I have hesitated to wade into this acrimonious public debate. Yet my family has gotten forwarded HuffPo columns that hype the supposed link between vaccines and autism. As a public health researcher and as a caregiver, I take umbrage.
I should say at the outset that I have never in any way taken a dime from a vaccine manufacturer. I should also that I accept the need to closely regulate the vaccine industry. Four million children are born in America every year. Most greatly benefit from vaccination. There are a small number of real tragedies in which some vaccine harms specific children.
Sensible regulation isn't easy. Vaccine epidemiology is an imperfect science, and policymakers must consider both the risks and benefits of these products. Autism spectrum disorders are especially mysterious, varied, and frightening. It is not clear that the incidence of these disorders is rising. Whatever the trend, these conditions merit a determined, disciplined, and sustained public health response to help individuals and families who suffer because of these conditions.
Spreading debunked rumors will not help anyone here. Last month, I watched the pilot episode of the ABC series, Eli Stone. This show is funny, well acted, inspiring. It includes a great cameo of George Michael singing "You've got to have faith." Mr. Stone himself is a heroic, Grisham-style litigator who sees heavenly visions brought about by divine intervention, a brain aneurysm, or some combination of these things.
Driven by these visions to forsake the usual corporate law road, Eli bravely represented a stunning young mom who is suing a vaccine manufacturer. The drug company makes vaccines which include an ingredient "mercuritol," a compound which the show clearly presents as the likely cause of her son's autism.
The show powerfully illustrates the dangers of corporate greed -- not the greed of the fictitious drug company, but of ABC itself for spreading damaging and unfounded myths.
Except when George Michael is singing, the whole episode is a thinly-veiled allusion to the thimerosal controversy. Despite all evidence, this faux debate has persisted because of the sincere but harmful actions of Congressman Dan Burton and a misguided segment of the autism advocacy community.
As reported in an excellent New York Times story by Edward Wyatt, there is no scientific debate over the alleged link between vaccines and autism. I know that many good people believe that vaccines have harmed their children, but there is just no evidence that vaccines lay behind the concerning rise in diagnosed autism cases in recent years.
Among the reasons not to believe it:
• The effective removal of thimerosal from vaccines brought no observable impact on autism rates.
• Unvaccinated autistic children show the same age of onset as do vaccinated autistic children.
• Major studies and several expert panel reports in the United States and around the world have investigated this issue exhaustively, and found no reason for worry.
For the real information, I encourage readers to check out the websites of the Institute of Medicine here, and the American Academy of Pediatrics here.
I'll simply say that the scientific controversy has been put to bed long ago, even if many people angrily respond to this post.
Unfortunately, the same social currents that lead people to fear vaccines lead people to dismiss the messengers and messages that might assuage these fears. Elaine Showalter's Hystories: Hysterical Epidemics and Modern Culture appeared 10 years ago. Too bad, because the vaccine-autism controversy provides a great illustration of how hysterical epidemics are spread through an interaction of families in pain, underlying cultural anxieties, issue advocates, and the modern media.
The vaccine-autism controversy features heart-wrenching testimony from parents who faithfully took their child to the pediatrician for shots, only to witness the onset of autism soon after. On the other side, it features pharmaceutical companies, often poster boys for corporate greed. It taps into public distrust of the influence and social authority of scientific medicine. It taps into public fears about strange chemicals that penetrate our bodies in novel combinations to do strange things.
The controversy also reflects complacency about infectious disease. The early Salk vaccine brought real danger. Early manufacturing errors infected hundreds of children with polio. Fifty years ago, Americans tolerated the risk, because my parents' generation had very recently lived in fear that their kids would become paralyzed after swimming in the local swimming pool.
When enough people are vaccinated in a given community, an infectious disease such as measles is unable to gain a foothold. The public health community calls this herd immunity. This is what tamed polio. That's also what we too much for granted these days.
Many people chafe at mandatory vaccination, for religious, political, and other reasons. Ron Paul raises this issue in his campaign litter. Whatever you think of the competing Democratic health plans, here is a real issue of individual mandates on which we should all agree. Especially if vaccination brings minor inconveniences, discomfort, and either imaginary tiny risks, it's very tempting to let someone else, let someone else's child, assume these burdens.
Public health practitioners fear that television shows such as Eli Stone and recent appearances by celebrities on Oprah spreading similar rumors will discourage people from getting flu shorts or immunizing their kids. Practitioners' fears are reasonable. They are rooted in long experience. Flu kills a surprising number of Americans every year. According to the American Academy of Pediatrics, failure to immunize toddlers was a major cause of a U.S. measles epidemic which resulted in 11,000 hospitalizations and 120 deaths. Fanciful TV shows should not influence peoples' attitudes and behavior regarding important matters in the real world. A trainload of medical and public health studies indicate that they do.
More to the point, a later-retracted 1998 study that alleged an autism link convinced many British parents not to vaccinate their kids. The study was discredited, but not before it stoked needless measles outbreaks in which hundreds of children were hospitalized and a few died. A 2006 story in the British paper, the Guardian, starts out:
England is experiencing its biggest measles outbreak in 20 years, fuelled by the reluctance of some parents to have their children immunised because of now-discredited claims of a link between the MMR jab and autism.
There have been 449 reported cases of measles since the beginning of the year,... That, in less than six months, is more than double the 438 for the whole of 2003. Last year there were only 77 cases.
The article, which can be linked here makes sobering reading,
My own displeasure is personal. My wife and I are caregivers for an intellectually disabled man. I know only too well that families are drawn to quackery and hokum. I have also seen how hard it is for medical science to compete for airtime with unfounded theories and worthless products and therapies. I suspect that false rumors are hard to debunk through straight information. Many parents in difficult cirumstances have bad experiences with the schools, social services, and medical providers to whom they turn for help. When these systems and providers fail to show a competent and caring human face, parents themselves turn away. They easily fall prey to all sorts of mischief.
Given these realities, it is especially irresponsible to falsely blame vaccines for health difficulties. And there is something heartless for major television networks to coyly spread myth in this area. We are used to politicians who doubt global warming and evolution, the cranks who claim that Jewish doctors are spreading AIDS. Of course, the problem goes deeper, and crosses every ecumenical and political line. My friend Mark Kleiman spearheads one of the best blogs in the web: the reality-based community. Out in the real world, the reality-based community is always embattled because reality so often fails to provide the answers or the consolation that people seek. Hence the permanent lure of scapegoating and magical thinking.
And there is always someone willing to make a buck on it. ABC's misleading story line stacked the deck in the usual storybook TV way. The network was shamed into running the usual "this fictional account" disclaimer, together with links to an earnest CDC website that few viewers will ever frequent. The network claims that the episode showed both sides -- a statement that could apply with equal merit to airing a debate over whether mosquitos spread AIDS.
In the end, Eli takes down the drug company for $5.2 million when its CEO is forced to admit that he refused to vaccinate his own child with the company's product. The show's sole connection to reality was ironic: A handsome trial lawyer swayed a pliable jury and TV audience to believe something that isn't true.
ABC got good ratings. Some unknown and unknowable number of people will surely avoid useful vaccines. It is depressing how low the penalties are for unethical corporate behavior. John Grisham, I have an idea for your next book.
