Blaming Ourselves

Andrew Wakefield, a former British surgeon and medical researcher, was recently denounced by the British Medical Journal in an editorial and a report on Wakefield's falsified data. The report showed that he hoped to make $43 million a year in a related medical test he patented. He already had his medical license revoked for both dishonesty related to the study and for the abuse of developmentally challenged children.¹ In spite of all this damning evidence against his findings and his permanently ruined reputation, his anti-vaccine message appeared so compelling to certain people that some parents around the world have taken the risk of not vaccinating their children, some with tragic results.

On a larger scale, California, one of the places where the anti-vaccine movement has flourished, is currently suffering the worst whooping cough outbreak since 1947, although the infection was nearly eradicated by the 1980s. Not vaccinating a child has consequences reaching far beyond that child and creates a public health danger. The ultimate goal in the push for vaccinations for contagious diseases has been, from a public health perspective, to develop "herd immunity" in order to reduce or completely stop the spread of a disease. In the case of smallpox, for example, the disease has been completely wiped out due to vaccinations. However, the anti-vaccine movement has become so concentrated in some areas that it has led to a dramatic decrease of herd immunity, below the estimated 90% vaccination rate needed for measles, mumps, and rubella to stop spreading.²

This, understandably, frustrates doctors and scientists. Why do the parents choose to take this risk?

It would be easy to blame it on a lack of reason, to place these parents in the "ignorant other" often depicted in the battles ablaze in other fields, such as the current debate on global climate change or evolution. Such thinking has been entrenched in many scientists' attitude for a long time.³ With so much frustration on both sides, it's easy to paint the divide as a war — but this closes off paths toward understanding each other. Both scientists and skeptics would do well to understand each other.

With the anti-vaccine movement, the parents were desperate for answers. This is grief that they are reacting to, not an "epidemic of ignorance" among a duped public as some portray it. In a recent Associated Press article, Dr. Paul Offit, who has written books criticizing the anti-vaccine movement, summed it up eloquently: "This scared people and it's hard to unscare them. Until medicine can step up and say, 'We understand the cause of autism,' they may never be assured."⁴

Furthermore, here's the thing about the reasoning behind those that looked to Wakefield's paper for a solution: They had attempted to base their decision on science. Andrew Wakefield's obviously flawed paper was published in Lancet, a well-respected journal, after being thoroughly peer reviewed. Although it was later retracted, why did Lancet publish Wakefield's paper in the first place? When such a huge mistake slips through in the sciences, that mistake suddenly becomes immensely credible. It is then lauded as real scientific progress (expecting, perhaps, that other papers will follow while other scientists are slower to come around), the kind of progress parents of autistic children are desperate to see.

How did the respected system of science publishing and peer review fail so spectacularly? I've seen papers from Science or Nature that could have used better methods or more rigorous statistical analysis (and so have a number of you, I'm sure), but Wakefield's paper was something else altogether: It was flawed from start to end. In several other instances, serious problems with papers are not discovered until after they are published, and journal editors are often unwilling to retract their papers. Before those in the science community bash anti-vaccine parents, they need to first ask themselves where things went wrong in the first place, before they accidently appear to advocate another harmful idea.

Image Credit: Jennifer P. (via Flickr)

References::

1. General Medical Council. Fitness to Practice Panel Hearing. January 28, 2010.

2. Salathé, M. & Bonhoeffer, S. "The effect of opinion clustering on disease outbreaks". Journal of the Royal Society, Interface/The Royal Society 5, 1505–1508 (2008).

3. Snow, C. P. The Two Cultures. Cambridge: University Press. 1960.

4. "Will autism fraud report be a vaccine booster?" Associated Press. January 6, 2011.

For a long list and summary of research showing no link between the MMR vaccine, vaccine preservatives, and autism by the American Academy of Pediatrics, go to: http://www.aap.org/immunization/families/faq/vaccinestudies.pdf