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The Unreasonableness of the Anti-Vaccine Movement

[NOTE 10:36 am CST 2/19/2010: In the comments Frank33 noted that, per an ABCNews article posted September 1, 2009, some seasonal influenza vaccines do still contain thimerasol. I’ve corrected the post to acknowledge that.  I also corrected two minor typos that had no effect on the content or context of the post.]

One of my favourite online hangouts is “The Fogbow,” a forum that focuses primarily on combating the beliefs of and disinformation spread by birthers and their multifarious claims regarding Obama’s eligibility to serve as President. Recently, I finished reading Seth Mnookin‘s new book “The Panic Virus: A True Story of Medicine, Science, and Fear” about the controversy linking vaccines to autism. I found the mindset and belief-patterns of the anti-vaccine movement to be amazingly similar to those of the birthers and commented on it. I also comments on how there are some controversies where I can better understand why people might have questions – even if I don’t believe that their overall theory is correct – while others I can’t understand where the questions are coming from at all. One of my fellow Fogbowers replied, saying:

Actually, “vaccines cause autism” came from a study published in a legitimate medical journal. Unfortunately, the study itself was a complete fraud. The disgrace responsible, Andrew Wakefield, even sought to profit from his fraud. Even prior to the recent exposure of the study as a complete fraud, it had never been corroborated and all but discredited, but one can forgive naïve people for falling for a hoax when it is published in The Lancet.

Below is a slightly edited copy of my response. The only edits done were to correct spelling errors, add a section I’d forgotten in the initial post and had to post in a separate message later – here I’ve combined them so it flows better, and include links to other sites with further information. No content or context has been changed:

Perhaps initially, but even then, there were a number of indications that the study was problematical, and while parents might not have been able to make a well-informed, critical analysis of the information, from what I’ve read (especially in “The Panic Virus,” though from other sources as well) their doctors DID have access to information that they should have been able to use to help calm concerned and/or naïve parents and give them solid guidance in a matter as serious as the need for immunization – not just for the individual, but also to help maintain “herd immunity.”

This is from the book regarding that paper and how it was presented to the public (emphasis added):

The paper’s title didn’t make it an obvious candidate for articles in the next day’s broadsheets; even the most creative headline writers would have trouble coming up with a pithy leader for a piece about “Ileal-Lymphoid-Nodular Hyperplasia, Non-Specific Colitis, and Pervasive Developmental Disorder in Children.” But the Royal Free [Hospital]’s PR team gave hints that this was no ordinary paper: They’d put together a twenty-minute promotional video for the occasions and assembled a panel of five of the hospital’s researchers to address the report’s implications. Andrew Wakefield, the paper’s lead author and it’s “senior scientific investigator,” was the star of both.

It didn’t take long to figure out what all the fuss was about. Contrary to the paper’s title, the main thrust of the press conference was not the possible connection between intestinal and developmental disorders – it was Wakefield’s supposition that MMR vaccine, which had been used in the United States since the early 1970s and in Great Britain for the previous decade, could very well be responsible for the dramatic rise in rates of autism. In order to support this theory, Wakefield piggybacked on his claim that he’d found the measles virus in the intestinal tracts of IBD patients – a claim that had already been discredited by other studies. Some children, he speculated, had immune systems that, for some unknown reason, were unable to handle the combination of the three vaccines at once. As a result, the measles component of the vaccine took root in the lining of the small intestine, causing a “leaky gut.” The next step in Wakefield’s hypothesis was dependent on a widely discredited “opioid excess” theory of autism, which drew parallels between autistic children and doped-up lab rats: After the opioid peptides that are naturally produced during digestion escaped through the gut’s newly porous walls, Wakefield argued, they breached the blood-brain barrier and overwhelmed the developing children’s brains. The result was autism.

Knowing that the paper’s finding would be controversial from the start, the five experts who addressed the media had agreed beforehand that regardless of their individual interpretations, they’d deliver one overarching message: Further research needed to be done before any conclusions could be drawn, and in the meantime, children should continue to receive the MMR vaccine. Once the tape recorders began to roll, however, Wakefield went dramatically off-script: “With the debate over MMR that has started, ” he said, neatly eliding over the fact that he was, at that very moment, the person responsible for igniting the debate, “I cannot support the continued use of the three vaccines given together. We need to know what the role of the gut inflammation is in autism… My concerns are that one or more case of this is too many and that we put children at no greater risk if we dissociated those vaccines into three, but we may be averting the possibility of this problem.” Almost immediately, the press conference descended into near chaos. Even if Wakefield’s study had been more comprehensive and his data more robust, it was virtually unprecedented for a research scientist to advocate wholesale changes to health policy. After stressing that the MMR vaccine had been given to millions of children around the world and had saved untold numbers of lives, Arie Zuckerman, the dean of the Royal Free Hospital‘s medical school. became so agitated he began banging on the lectern. “If this were to precipitate a scare that reduced the rate of immunization,” he said, “children will start dying from measles.”

Zuckerman’s frustration was understandable. As scientists around the world already knew, there were ample reasons to view Wakefield’s latest effort skeptically. After an initial peer review raised questions about the quality of Wakefield’s research and the soundness of his reasoning, Richard Horton, the editor of The Lancet, demanded the paper be rewritten in such a way that made clear the speculative nature of the work and slapped an “Early Report” label above the title and over the header of each page. Horton also to the even more unusual step of asking Robert Chen and Frank DeStefano, two American vaccine specialists at the CDC, to prepare an evaluation of Wakefield’s paper that would appear in print. “Usually, when they publish a commentary, it’s to extol the study or show how it’s advanced the field,” DeStafano says. That was obviously not the case here. When he first read the paper, DeStefano says, his reaction was, “There really didn’t seem to be that much there. It was kind of like, Why were they publishing the article?”

Of course, the media focused more on what came out of the press conference rather than what was actually printed in the journal, but The Lancet, while going ahead and publishing the paper, (full text of study at link, free registration required to access) tried to make it clear (at least to other scientists reading the journal) that this was very preliminary information only. The press conference was NOT put together by the publishers of The Lancet, but rather by the Royal Free Hospital, where he worked at the time. So the journal tried to put the paper in a more responsible context of something that was very preliminary, and the Hospital – by having all of the presenting scientists agree ahead of time to focus on the message that the study wasn’t strong enough to make any changes to how parents vaccinated their children or to the public policy of vaccination – tried to ensure that the study would not be misinterpreted, Andrew Wakefield went rogue and made sure the panic button got pushed and the media followed his lead without trying to verify his information. Knowing now that he had tried to get a patent on a single-dose measles vaccine formula (the kind of thing parents concerned about giving their children the combined MMR vaccine jab just might want to be able to choose as an alternative) it seems fairly clear to me that his overall goal was to create a panic and get rich off of it.

Mnookin has an interesting story in his book about Wakefield’s attitude towards his research. Apparently, he’d been having some trouble getting financial backing for his work and, according to Brian Deer – an investigative journalist who did a significant amount of the investigative journalism that eventually led to the disclosures about Wakefield’s dubious motives and questionable research – in the early 90’s, Wakefield…

…began contacting high-level officials at the British Department of Health, requesting face-to-face meetings to discuss financial backing for his work. His entreaties seemed to go beyond a sober recitation of the value of his research: In an October 1992 letter to David Salisbury, who at the time was the head of the British vaccine program, Wakefield wrote, “My concern is that although measles, and in particular the vaccine, may have no association with Chron’s disease whatsoever, what will be picked up by the press is the apparent association between the increasing incidence of disease and the vaccine.” It was an odd point for a researcher to make. Instead of arguing the merits of his work, Wakefield seemed to be warning about the possible public fallout of his conclusions.

Also of interest, in looking at the charts associated with the paper, it lists when the subject received the MMR vaccine, how long after the vaccine was given did the parents first note behavioural problems, and the age of onset for both the behavioural and bowel problems. Now, Wakefield’s theory was that the MMR caused bowel problems, and the bowel problems caused the autism, which caused the behaviour problems. Yet in the study – which only involved 12 subjects – 4 of them exhibited the behavioural problems at least 3 months prior to exhibiting any bowel problems, 5 more list “not known” for the onset of the bowel problems and one has nothing listed for the onset of bowel problems. One exhibited onset of both behavioural and bowel problems simultaneously, and only ONE subject actually had bowel problems before they had behavioural problems. Now, I’m not a scientist, but it would appear to me that if the theory is that physical damage to the bowel causes not only the bowel symptoms but also is the mechanism by which the toxic substances that lead to behavioural issues are able to reach the brain, then shouldn’t those bowel problem be observable BEFORE the behavioural ones?

In any event, as it became clearer that no other studies could demonstrate a link between the MMR vaccine, leaky guts and toxins crossing the blood-brain barrier, a shift much like how the birthers went from “not born in Hawaii” to “not eligible because his dad wasn’t a US citizen” took place, and focus moved from the idea that the vaccine caused gut-damage resulting in developmental disabilities to focusing on the use of Thimerosal as a preservative in the MMR vaccines. Part of the problem, however, was that concerns about the use of mercury in Thimerosal were generally predicated on known problems related to exposure to methylmercury, when Thimerosal used ethylmercury. (Mnookin offered a nice analogy about the differences between ethyl- and methyl- mercury: Alcohol can come in ethanol – or ethyl-alcohol – which is what most of us drink, or methanol – which is methyl-alcohol – that can cause serious toxic effects if ingested including blindness or death.) By conflating the properties of the more toxic methylmercury with the safer ethylmercury, it unnecessarily heightened fears surrounding the vaccines.

Even with that conflation, however, it wasn’t long before the US and UK governments began removing Thimerosal from vaccines, and by 2004 (IIRC) there were no more vaccines being given that contained any Thimerosal at all 2003, thimerasol has “not been a part of routinely administered childhood vaccines with the exception of some forms of the seasonal influenza vaccine.” according to a 2009 article at ABCNews. Yet rather than dropping, the rates of autism diagnoses are still increasing. If Thimerosal was the culprit – or even “a” culprit – that fact alone should have caused even true believers to question their beliefs. In addition, a study was done in Denmark where – because of the way there vaccination laws are structured – scientists were able to compare three groups of children: Those who had been vaccinated with Thimerosal vaccines, those who were given Thimerasol-free vaccines and those who were unvaccinated. The study showed no statistically significant difference between the three groups in terms of the rate of autism diagnoses.

My point in all of this is that while it might have been reasonable to have questions when the study was first published in 1998, that time has long passed. Even the original study that started the whole mess wasn’t nearly as disconcerting if looked at closely, and was thoroughly debunked several years ago, and as with any good conspiracy theory, when the first hypothesis evaporated, there were new ones to fill it’s place. Sadly, the misinformation attributable to the belief that vaccines can cause autism has already killed some children – both ones whose parents opted not to vaccinate them out of fear of the vaccine itself – and who then contracted one of the diseases they would have been protected against – and ones who weren’t yet old enough to be given any vaccines and got sick because other children in their neighbourhoods weren’t vaccinated and communities are beginning to lose their herd immunity.

Not only is believing that vaccines cause autism unreasonable based on years of scientific evidence (and confirmed in the Omnibus Vaccine Court proceeding regarding autism claims) but it’s also deadly.

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