The debate over childhood vaccination has been in the news on and off for almost a decade. In 2009 WIRED published a comprehensive cover story on the subject–An Epidemic of Fear–laying out the debate and investigating how unjustified and unscientific thinking was fueling a growing anti-vaccine moment. As another wave of narratives about vaccination dominate the media, we thought it was time to revisit our earlier coverage .
To hear his foes talk, you might guess Paul Offit is the most detested human in America. A pediatrician in Philadelphia, he is the coinventor of a rotavirus inoculation that could save tens of thousands of lives every year. Yet environmental activist Robert F. Kennedy Jr. slams Offit as a “biostitute” who whores for the pharmaceutical industry. Actor Jim Carrey calls him a profiteer and distills the doctor’s attitude toward childhood vaccination down to this chilling mantra:” Grab’ em and stab’ em .” Recently, Carrey and his girlfriend, Jenny McCarthy, went on CNN’s Larry King Live and singled out Offit’s vaccine, RotaTeq, as one of many unnecessary inoculations, all administered, “theyre saying”, for just one reason: “Greed.”
Thousands of people revile Offit publicly at rallies, on Web sites, and in volumes. Type pauloffit.com into your browser and you’ll find not Offit’s official site but an anti-Offit screed” dedicated to exposing the truth about the inoculation industry’s most well-paid spokesman .” Go to Wikipedia to read his bio and, as often as not, someone will have tampered with the page. The segment on Offit’s education was once altered to say that he’d analyse on a pig farm in Toad Suck, Arkansas.( He’s a graduate of Tufts University and the University of Maryland School of Medicine ).
Then there are the threats. Offit once got an email from a Seattle man that read,” I will hang you by your neck until you are dead !” Other bracing messages include” You have blood on your hands” and” Your day of reckoning will come .” A few years ago, a human on the phone ominously told Offit he knew where the doctor’s two children went to school. At a meeting of the Centers for Disease Control and Prevention, an anti-vaccine protester emerged from a crowd of people holding signs that featured Offit’s face emblazoned with the word terrorist and grabbed the unsuspecting, 6-foot-tall physician by the jacket.
” I don’t think he wanted to hurt me ,” Offit recalls.” He was just excited to be close to the personification of such evil .” Still, whenever Offit gets a letter with an unfamiliar return address, he holds the envelope at arm’s length before gingerly tearing it open.” I think about it ,” he acknowledges. “Anthrax.”
This isnt a religious dispute, like the discussion about creationism and intelligent design. Its a challenge to traditional science that intersects party, class, and religious lines.
So what has this award-winning 58 -year-old scientist done to elicit such venom? He boldly states — in speeches, in journal articles, and in his 2008 volume Autism’s False Prophets — that inoculations do not cause autism or autoimmune disease or any of the other chronic conditions that have been blamed on them. He supports this assertion with meticulous proof. And he calls to account the individuals who promote bogus therapies for autism — therapies that he says not only don’t work but often cause harm.
As a outcome, Offit has become the main target of a grassroots movement that opposes the systematic vaccination of children and the laws that require it. McCarthy, an actress and a former Playboy centerfold whose son has been diagnosed with autism, is the best-known leader of the movement, but she is joined by legions of well-organized supporters and sympathizers.
This isn’t a religious dispute, like the discussion about creationism and intelligent design. It’s a challenge to traditional science that intersects party, class, and religious lines. It is partly a reaction to Big Pharma’s blunders and PR blunders, from Vioxx to illegal marketing ploys, which have encouraged a mistrust of experts. It is also, ironically, a product of the epoch of instant communication and easy access to information. The doubters and deniers are empowered by the Internet( online , nobody knows you’re not a doctor) and helped by the mainstream media, which has an interest in pumping up bad science to create a “debate” where there should be none.
In the center of the fray is Paul Offit.” People describe me as a inoculation proponent ,” he says.” I find myself as a science proponent .” But in this battle — and attain no mistake, he says, it’s a pitched and heated combat –” science alone isn’t enough … People are getting hurt. The parent who reads what Jenny McCarthy says and thinks,’ Well, perhaps I shouldn’t get this vaccine ,’ and their child dies of Hib meningitis ,” he says, shaking his head.” It’s such a fundamental failing on our part that we haven’t remain convinced that parent .”
Consider: In certain parts of the US, vaccination rates have fallen so low that occurrences of some children’s diseases are approaching pre-vaccine levels for the first time ever. And the number of people who choose not to vaccinate their children( so-called philosophical exemptions are available in about 20 states, including Pennsylvania, Texas, and much of the West) continues to rise. In states where such opting out is let, 2.6 percentage of mothers did so last year, up from 1 percent in 1991, according to the CDC. In some communities, like California’s affluent Marin County, just north of San Francisco , non-vaccination rates are approaching 6 percentage( counterintuitively, higher rates of non-vaccination often correspond with higher levels of education and wealth ).
Science loses ground to pseudo-science because the latter seems to offer more comfort.
That may not sound like much, but a recent study by the Los Angeles Times indicates that the impact can be devastating. The Times found that even though only about 2 percent of California’s kindergartners are unvaccinated( 10,000 children, or about twice the number as in 1997 ), they tend to be clustered, disproportionately increasing the risk of an outbreak of such largely eradicated diseases as measles, mumps, and pertussis( whooping cough ). The clustering means almost 10 percentage of elementary schools statewide may already be at risk.
In May, The New England Journal of Medicine laid the blame for clusters of disease outbreaks throughout the US squarely at the feet of declining vaccination rates, while nonprofit health care provider Kaiser Permanente reported that unvaccinated infants were 23 times more likely to get pertussis, a highly contagious bacterial disease that causes violent coughing and is potentially lethal to infants. In the June issue of the journal Pediatrics , Jason Glanz, an epidemiologist at Kaiser’s Institute for Health Research, revealed that the number of reported pertussis cases jumped from 1,000 in 1976 to 26,000 in 2004. A disease that inoculations induced rare, in other words, is making a comeback.” This study helps dispel one of the commonly held beliefs among vaccine-refusing mothers: that their children are not at risk for vaccine-preventable diseases ,” Glanz says.
” I used to say that the tide would turn when children started to die. Well, infants have started to die ,” Offit says, frowning as he ticks off recent fatal cases of meningitis in unvaccinated children in Pennsylvania and Minnesota.” So now I’ve changed it to’ when enough infants start to die .’ Because plainly, we’re not there yet .”
The rejection of hard-won knowledge is by no means a new phenomenon. In 1905, French mathematician and scientist Henri Poincare used to say the willingness to embrace pseudo-science prospered because people” know how cruel the truth often is, and we wonder whether illusion is not more consoling .” Decades subsequently, the astronomer Carl Sagan reached a similar conclusion: Science loses ground to pseudo-science because the latter seems to offer more convenience.” A great many of these belief systems address real human needs that are not being met by national societies ,” Sagan wrote of certain Americans’ espouse of reincarnation, channeling, and extraterrestrials.” There are unsatisfied medical wants, spiritual wants, and needs for communion with the rest of the human community .”
Looking back over human history, rationality has been the anomaly. Being rational takes run, education, and a sober determination to avoid attaining hasty inferences, even when they appear to attain 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.
Before smallpox was eradicated with a inoculation, it killed an estimated 500 million people. And just 60 years ago, polio paralyzed 16,000 Americans every year, while rubella caused birth defects and mental retardation in as many as 20,000 newborns. Measles infected 4 million children, killing 3,000 annually, and a bacterium called Haemophilus influenzae type b caused Hib meningitis in more than 15,000 infants, leaving many with permanent brain damage. Infant mortality and abbreviated life spans — now regarded as a third world problem — were a first world reality.
Today, because the looming danger 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 danger: the ill effects of inoculations. If your newborn gets pertussis, for example, there is a 1 percent opportunity that the newborn will die of pulmonary hypertension or other complications. The danger of succumbing from the pertussis inoculation, by contrast, is practically nonexistent — in fact , no study has connected DTaP( the three-in-one immunization that protects against diphtheria, tetanus, and pertussis) to death in infants. Nobody in the pro-vaccine camp asserts that inoculations are risk-free, but health risks are minute in comparison to the alternative.
Still, despite peer-reviewed proof, many mothers dismiss the math and agonize about whether to vaccinate. Why? For starters, the human brain has a natural propensity to pattern-match — to ignore the old dictum” correlation does not imply causation” and obstinately persist in associating proximate phenomena. If two things coexist, the brain often tells us, they must be related. Some parents of autistic infants noticed that their child’s condition began to appear soon after a vaccination. The conclusion:” The inoculation must have caused the autism .” Sounds reasonable, even though, as many scientists have noted, it has long been known that autism and other neurological impairments often become evident at or around the age of 18 to 24 months, which just happens to be the same hour infants receive multiple vaccinations. Correlation, perhaps. But not causation, as analyzes have shown.
And if you need a new factoid to subsistence your belief system, it has never been easier to find one. The Internet offers a treasure trove of undifferentiated info, data, research, speculation, half-truths, anecdotes, and supposition about health and medication. It is also a democratizing force that tends to undermine authority, cut out the middleman, and empower people. In a world where anyone can attend what McCarthy calls the” University of Google ,” boning up on immunology before getting your child vaccinated seems like good, responsible parenting. Thanks to the Internet, everyone can be their own medical investigator.
There are anti-vaccine Web sites, Facebook groups, email alertings, and lobbying organizations. Politician dismiss the movement at their peril, and, unlike in the debates over creationism and global warming, Democrats have proved just as likely as Republican to share misinformation and fuel anxiety.
US senators John Kerry of Massachusetts and Chris Dodd of Connecticut have both curried favor with constituents by trumpeting the idea that inoculations cause autism. And Robert F. Kennedy Jr ., a scion of the most famous Democratic household of all, authored a profoundly flawed 2005 Rolling Stone piece called ” Deadly Immunity .” In it, he accused the government of protecting drug companies from litigation by concealing evidence that mercury in inoculations may have caused autism in thousands of children. The article was roundly discredited for, among other things, overestimating the amount of mercury in childhood inoculations by more than 100 -fold, causing Rolling Stone to issue not one but a prolonged series of corrections and clarifications. But that did little to unring the bell.
The bottom line: Pseudo-science preys on well-intentioned people who, motivated by love for their children, become vulnerable to one of the world’s oldest professions. Enter the snake-oil salesman.
When a child is ill, mothers will do anything to make it right. If you doubt that, just expend a day or two at the annual conference of the nonprofit organization Autism One, a group built around the conviction that autism is caused by inoculations. It shares its agenda with other advocacy groups like the National Autism Association, the Coalition for SafeMinds, and McCarthy’s Generation Rescue. All these organizations cite similar anecdotes — infants who appear to shut down and exhibit signs of autistic behaviour immediately after being vaccinated — as proof. Autism One, like others, also points to rising rates of autism — what many mothers call an epidemic — as evidence that inoculations are to blame. Eventually, Autism One asserts that the condition is preventable and treatable, and that it is the toxins in inoculations and the sheer number of childhood inoculations( the CDC recommends 10 inoculations, in 26 dosages, by the age of 2 — up from four inoculations in 1983) that blend to cause disease in certain sensitive children.
Their rhetoric often undergoes subtle shifts, especially when the scientific proof becomes too overwhelming on one front or another. After all, saying you’re against all inoculations does start to sound crazy, even to a parent in distress over a child’s autism. Until recently, Autism One’s Web site categorically blamed” too many inoculations given too soon .” Lately, the language has gotten more vague, quoting” environmental triggers .”
But the underlying argument has not changed: Vaccines harm America’s infants, and doctors like Paul Offit are paid shills of the drug industry.
To be clear, there is no credible proof explained that any of this is true. None. Twelve epidemiological studies have found no data that links the MMR( measles/ mumps/ rubella) inoculation to autism; six analyzes have found no trace of an association between thimerosal( a preservative containing ethylmercury that has significantly been removed from inoculations since 2001 1 ) and autism, and three other studies have found no indication that thimerosal causes even subtle neurological problems. The so-called outbreak, researchers assert, is the result of improved diagnosis, which has identified as autistic many children who once might have been labeled mentally retarded or just plain slow. In fact, the growing body of science indicates that the autistic spectrum — which may well turn out to encompass several discrete conditions — may largely be genetic in origin. In April, the journal Nature published two analyzes that analyzed the genes of almost 10,000 people and identified a common genetic variant present in approximately 65 percent of autistic children.
But that hasn’t stopped as many as one in four Americans from believing inoculations can poison children, according to a 2008 survey. And outreach by grassroots organizations like Autism One is a big reason why.
Researchers, alas, cant react with the same forceful certainty that the doubters are able to deploy not if theyre going to follow the rules of science.
At this year’s Autism One meeting in Chicago, I flashed more than once on Carl Sagan’s idea of the power of an” unsatisfied medical require .” Because a massive research attempt 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 strolled 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.
To a one, the speakers told mothers not to despair. Vitamin D would help, said one doctor and supplement salesman who projected the equation” No inoculations+ more vitamin d= no autism” onto a huge screen during his presentation.( If only it were that simple .) Others talked of the powers of enzymes, enemas, infrared saunas, glutathione drips, chelation therapy( the controversial — and risky — administration of certain chemicals that leech metals from the body ), and Lupron( a medication that shuts down testosterone synthesis ).
Offit calls this stuff, much of which is unproven, ineffectual, or downright dangerous,” a bungalow industry of false hope .” He didn’t attend the Autism One meeting, though his name was frequently invoked. A California woman with an 11 -year-old autistic son told me, aghast, that she’d personally heard Offit say you could safely dedicate small children 10,000 inoculations( in fact, the number he came up with was 100,000 — more on that subsequently ). A mama from Arizona, who introduced me to her 10 -year-old ” recovered” autistic son — a bright, blue-eyed, towheaded son who make his head on walls, she said, before he started getting B-1 2 injections — told him that she’d read Offit had induced $50 million from the RotaTeq vaccine. In her position, “hes in” the pocket of Big Pharma.
The central message at these seminars simmered down to this:” The medical establishment doesn’t care, but we do .” Every vendor I talked to echoed this theme. And every parent conveyed a frustrated, even desperate belief that no one in traditional science gives a hoot about easing their pain or addressing their hypothesis — based on day-to-day parental experience — about autism’s causes.
Actually, scientists have chased down some of these hypothesis. In August, for example, Pediatrics published an investigation of a popular hypothesis that children with autism have a higher incidence of gastrointestinal problems, which some allege is a result of injected viruses traveling to the intestines. Jenny McCarthy’s foundation posits that autism stems from these bacteria, as well as heavy metal and live viruses present in some inoculations. Mending your child, therefore, is subject to clearing out the” environmental toxins” with, among other things, special diets. The Pediatrics newspaper found that while autistic children suffered more from constipation, the cause was likely behavioral , not organic; there was no significant association between autism and GI symptoms. Moreover, gluten- and dairy-free diets did not appear to improve autism and sometimes caused nutritional deficiencies.
But researchers, alas, can’t react with the same forceful certainty that the doubters are able to deploy — not if they’re going to follow the rules of science. Those tenets allow them to claim only that there is no evidence of a link between autism and inoculations. But that phrasing — what sounds like equivocation — is just enough to allow doubts to not only remain but to fester. Meanwhile, in the eight years since thimerosal was removed from inoculations( a public relations misstep, in Offit’s view, because it seemed to indicate to the public that thimerosal was toxic ), the incidences of autism continue to rise.
The battle we are waging will determine what both health and freedom will look like in America. — Barbara Loe Fisher
In the wake of the latest thimerosal analyzes, most of the anti-vaccination crowd — even Autism One, despite the ever-changing rhetoric on its Web site — has shifted their aim away from any particular inoculation to a broader, fuzzier target: the sheer number of inoculations that are recommended. It voices, after all, like common sense. There must be something risky about dedicating too many inoculations to very young children in too short a hour. Foes argue that for some infants the present inoculation schedule makes a” toxic overload .”
” I’m not anti-vaccine ,” McCarthy says.” I’m anti-toxin .” She stops just short of calling for an outright banning. McCarthy delivered the keynote address at the Autism One meeting this year, just as she had in 2008. She described a standing-room-only crowd, many of whom know her not from her acting but from her frequent appearances on Tv talk proves, Oprah Winfrey’s Web site, and Twitter (@ JennyfromMTV ). McCarthy has authored two best-selling volumes on “healing” autism and is on the board of the advocacy group Generation Rescue( motto:” Autism is reversible “). With her stream-of-consciousness rants (” Too many toxins in the body cause neurological problems — look at Ozzy Osbourne, for Christ’s sake !”) and celebrity allure, she is the anti-vaccine movement’s most popular pitchman and prettiest face.
Barbara Loe Fisher, by contrast, is indisputably the movement’s brain. Fisher is the cofounder and president of the National Vaccine Information Center in Vienna, Virginia, the largest, oldest, and most influential of the watchdog groups that resist universal vaccination. At the Autism One meeting, Fisher took the podium with characteristic flair. As she often does, Fisher began with the story of her son Chris, who she believes was damaged by inoculations at the age of two and a half. A short film featuring devastating images of sick children — some of them apparently palsied, others with tremors, others catatonic — drove the phase home. The film, accompanied by Bryan Adams’ plaintive ballad “( Everything I Do) I Do It For You ,” ended with this message emblazoned on the screen:” All the children in this video were injured or killed by mandatory vaccinations .”
Against this backdrop, Fisher, a skilled debater which are normally faces down enunciate, well-informed scientists on live Tv, mentioned Offit often. She called him the leading” pro-forced-vaccination proponent” and cast him as a human who walks in lockstep with the pharmaceutical companies and demonizes caring mothers. With the likely introduction of a swine flu inoculation subsequently this year, Fisher added, Americans needed to wake up to the” draconian statutes” that could force every citizen to either be vaccinated or quarantined. That isn’t true — the swine flu inoculation, like other flu inoculations, will be administered on a voluntary basis. But no matter: Fisher’s argument turns inoculations from a public health issue into one of personal selection, an unwritten bit of the Bill of Rights.
In her speech, Fisher borrowed from the Bible, George Orwell, and the civil rights movement.” The combat we are waging ,” she said,” will determine what both health and freedom will look like in America .” She closed by quoting the inscription above the door of the Holocaust Memorial Museum in Washington, DC:” The first to succumb were the children .” And then she brought it home:” If we believe in compassion, if we believe in the future, we will do whatever it takes to give most children back the future that is their birthright .” The audience cheered as the words sank in: Whatever it takes . “ No forced vaccination ,” Fisher concluded. “ Not in America .”
Paul Offit has a somewhat nasal voice and a forceful delivery that conspire to attain him sound remarkably like Hawkeye Pierce, the cantankerous physician played by Alan Alda on the Tv series M* A* S* H . As a young man, Offit was a big fan of the demonstrate( though he felt then, and does now, that Hawkeye was ” much cooler than me “). Offit is quick-witted, funny, and — despite a generally mild-mannered mien — sometimes so assertive as to seem brash.” Scientists, bound only by reason, are society’s true anarchists ,” he has written — and he clearly watches himself as one.” Kaflooey hypothesis” attain him crazy, especially if they catch on. Fisher, who has long been the media’s go-to interview for what some in the autism arena call” mothers rights ,” builds him particularly nuts, as in” You just want to scream .” The reason?” She lies ,” he says flatly.
” Barbara Loe Fisher inflames people against me. And wrongly. I’m in this for the same reason she is. I care about children. Does she guess Merck is paying me to speak about inoculations? Is that the logic ?” he asks, exasperated.( Merck is doing no such thing ). But when it comes to mandating vaccinations, Offit says, Fisher is right about him: He is an adamant supporter.
” We have seat belt rules ,” he says.” Seat belts save lives. There was never a question about that. The data was absolutely clear. But people didn’t use them until they were required to use them .” Furthermore, government decisions not to buckle up threatens only you.” Unless you fly through the window and make somebody else ,” he adds.” I believe in mandates. I do .”
We are driving north( seat belts on) across Philadelphia in Offit’s gray 2009 Toyota Camry, having just completed a full day of rounds at Children’s Hospital. Over the past eight hours, Offit has directed a squad of six residents and med students as they evaluated more than a dozen children with persistent infections. He pulls into the driveway of the comfy four-bedroom Tudor in the suburbs where his family has lived for the past 13 years. It’s a nice enough house, with a leafy green yard and a two-car garage where a second Toyota Camry( this one red, a year older, and are subordinate to his wife, Bonnie) is already parked. Let’s just say that if Offit has indeed induced $50 million from RotaTeq, as his critics love to say, he is hiding it well.
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 $182 million. He continues to collect a royalty per year. It’s a fluke, he says — an unexpected outcome.” I’m not embarrassed about it ,” he says.” It was an expression of the results of a lot of work, although it wasn’t why I did the run , nor was it, candidly, the reward for the run .”
Similarly, the suggestion that pharmaceutical companies attain inoculations hoping to pocket huge gains is ludicrous to Offit. Vaccines, after all, are given once or twice or three times in a lifetime. Diabetes drugs, neurological drugs, Lipitor, Viagra, even Rogaine — stuff that a large number of people use every day — that’s where the money is.
That’s not to tell inoculations aren’t profitable: RotaTeq costs a little under$ 4 a dose to attain, according to Offit. Merck has sold a total of more than 24 million dosages in the US, most for $69.59 a pop — a 17 -fold markup. Not bad, but pharmaceutical companies do sell a lot of inoculations at cost to the developing world and in some cases give them away. Merck perpetrated $75 million in 2006 to vaccinate all children born in Nicaragua for three years. In 2008, Merck’s revenue from RotaTeq was $665 million. Meanwhile, a blockbuster drug like Pfizer’s Lipitor is a $12 billion-a-year business.
To understand exactly why Offit became a scientist, you must go back more than half a century, to 1956. That was when physicians in Offit’s hometown of Baltimore operated on one of his legs to correct a club foot, necessitating him to expend three weeks recovering in a chronic care facility with 20 other children, all of whom had polio. Parents were allowed to visit just one hour a week, on Sundays. His father, a shirt salesman, came when he could. His mother, who was pregnant with two brothers and hospitalized with appendicitis, was unable to visit at all. He was 5 years old.” 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.
There was something else, too. From an early age, Offit espoused the logic and elegance of the scientific method. Science imbued a chaotic world with an order that he found reassuring.
” What I loved about science was its reason. You have data. You stand back and you discuss the strengths and weaknesses of that data. There’s just something very calming about that ,” he says.” You devise a hypothesis, you establish burdens of proof, you subject your hypothesis to rigorous testing. You’ve got 20 pieces of a 1,000 -piece puzzle … It’s beautiful, really .”
There were no physicians in the Offit family; he decided to become the first. In 1977, when he was an intern at the Children’s Hospital of Pittsburgh, he witnessed the second event that would determine his career track: the death of a little girl from a rotavirus infection( there was, as yet , no inoculation ). The child’s mother had been diligent, calling her pediatrician just a few hours after the girl’s fever, vomiting, and diarrhea had begun. Still, by the time the girl was admitted, she was too dehydrated to have an intravenous line inserted. Physicians tried everything to rehydrate her, including sticking a bone marrow needle into her tibia to inject liquids. She died on the table.” I didn’t realize it killed children in the United States ,” Offit says, remembering how the girl’s mother, after hearing the terrible news, came into the room and held her daughter’s hand.” That girl’s image was always in my head .”
The choice not to get a inoculation is not a selection to take no danger. Its just a selection to take a different danger, and we need to be better about telling, Heres what that different risk looks like .” — Paul Offit
The third formative moment for Offit came in the late 1980 s, where reference is gratified Maurice Hilleman, the most brilliant inoculation maker of the 20 th century. Hilleman — a notoriously foulmouthed genius who toiled for years in the Philadelphia labs of Merck — fabricated vaccines to prevent measles, mumps, and rubella( and later came up with the combination of the three, the MMR ). He made inoculations for hepatitis A and B, Hib, chicken pox, pneumococcus, and meningococcus. He became Offit’s mentor; Offit subsequently became Hilleman’s biographer.
Offit believes in the power of good storytelling, which is why he writes volumes, five in so far. He dearly wants to pull people into the exciting mysteries that scientists wrestle with every day. He wants us all to understand that vaccines run by introducing a weakened strain of a particular virus into the body — a strain so weak that it cannot attain us sick. He wants us to revel in this miracle of vaccination, which causes our immune systems to produce antibodies and develop” memory cells” that mount a defense if we later encounter a live version of that virus.
It’s easy to see why Offit felt a special pride when, after 25 years of research and testing, he and two colleagues, Fred Clark and Stanley Plotkin, joined the ranks of the inoculation inventors. In February 2006, RotaTeq was approved for inclusion in the US vaccination schedule. The inoculation for rotavirus, which each year kills about 600,000 children in poor countries and about 40 children in the US, probably saves hundreds of lives a day.
But in certain circles, RotaTeq is no grand accomplishment. Instead, it is offered as Exhibit A in the case against Offit, proving his irredeemable bias and his corrupted point of view. Using this reasoning, of course, Watson and Crick would be unreliable on genetics because the Nobel Prize wins had a vested interest in genetic research. But despite the illogic, the argument has had some success. Consider the CDC’s Advisory Committee on Immunization Practices, which reviews new inoculations and administration schedules: Back in the late’ 90 s and early’ 00 s, Offit was a member of the panel, along with experts in infectious diseases, virology, microbiology, and immunology. Now the 15 -person panel is made up mostly of state epidemiologists and public-health officials.
That’s not by collision. According to science journalist Michael Specter, writer of the new volume Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet and Threatens Our Lives , the dispute surrounding inoculation security has induced absence of expertise a requirement when choosing members of prominent advisory panels on such issues.” It’s shocking ,” Specter says.” We live in a country where it’s actually a detriment to be an expert about something .” When expertise is lessened to such an extent, irrationality and anxiety can run amok.
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 gratified Linderman at Autism One. He’d dedicated 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.
It was hard to argue with that.
Despite his reputation, Offit has occasionally met a inoculation he doesn’t like. In 2002, when he was still the states members of the CDC’s advisory committee, the Bush administration was lobbying for a program to give the smallpox inoculation to tens of thousands of Americans. Dread of bioterrorism was rampant, and everyone voted in favor — everyone except Offit. The reason: He feared people would die. And he didn’t keep quiet about his reservations, making appearances on 60 Minutes II and The NewsHour with Jim Lehrer .
The problem with the inoculation, he said, is that” one in every million people who gets it succumbs .” Moreover, he said, because smallpox is visible when its victims are contagious( it is marked by open sores ), outbreaks — if the working group ever were any — could be quickly contained, and there would be plenty of time to begin vaccinations then. A preventive inoculation, he said,” was a greater risk than the risk of smallpox .”
Ah, danger. It is the idea that fuels the anti-vaccine movement — that mothers should be allowed to opt out, because it is their right to evaluate danger for their own children. It is also the idea that underlies the CDC’s vaccination schedule — that the risk to public health is too great to allow individuals, one by one, to make decisions that will impact their communities.( The concept of herd immunity is key here: It holds that, in diseases passed from person to person, it is more difficult to maintain a chain of infection when large numbers of its own population are immune .)
Risk is also the motivate idea in Offit’s life. This is a man, after all, who opted to give his own two children — now teenagers — the flu inoculation before it was recommended for their age group. Why? Because the risk of damage if his children got sick was too great. Offit, like everybody else, will do anything to protect his children. And he wants Americans are totally educated about danger and not hoodwinked into thinking that falling inoculations keeps their children safe.” The selection not to get a inoculation is not a selection to take no danger ,” he says.” It’s just a choice to take a different danger, and we need to be better about telling,’ Here’s what that different risk looks like.’ Dying of Hib meningitis is a horrible, ugly route to die .”
Getting the measles is no walk in the park, either — not for you or those who come near you. In 2005, a 17 -year-old Indiana girl get infected on a trip to Bucharest, Romania. On the return flight home, she was congested, coughing, and feverish but had no rash. The next day, without realise she was contagious, she went to a church assemble of 500 people. She was there just a few hours. Of the 500 people present, about 450 had either been vaccinated or had developed a natural immunity. Two people in that group had vaccination failing and got measles. Thirty-two people who had not been vaccinated and therefore had no resistance to measles also got sick. Did the girl encounter each of these people face-to-face in her brief visit to the picnic? No. All you have to do to get the measles is to inhabit the airspace of a contagious person within two hours of them being there.
The frightening implications of this kind of anecdote were illustrated by a 2002 study published in The Journal of Infectious Diseases . Seeming at 3,292 cases of measles in the Netherlands, such studies found that the risk of contracting the disease was lower if you were completely unvaccinated and living in a highly vaccinated community than if you were completely vaccinated and living in a relatively unvaccinated community. Why? Because inoculations don’t always take. What does that entail? You can’t minimise your individual danger unless your herd, your friends and neighbours, also buy in.
Science must somehow prove a negative that inoculations dont cause autism which is not how science typically works. Until the cause of autism is discovered, scientists can establish only that inoculations are safe and that threshold has already been met.
Perceived risk — our changing relationship to it and our increasing intolerance of it — is at the crux of inoculation safety concerns , not to mention pertained dreads of pesticides, genetically modified food, and cloning. Sharon Kaufman, a medical anthropologist at UC San Francisco, observes that our concept of danger has evolved from an external menace that’s out of our control( guess: statistical probability of a plane crash) to something that can be managed and controlled if we just attain the right decisions( feed less fat and you’ll live longer ). Improved diagnostic tests, a change in consumer awareness, an aging society determined to stay youthful — all have contributed to the growing perception that risk( of death, illness, collision) is our responsibility to reduce or eradicate. In the old order, risk management was in the hands of your doctor — or God. Under the new dispensation, it’s all up to you. What are the odds that your child will be autistic? It’s your job to manage them, so get thee to the Internet, and fast.
The thimerosal debacle exacerbated this tendency, particularly when the American Academy of Pediatrics and the Public Health Service issued a poorly worded statement in 1999 that said ” current high levels of thimerosal will not hurt infants, but reducing those levels will attain safe inoculations even safer .” In other words, there’s no scientific proof whatsoever, but you never know.
” When science came out and said,’ Uh-oh, there may be a risk ,’ the stage was already defined ,” Kaufman says , noting that many mothers felt it was irresponsible not to have doubts.” It was Pandora’s box .”
The result is that science must somehow prove a negative — that inoculations don’t cause autism — which is not how science typically works. Edward Jenner invented vaccination in 1796 with his smallpox vaccination; it would be 100 years before science, such as it was, understood why the inoculation run, and it would be even longer before the specific cause of smallpox could be singled out. Until the cause of autism is discovered, scientists can establish only that inoculations are safe — and that threshold has already been met.
The government is still considering funding more research trials to look for a connection between inoculations and autism. To Kaufman, there’s some justification for this, given that it may be the only route to address everyone’s doubts. But the thimerosal panic suggests that, if bungled, such trials could make a bad situation worse. To scientists like Offit, further analyzes are also a waste of precious scientific resources , not to mention taxpayers’ money. They take funding away from more pressing matters, including the search for autism’s real cause.
A while back, Offit was asked to help put together a reference text on inoculations. Specifically, his colleagues wanted him to write a chapter that assessed the capacity of the human immune system. It was a hypothetical exert: What was the maximum number of inoculations that a person could handle? The phase was to limb physicians with information that could reassure mothers. Offit set out to determine two factors: how many B cells, which make antibodies, a person has in a milliliter of blood and how many different epitopes, the part of a bacterium or virus that is recognized by the immune system, there are in a inoculation. Then, he came up with a rough calculate: a person could handle 100,000 inoculations — or up to 10,000 inoculations at once. Currently the most inoculations infants receive at any one time is five.
He also published his findings in Pediatrics. Soon, the number was attached to Offit like a scarlet letter.” The 100,000 number builds me sound like a madman. Because that’s the image: 100,000 shootings sticking out of you. It’s an awful image ,” Offit says.” Many people — including people who are on my side — have blamed me for that. But I was naive. In that article, I was being asked the question and that is the answer to the question .”
Still, he hasn’t backed off. He feels that scientists have to work harder at winning over the public.” It’s our responsibility to stand up for good science. Though it’s not what we’re training to do ,” he says, admitting that his one unhappines about Autism’s False Prophets is that it didn’t hold scientists accountable for letting anxiety of criticism render them mute.” Get out there. There’s no venue too small. As someone once said, it would be a very quiet forest indeed if the only birds that sing were those that sang best .”
So Offit maintains singing. Isn’t he afraid of those who wish him harm?” I’m not that brave ,” he says.” If I really believed my life was at risk or my children’s lives were at risk, I wouldn’t do it. Not for a second .” Maybe, he acknowledges, he’s in denial.
Later, I ask his wife the same question. When it comes to her husband’s welfare, Bonnie Offit is ferociously protective. A pediatrician with a thriving group practise, she still builds time to monitor the blogosphere.( Her husband refuses to read the two attacks .) She wants to believe that if you” keep your finger on the pulse ,” as she sets it, you are able to keep your loved ones safe.
Still, she worries. On the day I find myself sitting at her dining room table, every front page in the nation features an article about George Tiller, the abortion physician gunned down at his church in Wichita, Kansas. When her husband leaves the room, Bonnie brings up the killing.” It upsets me ,” she says, seeming away.” I didn’t even tell him that. But it perfectly upsets me .”
Her husband, meanwhile, still rises every morning at 4 am and heads to his small, tidy study in a spare bedroom. Every morning, he spends a couple of hours working on what will be his sixth volume, a history of the anti-vaccine movement. Offit gets aroused when he talks about it.
In 19 th-century England, he explains, Jenner’s smallpox vaccine was known to be effective. But despite the Compulsory Vaccination Act of 1853, many people still refused to take it, and thousands succumbed unnecessarily.” That was the birth of the anti-vaccine movement ,” he says, adding that then — as now — those at the forefront” were great at mass marketing. It was a print-oriented society. They were great pamphleteers. And by the 1890 s, they had driven immunization rates down to the 20 percentage scope .”
Immediately, smallpox took off again in England and Wales, killing 1,455 in 1893. Ireland and Scotland, by contrast,” didn’t have any anti-vaccine movement and had the highest immunization rates and very little incidence of smallpox disease and death ,” he says, taking a breath.” You’d like to think we would learn .”
Offit wants the book to be cinematic, visually riveting. He believes, fervently, that if he can hooking people with a good, truthful story, perhaps they will absorb his hopeful message: The human race has faced down this kind of doubt before.
His battle is, in at least one respect, probably a losing one. There will always be more illogic and confusion than science can fend off. Offit’s idea is to inoculate people one by one, until the virus of anxiety, if not fully erased, at least recedes.
Amy Wallace ( ecallawyma @gmail. com) has written for GQ, Esquire, and The New Yorker. This is her first article for Wired.
1. An earlier version of this story suggested that no childhood inoculations contain thimerosal; in fact some versions of the influenza inoculation, which is not typically mandated for children’s admission to school, does contain the preservative. Go here for a further explanation .