This month’s issue of WIRED features a great story by Amy Wallace: “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All.” It’s an overview of the anti-vaccination movement in the United States, a topic that should be very familiar to anyone who reads Discover‘s baddest astronomer. At ScienceBlogs, Orac and Abel Pharmboy gives big thumbs-up to the article.
The anti-vaccination movement is a little weird — they claim that vaccines, which are universally credited with wiping out smallpox and polio and other bad things, are responsible for causing autism and diabetes and other also-bad things, all just to make a buck for pharmaceutical companies. The underlying motivation seems to be a combination of the conviction that things must happen for a reason — if a child develops autism, there must be an enemy to blame — and a general distrust of science and technology. Certainly the pro-science point of view is fairly unequivocal; like any medicine, vaccines should be used properly, but they have done great good for the world and there are very real dangers of increased risk for epidemics if enough children stop receiving them. Good for WIRED for taking on the issue and publishing an uncompromisingly pro-science piece on it.
But the anti-vax movement is more than just committed; they’re pretty darn virulent. And since the article came out, author Amy Wallace has been subject to all sorts of attacks. She’s been documenting them on her Twitter feed, which I encourage you to check out. Some lowlights:
- I’ve been called stupid, greedy, a whore, a prostitute, and a “fking lib.” I’ve been called the author of “heinous tripe.”
- J.B. Handley, the founder of Generation Rescue, the anti-vaccine group that actress Jenny McCarthy helps promote, sent an essay titled “Paul Offit Rapes (intellectually) Amy Wallace and Wired Magazine.” In it, he implied that Offit had slipped me a date rape drug.
- Just now, I got an email so sexually explicit that I can’t paraphrase it here. Except to say it contained the c-word. And a reference to dead fish.
- In his book, Autism’s False Prophets, Dr. Offit writes about scientists who have been intimidated into staying silent about autism/vaccines. If scientists – who are armed with facts and trained to interpret them – are afraid, can it be any surprise that a lot of parents are, too?
It’s pretty horrifying stuff. But there is good news: Wallace also reports that the large majority of emails she has received were actually in favor of the piece, and expressed gratitude that she had written it. There are strong forces arrayed against science, but the truth is on our side, and a lot of people recognize it. It gives one a bit of hope.
1. JB Handley Says:
October 26th, 2009 at 8:18 pm
So that is justification for the obscene hate mail sent to Ms. Wallace, for no other reason than writing an article that wasn’t favorably disposed to your ’cause’? And then you have the nerve to claim that because Phil didn’t use insults in his response to you, you will respond in kind?
Just goes to show what simmers beneath your shaky facade.
Vaccines aren’t perfect and it seems that unless a person accepts whatever doctors and public-health officials say without reservation, that person is considered an ignorant, anti-science jerk. People should maintain a healthy skepticism about all medical treatments. Doctors and medicines have been around for thousands of years and we know for a fact that 99% of all the medicines and procedures during that time were at best worthless and frequently outright harmful.
If you think only a fool would question the value of the H1N1 flu vaccine, read this:
http://www.theatlantic.com/doc/200911/brownlee-h1n1
And if you think the mainstream media is unbiased about reporting on vaccines, consider this: On October 28, 2008, the New York Times published an article by Donald McNeil stating that Type 2 polio had been eradicated from the planet in 1999. Not only was the Times mistaken, but they have failed to report that Type 2 polio is on the rise and that it is actually CAUSED by the vaccine that was designed to prevent it. (See Science 325, 660 for details.)
Mmh, that issue of Wired has been sitting on my desk for a while; I better go read it…
I’ll see you one Brownlee H1N1 article and raise you one Revere rebuttal on why that article is a piece of crud.
http://scienceblogs.com/effectmeasure/2009/10/the_atlantic_article_sur_rebut.php
Gary 7 said, “I often refer to the Danish study that compared autism rates between 400,000 vaccinated children vs 100,000 unvaccinated children and found no difference between those two groups. As far as I am concerned, that’s pretty much the last word.”
Gary: that study didn’t do what you think it did. For one thing, all the kids WERE vaccinated. If you’d care to see a different take on the study, please read:
http://www.fourteenstudies.org/HG_2_details.html
I think it is a very poorly-designed studies with many conflicts and a fatal flaw in how they collected data.
JB Handley
Still no comment on the ‘essay’ sent to Ms. Wallace? Wouldn’t think so – I’d be embarrassed too.
So who is right about the Danish study – this is *really* annoying.
It is just a simple empirical question. The internet is full of reports
that about 100000 Danish children in the study were *not*
vaccinated; see e.g.:
http://www.ncbi.nlm.nih.gov:80/pmc/articles/PMC1124634/
which says among other things:
“There was no increase in the risk of autistic disorder or other autistic-spectrum disorders among vaccinated children as compared with unvaccinated children (adjusted relative risk of autistic disorder, 0.92; 95% confidence interval, 0.68 to 1.24; adjusted relative risk of other autistic-spectrum disorders, 0.83; 95% confidence interval, 0.65 to 1.07).”
This is apparently a quote from the study article itself.
So – are the authors of the study just lying here, or is someone else
lying and/or twisting the truth?
I find it absolutely bizarre that these folks are so focused on vaccines when their entire environment has been contaminated with toxic chemicals. Fifty components to a vacine? They should check out what can be in a bottle of perfume or cologne. I’ve seen studies finding large lists of organic chemicals, including benzene, in perfumes and colognes. Then there’s all those artificial laundry scents, fire retardants in clothing, furniture and mattresses, formaldehydes in building materials, lawn chemicals, pesticides, cleaning materials with toxic chemicals, mercury and other contaminates in fish, etc. Our bodies probably have thousands of chemicals in them that weren’t there prior to the industrial revolution, and the list probably gets longer every day.
I am 58, had measles in 1960, and apparently just got it again. I was recently hospitalized for four days with a mystery infection that might as well have been measles if it wasn’t. (If it looks like a duck, walks like a duck, and quacks like a duck, then …) It was finally diagnosed by eliminating about 15 other types of infections and finally a skin biopsy. No one at first imagined it could be measles because young doctors don’t see it anymore, so proper testing for it was done too late for a definitive standard lab diagnosis. I was extremely ill with high fever, a nasty itchy angry red rash all over my body, and I also had coughing, vomiting, diarrhea, and general respiratory distress requiring oxygen and nebulerizers (measles is a respiratory infection, and possibly the most contagious infection known). Fortunately I did not get the encephalitis that can go along with it. Measles is very dangerous for adults, and I got again possibly because I have an antibody deficiency. This is just one of those nasty infections that needs to be kept in a bottle.
Bill,
The reason for your confusion is that Mr Handley is referring to a different study. The one you cite is this: “A POPULATION-BASED STUDY OF MEASLES, MUMPS, AND RUBELLA
VACCINATION AND AUTISM” New England Journal of Medicine 2002.
It compared, as you say, all the children born in Denmark between 1991 and 1998, approximately half a million children. Of those, 440,000 were vaccinated and 96,000 were not. There was no increase in autism or autism spectrum disorder diagnoses in the vaccinated group. A very well done tight study that is significant evidence against the vaccine-autism hypothesis.
The critique Mr Handley linked to is this study: “Thimerosal and the Occurrence of Autism: Negative Ecological Evidence from Danish Population-Based Data” in Paediatrics 2003. This looks like an analysis of the data from the earlier NEJM study, but this one I haven’t read, so can’t comment on the critique offered.
I would be interested to hear Mr Handley’s comments on why a study of half a million children that shows no increase in autism rates with vaccination can be easily dismissed.
Not that this has to do anything with the autism debate – but i too got told by a physician that it’s probably better not to get the first batch H1N1 vaccination.
so there always should be a risk analysis, but in some cases, like MMR it seems pretty clear that the outcome is in favour of vaccinating. the problem with the individual decision however remains, and this is the crux. for cases where it is clear that the vaccination is the preferred alternative and especially in cases where a potentially dangerous disease can be eliminated entirely, i think the public actually has a right to demand that everyone gets the shot. i’m always horrified by the anti-vaccination parents sending their children to the same kindergarten where my children are before they got the full protection package. i feel this is completely irresponsible on their part.
@44
“I am not a threat, nor a cost, to the society as a whole because i choose not to be vaccinated.”
Actually, you are. Despite illusions to the contrary, you’re probably no better off against any strain you have not encountered than Joe Random, unless Joe Random has complications weakening his general immune system. Have you submitted to testing to see how much above average your immune system is? Or is that something that anybody can figure out, in which case can someone point me to a site that explains how this self-evaluation is done?
When you refuse immunisation, you voluntarily choose to become a potential infectee (which will become a cost to your company/business, thus society as a whole, when he has to spend two weeks in an unproductive state), and a potential carrier of disease, contaminating others. Your choice is not an individual choice, it’s a choice that engages everybody around you. It’s an hermit choice : it’s justifiable if you do not interact with society, if your work has no value and you don’t meet any other people.
There’s plenty of personal choices that run the risk of profound repercussions on others. Driving while drunk could be argued to be a personal choice (it’s me, it’s my car, I’m aware of the risks), yet society will not tolerate it even if you do, because you put yourself at risk (and ruin your contribution to society), and you put others at risk by your reckless decision. Of course, refusing to vaccinate oneself against epidemic diseases isn’t driving after two drinks, but the difference here is a difference of degree and magnitude, not one of quality.
And it’s up to society as a whole to draw limits where your individualism overspills “too much” into others. For vaccination, it’s not drunk driving, it’s driving when tired – something that’s entirely legal, but that everyone will tell you it’s bad for you, put pressure on you to avoid doing, and which entails real consequences. Even if you’re an übermensch that can’t get ill (me, falling asleep at the wheel? no way)
@spyder: As the the new H1N1 strain is novel – that is, never before seen in humans, your experience with cold and flus is likely entirely irrelevant. The immune system doesn’t learn how to fight generic viruses; it builds antibodies which target specific proteins on each specific virus. For some viruses, like measles, the proteins involved never change much, so one vaccine (or encounter with the virus itself) is usually enough to teach the body how to fight it off in the future. For the flu, this is not true. There is often considerable cross-immunity for different flu types – that is, if you are immune to one variety, you’ll get partial immunity to another. It has been shown that this particular new strain evades any such cross immunity except possibly in people who were around during the 1918 flu pandemic. That strain had enough in common with this one that there may be some cross-immunity, but really, that’s it.
@JB Handley
You say the 2nd study linked to by Phil Plait is “…not even a study. It’s a phone survey completed in the UK”
I went to the link and read the PDF and I can find nothing in the paper that mentions a phone survey. It was done in two phases. One was either a paper survey or an online survey. Phase 2 used a subset of the Phase 1 respondents and the paper suggests they were face-to-face interviews conducted by people with clinical training in diagnosing ASD.
I have spent some time at the Age of Autism site reading and your faulty information regarding the UK study matches a general pattern I saw at Age of Autism which is misinterpretation and half-truths. I will give you the benefit of the doubt and assume you are just misinterpreting the UK study rather than just flat-out lying about it.
http://www.ic.nhs.uk/statistics-and-data-collections/mental-health/mental-health-surveys/autism-spectrum-disorders-in-adults-living-in-households-throughout-england–report-from-the-adult-psychiatric-morbidity-survey-2007
Re: MMR in Denmark.
Sorry, I referenced Hg study from Denmark, not MMR.
My perspective:
The use of the term “unvaccinated” in this study ONLY pertains to the MMR, not other shots, so the term is misused and misleading. Kids in Denmark, where vaccination rates are very high, receive 8-10 other shots before MMR, and the study remains silent.
Also, here’s some helpful critique of the study, for those who care to consider it:
http://www.taap.info/yazbak_studies.html
nterestingly, Kreesten Meldgaard Madsen, author of “A Population-Based Study of Measles, Mumps and Rubella vaccination and Autism”, (5) the study funded by the CDC stated “Studies designed to evaluate the suggested link between MMR vaccination and autism do not support an association, but the evidence is weak and based on case-series, cross-sectional, and ecologic studies; No studies have had sufficient statistical power to detect an association, and none has a population-based cohort design” (References 10-16).” In the Madsen bibliography, reference 10 is the first Taylor study (The Lancet); reference 11 is the one by Kaye (BMJ) and reference 12 is the study by Dales (JAMA). For reasons known only to him, Dr. DeStefano still mentioned the Taylor, Kaye and Dales studies as reliable and listed them as references 23, 22 and 19 respectively.
Dr. DeStefano and Associates describe the Madsen MMR study as “particularly persuasive”. In fact, that study, because of an integral flaw in its design, could not have shown, that indeed there had been an increase in autism after routine MMR vaccination was initiated in Denmark.
The following is part of the analysis by Dr. Gary Goldman and myself of data from the Danish Psychiatric Central Register, the same data that Madsen used. It clearly shows that there has been a serious increase in autism in children under 14 in Denmark in the last few years. (Graph I)
Graph I Incidence of Autism in Denmark by Age Group
Source: The Danish Psychiatric Central Register
The MMR vaccine was introduced in Denmark in 1987. It has been estimated that only 70% of the 15-month old children received the triple vaccine in 1987-1988. The percentage of vaccinated toddlers then reached and remained at 80 to 88% for several years. It is estimated that in the last three years about 95% of the 15-month old children in Denmark received the MMR vaccine.
The present rise in autism in Denmark has clearly started 4 to 5 years after the introduction of the MMR vaccine and it appears to correspond with the percentage of children who received the MMR.
The mean age at the time of diagnosis in Denmark is probably around 4.7 years (“The mean age at diagnosis for autism was 4 years, 3 months, and for autistic spectrum disorders 5 years, 3 months.”) Approximately 25% of autism cases in Denmark are reported in children under the age of 5 with the remainder 75% of affected children being reported when they are 5 to 19 years old. Given these percentages, any inferences about disease in the under-5 group, in which the disease has not yet become manifest, are potentially flawed.
The 2,129,864 person-years reported in the Madsen study divided by the number of children 537,303 indicates that the average age of the children in the study is less than 4 years (range 1 to 7 years). Those children would be 5 to 12 years old in 2003. Because the mean age at diagnosis is 4.7 years in Denmark, the Madsen study could NOT have detected many of the cases of autism that were subsequently diagnosed when these children were older, thereby missing the temporal connection between MMR vaccination and autism.
The 0-4 year old group of children (Graph I, black) remains the lowest from 1980 to 1991, because autism was/is rarely diagnosed under the age of 4 in Denmark. The prevalence of autism in that age group starts climbing after 1991, 4 years after the introduction of the MMR vaccine, to become the second highest by 1993.
The 5 – 9 age group is the earliest cohort that received the MMR vaccine after coverage has improved and is also old enough to be diagnosed. There are consistently more and more affected children in this age grouping.
The 10 –14 age group (dark green) represents the earlier cohort that first received the MMR vaccine, but at lower coverage rates. Those affected children aged 10 to 14 in 2003 were aged 1 to 5 in 1994. They reflect the startup of the autism increase associated with the startup and progression of the MMR vaccination program.
The 15 –19 age group (light green) were aged 1 to 5 in 1989; their number increases but at a much slower rate than in the younger age groups.
Lastly, the 20 – 24 age group (brown) shows only a slight increase starting in 1994 possibly because few if any of this cohort, received the MMR vaccine at a vulnerable age.
Even when one takes into account the classification change that took place in 1993/1994 and the addition of outpatients to the database in 1995, it is evident, when five additional years are considered, that the conclusions of the Madsen group are invalidated and that the data appears to support the hypothesis that increases in autism in Denmark, may be correlated with increases in percentage coverage and number of children receiving MMR vaccination.
It is likely that in Graph I, the 0 – 4 year group of affected children represents those who were not generally diagnosed earlier, that the 5 – 9 age group represents the highest increase that occurred after wide-spread coverage of the MMR vaccine and that the 10 – 14 age group represents the earlier cohort that first received the MMR vaccine, but at a low coverage rate.
It is possible that the rate of autism will now level off at the higher rate since children receiving MMR immunization have now saturated the age groups and replaced individuals in the age groups that were previously unvaccinated.
Approximately 65,000 babies are born every year in Denmark. Graph I shows the early slow ramp-up period due to low vaccination rates. When MMR vaccination coverage improved beyond a certain level, from 1993 to 2001, there was a steady and increasing trend in autism every year. That gradual rise leveled out after the entire cohort aged 95%). It is entirely possible that many of the children of the most affected 5 to 9 group, could have started with symptoms as early as the second year of life.
The prevalence rate of autism in Danish children under the age of 14 has increased by 729% from 17.67 per 100,000 Population in 1980 to 146.42 in 2002. (Graph II)
Graph II Children with Autism under Age 14 In Denmark per 100,000 Population.
Source: The Danish Psychiatric Central Register.
The prevalence of autism in children and teens under the age of 14 in Denmark, which was 131.42/100000 in the 7 years before the MMR vaccine, increased by 542% to 843.73/100000 in the last 7 years. Indeed, the prevalence of autism in that group was 11% higher (146.42/131.42) in 2002 alone than in the combined 7 years before the introduction of the MMR vaccine.
Two doses of MMR are administered in Denmark, one at age 15 months, and one at age 12 years. The data suggest that the main concern is the vaccination given at age 15 months.
The prevalence of autism in Denmark in the 0 to 14 year-olds leveled off in the last 3 years, when toddler MMR coverage reached the 95 – 98% level. The reason why this did not take place in the United States in the 90’s was probably because pediatric vaccines in the US contained Thimerosal, further supporting the argument that the study was flawed in principle because countries with strikingly different vaccination practices cannot and must not be compared.
Conclusions
Autism has increased in Denmark after the introduction of the MMR vaccine as evidenced by the fact that the rate ratio i.e. the incidence of autism after vs. before MMR vaccination is 8.8 (95% C.I., 6.3 to 12.1) among 5 to 9 year old Danish children.
The Madsen study did not reveal this statistically significant increase.
Dr. DeStefano and his colleagues at the CDC should research the causes of Regressive Autism rather than defend a vaccine in trouble.
Parents are more likely to forgive errors than cover-ups.
Mr. Handley, I’ll leave the critiquing of the methodology to Phil and the others who are better at this than me right now. I do, however, want to skewer your lack of training and your impetuosity on this.
Let’s pull a couple of quotes, shall we?
“I’m not intellectually intimidated by any of these jokers. Their degrees mean zippo to me, because I knew plenty of knuckleheads in college who went on to be doctors, and they’re still knuckleheads (I also knew plenty of great, smart guys who went on to be doctors and they’re still great, smart guys).
” I chose a different path and went into the business world. In the business world, having a degree from a great college or business school gets you your first job, and not much else. There are plenty of Harvard Business School grads who have bankrupted companies and gone to jail, and plenty of high school drop-outs who are multi-millionaires. Brains and street-smarts win, not degrees, arrogance, or entitlement.”
Oh! You went into business! Like that helps you understand this at all. Let’s set one thing straight: it takes brains to get a degree, and street-smarts don’t count for anything in a world where knowing the field counts. An individual who only knows stocks, bonds, and businessese is not someone anyone should trust to know anything about science.
“I have been astonished by the culture of arrogance and elitism that medical schools appear to breed in their doctors and scientists. The culture tends to produce an “us vs. them” mentality, where doctors collectively back each other up on controversial issues, typically without understanding the issue for themselves.”
Actual controversial issues actually make people within the scientific community fight EACH OTHER, not do what some perceive as science against the tiny little pseudo-mavericks. I’m not saying the scientific or medical community is monolithic, because there are a few crackpots, but, uh, most of us agree that autism isn’t caused by vaccines.
In fact, both of my parents are vaccinated; they are not autistic.
And mind you, the fact that you’re the parent of an autistic son doesn’t make me give you any sympathy either when it’s obvious that you think you know better than someone who’s taken basic sciences and gone through four years of medical school in addition to getting a college degree and usually also gone through a residency.
Parents are not the experts on their children. Pediatricians are.
Quit the sob story.
Unfortunately the sort of attitude towards the autism stereotype on the comments and surrounding issues is just the tip of the whole complex iceberg. Usually the media is driven by the curebie agenda which is evident from the negative response. The autistic spectrum side of things on these issues is readily available on the web on numerous blogs.
I don’t have a particular opinion about vaccines one way or the other, but I do hate to have my time wasted. Someone at 3QuarksDaily thought fit to call our attention to this silly, facts-free piece, as if science were some sort of flag or banner to be waved rather than a cogent set of arguments in relation to experiment. I’m going to check out the person at 3Q who wasted my time, and revise my opinion of a site I had been coming to like. I can see why the author here, “Sean,” wouldn’t want to have his or her full name appended to this bit of fluff. I’ll leave my full name.
By the way, squalene, one of the compounds antivaxxers whine about, is present in humans already, and also present in olive oil and other sorts of oils that go into food that – guess what? – humans eat.
LOL, antivaxxers’ bodies generate toxins! OH NOES!
(If you honestly think an endogenous compound is toxic to humans, you’ve got problems.)
Mr Handley,
I have taken a close look at the critique of the NEJM study that you posted. I would like to go through it, as its conclusions do not seem valid.
Firstly, you point out that the study examined only MMR vaccinations and so the children were not “unvaccinated” in this sense. It is true the study does not mention other vaccinations, and so we simply do not know if the children in the unvaccinated cohort received other shots or not; the authors evidently did not address this issue. However, the rest of your critique explicitly examines the connection between MMR and autism – you specifically state your data supports the notion “increases in autism in Denmark, may be correlated with increases in percentage coverage and number of children receiving MMR vaccination.” Given that this is your hypothesis, the methodology of the NEJM study is entirely appropriate to examine it.
Your main concern with the study, as far as I can understand it, is that you believe the average age of the children in the study was under 4 years, and that as autism in Denmark is usually diagnosed over this age, the study could not have detected cases occurring later in these children, thus missing the temporal connection.
This is not a valid criticism. The average length of follow up for each child was around 4 years; the study ended 1 year after the last birth cohort of 1998. It is true that if this period had been longer some more cases from the latest cohorts would be picked up, but even without that there is a huge cohort of children with an ample time of follow up. All children were followed up for at least one year after they received the MMR vaccine – given that parents who believe their child has been damaged by vaccines do so because the start of the symptoms is associated with vaccine being given, any significant association would have been noted. To suggest anything else is to imply you believe the vaccine induces autism years after it is given.
The rest of the data you produce just aims to show a correlation between increasing diagnoses of autism and the introduction of the vaccine. As always, this does not show causation, and this very convincing paper that, despite your criticisms, does show no increase in autism diagnoses associated with MMR vaccination does much to disprove this suggestion.
It seems to be a common misdirection ploy to focus on the insults, but never actually address the details.
Did you actually type that? Are you, one of the great purveyors of insults in the autism world, expecting anyone to take you seriously in this statement?
Take away your insults and your junk science and you have nothing left.
JB, if I call you out for the clown you are, does that make this hate mail?
David Ker Thompson, if you click on the blogger’s name (Sean), you will find his last name in the URL: …/cosmicvariance/author/scarroll/ … See, it is Carroll.
Does that help you understand the content of what he wrote any better? Did you understand it was not really about science, but the reaction some unschooled people have about writers of science? Kind of like the behavior you displayed.
JB,
I use your fourteen studies website in lectures on denialism and bad science.
I have yet to hear anyone disagree with my position.
JB Handley claims “I receive more hate mail in a day than Ms. Wallace has probably gotten in her lifetime. Unlike Ms. Wallace an Paul Offit, I just don’t whine about it.”
Sure you do, JB, sure you do. If you stopped censoring comments at AoA, we might see those hate mails, but until you do that, we just aren’t going to believe you. All we see is the fawning adorations of your sycophants.
On the other hand AoA implicitly supports “outing” those they don’t agree with, allows publication of their place of work, and allows people to insult them openly. Look at the comments on this piece. You need to read the comments from the bottom up, and there are two pages, so start at the bottom, and read up, then go back to the bottom and click on “previous”.
http://www.ageofautism.com/2009/03/iacc-ethical-disaster-zone/comments/page/2/#comments
I fully expect to see the AoA post disappear after I make this comment, so I’ve grabbed a screen shot.
JB Handley screwed up when he made his “date-rape” comments to Amy Wallace.
Instead of doing the right thing and apologizing, he is trying a classic diversion strategy. The strange part, he’s whining about how he doesn’t whine. He wants to come across as strong and in-control, when he obviously wasn’t when he wrote Amy Wallace.
Just to point out something that should be obvious to anyone giving the matter any critical thought:
An increase in diagnoses of autism does not necessarily imply an increase in the number of actual autistic people. It is beyond simple to point out that the increase in autism diagnoses and the increase in vaccinations are both symptoms of a third trend, which is our general increase in medical knowledge. In fact, this is an example of the classic case of correlation not equaling causation.