Terra Sigillata


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One of the most engaging and clearly-written pieces of science journalism over the last year or so was published in Wired magazine last week. Amy Wallace’s, “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All,” is part interview with rotavirus vaccine developer, pediatric infectious disease physician, Dr Paul Offit, and description of the anti-vaccination movement in the United States.

Wallace’s work is the centerpiece of a collection of smaller articles providing science-based information about vaccination that also refutes common anti-vaccination myths including “How To Win An Argument About Vaccines” and “The Misinformants: Prominent Voices in the Anti-Vaccine Crusade”.

Wired’s follow-up discussion of the issue includes, “A Short History of Vaccine Panic,” for those of us who “have a day job” and not enough time to read Paul Offit’s 2008 book, “Autism’s False Prophets.”

I have to admit that it wasn’t until I began blogging four years ago that I realized just how vocal the anti-vaccination movement was in the United States. I come from a time (just on the tail end of the Baby Boom) where I still have relatives who were afflicted with polio and other now-preventable infectious diseases. The devastation of these childhood illnesses makes the risks (yes, I agree there are some risks) of vaccination itself inconsequential.

Vaccination is a risk-benefit proposition but one where someone else’s view affects us all. Lack of vaccination compromises “herd immunity” that keeps us all safe, for example, from diseases like smallpox that have been eliminated from the face of the earth. For example, I wrote most recently about a whooping cough outbreak in southwestern Colorado and prior calls in Durango for vaccination as a socially responsible act, much like cutting brush on one’s property to protect a neighbor’s house in a wildfire.

Others, such as my colleague, Orac, have commented on Wallace’s article for its scientific and medical accuracy. However, I wanted to focus on the effectiveness of the writing as a scientific communication tool because much of the article gives the reader a concise view of issues and psychology that often take typical bloggers thousands of words to express (and still less effectively!).

The Motives of Paul Offit

Wallace does a terrific job of showing us just how scary life is for Paul Offit and his family (with death threats reminiscent of those by animal rights and anti-abortion activists). He is a doc at the Children’s Hospital in Philadelphia and, as mentioned earlier, is one of the developers of a vaccine for rotavirus sold commercially as RotaTeq®. While not particularly deadly (although the parents of the 20-60 dead US infants and toddlers annually may beg to differ – as well as those of the half million worldwide), rotavirus causes a severe form of acute diarrhea in several hundred thousand US kids annually under age 5. If you’ve had a kid with it, you wish they didn’t have to endure it if a vaccine would prevent the infection and sequelae.

Wallace also describes how Offit was in the hospital with kids suffering from polio in the mid-1950s. Hence, unlike many of today’s anti-vaccination advocates, Offit was influenced deeply and early by witnessing firsthand the devastation of now-preventable infectious diseases. That’s the world in which my parents and grandparents lived.

“It was a pretty lonely, isolating experience,” Offit says. “But what was even worse was looking at these other children who were just horribly crippled and disfigured by polio.” That memory, he says, was the first thing that drove him toward a career in pediatric infectious diseases.

Wallace goes on to describe a case in 1977 where, as an intern, Offit observed the death of a child from rotavirus, being surprised that the disease still killed kids. I’d say that many of us in science and medicine were influenced similarly in pursuing our respective career tracks.

Anti-vaccination advocates often criticize Offit for being in the pocket of Big Pharma (whatever that really means) because he made $50 million from the development of the RotaTeq vaccine. Offit admits to it being several million – a much more realistic number given what I know about deals made by institutions vs. remaining payouts to individual scientists – and he has every right to benefit from the intellectual property he has developed from his hard work. Offit has a four-bedroom house with his wife (who is also a pediatrician) and they each drive a Toyota Camry. He does not appear to have an extravagant lifestyle and, to be honest, why should we begrudge him if he did?

Offit acknowledges that he received a payout — “several million dollars, a lot of money” — when his hospital sold its stake in RotaTeq last year for $182 million. He continues to collect a royalty each year. It’s a fluke, he says — an unexpected outcome. “I’m not embarrassed about it,” he says. “It was the product of a lot of work, although it wasn’t why I did the work, nor was it, frankly, the reward for the work.”

There are plenty of us who have our kids vaccinated for rotavirus and I’m perfectly happy for Offit to collect a royalty. Does this make him evil? In fact, last week the CDC published that the vaccine is already responsible for reducing cases and hospitalizations for rotavirus. If that’s the definition of evil then I aspire to be evil.

Wallace also notes indirectly that the anti-vaccination movement is doing just what they accuse Offit of doing: making money off of the situation:

At this year’s Autism One conference in Chicago, I flashed more than once on Carl Sagan’s idea of the power of an “unsatisfied medical need.” Because a massive research effort has yet to reveal the precise causes of autism, pseudo-science has stepped aggressively into the void. In the hallways of the Westin O’Hare hotel, helpful salespeople strove to catch my eye as I walked past a long line of booths pitching everything from vitamins and supplements to gluten-free cookies (some believe a gluten-free diet alleviates the symptoms of autism), hyperbaric chambers, and neuro-feedback machines.

Yes, where the science is not yet complete, pseudoscience (and the attendant money-grubbing hucksters) fill the void. The difference between them and Offit: the product Offit developed has extensive scientific data to back up its effectiveness.

Efficiency of words

But getting back to what impressed me most about Wallace’s article was how concisely she presented her content. Here, she sums up one of my discussion points above:

Today, because the looming risk of childhood death is out of sight, it is also largely out of mind, leading a growing number of Americans to worry about what is in fact a much lesser risk: the ill effects of vaccines.

To describe the hypocrisy of an Offit opponent:

Hence the death threats against Paul Offit. Curt Linderman Sr., the host of “Linderman Live!” on AutismOne Radio and the editor of a blog called the Autism File, recently wrote online that it would “be nice” if Offit “was dead.”

I’d met Linderman at Autism One. He’d given his card to me as we stood outside the Westin O’Hare talking about his autistic son. “We live in a very toxic world,” he’d told me, puffing on a cigarette.

To describe the logical trapping of pseudoscience believers:

. . .the astronomer Carl Sagan reached a similar conclusion: Science loses ground to pseudo-science because the latter seems to offer more comfort. “A great many of these belief systems address real human needs that are not being met by our society,” Sagan wrote of certain Americans’ embrace of reincarnation, channeling, and extraterrestrials. “There are unsatisfied medical needs, spiritual needs, and needs for communion with the rest of the human community.”

Looking back over human history, rationality has been the anomaly. Being rational takes work, education, and a sober determination to avoid making hasty inferences, even when they appear to make perfect sense. Much like infectious diseases themselves — beaten back by decades of effort to vaccinate the populace — the irrational lingers just below the surface, waiting for us to let down our guard.

To describe how people evaluate, incorrectly, perceived vs. actual risks:

Perceived risk — our changing relationship to it and our increasing intolerance of it — is at the crux of vaccine safety concerns, not to mention related fears of pesticides, genetically modified food, and cloning. Sharon Kaufman, a medical anthropologist at UC San Francisco, observes that our concept of risk has evolved from an external threat that’s out of our control (think: statistical probability of a plane crash) to something that can be managed and controlled if we just make the right decisions (eat less fat and you’ll live longer).

Most recently, Wired demonstrates that, like the rest of us who employ the scientific method to evaluate data, it’s okay to admit (as well as the responsible thing to do) when one makes a mistake and then describe the consequences, or lack thereof, of the misstatement. For example, Wallace’s article did mistakenly state that vaccines no longer contain thimerosal, an anti-microbial preservative that has proven safe in over a dozen studies:

An earlier version of this story suggested that no childhood vaccines contain thimerosal; in fact some versions of the influenza vaccine, which is not typically mandated for children’s admission to school, does contain the preservative. Go here for a further explanation.

Amy Wallace the journalist

Finally, what I think also impresses me is Amy Wallace herself and her approach to this article. Wallace is not your typical science journalist. The majority of her portfolio is comprised of works on Hollywood and the entertainment industry. She is not a lobbyist or otherwise a representative of the pharmaceutical industry – as you might guess, she is already being accused of being such by anti-vax advocates, In fact, Wired has published a follow-up on Ms. Wallace’s background in response to a misinformation campaign about her that has already developed. (Nor this hasn’t stopped the anti-vax commenters from stating that the entire Wired feature is a paid hit job for the pharmaceutical industry.)

When the facts don’t support an opponent’s view on a pharmaceutical or therapeutic issue, the tendency is an intellectually lazy cry of “Pharma Shill.”

Wallace’s approach to Offit himself is, I think, so effective because she is supremely experienced at writing about personalities, their inner workings, and how they are viewed by the public. As an entertainment writer, she also has to delve into the truths behind the motivations of people and get past appearances and hype. She went above and beyond in giving time and publicity to anti-vaccination advocates, and their websites, and pretty much gave the reader all they need to make up their own minds about the issue.

But most importantly, all of scientists with whom I communicate on blogs and Twitter have agreed that the science reported in Wallace’s article is virtually entirely valid and supported by solid, published data (Orac has an issue with her thesis that anti-vaccinationist emerged due to Pharma’s high-profile missteps but otherwise applauds her work).

But the combination of scientific validity, her engaging writing style, and historical/psychological commentary on pseudoscience comes together to create an overall win and an example of what science journalism can be.

The record-setting pageviews for Wired and froth in the comments from anti-vaccination activists tells us all we need to know about how influential Ms. Wallace’s article is already and will continue to be.

Congratulations, Amy, and thank you.

Comments

  1. #1 Broken Link
    October 25, 2009

    Decreased vaccination rates, and subsequent resurgence of disease are not the only consequences of the anti-vaccine movement. In a lengthy piece at LB/RB, a guest blogger describes a different consequence.

    http://leftbrainrightbrain.co.uk/?p=3144

    Many thousands of children are being used as guinea pigs in their parents’ efforts to “recover” them from “vaccine-induced-autism”.

    While the article itself is revealing, the comments are even more so. The post attracted some of the more rabid anti-vaxers who were very annoyed that their cosy yahoo group environment had been breached.

  2. #2 jre
    October 26, 2009

    I, too, thought the Amy Wallace piece was clear, direct and well-written. More science writing should have this kind of immediacy, because a depressingly large number of well-educated people have been lured away from rational medicine and this, I think, is what it will take to bring them back.

  3. #3 Sili
    October 28, 2009

    For all that I fanboy over Ben Goldacre, I think he needs to offer a – partial – apology to humanities graduates. They’re obviously not all flaky and scientifically illiterate. In fact ms Wallace demonstrates – as you say – that she know how to communicate.

    And for the record I read the Wired piece when Ben linked to it, so he knows. (Here via Cosmic Variance.)

  4. #4 jre
    October 28, 2009

    Sean Carroll’s article in Discover continues to draw comments from JB Handley, who started by brushing off criticism of his “rape” remark:

    I receive more hate mail in a day than Ms. Wallace has probably gotten in her lifetime. Unlike Ms. Wallace an Paul Offit, I just don’t whine about it.

    Just for reference, I looked it up in the dictionary:

    shameless, (shām-ləs) adj., See Handley, JB

  5. #5 erin
    October 28, 2009

    Her piece was great if you like one sided journalism that didn’t interview one single doctor (and there are many) who are against many vaccinations… My God could she kiss Offit’s ass any more than she did?

    I think not.

  6. #6 Abel Pharmboy
    October 28, 2009

    erin, it seems that Wallace took the approach of talking with many doctors and experts, attending Autism One conference and speaking to people there, and presenting facts based on the preponderance of medical evidence. Yes, there are doctors who oppose vaccination but most who do are not guided by scientific facts and/or have a poor understanding of experimental design, epidemiology, and biostatistics.

    Objectively regarding Offit, I thought this was the first account where we gain an excellent insight into Offit the physician, his guiding forces, motivations, and approach to science (recall that he was a lone and vocal opponent to smallpox vaccination in the post-9/11 anthrax days).

    I’m sorry that you felt otherwise but I appreciate you weighing in here.

  7. #7 Chester Burton Brown
    October 29, 2009

    I think Erin’s comment (http://scienceblogs.com/terrasig/2009/10/one_of_the_most_engaging.php?utm_source=combinedfeed&utm_medium=rss#comment-2031717) above illustrates a key problem in this debate: those who insist on viewing it as an argument from authority where one authority is pitted against another and their credentials thrown against one another and the ad hominems flow like water.

    The point is that science issues don’t hinge on arguments from authority. Science does not demand faith, only diligence. This means that someone like Erin would better invest her time by READING the literature herself; if she is not sufficiently educated to do so, her next step should be to gain further education so that she can empower herself to understand the studies rather than put her trust in an authority with an agenda for interpret it on her behalf.

    Science is “open source”, after all. No secrets.

  8. #8 jre
    October 29, 2009

    It’s also worth pointing out that, in cases where a deep divide exists as to the facts of a case, it is next to impossible to maintain impartiality without descending into a farcical pretense of quoting both sides equally.

    In science reporting, a journalist is obliged to seek the truth, not balance.

    If Paul Offit is correct in saying that vaccines do vastly more good than harm — and make no mistake, this is an issue of fact, not opinion — then he deserves praise for standing up to the anti-vaccine movement, including doctors who may oppose vaccination, because that movement and those doctors are wrong on the facts.

    It might still be reasonable to criticize Amy Wallace as not having researched the anti-vaccine argument, or not having talked with vaccine opponents. But it is clear from the article that she did do that research, and talked with those people. But she did not agree with them — and that, in a science reporter, is no sin.

    It is also worth noting that an exhaustive survey of the evidence regarding vaccines and autism is available free from the National Academies Press. That report reviewed a huge volume of primary research on vaccines and autism, and considered statements arguing for and against an effect. That’s the way science and health policy should be discussed, and until Amy Wallace’s critics start doing it themselves, it’s hard to take their accusations of bias very seriously.

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    October 30, 2009

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  10. #10 jre
    October 30, 2009

    The ever-improving sophistication of spambots continues to amaze me; but, then, I’m easily amazed.

  11. #11 ehw
    May 15, 2010

    From jre: “It is also worth noting that an exhaustive survey of the evidence regarding vaccines and autism is available free from the National Academies Press. That report reviewed a huge volume of primary research on vaccines and autism, and considered statements arguing for and against an effect. That’s the way science and health policy should be discussed, and until Amy Wallace’s critics start doing it themselves, it’s hard to take their accusations of bias very seriously.”

    If you read the conclusions of and recommendations made by the National Academies (back in 2004), you will find a refreshingly logical and rational assessment of this issue:
    1) Regarding MMR: “The committee concludes that the evidence favors rejection of a causal relationship at the population level between measles-mumps-rubella (MMR) vaccine and autistic spectrum disorders (ASD). However, this conclusion does not exclude the possibility that MMR vaccine could contribute to ASD in a small number of children.” They conclude that further research is warranted to assess whether a small number of children have some sensitivity to the MMR vaccine.
    2)Regarding Thimerosal: “The committee concludes that although the hypothesis that exposure to thimerosal-containing vaccines could be associated with neurodevelopmental disorders is not established and rests on indirect and incomplete information, primarily from analogies with methylmercury and levels of maximum mercury exposure from vaccines given in children, the hypothesis is biologically plausible.
    The committee also concludes that the evidence is inadequate to accept or reject a causal relationship between thimerosal exposures from childhood vaccines and the neurodevelopmental disorders of autism, ADHD, and speech or language delay…The committee recommends the use of the thimerosal-free DTaP, Hib, and hepatitis B vaccines in the United States, despite the fact that there might be remaining supplies of thimerosal-containing vaccine available…The committee recommends research to identify a safe, effective, and inexpensive alternative to thimerosal for countries that decide they need to switch from using thimerosal as a preservative.”
    There are many different lines of arguments here:

    -There is greater risk to the population at large associated with forgoing vaccinations. Ie. people should vaccinate their kids.
    -Yet is impossible to prove that something is safe (for everyone), so more research should be done to uncover the mechanism(s) of autism and of adverse effects of vaccination, such that they may be mitigated (to improve the risk-benefit ratio).
    -Evidence implicating thimerosal is weak, yet mercury compounds are known neurotoxins. The existence of mercury-free alternatives makes it possible to forgo the risk and switch to the alternatives. The cost of this is a financial cost to certain parties in the loss of existing thimerosal-containing vaccines, a cost that the National Academies (and presumably the general public, as well as health professionals) deem acceptable.
    -That epidemiological studies find no association between MMR and autism onset does not preclude a causal relationship between MMR and the onset of autism in a small proportion of children. Further study of children with autism may uncover biomarkers that could enable an epidemiological look at a sample enriched for those who show this biomarker.
    More knowledge of the etiology of a disease like autism can improve(and define) diagnosis, prevention and treatment, as well as inform on the possible causal influences of something like vaccination.

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