Ethics and the promotion of another anti-vaccine book

Here’s a chance for some skeptical activism if you happen to live in New York and its environs. It’s book promotion event for the most recent anti-vaccine propaganda piece, Vaccine Epidemic: How Corporate Greed, Biased Science, and Coercive Government Threaten Our Human Rights, Our Health, and Our Children by Louise Kuo Habakus and Mary Holland. Naturally, the propaganda blog for all things anti-vaccine, Age of Autism, is furiously pimping away in a histrionic post entitled Is it Ethical to Kill Children to Save Children? Friday Night NYC Event Explains:

Should the government promote a medical intervention that undeniably causes death and serious injury to a minority in order to save the lives of the majority?

Vaccines are credited with saving the lives of millions of people from many diseases, but they have also taken lives. In Vaccine Epidemic: How Corporate Greed, Biased Science, and Coercive Government Threaten Our Human Rights, Our Health, and Our Children, authors Louise Kuo Habakus and Mary Holland explain that the current vaccine program stakes the life of one child over another. No parents should be compelled to take actions that could cause their child to live a life of suffering, or even die.

Bill Gates recently stated on CNN that people who question the safety of vaccines are liars who are killing children: “So it’s an absolute lie that has killed thousands of kids… the people who go and engage in those anti-vaccine efforts — you know, they, they kill children.” In reality, it is the people who fail to question the safety of the current vaccine program who may be allowing innocent infants and children to suffer serious injuries, and even death. Could some of these injuries and deaths have been avoided?

One wonders if Habakus and Holland are opposed to mandatory seatbelt laws. After all, in a small proportion of crashes, seatbelts and airbags can actually cause serious injury–or even death. I’ve even seen a handful of cases myself, back when I was a general surgery resident rotating on trauma cases. The constellation of injuries due to seatbelts is actually well characterized. What is also well-known is that seatbelts save far more people than they injure. If you’re in a car crash, your chances of surviving are much, much higher if you are wearing your seatbelt properly in a car with a good airbag system than they are if you are not. These anti-vaccine propagandists might as well rephrase the question: Is it ethical to kill drivers to save drivers? We could even point out that the same argument applies for infant and child car seats. A few will suffer injuries from the belts and car seat, even though the car seat will dramatically decrease the risk of a child’s dying in a crash. Should we therefore eliminate all mandatory child car seat laws and just let parents decide whether or not to strap their children in? It’s basically the same argument the anti-vaccine movement is making for vaccines. There may come a point where vaccines have become so effective and so many people are vaccinated that the risks of vaccines become equivalent to the risk of the disease (much diminished by vaccines), but then in that case the problem is that if enough people stop vaccinating the disease will come roaring back. There could be an interesting moral debate there on whether, as Spock put it in my favorite Star Trek movie of all time, “the needs of the many outweigh the needs of the few–or the one,” but that is not what the anti-vaccine movement is about. It’s about claiming that vaccines hurt and kill children.

Don’t get me wrong: Any death is tragic, but when AoA asserts, “People die from vaccines just as people die from infectious disease. Life is sacred, and one child’s death is not more tragic than another’s.” I want to point out that the converse is true, and that it is not the pro-science-based medicine side that is minimizing the importance of the deaths of children; rather, it is the anti-vaccine side. Indeed, just in the last week we had a commenter who basically said that children dying in Third World countries didn’t matter to him because they don’t affect his calculations of risk-benefit ratios. I doubt you’ll ever see such a callous attitude from anyone on “our side” regarding children who suffered (or may have suffered) legitimate vaccine injury of a kind for which there is scientific evidence. The callousness infests the “autism biomed” movement as well. Indeed, another question to retort would be: Is it OK to kill children with chelation therapy in order to save children? Remember, when Tariq Nadama was killed with the quackery known as chelation therapy, the anti-vaccine cranks came out of the woodwork to say, in essence (if you’ll excuse my French), “shit happens.”

Personally, though, I love how Habakus and Holland assert:

Vaccine Epidemic is pro-human rights, pro-science, and pro-justice for those injured by vaccination. The book is not anti-vaccine; it upholds the right to choose and affirms the international human rights standard of free and informed consent to all medical interventions.

Which is a load of fetid dingo’s kidneys. I’ve read one chapter from the book, e-mailed to me by the publicist. It’s a defense of Andrew Wakefield’s fraudulent research leading to his infamous, now-retracted Lancet paper in 1998. It’s chock full of the typical misrepresentations, attacks on Brian Deer, and other nonsense that we’ve come to know (and have contempt for) coming from Wakefield groupies. In any case, the claim that all Habukus and Holland are arguing for is “informed consent” brings me back to the concept of “misinformed consentm,” which is in reality what they are arguing for.

Misinformed consent is consent (or, perhaps more accurately, lack of consent, because the goal of those pushing misinformed consent is to frighten parents into refusing to vaccinate) based on misinformation about the true magnitude of the risks versus benefits of an intervention. Anti-vaccine activists cherry pick and torture existing scientific data to present a picture of vaccines as being very risky (causing autism, asthma, sudden infant death syndrome, and a veritable panoply of adverse outcomes) while at the same time being ineffective. A rational person, if she believes this picture because of ignorance or an insufficient background in science to recognize, well, B.S. when she sees it, would be making a rational decision to refuse vaccination because the information used to promote misinformed consent paints a picture of a dangerous procedure with little benefit, a picture that has no relationship to reality. The problem is, the picture’s all wrong, hence the concept of misinformed consent. The “autism biomed” movement does the same thing in the opposite direction by cherry picking, misrepresenting, and torturing the data for their quackery du jour as being effective and then downplaying the risks. So when parents agree to chelation therapy, hyperbaric oxygen, or even stem cell injections into the cerebrospinal fluid of autistic girls.

The bottom line is that many medical interventions, in particular preventative interventions, carry risks. Interventions carried out on healthy people have a very high bar to leap when it comes to safety, and vaccines can easily clear that bar. However, the risk is never zero. It’s a question of relative risk, something anti-vaccine propagandists have a serious problem understanding. Antivaccine loons like Habakus and Holland demand absolute, 100%, complete safety from vaccines, a standard they don’t demand of anything else, even activities that do not provide the health benefits of vaccines.

ADDENDUM: I am aware of Sherri Tenpenny’s gloating that I haven’t commented on this book yet. Perhaps I will ask the book’s publicist for a copy. I’m busy writing grants until the March 5 NIH resubmission deadline, though; so there’s no way I could try to read it before then. I also haven’t finished Seth Mnookin’s The Panic Virus yet (which is excellent thus far, by the way), and that has to come first. It’s all a matter of relative priorities, and taking on Vaccine Epidemic and the misinformation contained within is simply not important enough to me to justify carving time out of my insane schedule between now and March 5 to get started on it now. It certainly doesn’t mean enough to me to buy a copy, particularly given that doing so would enrich anti-vaccine loons and contribute to the book’s sales figures, if even by a tiny bit.