The anti-vaccine movement versus the truth

My alma mater has let me down.

As many of you know, I went to the University of Michigan for both my undergraduate degree and for medical school. I still have a fairly strong attachment to the school, which is why I can still be disappointed when its faculty let me down. Unfortunately, it’s happened, and this time U. of M. has disappointed by inadvertently providing ammunition for the anti-vaccine movement. I’m referring to a poll released by the C.S. Mott Children’s Hospital (which is where I did my pediatrics rotations when I was in medical school). The poll results are being trumpeted across the anti-vaccine blogosphere as though they are vindication. The press release announcing the poll results starts out badly and goes downhill from there:

ANN ARBOR, Mich.–Each year, hundreds of millions of public and private dollars are spent on medical research to improve the health of children – yet parents have little input regarding how those dollars should be spent.

Apoll released by the C.S. Mott Children’s National Poll on Children’s Health shows that nearly 9 in 10 parents rank vaccine safety, and the effectiveness and safety of medicines, as the most important topics in children’s health research today.

The first thing that one has to realize is that this is not a study. It was not published in the pediatrics or other medical literature. Consequently, it wasn’t vetted through the process of peer review. In fact, as you will see, the poll is laughably thin gruel to base such conclusions on, as you will see. Instead of being published in the peer-reviewed literature, this poll was posted to the U. of M. Medical School website and entitled Parent Views on Medical Research: Safety of Vaccines & Medicines Top Priorities. It wasn’t too hard to find the full report, which is here. The report has a single figure, which is listed here. However, here’s the money link. Whenever you hear the results of a poll, it’s critical to go to the source and try to discover the actual questions that were contained in the poll, and that’s just what I did. Leaving aside questions about demographics, here is the actual meat of the survey:

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Yes, that really is all there is to the poll, as far as I can tell. No wonder this poll wasn’t published as a real study. Heck, if I had been a parent filling out this poll, I would have marked the “safety of vaccines given to children” as “very important,” and no one would ever accuse me of thinking that vaccines are unsafe, that they cause autism, or that we should be doing scientifically dubious studies of the sort currently demanded by the anti-vaccine movement.

All such an answer means is that, yes, people consider vaccine safety important. They should consider vaccine safety important, because it is very, very important! That’s why millions upon millions of dollars and person-hours have been spent–oh, I don’t know–actually studying vaccine safety. There are rigorous pre-marketing testing requirements and many regulations governing the production and marketing of vaccines. Meanwhile, the question of whether vaccines cause autism has been tested over and over and over and over again. The answer is always the same: When the study is done by reputable scientists using well-designed epidemiological methodology (in marked contrast to the way the anti-vaccinationists and antivaccine-sympathetic investigators do it), there is no evidence that vaccination is associated with a detectably elevated risk of autism–or any other adverse neurodevelopmental outcome, for that matter. In essence, no detectable association between vaccines, thimerosal-containing or otherwise, and autism greater than the noise inherent in such studies can be detected. We can say with a high degree of certainty that vaccines don’t cause autism. Is the certainty absolute? Of course not. No scientific certainty ever is. Our level of certainty that vaccines don’t cause autism is, however, about as high as we could ever ask for in epidemiological and clinical studies.

Sadly, the lead poller seems oblivious to how his poll results would be used and abused by the anti-vaccine movement. Worse, he extrapolated far beyond what this rather paltry poll could support:

“In this poll, parents overwhelmingly see the need for research on the safety of vaccines and medications given to children,” says Matthew Davis, M.D., director of the poll and associate professor of pediatrics and internal medicine in the Child Health Evaluation and Research Unit at the U-M Medical School. “Parental concerns about the safety of vaccines have increased markedly over the last decade, due to alleged but later disproven links between vaccines and autism and related concerns about mercury and other preservatives used in vaccines.

“Assurances from health care providers and government officials that vaccines are safe have been insufficient. Rather, it’s clear from this poll that parents want more research about the safety of vaccines for their young children and adolescents.”

Maybe. We have no way of knowing because, as far as I can tell, the poll didn’t actually ask parents some very important questions that might actually allow us to make some conclusions, questions like whether or not parents believe that vaccines are safe, that they cause autism, that the amount of research currently being done on vaccine safety is adequate, or that vaccines are safer than leaving children open to diseases that vaccines protect them against. Dr. Davis is reading far more into his poll results than is justified. I mean, come on! He didn’t even ask whether parents want more research into vaccines. Even if he had, that’s the sort of question that has to be carefully phrased or buried within several questions to make sure that the poll is actually measuring a real desire. After all, among lay people, it almost always makes sense to ask for “more research,” particularly if no mention of resource allocation is made. One way to control for that is to lay out situations that include how much further study would cost and then how strongly the respondents still want “more research.” Yet, instead of mentioning these problems and possibilities, the report concludes:

Similarly, the safety and effectiveness of medications given to children is viewed by parents as a very important area of research. These views may be prompted by high-profile recalls of medications, or by recent reports suggesting that some common over-the-counter medicines are ineffective for kids. Clearly, parents recognize the importance of continuing research about medications, and see the potential for research to help them be better informed about the potential benefits and risks of treatments for their children.

This is what’s known as a “well, duh!” conclusion. I’d be surprised if the vast majority of parents weren’t concerned about the safety and efficacy of medications. The real questions are whether that level of concern has changed, and, if it has, why. Moreover, another aspect of the poll results suggest that parents don’t actually judge relative risks very well. For example, the item that came in the lowest was “leading causes of injuries,” with only 46% of parents rating this item as “very important.” Yet injuries are a huge cause of harm to children. Certainly, childhood injuries harm far more children than vaccines. It’s not even remotely close.

Of course, the most pernicious problem with this poll is the utter cluelessness with which it was promoted, a cluelessness that has allowed an opening for the anti-vaccine cranks at Age of Autism to take full advantage of this poll. First up, we have Kim Stagliano posting Vaccine Safety: Why Parents Are Concerned in that wretched hive of scum and quackery The Huffington Post. In her HuffPo piece, Stagliano demonstrates once again that no tactic is too shameless for her to use in the cause of trying to convince people that parents all agree with her pseudoscientific belief that vaccines cause autism and all sorts of horrible things. Stagliano starts off calling this poll a “study” (it’s not) and then making the claim that currently there are now “48 vaccinations” on the vaccine schedule before age 6. Her audacity leads me to wonder once again at how it’s really amazing how antivaccinationists pump up the numbers each time I read; last I read the anti-vaccine propaganda literature it was 36 and the CDC schedule is clearly nowhere near 48. Next is the obligatory swipe at Dr. Paul Offit, who, unlike Stagliano or the rest of the merry band of anti-vaccine loons at AoA, has actually done something to protect children against infectious diseases. This is in marked contrast to AoA flacks like Stagliano, whose activities risk decreasing herd immunity to the point where vaccine-preventable diseases return, with potentially devastating results. Come to think of it, I admire Paul Offit. I have little but contempt for Stagliano and the crew at AoA because they deserve nothing more.

Then, Stagliano decides to try to appeal to the liberal tendencies of the HuffPo readership:

I imagine that many (perhaps a majority) of Huffington Post readers are pro-choice and respect a woman’s right to choose. Should a woman lose the right to make appropriate, safe medical choices in conjunction with her pediatrician for her child once she becomes a mother? If you are pro-life, does a mother’s right to protect her child end when the baby is born?

Nice try on Kim’s part. It was a nice try to appeal to the liberal tendencies of your readership. The two are not the same. For instance, the decision not to vaccinate is neither safe nor appropriate. Many anti-vaccine parents like Kim make the bad choice not to vaccinate, take advantage of the herd immunity due to children who are vaccinated, and then conclude that they must be right when their children are lucky enough not to come down with vaccine-preventable diseases. I have frequently said that adults have the right to choose whatever medical care they desire, even out-and-out quackery. They have every right to refuse medical treatment. That same right does not, however, extend to denying medical care to children or to endangering children. Make no mistake, failure to vaccinate is the same thing as denying recommended medical care to children. Worse, such a decision does not affect just the unvaccinated. It affects any children with whom unvaccinated children come into contact, which is why it’s entirely appropriate to require vaccination before day care or school.

Then, of course, the anti-vaccine propaganda blog AoA jumps on the bandwagon with a post entitled Alert your Lawmaker That Vaccine Safety Is an American Priority. Once again, this is not a study. It’s simply a poll, and it doesn’t even ask that many questions, much less the right questions. All it says is that, yes, parents think that vaccine safety is important, which it is. It doesn’t in any way validate the pseudoscientific views promulgated by AoA that vaccines cause autism that they don’t work, or that they do far more harm than good. Yet that’s what Kim Stagliano and AoA are trying to convince you and our legislators that this poll means. Worse, through their apparent inexperience in dealing with the anti-vaccine movement made it really easy for AoA and Kim Stagliano to do use this poll for their own antivaccine propaganda purposes.

And that’s just what they did.