Whither the anti-vaccine movement?

ResearchBlogging.orgYesterday, I congratulated that bane of anti-vaccine movement and great vaccine scientist, Dr. Paul Offit, for having been accepted into the Institute of Medicine. It’s a huge honor, and one well-deserved. At the time, I contrasted Dr. Offit, who has ascended to the highest heights of his profession through good science, with Dr. Andrew Wakefield, architect (or at least the most important architect) of the anti-MMR hysteria that gripped the U.K. in the late 1990s that’s only now starting to abate, who is reduced to speaking in front of crank physician groups, being feted at anti-vaccine conferences, and appearing at crank anti-vaccine demonstrations pathetic even by the standards of crank anti-vaccine demonstrations. It almost makes me feel sorry for Wakefield. Almost.

In any case, at the time I said I’d try to soldier my way through the video of Wakefield speaking at the annual meeting of the Ayn Randian crank physician group the American Association of Physicians and Surgeons (AAPS). And try I did. I really did. But even alcohol wasn’t enough to get me through all 45 minutes, and, given that it was a work night, I was limited to only one or two beers at most. That’s not nearly enough. Deconstructing this much concentrated, neuron-apoptosing idiocy is a weekend project. Actually, it’s a vacation project, because I’d need to ask one of my partners to cover for me. Wakefield’s just not worth it.

So, I had to find a different way to honor Dr. Offit, and I found it in an article that was just published. It’s by Anna Kirkland at the University of Michigan entitled The Legitimacy of Vaccine Critics: What Is Left after the Autism Hypothesis? I don’t agree with everything in the article, but it’s a good primer on the recent history of the anti-vaccine movement and speculates on what will come next now that the hypothesis that vaccines cause autism has been so thoroughly discredited.

Let’s dispose of one thing right away that I don’t particularly like about the article:

The last dozen years have seen a massive transnational mobilization of the legal, political, and research communities in response to the worrisome hypothesis that vaccines could have a link to childhood autism and other developmental conditions. Vaccine critics, some already organized and some composed of newly galvanized parents, developed an alternate world of internally legitimating studies, blogs, conferences, publications, and spokespeople to affirm a connection. When the consensus turned against the autism hypothesis, these structures and a committed membership base unified all the organizations in resistance. This article examines the relationship between mobilization based on science and the trajectory of legitimacy vaccine criticism has taken. I argue that vaccine critics have run up against the limits of legitimate scientific argument and are now in the curious position of both doubling down on credibility-depleting stances and innovating new and possibly resonant formulations.

While Kirkland gets a lot right in her article, I don’t like the way she writes, “when the consensus turned against the autism hypothesis.” The reason, of course, is that the scientific consensus was never for the autism hypothesis to begin with. In strictly scientific terms, the very most you can say about the vaccine-autism hypothesis is that for a brief period of time scientists considered it not sufficiently implausible (barely) to ignore completely, particularly given that the fear mongering of the anti-vaccine movement was having an effect on public confidence in the vaccine program. Over the last 15 years, numerous studies have been done, and none of them performed by reputable scientists using rigorous methodology have found a hint of a trace of a whiff of an association between vaccines and autism. As I’ve said before, the vaccine-autism hypothesis is no more! It has ceased to be! It’s expired and gone to meet its maker! It’s a stiff! Bereft of life, it rests in peace! If anti-vaccinationists hadn’t nailed it to the perch it’d be pushing up the daisies! Its metabolic processes are now history! It’s off the twig! It’s kicked the bucket, it’s shuffled off its mortal coil, run down the curtain and joined the bleedin’ choir invisibile!! The vaccine-autism hypothesis IS AN EX-HYPOTHESIS!!

To which, the anti-vaccine movement always replies, “It’s pinin’ for the fjords.”

Sorry. I know I use that routine too much, but it’s so appropriate. I try to make sure that there are at least a few months between uses. Of course, an alternate Monty Python analogy for the vaccine-autism hypothesis is that it’s very much like the Black Knight in Monty Python and the Holy Grail, with science playing the role of King Arthur. Kind of like:

Millions and millions of federal research dollars have been spent in response to parents and their advocates’ calls for answers. The mainstream consensus from scientists and the courts has been overwhelmingly against any connection between vaccines and autism. Although all of these expenditures may now seem a waste of resources on a discredited hypothesis, we must remember that uncertainty existed initially and that the question was extremely urgent.

It fairly rapidly became apparent that this hypothesis had lost its arms and legs. After the early 2000s, there was plenty of evidence to conclude quite reasonably from a scientific basis that there was no correlation between vaccines and autism. Arguably, far more money has been spent on this question than actually needed to be spent to answer the question, and more continues to be spent. No doubt anti-vaccine advocates will try to portray this viewpoint contemptuously as “science has spoken” or “the science has been settled,” but in fact science has more or less spoken and the science has been pretty well settled. Scientists have looked and looked and looked for a correlation between vaccines and autism and just haven’t found it. That doesn’t completely rule out a link in rare situations, but it’s pretty persuasive evidence that neither vaccines nor the mercury that was in many childhood vaccines until the end of 2001 are causes of the “autism epidemic.”

What’s more interesting is the question that Kirkland asks next. After a description of the Autism Omnibus, she wonders, “But what should we make of vaccine critics now, who have had such power to activate a research agenda, command political attention, and conduct years of litigation, as the consensus has settled against them?” While it’s easy to be Orac and answer as a bit of a smart-ass that there’s nothing new to make of them because they’ve always been a bunch of promoters of pseudoscience with an extreme hostility towards legitimate science when it doesn’t say what they believe and what they want it to say. However, arguably, there is a change in the anti-vaccine movement now that its best shots have come up short, with study after study going against it and its lynchpin effort (the Autism Omnibus) crashing and burning.

Kirkland then decides to discuss what she considers to be the two most important and influential anti-vaccine groups, the National Vaccine Information Center (the NVIC, Barbara Loe Fisher’s group) and SafeMinds (Sallie Bernard’s group), both of which she describes as the “go-to representatives for vaccine concerns in the policy process” and as having “no real competitors.” I had to chuckle at that passage, because that’s “gonna leave a mark,” as they say, on J.B. Handley and his group Generation Rescue. In fact, I’m half-tempted to e-mail J.B. a copy of the PDF file. Whatever J.B. thinks about being so seriously snubbed, I’m not sure I agree with Kirkland here in virtually completely dismissing Generation Rescue thusly:

This organization is oriented to serving parents much more than it is focused on policy, so it is not as important to this analysis.

Be that as it may, Kirkland accurately describes the increasingly large series of papers that started hitting the medical literature in the early 2000s that failed to find any correlation between vaccines and autism or thimerosal in vaccines and autism. She also concisely describes the fall of Andrew Wakefield, all the way to the General Medical Council of the U.K. stripping of him of his license to practice, appropriately pointing out that he is a “charismatic leader” upon whom the anti-vaccine movement relied too much, such that when his fall came they didn’t know what to do. Pointing out that the MMR vaccine never had thimerosal in it, she writes:

Policy makers and experts in the vaccine program believe vaccines are a lifesaving intervention backed by a proven system of pre-and postlicensure testing and surveillance, and that adverse events are rare. Critics believe that vaccines are damaging on a wide scale and promoted in bad faith by corrupted officials. All the vaccine-critical organizations have doubled down on the autism hypothesis and continue to embrace its discredited expositors (Habakus and Holland 2011; Fisher 2010). This gulf has been unbridgeable.

It’s amusing how Kirkland cites the book by Louise Kuo Habakus and Mary Holland’s book Vaccine Epidemic, as evidence of how the anti-vaccine movement still embraces discredited expositors of the vaccine-autism hypothesis. In any case, it turns out that Kirkland did a lot of her research attending the 2009 NVIC conference in order to see the “scientific leaders” of the anti-vaccine movement up close and personal, eschewing Generation Rescue’s preferred conference, Autism One, as being primarily geared at parents and:

Autism One is also known for excluding journalists perceived to be hostile to the conference’s message, while the NVIC event was explicitly open to the public. My IRB approval does not include any deceptive presentation, nor would I have been comfortable posing as a parent of a child with a disability.

I’m starting to like this Anna Kirkland, even though I don’t agree with all her conclusions. She is more or less accurate, however, in describing what she calls the “typology of vaccine critics.” These include what she terms “activist parents,” whom she notices as tending to be “white and middle to upper income with college degrees.” These parents usually have a child with a disability, these days most frequently autism or a related disorder, and blame vaccines. The next type of “vaccine critic” (I dislike that term; Kirkland should call them what they are: Anti-vaccine) is comprised of allied health professionals with longstanding anti-vaccine views. These included various “alternative medicine” practitioners, chiropractors, vaccine “skeptical” MDs like our old friend Dr. Jay Gordon (whose recent appearance on TV might be blog fodder soon), and others. Kirkland characterizes them as often basing their opposition to vaccines in libertarian (or, as I would have called it, “health freedom”) political view and providing “critical funding and publicity,” along with an air of legitimacy:

These professionals share an antiregulatory political agenda that keeps them in opposition to government regulation of supplements by the U.S. Food and Drug Administration or to heath care reforms like the Patient Protection and Affordable Care Act or the creation of registries and tracking of vaccination rates. The libertarian physicians are opposed to electronic medical records, for example, and no one who shares their perspective would support participation in the public health surveillance that would help to monitor postlicensure safety of vaccines and drugs (e.g., a national vaccine registry). Members of this group hold the most extreme views, such as denying that HIV causes AIDS (Null 2001), so managing the balance between pleasing them and keeping their views from hurting wider credibility is a big challenge.

The AAPS is an organization that fits this description almost perfectly. It embraces many forms of denialism, including vaccine denialism, anthropogenic global warming denialism, and the unsupported claim that abortions cause breast cancer. No wonder it embraced Andrew Wakefield.

Tbe remaining categories include donors, “researchers” (quotation marks mine; I wouldn’t have called the likes of Mark and David Geier “researchers” by any stretch of the imagination), and journalists, bloggers, and other media producers. Many familiar characters are discussed, such as the aforementioned Geiers, David Kirby, Arianna Huffington and her stable of Huffington Post anti-vaccine bloggers and quacks who have turned HuffPo into such a wretched hive of scum and quackery, and the like. She does at least note that the anti-vaccine movement’s “researchers” tend to publish in non-peer-reviewed journals of very low repute.

Putting it all together, Kirkland proposes three different competing underpinnings of anti-vaccinationism. These include “holistic health ontology.” This is, of course, no surprise to anyone who’s been following the anti-vaccine movement as long as I have:

On this view, diseases of the past were actually defeated by sanitation, homeopathy, and nutrition, not vaccines. Attributing their vanquishing to vaccines is part of the orthodoxy of mainstream medicine. The foundational disagreement is whether the germ theory of disease is central to medicine (for a book- length treatment, see Baker 1994, Appleton 2002, and Trebing 2004). As Palevsky (2009) put it in his conference address: “So, in our conventional teaching, there’s this germ theory. And the theory is that microorganisms are the cause of many diseases. . . . Might I say that this is just a theory. Germs may play a role in children getting sick, but they may not be the reason that children get sick.”

Germ theory denialism, anyone?

Then, of course, there is the libertarian “health freedom” perspective:

The vaccine-critical movement is quintessentially neoliberal, blending holistic self-care with the elevation of the individual and the private family over collective goods. Maternal management of every possible risk to her own children becomes paramount (Kaufman 2010).

It has been said that anti-vaccine activists are in essence selfish in that arguments involving social responsibility and herd immunity fall on deaf ears when directed at them. Remember my discussion of how alternative medicine produces the “illusion of control.” The anti-vaccine movement is a perfect example. Many of these parents seem to think that they can prevent all diseases through giving their children the right diet and the right lifestyle. If necessary, they choose when to infect their children (“pox parties”) in order to give them “natural immunity” (as opposed to vaccine-based immunity, which they reject as “unnatural”). They also take umbrage when it is pointed out that their unvaccinated children are potential pools for vaccine-preventable diseases to spread, an assumption seemingly based on their tendency to all-or-nothing thinking. To their way of thinking, if vaccines are 100% effective, then the vaccinated have nothing to fear from the unvaccinated. Would that were true!

Where Kirkland stumbles is in characterizing the last underpinning of the anti-vaccine movement as the “vaccine safety perspective” because, if you really take a close look at claims that, “I’m not ‘anti-vaccine, I’m pro-safe vaccine” or claims of being a “vaccine safety advocate,” you will inevitably find that this is just a smokescreen for anti-vaccine views. Kirkland appears not to understand this and actually takes “pro-safe vaccine” wing of the anti-vaccine movement at their word. Even though she correctly identifies why a randomized “vaccinated versus unvaccinated” study would be inherently unethical, she fails to realize that all these calls for studying “vaccinated versus unvaccinated” populations are in reality both a fishing expedition and a delaying action. She quotes Vicky Debold saying, “We ask that the government begin to fund research that evaluates the effect of vaccination, against no vaccines at all, on biomarkers of immunity, biomarkers for metabolic dysfunction, neuro-developmental outcomes, including autism, immune-mediated illnesses of all sorts, autoimmunity, allergies, asthma, epilepsy, intellectual and learning disabilities, all the things that we know are epidemic in our children. We ask for all of that.” Unfortunately, she doesn’t realize that for a study to be ethical it is also necessary that there be preclinical and epidemiological data supporting the need for such a study, and there just isn’t any such compelling data suggesting that all these biomarker studies would be fruitful or likely to find anything of value, particularly given that there are already plenty of studies failing to find any links between vaccines and autism, learning disabilities, asthma, and adverse neurodevelopmental outcomes. Similarly, Kirkland doesn’t seem to understand that the purpose of calling for studies looking for subgroups that are “hypersusceptible” to vaccine injury serves a similar purpose. They function to create doubt where scientifically there is little or no doubt. They serve to provide the illusion that there is a scientific question remaining.

In fact, these studies are nothing more than moving the goalposts. When studies failed to find a relationship between thimerosal in vaccines and autism, anti-vaccinationists started invoking the “toxin gambit” in which they point to every single scary-sounding chemical in vaccines and claim that they have to be studied for safety. Or another good example is how after studies failed to link vaccines to autism anti-vaccine activists pivoted effortlessly to claim that it was “too many too soon” that were “overwhelming” the immune system as a rationale for delaying vaccines. No matter what scientific studies come out failing to support the anti-vaccine hypothesis du jour, anti-vaccine activists always–always–find a way to shift the goalposts to a new hypothesis. These are not legitimate “vaccine safety” activists. In fact, I highly doubt that such a creature exists, at least not affiliated with organizations like the NVIC or SafeMinds. Moreover, there is always one characteristic in all of the hypotheses of autism causation that these groups propose. Like the “fixed point in time” in the last couple of seasons of Doctor Who, the fixed point in time and space in the anti-vaccine universe is that, whatever reason for autism causation anti-vaccinationists think of, vaccines will always somehow be involved as a cause. Always. Because to them, it’a always about the vaccines.

None of this stops Kirkland from ending with a plea:

There will no doubt continue to be a vaccine-critical movement composed of all the parts described here, but it will be interesting to see how different components manage this new context of diminished scientific resonance for the claims of the last decade. One view of the role of advocacy groups in democratic government is that they play a critical role in keeping important items on the agenda, synthesizing information for the general public, and promoting accountability. Vaccine safety is a critically important public concern, but I fear we have not been well served by leading groups who currently own the issue. My hope is that vaccine safety advocates will reorient themselves toward critical yet epistemically responsible collaboration with vaccine policy makers. Unfortunately, that route looks increasingly difficult because of the alliances that have held the movement as a whole together.

“We have not been well-served” by SafeMinds and the NVIC? Ya think?

To be fair, we all hope that vaccine safety advocates, if there are any left affiliated with the anti-vaccine movement, will dissociate themselves from the cranks and become a force for science-based vaccine policy. I’m just not going to hold my breath waiting. Kirkland gets a lot right in her post. Unfortunately, she falls into the same trap that a lot of people naive to the movement tend to fall into, namely the trap of not realizing that the anti-vaccine movement is an anti-science movement that promotes pseudoscience and is unrelentingly opposed to vaccines. People dedicated to actual science don’t associate themselves with the anti-vaccine movement; hence, these fantastical “reasonable” activists who are “pro-vaccine safety” are not to be found in or associated with groups like SafeMinds, the NVIC, or Generation Rescue. Such people might have existed at one time (indeed, Barbara Loe Fisher probably originally fit the description of a “vaccine safety advocate” back in the 1980s when she got started but long ago devolved into anti-vaccine crankery), but in the anti-vaccine movement of the last decade or so? Not so much. It’s a shame Kirkland apparently didn’t realize that, but on the other hand she did an excellent job of pointing out how marginalized the anti-vaccine movement has become. It’s rapidly on its way to joining creationists far out on the fringe.

Of course, perhaps it only seems that she falls into this trap because you can’t explicitly call a crank a crank in academic literature. Let’s hope so. In the meantime, the anti-vaccine movement, having had the last shred of its already underwhelming scientific credibility reduced to nothing, is descending further and further into denialism and pseudoscience.

REFERENCE:

Kirkland, A. (2011). The Legitimacy of Vaccine Critics: What Is Left after the Autism Hypothesis? Journal of Health Politics, Policy and Law DOI: 10.1215/03616878-1496020