Sometimes, when it comes to the anti-vaccine movement, I feel as though I’m bipolar. There are times when I’m incredibly depressed that pseudoscience and fear mongering are winning out, leaving our children vulnerable to infectious diseases not seen in decades and believing that it’s only a matter of time before we start seeing really major outbreaks. This mood tends to strike me when I see actual stories about plummeting vaccination rates and, well, small outbreaks of diseases associated with low vaccination rates and unvaccinated children.
There’s a condition in surgery known as a “sentinel”–or “herald”–bleed, which is generally associated with something called an aortoduodenal fistula, which is an abnormal communication between “big red” (the aorta) and the duodenum. One condition in which aortoduodenal fistulae occur is when there is synthetic graft material in the aorta behind the stomach, which is generally the case after an open repair of an abdominal aortic aneurysm. However, they can also occur after pancreatic surgery, such as the Whipple pancreaticoduodenectomy. In both cases, scarring and chronic inflammation lead to the abnormal connection. In the context of such fistulae, a “sentinel” bleed is generally a relatively small, self-limited upper GI bleed. The patient bleeds, then stops. Everything appears to have settled down. Then, usually hours although sometimes days later, the patient suffers a massive exsanguinating hemorrhage from the fistulae. There are other examples of herald bleeds. One arguably more common example is the herald bleed that occurs with the rupture of a cerebral aneurysm. The patient will complain of a sudden onset of the worst headache he’s ever had in his life, which will result in a workup. Often the CT will be negative, although a lumbar puncture will usually find blood in the cerebrospinal fluid. Then, when things appear to have settled down, the patient can suffer a massive subarachnoid hemorrhage that kills him or leaves him with permanent neurologic disability. Basically, the aneurysm will start with a small leak that seals itself off sometime before it ruptures and bleeds profusely.
The relatively small outbreaks, such as the measles outbreak in San Diego, could be viewed as being similar to sentinel bleeds, relatively small and self-limited. I fear the real outbreak, as well we all should. Thanks to the anti-vaccine movement, it’s a matter of time unless current trends reverse themselves. When I think about this, I become very depressed.
Sometimes, though, I feel a bit at the manic end of the bipolar spectrum. These feelings tend to occur when very bad news, of which there’s been more and more lately, strikes the anti-vaccine movement. Examples are much more common in the last year than before and include the fall of Andrew Wakefield. Also, happily, the media have been less and less sympathetic to the anti-vaccine movement, turning the narrative from that of plucky parents fighing The Man and the uncaring system to people who reject science when they don’t like it and whose irresponsibility endangers every children. We saw this in Chris Mooney’s Why Does the Vaccine/Autism Controversy Live On?, Amy Wallace’s An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All, and excellent exposes by Trine Tsouderos and Pat Callahan on the autism biomed movement and how dubious autism “treatments” based on anti-vaccine beliefs refuse to die. The result is that, over the last year, I definitely get the feeling that the tide has turned. Reporters see a good story in the anti-vaccine movement, but anti-vaccine parents are no longer invariably the sympathetic figures in that story. This is a good thing indeed!
Not surprisingly, seeing their glowing press coverage evaporate, the anti-vaccine movement has gotten a bit…well, frustrated. Signs of that frustration are evident in anti-vaccine zealots’ increasingly vicious attacks on those who have the temerity to point out that science is not on their side. Amy Wallace, for instance, was the victim of misogynistic attacks by J.B. Handley, while Steve Novella was at the receiving end of one of J.B. Handley’s rants. Perhaps the most spectacular meltdown came when the anti-vaccine crank blog Age of Autism posted a crudely Photoshopped image of Trine Tsouderos, Steve Novella, Paul Offit, Amy Wallace, and Thomas Insel sitting around a Thanksgiving table preparing to feast on a baby. Meanwhile, a steady stream of invective likens those who stand up to science to Nazis, Stalin, and all manner of evil.
Given this background, I wondered what to expect after the airing of a FRONTLINE episode The Vaccine War, which I reviewed the other day. I didn’t have long to wait. The chief spokescelebrity, Jenny McCarthy herself, weighed on–where else?–The Huffington Post with a little ditty called Frontline’s “The Vaccine War” Misses Half the Story. Not to be outdone, on the very same day, that pediatrician to the stars, consigliere to the anti-vaccine movement with serious anti-vaccine tendencies that he refuses to admit, Dr. Jay Gordon, weighed in with an outraged screed of his own entitled PBS Frontline on Autism Resorts to Pseudo-Documentary, Tabloid Journalism. Both are pathetic–woo-ful, if you will–whines, and the very fact that they were written suggests the impotence of the anti-vaccine movement in the face of science that passed them by at least five years ago.
Of the two, Dr. Gordon’s strikes me as the more pathetic. Here’s the reason. Take a look at the introduction:
Tonight PBS aired a show called “The Vaccine War.” I was interviewed at great length and in great depth about vaccines and my point of view and expressed my ambivalence about the polarization of this issue and the need for more calm reasoned discussion about the number one question that new parents have. I told Kate McMahon, the co-producer of the show, that there was a large group of doctors and others who cannot be dismissed with the facile label “anti-vaccine” because we still give vaccines and see a place for them in the practice of medicine but we do not agree with the current vaccine schedule nor the number of vaccines children receive all at one time.
A few days ago, Ms.McMahon emailed me to tell me that the decision had been made to omit my interview from the show. There would not be one word from me. She didn’t tell me that she had also omitted 100 percent of Dr. Robert Sears interview. And that any other comments from physicians supporting the parents on the show in their ambivalence about vaccines or their decision to refuse all vaccines would also be omitted.
Well, boo-hoo! Cry me a river. Surely someone as media-savvy as Dr. Gordon seems to be must realize that lots of interviews are taped for documentaries and that often, out of two hours of tape, nothing or only one sound bite will end up finding its way into the final documentary. It’s not malice. It’s not necessarily bias. It’s just the way it is. In fact, if Dr. Jay hasn’t learned anything since some of his more spectacular examples of foot-in-mouth disease, such as his invocation of the formaldehyde gambit or his utterly risible comparison of vaccine science to tobacco companies’ denialist tobacco science, McMahon may have done him a huge favor by cutting him from The Vaccine Wars. She saved Dr. Jay from an opportunity to dig himself in even deeper and make himself look even worse than he does now. Unfortunately, denied that opportunity for a national television audience, Dr. Jay tries to seize an opportunity to do so for a national blog audience with his open letter to McMahon. It is a highly target-rich environment, particularly his wounded sense of utter betrayal:
I trusted you by giving you two or three hours of my time for an interview and multiple background discussions. I expressed my heartfelt reservations about both vaccines and the polarizing of this issue into “pro-vaccine” and “anti-vaccine” camps. I told you that there was at least a third “camp.” There are many doctors and even more parents who would like a more judicious approach to immunization. Give vaccines later, slower and with an individualized approach as we do in every other area of medicine.
What did you create instead?
“The Vaccine War.”
A war. Not a discussion or a disagreement over facts and opinions, but a war. This show was unintelligent, dangerous and completely lacking in the balance that you promised me — and your viewers — when you produced and advertised this piece of biased unscientific journalism.
Project much, Dr. Jay? I wonder what I would find if I searched Age of Autism for wors like “war” and “battle” and other terms like that? Let’s see, there’s Are We Winning the Vaccine-Autism War?, complete with a picture of the Marines raising the American flag at Mount Suribachi on Iwo Jima. Then there’s AoA’s Kent Heckenlively opining, “The war has begun,” not to mention a whole section on AoA devoted to Parent Warriors. Heck, Jenny McCarthy herself called one of her autism books peddling nonsense vaccine-autism Mother Warriors, fer cryin’ out loud! From my perspective, it isn’t so much public health officials, physicians, and scientists who are viewing the vaccine-autism manufactroversy as a “war” and therefore crafting their rhetoric accordingly. It’s the anti-vaccine movement itself using martial language to describe the manufactroversy.
Remember how I’ve said on occasion before that I hate to be too harsh on Dr. Jay because he reacts like a whipped puppy when too much insolence, respectful or not-so-respectful, is applied? Well, this is what I mean, except that sometimes he reacts with wounded, righteous indignation. And when he gets righteously indignant, he becomes incoherent, at least when it comes to science, leading him to launch into a whole bunch of the same old scientifically ignorant blather that he has regaled us with so many times before in the past:
Autism. An epidemic caused by environmental triggers acting on genetic predisposition. The science is there and the evidence of harm is there. Proof will come over the next decade. The National Children’s Study will, perhaps by accident, become a prospective look at many children with and without vaccines. But we don’t have time to wait for the results of this twenty-one year research study: We know that certain pesticides cause cancer and we know that flame retardants in children’s pajamas are dangerous. We are cleaning up our air and water slowly and parents know which paint to buy and which to leave on the shelves when they paint their babies’ bedrooms.
The information parents and doctors don’t have is contained in the huge question mark about the number of vaccines, the way we vaccinate and the dramatic increase in autism, ADD/ADHD, childhood depression and more. We pretend to have proof of harm or proof of no harm when what we really have is a large series of very important unanswered questions.
Dr. Jay seems so confident when he proclaims autism an “epidemic” caused by environmental triggers acting on genetic disposition. Unfortunately for him, the evidence thus far doesn’t support such a sweeping statement. For one thing, as has been discussed time and time again, it is unlikely that the true prevalence of autism has increased as dramatically as the numbers make it appear. Diagnostic substitution and broadening of the diagnostic criteria have contributed, as has increased screening for autism. Whenever a condition or disease is screened for in a population, more of it will be found. Always. Be that as it may, there is considerable evidence that the true prevalence of autism and ASDs has not increased that dramatically, if it has increased at all. The “autism epidemic” is almost certainly mostly due to artifacts changes in awareness, diagnostic criteria, social implications. One dramatic indicator of this was a recent study that showed that the risk of being diagnosed with an autism spectrum disordercorrelates with social proximity to another family with a child with an ASD diagnosis, suggesting that the increase in ASD diagnoses is largely due to societal factors.
Note also how Dr. Jay is up to his old tricks again, comparing a questionable, probably nonexistent “epidemic” of autism to known diseases and known risk factors for harm, such as pesticides. He then likens vaccines to pesticides and flame retardants in children’s pajamas with utter confidence, the result being that he can fool the unwary into thinking that, wow, vaccines really must be dangerous. (Does anyone really believe Dr. Jay’s assurances that he is “not anti-vaccine” anymore? I sure don’t.) He then does the denialist do-si-do and spreads fear, uncertainty and doubt by, in essence, demanding proof of no harm. Science can never give proof of a negative. The best it can do is to estimate how likely a positive is, and in the case of vaccines and autism numerous studies have failed to find a correlation. Based on current data, the likelihood that Dr. Jay’s fevered, fear-filled fantasies of deadly vaccines causing autism is true is exceedingly low. Dr. Jay also points to a whole bunch of questions that–or so he claims–have not been answered. Too bad Dr. Jay didn’t mention just what those questions are. Maybe it’s because the questions have been asked and answered, but Dr. Jay didn’t like the answers. Scratch that. There’s no “maybe” about it.
The last part of Dr. Jay’s open letter is just plain embarrassing. Really. I was actually embarrassed for him when I read this:
I base everything I do on my reading of CDC and World Health Organization statistics about disease incidence in the United States and elsewhere. I base everything I do on having spent the past thirty years in pediatric practice watching tens of thousands of children get vaccines, not get vaccines and the differences I see.
Vaccines change children.
Most experts would argue that the changes are unequivocally good. My experience and three decades of observation and study tell me otherwise. Vaccines are neither all good–as this biased, miserable PBS treacle would have you believe–nor all bad as the strident anti-vaccine camp argues.
Note what Dr. Jay doesn’t say. He doesn’t say that he bases his practice on the actual science-based recommendations of the CDC regarding vaccines. That much is painfully obvious. If you don’t believe me, look at this Tweet he posted the other day:
That’s right. Dr. Jay just told a mother not to vaccinate her son without ASD because his brother has autism. There is zero science to support such a reckless and potentially dangerous recommendation, yet Dr. Jay makes it anyway because he somehow believes that siblings of children with autism have some sort of genetic “trigger” that vaccines will set off, thus causing autism. For shame, Dr. Jay! For shame! There is no excuse for a pediatrician to make such an irresponsible recommendation for a child, and, if Dr. Jay is making this recommendation on Twitter, just imagine to how many of his patients’ parents he is making the same irresponsible recommendation.
Also note how much Dr. Jay touts his 30 years of experience. Don’t get me wrong; experience can be a good thing. However, personal experience that doesn’t acknowledge current medical science becomes out of date, distorted by one’s own beliefs, and often devolves into dogma- and anecdote-based, rather than science-based, medicine, prone to confirmation bias (which is almost certainly what Dr. Jay is refusing to acknowledge in his stories of so much autistic regression after vaccines). I’ve gone over this problem with Dr. Jay before ad nauseam, both on this blog and in prolonged e-mail exchanges with Dr. Jay, who complains most piteously when I point out that he is not a scientist and that he himself points out that he doesn’t have any good scientific evidence to back up his fear of vaccines. Sorry, Dr. Jay. You’re a nice guy and all, but you spread misinformation–dangerous misinformation, particularly when you say things like this:
The way vaccines are manufactured and administered right now in 2010 makes vaccines and their ingredients part of the group of toxins which have led to a huge increase in childhood diseases including autism.
There’s only one word that describes such a statement: Bullshit. That’s what Dr. Jay is full of in this post. I had some nits to pick with FRONTLINE over this show, but not about the science. The producers got the science right, and they were also right not to give time to a pediatrician who values personal anecdotes over science and blithely gives out irresponsible advice over Twitter and sounds like a mad scientist in a B-movie ranting “I’ll show you all!” as he says, “The science is there and the evidence of harm is there. Proof will come over the next decade.” Except that neither the science nor evidence of harm is there.
Jenny McCarthy’s post is, believe it or not, even more brain dead. Since it quotes Dr. Jay and regurgitates the usual Generation Rescue talking points, I don’t know that I want to spend a lot of time on it, particularly given that it piteously echoes much of the same complaints of Dr. Jay about FRONTLINE special being so unfair and mean to Generation Rescue. From my perspective, FRONTLINE bent over backwards to be fair. Not once did it call out GR for being anti-vaccine; heck, it even called GR a group of “concerned parents,” ignoring the group’s history of anti-vaccine activism.
No, being unfair to Generation Rescue is not a problem that FRONTLINE had.
Perhaps most telling is this remark by McCarthy:
For those who’ve watched the show, you know that the Frontline producers broke their promise and presented our entire community’s position through my interview and just two other parents — Barbara Loe Fisher and J.B. Handley.
Where are the doctors and scientists who support our community and support the idea that vaccines may be a trigger for autism? In Frontline’s world, they don’t exist.
Imagine how much more credible the countless stories of children regressing into autism after vaccine appointments would be if a doctor were saying the same thing.
This comment strikingly echoes similar comments by Anne Dachel whining about FRONTLINE on the anti-vaccine propaganda blog Age of Autism:
The claims of parents were noted and dismissed on Frontline.
Not exactly. The claims of parents regarding causation were noted and dismissed based on scientific studies. The show itself gave parents ample time to discuss their non-science-based fears and beliefs about vaccines. Dachel then continues:
A growing number of parents say that vaccines can cause autism and that more studies need to be done. Frontline reported that the science is in. There’s no need for more research because multiple, large-scale studies from around the world have looked at the question and the answer is no.
Ten of thousands of parents report that their children were normally developing until they were vaccinated. They regressed and became autistic. Paul Offit, MD, Anthony Fauci, MD and Eric Fombonne, MD declared that regression following vaccinations is mere coincidence.
Not exactly. Drs. Offit, Fauci, and Fombonne didn’t “declare” regression to be “coincidence.” They merely pointed out that multiple large epidemiological studies have failed to find any evidence that autistic regression in temporal proximity to vaccination is not coincidence. There’s a difference. It’s subtle, I know, perhaps too subtle to penetrate the antiivaccine zealot’s brain. It means that no association has been found at the statistical power level of the studies done. That means it is possible that there might still be a small correlation in a small number of children. However, even given that possibility, there is no good evidence that the “trigger” now claimed by anti-vaccine activists exists, and, even if it did, that would be hugely different thing than the hysterical claims that vaccines have been the primary cause of the “autism epidemic” over the last 20 years. If it were true that vaccines were such a major cause, then the studies performed would almost certainly have found a correlation strong enough to cause an “epidemic” by now. The incredibly shrinking vaccine-autism hypothesis has been reduced to saying that maybe in a small number of children, just maybe, the odd vaccine reaction might, if the child has the genetic predisposition, trigger autism. Vaccines have gone from the bogeyman causing thousands upon thousands of cases of autism in normal children to something that, if you squint real hard and make up genetic predispositions for which there are no good data, you might be able to paint a tenuous connection. The null hypothesis has not been disproven; according to the best science currently available there is no correlation between vaccines and autism, and FRONTLINE was correct to hammer that point home again and again.
I did like one thing that Dachel said, though:
I think a better name for the show would have been, “The Anti-vaccine Movement: Misguided and Dangerous.”
That would have been an excellent title for the show, although I would have probably come up with something even more “insolent” if I were a FRONTLINE producer. Of course, that’s probably why I’m not a FRONTLINE producer.
These days, for the first time in years, I’m optimistic about vaccination. I get the distinct sense that the power and influence of the anti-vaccine movement has peaked. It’s crested and appears to be on the wane now. That doesn’t mean the movement can’t still do enormous mischief, nor does it mean that it is going away any time soon. After all, as long as there have been vaccines, there has been an anti-vaccine movement. What is encouraging is that increasingly the mainstream media is realizing that the anti-vaccine movement as embodied by Jenny McCarthy, J.B. Handley, Barbara Loe Fisher, and their ilk is made up of a bunch of cranks pushing pseudoscience. Some of them are even beginning to appreciate that a whole lot of autism “biomed” quackery produces a huge incentive for various “alt-med” practitioners to keep the myth that vaccine cause autism alive. And these are all good things. Unfortunately, I don’t know if they’ll be enough. If there’s one thing that the anti-vaccine movement has shown, it’s that it’s always ready to come back, and, even if the latest setbacks destroy its ability to mobilize a mass message, I fully expect that anti-vaccine sentiments will return one day.
Damn. My manic phase appears to be ending.