I realize I complain periodically about when I get into what seems to me to be a rut in which I’m writing pretty much only about anti-vaccine lunacy. This is just such a week, when the news on the vaccine front has been coming fast and furious, first with Andrew Wakefield’s being found to have behaved unethically and dishonestly by the British General Medical Council, only to be followed up a few days later with the news that the editors of The Lancet had retracted his 1998 paper, the paper that started the MMR scare in the U.K. and launched a thousand autism quacks. Meanwhile, the cranks will leap to the defense of their hero, providing additional blogging opportunity. Sometimes these events will stretch out for several days or even a week when it appears that the only thing I’m writing about is vaccines. Depending on my mood, I’ll rail against fate and resist, often with Godfather, Part 3 references, before reluctantly charging back into the fray. Sometimes, when I’m in the mood for some seriously not-so-Respectful Insolence, I’ll just go with the flow and ride the wave for as long as it lasts before moving on to other topics.
This is one of those times.
Seeing the patron saint of the anti-vaccine movement, the man who started it all in the U.K. (at least the most recent incarnation of the anti-vaccine movement) finally forced to answer for his misdeeds by potentially having his U.K. medical license struck off and actually having the original source of his influence expunged from the scientific literature, demands nothing less. This is what I do in the blogosphere, and I want to make sure that there is copious explanation of what’s going on and why. If I can’t always resist indulging in a little schadenfreude at times, well, the blog pseudonym notwithstanding I am still human. Even so, I have to prioritize. Even though I rather miss our old friend, pediatrician to the anti-vaccine stars and apologist for the anti-vaccine movement Dr. Jay Gordon, has resurfaced in the Huffington Post just asking for a heapin’ helpin’ of not-so-Respectful Insolence, something else demanded my attention first. The reason is quite simple. It epitomizes what is most wrong with science journalism. That’s why I hereby list the two worst offenders for execrable reporting of the Wakefield Lancet retraction.
Offender #1: CNN
Offense: “Tell both sides” fallacy with a heapin’ helpin’ of anti-vaccine loon Kim stagliano
Evidence: See the video.
The above video is truly painful to behold and emblematic of how the “tell both sides” model of journalism favors pseudoscience. First, the correspondent (Don Lennon) and Elizabeth Cohen, CNN’s senior medical correspondent, get parts of the story painfully wrong. For example Cohen provides only two dates in her time line for the Wakefield story: 1998 and 2010. This is rather like describing a timeline for World War II with only two years, 1939 and 1945. Completely ignored were a couple of more key years: For example, 2004, which was when Brian Deer’s first big revelations about Wakefield’s dishonesty and undisclosed conflicts of interest came to light and 10 of 13 of the authors retracted their names from Wakefield’s paper; 2007, when the General Medical Council started its proceedings; and 2009, when Brian Deer revealed evidence suggesting that Andrew Wakefield probably committed outright scientific fraud. Those are kind of important years in the Wakefield saga, wouldn’t you agree?
Next, Stagliano dives into some serious burning stupid, spraying it through CNN like gasoline spraying from a gas tank with a hole in it. In the process she shows that she is utterly clueless regarding even the basic language of medical science. First, Stagliano starts by condescendingly correcting Lemon by making a specious distinction between a study and a “case series,” stating that Wakefield’s study is not really a “study” at all and that he “didn’t do” it because it’s just a case series. Kim, Kim, Kim, Kim. Here’s one hint: Don’t be condescending unless you know what you’re talking about; you end up looking really dumb. A case series when published in a medical journal is a study. Period. It even requires IRB approval and everything–just as all studies using human subjects do! Moreover, it was represented as a prospective study (although it later turned out that it wasn’t really a prospective case study of truly consecutive cases). And to claim that Wakefield “didn’t do it” because it’s a case series is just plain silly. Who does Stagliano think designed the inclusion and exclusion criteria, looked at the charts, recruited the subjects, and analyzed the data and studies, if not Wakefield and his team? In any case, a case series is one kind of a medical study, and it irritates the crap out of me to see Stagliano self-righteously correct a correspondent based on her ignorance of that simple fact. That Ms. Stagliano could go on national TV and make such an ignorant statement should be a source of embarrassment to her forever. Condescension and ignorance are not an appealing combination.
Next, Stagliano parrots the line that Wakefield supposedly did not say that there was a link between vaccines and autism in his original 1998 study (I love referencing it over at Generation Rescue). Let’s go back and see what Wakefield wrote, shall we? First, there was this interpretation:
We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.
And what was this “trigger”? Clearly, Wakefield wanted to implicate the MMR vaccine. It is true that he did write:
We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described. Virological studies are underway that may help to resolve this issue.
However, after you’ve been in the science biz a while, you come to recognize statements that are almost certainly there not because the author wants them to be there but because the reviewers of the manuscript forced the author to include them in the revised manuscript if they wanted their paper published. The above passage strikes this surgical scientist as being just one of those statements demanded by reviewers. One reason is that it sticks out like a sore thumb from the rest of the discussion; it caught my attention when I read it because it didn’t jibe with the rest. Moreover, Table 2 in the paper explicitly tries to link MMR vaccination to subsequent autistic regression and bowel symptoms. What the paper is trying to show is very clear, that one disclaimer notwithstanding, and those who know how to read scientific and medical journal articles can recognize that. Reinforcing that impression is what Wakefield writes later in the manuscript:
If there is a causal link between measles, mumps, and rubella vaccine and this syndrome, a rising incidence might be anticipated after the introduction of this vaccine in the UK in 1988.
We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.
Basically, the entire discussion comes across to me (and I’ve been in the science biz a while) as the result of reviewers reining in the more–shall we say?–speculative interpretations of Wakefield’s study. In any case, it’s very disingenuous of Wakefield and the anti-vaccine movement to claim that Wakefield never said that the MMR causes autism in the Lancet paper, given that the paper isn’t how the public learned about the study. It was the press, starting with the the press conference he gave upon the release of the study. In that press conference, Wakefield went far beyond what he wrote in the manuscript. Indeed, appearing in a 20-minute video released by the Royal Free Hospital, Wakefield laid down these gems:
No, the work certainly raises a question mark over MMR vaccine, but it is, there is no proven link as such and we are seeking to establish whether there is a genuine causal association between the MMR and this syndrome or not. It is our suspicion that there may well be but that is far from being a causal association that is proven beyond doubt.
OK, not so bad. Yet. Let’s see what else Wakefield said:
And I have to say that there is sufficient anxiety in my own mind of the safety, the long term safety of the polyvalent, that is the MMR vaccination in combination, that I think that it should be suspended in favour of the single vaccines, that is continued use of the individual measles, mumps and rubella components.
Uh-oh. Not so good.
INTERVIEWER: So you’re saying that a parent should still ensure that their child is inoculated but perhaps not with the MMR combined vaccine?
DR ANDREW WAKEFIELD: Again, this was very contentious and you would not get consensus from all members of the group on this, but that is my feeling, that the, the risk of this particular syndrome developing is related to the combined vaccine, the MMR, rather than the single vaccines.
So Wakefield clearly believes this syndrome of autistic regression and bowel problems is due to the MMR, and he basically says so right here:
INTERVIEWER: Of course there’ll be many parents whose children have had this MMR vaccine who will now be concerned about what may happen to their children. What advice would you give to them?
DR ANDREW WAKEFIELD: Well, the interesting thing is that the damage, the behavioural or developmental change tends to occur quite soon after administration, and this is where, why parents or GPs or paediatricians have been able to make the link, the association with MMR. So if that hasn’t happened then it is extremely unlikely to happen.
INTERVIEWER: But there are going to be parents now whose children are about to have the vaccination, and they’re gonna say: I’m not gonna risk it. What would you say to them?
DR ANDREW WAKEFIELD: Well, my message is for the Department of Health and the regulatory authorities, and that is that this needs urgent investigation; it needs funding and it needs the appropriate level of commitment in terms of basic scientific research and clinical research to answer the question. And until that time we cannot offer any definitive evident, any definitive message to parents about this.
INTERVIEWER: Sounds to be saying, you seem to be saying perhaps don’t?
DR ANDREW WAKEFIELD: My opinion, again, is that the monovalent, the single vaccines, measles, mumps and rubella, are likely in this context to be safer than the polyvalent vaccine.
BZZZZZZT! Wrong answer! In fact, as Dr. Mary Ramsay points out, this recommendation that the MMR vaccine be broken up into its separate components came out of nowhere. It wasn’t based on any evidence, either in Wakefield’s Lancet article or from anywhere else.
In any case, parents got the message Wakefield was laying down; only he didn’t lay it down in the paper itself. He was laying it down in his public appearances, aided and abetted by the sensation mongering credulous British press. Wakefield was telling them that the MMR could cause autism. Oh, sure, he qualified it with enough weasel words to appear cautious, but basically recommended that parents get single vaccines, rather than the trivalent vaccine (MMR), because the MMR was somehow not as safe, because he thinks it causes autistic regression. It’s all there, and it’s all clear. It’s also why whenever I hear an anti-vaccine loon like Kim Stagliano oh-so-piously and condescendingly proclaim that Andrew Wakefield never said that the MMR causes autism and said that it didn’t in the paper, I become quite annoyed at the half-truth and how they almost always leave out the press conferences Wakefield gave back in 1998 in which he wasn’t anywhere near so circumspect.
This study demonstrates that the MMR vaccine triggered autistic behaviors and inflammatory bowel disease in autistic children
D’oh! Maybe Ms. Stagliano should tell Mr. Handley that he’s wrong in his interpretation of this study. Wakefield never said that, right?
I will give the reporters credit for at least mentioning that Ms. Stagliano’s third child is on the spectrum but not fully vaccinated. However, I was always under the impression that her third child is completely unvaccinated. Be that as it may, Stagliano tries to tell us that the manifestation of autism in her third child was different, which strikes me as a bit of denial. In other words, vaccines clearly didn’t cause her third child’s autism; so it must be a “different” form of autism! Yeah, that’s the ticket!
Stagliano then launches into the same old antivax talking points about the vaccine court’s having compensated children for being made autistic after vaccines. I’ve discussed that before in detail both here and just yesterday; so I see no need to tread the same ground again so soon. I do like her use of the Toyota analogy. For one thing, it isn’t the Prius that’s being recalled. Yes, I know that it was announced the other day that the 3rd generation Prius has problems with its anti-lock brakes, but that problem sounds minor compared to the accelerator problems for which Toyota has undertaken a massive recall of eight of its most popular models; so that analogy fails there. But on another level it’s hilarious to to see Ms. Stagliano use the example of driving a child to school in a car because, as I’ve pointed out before, driving a car–even a perfect car with no acceleration problems–is far, far more dangerous than any vaccine. Yet, I doubt that Ms. Stagliano thinks twice about taking her children wherever they need to go in her car. I also find it completely disingenuous of her to claim that she supports vaccination. Oh, really? What would it take for her to be convinced that vaccinating her kids is safe enough that she would do it? Antivaccinationists can never anser this question, other than either by demanding impossible levels of perfection that they don’t, for example, demand from autos or by shifting the goalposts each time it is pointed out that, yes, vaccines really do meet that standard of safety.
The rest of it consists of the same crank arguments based on straw men, such as the claim that we’re “shutting down science” and appeals to fallacious authority, such as Bernadine Healy, who, sadly, has betrayed her previous role as the Director of the NIH and become nothing more than another useful idiot for the anti-vaccine movement, if she hasn’t actually gone over to the dark side and become fully anti-vaccine. No, it isn’t “shutting down science” to point out that Andrew Wakefield was dishonest and unethical in how he carried out his “research,” nor is it “censorship” to retract the fruits of that unethical and dishonest research. It’s also amusing when she once again pulls the “vax versus unvaxed” study gambit without understanding what that would entail.
But what’s really disturbing is the false “balance.” At the end of the segment, we have Ms. Stagliano being praised for her “passion,” and, if you look at the whole segment, you’ll notice that Stagliano has had at least as much time to state her views than the real experts, namely Dr. William Shaffner, the Chairman of the Department of Preventative Medicine at Vanderbilt, who’s squeezed in as the token skeptic to try to refute the passion of the anti-vaccine movement. I’ll give him credit for being reasonable and direct and emphasizing that we should move on to other hypotheses. I also like how he kept repeating that we need to find the real cause of autism, driving home the point that vaccines are not the real cause, the “passion” of the anti-vaccine movement notwithstanding.
CNN exhibited a more than EPIC FAIL here.
This one is pretty painful, too. Basically it paired Mark Blaxill, who is neither a scientist nor a physician but rather an MBA, with Dr. Marc Siegel, a FOX NEWS medical correspondent and Blaxill demonstrates all the science knowledge one would expect from an MBA. He shows it by repeating the very same anti-vaccine talking point that Stagliano did. He does, however, at least call it a study. Then he repeats the same claim that Wakefield worshipers always repeat, namely that Wakefield’s study has been “replicated.” Again, that is a half truth in that there are a few who have claimed to replicate Wakefield’s results, but none of them are reputable and they’re virtually all affiliated with the anti-vaccine movement or Wakefield himself. Indeed, the latest paper represented as a “replication” of Wakefield’s work comes from Arthur Krigsman, Wakefield’s partner in woo at Thoughtful House. But, hey, who needs to know that? Besides, Blaxill’s got anecdotal evidence, and he appeals to it right after claiming Wakefield’s work has been replicated.
Dr. Siegel got some good licks in, but Blaxill then tried to paint himself as the reasonable and not excitable, as he lays down another favorite anti-vaccine ploy, namely that it is a choice between autism and the measles. That’s utterly ridiculous. The MMR vaccine doesn’t cause autism. The science is very, very clear on that. Consequently, when Blaxill says that he’s “not afraid of measles” and would rather deal with measles than autism, it’s a false dichotomy.
FOX NEWS joins CNN in EPIC FAIL here.
These two clips illustrate one of the most frustrating things about the media’s coverage of medical issues, namely that it’s not about the science. It’s about the human interest and the conflict. It isn’t interesting or compelling to state that the science has conclusively shown that the MMR is safe in response to the GMC ruling and the Lancet retraction. It is interesting to find a parent who erroneously believes that vaccines gave his child autism and pair him with a physician. Never mind that as an MBA he has no medical expertise and what scientific knowledge he has is so wrong that it’s not even wrong. Have him “debate” the medical correspondent! Whatever happens, it’ll be interesting TV. Who cares if it gives the impression that there is a real scientific controversy when there isn’t? Who cares if it elevates the crank to appear to an equal plain with a real physician or scientist? Who cares, as long as it brings the ratings? This sort of thing is irritating enough on fluff shows like The Doctors or when Oprah or Dr. Oz does it. However, it’s inexcusable coming from news organizations that are allegedly dedicated to accuracy.
The problem boils down to a set of rules that work well for journalists in one circumstance dont’ work so well when reporting on science. The “tell both sides” imperative that drives so much journalism is reasonable for issues of policy and politics. After all, such issues are often driven as much by values as evidence, and usually there are reasonable arguments to be made for both sides. At the very least, usually the level of evidence supporting two different political views is fairly close in quality and quantity, and values often matter at least as much as evidence, if not more. In such circumstances, it makes sense to present both sides more or less equally.
In contrast, science and medicine can often declare one side or another in a debate to be definitely wrong. Think science-based medicine versus the quackery that is homeopathy, for instance–or science versus the beliefs of the anti-vaccine movement. In such a case, presenting “both sides” as though they had equal validity ends up elevating the side of pseudoscience to a level on par with that of real science. In doing so, it makes pseudoscience and quackery appear equal to science and gives the impression that there is a real scientific controversy rather than a manufactroversy. Add to that sensationalistic journalists, such as the ones in the U.K. who aided and abetted Andrew Wakefield, and you have a press that is every bit as guilty as Wakefield in facilitating the resurgence of measles.
Treatment of the MMR-autism scare similar to how FOX NEWS and CNN covered let’s you see how this could be the case across the pond. Sadly, our own news sources are no better, and if Wakefield had been in American it wouldn’t have surprised me if we had had the same results as far as plummeting vaccination rates and the return of the measles.