The annals of “I’m not anti-vaccine,” part 4 (End of 2010 edition)

Part 1 is here.

Part 2 is here.

Part 3 is here.

I realize I say these things again and again and again, but they bear repeating because together they are a message that needs to be spread in as clear and unambiguous a form as possible. First, whenever you hear someone say, “I’m not anti-vaccine,” there’s always a “but” after it, and that “but” almost always demonstrates that the person is anti-vaccine after all. Second, for antivaccine loons, it’s always about the vaccines. Always. It’s not primarily about autism advocacy; it’s primarily about the vaccines and blaming them for autism. Autism advocacy is a secondary consideration subsumed to the needs of trying to convince people, against all science and reason, that vaccines cause autism.

Nowhere are these principles demonstrated more clearly and on a more regular basis than on the propaganda blog for the anti-vaccine organization Generation Rescue. The bloggers on that blog, Age of Autism, will howl with indignation whenever it is pointed out by me or some other skeptical, science-based blogger that they are anti-vaccine to the core that they are not “anti-vaccine,” but “pro-safe vaccine” or “pro-vaccine safety.” The first time I remember seeing that sort of “argument,” it came from Jenny McCarthy herself, and, after that, I began to hear it on virtually every anti-vaccine blog. It’s a talking point, and, to the naive, a good one. So good is it that those who repeat it probably actually believe it about themselves.

And AoA has been on a role in this last week of 2010. If you want evidence that, to AoA, it’s first and foremost all about the vaccines, take a look at a sampling of its posts since Christmas:

Of course, if you want to see an example that really nails it, just take a look at this post, Age of Autism Awards 2010: Dr. Paul Offit, Denialist of the Decade.

“Denialist.” You keep using that word. I do not think it means what you think it means.

In fact, this appears to be a relatively new talking point among the anti-vaccine set. Stung by being lumped in with evolution denialists, anthropogenic global warming denialists, not to mention quacks and “alternative medicine” advocates (denialists of science-based medicine), apparently anti-vaccine activists have decided that they’ll try to appropriate the term “denialist” by referring to those who refute their pseudoscientific nonsense as “vaccine safety denialists” or some similar term. Jake Crosby seems particularly enamored of this technique and might well have been among the first to use it. Given the pure silliness that spawned the term, it wouldn’t surprise me if Jake coined it. Be that at it may, Dr. Offit gave an interview to the Point of Inquiry podcast last year entitled The Costs of Vaccine Denialism, which might well be why AoA decided to bestow this “honor” upon him.

In this case, mercury militia inspiration Dan Olmsted does the “honors,” such as they are, beginning thusly:

Why bother to call attention to Dr. Paul Offit, the vaccine patent-holder who has led the attack on the idea that vaccines have anything to do with autism or any of the myriad of other ailments afflicting this generation of American children?

Ah, yes. Note the tired old anti-vaccine framing of Dr. Offit as a “patent holder” on a vaccine, as though the only reason Dr. Offit fights for science and advocates for vaccines is because he stands to make money off of his rotavirus vaccine. In reality, the reason Dr. Offit leads “the attack on the idea that vaccines have anything to do with autism or any of the myriad of other ailments afflicting this generation of American children” is because the vast preponderance of scientific evidence does not support the idea that vaccines have anything at all to do with “autism or any of the myriad of other ailments afflicting this generation of American children.” I know, I know, it’s a radical concept, but apparently it can’t infiltrate the brains of the hive mind that is AoA that anyone might actually oppose their pseudoscience and anti-science based on good science rather than because of self-serving or selfish reasons, which is no doubt why Olmsted continues:

Well, because other people are paying attention — including the nation’s pediatricians and the mainstream journalists who need to start calling him to account. Offit has a new book out — “Deadly Choices: How the Anti-Vaccine Movement Threatens Us All.” Here’s the question doctors who recommend him to nervous parents, and parents unsure what to think, and journalists who interview him, need to ask: Why is Offit transparently opposed to ever studying the health outcomes of vaccinated versus unvaccinated Americans, even as he acknowledges that vaccines have a long history of causing serious side effects?

Once again, the reason why most vaccine scientists don’t think the types of “vaccinated versus unvaccinated” studies desired by anti-vaccine activists like Mr. Olmsted would be worthwhile or revealing boil down to three reasons:

  1. There is no compelling preliminary evidence to lead scientists to think that vaccines might cause autism adequate to justify a large “vaccinated versus unvaccinated” study. According to the Helsinki accord, before human subjects research projects can be undertaken, there has to be compelling preclinical (i.e., cell culture and animal experiments) and/or clinical evidence to suggest that a human study is warranted. For the vaccine/autism hypothesis, there is neither.
  2. Doing such a study in the most rigorous fashion (a double-blind placebo-controlled study) would be completely unethical, because it would leave the control (unvaccinated) group completely unprotected against dangerous and potentially fatal childhood illnesses.
  3. Doing an epidemiological study, such as a case-control or cohort study, would require huge numbers of children to achieve adequate statistical power to detect even a fairly large difference between the groups. I wrote about this last year.

Olmsted also makes this astoundingly bad argument:

Anyone concerned about any of these things fits Offit’s definition of anti-vaccine, because vaccines don’t cause any of them, because Paul Offit says so, a solipsism that is really quite breathtaking: “[B]ecause anti-vaccine activists today define safe as free from side effects such as autism, learning disabilities, attention deficit disorder, multiple sclerosis, diabetes, strokes, heart attacks, and blood clots — conditions that aren’t caused by vaccines — safer vaccines, using their definition, can never be made.”

Which is actually an excellent criticism of the “we’re not anti-vaccine, we’re pro-safe vaccine” canard. It’s not a solipsism at all. Leaving aside the observation that Olmsted apparently doesn’t know what a solipsism is. For instance, I don’t see how Offit’s statement indicates that he believes that only his own self exists or can be proven to exist or an extreme preoccupation with and indulgence of one’s feelings or desires. You could argue that Offit is wrong (he isn’t, but you could argue that), but I find it nothing more than a pseudointellectual affectation that Olmsted would use the word “solipsism” to describe Offit’s argument. Be that as it may, Offit makes a good point. The anti-vaccine movement ascribes autism, diabetes, ADHD, learning disabilities, asthma, and a panoply of conditions and diseases to vaccine injury when there is no good scientific evidence that vaccines cause any of them. How can you eliminate side effects that vaccines don’t cause? Even if you did, anti-vaccine loons like Dan Olmsted wouldn’t believe you did anyway.

Olmsted also misses the point about the unethical nature of a “vaccinated versus unvaccinated” study:

So it’s no surprise that his “can’t be done” argument against studying unvaccinated populations for any untoward outcomes arrives in the middle of an attack on Handley. Offit quotes J.B.’s comments on a Larry King segment in April 2009: “Larry, we have no idea what the combination risk of our vaccine schedule looks like. At the two-month visit, a child gets six vaccines in under fifteen minutes. The only way to test that properly would be to have a group of kids who get all six and a group of kids who got none and see what happens. They don’t do that testing. They have no idea.”

Wow. That certainly sounds as though Handley proposed a vaccinated versus unvaccinated study in which one group is not given any vaccines! I even went to the CNN transcript, and that’s what Handley said in context. In fact, Handley’s entire appearance demonstrated that he is incredibly poorly informed. Yet, Olmsted can later say:

Offit goes on, outrageously, to compare Handley’s proposal to the infamous Tuskegee experiment in which doctors withheld treatment from black males suffering from syphilis in order to study the natural course of the disease.

P-LEEZE. No one I know of is suggesting that a study of unvaccinated children deliberately withhold vaccination. Rather, there are growing numbers of never-vaccinated children in America — a fact Offit acknowledges with dismay — and plenty of families willing to participate in such a study. State governments have vaccine waivers on file for public school attendance that are another obvious source of non-life-threatening data.

No one, Mr. Olmsted? Then what do you think Handley was talking about on Larry King’s show back in April 2009? It sure sounded like a study in which vaccination would be intentionally withheld from one group to me. True, later I recall that Handley–shall we say?–having finally had it sink into his brain that a randomized trial of vaccinated versus unvaccinated children would be considered unethical, has backed off from such statements and now appears to advocate epidemiological studies of unvaccinated chidren. Unfortunately, his idea of a good study is a particularly incompetent phone survey that Generation Rescue undertook a few years ago. And whether anyone that Olmsted knows is promoting a prospective randomized trial of vaccinated versus unvaccinated children, there certainly are anti-vaccine loons out there who are. Olmsted himself then concludes by begging for a vaccinated versus unvaccinated study himself–any vaccinated versus unvaccinated study, it would appear:

Oddly, when it comes to doing such studies [“vaccinated versus unvaccinated” studies] in human populations, and studying the autism levels in the Amish, the homeschooled, or philosophical objectors, vaccine industry proponents resist mightily. Conducting human vax/unvax studies in existing unvaccinated groups would be so fraught with methodological problems that they are ‘retrospectively impossible.’ As for controlled studies, they would be so burdened with permission problems that they would be ‘prospectively unethical.’ In short, the resistance to the proposal to do vax/unvax work has not only taken the attitude that ‘we already know the answers,’ but ‘we should not seek to know.’ It’s pretty hard to make scientific progress in the face of this kind of epistemological nihilism.”

Again, go back to reason #3 as to why a retrospective vaccinated versus unvaccinated study would be methodologically very difficult, requiring huge sums of money and huge numbers of patients. Any money that would go to such a study would, in this era of fiscal restraint at the NIH, be money that would not go to more promising lines of research that are not based on dubious science and even outright pseudoscience, which would be arguably unethical. As for why prospective studies would be unethical, go to reasons #1 and #2. Doing such a study would require that scientists collude with non-vaccinating parents in allowing one group being studied have medical care that does not meet the standard of care. According to the Helsinki Declaration, in any human subjects experiment, ethically every subject must receive at least the standard of care, which is one reason why placebo-controlled trials are becoming less frequent. These days, placebos can only be ethically used in clinical trials for either self-limited conditions or for conditions for which there is no effective treatment in the standard of care; otherwise, experimental treatments are compared or added to the standard of care. In any case, this is the same reason why some HIV/AIDS clinical studies in developing countries in which groups not receiving antiretrovirals are studied have run into complaints about their ethics. That Olmsted and the rest of his merry band of anti-vaccine activists do not understand these basic concepts of clinical research ethics is not surprising, but it does lead them to make the same sorts of fallacious arguments again and again.

As 2010 draws to a close, it’s obvious that Olmsted and his fellow travelers at AoA are just as committed to their pseudoscience as they’ve ever been. Fortunately, 2010 has not been a good year for the anti-vaccine movement. Its patron saint (Andrew Wakefield) has been disgraced, having had his medical license in the U.K. yanked. Mark Blaxill and Dan Olmsted’s book tanked without even much of a peep. The tide against them that began in 2009, has continued to produce an increasing realization among the press and health officials of the harm that the anti-vaccine movement is doing. The anti-vaccine movement used to get mainly uncritical, or only mildly challenging, coverage. Now it gets stories by Trine Tsouderos and books to be released in January by Paul Offit and Seth Mnookin about the anti-vaccine movement. It’s also crystal clear that, after all these years, it’s not about autism advocacy. Not really. It’s all about the vaccines. It’s always about the vaccines. It was about the vaccines in 2010, and it will be about the vaccines in 2011.

Unfortunately.