Antivaccine fear mongering? What antivaccine fear mongering? I don’t see any antivaccine fear mongering.

Here we go again.

Every so often, criticism of the antivaccine movement builds to the point where it extends beyond the blogosphere to enter the national zeitgeist in a way in which people other than blogging geeks like myself start to take notice. It happened a few years ago, when washed up actress Jenny McCarthy teamed up with the antivaccine propaganda group Generation Rescue to sell her story of how she believes that vaccines caused her son Evan’s autism and managed to score an appearance on The Oprah Winfrey Show. It happened again three years ago, as preparations for the H1N1 pandemic were in high gear and antivaccine conspiracy theorists were in even higher gear. Or maybe they were just higher, if the “quality” of their arguments were any indication. It happened again a couple of years ago, as Andrew Wakefield achieved his apotheosis among antivaccinationists at the same time he fell into utter disgrace among everyone else, having had his U.K. medical license stripped from him, seen his infamous 1998 Lancet article that launched the anti-MMR scare retracted, and had his position as “medical director” at the autism quackery clinic Thoughtful House stripped from him.

Now, I think it’s happening again today. It’s not entirely clear why, but I think it’s in response to the recent string of measles and pertussis outbreaks. Whatever the cause and whether or not the disturbance I’m sensing in the Force is real or not, one thing you can almost always count on when criticism of the antivaccine crankosphere reaches a certain crescendo, it’s that someone on ostensibly “our” side, someone respectable, will decide to start criticizing those of us who devote a significant portion of our writing time to studying and countering the antivaccine movement for being too “strident.” Part of that critique almost always involves claiming that we are being too harsh on antivaccine parents, that we don’t understand, and—oh, by the way—can’t we all just get along? Yes, in essence, this countercriticism usually comes in the form of an article that is one massive exercise in tone trolling. This time around, it’s by a Canadian academic named Alan Cassels for the blog Pharmawatch Canada in the form of a post with a title that will induce cringes (and probably more than a little bit of ridicule) from some of us who deal with antivaccine propaganda), entitled Time to outlaw vaccine propaganda: Are we taking the easy way out by labeling vaccine questioners anti-science loonies?. The short answer is no. (Actually, it’s not just “no” but “Hell, no!”). The long answer follows.

Cassels begins by asking the following questions:

Are lifesaving vaccines being ignored by parents because of illegitimate safety concerns?

I could make this one of the shortest Orac posts ever written by using the short answer to this question (“yes”), but you know I have a hard time doing that, particularly when responding in longer form gives me the opportunity to produce entertaining riffs that amuse myself (and hopefully you). Before I do that, I’ll point out that Cassels uses as examples of what he refers to as “prominent health pundits” commenting on the situation. For instance, he cites André Picard at The Globe and Mail saying that the decline in vaccination rates in the U.K. is the result of parents “shunning vaccination in small but significant numbers because of imaginary fears largely concocted by quacks and charlatans,” a point I can’t argue with and have made myself on numerous occasions. Also cited is a good bud, Steve Salzberg, who criticized certain well-known antivaccine doctors for using “their medical degrees and their faux concern ‘for the children’ to frighten parents into keeping their kids unvaccinated.” Again, it’s a point I fully agree with, as is Salberg’s indictment of media complicity in spreading the antivaccine message. Indeed, these things are so mind-numbingly obvious to anyone of a science-based bent that it’s hard to imagine that Cassels doesn’t see them. Either he’s not of a science-based bent or he has a bit of an ideological bug up his butt about vaccines. Alternatively, maybe he’s one of those guys who just doesn’t like “experts” and sees them as “arrogant.” Let’s find out.

Cassels grudgingly concedes that maybe, just maybe, the media might be feeding antivaccine hysteria and that we “certainly have our share of charlatans and quacks in cyberspace, aided and abetted by cyberchondriacs of all stripes,” observations whose obviousness is only rivaled by its banality, not to mention the lack of mooring in reality his dismissal of antivaccine fear mongering as an important contributing factor to parents’ fears demonstrates. In particular, the media in the U.K. was arguably the most important factor in allowing Andrew Wakefield to spread his misinformation pseudoscience about the MMR vaccine that blames it for causing autism in the face of no evidence that it does and overwhelming evidence that it does not. I’ve said it time and time again, the U.K. media aided and abetted Wakefield. In fact, you could even say that the U.K media created Wakefield. In any case, these faux profound observations lead Cassels to state that there is “real fear among parents, a fear that is palpable.” Of course it is! It takes only a few minutes’ online exposure to hype “illegitimate fears.”

He next asks, “What is at the heart of these concerns? Can it really be due to vaccine fear-mongering?” Once again, I’m half-tempted simply to say that, yes, it really can be due to vaccine fear mongering, but I do feel somewhat obligated to follow my answer up by asking Cassels: Are you on crack? Have you seen antivaccine websites? Have you ever personally delved into antivaccine discussion forums? Have you ever lurked at MotheringDotCom (MDC), that website for “natural” mothering that many new mothers find (because its forums rank high on Google searches for important parenting topics) whose forums are the most wretched hives of antivaccine scum and quackery? Have you ever read, which is as highly trafficked a website as the NIH website, a website that relentlessly attacks vaccines on a near-daily basis and whose owner has helped that antivaccine group National Vaccine Information Center to place its advertising in various high profile places? I think the answer is obvious. The answer is either “no,” or it’s that Cassels has antivaccine tendencies himself—or perhaps a combination of the two.

Because Cassels tells me that it’s such a horrible thing to call people antivaccine, for the moment I’ll choose the option that he is clueless about the antivaccine movement rather than sympathetic to it. However, as far as I’m concerned, it’s not wrong to tell it like it is if you have evidence to back your opinion up, and when I see antivaccine words and actions, I call it as I see it, and what I see is Cassels regurgitating antivaccine propaganda that he clearly knows nothing about and does not recognize as antivaccine proganda. This parroting reaches its height in the following passages, in the first of which Cassels answers his own question about whether the fears of parents can be due to antivaccine fear mongering:

I don’t think it [parents’ fear] is [due to antivaccine fear mongering]. Parents just want to keep potentially harmful things away from their children. And they turn to health experts for guidance, but here’s my take on things: health authorities often fail to acknowledge the risks of some vaccines, refuse to discuss uncertainty over a vaccine’s effectiveness, hype the seriousness of common everyday viruses (c’mon folks, really? The flu? Chicken pox?) and keep piling more and more vaccines onto the list of ‘recommended’ childhood shots threatening to turn our kids into pincushions. Now you’ve got a recipe for even more skepticism and fear-mongering.

All of which is utter nonsense, the proverbial load of rotting, fetid dingo’s kidneys. First off, his dismissal of the flu reveals such enormous ignorance that it’s hard to take him seriously. The flu can kill, and does kill, each and every flu season. (Perhaps Cassels doesn’t think there could be another pandemic like the influenza pandemic of 1918, which killed millions and might have killed more people than the Black Death.) Chicken pox can result in serious complications.

Also, if Cassels thinks that health authorities don’t discuss uncertainty about some vaccines with the public, he is obviously not paying attention. Yes, parents want to keep their children safe. No one, least of all those of us trying to do our best to counter the misinformation, pseudoscience, and fear mongering of the antivaccine movement, say otherwise. None of us doubt the sincerity of these parents. There is one thing that Cassels clearly doesn’t understand. There are two general types of parents who fear vaccines. There are the leaders of the antivaccine movement, who do their best to spread misinformation and fear about vaccines in order to dissuade parents from vaccinating through the use of what I like to call “misinformed consent,” in which they massively exaggerate (or outright make up) risks of vaccination and similarly massively minimize their effectiveness. Whatever their reasons for being antivaccine, be it the mistaken belief that vaccines somehow caused autism in their child, the usually mistaken belief that vaccines somehow injured their child, or philosophical leanings that make them distrust authority or pharmaceutical companies and believe that “natural is better,” this is what they do.

Then there is the target audience for the antivaccine movement: The much larger group of great undecideds. These are parents who might have a tendency to distrust authority, prefer “natural” over pharmaceutical, or other leanings that might make them worry about vaccines. These parents are not antivaccine, but they are susceptible to the propaganda spread by the antivaccine movement. This is our target as well. I, for one, realize that I can’t persuade die-hard antivaccinationists like J.B. Handley, Dan Olmsted, Jake Crosby, Mark Blaxill, or Barbara Loe Fisher that the “injuries” that they ascribe to vaccines have no basis in evidence. I can, however, persuade the fence-sitters. To Cassels, however, all of these parents, the hard core antivaccinationists and the undecideds, seem to be all the same.e

Cassels then refers to recent outbreaks of pertussis, which, as I’ve described, appear to be due to waning immunity, not because the vaccine doesn’t work, as the antivaccine movement tries to claim (and, apparently, Cassels seems to be implying). Cassels then opines:

For some, the complications of whooping cough can be deadly and it can lead to pneumonia, convulsions, and even brain damage and death. It’s not to be trifled with. You’d certainly want to shelter your child from whooping cough if you could, but the advice around the vaccine is conflicting. Some groups, such as the CDC recommend vaccination of pregnant women and infants yet the vaccine leaflets themselves say it is unknown whether the vaccines cause fetal harm. Some say the vaccine is highly effective, while others point to studies showing even fully vaccinated children still get whooping cough. No one seems to know how many booster shots you need to keep your child protected. Clearly this is a breeding ground for confusion.

Notice where Cassels links. Does he link to the CDC? No. Does he link to the CHOP Vaccine Education Center? No. Does he link to any reputable site? Most assuredly not. He links to the NVIC, which is one of the oldest and most notorious antivaccine advocacy groups that there is, founded and still led by the grande dame of the antivaccine movement herself, Barbara Loe Fisher. This is a website that features a truly dishonest and pseudoscientific Vaccine Ingredient Calculator, as well as an “International Memorial for Vaccine Victims.” It’s a website chock full of antivaccine misinformation so wrong that its statements and reality are related by coincidence only, pseudoscience, propaganda, and pure nonsense. This is the same group that aired antivaccine ads on the CBS JumboTron at Times Square and insinuated its ads into Delta Airlines online entertainment. Either Cassels is unaware of this background, or he approves of the NVIC; I have a hard time thinking of other reasons why he would cite such a completely useless source chock full of misinformation and lies. Let’s put it this way, there is no plausible scientific reason to think that the vaccine causes fetal harm if the mother is vaccinated.

As for the issue of fully vaccinated children getting whooping cough, Cassels needs to get a clue. No vaccine is 100% effective, and the waning immunity observed in some studies of the acellular pertussis vaccine doesn’t mean the vaccine doesn’t work. It means the vaccine schedule needs to be adjusted. Does all this seem concerning to parents? Sure. Could it cause confusion? Sure. That’s the germ of truth that Cassels harps on. What he seems oblivious to is the fact that there really is an antivaccine movement that takes scientific uncertainty whenever it can and uses it to try its very best to amplify that confusion to the point where the public loses faith in the vaccine program. Indeed, no less a luminary in the antivaccine movement than J.B. Handley himself bragged about doing just that. No doubt Cassels is unaware of this, to the point where he concludes:

At the end of the day, most parents just want to know the answer to one simple equation: what is the likelihood that a vaccine will prevent a deadly disease, versus what are the chances of a serious adverse reaction to the vaccine? Shouldn’t this be a simple question to answer? But it isn’t. If public health authorities want to improve vaccination rates, they’d drop the patronizing assurances and start providing the public with some hard evidence of the benefits and harms of immunizing or not immunizing. And the media would help by not scorning parents who ask legitimate questions. Only then will you see vaccination rates improve.

Cassels seems to think that scientists and doctors don’t bother to ask themselves and then answer the question, for both themselves and parents, the relative risk-benefit ratios of various vaccines. Gee, it’s not as though scientists don’t write about the relative risks and benefits of vaccines all the time. It’s also not as though scientists don’t try to communicate information to the public. In actuality, the reason why parents leaning towards antivaccine views are unhappy with the answers they’re getting from health authorities is because the risks of vaccines listed by health authorities do not include the risks that the antivaccine movement attributes to them. Health authorities do not tell them that there is a risk of autism due vaccines because the best science currently available in copious quantities tells them that there isn’t one, at least not a risk that large epidemiological studies can detect, which is the best that science can do. Health authorities don’t tell them that there is a risk of sudden infant death syndrome (SIDS) due to vaccines, because the best science has failed to find it—and not for lack of looking, either. They are unhappy because health authorities do not tell them that vaccines cause autoimmune diseases, developmental disorders, and a whole host of other complications that the antivaccine movement attributes to them, because vaccines don’t cause all those problems. Instead, health authorities tell it like it is, but because they don’t include fantasy-based risks from vaccines they are dismissed as hiding something or somehow downplaying risks from vaccines. That’s the bottom line. And who hypes these risks? The antivaccine movement. And, as multiple studies have shown, their primary tool for spreading such misinformation is the Internet. Worse, it takes very little exposure to antivaccine misinformation (or, as Cassels would call it, “illegitimate fears” of vaccines) to influence a parent to be fearful of vaccines. It’s Dr. Google and Mr. Hyde.

My guess is that, if Cassels sees this post, he’ll view it as just more “demonization” of antivaccinationists or of parents who “raise legitimate questions” about vaccine safety. Nothing could be further from the truth. It’s Cassels who can’t tell the difference between antivaccine ideologues and parents who are confused because of the misinformation on the Internet promoted by antivaccine ideologues, blurring the difference to the extent that he parrots antivaccine talking points, probably unknowingly, and tries to deny that antivaccine propaganda has an effect. He might also think that my use of the words “ignorant” and “clueless” are ad hominem attacks. They are not. They are simply observations about statements Cassels has made.

After seeing such a heapin’, helpin’ of dubious arguments, credulity towards antivaccine pseudoscience, and utter cluelessness, I wondered just who Alan Cassels is. Apparently he’s written a book called Seeking Sickness: Medical Screening and the Misguided Hunt for Disease. Of course, the complicated issues behind screening for mammography and prostate cancer have been regular topics on this blog. The blurb for Cassels’ book reads a bit more—shall we say?—stridently than my nuanced discussions of these issues. From the blurb on his book, Cassels seems to be a man who is deeply suspicious of medicine and thinks that screening tests are worthless. It isn’t surprising that he would tend to think that, given the message of his book that the benefits of screening are oversold and the risks downplayed, that he would conclude that the reason for parents’ fears of vaccines is the same. If the antivaccine movement didn’t exist and weren’t so vocal, maybe he’d have a point. As it is, he doesn’t have much of one.