NOTE: This review of Dr. Offit's book Autism's False Prophets originally appeared over at The ScienceBlogs Book Club. However, now that the book club for this particular book has concluded, I am free to repost it here for those who may not have seen it and to archive it as one of my own posts. Besides, I know the antivaxers are more likely to see it here...
Well, not really. I might have one of the two. Or not.
Be that as it may, I'm Orac, and I blog regularly at Respectful Insolence. In the more than two and a half years I've been with ScienceBlogs (not to mention the more than a year before that on my own), I've become known as its resident "vaccine blogger." True, others around here sometimes do posts about vaccines, antivaccine lunacy, and the discredited idea that vaccines somehow cause autism, but with nowhere near the frequency and intensity that I do. Without a doubt, I've done more posts about the misinformation, pseudoscience, and outright quackery spread by antivaccine activists such as J. B. Handley's Generation Rescue and his recently recruited empty-headed celebrity spokesperson Jenny McCarthy, not to mention a number of others who promote the resurgence of infectious disease by sowing doubts about the safety of the most effective weapon the mind of humans have ever devised against it. The reason that that antivaccine movement and applying science and critical thinking to the myth that mercury-containing vaccines or vaccines themselves somehow cause autism or all sorts of other dire complications have become such a major theme of my home blog is that few uses of "alternative" medicine bother me as much as the antivaccine orientation of so much of the movement supporting it, a movement that has also led to all manner of "biomedical" treatments (quackery). No doubt that's why I was chosen to be one of the bloggers discussing this book, and I'm quite happy to do it.
What you might not know is how I developed my interest in this particular area of dangerous pseudoscience. After all, I'm a cancer surgeon and an NIH-funded cancer investigator, not a pediatrician, immunologist, or neurologist. As hard as it is for me to believe, given that it seems today that I've always been refuting this nonsense, I only first discovered the antivaccine movement about three and a half years ago. True, I had been a regular on certain Usenet newsgroups for at least four or five years before that and had encountered antivaccinationists there before, but my contact with them online had been sporadic, and they seemed "out there" even in comparison to the usual run-of-the-mill alt-med maven. But then in the spring of 2005 I started to notice in a big way the cadre of pseudoscientists, parents of autistic children, and others who pushed the myth that thimerosal-containing vaccines or vaccines in general cause autism. Oddly enough, it started out with the Huffington Post, of all places. In May 2005, Arianna Huffington started a large group blog, chock full of famous pundits and celebrities writing blog posts. Within three weeks of its formation, I had noticed a very disturbing aspect of the Huffington Post, and that was that it appeared to be providing a major soapbox for antivaccinationists, including a post by Janet Grilo of Cure Autism Now, two posts by that propagandist of antivaccinationists David Kirby, and posts by that Santa Monica pediatrician to the children of the stars, Dr. Jay Gordon, a man who assiduously denies being "antivaccine" but parrots the most blatantly obvious talking points of the antivaccine movement and is currently best known as being the pediatrician for Jenny McCarthy's son Evan. At the very least, Dr. Gordon is an apologist for the antivaccination movement, and he has become one of the "go-to" guys for the media looking for physicians who are "vaccine skeptics," making numerous radio and TV appearances to promote his "skepticism."
The next phase of my "awakening" to just how pervasive antivaccine fearmongering and pseudoscience were came when Robert F. Kennedy, Jr. wrote an incredibly dishonest and deceptive screed that got wide coverage in the summer of 2005. His article, called, charmingly enough, Deadly Immunity was a rehash of all the misinformation about thimerosal in vaccines and autism wrapped up with in a bow of conspiracy-mongering worthy of a 9/11 Truther with a penchant for quote-mining that would make a creationist blush. The article appeared simultaneously on Salon.com (which normally doesn't publish such nonsense) and Rolling Stone, a magazine that really should stay away from science and stick to covering entertainment and politics. It was followed by a media blitz by RFK Jr. and antivaccine propagandist David Kirby, best known for his credulous treatment of the thimerosal/autism link, Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy, published a few months before RFK, Jr.'s article, and his subsequent activities posting antivaccine nonsense on Huffington Post and, more recently, on the quackery-promoting antivaccine blog Age of Autism.
Suffice it to say that at the time I prefaced a post about RFK, Jr.'s article by saying that Salon.com had "flushed its credibility down the toilet" and referred to the article itself as the "the biggest, steamingest, drippiest turd Salon.com has ever published." I bring this up so that the reader knows where I am coming from. Indeed, since that time in the summer of 2005, I've been wondering when scientists, public health officials, and physicians supporting science-based medicine would finally wake up and start to push back against this tide of antivaccine nonsense, which is starting to result in the resurgence of measles and other vaccine-preventable diseases. This year, I've seen some hopeful signs, including organizations like Voices for Vaccines and Every Child By Two, as well as other signs of push-back against the antivaccine movement, which, I hate to admit, has been clearly winning the P.R. war. What there hasn't been yet is a book written from a scientific viewpoint that directly addresses the history of the recent resurgence of the antivaccine movement and refutes the pseudoscience that it promotes.
Until now, that is.
Released last month was a direct shot across the bow of the antivaccine movement in the form of a book by vaccine scientist and physician Dr. Paul Offit of the University of Pennsylvania's Childen's Hospital of Philadelphia, a man whom the antivaccine movement views as an unholy combination of Hitler, Stalin, Mao, Darth Vader, and Satan Incarnate because of his staunch advocacy of vaccines and his willingness to stand up to the antivaccine movement. The book is entitled Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure. Overall it is an excellent primer on the subject and should be required reading for anyone curious about how the antivaccine movement became so pervasive and powerful.
The book begins with a rather interesting choice for a quote:
When religion was strong and science weak, men mistook magic for medicine. Now, when science is strong and religion weak, men mistake medicine for magic.
Actually, I would quibble about whether religion is actually weak these days. In this country, at least, fundamentalist religion, in particular fundamentalist Christianity, seems stronger than ever, permeating society so thoroughly that it is unthinkable that an atheist President will be elected in my lifetime. Elsewhere, fundamentalist Islam and other religions hold sway. Later in the book Dr. Offit makes the connection between religion and the antivaccine movement, which strikes me as a bit incongruous with this quote. However, the quote does characterize quite succinctly that what we are dealing with in the antivaccine movement is not science. Rather it is more akin to religion, because scientific evidence exonerating vaccines as a cause of autism rarely changes the minds of adherents to the antivaccine faith.
One thing I was not aware of is just how much Dr. Offit has been harassed by antivaccine zealots because of his advocacy for vaccination. He lays it all out right from the very first passage in the book:
I get a lot of hate mail.
Every week people send letters and e-mails calling me "stupid," "callous," an "SOB," or "a prostitute." People ask, "how in the world can you put money before the health of someone's baby?" or "How can you sleep at night?" or "Why did you sell your soul to the devil?" They say "I don't have a conscience," am "directly responsible for the death and damage of hundreds of children," and "have blood on [my] hands." They "pray that the love of Christ will one day flood [my] darkened heart." They warn that my "day of reckoning is coming."
Dr. Offit then describes how he became interested in pediatrics and vaccines and the path that led him to become an infectious disease specialist studying vaccines, describing in moving terms one child he took care of who died of a rotavirus infection and how that led him into his current work. Fairly conventional stuff, but it's necessary to understand where Dr. Offit's coming from. He then goes on to describe how he became an advocate for vaccines in the 1990s and how that led to his daily vilification. (Just search Age of Autism if you want to get a flavor of the sort of stuff Dr. Offit is subjected to day in and day out by his enemies.) As part of this campaign, Dr, Offit has even been subject to death threats and calls in which implied threats were made against his family and children. Indeed, after he had casually mentioned his children's names during Congressional testimony in front of quackery-supporting antivaccinationist Congressman Dan Burton's committee, in which he answered a question by Representative John Tierney about whether he vaccinated his own children, a concerned member Tierney's staff warned him, "Never, never mention the names of your own children in front of a group like this." Some of these threats were credible enough that the University of Pennsylvania routinely checks his mail for suspicious letters and packages and he has periodically required an armed guard.
Personally, I find Dr. Offit's story quite credible. Indeed, I've occasionally been at the receiving end of but a small fraction of the vitriol directed at him. True, I have never been physically threatened (although one time I met someone whom I mistakenly thought--just for an instant--was a particularly persistent antivaccinationist who detested me and it momentarily frightened me), but antivaccinationists have certainly done their best to destroy my Google reputation. Usually, the attacks take the form of slander and ad hominem attacks. For example, not only have I been personally attacked by J.B. Handley of Generation Rescue himself on Age of Autism in a prolonged screed, the comments after which mocked my appearance and questioned my manhood, but one particularly deranged antivaccine advocate, who has in the past shown up at least once in the comments on my own blog and is so off the deep end that even antivaccinationists are embarrassed by him, has written posts accusing me of "sodomizing autistic children" and of being a "member of NAMBLA." (Google it if you don't know what the acronym means.) He bases his accusations on a list circulated on Usenet by Holocaust deniers back around 2000 designed to smear those of us involved in the fight against online Holocaust denial as pedophiles. The list is so obviously a pile of lies, but that didn't stop him and it doesn't stop other cranks from periodically resurrecting this zombie and setting it loose to try to eat the brains of those who see it. Indeed, this same blogger/commenter has even tried to link Kathleen Seidel to NAMBLA as well. (More on her later, as she is a major player in the book.) Now, I'm just a rather insignificant blogger, not a vaccine researcher who has been on national television and testified in front of Congress about vaccine safety, and I've experienced a somewhat disturbing amount of abuse and vitriol. I can only imagine what Dr. Offit has been subjected to.
After describing his stake in this debate, Dr. Offit dives right in, beginning with a brief history of vaccines and then of the condition known as autism, serving as a background, including some earlier forms of autism "treatments" such as facilitated communication, a now discredited technique that led to false accusations of rape and child abuse against parents based on nothing more than suggestibility and the ideomotor effect. He then proceeds to describe how Andrew Wakefield's litigation-funded research published in The Lancet in 1998 led to a scare over the MMR vaccine that has not abated even a decade later and has also led to measles again becoming endemic in the U.K. That's just the warmup. I have to admit that this is the first book I've ever read about a topic that I had been following in detail and writing about myself periodically. Consequently, my review is filtered through that prism, just as Kev's viewpoint is filtered through the prism of his actually "having lived" the story told in this book. It may also be the reason why I found how Dr. Offit structured the first part of his story particularly jarring. He begins the thimerosal story with a chapter entitled "Mercury Rising." This chapter is a fairly straightforward and relatively uncritical recitation of the "science" used by antivaccinationists to show that mercury causes autism. From my perspective, having read and analyzed many of these studies and knowing that they are at best irrelevant and at worst rank pseudoscience, I found this chapter especially disturbing. I think I know what Dr. Offit was trying to do: To show how the steady drumbeat of such studies can give the impression that there is scientific legitimacy to the question fo whether vaccines cause autism, but it was hard to swallow. True, Dr. Offit immediately follows the chapter with "Mercury Falling," in which he demolishes over and over again the "science" claiming to show that mercury in vaccines causes autism, but the overall effect disturbed me. Of course, that's just me. I'd be curious to hear what others who have read the book thought of this structure.
One person who comes in for criticism is Dr. Neal Halsey, who in 1999 was head of the American Academy of Pediatrics' vaccine advisory committee and was also instrumental in persuading the CDC to recommend the removal of thimerosal from vaccines even though there wasn't any real science to show it to be dangerous. Two interesting points come out of this chapter that I hadn't been aware of. First was the dynamic of how this came about. Many of the meetings held to discuss the matter were done by conference calls often dominated by Dr. Halsey. Indeed, the CDC committee was initially not at all enthusiastic about Dr. Halsey's recommendations because they didn't see any science compelling enough to warrant urgency. However, through force of will during several conference calls Dr. Halsey ultimately won the day. What seems to have happened is that, absent sitting in a room with all the players, members of the CDC got the impression that a "snowball" was growing in favor of doing something. Members later said that they were extremely skeptical but that with Dr. Halsey dominating the conversations and the inability to see the body language of other members of the committee, they didn't realize that they were not alone in their extreme skepticism about the advisability of "doing something now." The second point is that the banning of thimerosal absent compelling evidence that it caused harm was a fantastic example of the "precautionary principle" run amok, in which a ban was recommended "just in case." That decision more than any other, argues Dr. Offit, was responsible for the subsequent nine years of antivaccinationist fearmongering over mercury in vaccines. After all, parents not unreasonably think, if the CDC and AAP recommended removing thimerosal from vaccines, there must have been a reason. Maybe there was something wrong that is now being hidden! Reassurances by the CDC that the recommendation was "just as a precautionary measure" designed to "make vaccines even safer" were not particularly convincing in comparison. Actions speak louder than words, after all. In other words, although antivaccine advocates were agitating about thimerosal in the late 1990s and likely would have continued to do so, the ultimate magnitude of the thimerosal scare in the U.S. was largely a self-inflicted wound on the part of the CDC and AAP.
One face familiar to me was featured prominently in this book, a woman named Kathleen Seidel, who created the Neurodiversity website and blog. She has been a thorn in the side of antivaccinationists for several years now. Arguably her biggest contribution is how she has revealed the sordid details of the conflicts of interest and pseudoscience "Behind the Mercury Curtain," so to speak (the title of the chapter in Autism's False Prophets featuring Seidel). She was the first to uncover how Dr. Mark Geier and his son David formed a dubious and "elusive" institute and packed an institutional review board of that institute with their cronies to rubberstamp their unethical "clinical trials" using chelation therapy and the powerful anti-androgenic and -estrogenic drug Lupron under the guise of treating "precocious puberty." Indeed, my learning about the Geiers and their highly unethical research behavior back in 2006 was the second "awakening" I had about the antivaccine movement.
Through the latter part of the book, Dr. Offit reviews all the other major players in the antivaccine movement. They're almost all there: J.B. Handley of Generation Rescue (now rechristened as "Jenny McCarthy's Autism Organization") and Age of Autism; Jenny McCarthy and her "Green Our Vaccines" nonsense; aging shock-jock Don Imus; chemistry professor-turned-antivaccinationist Boyd Haley; Mady Hornig; Richard Deth; David Kirby; and, of course, Robert F. Kennedy, Jr. None of them are spared, nor should they be. For someone as interested as I, there wasn't much there that I didn't already know, although I was surprised to learn just how tightly RFK, Jr. is affiliated with trial lawyers (I had always thought he was idealistic but seriously misguided on the question of vaccines) and how David Kirby apparently used to bluster and bully that he was "with the New York Times" to try to obtain interviews when in fact he was never anything more than a freelancer who was occasionally published in the Gray Lady. However, to those who aren't familiar with these characters, it is potentially eye-opening. Unfortunately, one aspect of this story that is missing is how antivaccine activists have coopted the case of Hannah Poling to serve their propaganda. True, the case didn't really explode onto the scene until March. Perhaps it was too late to include it in the hardcover book, and I hope that Dr. Offit will write an update for the paperback edition. Indeed, the manipulation of the Hannah Poling case and the way that antivaccinationists latched on it as "evidence" that rare mitochondrial disorders are allegedly a factor predisposing to "vaccine injury" causing autism warrant a complete chapter in and of themselves.
The closing third of the book deals with how science is handled in the courts and in society. There is an extensive discussion of the Autism Omnibus and how weak the plaintiff's case was in the first "test case." More importantly, Dr. Offit echoes a lament that I have made time and time again about how science is so frequently misrepresented and abused in the media, describing specific examples. One point he makes is that scientists always tend to qualify their remarks and be very careful about stating conclusions. That's nothing but good science (remember, science can never absolutely prove that there is no correlation between vaccines and autism, only suggest just how very, very unlikely it is that there is one), but such "weasel words," which are normal qualifications of the uncertainty inherent in scientific conclusions, leave the average layperson thinking that there really is a major controversy among scientists. In the case of whether vaccines cause autism, there is not. Dr. Offit also compares the P.R. techniques used by the antivaccine movement to discount the science exonerating thimerosal-containing vaccines or vaccines in general as a cause of or contributor to autism to how the tactics tobacco companies used back in the 1950s and 1960s to try to convince people that there was still a scientific controversy over whether cigarette smoking causes lung cancer. He also points out how, in this age of science, belief in magic and the paranormal remain very common, making the connection between the lack of critical thinking skills that allow such superstition to continue to flourish and how easily pseudoscience can become accepted as "fact"--a point I have made many times before.
Of course, no review would be complete if I didn't briefly mention two things that bugged me about this book. No book is perfect, and Dr. Offit's is no exception. Don't get me wrong, though. Overall Autism's False Prophets is an excellent book that I recommend highly. Nonetheless, I do have two minor nits to pick. The first is that Dr. Offit approvingly quotes Steven Milloy twice and Michael Fumento once, both of whom are well known corporate shills, apologists for conservative politics, antienvironmentalists, and anthropogenic climate change "skeptics." (Indeed, Steve Milloy is known for his famous and dubious "Ultimate Global Warming Challenge.") Moreover, both have been accused of ties to the very tobacco companies to which Dr. Offit compared antivaccinationists to, and both have conflicts of interest in the form of ties to and/or funding from the industries whose interests they virtually always champion, be it big oil, big pharma, or big tobacco. That they happen to be correct in condemning the antivaccination movement is not a good enough reason to cite them, and Dr. Offit could have made his points just as well without including quotes from such tainted sources. Even though the quotes themselves argue Dr. Offit's case about science and society and the law, anyone who has skeptically examined the rhetoric of Milloy or Fumento will know that neither of them is a credible spokesman for science-based medicine.
The second nit is that Dr. Offit comes off as a bit credulous about the National Center for Complementary and Alternative Medicine (NCCAM). Indeed, at one point he states:
But what worried many scientists and physicians about NCCAM was that alternative medicines would be exempt from the scientific method. Fortunately, that hasn't happened.
I would argue that that is exactly what has happened with the rise of NCCAM. Dr. Offit then goes on to argue that NCCAM has tested "several alternative medicines" and concluded that they didn't work, mentioning laetrile. Actually laetrile was tested and found to be ineffective back in the 1980s, several years before the office that was the precursor to NCCCAM was ever established in the NIH. In any case, I invite Dr. Offit to read articles arguing this very point written by Wally Sampson (perhaps the most infamous call for NCCAM to be defunded), Steve Novella, Kimball Atwood, and me that argue otherwise and that NCCAM is a corrosive force against science-based medicine and for the accelerating infiltration of pseudoscience into academic medicine.
Be assured, however, that from my point of view the two nits I just picked are inconsequential compared to what is good and accurate about Autism's False Prophets. Indeed, that I noticed them at all is probably a consequence of my having been active in the skeptical movement a long time (i.e., I "know too much"). After the virtually nonstop barrage of antivaccine propaganda and pseudoscience that has permeated the national zeitgeist, especially since Jenny McCarthy became a convert to antivaccinationism a little more than a year ago, Dr. Offit has provided a refreshing, science-based change of pace on the topic of vaccines and autism that pulls no punches. Every parent who has concerns about vaccines should read it to learn just how weak and without basis in science the claims of antivaccine "scientists" and advocates are and just how riddled with conflicts of interest every bit as bad as any attributed to big pharma so many of the luminaries of the antivaccine movement are. Even better, those out there who might be worried that Dr. Offit will be profiting from sales of his book can take comfort in the fact that Dr. Offit will not receive any money from it. He has promised to donate all royalties from sales of Autism's False Prophets to autism research. Of course, it won't be the type of autism "research" funded by Generation Rescue or performed by the likes of Boyd Haley, the Geiers pÃ¨re et fils, Andrew Wakefield, Laura Hewitson, Raymond Palmer or other false prophets of autism. It will go to real scientists doing real research on the science of autism and treatments designed to help autistic children, rather than subjecting them to a mind-dizzying panoply of "biomedical" interventions that are not only expensive but useless and potentially dangerous.
Education and contributing to science-based medicine, what more could one ask for? What will be amusing is watching Autism's False Prophets being released at the very time as Jenny McCarthy's latest antivaccination Indigo woo-fest Mother Warriors. No doubt McCarthy's book will be a best-seller, as there is an unending appetite for this sort of paranoid conspiracy-mongering. Indeed, there is a reason why Jenny McCarthy has been able to reenergize the antivaccine movement, both with star power (her boyfriend Jim Carrey's star power far more than her D-list star, which had been fading before she latched onto the autism "biomed" movement), money because of the fundraisers she and Carrey can front, and the manner in which she can resurrect Andrew Wakefield's career. It's good to see that there is at least one lone voice calling her, Wakefield, Mark and David Geier, and J.B. Handley, and all the antivaccinationists who endanger public health out for their pseudoscience.
My copy just arrived today. Am looking forward to reading it.
" Besides, I know the antivaxers are more likely to see it here"
Mr. Orac, this is clearly not the work of a master baiter. Try again.
Orac: I understand what you fear -- that while Dr. Offut wants to have some sort of dramatic tension (the "Merc Rising" chappie) before lowering the boom (the "Merc Falling" chapter), the professional quote-miners of the anti-vax movement will have a field day here.
It reminds me of efforts to "prove" that "loyal black slaves" were allowed to bear arms for the Confederacy. The modern-day promoters of this use certain 1915 issues of the old magazine The Confederate Veteran as evidence, but carefully ignore the later issues of the mag that debunk the claims.