Welcome to ScienceBlogs' virtual book club, a hosted discussion of a stimulating current title in science. The participants are authors, pundits, bloggers, experts, and readers like you.
My name is Paul Offit. I'm the chief of the division of infectious diseases at the Children's Hospital of Philadelphia and my published expertise is in the area of vaccine safety and rotavirus-specific immune responses. (I'm the co-inventor of the rotavirus vaccine, RotaTeq). I've written a book about the vaccine-autism controversy titled AUTISM'S FALSE PROPHETS: BAD SCIENCE, RISKY MEDICINE, AND THE SEARCH FOR A CURE. First: a little background on autism and the birth of the controversy.
There is no known cause or cure for autism. But in the late 1990s two hypotheses garnered a great deal of media attention. The first, advanced by a gastroenterologist in London, posited that the combination measles-mumps-rubella vaccine (MMR) caused autism. The second, advanced by parent advocacy groups in the United States, argued that thimerosal, an ethylmercury-containing preservative that had been used in vaccines since the 1930s, was responsible. The notion that vaccines caused autism wasn't surprising; vaccines have often been blamed for chronic disorders such as asthma, allergies, diabetes, multiple sclerosis, epilepsy, and mental retardation.
In response to the concern that vaccines caused autism, the public health and academic communities responded, performing a series of large, carefully controlled, epidemiological studies. Ten separate groups of investigators found no link between MMR and autism and six groups found no link between thimerosal and autism. Because of the strength, consistency, and reproducibility of these studies, the notion that MMR or thimerosal cause autism is no longer a scientific controversy.
The reason that I wrote the book is because of what happened after the studies exonerating vaccines had been performed and published. The media, using the journalistic mantra of balance, continued to cover the story as if it were a controversy. But the controversy is between those who believe in science as a way to answer scientific questions and those who don't. The "vaccine-autism controversy" is really an anti-science story. Science is viewed by many in the media as just one more opinion in a sea of opinions.
The continued portrayal by the press that vaccines might cause autism has done a lot of harm. Harm because many parents are choosing not to vaccinate their children, witness the recent measles epidemic in the United States, the largest in more than a decade. Harm because the false notion that vaccines cause autism has caused parents to choose dangerous therapies, such as chelation. And harm because the notion that vaccines might be the problem continues to divert resources away from far more promising leads. My hope for this book is that people confused about this subject will see the sand on which the notion that vaccines cause autism is built. And also get a better look at the motivations of the fringe scientists, lawyers, journalists, and parent advocates who continue to flak for the irresponsible notion that vaccines cause autism.
Medicine & Health
Brain & Behavior
Comments
Dr. Offit, thank you for writing this book. It elucidates in a concise way how this whole thing came about, why it shouldn't be an issue, and yet why it still is one. I literally just finished reading it moments ago.
After so many times where the scientific community with the evidence that shows that there is no vaccine-autism link either remained silent or was pushed aside or dismissed with appeals to emotion or post hoc ergo propter hoc arguments, it was refreshing to see that so many stood up to ABC's misrepresentation of the facts in that episode of Eli Stone.
I should say that I'm not affected by autism (although with the widening of the spectrum and my hyperlexia, I started to wonder), but I find it reprehensible that these anti-vaccinationist are causing real harm to children by scaring parents out of immunizing their children. I have to side with Amanda Peet on this one; if they refuse the truth in light of all evidence, they are parasites.
It is definitely an emotionally-charged issue, and it is difficult not to think of the anti-vax movement in less than flattering terms. I look forward to this discussion.
Posted by: mandydax | October 1, 2008 5:38 AM
I've yet to receive my copy of the book and I look froward to reading it when it arrives.
Thanks for writing it. I'll keep a close eye on these discussions too.
Posted by: Sharon | October 1, 2008 8:17 AM
Shall we call you Paul, or Dr. Offit? Hmm... the mysteries abound...
I finished the book last night and am in the process of writing up the review now.
Posted by: mollishka | October 1, 2008 8:55 AM
Dr. Offit, many thanks for the book. I must confess that I had bought into the hype. My son was born in 2002 and, even though we had heard some of the "controversy", we still elected to have him vaccinated. When my daughter was born in 2006, we decided that the "risk" wasn't worth it and we would delay vaccination until we could find out more. Being relatively young, we had no experience with the diseases the vaccines were preventing. They were completely unknown. But autism we could see. It affected people we knew. Mistrust of the government was running high and it seemed quite conceivable that the government and its agencies would not be telling us the whole story. Because of the herd protection, we felt comfortable holding off while we looked into it.
That herd protection lulls you into a false sense of security. It wasn't high on our list of priorities to do any serious investigation, so we just kept moving along. Fortunately, I stumbled onto ScienceBlogs. Several bloggers (Orac, you there?) wrote so clearly, so passionately yet backed up by cold hard facts, that it became impossible to doubt the truth: that vaccines were safe and had no link whatsoever to autism or any of the other wild links that were put out there.
We are currently getting my daughter caught up on her shots. This book has gone a long way to resolving any lingering doubt in my wife's mind. Seeing the facts so clearly laid out, demonstrating the sequence of events and revealing peoples motivations, all in one place; it has much more of an impact than scattered news stories spread out over years, mostly drowned out by the antivaxers' hype.
I will definitely be presenting this book to those who still doubt and hope that it will make a difference.
Posted by: CyberLizard | October 1, 2008 9:22 AM
I wanted to get a review up before being "contaminated" by the discussions here (which I'm looking forward to!). I don't have kids and I don't personally know anyone with autism (though I have several friends with autistic siblings), so before reading this book all I knew about the controversy is that people are easily frightened and gullible.
Here's the review on my blog and also at LibraryThing.
Posted by: mollishka | October 1, 2008 9:45 AM
This book is a great play by play of the whole vaccine-autism controversy and the media buzz it created. Dr Offit has done such a nice job standing up for vaccines and perhaps more importantly, the need for science to drive medicine even if that makes parents uncomfortable. My question is for Dr. Offit and I wonder if you feel that perhaps more of the professionals in the public health field should have stepped forward to confront the bad science head-on. Any thoughts on that? Thank you.
Posted by: Melissa | October 1, 2008 10:36 AM
Excellent book, Paul. In my microbiology class, I've fended questions from students regarding whether vaccines were "safe". Most students, although educated and worldly, were unaware of the studies showing no relationship between vaccines and autism for example.
The most disturbing issues for me (highlighted in your Ch. 9) is the tendency of the media 1) to report only "sexy" stories 2) seek unwarranted "balance".
It is clear that the media attention given to reports that vaccines were unsafe far outweighed reports that vaccines are safe.
Moreover, reports of the safety of vaccines were often accompanied by contradictory opinions in the interests of "balance". I liken this to the Intelligent Design controversy where some believe educators should present "all sides" of the evolution "controversy".
So, my question to the panel is "What do we do about it?" Can we create a media whose primary objective is to inform rather than to entertain, and, if so, how can we get people to pay attention to it?
Posted by: John Dennehy | October 1, 2008 10:38 AM
But the controversy is between those who believe in science as a way to answer scientific questions and those who don't. The "vaccine-autism controversy" is really an anti-science story. Science is viewed by many in the media as just one more opinion in a sea of opinions.
This is a beautiful summary of a lot of the problems going on with media reporting of scientific issues today, not just vaccination. The idea that scientific research produces "just another opinion" that is somehow just as valid as the unsubstantiated beliefs of shouting mothers is the key to the manufactured controversy, and what we really need to do is find a way to educate the general public as to why that isn't the case. The press isn't helping.
I find it interesting that this sort of thinking is prevalent basically anywhere that people are able to voice their opinions; if you look at the "talk" pages for many popular wikipedia articles covering pseudoscience or "alternative medicine" you'll inevitably see someone complaining about how the article is "biased" toward the "scientific point of view" and is therefore not compliant with wikipedia's goal of "neutral POV." But if science--man's tool for overcoming his own biases--doesn't offer a neutral POV, what does?
I think the real problem is that too many people have succumbed to a kind of post-modern media-propagated fallacy that you should just let both sides yell a lot and assume that the truth is some calculable mean that can be derived from the yammering on both sides.
Posted by: N.B. | October 1, 2008 10:50 AM
This was a very engaging book, and I learned a lot. But I was also reading "The Republican War on Science" at the same time, and I can see why people have a problem believing that good science will eventually "win out" over bad science and that it doesn't matter who pays for the study.
We have government-funded scientists pushing for a "bill of rights" so they can publish their findings unedited by any government officials. Knowing this, it's hard for me as a citizen to reconcile what SHOULD happen in science with what apparently DOES happen in some rare cases.
While I certainly don't believe vaccines cause autism, I can sort of understand the public's confusion. Bad science may not be reproduced by other investigators, but if it has already been PUBLISHED in the media, and that publication gives it an undeserved air of credibility. Efforts to clear up misunderstandings or report contrary studies are then simply viewed as part of a paranoid fantasy of the government or drug company's conspiracy to silence the "truth."
The big question seems to be "how do we prevent bad science from reaching the mainstream media before it has actually been repeated and tested and is READY for public consumption?"
Posted by: AmandaM | October 1, 2008 10:59 AM
Thank you again, Dr. Offit, for writing this valuable book!
I agree wholeheartedly with AmandaM's last post about the big question of preventing bad science from reaching the mainstream media- especially so with such an emotionally-laiden topic like Autism. The question I walk away with is how are scientists, who supposedly abide by the scientific method, able to produce such bad science ? I found it astounding that co-authors on Wakefield's powerful paper were not aware of what was actually happening in the selection of research participants, potential biases, etc. With that thought in mind, how do we prevent bad science from circulating amongst the scientific community before it even has a chance to reach the mainstream media? Thank goodness that Wakefield was exposed so the editorial system in place is hypervigilant...
Beyond my astonishment at how Wakefield's studies were conducting and te wide brush strokes with which his claims were painted, I am thankful that researchers are out there willing to expose the truth at the expense of their own safety. I am an in-home therapist for children with autism and the information in this book is so valuable for me to convey to the parents for whom I work. Many thanks!
Posted by: Wendy | October 1, 2008 11:37 AM
Haven't read the book but have followed the controversy for some time. I'm glad this book is out there but fear there is no way to stem the anti-science, 'greedy industry' side of this war. Jenny McCarthy was on cnn video today (1 Oct 08) pushing her new book and I'm guessing that Dr. Offit isn't anywhere near as cute as she is on the cover providing a distinct disadvantage at the book store to a sadly large portion of America.
If your child has autism, do you buy a book that explains, in detail, how vaccines are not to blame, gives no (or little) hope of a cure? Or do you pick up the book that has many emotionally wrenching stories of other kids just like your own and that promises a way to cure the disease?
This is a tough sell in an environment where a large percentage of the population believes in woo, intelligent design, creationism, and angels.
Good luck and thanks for all the fish.
Posted by: Mike | October 1, 2008 11:44 AM
Those who are interested in learning more about Autism Spectrum disorders should feel free to listen to the free Autism Spectrum Podcasts put out by Midnight In Chicago at www.mic.mypodcast.com
"Autism and vaccines: Parts I & II" might be particularly interesting to many here.
Posted by: Thomas D. Taylor | October 1, 2008 11:52 AM
Dr. Offit, you are my hero. Thank you for standing up for science and reason on this most important issue. Also, I am visually impaired, and I wonder if you would consider putting your book on audio. Thanks again and keep up the good work!
Posted by: Richard Rasmussen | October 1, 2008 12:08 PM
I was one of the lucky 50 people that received this book for free thanks to this bookclub. I have a couple of chapters to go so I think I can chime in for a quick comment.
This book is a must read, in my opinion, for any lay person, such as myself, who has an interest on the issue of autism. In very concise, easy to understand language it gives you a nice history of the "controversy" without getting bogged down in medical jargon, which would have put it out of most of the public's reach. I didn't know much about Andrew Wakefield and how important a role he'd played in creating the actual anti-vaccination movement heralded by the likes of Jenny McCarthy and Jim Carrey. And this is an important issue. You have a few rogue scientist who for whatever reason (financial gain, 15 min of fame, error) go out and make these wild claims, that cause so much trouble and end up costing society so much in terms of money, and lives and suffering. This book is a very nice case study of why one study or two do not make science, why the literature as a whole is what matters, why being able to reproduce a study is so so important.
The most important thing for me is the fact that this book so clearly shows the constant goal posting moving coming from the pseudoscientific crowd. MMR causes Crohn's,...well no but it causes autism....well no but thimerosal causes autism....well no but vaccines cause autism so let's green them. This is one of their preferred techniques, when the evidence does not please them they make up a new "controversy" and demand attention, which the media is glad to give them. The problem is that these folks are making up unsubstantiated claims, and then REAL SCIENTISTS have to waste time and resources showing them wrong. And for what? Just so they can start the process anew with a new fantasy. In the mean time, real scientific research has to pay the price for it.
ALL POLITICIANS AND POLICYMAKERS SHOULD BE REQUIRED TO READ THIS BOOK. Unfortunately, we already know that most of them are allergic to reason and logic, so most likely they will not. But if we can get parents, specifically parents of autistic kids, to read this book, there is a very good chance that some of them will see the truth and will be able to save themselves, and most importantly their kids, from all the cranks out there.
Paul Offit has done a great job in this book and I congratulate him for that.
Posted by: Skepdude | October 1, 2008 12:18 PM
I just got my copy of the book yesterday.
Best autism book I've got hands down. I'm making other people read it when this is done. The way the changes that led to the perception of vaccines as dangerous, ouch. THANK YOU DR OFFIT. You and many of the people in that book are among my heroes.
Posted by: Kassiane | October 1, 2008 12:34 PM
I was also one of the lucky fifty to receive a free copy of the book (thank you very much!), and as I commented in Kevin's post I only wish there was more discussion of mitochondrial physiology in the book. Dr. Offit nicely lays out in lay terms much of the science supporting vaccines, and to give digestible explanations of mtDNA mutation threshold effect, importance of the tissue affected by mitochondrial dysfunction (i.e high relative OXHPHOS activity or low), and the stochastic distribution of mutations, would have been very helpful for putting the Poling case in context for what it proves and doesn't prove about vaccines. However, it might have been publication timing issues, as Orac pointed out.
Posted by: MitoScientist | October 1, 2008 12:47 PM
The book is about the fact that even though scientific evidence overwhelmingly proves that these claims of vaccinations causing autism have no footing, the media still gives them a large amount of covereage in the name of 'balance'. This reminds of a few other things that are so commonly blogged about - Climate change and the few outsiders who claim that it is not happening and Evolution vs. Creation science. In both cases, it is common for a small minority of opinion to get equal footing in the media with the sole purpose of telling both sides of a story - Even when the story really only has one side that has empirical support.
Should the media relax its focus on minority opinions? This is a tough call. Think about the history of scientific progress. Imagine you were watching Katie Couric discussing Galileo's ideas in the early 17th century. The majority opinion, overwhelmingly accepted was that the sun revolved around the earth. It is what the media (at that time I guess Katie Couric would have been a priest, as they were the media of the time) had been saying for centuries. Along came Galileo with his novel, yet empirically based observations, claiming that, in fact, the sun was stationary and the earth rotated about the sun. Should he receive equal footing on the nightly news? My answer is yes in this case, as Galileo's observations were based on empirical data that people were able to replicate in their own laboratories (or castle towers as the case may be).
How is this different than the case with the novel (and if true, exciting) claim by the anti-vaccination crowd? Why should they not receive equal billing in the media? In this case, it has been shown time and time again, that the few empirically based, scientific studies that support vaccination as a cause of autism, have been shown to be the result of poor analysis, biased sampling, and personal belief rather than good empirical science. The more appropriate studies, that are non-biased, with large samples - these all say the same thing. Vaccinations are safe - they do not cause autism. That is what makes the anti-vaccination crowd different than Galileo. Galileo performed good science - the anti-vaccinationists do not.
Science gives a very objective means by which to look at the quality of the research. There are firm, strict, rules (non-biased sampling, adequate sample sizes etc..) that if followed give credence to the results. If these rules are not followed, then you shouldn't believe the work.
Posted by: Kevin Emerson | October 1, 2008 12:51 PM
I, too, was one of the lucky 50 who received a free copy of the book. I am still working my way through the last few chapters, but I have read enough to realize that it is an extraordinarily important contribution to the cause of evidence-based medicine. Thank you, Dr. Offit, for producing such a clear, well-written account of the rise of antivaccination activism.
I have a question regarding the choice you made to present the early findings (of, e.g., Wakefield) that contributed to the public panic over vaccine safety without simultaneous editorial comment or correction. Being somewhat familiar with the background, I could anticipate the refutations to come, but I wondered whether a reader with less or no prior knowledge of this particular topic might have had to work a bit harder to get through these bits. One possible reason for this approach that I can think of is that presenting the information empirically recreated, to some degree, the way it was presented to the scientific community and then to the public. As such, it gave me a really good sense of what it must have been like to hear these 'facts' spoken so confidently and officially, and how difficult it is to undo the damage when fallacious research findings are disseminated in such a way. I would be interested to hear your rationale for your approach to the early background of the movement, Dr. Offit.
Posted by: Danio | October 1, 2008 1:07 PM
Who says the controversy is about vaccines? The controversy is about toxins. Do you not believe that ethyl mercury is toxic? If you do believe that it is, I would like to ask you why you have not worked on a different kind of vaccine preservative. It is not only irrational to use Thimerosal in vaccines considering mercury destroys the immune system (vaccines are not supposed to destroy the immune system, they are supposed to help) but also because mercury is notorious for interacting with chemicals in an unwanted fashion.
Also, why is it that mercury-free vaccines, or for that matter single dose vaccines (generally mercury-free) are often not available to those who are willing to pay for them?
Posted by: Birgit Calhoun | October 1, 2008 1:27 PM
@Danio
I thought the way that the early findings of Wakefield were presented was just excellent. I very much liked the even, non-combative tone. The most important reason is that it showed that parents (and many doctors and scientists) were behaving rationally when they thought there might be a plausible connection between MMR and vaccination. In hindsight, and as presented in the subsequent chapters, we can see that the apparent connection was groundless. However, Dr. Offit does not take the easy route of ridiculing the people who initially bought into this failed hypothesis. His respectful tone makes the book palatable to those who are on the fence. And let's face it, the die-hard anti-vaxers will not be swayed by this book. Nothing will change their minds. It's the parents and doctors still unsure about a possible connection between autism and vaccines who can be reached.
Posted by: Jennifer | October 1, 2008 1:43 PM
Dr Offit - I got my free copy and read it all in one day. It was very engrossing and hard to put down. I'll post more when I am at home and have the book with me, I forget exactly where the section I had questions about is, within the book.
I will say that I didn't know about much of Wakefield's early research, since I only read some of Brian Deer's later research pieces. I was also amazed at the progession of the goal-post moving you pointed out.
I never worried about thimerosal. I'm of the generation who played with Merthiolate, painting ourselves as much as we could because the red color was cool. Except, of course, when we had open wounds, in which case we ran as far and as fast away as we could... :) My mother used it on EVERY wound, even after our shots, to prevent infections. My family also wore/wears contact lens and used thimerosal-containing solutions for many years. If the amounts we were exposed to are any indication, we all should be autistic.
I would reply to Birgit but don't want to hijack this thread. All I'll say is please prove that mercury free vaccines are not available for almost all single dose vaccines. (also, "mercury" has more than one formulation...which do you mean? ethyl mercury? methyl mercury? elemental mercury? They all have different LD50 levels, different risk levels and are eliminated at different rates).
Posted by: Dawn | October 1, 2008 1:45 PM
I just read through the book. I enjoyed it (I do like reading about science history). It was well written and informative.
I don't have any children of my own, but have sent the book onto my sister, who is expecting her first. I hope she gets as much out of it as I did.
And to Birgit Calhoun... Mercury has been removed from children's vaccines for quite a while, and autism rates haven't dropped. The mercury = aultism link is dead as dead can be. Why are you spouting the same old garbage?
Posted by: Craig | October 1, 2008 1:51 PM
I think it's worth noting, as Dr. Offit did in the book, that mercury only causes damage at certain concentrations and above. We all have mercury in our bodies, it comes from a lot of sources. Also, the chemical make-up (i.e. methylmercury versus ethylmercury) has much to do with how our bodies react with the substance and how fast it is removed. Oxygen is essential to life, but superoxide (O2-, elemental oxygen plus one extra electron) is a very destructive molecule biochemically, causing protein oxidation and DNA damage, among other detrimental effects. Its all in the details, folks.
Posted by: MitoScientist | October 1, 2008 2:03 PM
Dr. Offit. I wonder if you could answer some science questions for me?
1) Is mercury more toxic to newborns and infants than to adults?
2) Have you ever analyzed a multi-dose vaccine vial for mercury concentration? (If you had you would realize that the concentration is 50,000 ug/liter, a level 250 times higher than what the EPA classifies as hazardous waste based on toxicity characteristics
http://www.epa.gov/epaoswer/hazwaste/mercury/regs.htm#hazwaste). Why do you refer to this concentration as miniscule?
3) Is ethylmercury, a short-chain organomercury compound as toxic as other forms of mercury? ( recent research shows that ethylmercury is immediately distributed to the brain. Primates exposed to injected ethylmercury, as opposed to equal doses of ingested methylmercury, end up with twice as much Hg++ deposited in the brain. This form remains permanently trapped and has been identified as the primary toxic agent in degenerative brain diseases. (Burbacher T, Shen D, Liberato N, Grant K, Cernichiari E, Clarkson T. 2005. Comparison of blood and brain mercury levels in infant monkeys exposed to methylmercury or vaccines containing thimerosal. Environmental Health Perspectives. 113:1015-1021)
4) Do brain damaged kids behave in a way so that some psychiatrist will label them as somewhere on the autism spectrum?
5) Is autism your area of specialty? How many kids have you diagnosed?
Posted by: Maggy | October 1, 2008 2:06 PM
I received a copy of Dr. Offit's book from ScienceBlogs, thank you very much! I am struggling to read it a little bit at a time, as I am visually impaired. I do appreciate both the style and content of the book. The Wakefield story is presented concisely and is easy to follow. I hope I will be able to keep up with the discussion.
From first reading on Orac's blog that the book was coming out, I began looking for an audio version. I easily found Jenny McCarthy's books and much more pseudoscience available (under the subject heading of Science and Medicine) in audio formats, but not Dr. Offit's book. This is the case with most popular science books.
I hope we will soon see Autism's False Prophets featured on Audible.
Posted by: Stella | October 1, 2008 2:14 PM
Thank you to Columbia University Press for the free copy of Autism's False Prophets. I was one of the lucky 50! I read it through very quickly...and I've already figured out which person to pass it on to next. I've called my congressman's staff and recommended it.
Thank you Dr. Offit for stepping forward. I know it can't be fun having some groups try to tarnish your name.
I thought the book was very well written. I thought I was keeping up on the details of these events, but there was very good information in there.
I look forward to the discussion.
Posted by: Matt | October 1, 2008 2:20 PM
"This is a tough sell in an environment where a large percentage of the population believes in woo, intelligent design, creationism, and angels".
You almost forgot those wacko's who believe injecting newborns and infants with large quantities of orgnic mercury is dangerous crowd!
Posted by: Jane | October 1, 2008 2:28 PM
The book is brilliant and brave. The thing I can't believe is that Wakefield and cronies are carrying on as if all is well. They should be in prison. Instead, they're merrily scoping away, pretending Wakefield's work hasn't been debunked six ways from Sunday.
I wonder whether better science education would help. It seems to me people weren't always as credulous as today's "mercury moms." I think maybe it's not exactly science education, but the instillation of the idea that there is more to a subject than one can master in an evening spent Googling.
Posted by: isles | October 1, 2008 2:40 PM
Offit,
I invited you to help prove your point by helping us raise funds for autism but you never answered me. Here's the invitation again. How about it? Here's your chance to look like a good guy.
http://hatingautism.blogspot.com/2008/08/lets-help-paul-offit-help-autistic.html
Posted by: John Best | October 1, 2008 2:44 PM
Paul, I look forward to your answers to "Miss Smarty Pants" Maggy.
Posted by: Bruto | October 1, 2008 2:46 PM
Offit,
Here's another link discussing your malpractice. Why don't you try to show me I'm wrong? I don't think you have the guts.
http://hatingautism.blogspot.com/2007/09/paul-offit-md-despicable-dimwit.html
Posted by: John Best | October 1, 2008 2:47 PM
Part of the great value of the book to me was that I am a "late entry" into the field of consideration of the vaccine/autism link.
Since my oldest son was not diagnosed until 2004 (at age 3), much of the controversy has simmered, boiled, and overflowed by then. This book did an excellent job of reconstructing the history of the failed hypothesis from its genesis. It allowed me to understand what had transpired to create the frothing mass of anger and denialism that is today's autism-antivax crowd, who all played a role in creating the mess, and what cultural components continue to drive it in the face of the copious amount of new information that has come to light over the past few years.
Thanks, Dr. Offit, for writing it. Its a seminal work in terms of understanding the story behind the science in the field of autism etiology.
Posted by: Steve D | October 1, 2008 2:54 PM
It is sad that my initial comment on this thread should be so negative but here we go.
Firstly, please ignore John Best. He is a troll who loves attention.
Secondly, Maggy: have you read the book?
Posted by: Kev | October 1, 2008 3:06 PM
Thanks to Dr. Offit for presenting the history of the vaccine controversy in such a clear, engaging manner, and to ScienceBlogs and Columbia Press for providing free copies.
Dr. Offit: how exactly will the royalties generated from book sales go towards autism research?
Posted by: Kathryn | October 1, 2008 3:29 PM
I enjoyed the book because it was written clearly, and though it may have seemed repetitive it explained in great detail the science, the way science works and the events of the past two decades. It brought back memories of how I saw events occur through my computer screen as I participated in forums on Compuserve, my short stint on Usenet, and my experience of being on the Apraxia-Kids listserv for almost a decade.
One think I noticed was that one could have a good sensible conversation of the science around vaccines ten years ago, and then it went downhill. Examples can be seen here with comments from Birgit Calhoun, Maggy and John Best. These people have obviously not read the book and no interest in any kind of real discussion.
Posted by: Chris H. | October 1, 2008 3:40 PM
Kev and Chris H,
We can see from your cowardly comments that neither one of you have the guts to face the truth I and others present.
Kev has been calling me a troll for a long time because he's too afraid to face me. I wonder if Offit is also afraid to address the concerns I have with his malpractice.
Posted by: John Best | October 1, 2008 3:44 PM
Craig! Before you attack me about mercury in vaccines, check the facts. There are a number of vaccines that still contain a good dose of Thimerosal. I know that, even though there is a claim that mercury has been removed from vaccines, the vaccines already in doctors' offices were not recalled. Furthermore has anyone actually gone to the trouble of checking what's in the vaccines? Mercury is still used to make vaccines, which is then removed to satisfy a certain presumption. Besides I did merely ask a few questions. Apparently my statements don't please you.
But don't blame me for stating some facts and making your life less pleasant. I can take your abuse. Meanwhile, trust me, mercury poisoning does exist.
Also if you read my website, you'll find out some other facts about mercury. Mercury is all over the environment. It even occurs in vegetables. Also note that once ethyl-mercury is in the brain, it turns into inorganic mercury which does not pass back into the bloodstream very easily. I understand it takes about twenty years.
By the way, if all you can do is attack, you won't make a good scientist.
Posted by: Birgit Calhoun | October 1, 2008 3:46 PM
I hope this book discussion isn't going to turn into the usual antivaxer tango of wild claims and knownothingness.
Kathryn, I've read that all the profits on the book will go to the Center for Autism Research at the Children's Hospital of Philadelphia.
Posted by: isles | October 1, 2008 4:04 PM
I am mainly saying that mercury is toxic in all its forms and that includes dental amalgam vapors, vapors from certain paint, fish, paper products, shall I go on?
As far as being able to obtain single doses, let's say diphtheria vaccine by itself, they have not been available where I checked. Also I tried to get a flu shot without Thimerosal, and it was not available when I wanted one. I looked at the insert.
Read my website. I have read quite a bit on the subject. Maybe I am not the scientist you like, but as long as nobody knows what causes autism, I am just as good a scientist as anyone. Birgit
Posted by: Birgit Calhoun | October 1, 2008 4:07 PM
Birgit, dose makes the poison. Oxygen, salt, zinc, vitamin C - you name it, is toxic at some levels, and safe at others.
Thimerosal has been gone from scheduled childhood vaccines since 2002. So why haven't diagnoses for today's 3-5 year olds declined accordingly?
Posted by: AutismNewsBeat | October 1, 2008 4:18 PM
Me, too. On the other hand, there are plenty here who can counter antivax nonsense.
Posted by: Orac | October 1, 2008 4:23 PM
Birgit, please read the book. Then you will see what the relative risks are. It is not a difficult book to read, I read it mostly in one day. See if you can find one in your local library, or go buy the book (the proceeds go to real research). The answers to your questions are in the book, including an explanation of why there is a danger of methylmercury in fish (pages 114 through 116).
Posted by: Chris H. | October 1, 2008 4:25 PM
Maggy,
Dr. Offit appears to be busy, so I'll take a crack at some of your questions.
It has been generally accepted that mercury is more "toxic" to developing animals than to adults. However, as the experience at Minamata, Japan showed, mercury - even at high doses and even with intrauterine exposure - does not cause autism.
This is a three-part question, so I'll give my answer in three parts.
[a] The highest concentration of thimerosal used in vaccines was 50 mcg/ml, which - as Maggy states - works out to 50,000 mcg/l, or 50 mg/l. This can also be expressed as 50 parts per million (ppm).
To put that in perspective, 50 ppm is the equivalent of one drop (1/10 ml) in 2,000 liters of water. That's one small drop in a volume equal to a hot tub that could accommodate 6 adults.
[b] Yes, you are correct that the EPA considers liquid waste with over 0.2 mg/l mercury to be "hazardous waste". On the other hand, that same document states that diluting the waste to below that concentration. The EPA rules you cite are for disposal of liquid waste and are not directly relevant to human exposure.
It's a very powerful emotional image to think of vaccines as "hazardous waste", but the same is true of many of the things we use in our homes on a day-to-day basis.
[c] The amount of mercury children receive from vaccines in the form of thimerosal is indeed "miniscule". Even at the highest concentration, the amount in a single vaccination is comparable to the amount of mercury (in the form of more "toxic" methylmercury) in a tuna salad sandwich.
The sad fact is that we are all exposed to mercury (and arsenic and cadmium and ....) every day, from the day we are conceived to the day we die. Our bodies have evolved the ability to tolerate this exposure. If a child were born without the ability to tolerate the "miniscule" amount of mercury in vaccines, they would be unable to tolerate the mercury in their air, water and food.
Oh, and before you go on about how autistic children have "mercury efflux disorder". you might want to look at Gundacher, et al (2007). They showed that people with a true "mercury efflux disorder" not only had elevated hair mercury, they also didn't have autism.
In your full question, you cite Burbacher et al (2005). Unfortunately, you've either misread the article or have had it mis-explained to you. Burbacher et al showed that less ethylmercury was retained in the brain, although a higher percentage of the total retained amount (which, again, was lower in the ethylmercury group) was in the brain. This was due, they postulated, to a higher percentage (of the lower overall retained amount) being in the form of inorganic mercury. In all instances and in all tissues, the ethylmercury-exposed animals had less retained mercury than the methylmercury-exposed animals.
Pichichero et al (2008) confirmed this in a study of ethylmercury excretion in infant humans who had been vaccinated with thimerosal-containing vaccines. They found that the half-life of ethylmercury in infants was a bit less than 4 days - significantly shorter than the half-life of methylmercury in adults.
I'll leave the rest of your questions to Dr. Offit and the rest of the people on this 'blog. In the future, you might find that you can learn more if you ask real questions instead of trying to interject anti-vaccination "talking points".
Prometheus
Posted by: Prometheus | October 1, 2008 4:27 PM
I'm always tempted to just ignore the trolls. They'll think we're ignoring them because they're right and we're wrong, and we'll know we're ignoring them because they aren't worth the time or effort. Everyone feels better about themselves, everyone wins.
Oh yeah, except the kids of these assholes who are more likely to die of preventable diseases than protected children.
Posted by: mollishka | October 1, 2008 4:27 PM
I'm tired of this nonsense. Do you think people are stupid Brigit? Are we to believe that a significant portion of vaccines doctors keep around are from the 1990s?
FYI - random surveys have been done. By 2002 no more than 3% of vaccines were thimerosal-containing in the US.
Posted by: Joseph | October 1, 2008 4:35 PM
Readers should know that John Best has recommended on his low-traffic blog that all parents of autistic children kill their autistic children before they become a certain age, and that the parents should kill themselves. He's also put out death threats to people who oppose his violent rhetoric. He needs to be locked up for a few years. John has been a prominent Rescue Angel for the Generation Rescue group. What does that tell you about them?
Posted by: ze | October 1, 2008 4:42 PM
Ze,
It's true, I do think people who lie about the cause and cures for autism should be hung, or dragged behind a horse for a few miles for fun.
Joseph,
Thimerosal in the flu shot to pregnant women has a better effect on fetuses than the HepB did in causing autism since the fetuses are very small and their brains are still developing. It has the added bonus of scrambling the kids' brains before they're born so the parents don't see the kid regress to give them a clue that something caused the kid to no longer be normal.
Are you the same Joseph who's a wizard with stat's? Why don't you tell us the rate of increase in autism for New Hampshire and Mississippi between 1993 and 1994? See if you can correlate that with the advent of the HepB shot in 1991. Try to just give us simple numbers here with no extra junk about your opinions on aborted Downs Syndrome babies.
Posted by: John Best | October 1, 2008 4:55 PM
Birgit, I went to your website and did not find anything useful, other than you are a librarian. You have no excuse to not have obtained a copy of the book and read it. Now, please find a copy and spend a couple of evenings reading the book.
Posted by: Chris H. | October 1, 2008 4:57 PM
John Best has made those death threats against those with whom he can not argue intelligently. He also said that all parents should kill their autistic children and then kill themselves. He needs to be locked up.
Posted by: ze | October 1, 2008 5:15 PM
Dr. Offit,
I would like to take this opportunity to thank you for your bravery and dedication to children's health (and to thank your publisher for the book!). I'm on my second read-through of your book, and when I finish it I'll be passing it on to my mom, who works with new moms, so she can help combat the fog of misinformation that swirls around this issue.
Posted by: Oblique Red | October 1, 2008 5:29 PM
Ze - your comments about John are accurate but they are simply giving him attention which he craves. The absolute best tactic for dealing with John is to starve him of attention.
Posted by: Kev | October 1, 2008 5:30 PM
First: a little background on autism and the birth of the controversy... There is no known cause or cure for autism. But in the late 1990s two hypotheses garnered a great deal of media attention.
Somewhat related to this history (I suspect), was the observed rise in autism cases in the 90s. Presumably, this set of an alarm involving the general public looking for possible explanation(s). Gernsbacher, Dawson and Goldsmith (2005) wrote an article suggesting that rather than an environmental/biological cause, the rise was probably due to three (research-related) factors: a broadening of the diagnostic criteria for autism, increased public awareness of autism, and increased focus on intentionally finding autism cases.
Reference
Gernsbacher, M.A., Dawson, M., & Goldsmith,H.H. (2005). Three reasons not to believe in an autism epidemic. Current Directions in Psychological Science, 14, 55-58.
http://www.psychologicalscience.org/media/releases/2005/pr050630.cfm
Posted by: Tony Jeremiah | October 1, 2008 5:34 PM
If you really think it would be fun to be dragged like that then I guess whatever floats your boat, John. Let us know how it was afterwards, would you?
Posted by: D. C. Sessions | October 1, 2008 5:40 PM
Birgit: you've misunderstood what "single dose" and "multiple dose" mean. A single dose vaccine means that each vial of vaccine is used for only one person; in other words, it contains only the dosage for a single person. A multiple dose vaccine means that several people get vaccinated with the contents of one vial. Since that means the vial can't be kept completely sealed from the time it's manufactured to the time the last dose in it is used, multi-dose vaccines need to contain preservatives to keep potentially infectious bacteria from growing in the vial.
Posted by: ebohlman | October 1, 2008 5:49 PM
Kev,
Are you still training your daughter like a monkey or have you decided to try more advanced methods? Has she asked you to cure her yet?
The chelation is going well with my son, maybe you should try it.
Posted by: John Best | October 1, 2008 5:52 PM
John Best, ladies and gentlemen. When he's not issuing death threats, he's insulting little autistic kids.
How many years is it now, John, that chelation has been going "well"? 4? 5?
Posted by: Joseph | October 1, 2008 6:05 PM
@CyberLizard #4: I'm so glad to see that ScienceBlogs is making a difference.
@Danio #18: I also was wondering about the way it was presented as I was reading it. I knew that what Wakefield was presenting was not correct, and I felt the discomfort that many people must have felt about that time. There's an inner feeling of "look at all this evidence; it must be right!" I understand that there was a chronology of the rise and fall of mercury and then the revelations of what was behind the curtain. However I do wonder what someone ignorant of the vindication of thimerosal and vaccines as a cause of autism would have thought while reading through that.
Glad to see we have some trolls in the thread, too. :P I think before trying to "contribute" to a book club discussion, people should really read the book in question. Thank you, Prometheus. :D
Posted by: mandydax | October 1, 2008 6:11 PM
Dr. Offit, thanks not only for writing for the book but for it coming out in September of 2008: Perfect timing to go book-to-book with McCarthy and her "mother warriors."
When you blog about mercury and vaccines and autism, inevitable that you should get at least a small store of Best comments.
Posted by: Kristina | October 1, 2008 6:11 PM
Here's a primer to what it's like to live with a naricissistic parent. http://abusesanctuary.blogspot.com/2008/09/abusive-narcissistic-parents.html I believe this explains some of what we see with JB Handley, Lyn Redwood, Jenny McCarthy and others. These egomaniacs decided ahead of time that their children would be "perfect" and only "perfect" and anything that reflects badly on them must be exorcised, destroyed, warred against, or "cured" immediately before anyone else notices that their child isn't going to be the next president of General Electric or NBC, the next editor of Playboy magazine or the next board member of Genisoy. Jenny was on CNN complaining how vaccines made their "perfect" (her word) children regress into autism. There's a picture of her on the screen behind her in the CNN interview dressed as a witch. Now that is perfect.
Posted by: Also 2 | October 1, 2008 6:18 PM
Dr. Offit,
Thank you for writing this book, and thanks to ScienceBlogs for sending me a copy (but only received it yesterday, so have some catch up reading to do).
One aspect that I am finding very interesting is the prior history and backstory on some of the players that I am familiar with in the context of the thimerosal-autism, MMR-autism, and vaccine-autism controversies. Learning of their prior associations with failed hypotheses, faulty science and medical woo is new information for me, and is much appreciated.
Posted by: Regan | October 1, 2008 6:36 PM
Joseph,
You don't do well at reading comprehension. Criticizing how a stupid parent trains his child is not a reflection on the child. It only addresses the stupidity of the parent.
I take my time with chelation to make sure I don't screw it up and hurt him by trying to go too fast. The time it takes is irrelevant to the quality.
Where are those stat's, Joe?
Posted by: John Best | October 1, 2008 6:44 PM
Dr. Offit, one of the things about the book that left me a bit dazed was the way the order of events were presented. I understand that with the way the chapters were laid out, events from one chapter might precede or be concurrent with events from another chapter. I mentioned this in comment to mollishka's review: I think that a time-line showing when each thing happened relative to the others would have helped a lot. I did get confused as to chronology a bit, too.
Perhaps something for a future edition?
Posted by: mandydax | October 1, 2008 7:07 PM
Dr. Offit is right. Vaccines do not cause autism. Autism is simply a term from the psychiatric DSM-IV manual. It's nothing but a smokescreen. It provides an alibi for the drug companies who added mercury to vaccines at levels 250 times higher than hazardous waste levels (based on toxicity characteristics). It provides an alibi for the CDC, FDA, the American Academy of Pediatrics and the other drug company cronies who are responsible for the safety of our children. It provides an alibi for the people who administered this poison. It provides an alibi for health insurance companies so they don't have to pay for treatment for these sick kids. It provides an alibi for psychiatrists so they can force powerfull anti-psychotic drugs on these kids who are already terribly confused.
There will never be an identifiable cause for autism. There are though 11 published papers which identify the underlying medical condition of autism as neuroinflammatory disease. My favorite is ' Neuroglial activation and Neuroinflammation in the Brain of Patients with Autism'. This was published by John Hopkins University. Now, do you want to debate whether mercury, a known neurotoxin, added to childhood vaccines at levels 250 times higher than what the EPA identifies as hazardous waste, causes neuroinflammatory disease? Do you want to debate whether brain damaged kids behave in a way so that some psychiatrist can label them as somewhere on the 'spectrum'?
Posted by: Adolph Himmler | October 1, 2008 7:10 PM
A.H.--using a name like that should be grounds for deleting your post. I don't know why you would want to ally yourself with that historic personage, but that's your choice.
Couldn't you go back to Pete, Joe, or Thomas of WI (names you have used to post this on other forums)?
Posted by: Sullivan | October 1, 2008 7:17 PM
I would really appreciate it if someone in the know would post the links to install a 'killfile' program. I would delight in blocking John Best's vitriol from my personal view of this and future pages, as it's unlikely he will go away on his own. I imagine that a few other commenters who are keen for an opportunity to discuss these important issues without him raving away in the background could make use of the killfile as well. Thanks.
Posted by: Danio | October 1, 2008 7:18 PM
"If your child has autism, do you buy a book that explains, in detail, how vaccines are not to blame, gives no (or little) hope of a cure? Or do you pick up the book that has many emotionally wrenching stories of other kids just like your own and that promises a way to cure the disease?"
I think this is EXACTLY the point (whoever it was that made that comment a ways up there) And let's be fair, it's not just because families who have autistic children are distraught and can't think clearly. It's a failure of science education in total. We live in an environment where being "intellectual" is an insult, the educated and knowledgeable are distrusted, and celebrities and preachers tell us how we should evaluate the world around us.
By the way, I'm a parent of TWO autistic children, but before that, I was a science major. What do I do? I read the science. I read the journals on different occupational, tactile and emotional therapies that have proven effective in some situations, I've used those therapies on my child, continuing what works, discarding what doesn't work, and I've continued to keep up to date with PEER REVIEWED journals in child development and continued to work with my children and their schools, doctors and so on.
And guess what? They're doing pretty well.
Ignorance of science and distrust of evidence would not have gotten my kids as far as they've gotten.
Posted by: Kate | October 1, 2008 7:27 PM
I've followed the anti-vaccinationist propaganda for a few years, but had never delved as deeply into it as I was prompted to do while reading your book, Dr. Offit. My hat is off to you for writing a very readable, very comprehensive account of the lunacy of the antivacs and the measured and reasonable replies of the scientists.
Of the fight, the only thing I can add at this point is that I believe the antivacs have actually outdone the creationist crowd in terms of their sheer will to adhere to a view that has been so thoroughly discredited. It boggles the mind how much sheer will to believe a view can distort one's ability to perceive the evidence.
Again, my hat is off. Great book.
Posted by: John Rummel | October 1, 2008 7:35 PM
I'm sorry. I thought we all agreed that injecting newborns and infants with organic mercury was a wonderful, safe, life enhancing idea. We invented this you know. Not Offit (who is taking all the credit). The money made off of these little pr(offit) centers would have fueled the machine for another 100 years!
Posted by: Adolph Himmler | October 1, 2008 7:36 PM
I'm so sick of the stupid "pharma shill" arguments. Ya know, the money to be made off of treating autistic children and adults, both in terms of money spent on quack cures and on real treatments, probably dwarfs the money made from giving children vaccines by orders of magnitude.
Posted by: Adrienne | October 1, 2008 7:48 PM
I want to know how many children with mitochondrial disorders have been benefited by Dr. Offit's rotavirus vaccine since a bad case of diarrhea can set off a mitochondrial crisis and possibly lead to encephalitis? How many children didn't get encephalitis/retardation/autistic symptoms because of his work with vaccines?
Posted by: Ms. Clark | October 1, 2008 7:56 PM
Himmler Said:
Yes, I would very much like to debate that point. First you'll have to show me that the levels of mercury found in a brain following vaccination are even close to levels that cause neuroinflammation, never mind your idiotic 250 times EPA threshold, then I'd like you to show us evidence that autism is caused by neuroinflammation or that mercury alone is the sole agent that triggers neuroinflammation.
Feel free to crib from Jenny or Kirby's books.
Posted by: notmercury | October 1, 2008 7:58 PM
Me too, Adolph. You clearly don't understand the level you cite (a well known but mistaken canard). That's based on parts per billion. The argument says that 200 ppb is classified by the EPA as hazardous waste, and vaccines have much more than that. Sure, but does ppb actually matter, or does the amount of mercury matter?
According to your argument, if I have a solution with a total weight of 1 microgram, and 200 ppb mercury, it would be a dangerous solution. Yet, the solution would only contain 0.0000002 micrograms of mercury. I'd suggest it would be completely safe to ingest that 200 ppb solution. In fact, it would probably be quite safe to ingest a million of those solutions.
The dose is what matters. The ppb just confuses things and it was meant as an environmental guideline, not one for vaccines.
Posted by: Joseph | October 1, 2008 8:37 PM
Danio - if you are a Firefox user then first go here and install Greasemonkey:
https://addons.mozilla.org/en-US/firefox/addon/748
And then here and install Killfile:
http://userscripts.org/scripts/show/4107
which covers lots of blogtypes, including scienceblogs.com
When its running, you'll see a 'kill' or 'hide' option by each comment. Start plonking :)
Posted by: Kev | October 1, 2008 8:40 PM
The anti-science radical capitalists, who nowadays drive anti-science other than creationism, accuse "the left" of being "just as bad" because they ignore a "consensus" for example that GMOs are "completely safe" as foods and as living species, the way the anti-science market fundies are "said to ignore" a consensus on things like global warming, tobacco addiction and cancer links, species adaptation to DDT, etc.
But this autism thing was pushed by a hero of the left environmental community, RFK, Jr., who did a well-received analysis of voting machines. Initially, it had a lot of support that cut across economic, political, income and religious lines, frankly. But it's mostly what the market fundies describe as "the left" - people who believe in and accept the precautionary principle and who are suspicious of industry-driven research - who have accepted the vindication of vaccines. When I saw the results from Denmark, for instance, I never gave the autism from vaccines idea another thought, and I excoriated Robert Kennedy, Jr. for still pushing it after it became anti-science.
I believe there's considerable evidence that it's the market and religious fundamentalists who are still the main anti-science contingent, frankly. To say animal protection activists are anti-science is to miss the point of most of them. They will stretch the truth to make animal studies look less useful than they are, but their thrust is not mainly that animal research doesn't work, but that it's immoral to a degree. And, frankly, most of the research the market fundies claim shows a consensus on the safety of GMOs IS bogus. Moreover most