The Vaccine War?

I haven’t mentioned this before. The reason is not because I don’t find it interesting or potentially blog-worthy, but rather because it slipped my mind and other things caught my interest last week. Given that the show is going to air beginning tomorrow, I thought that a few thoughts were in order. PBS’s Frontline is going to air a show entitled The Vaccine War, and here’s a preview:

The press release describing the episode gives me reason for concern:

Vaccines have changed the world, largely eradicating a series of terrible diseases, from smallpox to polio to diphtheria, and likely adding decades to most of our life spans. But despite the gains–and numerous scientific studies indicating vaccine safety–a growing movement of parents remains fearful of vaccines. And in some American communities, significant numbers of parents have been rejecting vaccines altogether, raising new concerns about the return of vaccine-preventable diseases like measles and whooping cough.

In The Vaccine War, airing Tuesday, April 27, 2010, at 9 P.M. ET on PBS (check local listings), FRONTLINE lays bare the science of vaccine safety and examines the increasingly bitter debate between the public health establishment and a formidable populist coalition of parents, celebrities, politicians and activists who are armed with the latest social media tools, including Facebook, YouTube and Twitter, and are determined to resist pressure from the medical and public health establishments to vaccinate, despite established scientific consensus about vaccine safety.

So far, so good. It is true that there is a war going on, and it is a war between the forces of pseudoscience and autism quackery versus science-based medicine. Caught in the middle are parents who don’t know whom to believe, but, more importantly, the war puts children at risk for vaccine-preventable diseases. It is a war that until recently the anti-vaccine movement was clearly winning. Having followed the issue since the early 2000s and having become involved as a blogger in a big way in 2005, I had the impression that the CDC, AAP, and various public health authorities didn’t really take anti-vaccine crank groups like Generation Rescue seriously until around 2008, which is when they finally began pushing back. Add to that the very public fall of Andrew Wakefield, patron saint of the anti-vaccine movement, beginning with evidence showing that he had probably committed scientific fraud coming to light in February 2009 and continuing with his being found to have committed research misconduct by the British General Medical Council this year, which led in rapid succession to his infamous 1998 Lancet paper and 2009 NeuroToxicology “monkey study” paper being withdrawn, which later led to his being pushed out of his position at Thoughtful House, and 2010 has been an even rougher year for the anti-vaccine movement than 2009.

As much as I’d like the issue to be the science, which has thus far given no support to the contention that vaccines cause autism or any of the other diseases and conditions attributed to them by the anti-vaccine movement, rather than personality the fact is that most people don’t think that way. At least, they generally don’t base their decisions on science. Authority matters, and people tend to base their decisions on the opinions of people they trust. Destroy trust in Andrew Wakefield, which is what has happened to the point that even his staunchest supporters at Thoughtful House decided that he had become a liability and gave him the boot. As much as I wish that it weren’t about personalities and authority, I can’t help but appreciate that Andrew Wakefield’s downfall is something that can be pointed to when discussing vaccines with undecided parents leaning towards not vaccinating as a way of telling them in a way that they can understand that the claims about the MMR vaccine causing autism have been discredited. True, whether or not Wakefield is struck off the list of licensed physicians in the U.K. is irrelevant to the scientific question of whether the MMR vaccine causes autism, it is someting that people without a medical background understand.

Unfortunately, that’s one reason why this Frontline special worries me. It looks to me as though it will give far too much airtime to the anti-vacine movement anbd fall too far into the “tell both sides” journalistic trope that irritates me to no end when it comes to stories about science. Yes, the press release does quote Anders Hviid, an epidemiologist at the Statens Serum Institut in Denmark:

“Scientifically, I think the matter is settled,” says Anders Hviid, an epidemiologist at the Statens Serum Institut in Denmark. In one of the largest and most comprehensive epidemiological studies available, Hviid and colleagues analyzed data on more than a half million children and found no link between the MMR “triple shot” for measles, mumps and rubella and an increased rate of autism–a link that’s been strongly asserted for years by anti-vaccine activists. Similar epidemiological studies in Denmark also failed to reveal a link between the mercury preservative thimerosal and autism. In fact, around the world, peer-reviewed epidemiological studies have found no link between autism and either the MMR shot or thimerosal.

Quite right. Scientifically, the matter is settled, no matter how much anti-vaccine activists want to make you think that it isn’t. There is no credible scientific evidence that vaccines or thimerosal-containing vaccines cause autism–or are even correlated with autism. There is no credible evidence that vaccines cause or are even correlated with the chronic diseases attributed to them by the anti-vaccine movement.

Unfortunately, it looks as though The Vaccine War will give the loons a lot of opportunity to spew their nonsense:

But vaccine skeptics like celebrity Jenny McCarthy, whose son, Evan, was diagnosed with autism following a series of vaccinations, including MMR, are convinced that further study into the other 15 pediatric vaccines and their additives will ultimately reveal a link. “Something happened. And when I say something, I mean a behavior, a trigger,” McCarthy tells FRONTLINE. “Is it mercury? Is it the schedule? Is there just too many? My answer to people and what I’ve been telling them is, ‘It’s all of the above.’ We don’t know for sure, which is why we keep saying, ‘Study it.'”

Further vaccine safety research is what businessman J.B. Handley, who founded the autism support group Generation Rescue, has been calling for, too. Handley tells FRONTLINE he has little doubt that vaccines are responsible. “There is no real-world study that shows me that those six vaccines didn’t cause my son’s autism.”

First off, these are not “vaccine skeptics.” Skepticism involves accepting valid scientific evidence, something Jenny McCarthy and J.B. Handley are utterly incapable of doing if that evidence conflicts with their beliefs that vaccines cause autism and all sorts of other health issues. Indeed, J.B. Handley even says as much in this press release when he says that there is no real-world study that convinces him that vaccines didn’t cause his son’s autism! If that isn’t admitting that there is no scientific study or collection of data that will ever change his mind, I don’t know what is. No, Jenny McCarthy and J.B. Handley are vaccine denialists, anti-vaccinationists, anti-vaccine loons. They use classic denialist tactics of spreading fear, uncertainty, and doubt, or, as we like to abbreviate it, FUD, about vaccines. They use the same sorts of FUD tactics, logical fallacies, and types of misinformation used by creationists, 9/11 Truthers, cancer quacks, Holocaust deniers, and all manner of conspiracy theorists to promote their views. They are not worthy of the term “skeptic.” They are pseudoskeptics, who reflexively doubt and attack anything that conflicts with their anti-vaccine beliefs. That is not skepticism; it is denialism. As such, it should never be presented as a counterpoint to scientists, because the opinions of J.B. Handley and Jenny McCarthy are not equivalent to science; they are reflexive rejection of science.

The results of the efforts of the anti-vaccine movement are places like Ashland, Oregon:

The mothers in the video segment above appear very reasonable. They probably are reasonable, but they are definitely wrong. Moreover, what is most irritating is the smug sense of selfishness that they exude. They don’t care about anyone else. They labor under the delustion that vaccines are 100% effective, hence their apparent belief that their decision doesn’t affect anyone but themselves and their children and that their children won’t endanger anyone else. Again, they are wrong. From my perspective, the public health officer in this segment, Dr. Jim Shames, has the patience of the proverbial saint as he tries to get through to the women in the segment, particularly the one who asks, “If I don’t vaccinate, who am I putting at risk?” This same mother seems to be laboring under the delusion that she can somehow magically keep her child from being exposed to these diseases.

Attitudes such as these only exist because of the success of vaccines. Thanks to that success, these mothers are blithely ignorant of the dangers of infectious disease and thereby convinced of their own righteousness in keeping their children safe only because they have never seen the diseases that vaccines prevent. They’ve never seen a case of measles leading to encephalitis. They’ve never seen a case of pertussis so severe that the child can’t sleep and can’t eat because of the coughing. They’ve never seen anyone crippled by polio. They’ve never seen a child with Haemophilus influenza type B meningitis. All they see is are doctors jabbing needles into their babies, and all they hear are voices on TV, the radio, and the Internet telling them that there are dire risks due to vaccines. We humans tend to value personal experience over what science tells us, and, lacking that personal experience of having seen these diseases or known parents of children who have suffered from these diseases, most people have a hard time taking the threat seriously. It’s easy to show with statistics that it is much riskier not to vaccinate than it is to vaccinate, but it’s difficult to convince a parent of that when that parent, for whatever reason, is predisposed to distrust vaccines but has never seen the consequences of a lack of vaccines.

It’s also worth noting that, despite the high percentage of unvaccinated children in Ashland, there is no evidence that autism rates are any lower there.

One aspect of this special that might be a bit less annoying is what I hope will be a substantive discussion of parental choice versus coercion:

Surveys reveal that America’s conversation about vaccines is complex, involving not only medical risks and benefits but also ideological beliefs about parental choice and the limits of government. “This is true even of individuals who see the benefits of vaccines as substantial,” political scientist Hank Jenkins-Smith tells FRONTLINE. “They still want it to be a choice. They don’t want it to be compulsory.” Government control over individual choice is another factor fueling the anti-vaccine backlash, despite the peer-reviewed science that vaccines are safe.

This is understandable. It is part of the American psyche to distrust government and to be resistant to the government telling them what to do with their children. Public health, in particular the vaccination program, is always a balance between personal rights and public good, and it is not always clear where that balance should be struck. A serious discussion of the issues on either side of the political and social debate could serve a useful purpose, if false equivalency between Jenny McCarthy’s viewpoint and that of science does not. Even so, it worries me to see the last quote being given to the grand dame of the anti-vaccine movement, Barbara Loe Fisher:

“People now have a way to get the information they couldn’t before, to communicate it to other people, and to have a robust public debate that is not controlled by money or political power or by government policy,” says Barbara Loe Fisher, president of the National Vaccine Information Center. “Physicians are going to have to get over the idea that they tell people what to do, and people are going to do it without questioning.”

As usual, BLF is being disingenuous. It is true that people can get information they didn’t have before, but a lot of it is not reliable scientific information. Rather, it’s misinformation spread by groups like hers that is leading not to a real debate based on facts, science, and evidence but rather to a manufactroversy, a pseudodebate, if you will. Scientifically, there really is no debate anymore. Politically there is. That’s not a bad thing in and of itself, but it is a bad thing if the information informing that debate is dominated by cranks like Jenny McCarthy, J.B. Handley, and Barbara Loe Fisher.

I hope I’m wrong, but unfortunately, in The Vaccine War, I smell the taint of false balance.