used to chemically castrate sex offenders. (In additional to being incredibly painful, the Geiers' "Lupron protocol" is very expensive: Treatment at one of their clinics can cost up to $70,000 or more a year.) In April, an investigation by the Maryland State Board of Physicians found the Geiers' treatment "endangers autistic children and exploits their parents by administering to the children a treatment protocol that has a known substantial risk of serious harm and which is neither consistent with evidence-based medicine nor generally accepted in the relevant scientific community." By the end of the year, Mark Geier's license to practice medicine had been suspended in California, Indiana, Maryland, New Jersey, Virginia, and Washington State; his son, meanwhile, had been charged with practicing medicine without a license.
  • These revelations, were, for the most part, reported in a way that accurately emphasized the moral and scientific bankruptcy of anti-vaccine claims. Not surprisingly, none of this diminished Wakefield's or the Geiers' standing among true believers. (Several months after the BMJ report was published, an anti-vaccine leader was quoted The New York Times Magazine as saying, "To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one.")

    What might be more surprising is the legacy of years of dispatches that created a false equivalency between verifiable facts and Wakefield's and the Geiers' outlandish allegations. These began almost the moment Wakefield held a press conference for his since retracted 1998 paper: Despite the fact that he was virtually alone in recommending the measles-mumps-rubella (MMR) vaccine be dropped, the London dailies ran stories like "Ban Three-In-One Jab, Urge Doctors" and "Doctors Link Autism to MMR Vaccination." For more than a decade, credulous (or lazy) reporters who were either unwilling or unable to grasp the basic scientific principles at hand regularly regurgitated the most specious anti-vaccine talking points. One of the more cringe-inducing examples occurred in an infamous 2007 story by CBS News's Sharyl Attkisson, who wrote, "There is no definitive research proving a link between vaccines and autism or ADD, but there is also no definitive research ruling it out." That statement betrays a profoundly mistaken understanding of the theory of falsifiability, which states that in order for a hypothesis to be a legitimate subject of inquiry, it has to have a single, corresponding null hypothesis--that is, it needs to be disprovable. Saying that there is not definitive research ruling out a link between vaccines and autism is like saying there is not definitive research ruling out a link between watching CBS News and rectal cancer: It's technically true only because it's functionally meaningless.

    Unfortunately, there is no restart button when it comes to public consciousness, and it will take quite a while to eradicate the effects of all of the fear and misinformation that were injected into the population. Don't take my word for this -- look at the data: One poll taken early last year found that only 52 percent of Americans knew vaccines did not cause autism. (Eighteen percent said they believed, despite the overwhelming amount of evidence to the contrary, that vaccines could cause autism; 30 percent said they weren't sure.) In October, Pediatrics reported that more than 10 percent of parents refuse to give their children some vaccines or adhere to "alternative" vaccine schedules that are based on little more than guesswork.

    The result has been a flourishing of vaccine-preventable diseases. A year after 10 infants died in California of pertussis (or whooping cough) infections, nationwide outbreaks continued to spread. While many of those were due to under-vaccinated adults who didn't realize they were due for a pertussis booster, there were countless more instances where the disease was spread among deliberately unvaccinated kids. (The best (or worst) example of this occurred at the Blue Mountain School, a small private school about 40 miles southwest of Roanoke, Virginia. It was shut down for a week after roughly half of its students were infected with pertussis; according to local health officials, most of the parents of the infected students had chosen not to have them vaccinated.)

    Even more alarming were the measles outbreaks that cropped up in virtually every region of the country, from the Northeast to the Pacific Northwest and from the Gulf Coast to Southern California. Unlike whooping cough, measles infections were spread almost exclusively by unvaccinated children and adolescents. The largest outbreak was in Minnesota, where anti-vaccine activists had targeted a community of Somali immigrants that appeared to be experiencing higher-than-expected rates of autism. That outbreak began when a deliberately unvaccinated child returned from Africa infected with the disease; by the time it had run its course, more than a dozen children had been hospitalized. As of December 8, the U.S. had recorded 221 laboratory-confirmed cases of measles in 2011 -- about four times more than usual and the most in any year since 1996.


    A few months ago, one of my students in MIT's Graduate Program in Science Writing came to my office to discuss what was becoming an overwhelming anxiety: She was worried, she said, that she was embarking on her career at the precise moment when the opportunities for science writers were at an all-time low. I certainly understand her concern: The seemingly never-ending contraction going on in the media industry has resulted in a shedding of specialists in every journalistic medium. That does not, however, mean that the public's hunger for information about science, medicine, and technology is shrinking; indeed, as our continuing struggle against vaccine-preventable diseases demonstrates, the need for reliable, accurate information is arguably greater than ever.

    Those realities have created an enormous amount of opportunity for budding science writers, blogging networks, and non-traditional newsgathering operations -- but with those opportunities come responsibility. The fact that a specific story is controversial (or that it is promoted by a particularly outspoken celebrity) does not mean it deserves the oxygen it needs to survive.

    Make no mistake: The cost of misinformation is great indeed. In a nation of more than 300 million, a couple of hundred of measles infections might not seem like a lot, but we need only look across the Atlantic to see how these figures can explode in an incredibly short amount of time. In 2006 and 2007, France had an average of 40 measles cases per year. In 2011, the country recorded more than 15,000 cases, including more than 650 cases of severe measles pneumonia, 16 cases of encephalitis and six deaths. A recent WHO report said 90% of measles cases in Western Europe were in "adolescents and adults who had not been vaccinated or for whom vaccination history was not reported."* The greatest risk of all, of course, is to infants, who are both too young to receive the MMR vaccine -- the first dose isn't given until kids are 12 months old -- and are the ones most likely to suffer serious complications. We owe it to them, and to ourselves, to make sure we do a better job in the future.

    *Correction, January 30, 2012: A previous version of this sentence incorrectly said the WHO's statement about unvaccinated adults and adolescents was made in reference to France; in fact, it was in reference to all of Western Europe. For the period under discussion, France had approximately 65 percent of all measles infections in Western Europe.

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