In response, I got an e-mail from someone who wishes to remain anonymous. I will paraphrase what he said to some extent, because I don’t want to risk “outing” him, but one some carefully selected excerpts should be safe:

We are in trouble on this issue because we see it as a scientific issue, and if we just line up the science, people will be reasonable and decide that we are right and Jenny McCarthy is wrong.

I see his point there. It’s really no different than, for example, the evolution/creationism war. Evolutionary biologists know that the evidence is so overwhelmingly on the side of the theory of evolution and against creationism or its bastard offspring “intellgent design” creationism that they do tend to think that, if the public were just informed of the science and the evidence, they would come to the reasonable conclusion: That evolution represents the best theory of the origins of life that science has to offer, and creationism is without foundation in science. However, this attitude neglects the influence of fundamentalist religious beliefs, which are in direct opposition to the science of evolution and lead fundamentalists to reject evolution in spite of the overwhelming evidence in favor of it. When it comes to the whole issue of vaccines and autism, the evidence is nearly as overwhelming against the claim that vaccines or mercury in vaccines causes autism. So, a reasonable scientist thinks, just showing the overwhelming evidence that fails to support the hypothesis that vaccines cause autism should bring reasonable parents around. However, it can be argued, that viewpoint neglects the overwhelming emotional attachment parents have to their children, the malign effect of antivaccinationist propaganda which tells them that their child was somehow damaged and somebody must be made to pay, and the normal human cognitive quirks that make us seek patterns and be fast to see correlation as causation. I can see that.

My commenter then described a seminar about risk communication that he had attended and one presentation in particular. In this presentation it was described what’s important to people under “low concern” and “high concern” conditions. The presentation

showed two pie charts, on what determines credibility under “low concern” conditions (expertise and credentials are what matters) and under “high concern” conditions – and under the latter, it’s not expertise/credentials, but empathy and caring, and the big collective “we” are not good at that. I have great respect for Paul Offit (who, by the way, writes more books than I read – well, almost) but he is wrong on what we need to do to deal with this.

Instead of being clearer that vaccines don’t cause autism, we need to not overstate what we know (lots of studies have looked at MMR and thimerosal, and no evidence that either of them are a cause of autism at the population level).

I’m not entirely sure I see where scientists are “overstating” what they know, but more on that later. He then cited two posts by Peter Sandman:

Thimerosal, autism, and misleading toward the truth
Does taking the thimerosal out of vaccines reassure people or scare them?

From these he boiled down Peter Sandman’s message thusly:

…we need to stop gloating when we say that. We should express regret – because, if thimerosal had caused autism, well, we’d be through it by now. We would have had a tough couple of years, but we’d have vaccines without thimerosal by now and families who felt like their families were being torn apart by the stresses of dealing with a severely affected child would have have been spared that.

While there are some interesting and potentially useful suggestions in the links above, I have to strenuously disagree with this last sentiment. Strenuously. I will agree that gloating and rubbing antivaccinationists’ face in the exoneration of thimerosal as a cause of autism is not a good idea as far as communication of science and risk go (and, remember, I’m not a risk communicator; so I frequently lapse in this area, especially when it comes to Generation Rescue and Jenny McCarthy), but Sandman is taking it too far to the other extreme. There is nothing to be sorry for, and I find it strange that he would castigate scientists for supposedly “exaggerating” the science exonerating vaccines (something I also disagree that scientists do) and then tell us to exaggerate “sorrow” that a nonexistent risk believed by the public was found to be without a foundation in science. What’s there to be sorry about, other than at the money and effort being wasted chasing a failed hypothesis long after it’s was known with a high degree of confidence not to be valid? I fail to see how that would help or mitigate the damage already done. In fact, if I were a parent concerned about vaccines causing autism, I would find such an statement even more condescending and insulting to my intelligence than anything Paul Offit’s been accused of. But that’s just me, I suppose. Or maybe not. In any case, I would frame it more like, “This is great news. Now we can move on to other, more promising areas of research.”

Which is what scientists have been trying to do, but antivaccinationists won’t let them.

The other thing that I really detest in Sandman’s posts is his flagrant use of false equivalences:

The article you refer to is “Mistrust rises with autism rate,” by Anita Manning (USA Today, July 7, 2005). The article reviews the unending controversy between vaccination opponents, who charge that there has been a cover-up of evidence suggesting a link between thimerosal and autism, and vaccination proponents, who claim that the evidence of any such link is extremely weak and almost certainly false. (Thimerosal is a form of mercury that has been widely used to keep vaccines sterile.)

The latest wrinkle in this controversy came with an article by Robert F. Kennedy Jr. focusing on a June 2000 meeting of scientists and public health officials at the Simpsonwood Conference Center near Atlanta. Kennedy wrote that transcripts of the Simpsonwood meeting show the cover-up in action; vaccination supporters retort that the evidence discussed at the meeting was nowhere near persuasive enough to justify serious concern.

My key point is that both sides are right.

Jody Lanard and I first used the phrase “misleading toward the truth” to describe USDA risk communications about mad cow disease. People (including scientists) who believe they are right on the merits tend to withhold information that they fear might lead others to an erroneous conclusion. On vaccination safety, maybe proponents are 85% right. That’s not good enough for them, and too often they are less than candid about the other 15%. (Some of this is the sort of “conspiracy” the recent Kennedy/Simpsonwood kerfuffle is all about; some of it is more basic, like not bothering to mention that mercury is a poison in a disquisition the main thrust of which is the safety of thimerosal.) Leave aside whether or not this is dishonorable; it is demonstrably unwise. In a porous democracy like the U.S., the other 15% inevitably comes out – and the reluctance of proponents to acknowledge it makes it look much more compelling than it deserves.

Suppose the vaccination case isn’t 85% right but 99% right. All the more reason to be candid about that other one percent. The stronger your case actually is, the more foolish you are to try to make it look even stronger than it is.

And:

Public health professionals claim that the weight of the scientific evidence shows that thimerosal does not cause autism. Critics claim that the public health profession is covering up the portion of the evidence that shows otherwise. Although I’m not qualified to assess either claim definitively, my strong impression is that both claims are true. (See for example my discussion of the June 2000 Simpsonwood Conference in the Guestbook entry linked above.)

That is, I think that the experts have solid grounds for concluding that thimerosal in pediatric vaccines is very unlikely to be responsible for the surge in autism diagnoses. And I think that once they reached that conclusion the experts have too often sought to reassure the public by overstating their degree of certainty, and have tried to ignore or discredit the evidence (a lot of anecdotal evidence plus a few studies) that suggested there might be something to the relationship after all. That’s what I mean by “misleading toward the truth.”

Overstating a mostly valid conclusion and hiding the small amount of contrary evidence is an incredibly common (and tempting) mistake. It is most common (and tempting) when people are upset, when you want to calm them down, and when all you have to work with is a pile of studies that didn’t find the effect they were looking for, plus a handful that might have found something. The evidence is maybe 85% on your side, but you’re afraid that acknowledging the other 15% might prolong the debate you’re trying to quell. So you suppress the 15%.

Sandman may know public relations, but he’s clueless about the science. Both sides are not, nor were they, “right.” The antivaccinationist side relied on conspiracy-mongering and quote-mining to create the legend of Simpsonwood as a place where the CDC plotted to hide the evidence that mercury in vaccines was the main cause of the “autism epidemic.” Indeed, it’s not 85% correct or even 99% correct to state that science has failed to find a link between thimerosal and autism. It’s more like 99.9999% right. Moreover, Sandman fails to present a single bit of evidence that, regarding thimerosal at least, the FDA, CDC, or vaccine proponents have been less than honest. He just asserts it as though it’s true. It’s also a total distortion that scientists don’t mention that mercury is a poison. They do, and I do. I have. So does Dr. Offit; indeed he says explicitly in the book that it is and even devotes a section of the chapter Mercury Falling to explaining why the dose makes the poison and why, at the doses used in vaccines, mercury is not toxic and that, contrary to the claims of antivaccine activists, even if mercury were toxic at the levels used the symptoms of mercury poisoning do not resemble the symptoms of autism. Dr. Offit hammers that point home over and over, and discusses why it is impossible to avoid mercury:

Because everyone drinks water, everyone has small amounts of methylmercury in their blood, urine, and hair. A typical breast-fed child will ingest almost 400 mcg of methylmercury during the first six months of life. That’s more than twice the amount of mercury than was ever contained in all the vaccines combined. And because the type of mercury in breast milk (methylmercury) is excreted from the body much more slowlly than that contained in vaccines (ethylmercury), breast milk mercury is more likely to accumulate. This doesn’t mean that breast milk is dangerous, or that infant formula is dangerous, or that water is dangerous. Not at all. It means only that anyone who lives on the planet will consume small amounts of mercury all the time. During legislative hearings to ban mercury-containing vaccines, some politicians have stood up and said: “I have zero tolerance for mercury.” This kind of statement makes for a great sound bite. But because mercury is an inescapable part of our environment, politicians with zero tolerance for it are going to have to move to another planet.

I get the feeling that Sandman is attacking a gigantic straw man argument here, leading him to conclude:

The core problem for vaccination proponents, in short, isn’t that your critics exaggerate and distort. That’s true, but it’s not your core problem. Your core problem is that you also exaggerate and distort – and feel justified in doing so because you are (mostly) in the right, and don’t notice that it keeps backfiring on you. Or to put it a bit differently, your core problem isn’t that the public doesn’t trust you. That’s increasingly true too, but it’s not your core problem. Your problem is that you don’t trust the public.

And, worst of all:

My best guess is that vaccination proponents are “lying” (exaggerating and distorting) on behalf of the truth. That’s why I wish they’d stop.

That’s right. Sandman is accusing scientists like Paul Offit of lying in the name of defending vaccines. Of course, he can’t point to a single lie. Not one documented lie told by the CDC or other vaccine proponents to parents. Certainly he can’t point to one when it comes to thimerosal. In fact, the worst he can point to is a bit of a nonsequitur, namely a problem with the oral polio vaccine in Africa where, given the superstition and Islamic fundamentalists ready to jump at such problems, being reluctant to tell everything right away about a vaccine problem is somewhat understandable.

Sandman’s complaint is nothing more than a tu quoque fallacy writ large, and it’s a huge exaggeration. Antivaccinationists peddle outrageously false information and pseudoscience in a constant barrage of misinformation, exaggeration, cherry-picked data, and quote-mining on blogs like Age of Autism, while othe occasional vaccine proponent who may not be circumspect enough in not expressing too high a degree of certainty for Sandman’s judgment is to him equivalent to the tsunami of misinformation that comes from the antivaccine side. (Apparently, though, it’s OK for Sandman to “exaggerate and distort” while castigating scientists for “exaggerating and distorting” because he knows he’s in the right in his criticism.) In fact, it’s so wrong-headed that I have a hard time reading it without getting angry. Again, Sandman gives no specifics in the thimerosal controversy where vaccine proponents exaggerate and distort. He repeats the same essential message again in his later post, again bringing up the same straw men again and again not being able to give a single example, other than polio vaccine use in Nigeria, for which he castigated health officials for not acknowledging a very small risk of polio due to attenuated live virus polio vaccine. The only point he makes that I can sort of agree with is that if your position is 99% correct, at least acknowledging the other 1% is wise. However, I would also counter that there must come a certain level of certainty where acknowledging the “other side” gives pseudoscience an unjustified and undue appearance of validity. If you’re 99.999999% correct, are you obligated to acknowledge the other 0.0000001%, just to be “conciliatory”? Are evolutionists obligated to acknowledge creationist pseudoscience just to be “conciliatory”?

Then we come back to the exactly the same problem that Dr. Offit and I have described and why what Sandman says is a straw man: Scientists do couch their conclusions with “error bars,” so to speak. That’s a major problem in communcation, in fact. They do do exactly what Sandman decries them for supposedly not doing: Stating that, to the best of our knowledge, there is no association between thimerosal and autism and that multiple studies have failed to find a link but then qualifying it to point out that we can never completely prove a negative or that in a small number of susceptible individuals there might still be a possibility. That’s the very nature of how science works, especially in epidemiology: It can never completely prove a negative. Unfortunately, when scientists do acknowledge even the tiniest degree of uncertaint, antivaccine activists take that crack in the door and jump right on through: “See, see! There is a controversy! There might be a chance that vaccines do cause autism!”

I’m not saying that everything Sandman says is on that level of dubiousness. Certainly, I actually agree with him on this advice:

• Attribute the change to the power of opposition groups. By far the easiest way to establish that a new precaution isn’t hypocritical is to concede that it’s a response to pressure. “If you’re so sure thimerosal is safe, why are you removing it?” “Because our critics won that fight!”
• Explain the practicality of the decision. Whether it’s a genuine risk or not, a vaccine that significant numbers of people fear to take (or to let their children take) isn’t an effective vaccine. You’re not just deferring to your critics; you’re deferring to reality.

Exactly. Simply say: The antivaccinationists won that battle, and given how much fear they were provoking among parents banning thimerosal was the most practical way to blunt that fear.

Sandman is certainly correct in saying that science communicators would do well to be more empathetic, even giving some suggestions how to do it. However, his “sorry” gambit strikes me as far more condescending and paternalistic than telling it like it is and doing our best to make parents understand that we empathize with their difficulties. As we all realize, raising an autistic child is an incredibly difficult task, and I have grave doubts if I could ever manage it, for example. However, Sandman dresses up the simple message that given current science the chances that vaccines or mercury cause or contribute to autism but that we understand why at the individual level parents might believe they do in a whole load of false equivalences and advice that might make sense in the case of a scientific question whose anser is less clear-cut, but it’s advice that falls apart when it comes to defending science against pseudoscience.

ADDENDUM: I didn’t see this before, but it’s been pointed out to me that Peter Sandman has a rather infamous reputation among P.R. men, having done damage control for some of the largest corporations in the world. See:

1. Sourcewatch: Peter Sandman
2. Advice on Making Nice: Peter Sandman Plots to Make You a Winner
3. Sandman’s Cagey Tactics
4. Some Clients of Peter Sandman
5. Mining PR Exec Lauds Peter Sandman
6. Sorry is the hardest word for AWB

Interesting.

One of the major points made by Dr. Offit in Autism’s False Prophets is how badly the media deals with scientific issues and stories in which science is a major component. Indeed, he devotes two full chapters, Science and the Media and Science and Society, to a lament that pseudoscience such as antivaccine fearmongering is so easily promoted by the media and accepted by large numbers in American society. He lists a lot of the usual culprits, such as a poor understanding of science by the vast majority of Americans. Of course, there is also the false “balance” given antivaccine cranks in the media, which follows the journalistic mantra of “tell both sides,” not understanding such a tactic produces a false equivalence of the two when applied to issues of science versus pseudoscience and produces the impression that there is a real scientific controversy when there is not. (Indeed, this is so common that a term has been coined for it “manufactroversy,” which is short for “manufactured controversy”; a better description of the antivaccine reality distortion field would be hard to find.) Another excellent point is how the culture of science differs from that of the sound bite culture of media; scientists are often tentative and refuse to speak in absolutes, knowing the limitations of studies. We rarely say “never,” “always,” or “impossible.” So, when a reporter asks if vaccines cause autism, we almost always say something along the lines of, “studies thus far have found no link between vaccines and autism, rather than “vaccines don’t cause autism.” We do it because it’s more accurate and, as Dr. Offit points out, it’s impossible for science to completely prove a negative. The best we can do is estimate the probability, and the existing science is conclusive that there is very, very little chance that vaccines cause or contribute to autism. We can never say “zero” chance, but we can say the chance is vanishingly small. Unfortunately, that is perceived by the lay person as meaning that there’s still a chance. Finally, Dr. Offit even dares to go one place where I honestly didn’t expect him to go and mention the prevalence of religion and belief in the paranormal as contributing factors to the lack of critical thinking skills that allow the antivaccine dogma to flourish.

If only he hadn’t so approvingly quoted industry shills and all purpose denialists Steve Milloy and Michael Fumento, as I pointed out in my review on Wednesday, Autism’s False Prophets would have been near-perfect in hitting all the right notes on this issue.

One thing, however, I didn’t see so much in the book that I would have liked to see more of is how scientists and physicians could effectively counter the propaganda laid down by the likes of Jenny McCarthy and the movement of which she is currently the most famous member. For example, lately she’s been on CNN (as I described here, although unfortunately the video appears to have been removed), on The Oprah Winfrey Show, and all over the media promoting her book Mother Warriors: A Nation of Parents Healing Autism Against All Odds. Last year at exactly this time of year, she was promoting her previous book Louder Than Words: A Mother’s Journey in Healing Autism. Why is her message so effective, even though she is dumb as a rock when it comes to anything having to do with science and is so full of hubris that she thinks her Google education trumps expert knowledge and a wealth of solid epidemiological studies?

It’s her frame.

To recap for those who are new to ScienceBlogs thanks to the book club, two ScienceBloggers, Chris Mooney and Matthew Nisbet argued that scientists aren’t doing a very good job of communicating science issues to the public. On issues of importance that science impacts, such as global climate change and evolution education, they postulated, one strategy by which scientists could do a better job of communicating what science tells us about these issues and persuading the public of the validity of the science behind these controversial issues is to “frame” them better. As they said in their original article in Science:

In reality, citizens do not use the news media as scientists assume. Research shows that people are rarely well enough informed or motivated to weigh competing ideas and arguments. Faced with a daily torrent of news, citizens use their value predispositions (such as political or religious beliefs) as perceptual screens, selecting news outlets and Web sites whose outlooks match their own. Such screening reduces the choices of what to pay attention to and accept as valid.

Frames organize central ideas, defining a controversy to resonate with core values and assumptions. Frames pare down complex issues by giving some aspects greater emphasis. They allow citizens to rapidly identify why an issue matters, who might be responsible, and what should be done.

I was initially surprised when Nisbet and Mooney’s thesis provoked a great deal of hostility among some science bloggers, and not just members of the ScienceBlogs collective. I say “to my initial surprise” because, initially at least, the whole idea seemed so mind-numbingly obvious to me, as I explained in my usual verbose fashion in these two posts. Basically, I attibuted much of the conflict to a cultural divide between “pure” scientists and science teachers and practitioners of more applied science, such as physicians like me, the latter understanding that you have to find a way to simplify and communicate in a way that your audience understands. And so it was for many months that I remained puzzled by the extreme intensity of the debate, whose nastiness at times seemed to go far beyond the actual difference between the two camps. Before too long, the very mention of the word “framing” became all but certain to set certain members of the ScienceBlogs collective into rabid fits of vicious invective that leave rational discourse behind, inspiring Mooney and Nisbet to return fire in ways that did not bring glory upon them, to put it mildly.

Even so, at the risk of reigniting these wars, I think that the reason Jenny McCarthy, and by extension the rest of the rabid antivaccine movement, succeed is because they use a handful of very simple and persuasive frames. For example:

1. Autism as vaccine injury. This frame has been so effective that, as has been pointed out, if you ask someone about autism these days almost inevitably vaccines are linked to it. It matters not one whit that there is no convincings scientific evidence that vaccines trigger autism and there’s a lot of evidence that they do not. Autism is now “vaccine injury.” It’s simple and, supported by anecdotes, seemingly compelling.
2. Vaccination as an assault on personal freedom. This always resonates in the U.S., where vaccination is represented as the intrusion of the nigh-fascistic state into the affairs of families. This is very much of a piece with the “health freedom” movement that promotes quackery in the name of “freedom.”
3. “Green Our Vaccines” and its variant, “We are not ‘antivaccine’; we’re pro-safe vaccine.” Wonderfully Orwellian in its twisting of language and arguably the most effective frame thus far used by antivaccinationists. They argue that vaccines are full of “toxins” (They’re not) and do the antivaccinationis version of the Gish Gallup whenever studies are published exonerating a vaccine ingredient in causing autism. When that happens, they just move on to move the goalposts. If it’s not mercury, then it must be the aluminum. If it’s not aluminum, it must be the formaldehyde. If it’s not the formaldehyde, it must be the antifreeze (never mind there’s no antifreeze in vaccines; they’re on a roll). And if it’s none of the above, it’s some undefined synergistic combination that demands that every ingredient be tested individually. Since there are so many “toxins” in vaccines, they must be “greened” before they’re safe. Of course, to the antivaccinationist, vaccines can never be “green” enough. Just ask one what, specifically, it would take for her to be convinced that the toxins are gone. What, specifically needs to be removed? You’ll get a vague and meaningless answer (like the one that Jenny McCarthy routinely gives) to get the “toxins” or “junk” out of the vaccines.
4. Too many too soon. If it’s not a specific “toxin” or combination of toxins in the vaccines, then it must be the whole kit and kaboodle, the whole vaccination schedule! It’s “too many” antigens overloading the immune systems of infants, don’t you know! Dr. Offit has explained why this gambit is a load of hooey, scientifically speaking, but to the average lay person it sounds compelling. Why not delay vaccines? Why not space them out? Just in case? Oh, wait. It’s the precautionary principle again, as I discussed in my review of the book.

There are other frames, but those are clearly the Four Horsemen of the Vaccipocalypse that will, if unchecked, lead to suffering and death among children from vaccine-preventable diseases if unchecked.

One of the overarching topics of this my home blog, Respectful Insolence, since very early in its history has been combatting antivaccinationist lunacy and lies. Indeed, I was, as far as I can tell, the first person ever to point out what a cesspit of antivaccination propaganda The Huffington Post was right from its start. Resistance to vaccination and pseudoscientific misinformation every bit as ridiculous as any creationist nonsense appears to be growing, fueled by Generation Rescue, Jenny McCarthy, and the dedicated band of antivaccinationists who deny they’re antivaccinationists over at Age of Autism. It’s even progressed to the point of rallies on Washington, such as the recent “Green Our Vaccines” rally.

That is why I now ask everyone reading this post (and especially the pro-”framing” contingent) a question: How can we physicians and scientists deal with antivaccinationism? What “frames” can we use to combat the likes of Jenny McCarthy?

It’s a simple question. I would even argue that, in the short term at least, it’s a far more important problem than convincing the public of the validity of evolution or that we should do something to try to alleviate or reverse the effects of greenhouse gasses. The dire consequences of global climate change are far in the future, at least when compared to a human lifespan. None (or virtually none) of us will be alive 100 years from now, and most of us will be old or dead fifty years from now. It is not us, but our children, who will suffer if the models for global warming are correct, and it will be very difficult to evaluate end measures of effectiveness of “framing” in that length of time. In addition, the situation with antivaccine activism is very similar to the situation with creationism. The scientific consensus is that vaccines do not cause autism and are, as far as medical interventions go, incredibly safe, just as the scientific consensus supports the theory of evolution. Just like the situation with creationism, there is a hard-core contingent of antivaccine denialists who are loud, vocal, and probably unswayable, bolstered by ideology plus pseudoscience generated by a small cadre of “scientists” who have become convinced that for autism (and other disorders), it absolutely, positively has to be the vaccines. Finally, just like the situation with creationism there is the vast middle, Americans with little knowledge of science who hear the “charges” against vaccines and wonder if maybe, just maybe, the myths are true, making them hesitant to vaccinate their children. After all, the whole concept that there are “toxins” in vaccines sounds compelling to the average, scientifically untrained person, even though on a strictly medical and scientific basis it is not.

In contrast to the effect of ideologically motivated antiscience on evolution education or whether or not we as a society do anything to address global climate change, the ideologically-motivated antiscience known as antivaccinationism has a much more rapid deleterious effect. Thanks to fearmongering over vaccines, measles is already endemic again in the U.K., after previously having been conquered, while in the U.S. it is surging back as well, fueled by lower vaccination rates. If current trends continue, and antivaccine activists make good on an earlier promise of a “fall offensive” against the vaccination schedule, it won’t be long before other vaccine-preventable diseases start making a comeback as well.

If ever an effective framing strategy were needed to counter the Orwellian “green our vaccines” movement, the time is now. The question is: How? Whatever the frame, it has to be simple, scientifically supported, and able to resonate with typical parents. Hardcore antivaccine activists won’t be persuaded by any frame we can think of, but there are a lot of parents out there who aren’t hardcore antivaccinationists but have heard their rhetoric and are afraid of vaccines because of it. How do we reach them?

Come to think of it, this is an area that I really wish I had seen more of in Autism’s False Prophets. Dr. Offit does an excellent job of laying out the deficiencies in how vaccine science is communicated to the public today, deficiencies that leave a huge opening for antivaccine pseudoscience to permeate the national zeitgeist, but I’d really like to hear from him suggestions for frames or other strategies to counter it.

Well, not really. I might have one of the two. Or not.

Be that as it may, I’m Orac, and I blog regularly at Respectful Insolence. In the more than two and a half years I’ve been with ScienceBlogs (not to mention the more than a year before that on my own), I’ve become known as its resident “vaccine blogger.” True, others around here sometimes do posts about vaccines, antivaccine lunacy, and the discredited idea that vaccines somehow cause autism, but with nowhere near the frequency and intensity that I do. Without a doubt, I’ve done more posts about the misinformation, pseudoscience, and outright quackery spread by antivaccine activists such as J. B. Handley’s Generation Rescue and his recently recruited empty-headed celebrity spokesperson Jenny McCarthy, not to mention a number of others who promote the resurgence of infectious disease by sowing doubts about the safety of the most effective weapon the mind of humans have ever devised against it. The reason that that antivaccine movement and applying science and critical thinking to the myth that mercury-containing vaccines or vaccines themselves somehow cause autism or all sorts of other dire complications have become such a major theme of my home blog is that few uses of “alternative” medicine bother me as much as the antivaccine orientation of so much of the movement supporting it, a movement that has also led to all manner of “biomedical” treatments (quackery). No doubt that’s why I was chosen to be one of the bloggers discussing this book, and I’m quite happy to do it.

What you might not know is how I developed my interest in this particular area of dangerous pseudoscience. After all, I’m a cancer surgeon and an NIH-funded cancer investigator, not a pediatrician, immunologist, or neurologist. As hard as it is for me to believe, given that it seems today that I’ve always been refuting this nonsense, I only first discovered the antivaccine movement about three and a half years ago. True, I had been a regular on certain Usenet newsgroups for at least four or five years before that and had encountered antivaccinationists there before, but my contact with them online had been sporadic, and they seemed “out there” even in comparison to the usual run-of-the-mill alt-med maven. But then in the spring of 2005 I started to notice in a big way the cadre of pseudoscientists, parents of autistic children, and others who pushed the myth that thimerosal-containing vaccines or vaccines in general cause autism. Oddly enough, it started out with the Huffington Post, of all places. In May 2005, Arianna Huffington started a large group blog, chock full of famous pundits and celebrities writing blog posts. Within three weeks of its formation, I had noticed a very disturbing aspect of the Huffington Post, and that was that it appeared to be providing a major soapbox for antivaccinationists, including a post by Janet Grilo of Cure Autism Now, two posts by that propagandist of antivaccinationists David Kirby, and posts by that Santa Monica pediatrician to the children of the stars, Dr. Jay Gordon, a man who assiduously denies being “antivaccine” but parrots the most blatantly obvious talking points of the antivaccine movement and is currently best known as being the pediatrician for Jenny McCarthy’s son Evan. At the very least, Dr. Gordon is an apologist for the antivaccination movement, and he has become one of the “go-to” guys for the media looking for physicians who are “vaccine skeptics,” making numerous radio and TV appearances to promote his “skepticism.”

The next phase of my “awakening” to just how pervasive antivaccine fearmongering and pseudoscience were came when Robert F. Kennedy, Jr. wrote an incredibly dishonest and deceptive screed that got wide coverage in the summer of 2005. His article, called, charmingly enough, Deadly Immunity was a rehash of all the misinformation about thimerosal in vaccines and autism wrapped up with in a bow of conspiracy-mongering worthy of a 9/11 Truther with a penchant for quote-mining that would make a creationist blush. The article appeared simultaneously on Salon.com (which normally doesn’t publish such nonsense) and Rolling Stone, a magazine that really should stay away from science and stick to covering entertainment and politics. It was followed by a media blitz by RFK Jr. and antivaccine propagandist David Kirby, best known for his credulous treatment of the thimerosal/autism link, Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy, published a few months before RFK, Jr.’s article, and his subsequent activities posting antivaccine nonsense on Huffington Post and, more recently, on the quackery-promoting antivaccine blog Age of Autism.

Suffice it to say that at the time I prefaced a post about RFK, Jr.’s article by saying that Salon.com had “flushed its credibility down the toilet” and referred to the article itself as the “the biggest, steamingest, drippiest turd Salon.com has ever published.” I bring this up so that the reader knows where I am coming from. Indeed, since that time in the summer of 2005, I’ve been wondering when scientists, public health officials, and physicians supporting science-based medicine would finally wake up and start to push back against this tide of antivaccine nonsense, which is starting to result in the resurgence of measles and other vaccine-preventable diseases. This year, I’ve seen some hopeful signs, including organizations like Voices for Vaccines and Every Child By Two, as well as other signs of push-back against the antivaccine movement, which, I hate to admit, has been clearly winning the P.R. war. What there hasn’t been yet is a book written from a scientific viewpoint that directly addresses the history of the recent resurgence of the antivaccine movement and refutes the pseudoscience that it promotes.

Until now, that is.

Released earlier this month is a direct shot across the bow of the antivaccine movement in the form of a book by vaccine scientist and physician Dr. Paul Offit of the University of Pennsylvania’s Childen’s Hospital of Philadelphia, a man whom the antivaccine movement views as an unholy combination of Hitler, Stalin, Mao, Darth Vader, and Satan Incarnate because of his staunch advocacy of vaccines and his willingness to stand up to the antivaccine movement. The book is entitled Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure. Overall it is an excellent primer on the subject and should be required reading for anyone curious about how the antivaccine movement became so pervasive and powerful.

The book begins with a rather interesting choice for a quote:

When religion was strong and science weak, men mistook magic for medicine. Now, when science is strong and religion weak, men mistake medicine for magic.

Actually, I would quibble about whether religion is actually weak these days. In this country, at least, fundamentalist religion, in particular fundamentalist Christianity, seems stronger than ever, permeating society so thoroughly that it is unthinkable that an atheist President will be elected in my lifetime. Elsewhere, fundamentalist Islam and other religions hold sway. Later in the book Dr. Offit makes the connection between religion and the antivaccine movement, which strikes me as a bit incongruous with this quote. However, the quote does characterize quite succinctly that what we are dealing with in the antivaccine movement is not science. Rather it is more akin to religion, because scientific evidence exonerating vaccines as a cause of autism rarely changes the minds of adherents to the antivaccine faith.

One thing I was not aware of is just how much Dr. Offit has been harassed by antivaccine zealots because of his advocacy for vaccination. He lays it all out right from the very first passage in the book:

I get a lot of hate mail.

Every week people send letters and e-mails calling me “stupid,” “callous,” an “SOB,” or “a prostitute.” People ask, “how in the world can you put money before the health of someone’s baby?” or “How can you sleep at night?” or “Why did you sell your soul to the devil?” They say “I don’t have a conscience,” am “directly responsible for the death and damage of hundreds of children,” and “have blood on [my] hands.” They “pray that the love of Christ will one day flood [my] darkened heart.” They warn that my “day of reckoning is coming.”

Dr. Offit then describes how he became interested in pediatrics and vaccines and the path that led him to become an infectious disease specialist studying vaccines, describing in moving terms one child he took care of who died of a rotavirus infection and how that led him into his current work. Fairly conventional stuff, but it’s necessary to understand where Dr. Offit’s coming from. He then goes on to describe how he became an advocate for vaccines in the 1990s and how that led to his daily vilification. (Just search Age of Autism if you want to get a flavor of the sort of stuff Dr. Offit is subjected to day in and day out by his enemies.) As part of this campaign, Dr, Offit has even been subject to death threats and calls in which implied threats were made against his family and children. Indeed, after he had casually mentioned his children’s names during Congressional testimony in front of quackery-supporting antivaccinationist Congressman Dan Burton’s committee, in which he answered a question by Representative John Tierney about whether he vaccinated his own children, a concerned member Tierney’s staff warned him, “Never, never mention the names of your own children in front of a group like this.” Some of these threats were credible enough that the University of Pennsylvania routinely checks his mail for suspicious letters and packages and he has periodically required an armed guard.

Personally, I find Dr. Offit’s story quite credible. Indeed, I’ve occasionally been at the receiving end of but a small fraction of the vitriol directed at him. True, I have never been physically threatened (although one time I met someone whom I mistakenly thought–just for an instant–was a particularly persistent antivaccinationist who detested me and it momentarily frightened me), but antivaccinationists have certainly done their best to destroy my Google reputation. Usually, the attacks take the form of slander and ad hominem attacks. For example, not only have I been personally attacked by J.B. Handley of Generation Rescue himself on Age of Autism in a prolonged screed, the comments after which mocked my appearance and questioned my manhood, but one particularly deranged antivaccine advocate, who has in the past shown up at least once in the comments on my own blog and is so off the deep end that even antivaccinationists are embarrassed by him, has written posts accusing me of “sodomizing autistic children” and of being a “member of NAMBLA.” (Google it if you don’t know what the acronym means.) He bases his accusations on a list circulated on Usenet by Holocaust deniers back around 2000 designed to smear those of us involved in the fight against online Holocaust denial as pedophiles. The list is so obviously a pile of lies, but that didn’t stop him and it doesn’t stop other cranks from periodically resurrecting this zombie and setting it loose to try to eat the brains of those who see it. Indeed, this same blogger/commenter has even tried to link Kathleen Seidel to NAMBLA as well. (More on her later, as she is a major player in the book.) Now, I’m just a rather insignificant blogger, not a vaccine researcher who has been on national television and testified in front of Congress about vaccine safety, and I’ve experienced a somewhat disturbing amount of abuse and vitriol. I can only imagine what Dr. Offit has been subjected to.

After describing his stake in this debate, Dr. Offit dives right in, beginning with a brief history of vaccines and then of the condition known as autism, serving as a background, including some earlier forms of autism “treatments” such as facilitated communication, a now discredited technique that led to false accusations of rape and child abuse against parents based on nothing more than suggestibility and the ideomotor effect. He then proceeds to describe how Andrew Wakefield’s litigation-funded research published in The Lancet in 1998 led to a scare over the MMR vaccine that has not abated even a decade later and has also led to measles again becoming endemic in the U.K. That’s just the warmup. I have to admit that this is the first book I’ve ever read about a topic that I had been following in detail and writing about myself periodically. Consequently, my review is filtered through that prism, just as Kev’s viewpoint is filtered through the prism of his actually “having lived” the story told in this book. It may also be the reason why I found how Dr. Offit structured the first part of his story particularly jarring. He begins the thimerosal story with a chapter entitled “Mercury Rising.” This chapter is a fairly straightforward and relatively uncritical recitation of the “science” used by antivaccinationists to show that mercury causes autism. From my perspective, having read and analyzed many of these studies and knowing that they are at best irrelevant and at worst rank pseudoscience, I found this chapter especially disturbing. I think I know what Dr. Offit was trying to do: To show how the steady drumbeat of such studies can give the impression that there is scientific legitimacy to the question fo whether vaccines cause autism, but it was hard to swallow. True, Dr. Offit immediately follows the chapter with “Mercury Falling,” in which he demolishes over and over again the “science” claiming to show that mercury in vaccines causes autism, but the overall effect disturbed me. Of course, that’s just me. I’d be curious to hear what others who have read the book thought of this structure.

One person who comes in for criticism is Dr. Neal Halsey, who in 1999 was head of the American Academy of Pediatrics’ vaccine advisory committee and was also instrumental in persuading the CDC to recommend the removal of thimerosal from vaccines even though there wasn’t any real science to show it to be dangerous. Two interesting points come out of this chapter that I hadn’t been aware of. First was the dynamic of how this came about. Many of the meetings held to discuss the matter were done by conference calls often dominated by Dr. Halsey. Indeed, the CDC committee was initially not at all enthusiastic about Dr. Halsey’s recommendations because they didn’t see any science compelling enough to warrant urgency. However, through force of will during several conference calls Dr. Halsey ultimately won the day. What seems to have happened is that, absent sitting in a room with all the players, members of the CDC got the impression that a “snowball” was growing in favor of doing something. Members later said that they were extremely skeptical but that with Dr. Halsey dominating the conversations and the inability to see the body language of other members of the committee, they didn’t realize that they were not alone in their extreme skepticism about the advisability of “doing something now.” The second point is that the banning of thimerosal absent compelling evidence that it caused harm was a fantastic example of the “precautionary principle” run amok, in which a ban was recommended “just in case.” That decision more than any other, argues Dr. Offit, was responsible for the subsequent nine years of antivaccinationist fearmongering over mercury in vaccines. After all, parents not unreasonably think, if the CDC and AAP recommended removing thimerosal from vaccines, there must have been a reason. Maybe there was something wrong that is now being hidden! Reassurances by the CDC that the recommendation was “just as a precautionary measure” designed to “make vaccines even safer” were not particularly convincing in comparison. Actions speak louder than words, after all. In other words, although antivaccine advocates were agitating about thimerosal in the late 1990s and likely would have continued to do so, the ultimate magnitude of the thimerosal scare in the U.S. was largely a self-inflicted wound on the part of the CDC and AAP.

One face familiar to me was featured prominently in this book, a woman named Kathleen Seidel, who created the Neurodiversity website and blog. She has been a thorn in the side of antivaccinationists for several years now. Arguably her biggest contribution is how she has revealed the sordid details of the conflicts of interest and pseudoscience “Behind the Mercury Curtain,” so to speak (the title of the chapter in Autism’s False Prophets featuring Seidel). She was the first to uncover how Dr. Mark Geier and his son David formed a dubious and “elusive” institute and packed an institutional review board of that institute with their cronies to rubberstamp their unethical “clinical trials” using chelation therapy and the powerful anti-androgenic and -estrogenic drug Lupron under the guise of treating “precocious puberty.” Indeed, my learning about the Geiers and their highly unethical research behavior back in 2006 was the second “awakening” I had about the antivaccine movement.

Through the latter part of the book, Dr. Offit reviews all the other major players in the antivaccine movement. They’re almost all there: J.B. Handley of Generation Rescue (now rechristened as “Jenny McCarthy’s Autism Organization”) and Age of Autism; Jenny McCarthy and her “Green Our Vaccines” nonsense; aging shock-jock Don Imus; chemistry professor-turned-antivaccinationist Boyd Haley; Mady Hornig; Richard Deth; David Kirby; and, of course, Robert F. Kennedy, Jr. None of them are spared, nor should they be. For someone as interested as I, there wasn’t much there that I didn’t already know, although I was surprised to learn just how tightly RFK, Jr. is affiliated with trial lawyers (I had always thought he was idealistic but seriously misguided on the question of vaccines) and how David Kirby apparently used to bluster and bully that he was “with the New York Times” to try to obtain interviews when in fact he was never anything more than a freelancer who was occasionally published in the Gray Lady. However, to those who aren’t familiar with these characters, it is potentially eye-opening. Unfortunately, one aspect of this story that is missing is how antivaccine activists have coopted the case of Hannah Poling to serve their propaganda. True, the case didn’t really explode onto the scene until March. Perhaps it was too late to include it in the hardcover book, and I hope that Dr. Offit will write an update for the paperback edition. Indeed, the manipulation of the Hannah Poling case and the way that antivaccinationists latched on it as “evidence” that rare mitochondrial disorders are allegedly a factor predisposing to “vaccine injury” causing autism warrant a complete chapter in and of themselves.

The closing third of the book deals with how science is handled in the courts and in society. There is an extensive discussion of the Autism Omnibus and how weak the plaintiff’s case was in the first “test case.” More importantly, Dr. Offit echoes a lament that I have made time and time again about how science is so frequently misrepresented and abused in the media, describing specific examples. One point he makes is that scientists always tend to qualify their remarks and be very careful about stating conclusions. That’s nothing but good science (remember, science can never absolutely prove that there is no correlation between vaccines and autism, only suggest just how very, very unlikely it is that there is one), but such “weasel words,” which are normal qualifications of the uncertainty inherent in scientific conclusions, leave the average layperson thinking that there really is a major controversy among scientists. In the case of whether vaccines cause autism, there is not. Dr. Offit also compares the P.R. techniques used by the antivaccine movement to discount the science exonerating thimerosal-containing vaccines or vaccines in general as a cause of or contributor to autism to how the tactics tobacco companies used back in the 1950s and 1960s to try to convince people that there was still a scientific controversy over whether cigarette smoking causes lung cancer. He also points out how, in this age of science, belief in magic and the paranormal remain very common, making the connection between the lack of critical thinking skills that allow such superstition to continue to flourish and how easily pseudoscience can become accepted as “fact”–a point I have made many times before.

Of course, no review would be complete if I didn’t briefly mention two things that bugged me about this book. No book is perfect, and Dr. Offit’s is no exception. Don’t get me wrong, though. Overall Autism’s False Prophets is an excellent book that I recommend highly. Nonetheless, I do have two minor nits to pick. The first is that Dr. Offit approvingly quotes Steven Milloy twice and Michael Fumento once, both of whom are well known corporate shills, apologists for conservative politics, antienvironmentalists, and anthropogenic climate change “skeptics.” (Indeed, Steve Milloy is known for his famous and dubious “Ultimate Global Warming Challenge.”) Moreover, both have been accused of ties to the very tobacco companies to which Dr. Offit compared antivaccinationists to, and both have conflicts of interest in the form of ties to and/or funding from the industries whose interests they virtually always champion, be it big oil, big pharma, or big tobacco. That they happen to be correct in condemning the antivaccination movement is not a good enough reason to cite them, and Dr. Offit could have made his points just as well without including quotes from such tainted sources. Even though the quotes themselves argue Dr. Offit’s case about science and society and the law, anyone who has skeptically examined the rhetoric of Milloy or Fumento will know that neither of them is a credible spokesman for science-based medicine.

The second nit is that Dr. Offit comes off as a bit credulous about the National Center for Complementary and Alternative Medicine (NCCAM). Indeed, at one point he states:

But what worried many scientists and physicians about NCCAM was that alternative medicines would be exempt from the scientific method. Fortunately, that hasn’t happened.

I would argue that that is exactly what has happened with the rise of NCCAM. Dr. Offit then goes on to argue that NCCAM has tested “several alternative medicines” and concluded that they didn’t work, mentioning laetrile. Actually laetrile was tested and found to be ineffective back in the 1980s, several years before the office that was the precursor to NCCCAM was ever established in the NIH. In any case, I invite Dr. Offit to read articles arguing this very point written by Wally Sampson (perhaps the most infamous call for NCCAM to be defunded), Steve Novella, Kimball Atwood, and me that argue otherwise and that NCCAM is a corrosive force against science-based medicine and for the accelerating infiltration of pseudoscience into academic medicine.

Be assured, however, that from my point of view the two nits I just picked are inconsequential compared to what is good and accurate about Autism’s False Prophets. Indeed, that I noticed them at all is probably a consequence of my having been active in the skeptical movement a long time (i.e., I “know too much”). After the virtually nonstop barrage of antivaccine propaganda and pseudoscience that has permeated the national zeitgeist, especially since Jenny McCarthy became a convert to antivaccinationism a little more than a year ago, Dr. Offit has provided a refreshing, science-based change of pace on the topic of vaccines and autism that pulls no punches. Every parent who has concerns about vaccines should read it to learn just how weak and without basis in science the claims of antivaccine “scientists” and advocates are and just how riddled with conflicts of interest every bit as bad as any attributed to big pharma so many of the luminaries of the antivaccine movement are. Even better, those out there who might be worried that Dr. Offit will be profiting from sales of his book can take comfort in the fact that Dr. Offit will not receive any money from it. He has promised to donate all royalties from sales of Autism’s False Prophets to autism research. Of course, it won’t be the type of autism “research” funded by Generation Rescue or performed by the likes of Boyd Haley, the Geiers père et fils, Andrew Wakefield, Laura Hewitson, Raymond Palmer or other false prophets of autism. It will go to real scientists doing real research on the science of autism and treatments designed to help autistic children, rather than subjecting them to a mind-dizzying panoply of “biomedical” interventions that are not only expensive but useless and potentially dangerous.

Education and contributing to science-based medicine, what more could one ask for? What will be amusing is watching Autism’s False Prophets being released at the very time as Jenny McCarthy’s latest antivaccination Indigo woo-fest Mother Warriors. No doubt McCarthy’s book will be a best-seller, as there is an unending appetite for this sort of paranoid conspiracy-mongering. Indeed, there is a reason why Jenny McCarthy has been able to reenergize the antivaccine movement, both with star power (her boyfriend Jim Carrey’s star power far more than her D-list star, which had been fading before she latched onto the autism “biomed” movement), money because of the fundraisers she and Carrey can front, and the manner in which she can resurrect Andrew Wakefield’s career. It’s good to see that there is at least one lone voice calling her, Wakefield, Mark and David Geier, and J.B. Handley, and all the antivaccinationists who endanger public health out for their pseudoscience.