“A Dose of Controversy”: More like a dose of equivocation

Last Thursday, I expressed dismay about an upcoming NBC news special, A Dose of Controversy, which is about a man who arguably caused more damage to public health than just about anyone in the last decade, namely Andrew Wakefield. Anyone who’s a regular reader of this blog knows just what I think of Andrew Wakefield. I’ve made no secret of it; I have little but contempt for the man, whom I view as incompetent, dishonest, and a quack. Andrew Wakefield, as you may recall, is the British gastroenterologist who in 1998 published a study in The Lancet that claimed to find a link between the MMR vaccine and “autistic enterocolitis.” This study, aided and abetted by truly irresponsible journalism, launched a panic in the U.K. that is only now starting to abate. In the interim, measles, once thought conquered, has become endemic again in the British Isles. In any case, it matters not to the anti-vaccine movement that (1) his study was poorly designed and utterly refuted by later studies; (2) it was revealed that Wakefield received £435,643 in fees, plus £3,910 expenses from lawyers trying to show that the MMR was unsafe; (3) the PCR laboratory that Wakefield used was so poorly run that it apparently had no knowledge of the concept of a negative control; and (4) strong evidence has been revealed that Wakefield falsified data.

If there’s one thing that causes my teeth to grind almost as much as the thought of Andrew Wakefield on national TV, free to spew his pseudoscience, self-aggrandizement, and comparisons of his plight to that of Galileo, it’s the convention of “balance” in news stories. I’ve written extensively about this bogus false equivalence between pseudoscience and science, particularly regarding the vaccine/autism manufactroversy. One extreme example was a particularly execrable episode of an execrable TV show, The Doctors, in which the “tell both sides” mantra led to an infuriatingly inaccurate picture, in which the beliefs of anti-vaccine apologists like Dr. jay Gordon were treated as equivalent to those of scientists.

As I expected, the NBC special is cut from exactly the same cloth; it’s just that the seams don’t show as badly.

I don’t know what possessed me, but I considered it more or less my duty to subject myself to this nonsense. So I did just that yesterday evening, as NBC aired A Dose of Controversy. It was torture, but I do it all for you (and because it’s a quick blog post). I did it even though the site, much less the voice, of Andrew Wakefield, as Pink Floyd sang in The Wall, fills me with the urge to defecate.

Of course, I knew right away from the title of the broadcast that this broadcast was going to be a “tell both sides” crapfest right from the start. The reason, of course, is that politics is not medicine. In politics and many other controversies, there often are two sides with cases of similar validity. In such cases, it is critical to report both sides fairly and accurately. However, in science and medicine, the “tell both sides” mantra often grossly exaggerates the validity of pseudoscience when it’s a conflict between pseudoscience and science. That’s exactly what’s going on with the vaccines/autism “controversy,” because there is no medical controversy over whether the MMR vaccine causes autism or whether vaccines in general cause autism. Rather, it’s what we call a “manufactroversy,” or a manufactured controversy. It’s pseudoscience versus versus science, but Lauer et al starts out painting the story as that of the proverbial “brave maverick doctor” (Andrew Wakefield), who thinks he’s found a horrible result that the medical establishment does not want to acknowledge, which is why it tries to shut him down. Meanwhile, it has a horrible graphic between each segment that shows a vaccine being drawn up, with newspaper headlines and pictures of Wakefield flashing behind it.

The First half of the show is constructed as mainly “dueling interviews,” one with Andrew Wakefield and the other with Brian Deer, interspersed with brief clips that provide background and serve as exposition, right from the start setting up the false equivalence. It also sets up the “brave maverick doctor” against the dogged journalist. Who couldn’t love a story like that? In this case, I can’t. The broadcast did hit all the low points of Andrew Wakefield’s career, such as his conflict of interest, in which he was paid large sums of money for two years before his 1998 Lancet paper by lawyers preparing a class action suit against vaccine manufacturers; his being investigated by the General Medical Council; the infamous incident in which Wakefield got blood samples from healthy children at a birthday party and then later joked about two children fainting and one passing out; and the fact that several of the children in his study were plaintiffs in the class action lawsuit. However, it assiduously avoided the F-word (scientific fraud), and, worse, it set up the allegations in a he said/she said structure, in which Wakefield makes claims, which are then refuted; or Brian Deer describes the findings of his investigation, each of which Wakefield always has a glib explanation for.

Actually, if you want to get a feel for how this whole episode was done, there was the infuriating manner in which Lauer interviewed Deer. For example, he asked Deer, “In your opinion how much was Wakefield paid?” as though the number Deer came up with was, as Asimov so famously said about a “theory,” something Deer had “dreamt up after being out drunk all night.” Come to think of it, the word “theory” is bandied about referring to the hypothesis that vaccines cause autism; it always irritates the crap out of me how that word is misused because in science it is a term with a lot of certainty behind it whereas in colloquial usage it does often mean a “hunch” or an “idea.” Then Lauer repeats the offense by saying to Deer, “It’s your opinion that Wakefield was involved in the development of another vaccine,” again, as though Deer’s conclusions about Wakefield’s conflicts of interest were nothing more than mere opinion, no more or less likely to be valid than Wakefield’s assertions. It is a fact that Wakefield received £435,643 in fees, plus £3,910 expenses from lawyers trying to show that the MMR was unsafe, a matter of public record. Deer’s “opinion” has nothing to do with it. It is a fact that Wakefield had a patent application for a single dose measles vaccine filed before he published his Lancet paper. These are not matters of “opinion.”

Despite this, Brian Deer did get in some good zingers, for example:

  • “This thing stank from the day it appeared.”
  • “Wakefield was greedy, and that’s how I caught him.”

Best of all, after Lauer asked Deer, “Do you ever worry that Andrew Wakefield is right?” his response was an unquivocal “no.” Nor should he. Again, as Pink Floyd sang, the evidence is “incontrovertible.” At another point, when Lauer says:

LAUER: This back and forth between you and Andrew Wakefield has been going on a long time. It seems that Dr. Wakefield has an answer for everything you allege.

DEER: And the dog ate his homework. He’s always got a story…This guy sued me. I could have lost my home; I could have lost everything apart from what I’m wearing.

And about Wakefield’s suit having gone nowhere, Deer quipped, “I’ve got the check” (for Deer’s legal fees).

Paul Offit was also interviewed. He got in some good licks, too, describing how he had been threatened, how an anonymous caller had mentioned his children’s names, a clear threat that he knew who they were and where they went to school. He even admitted that there was one time when he considered giving it all up, and that was it. Still, when he wondered why parents listen to celebrities like Jenny McCarthy instead of scientists and physicians, he encapsulated every frustration those of us on the side of science have felt. That was the power and the problem. At times Dr. Offit came across as testy and angry. Now, far be it from me to criticize a man like Dr. Offit for being angry at what anti-vaccinationists have done to public health in this country, and I very much liked how uncompromising he was when he pointed out that the anti-vaccine movement has caused considerable harm. Unfortunately, the comparison with the unctuously calm demeanor of Andrew Wakefield does not work to Dr. Offit’s advantage. He was right about each and every canard of the anti-vaccine movement he shot down, but his passion came across a bit too angry.

Then, of course, there was Bernadine Healy. I’ve written about her having aligned herself with the anti-vaccine movement before. Here she does it again, big time, providing quotes that only J.B. Handley or Andrew Wakefield himself could love: “Scientists have to be listened to. I don’t think it’s terribly humble to say stop, we have all the answers, shut down the research”:

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Straw men that big are usually seen in the Burning Man every year, and Healy could be just the guy who sets it ablaze. No one has ever said that we “have all the answers.” What science says is that the evidence against the contention that vaccines cause autism is such that by any reasonable stretch of the imagination the hypothesis has been refuted.

Perhaps the most disturbing part of the show occurs near the end, when NBC went into Thoughtful House and followed parents of an autistic child through an endoscopy by Dr. Arthur Krigsman. Tim Kasemodel is interviewed about his son Thomas, who is shown being sedated so Krigsman can do both an upper and lower endoscopy on him. The cost is reported to be $4,500 out of pocket, not to mention the pain, fear, and distress to which Tom Kasemodel is subjected being subjected to a medical procedure that is almost certainly unnecessary. It’s very striking how all the trappings of scientific medicine are there, but none of the methodology. Indeed, Lauer inadvertently stumbled on just the issue:

LAUER: Based on your experience, have you made children better? Anecdotally do you have evidence?” Do they get better?

Wakefield, of course, responds in the affirmative. What Lauer should have asked Wakefield is whether he has randomized controlled clinical trials to support his belief that autistic children “get better” at Thoughtful House. He doesn’t, but pretty much every child they scope (85%, according to Dr. Krigsman) has “autistic enterocolitis,” even though, as in the case of Tom Kasemodal, Dr. Krigsman was hard-pressed to find abnormalities. (“Mild or softer findings,” he said about Tom.) Of course, on pathology, Thoughtful House pathologists apparently found “mild inflammation.” What did Krigsman prescribe? Lots of supplements, daily laxatives, and periodic colon cleansing. Can you imagine subjecting an autistic child to laxatives and colon cleanses? As far as I’m concerned, that’s child abuse, particularly given that there’s no scientific justification for it.

Sadly, A Dose of Controversy falls into the same trap that so many media examinations of pseudoscience fall into. It applied the journalistic convention designed for stories about politics, legal matters, and other human conflict to something it’s not well-suited for, the battle between pseudoscience and science. In doing so, it gives the impression that there is actually far more to the pseudoscience than there in fact is. Even worse, it dollops onto that convention another cliche, namely the iconoclast, the rebel, the “brave maverick doctor bucking the system against who the system stands united. Pile it all together, and it was a huge missed opportunity. Two statements illustrate this well, both occuring near the end of the report. First Lauer describes Wakefield as a man who will listen to these parents, respond to them, and stand up for them, while Wakefield says, “I don’t know if vaccines cause autism. I know it’s a question that needs to be asked and I’m not going to walk away from it.”

I predict that the phones at Thoughtful House will be ringing off the hook this week. I guess I should be grateful that, for whatever reason, Jenny McCarthy wasn’t interviewed for this report.