The Anti-Vaccine Movement Lives on

Discover Magazine's website currently is hosting an article on why the anti-vaccine movement continues to grow despite the fact that all scientific evidence is mounted against them.

The anti-vaccine movement arguably began in 1999 when Andrew Wakefield published an article claiming a link between thimerosal, a preservative used in some vaccines, and autism. The "study" used a very small sample size, insufficient for clinical purposes, and it was later revealed that Wakefield had multiple financial interests in both decreasing the use of existing vaccines (because he had patented new ones) and in tying thimerosal and autism (he was being paid by attorneys representing families who wished to prove such a connection in order to claim a large financial settlement). The Lancet, the journal that published the paper, has since backed away from it after it came under fire by non-biased researchers, and Wakefield's co-authors have repudiated the paper, describing both flaws in the study method and stating that Wakefield never disclosed his financial interest in the matter to them.

But it was too late. With the publication of the paper, many people became understandably scared, and as these people began to merge with a larger group that likes to blame all manner of evils on the pharmaceutical industry*, and as such, a movement thoroughly sealed into an echo chamber rose, and no amount of strong, damning evidence proving them wrong will stop their march.

The Discover article discusses the current state of this movement, and there area few excerpts very much worth noting. For example, Wakefield's article pinned thimerosal as the culprit, and the alleged dangers of timerosal was long the rallying cry of the anti-vaxxer movement, but the preservative has long since been removed from vaccines, and so, rather than accept that the vaccines weren't the problem to begin with, they've simply changed their specific target:

In 2005 David Kirby stated that if autism rates didn’t begin to decline by 2007, “that would deal a severe blow to the autism-thimerosal hypothesis.” But as McCormick notes, despite the absence of thimerosal in vaccines, reports of autism cases have not fallen. In a 2008 study published in Archives of General Psychiatry, two researchers studying a California Department of Developmental Services database found that the prevalence of autism had actually continued increasing among the young. Kirby concedes that these findings about the California database represent a “pretty serious blow to the thimerosal-causes-autism hypothesis,”...in the face of powerful evidence against two of its strongest initial hypotheses—concerning MMR and thimerosal—the vaccine skeptic movement is morphing before our eyes. Advocates have begun moving the goalposts, now claiming, for instance, that the childhood vaccination schedule hits kids with too many vaccines at once, overwhelming their immune systems. Jenny McCarthy wants to “green our vaccines,” pointing to many other alleged toxins that they contain. “I think it’s definitely a response to the science, which has consistently shown no correlation,” says David Gorski, a cancer surgeon funded by the National Institutes of Health who in his spare time blogs at Respectful Insolence, a top medical blog known for its provaccine stance. A hardening of antivaccine attitudes, mixed with the despair experienced by families living under the strain of autism, has heightened the debate—sometimes leading to blowback against scientific researchers.

In addition, the focus on vaccines, against all evidence to the contrary, has resulted in both threats (including death threats) to researchers working on the real sources of autism, and in the re-appearance of often deadly disease long thought defeated:

But in 2006 Shattuck came under fire after he published an article in the journal Pediatrics questioning the existence of an autism epidemic. No one doubts that since the early 1990s the number of children diagnosed with autism has dramatically increased, a trend reflected in U.S. special education programs, where children enrolled as autistic grew from 22,445 in 1994–1995 to 140,254 in 2003–2004. Yet Shattuck’s study found reasons to doubt that these numbers were proof of an epidemic. Instead, he suggested that “diagnostic substitution”—in which children who previously would have been classified as mentally retarded or learning disabled were now being classified on the autism spectrum—played a significant role in the apparent increase.

Shattuck did not reject the idea that rising autism levels might be in part due to environmental causes; he merely showed the increase was largely an artifact of changing diagnostic practices, which themselves had been enabled by rising levels of attention to autism and its listing as a diagnostic category in special education. Yet simply by questioning autism epidemic claims in a prominent journal, he became a target. “People were obviously Googling me and tracking me down,” he recalls. Shattuck emphasizes that most e-mails and calls merely delivered “heartfelt pleas from people with very sick kids who’ve been led to believe a particular theory of etiology.” The bulk weren’t menacing, but a few certainly were.

********

“If there has been a more harmful urban legend circulating in our society than the vaccine-autism link,” University of Pennsylvania bioethicist Arthur Caplan wrote in The Philadelphia Inquirer, “it’s hard to know what it might be.” One type of harm, as Shattuck’s story shows, is to individual scientists and the scientific process. There is a real risk that necessary research is being held back as scientists fear working in such a contested field. Shattuck’s experience is not unique. Offit cannot go on a book tour to promote Autism’s False Prophets because of the risk involved in making public appearances. He has received too many threats.

...and...

Given enough vaccine exemptions and localized outbreaks, it is possible that largely vanquished diseases could become endemic again. (That is precisely what happened with measles in 2008 in the U.K., following the retreat from the MMR vaccine in the wake of the 1998 scare.) The public-health costs of such a development would be enormous—and they would not impact everyone equally. “If vaccine rates start to drop, who’s going to get affected?” Peter Hotez asks. “It’s going to be people who live in poor, crowded conditions. So it’s going to affect the poorest people in our country.”

In addition, the alternative medicine industry has capitalized on the fear of vaccines, and has produced many treatments alleged to cure autism (in each case, unproven) that pose very serious health threats in and of themselves:

Yet another cost comes in the rush toward unproven, and potentially dangerous, alternative therapies to treat autism. It is easy to sympathize with parents of autistic children who desperately want to find a cure, but this has led to various pseudoremedies whose efficacy and safety have been challenged by science. These include facilitated communication, secretin infusion, chelation therapy (which involves pumping chemicals into the blood to bind with heavy metals such as mercury), and hormonal suppression. It is estimated that more than half of all children with autism are now using “complementary and alternative” treatments.

And it is noted that in the end, the fact that 20th century vaccination programs have been so successful may be the reason why the anti-vaccine movement has gotten traction.

Paradoxically, the great success of vaccines is a crucial reason why antivaccination sentiment has thrived, some scientists say. Most of the diseases that vaccines protect against have largely been licked. As a consequence, few people personally remember the devastation they can cause. So with less apparently on the line, it is easier to indulge in the seeming luxury of vaccine skepticism and avoidance.

After I initially wrote this, but before it dropped into the blog feed, I heard this podcast, which covers much of the same ground. It's an interview between a research scientist and a television producer who produced a television show on the anti-vaccine movement in Australia. It's worth a listen.

One of the ironies of the anti-vaccine movement is that, unlike other anti-science movement such as creationism, it is more common amongst the well-educated and affluent. Although I can claim no expertise, I would suspect that there are three basic reasons for this:

A) As a well-educated and relatively affluent person, I know that it is often difficult for us to concede when we don't know something, and as a result we are often taken in by people who want to sell us a bill of goods and who have a good story with which to do so. We know we're smart, so we forget that there are matters on which we are not as knowledgeable as we like to think, and medicine and biology are often part of this.

B) The alternative medicine industry has long catered to the affluent and well-educated, and this industry has been a hotbed of anti-vaccine rhetoric.

C) These communities are the ones in which we are least likely to be exposed to these diseases, and where we are most likely to have access to good medical care to deal with them if we are exposed. In other words, because we are relatively privileged from a medical standpoint, we are able to weather the storm of illness better than other communities, and as such we don't think much of destroying the herd immunity that keeps both our children and, especially, those of our less affluent neighbors from contracting diseases.

This last point really bothers me. Every time I hear a self-described liberal announce that they will not have their kids vaccinated, and announce that they believe in social justice, I want to grab them by the lapels and scream "those are two mutually exclusive viewpoints, you fucking idiot!"





*The irony to all of this is that the pharma industry is certainly not without its own very serious faults. However, by focusing on something as well-proven as the standard childhood vaccines, the anti-vax crowd is unintentionally helping the industry in two ways: 1) they are drawing attention away from the industry's real wrongdoings, and 2) by focusing on something where the science is so clearly and obviously against them, they allow the industry to paint all of its critics as crackpots.