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

Autism's False Prophets by Paul A. Offit
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's review
Oct 08, 2008

it was amazing
bookshelves: book-club, 2008, non-fiction, science
Read in October, 2008

This book is amazing, and well worth reading. For those who want the quick and dirty, here’s the last paragraph:

The science is largely complete. Ten epidemiological studies have shown MMR vaccine doesn’t cause autism; six have shown thimerosal doesn’t cause autism; three have shown thimerosal doesn’t cause subtle neurological problems; a growing body of evidence now points to the genes that are linked to autism; and despite removal of thimerosal from vaccines in 2001, the number of children with autism continues to rise. [emphasis mine] (247)

This last bit reveals the craven motives of some and the blind conviction that someone must be to blame in others as anti-vaccination groups (and clueless celebrities like Jenny McCarthy) continue to espouse this nonsense while children around the country face growing outbreaks of measles and other diseases that we had firmly in control.

I can’t imagine the difficult place a parent of a child with the more severe forms of autism must be in, and I can conceive of wanting to grab onto the hopes offered by the alternative medicine folks, but the science is in–vaccines have nothing to do with autism. And the continued arguments about it do a disservice to us in four ways. First, it distracts autism researchers from working toward real treatments and real understanding of the disease. Second, it endangers autistic children whose parents are tricked by these dubious studies and anecdotes of success into using alternative, expensive, and often dangerous treatments to “cure” the disease (a girl died of chelaton therapy, a dubious practice designed to pull the mercury out of the body). Third, it endangers children whose parents buy into the vaccine-autism link, leaving their children unprotected (many children have been hospitalized and a few have died of measles since this controversy started). Fourth, it endangers our public health as these un-vaccinated children circulate and risk spreading measles and other diseases easily conquered.

A more detailed discussion of the book follows.

Offit surveys the brief recent history of the oft-claimed link between autism and vaccines. In both the MMR debate (from the 1990s) and the thimerosal debate (from late 90s early 2000s), Offit develops the story not like a doctor, but like a seasoned journalist with a flair for drama. He starts by presenting the evidence proffered by the anti-vaccine crowds.

In the case of the MMR scare, a British research scientist named Andrew Wakefield held a press conference to coincide with the Lancet’s publication of his paper claiming a link between the MMR vaccine and autism. As Offit explains, the scare ran rampant, and tens (if not hundreds) of thousands of families decided against vaccination because of the dubious study. Over the course of the next few years, as more and more scientists pursued the studies, they found that Wakefield’s research was not reproducible, and that his conclusions could be completely disproved. Epidemiological studies showed, for example, that there was no difference in risk for autism in children who did and didn’t receive the MMR. Case closed, right? Nope, because Wakefield and his champions argued against the science, claiming a huge government cover-up, funded by the pharmaceutical companies. What they forgot to mention is that Wakefield’s funding came from a personal injury lawyer who was organizing a class-action lawsuit against vaccine companies. And then it came out that his samples didn’t show what he claimed.

So the target shifted, and thimerosal, a mercury-based preservative designed to make vaccines last longer in storage (an essential part of most vaccines), became the new target. Before Offit covers the public history of the debate, he covers the dubious science. He explains that thimerosal is made of ethylmercury, a version of mercury that leaves the system relatively quickly. This is opposed to methylmercury, which is the dangerous stuff we worry about finding in fish. Methylmercury leaves the body FAR more slowly than does ethyl. His first point (and most damning, IMO) is that the anti-vaccine crowd ignore (or hide) the difference between the two, regularly talking about EPA recommendations about intake of methylmercury as though they applied to ethylmercury. Mercury itself has also not been shown to have anything to do with autism. While some of the outward symptoms of mercury poisoning and autism are similar, they’re very different to experts. Offit points to a Japanese town with by vast numbers of mercury poisoning because of its polluted bay–their incidence of autism should be much higher if mercury is involved: their numbers aren’t higher.

The second part of the science that Offit highlights are the epidemiological studies. Early on in the thimerosal debate, people like journalist David Kirby–a banner carrier for the anti-thimerosal movement–wrote in 2004 that numbers for autism should start dropping, since thimerosal was removed from vaccines in 2001. When numbers continued to climb, they sidestepped the issue by beginning to criticize epidemiological studies. But it’s common sense. If thimerosal causes autism (and in fact, is blamed for the rampant rise of autism diagnoses in the last 20 years), then removing thimerosal from the vaccines should make autism rates drop. But like advocates for Intelligent Design, the target for the anti-vaccine people has become a moving one. When one theory about why vaccines cause autism is disproved, they move on to another rather than considering the overall hypothesis that vaccines have nothing to do with it. Epidemiological studies showing that un-vaccinated children are just as likely to be autistic as vaccinated ones are dismissed as biased.

So Offit details the sordid story of thimerosal, the ethymercury-based additive that has gotten the brunt of attention since the late 90s. He talks about how credulous celebrities and politicians jumped on the bandwagon as parents who believe the vaccine caused the problem have rallied behind anti-vaccine advocates. But again, Offit lays out the science in favor of the anti-vaccine theory, then shreds it. He reveals how the dubious practice of some scientists are not repeatable by others, and then how the original scientists (along with the parent advocacy groups) have significant financial stake in the anti-vaccine cause, either because they’re funded by anti-vaccine groups or because they’re planning huge lawsuits.

Offit’s discusses, at the end of the book, of the reasons the debate, a non-starter for most scientists now, has continued for so long. Here are a few of the big ones:

1. Scientists don’t like to speak in absolutes. The Scientific Method doesn’t allow it. Thus, when a scientist says “All evidence argues firmly against thimerosal as a cause of autism,” the anti-vaccine folks see a loophole, and call it ass-covering.
2. Journalists have no interest in producing public health stories to reassure people. Offit describes one such contact someone had with an assistant for Dateline; when they finished proposing the story on the science behind vaccines, the producer said “Wait, this isn’t a scare piece? My producer won’t go for that.”
3. Addendum for #1: most people don’t understand the scientific method. When bodies of scientists express an opinion (such as “MMR vaccine causes autism”) and then another group disagrees (”No it fucking doesn’t!”), the public hears that as uncertainty, rather than the system working.
4. Addendum for #2. The media like to portray “maverick” scientists as Galileos, people shut down because they’re going against the status quo. Instead, the mavericks we remember are the ones who were right. In other words, brilliant ideas often contradict common knowledge, but not everyone idea contradicting common knowledge is brilliant.

The desperation of parents seems to drive much of this fracas. In particular, one kind of experience is very common: parents take their one-year-old in to get the MMR shot and, shortly after, the child starts to show signs of autism. It’s hard not to imagine that there’s a connection, especially since the media has propagated this myth. But the human tendency to find patterns drives the problem here. If there was a common discussion of how being near blue cars causes accidents, there would be regular stories about how someone had passed a blue car, or been cut off by one, or something just before they got in an accident.

Two more versions of this reasoning. First, from The Simpsons

Homer: The Bear Patrol sure is doing a great job keeping us safe.

Lisa: Dad, that doesn’t make any sense. By that logic, I could claim that this rock keeps elephants away.

Homer: Tell me more.

Lisa: Well, there aren’t any elephants around, are there?

Homer: Lisa, I want to buy your magic rock.

Second, from the book: “The plural of anecdote is not evidence.”

Again, I don’t mean to make light of the experience of these children who have autism, but the blind faith they hold, even in the face of overwhelming evidence to the contrary, puts people in danger.

Overall, Offit’s book is an excellent read, and a great salve to the quackery it’s so easy to get sucked in by out on the Web.

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