Health care: September 2008 Archives

Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure

By Paul A. Offit

328 pages

If anybody thinks Paul Offit, infectious-disease specialist at one of the nation's best pediatric hospitals, overstates the physical threats he gets from antivaccinationists, here's a sobering rebuttal: There will be no book tour for Autism's False Prophets, Offit's plain-speaking chronicle of how vaccinations have been erroneously implicated in the rise of autism. The security risk is just too high says the book's publisher, Columbia University Press.

Paul Offit has become the medical equivalent of Salman Rushdie (who went into hiding after the publication of The Satanic Verses, which prompted a fatwa from the Ayatollah Khomeini). And it's not a bad analogy, given the blind faith practiced by those who thoughtlessly adhere to and profit from, against all credible scientific evidence, the idea that vaccines are somehow responsible for a neuropsychiatric condition that is so poorly understood.

In the book's prologue, Offit—who holds a patent on a rotavirus vaccine and who vocally advocates for vaccinations in general—reveals that he gets a lot of hate mail, some of it with religious overtones. One correspondent asked, "Why did you sell your soul to the devil?" and another prays "that the love of Christ will one day flood [his] darkened heart." Offit has also received gruesome death threats ("I will hang you by your neck until you are dead!") and non-too-subtle threats toward his children. But Offit's book, most importantly, is not about Offit.

Autism's False Prophets is a systematic unpacking of the relatively short history of autism, its identification 70 years ago, its rise in frequency (which is primarily, if not exclusively, due to increased recognition), and its broad manifestations, which have driven some parents of severely affected children to the unthinkable. Other parents, desperate for treatment, have been sucked into trying one or more bogus therapies (for instance, facilitated communication), which have been hawked by one or more charlatans willing to fill the therapeutic void in allopathic medicine.

As Offit writes, some of these false prophets are credentialed; some have no medical training whatsoever. Many have been either implicitly or outrightly endorsed by the media and political figures, with no consequences for those who sow the unfounded and dangerous idea that vaccines cause autism. One of the most prominent false prophets, according to Offit, is English gastroenterologist Andrew Wakefield, who attempted to implicate the MMR vaccine as a cause of autism in the late 1990s. Wakefield's work, which received tremendous media attention, was largely funded by a personal-injury lawyer, reveals Offit, and was later discredited on charges of fraud. However, Wakefield's ideas on the dangers of the MMR vaccine contributed to England's recent measles epidemic, and astoundingly, the doctor still has his rabid supporters.

There is also the father-son duo of Mark and David Geier, who (along with others) implicate the vaccine preservative thimerosal as a cause of autism through work performed in their home-basement laboratory in Maryland. The Geiers, in particular, have migrated into shocking territory by advocating dangerous chelation therapy and chemical castration with leuprolide (Lupron; TAP) for autistic children. Offit writes how librarian and tenacious blogger Kathleen Seidel, whose child was diagnosed with a form of autism, has nearly single-handedly revealed the highly questionable nature of the Geiers' work.

Parents of autistic children, like Seidel, who refuse to neglect science or waste their time, energy, and money on unproven and far-fetched treatments, are the poorly credited heroes of the autism story. Offit reveals that he wrote Autism's False Prophets for them. However, the noise from opportunists has been cranked up by ignorant, but highly influential (and arguably financially conflicted), political figures—specifically US Congressman Dan Burton, whose grandchild was diagnosed with autism, and tort lawyer Robert F. Kennedy, Jr., a vocal proponent of the idea that thimerosal causes autism. Public figures like Burton and Kennedy have essentially ignored the series of epidemiologic studies that have exonerated vaccines as the cause of autism, mindlessly asserting that the issue should be settled in the public, instead of scientific, arena. Consequently they divert attention and funding away from credible research into the causes of autism and its treatment.

At play in this mess, Offit soundly argues, is the media's undying hunger for controversy. The idea that vaccines don't cause autism, although true and of vital public interest, isn't particularly provocative. The story's would-be title would mimic a banal headline from the parody newspaper The Onion. Moreover, science itself, which many consumers find terribly dry, isn't easily conveyed in sound bites. Case in point is the appearance of IOM president Harvey Fineberg on "Meet the Press," when he found himself contending on air (in a show of journalistic "balance") with media-savvy writer David Kirby, author of the vaccine-maligning Evidence of Harm. And if "Meet the Press" can't be counted on to provide sound information, little can be expected of Oprah.

For readers who don't believe that science is a yelling contest, the events in Autism's False Prophets—events in which self-interested figures ride roughshod all over medical evidence—will anger. Nevertheless, it is this justifiable anger that can mobilize investigations away from life-saving vaccines and onto the very elusive causes of autism.

The overwhelming majority of American toddlers (age, 19-35 months) received at least 1 recommended vaccine last year, according to data from the National Immunization Survey (NIS), and coverage for at least 1 dose of varicella reached 90% for the first time. Detailed data from the survey were reported in this week's MMWR.

The coverage rate in 2007 for the recommended 4:3:1:3:3:1 series* of vaccinations was 77.4%, which was comparable to rates of previous years. However, the NIS report noted "substantial variability" of coverage among states (Maryland, 91.3%; Nevada, 63.1%) and urban areas (Philadelphia, 82.2%; San Bernardino, 69.6%). Nevertheless, very few children in the examined age group (0.6%) received no vaccinations whatsoever.

Coverage rates for the 4:3:1:3:3:1 series were not significantly different among racial or ethnic groups after adjusting for poverty status, but certain vaccines (ie, 4th dose of DTaP and 4th dose of PCV7) were less likely to be received by children living at or below the poverty level, according to the report. The ethnic group composed of American Indians and Alaska Natives had the highest coverage rates for the vaccination series and specifically for MMR (96.2%), HepB (96.7%), and varicella (94.9%). 

Despite the record number of measles cases reported this year in the United States, the percentage of toddlers who received at least 1 dose of MMR vaccine has remained stable since 2004 (Table). Still nearly 8% of American toddlers did not receive vaccination for the disease in 2007, and small geographic clusters of unimmunized children appear to account for this year's record number of cases of the highly contagious disease. (For those parents who remain wary of MMR vaccination owing to unsubstantiated fears of autism, yet another study published in this week's PLoS One dispels the connection. Orac provides the necessary background and details, sparing others the trouble of posting on the subject. Hosanna.)

Year	≥1 MMR Dose, %
2003	93.0
2004	93.0
2005	91.5
2006	92.3
2007	92.3

Data for the NIS were collected by means of telephone survey for more than 17,000 children (household response rate, 64.9%). The report acknowledges a possible underestimate of vaccine coverage owing to the exclusive use of provider-verified histories. In addition, clusters of unimmunized children were not likely to be detected, given the survey methods.

* Vaccine doses: 4 DTP/DTaP/DT, 3 polio, 1 MMR, 3 Hib, 3 Hep B, and 1 varicella.

Photo of toddler receiving pneumococcal vaccine from the CDC.