Paul Offit - The Costs of Vaccine Denialism

February 12, 2010

Recently, there was another nail in the coffin for vaccine skeptics. The British medical journal The Lancet took the dramatic step of retracting a 1998 paper that lies at the root of modern vaccine denialism.  Authored by a doctor named Andrew Wakefield and his colleagues, it was heavily touted as having uncovered a new cause of autism—the measles, mumps, rubella vaccine, or, the MMR vaccine.

Not so fast. Twelve years later, there are more problems with the paper than you can count—and yet somehow, it managed to spawn a movement.

In this conversation with host Chris Mooney, Dr. Paul Offit—author of Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure—discusses the state of the vaccine skeptic movement in light of this latest news. In particular, Offit explores why the tides may be turning on the movement—as well as the grave public health consequences of ongoing vaccine avoidance.

Paul A. Offit, MD is the Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. In addition, Dr. Offit is the Maurice R. Hilleman Professor of Vaccinology and a Professor of Pediatrics at the University of Pennsylvania School of Medicine. Dr. Offit has published more than 130 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC. Dr. Offit was a member of the Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention, is a founding advisory board member of the Autism Science Foundation, and is the author of five books, the latest of which is Autism’s False Prophets.

Books Mentioned in This Episode:


Comments from the CFI Forums

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Great show!

I was surprised that the parents’ old age correlating with higher number of autistic children (is it true?) wasn’t discussed.

Posted on Feb 12, 2010 at 10:59am by George Comment #1

Great show!

I was surprised that the parents’ old age correlating with higher number of autistic children (is it true?) wasn’t discussed.

George thanks for calling attention to the podcast…looking forward to it…

[ article just a couple days ago in NY Times on this topic…]

Older mothers are more likely than younger ones to have a child with autism, and older fathers significantly contribute to the risk of the disorder when their partners are under 30, researchers are reporting.

Posted on Feb 12, 2010 at 7:12pm by Jackson Comment #2

Great interview! Paul Offit is a genuine hero!

Posted on Feb 12, 2010 at 7:29pm by asanta Comment #3

Unfortunately away from my primary computer for the long weekend. If I get time I’ll download it otherwise I’ll wait until next week ...

Posted on Feb 12, 2010 at 7:37pm by dougsmith Comment #4

It’s no wonder the average citizen distrusts BIG SCIENCE.  First, we get critical issues with the science of global warming, and now this!  Heck, even “peer-reviewed” science has been tainted.  It may be unavoidable, but it’s too bad that so many scientists seem to be coming off as fund-seeking activists.

Posted on Feb 13, 2010 at 6:39am by iRandy Comment #5

While it is true that a relationship has been found between older parents and autism, it accounts for a very small percentage of cases.

Posted on Feb 13, 2010 at 8:50am by Jane Russell Comment #6

Chris, I enjoyed your inaugural podcast.  The hour-long interview format is invaluable.  The SGU rogues do good interviews, but their format does not allow for the kind of in-depth conversation that POI has become famous for.  Your plan to focus on what you know best - the intersection of science and public policy - is a solid one.  As is evidenced by the Offit interview, you professional background as a science writer will enrich the interviews.

Posted on Feb 14, 2010 at 8:00am by science-based humanist Comment #7

Great interview!

Many interesting points made, but one which struck me for some reason was Dr. Offit’s mention of how the suspicion of experts combined with the availablility of information on the Internet contributes to the tendency of some people to dismiss the true facts as presented by people like Dr. Offit with extensive expertise and instead follow the clear nonsense logic of the supremely confident but deeply ignorant like Jenny McCarthy. This touches my work directly in terms of the doctor/patient/client relationship (which I’ve written about HERE), but it seems to be a phenomenon that extends well beyond medicine. Yet another unanticipated down side to the free and easy access to information. The American suspicion of intellectuals, the worship of individual independance, and the notion of us all as Super Consumers capable of making our own decisions about even the most technical matters after a brief purusal of Gooogle seems like a recipe for bad decision-making on an enormous scale.

Posted on Feb 15, 2010 at 3:08pm by mckenzievmd Comment #8

The American suspicion of intellectuals, the worship of individual independance, and the notion of us all as Super Consumers capable of making our own decisions about even the most technical matters after a brief purusal of Gooogle seems like a recipe for bad decision-making on an enormous scale.

While I agree wholeheartedly on most of the issues here I think it is important to avoid excessive arrogance by science and modern medicine when it attacks ordinary people - and remembers that it has made mistakes, tragic ones such as thalidomide among others. People remember these and often have no way of retaining perspective on the science and the odds of a repeat.

Posted on Feb 15, 2010 at 3:44pm by scepticeye Comment #9

While I agree wholeheartedly on most of the issues here I think it is important to avoid excessive arrogance by science and modern medicine when it attacks ordinary people - and remembers that it has made mistakes, tragic ones such as thalidomide among others. People remember these and often have no way of retaining perspective on the science and the odds of a repeat.

The tragedy of thalidomide was avoided in the US by an assiduous FDA scientist who refused to allow the substance for sale in the US. Of course, if it were CAM, there would have been no such strictures against sale. I thought that your argument was for allowing the general sale of any substance that anyone feels will be efficacious for anything.

Thalidomide is actually effective for some endpoints, but its teratogenic properties make it completely unsuitable for anyone who will get pregnant. It should be illegal to prescribe it for a pregnant woman. (At least, IIRC. It’s been awhile since I kept up with the science on thalidomide).

Posted on Feb 15, 2010 at 3:56pm by dougsmith Comment #10

I thought that your argument was for allowing the general sale of any substance that anyone feels will be efficacious for anything.”

So you didn’t bother to read this sentence in my post ... again: “I suggest that the only valid element of this anti CAM hysteria is to have products labeled as not scientifically proven. I can live with that I suspect that most people would.”

Posted on Feb 15, 2010 at 4:11pm by scepticeye Comment #11

I thought that your argument was for allowing the general sale of any substance that anyone feels will be efficacious for anything.”

So you didn’t bother to read this sentence in my post ... again: “I suggest that the only valid element of this anti CAM hysteria is to have products labeled as not scientifically proven. I can live with that I suspect that most people would.”

Again, that caveat is insufficient.

Posted on Feb 15, 2010 at 4:21pm by dougsmith Comment #12

While it is true that a relationship has been found between older parents and autism, it accounts for a very small percentage of cases.

Very true. Also note the connection between diagnosis of autism and financial status. I would wonder if the connection between age of the parents also is in line with the fact that older parents may be more financially stable and able to secure diagnosis for their children. Young parents (very young) are often not in a financial position to get their children all the help they need.

Getting a formal diagnosis of autism, asperger’s or autistic spectrum disorders takes thousands of dollars in appointments with psychologists and/or psychiatrists. Very few of these, if any, are covered by health insurance. Young parents may not have the resources to secure a proper diagnosis for their child. I wonder if this helps to account for the larger amount of older parents with autistic children. That is, younger parents also have autistic children, but are either not recognizing the signs or not getting the professional help they need.

Posted on Feb 15, 2010 at 4:33pm by Jules Comment #13

While I agree wholeheartedly on most of the issues here I think it is important to avoid excessive arrogance by science and modern medicine when it attacks ordinary people - and remembers that it has made mistakes, tragic ones such as thalidomide among others. People remember these and often have no way of retaining perspective on the science and the odds of a repeat.

I’m not seeing an “attack on ordinary people.” in anything I said. I’m saying ordinary people should not expect to be the equal of trained professionals in terms of understanding complex domains like medicine, technology, law, and so on. Being informed and being an expert are two different things, and I think we all confuse them often. Doctors commenting outside of their area of specialisation are just as susceptible to this as lay people like Jenny McCarthy commenting on vaccination, so I don’t view it as an issue of arrogance or singling anyone out. I just think it is a natural human tendancy to overestimate our own understanding, and a good dose of humility and caution is called for, which ought to suggest the we be informed and engaged and yet also willing to recognize that professionals are likely to be right a greater proportion of the time than we dilletantes are.

Posted on Feb 15, 2010 at 4:40pm by mckenzievmd Comment #14

Finally got a chance to listen to this podcast. A few comments:

First, a big THANK YOU to Chris for his kind plug of the Forum in the intro. I hope that he’ll draw more folks here for discussion.

:-)

Second, it’s interesting to see the different approaches that Chris and DJ have to the interview process. It seems from this data point that Chris is a bit more proactive in arguing for the position he believes in, as opposed to DJ’s more cross-examination/devil’s-advocate approach. They’re both good ways to approach an interview. Frankly, I don’t think there’s a right or a wrong way here, so long as the interviewer is smart, knowledgeable and comfortable in the chosen approach, which both Chris and DJ are. Chris seemed very relaxed and I thought it went very well. Looking forward to more.

Posted on Feb 15, 2010 at 8:32pm by dougsmith Comment #15

I want to thank everyone for commenting on the first show and am so glad folks seemed to enjoy it, and that it got a lot of thoughts rolling around. Of course, with a guest as articulate and quotable as Paul Offit, you can’t really go very wrong.

Doug, I can do Devil’s Advocate too, but I think your distinction may be a meaningful one….

Off to plan the next show!

My best

Chris

Posted on Feb 16, 2010 at 4:12am by CMooney Comment #16

FYI Chris has a great segment from Morning Joe with Dr. Nancy Snyderman up on his blog HERE, about the nonexistent link between vaccines and autism.

Posted on Feb 16, 2010 at 8:36am by dougsmith Comment #17

While it is true that a relationship has been found between older parents and autism, it accounts for a very small percentage of cases.

Judging by the data from the NY Times article linked to by Jackson, the numbers appear to be far from insignificant.

Also note the connection between diagnosis of autism and financial status. I would wonder if the connection between age of the parents also is in line with the fact that older parents may be more financially stable and able to secure diagnosis for their children. Young parents (very young) are often not in a financial position to get their children all the help they need.

Jules, I guess it would be interesting to compare the relationship between age and autism in the U.S. and Canada. If it is the financial status as you suggest that plays a role here, the numbers in Canada should be significantly lower—since healthcare in Canada is free.

Posted on Feb 16, 2010 at 11:45am by George Comment #18

I found this:

How common is autism?
According to the Centers for Disease Control and Prevention in the United States, autism affects as many as 1 in every 150 children in that country. The statistics are the same in Canada.

Link.

Posted on Feb 16, 2010 at 11:53am by George Comment #19

George, in Canadian health care, is psychiatric care and care by a psychologist, also free? Here mental health care is often considered separate from medical care, and is sometimes not included in health insurance plans. People who need to take their child for psychological care often find themselves paying cash, or begging the over-worked school counselors to provide counseling.

Posted on Feb 16, 2010 at 1:11pm by Jules Comment #20

George, in Canadian health care, is psychiatric care and care by a psychologist, also free? Here mental health care is often considered separate from medical care, and is sometimes not included in health insurance plans. People who need to take their child for psychological care often find themselves paying cash, or begging the over-worked school counselors to provide counseling.

Hmm, as far as I know psychiatrists (not sure about psychologists) are free as long as they are recommended by another doctor, usually a family doctor.

Posted on Feb 16, 2010 at 1:45pm by George Comment #21

I hope nobody here expected a quick turnaround from the anti-vaccers.

From Jenny McCarthy’s site, we have “A statement from Jenny McCarthy and Jim Carrey”:

Dr. Andrew Wakefield is being discredited to prevent an historic study from being published that for the first time looks at vaccinated versus unvaccinated primates and compares health outcomes, with potentially devastating consequences for vaccine makers and public health officials.

It is our most sincere belief that Dr. Wakefield and parents of children with autism around the world are being subjected to a remarkable media campaign engineered by vaccine manufacturers reporting on the retraction of a paper published in The Lancet in 1998 by Dr. Wakefield and his colleagues.

The retraction from The Lancet was a response to a ruling from England’s General Medical Council, a kangaroo court where public health officials in the pocket of vaccine makers served as judge and jury. Dr. Wakefield strenuously denies all the findings of the GMC and plans a vigorous appeal.

Links apparently not turned on for me yet, so here’s the url: http://www.generationrescue.org/wakefield_statement2.html

Posted on Feb 17, 2010 at 2:11pm by Barefoot Bree Comment #22

It may be that the older parents are more aware of resources available to them, and thus, there may be a larger percentage of children who have older parents who are diagnosed as being on the spectrum.  However, it is not necessarily expensive to get a diagnosis, at least not in California, where a parent is able to self-refer to the Regional Center where a free evaluation is available.  However, it is likely that older parents are more aware of such resources and rights than are the younger parents.

Posted on Feb 17, 2010 at 4:50pm by Jane Russell Comment #23

For the sake of simple falsifiability, hasn’t it been shown that some kids with autism never got the measles vaccine?

Aside, I was kind of hoping the new POI would have better theme music and a different introductory voice.

Jordan

Posted on Feb 18, 2010 at 11:40am by Jordan Comment #24

For the sake of simple falsifiability, hasn’t it been shown that some kids with autism never got the measles vaccine?

Aside, I was kind of hoping the new POI would have better theme music and a different introductory voice.

Jordan

Yes, even the children of Christian Scientists and other groups who decline vaccines for religious reasons, have developed autism as well. In such cases, these nonsense followers claim the autism was “triggered” by dairy products, non-organic foods, pesticides, gluten or wheat in the diet, mercury in fish, and other claims.

When there is “something wrong” with a child, the parents (understandably) want to blame someone. But that should be a short “anger” phase the parents work through in therapy or with the support of family, and then realize it’s not their fault, these things just happen, and focus instead on moving forward and helping their child to improve with special services and therapy.

Posted on Feb 18, 2010 at 1:26pm by Jules Comment #25

In such cases, these nonsense followers claim the autism was “triggered” by dairy products, non-organic foods, pesticides, gluten or wheat in the diet, mercury in fish, and other claims.

Whatever causes autism I am sure it must be something “unnatural.” “Unnatural” is the Satan of the 21st century.

Posted on Feb 18, 2010 at 2:05pm by George Comment #26

Jules,

Thanks for that reply. So strange. If we wanted, we *could* abide the view that autism is triggered by dairy, or non-organics, or pesticides with little risk of significant harm. Not so with the anti-vaccers’ view, yet they are the most prominent voice. What’s up with that?

Jordan

Posted on Feb 18, 2010 at 2:13pm by Jordan Comment #27

If only someone could start a rumor, that autism is caused by not following the recommended pediatric vaccine schedule!  :-)

Strange they are so concerned with Autism, but not at all concerned about measles, chicken pox, rubella, mumps, pertussis, polio, tetanus, pneumonia, flu, etc.

Yes it is odd that they have the loudest voice. They are backed by fearful parents and nutty celebrities. What gives them fuel for the fire, is that symptoms or signs of autism arise around the same time a large series of vaccines are given (around 2 years old or so) Children developing normally suddenly regress. The parents can’t ignore the timing. They feel it must be the vaccines. Doctors and researchers have said time and time again, the timing is coincidence. It’s hard for parents to grasp. Various parents could blame different foods or environmental problems but no one could agree - but one thing they all had in common was vaccines - so that was their rallying point.

I can’t imagine being a pediatrician having to deal with parents who get their healthcare information off of woo-woo scare websites. I feel badly for them, having to spend so much time arguing with parents about why vaccines are needed and why they are safe. A friend at work, took her two year old for the series of “big vaccines” that so many are worried about. She started sort of saying “Well I’m a little concerned about what I’ve read online…” the pediatrician, probably frustrated and having been through this 14 times in a single day, stopped her mid-sentence and put her hand out “Ah ah ah ah - no. It’s safe. I wouldn’t give it to him if it wasn’t safe. He’s getting it. Here’s a brochure about vaccine safety.” She crammed the vaccine brochure in her hand and said “RELAX!” and got the vaccines out.

Posted on Feb 18, 2010 at 3:59pm by Jules Comment #28

wow. Great Interview of an expert witness. “Chris Mooney makes it look easy”...Chris gently returned to the topic, letting Offit emphasize that it is fully established that if vaccines were a cause of autism, the studies would show it—and they don’t.  He covered all the questions that were occurring to me and branched into other areas where there have been problems (thalidomide, reactions to swine flu vaccine) as well as current thinking on the causes of autism.

[link for review of Autism’s False Prophets in IJ Epidemiology—encouraging intro only]

[ review in Salon]

I wasn’t really aware of how fervently Offit has been attacked.

Mooney has some comments on his Discover blog including a good quote..this reminds me that sometimes I have wished that POI had transcripts.
[Mooney blog entry]

I have a niece who is severely autistic, and her parents chased every chance of a cure and every hint of hope.  It’s tough.

Posted on Feb 22, 2010 at 8:53pm by Jackson Comment #29