On Friday, while discussing what is perhaps the aspect of Autism's False Prophets that is at the same time the most important set of observations (namely, how the media and government miscommunicate science and how the public seems hardwired to misunderstand science) and its most glaring omission (namely, suggestions how to overcome this problem), I talked about "framing" or how we could potentially represent the current science on vaccines in a compelling way that will be persuasive to the bulk of concerned parents. We know that hard core antivaccinationist parents will not be persuaded by virtually anything we say, but they are relatively small in number. It may not seem that way, given how noisy they are and how effective they've become at propaganda and media manipulation, but they are. Far more numerous are parents who hear the alarming rhetoric of antivaccinationists and wonder if maybe there's anything to it all. They are the target audience.
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:
- Sourcewatch: Peter Sandman
- Advice on Making Nice: Peter Sandman Plots to Make You a Winner
- Sandman's Cagey Tactics
- Some Clients of Peter Sandman
- Mining PR Exec Lauds Peter Sandman
- Sorry is the hardest word for AWB
Interesting.
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Its just such a difficult dialogue occurring here, arguing a point with lots of quantifiers against a point that is only composed of absolutes (i.e. "vaccines are essentially exonerated of causing autism, but there is an extremely small chance they do" vs "vaccines cause autism, PERIOD!") I think there is something to be said about some scientists not trusting the public anymore. Individuals are easy to have a discussion with, and even a debate. The public at large, however, almost seems to enjoy shrugging off science at times, and its understandable that scientists and physicians get a bit burned out on listening to people who think they know more because they visited WebMD and watch Oprah. At the end of the day though, a lot of us got into science and medicine to help people, and part of doing that is stepping up and taking it upon yourself to explain what we know and don't know. Folks like Dr. Offit and the bloggers contributing here are doing just that, and their efforts should be applauded. If the real experts don't speak up, then that only leaves the sound of quacks talking.
In my very humble opinion, I think that scientists have very much _understated_ their views, while the antivaccinationists flagrantly overstate everything ("we won't stop fightng until no child has one drop of mercury in them").
By way of comparison, consider what a parent is told by various autism consultants and therapists: Some will guarantee that X or Y therapy WILL produce results ("we will get your child to talk"). Others will talk about the methods they use and inquire particularly about one's child and say they're looking forward to getting started and gently indicate that the end result can't be guaranteed.
It's absolute certainty (that may or may not be delivered on) vs. honest reality based on where a child is at; I know which sort of "therapy" has been truly effective for my son.
I think the 1% is acknowledged. Vaccine injury appears to exist. It's extremely rare, probably undetectable by epidemiology. It's possible that some vaccine injured individuals are autistic.
The problem is that this is not sufficient to the anti-vaxers. They want to fabricate hundreds of thousands of "late onset" vaccine injuries out of thin air. They want to label every single autistic person as vaccine injured, which is completely unacceptable.
BTW, the base framing example/experiment by Kahneman & Tversky suggests that a better frame for vaccines is to say "If we don't vaccinate, X number of people will die," rather than "vaccines are safe."
I think one of the factors the scientific community has to face, in addition to what has been said about the media and the antivax groups, is the lack of trust the American people have in our government. Trust in the government has been going downhill for quite some time and when events like the Vioxx scandal hit the media, the public has no problem believing that if one branch or department of our government is lying then they all can.
So when the CDC or the FDA comes out and says vaccines are safe, the seed of doubt is there. You don't even have to be a conspiracy theorist to have a healthy mistrust of the government these days. It's all too easy to extend this mistrust to all agencies. Unfortunately, it's hard to publicize when something doesn't go wrong, but boy do we love to holler and shout when things do.
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.
I actually do agree with this point. I'm a speech therapist. Some of my pediatric clients are autistic. I've had parents ask me about whether it's true that it's likely to have been caused by a vaccine. My answer tends to go something along the lines of, I wish it were something that simple. If it were, we'd be able to prevent and treat it much more effectively. That autism is a complex neurodevelopmental difference with a complex and poorly-understood etiology is hard for some families to understand, let alone to accept. A lot of families would love for it to be something simple and straightforward and definite. I can empathize with that. It doesn't mean I go about telling them what they want to hear regardless of whether or not it's true.
But, of course, I'm a clinician, not a scientist. So my angle is a bit different.
I could actually agree with your framing, more or less. However, I don't think that what Sandman recommended is the same thing; at least, the emphasis is sufficiently different that I can't agree with it.
There never was any reason to link autism to thimerosal, the only people who need to aplogize are the lawyers who deliberately took some facts and cold-bloodedly twisted them was tortured people at the CDC by pretending to be concerned for the welfare of children when they absolutely could not have cared less how many babies died, so long as they got their big fat cash payoffs.
It was entirely stupid to remove thimerosal from vaccines and I think it's a huge and selfish mistake to say that it was good that they took it out.
That is saying to the rest of the world, that American babies are worth more than the babies of the rest of the world.
The action of taking thimerosal out of vaccines (as if it was a toxin at vaccine levels) was cruel and stupid and endangered the lives a millions of children in countries where they could not afford to take it out. If parents in those countries say, 'well the Americans think it's a poison so it must be, I'll take my chances with diphtheria" then many, many babies could die, and needless stress would be put on parents who think they are choosing between poisoning from a vaccine and death from a disease.
Get real. The US is not the only country in the world, the decisions made here reverberate. Some countries took out thimerosal for other reasons (to make a combined vaccine with live virus). That's fine, thimerosal isn't essential to vaccines for those in rich countries, and maybe with enough money all vaccines can be made without preservatives in the future... but for now, it was dead wrong to take thimerosal out of vaccines based on an irrational fear of the amount of mercury in it. And the lawyers laughed and laughed and planned on how big their new yacht would be when the gov't acted as if they knew it was a toxin.
The "sobbing parents" are sometimes flat out liars, and we don't need to comfort people who are faking the dramatic pain, blah blah. And those parents only increased the stress of parents dealing with autistic kids who can't sleep or whatever because not only do the parents deal with the child's actions but now have the fake "knowledge" that the gov't poisoned their baby.
There's no "moving on" or healing there, the lawyers and the frauds are keeping the wounds open, and that is not the fault of the CDC or IOM or anyone else in public health! It's the stinking greedy lawyers who cooked this up and they are sitting back and laughing at the good scientists who are playing by rules of honesty and reality. The bad scieintists are sopping up the gravy coming through the greedy lawyers, and the autistic kids suffer the most, then the autistic adults, then the parents.
Who is apologizing to the autistic adults and the parents like me? No one. And no one needs to apologize to parents who think their kid was poisoned when the kid was not.
Sorry, I meant: There never was any reason to link autism to thimerosal, the only people who need to aplogize are the lawyers who deliberately took some facts and cold-bloodedly twisted them and used them to torment people at the CDC by pretending to be concerned for the welfare of children
To piggyback on what CyberLizard said, I can completely understand people's distrust in government, particularly their distrust in regulatory agencies. The current administration, in particular, seems to be fundamentally anti-regulation. I would like to see the existing regulatory agencies fully staffed and funded first of, and see where that gets us. After some housecleaning and some good press for government (i.e. government handles catastrophe well, government prevents fraud, whatever) this opinion may shift a bit.
That, it seems, will always be the trump card that the anti-vaxxers play when they deal with the public. I picture something like Larry King Live where Dr. Offit and Jenny McCarthy are on, discussing this topic. Dr. Offit says that there is no link between thimerosal and autism, and there is no link between vaccines in general or MMR specifically and autism and that the science has proven this. Jenny's simple response is the question, "Can you say that with 100% certainty?" Even if he were to explain ahead of time the limits of proving a negative and how 100% certainty is practically impossible (and that's literally practically, too, being that you'd have to determine the cause of autism in every single case, and even then, you could only be within a minuscule fraction of a percent of 100% certainty), this would let that seed of doubt that the anti-vaxxers plant grow in the minds of the undecided public viewing it. The general public doesn't understand how science works. They think that it's all about facts and finding the truth, and even then scientists are wrong all the time, as they seem to change their minds an awful lot. When a scientist learns something new that can change the way that a thing is thought about (e.g., Relativity introducing a mechanism by which gravity works), they get excited about it. It's a happy day because there is a whole new set of hypotheses to test! John Q. Public sees this same thing and thinks that these scientists have no idea what they're doing or talking about, what with their changing their minds and jargon. It sometimes takes a long time for a scientific truth to sink into the public consciousness. Unfortunately, with the anti-vax movement on full offensive, the time might only be curtailed with an epidemic of preventable diseases and hundreds or thousands of injured and dead children. It's so frustrating that they cannot see what they are doing.
I could actually agree with your framing, more or less. However, I don't think that what Sandman recommended is the same thing; at least, the emphasis is sufficiently different that I can't agree with it.
The bit I agreed with was only a small part of what he had to say, it's true. And kind of tangential to his main argument, come to that. Aside from that one point, I agree with your arguments here completely.
"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. "
Comparing those of us who disagree with unequivocal and universal advocacy of the current vaccination schedule to creationists is specious reasoning at it's worst, insulting and further polarizes the discussion.
@10 (& others):
I can't help wondering if how you state the statistics might help? Perhaps presenting results as showing upper limits to any possible link between vaccines and autism might be better than making "concrete" statements, then being made to take a defensive stance in reply?
You could, for example, phrase the results along the lines of "Our results show that if there is an link between vaccines and autistic people, it can occur at most in 1 in 85,000 autistic people", perhaps adding for emphasis, "leaving 84,990-odd of the 85,000 having autism from some unrelated cause".
(I'm inventing the '85,000' for the sake of providing an example.)
I realise that this, too, has confidence bounds, but ones that are perhaps easier to leave aside in the interests of simplicity without compromising accuracy--?
It is hard when you have many different studies, though, as they will all have different bounds and subtly different findings.
Poor, poor Dr. Gordon, he feels insulted. He's offered absolutely no evidence that this comparison is invalid because the opinions anti-vaccine advocates actually have a foundation in science, and instead seeks to draw attention to his hurt feelings. The discussion is likely to remain polarized regardless - determining reality via science is methodologically the polar opposite of belief and faith. Some people look to quality science, and some for sensationalistic magazine articles like RFK's Deadly Immunity.
Nope, Dr. Jay. Sounds about right to me. Antivaccine activists and, yes, vaccine "skeptics" like yourself use specious reasoning. Certainly you've shown me no science compelling enough to make me start to doubt my position. If you had the science you could persuade me I'm wrong. You haven't even tried.
But I digress. I welcome you to rejoin the discussion that you joined and then disappeared from several days ago:
http://scienceblogs.com/bookclub/2008/10/finally_science_pushes_back_ag…
It's not just me, of course, responding to your complaints.
Do'C,
Have some compassion here, Dr. Jay wants empathy, can't you see? http://santiagodreaming.blogspot.com/uploaded_images/keane%20waif-70933… That's all he wants, and to be able to sit next to the blonde airhead Jenny McYeasty at a card table at a casino-themed fundraiser. He's a man of few needs.
Actually, if Dr. Jay is unhappy with my comparison of the beliefs of antivaccinationists to those of evolution-denying creationists, wait until he sees what Kristina Chew's upcoming post. I was just in the control panel of the blog looking for comments caught in the spam filter, and I saw the title of her post. I couldn't resist reading what she had written thus far. (Sorry, Kristina.)
Suffice it to say, that it looks great thus far. Think about it this way. What is creationism but religion? I compared antivaccinationist beliefs to creationism. Kristina takes that comparison one step farther than I did, at least from what I can tell from her unfinished post. 'Nuff said.
How's that for plugging my co-blogger?
Dear Dr. Gordon,
You wrote:
The problem is, it isn't that you "disagree with unequivocal and universal advocacy". It is that you spread misinformation about vaccines.
Here are some of your pronouncements from the Cookie Magazine Q & A
Inaccurate fearmongering about aluminum and formaldahyde, without explaining why these trace ingredients are necessary.
More fearmongering, without distinguishing between correlation and causation. You are asserting that association in time=causality. Evidence, please, doctor.
Doctor Gordon, that is just magical thinking. I expect better than that from a physician.
Fearmongering. Oh, and isn't autism a condition that must be evident far before 84 months of age?
That is just a selection of what you said (or wrote) this past year, in a Q&A interview at Cookie Magazine.
Really, you are again fear-mongering. And can you also address the issue of "the dose makes the poison"? Oh, and that dreaded mercury. I am older than you, and I remember Mercurochrome. Both my grandmothers were Mercurochrome fanatics. A little scrape? I was painted.
It is exactly like the creationist argument -- deliberately distorting facts, and outright misrepresentation. Only you, sir, don't have the protection of religion.
I hope you will come back to read this, from my real-life pal Squid, relative to the child with autism I also know in real life, Leelo.
I sat with Squid as she agonized over the vaccination decision. You, sir, Dr. Gordon, are one of the people who added to her struggle, rather than relieving it. You are arguing from "instinct" rather than evidence.
Will you STOP calling thimerosal is "mercury". And stop pretending autism is the only concern that people have with regards to getting an injection of mercury.
It's an organic compound of mercury, like botox is a compound of nitrogen. And surprise surprise that effects its toxicity.
Dimethyl mercury is the most toxic manmade neurotoxin, and if I remember correctly, ethyl and methyl mercury are of comparable toxicity. Thimerosal quickly converts to ethyl mercury. MUCH more toxic than elemental mercury. Thousands of times? Something like that, anyway.
So it's completely unreasonable to compare it to elemental mercury, including the elemental mercury exposure limits, etc. Never mind autism for a second, thimerosal is still bad bad bad.
The organic group greatly enhances the ability of the molecule to penetrate the blood brain barrier.
just another peice of dishonesty from the pro-vaccinationists. This is a prime example of glossing over the 15 percent that doesn't support you. Nevermind the study for a second. Let's hear why you keep forgetting this salient fact.
Thimerosal breaks down to ethyl mercury, not methyl mercury. In fact, the ethyl group as opposed to the methyl group means that the thimerosal is eliminated faster by the body than dimethyl mercury.
Second, read again. The dose makes the poison. You regularly ingest a number of compounds that would kill you if you were exposed to too much.
Three, there's no good evidence linking the mercury/thimerosal in vaccines to any other condition.
Really, parroting standard and easily refuted antivax talking points is not the way to impress me or anyone else here.
I'm going to have to disagree with Orac; this comparison is indeed deeply unfair. Creationists may be harming the intellectual development of their children, but they tend not to put their lives at risk.
Not wishing to put Doctor Gordon in an awkward position regarding patient confidentiality, but could he please answer one general question which everyone in this discussion would benefit from knowing the answer to.
Dr Gordon, have you ever personally been involved with any patients who have been diagnosed with autism and who have subsequently been cured of the condition?
Enquiring minds want to know.
dimethylmercury is substantially more toxic than methylmercury (mono-methylmercury if you will) or ethylmercury. Not even close in comparison.
Both methyl- and dimethyl- are prepared with methylcobalamin, the same methyl-B12 Jenny used to "cure" her son.
Orac, I have not thanked you vociferously enough for your attention to this issue, your care in dissecting the spurious arguments of the antivaxxers, and your standing up to the BS dished out by apologists like Dr. Gordon. It helps me and my entire family to know there are people out there who aren't letting them get away with their seige against public health and their demonizing of autistic children. Some days it feels like we're chucking wadded-up paper napkins at the mob of pseudoscience-promoters-- and other days it feels like we've got an army at our backs. :) I thank you, and all your fellow Sciencebloggers tackling this issue, Scienceblogs for promoting this book, and Dr. Offit for having written it. Keep up the good fight!!!
By the way, aren't the exposure limits for mercury based on methyl mercury, not elemental mercury? I thought I'd read that somewhere.
Calli, I believe Dr. Offit mentions that in the book, although I don't have a copy with me to check.
Calli Arcale said "By the way, aren't the exposure limits for mercury based on methyl mercury, not elemental mercury? I thought I'd read that somewhere."
I'm not sure, you may have read about the discussion between "ethyl" versus "methyl" types.
It is explained on page 64 of the book under discussion. Here is one sentence from that page "For several hours Halsey listened while FDA officials pored over reams of data showing that the amount of ethylmercury children received from vaccines had exceeded that recommended by the EPA for methylmercury."
Harris Kol states:
You do not remember correctly. Dimethyl mercury is vastly more toxic than either methyl or ethyl mercury.
Oh, and I see that Dr. Gordon is back, making his "straw man" complaints.
He tries to contrast his "position" on vaccines to "...unequivocal and universal advocacy of the current vaccination schedule...". Frankly, this is exactly what "Intelligent Design" proponents try to do when they imply that modern evolutionary biology is unchanged from Darwin's original hypothesis.
Nobody - not the AAP, the CDC or the FDA - are arguing that the "current vaccination schedule" is the best possible schedule. It is simply a consensus - with all that implies - of what the experts in the field recommend. It's just a recommendation, if you recall - it is not mandated. If new data comes up showing that it needs to be changed, it will be changed - as it has in the past.
Dr. Gordon might want to try comparing his unquestioning acceptance of his own "experience" to the real position taken by most pediatricians: that vaccines may not be "100% safe", but they are a heck of a lot safer than not getting vaccinated.
Dr. Gordon appears to enjoy criticizing his opponent's science (usually by making spurious claims about "conflict of interest", "bias" or unspecified "flaws") without bothering to show any of his own - just like the creationists.
He likes to assert that there is no data showing that the current "aggressive" vaccine schedule doesn't cause autism, but he fails to provide any data (apart from his own vast experience) to show that it does. According to Dr. Gordon, we should follow "The Word" (of Dr. Jay Gordon) rather than scientific data - just like the creationists.
And then there's the whole "green vaccines" issue. Dr. Gordon tells us that we need to "green our vaccines" without bothering to mention - except in the vagues terms (e.g. "toxins") why. Just like the creationists tell us that teaching evolution in the schools will lead to anarchy or national socialism (see: Expelled) without explaining why.
I wonder if Dr. Gordon would like to tell us exactly what is in the current vaccines that makes them "non-green"? Be specific, Dr. Gordon - no vague bloviating about "toxins" and "bacteria" and "viruses" - tell us what you think needs to be removed and how much of that material the current vaccines contain.
If Dr. Gordon feels up to that task (I won't be holding my breath - he's shown a rare talent for evading questions), maybe he could outline for us what a "green vaccine" would contain. Unless, of course, he means to use either no vaccines or homeopathic vaccines (I realize that is redundant).
Well, Dr. Gordon, we're breathlessly (except for me, I'm not holding my breath, as I mentioned above) waiting to be enlightened by you.
Prometheus
If you're 99.999999% correct, are you obligated to acknowledge the other 0.0000001%, just to be "conciliatory"?
If you have the occasion to read rather a lot about risk communication and communication/PR tactics, the general recommendation of many experts in the field is "yes." I think you are oversimplifying to say it's merely to be conciliatory, because it's much more than that.
When us science geeks give all our caveats and margins of error and statistics, we're mostly not saying them in a way that reaches the general public very well. If we say, for example, "During daylight hours with less than 5% cloud cover with atmospheric particulates <25ug/m^3 and NOx & SOx <10 ppb, the sky appears to reflect light between 445 and 495nm to Homo sapiens without visual impairments whose retinas contain functional cones of all types", then the general public is told, "The sky is blue." They might hear, "the sky is blue" from a pediatrician, from a gov't official, or from individuals who take it upon themselves to frame science *sigh*, but that's what they hear.
The objection starts when they hear that the sky in some parts of the world is in fact dirty gray, or occasionally multi-colored, which is true, in a way--and we say, "well yeah, that's what we said," and then the conversation somehow gets possessed and degenerates into "my friend read about how sometimes it's orange, for real!" Sandman's point is that it's better to get the rare exceptions out of the way in clear, layperson's terms to begin with, up front, rather than making a blanket statement and hoping for the best, because that way you are the person defining the exceptions, not the loonies anti-blue-sky opinion-holders.
Now, how well that actually works in practice, I dunno. I personally don't have a problem with saying I'm sorry for things whether I am right or not, and I do find that it helps difficult, seemingly intractable situations. It's completely anti-intuitive to assume responsibility for other people's stupidity, it's a real whack to your ego, but he's right when he says it makes you look like a better person. It is really hard for someone publicly frothing at the mouth to look good when you're the one standing there all apologetic and shit. You can't do the "I'm sorry you're an asshat" either, but you can, "I didn't communicate this right, I was being insensitive to your issues, I should've (done whatever else) and I'm sorry." Your main objective is not to convince the idiot who figures the sky is orange, it's to convince the people in the audience who are having moments of doubt.
Neal Halsey needs to apologize for turning mercury into something scary far, far out of proportion with reality.
What he did would be like a scientist saying something overly specific and scary sounding about how if you go outside today you will be struck by gamma radiation or ionizing radiation... I'm not a physicist so I don't know what one might say that would be technically true, but would scare the living daylights out of lots of people.
"Listen, carefully, it has been discovered that all our clothing is reflecting rays from the electromagnetic spectrum of radiation!" something like that. It's pointlessly frightening.
I agree with Ms. Clark. What does Neal Halsey have to say now? Can someone invite him to comment? It was not fair to alarm the public with a theoretical concern when everyone agreed to address the issue with the appropriate science.
I can't speak to how Dr. Halsey might reflect on his contributory role in the current situation, and I am certainly not intending to act as apologist, but this might give some hint on his position in re: vaccines and autism,
Neal Halsey's letter to the NYTimes (it is stated that this was not published--instead a correction was issued by the newspaper.)
"To the editor,
Proposed title: Misleading the public about autism and vaccines."
...The unfortunate use of a sensationalized title in the article published November 10, 2002 in the New York Times Magazine "The not so crackpot autism theory: reports of autism seem to be on the rise. Anxious parents have targeted vaccines as the culprit. One skeptical researcher thinks it's an issue worth investigating." absolutely misrepresents my opinion on this issue. Also, the caption under the photograph of me "Neal Halsey says that vaccinologists have no choice but to take the thimerosal threat seriously" is a not a statement that I ever made..."
11/11/2002
From the page
"Vaccines Do Not Cause Autism"
(other articles and links)
Institute for Vaccine Safety
Johns Hopkins Bloomberg School of Public Health
(Dr. Neal Halsey is the Director).
"...Dr. Halsey expressed concern about subtle learning disabilities from exposure to mercury from environmental sources and possibly from thimerosal when it was used in multiple vaccines. However, this should not have been interpreted as support for theories that vaccines cause autism, a far more severe and complex disorder. Dr. Halsey submitted a letter to the editor of the New York Times to correct the misinterpretation of his opinion;..."
Orac, you wrote, disagreeing with Sandman for saying we should be regretful that MMR was found not to cause autism:
"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."
I heard Sandman at a recent conference, and he used that example. He said something like, "Have you ever thought how great it would have been if Wakefield had turned out right? We could have disaggregated the MMR vaccine and given the components at different times, and voila, far less autism. Thus -- we should express sorrow that Wakefield turned out wrong, becuase if he'd been right, we could have done something to prevent so many future cases of autism."
He wasn't saying to apologize; he was saying we should feel and convey sadness that Wakefield was wrong.
Just a paraphrase, but I think I'm close to what he said.
Think about it: If Wakefield had been right, we would have found a major preventable cause of autism. The fact that he turned out wrong? We shouldn't be so cheerful about that.
Which is almost as dumb as the version of his statement that was reported to me, IMHO. (Maybe he's changed it a bit.) If Wakefield were right, the vaccine industry would likely have been destroyed with lawsuits. Indeed, if you think fear of vaccines is bad now, after such a debacle we'd never get parents to trust vaccines again. It would have been a public health disaster. For a PR guy, I'm surprised that he wouldn't have realize that. Also, hypocrisy is never a good PR strategy, as far as I'm concerned. Sandman castigates scientists for supposedly being hypocritical in being willing to lie to support vaccines (a huge exaggeration at best and an outright lie on Sandman's part at worst), so what's his solution? Be hypocritical in expressing "sorrow"!
Finally, my criticism of Sandman's idiotic false equivalency gambit with regard to the stretching of the truth about vaccines stands.
Sandman's suggested fake sympathetic statement: "oh, gosh, I'm sorry that it didn't work out that Wakers was right because then we'd be past this autism thing," is predicated on the idea that there was ever a real increase in autism so that we ought to be expecting that several people would be looking for a cause and expecting that some nice sincere person would turn out to be wrong.
There was no reason ever to suspect a connection between vaccines and autism. No reason to think there was a real increase in autism. No reason to feel sorry except over the fact that so many people were duped by Wakefield and his merry band of lawyers and anti-vax sycophants.
The "offer the antivaxers your condolences thing is also predicated on the idea that all parents extensively mourn the fact they have a disabled child. Some parents actually enjoy having an ASD child, they aren't a curse.
And saying that every ASD child is a like curse is saying that to all ASD adults, that they were a curse to their parents and everyone wishes that they had been born not-autistic. Like that's supposed to make us all feel good about ourselves and make people more likely to want to employ us?
I'm probably too late to the party now, but to orac's response to my previous post:
Yes, ethyl mercury is what I said, not methyl. I didn't say it was linked to any conditions. Is reduced IQ a condition? Of course not. Is it bad? Obviously. I wouldn't be surprised if a large fraction of all human suffering is subclinical. So no wonder people try to get rid of it. With your subclinical-means-insignificant attitude so prevailant, no wonder some people turn away from mainstream medicine, you're not giving them much choice.
If the point is so easily refuted, why haven't you refuted it? I searched your blog, and you never have. Let's see you do it now, if it's so easy. The dose is only one part of the formula, but obviously the toxicity is another other part. Well, what's the toxicity of these different forms of mercury when it comes to subclinical neurotoxicity in vivo, then Mr. physician? Step down from your soapbox and give some actual numbers. So what if ethyl mercury is removed faster than methyl mercury? That may be correlated to toxicity, but it's a long way from the bottom line, and even if it did, that sort of argument still leaves the question of how problematic methyl mercury is, so at least an upper limit on the toxicity can be set.
In any case, pretending thimerosal is plain mercury is still a prime example of how you tend to gloss over some things for your own benefit. Pretending it doesn't matter if it's subclinical is another one. Autism isn't the only reason people avoid vaccines, anyway.
Yes I realize the doses are very small compared to the lethal dose, but there's definitely a lot of room for less obvious harm. Witness the upper limit on how much methylmercury from fish shouldbe consumed at once, according to smart people that know about these things. About 11 micrograms (from a can of tuna), only 10% gets absorbed, so one microgram, compared to 50 micrograms of ethyl mercury from a flu shot, all of which is absorbed at once, which may be less toxic that the methylmercury, sure, but not by all that much. There's no ways around that factor of fifty.
And all for a couple of bucks saved on single dose vials. That's just being stubborn, now.
"The "offer the antivaxers your condolences thing is also predicated on the idea that all parents extensively mourn the fact they have a disabled child. Some parents actually enjoy having an ASD child, they aren't a curse."
Exactly, Ms. Clark. I am one of those parents. I adore my son, and recognize that his ASD is what makes him so awesome to be around! The things he says, the way he views the world, his quirky mannerisms and talents-- I wouldn't miss out on my front-row seat watching his life unfold for anything. I kind of want to kick people who talk about autism like it's a curse.
Mr Kol, no one but you has claimed that various mercury compounds are comparable -- and your claim (that methylmercury is comparable to ethyl mercury) has already been rebutted in this very thread, though not extensively. I doubt very much that you have searched Orac's blog, since you clearly have not even searched this page.
Huh? Toxicity is a measure of the dose at which a substance becomes harmful -- so the dose still makes the poison. The body has robust mechanisms for getting rid of normal environmental levels of various harmful substances. As long as we do not greatly exceed those levels, we should be fine.
Strange that you searched Orac's blog and didn't find anything on that topic. It's a topic that he's written on many times.
This reminds me of Orac's cry, "the stupid, it burrrns"
The doofus obviously has no idea of what the "numbers" that measure toxicity actually are.
The standard measure of toxicity is the LD50, which stands for "lethal dose 50%"--the dose at which a poison kills half of a population.
In general, there is almost always a threshold dose of a poison below which it is entirely harmless. The only exception is cancers produced by substances that interact directly with DNA, where there is a nonzero (but statistically negligible) probability that a single molecule of toxin could induce a dangerous cancer. Every other form of toxicity requires some minimum number of molecules of toxin (i.e. a minimum dose), acting simultaneously in different locations in the body, to cause harm.
I do wonder how much of the empathy gambit is simply the problem that scientists have to admit they don't have a cure while the anti-vaccine contingent claim they do. It's much for friendly and emphatic to say "Yes, I can cure your son" than it is to say "We can do , and but there is no cure". Simple honesty means that scientists will be on some level less empathetic than others.
Calli, I said he never seems to have debunked it. No more or less. Go ahead and find the debunking on his blog, then, and post a link here, I used the search function with several different suitable keyword searches and didn't have any success.
The minimum harmful dose is obviously not a perfect way to get an idea of the actual effect a toxin has at doses above that.
A useful way to measure the toxicity in this instance could be to measure the detriment a toxin has on the iq of rats at various doses in various circumstances and during parts of their life cycle.
hariss kol said "A useful way to measure the toxicity in this instance could be to measure the detriment a toxin has on the iq of rats at various doses in various circumstances and during parts of their life cycle."
So what did you think of the description of animal studies starting on page 112?
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