It’s not often that I write about journalists having blood on our hands. Our willingness to aid foes of the MMR (Measles, Mumps, Rubella) childhood vaccination, however, is such a case.
When, in the name objectivity, we treat all sides equally in this battle between medicine and belief, we enlist in the Flat Earth Society.
On the other hand, credit goes to journalist Brian Deer who spent almost seven years unraveling the potentially lethal fraud that leads too many parents to reject the MMR shot in the belief that it can cause autism. And while he dug, the British medical establishment — or that part for whom the prestigious journal, Lancet, speaks — largely hid.
As his reward, Deer and the rival British Medical Journal, which recently examined and validated his reporting, are targets of wrathful parents who cannot distinguish between evidence of coincidence and cause. The BMJ issue last month also provoked renewed attention to MMR/autism in The New York Times, HuffingtonPost.com, thedailybeast.com, NPR and other media.
Science, medicine and epidemiology have not proved MMR does not cause autism. That’s rarely how science works. Instead, researchers say they’ve found no evidence that MMR causes autism. None of this, though, persuades these anguished parents of an absence of a causal link between MMR and autism. Worse, they reject evidence that MMR is safer for children than catching measles, mumps or German measles (Rubella).
The MMR/autism brouhaha began in 1998 in an “Early Report” in the British peer-reviewed medical journal, Lancet. In it, physician Andrew Wakefield linked the MMR vaccination to the onset of debilitating digestive problems and subsequent autism among young children. Coincidentally, there has been an uptick in diagnoses of autism, especially among boys, and parents want an explanation. Wakefield — neither a pediatrician nor an autism researcher/specialist — provided one. He became a hero to parents desperate to understand their seemingly healthy, normal youngsters’ devastating decline into autism. The implication was clear: Avoid MMR and escape the risk of autism.
Most physicians ignored Wakefield and continue to recommend and give the MMR vaccination. Now, however, so many parents continue to refuse the MMR vaccination that they create the risk of outbreaks of measles where none has been known for years. Deer dug into all of the available evidence and talked to some of the families whose children were among those examined for the study. Deer says some parents claim Wakefield misrepresented what they said and their children’s health problems. Wakefield studied 12 children; one parent says that’s not true; he recalls being told that his child was No. 13. There also was the suggestion that Wakefield accepted funds from plaintiffs’ lawyers who were seeking a causal connection between MMR and autism.
After its longest investigation of alleged misconduct, the British General Medical Council said Wakefield’s 1998 representations were “dishonest and irresponsible” and he’d displayed a “callous disregard” for the suffering of his test subjects. In its January issue, the British Medical Journal validates Deer’s reporting, no matter what celebrity activists may say.
BMJ editor Fiona Godlee wrote: “He (journalist Brian Deer) found that their (the parents’ and childrens’) data had been substantially misrepresented in order to give the result Wakefield needed. Thanks to the recent publication of the GMC’s six million-word transcript, the BMJ was able to check Deer's findings and confirm (Wakefield's) extensive falsification. As my colleagues and I write in an editorial this week, in no single case can the medical records be funny reconciled with what was published. This means that the MMR scare was based not on bad science but on a deliberate fraud. The original paper has received so much media attention, with such potential to damage public health, that it is hard to find a parallel in the history of medical science.”
The medical council revoked Wakefield’s license and he moved to the ‘States. Lancet retracted his article.
None of this convinces True Believers, as a recent huffingtonpost.com essay demonstrated. By “author, model and autism activist” Jenny McCarthy, it cites anecdotal evidence to support Wakefield and offers aid and comfort to those who cling to Wakefield’s discredited methods and findings. “I know children regress after vaccination because it happened to my own son,” she wrote. “Dr. Wakefield did something I wish all doctors would do: He listened to parents and reported what they said.”
McCarthy continued, in part, saying, “For some reason, parents aren't being told that this ‘new’ information about Dr. Wakefield isn't a medical report, but merely the allegations of a single British journalist . . .”
To accept that, you must also believe there is a conspiracy among pediatricians, Deer, Lancet, the General Medical Council and British Medical Journal to discredit Wakefield and hide the true cause of autism. Moreover, with her deficit in critical thinking, McCarthy confuses coincidence with cause. Coincidence can be the intellectual version of “shit happens.” It does not explain or prove why it happens.
I’ve just reread Wakefield’s 1998 Lancet paper. He doesn't explicitly blame MMR for autism. Instead, his paper is heavy with that suggestion. Deer, the General Medical Council, Lancet and British Medical Journal say Wakefield’s paper was not an honest piece of work.
Jenny McCarthy is not alone.
Others also reject evidence of fraud as well as methodologically rigorous studies that find no causal link between MMR and autism.
Coincidence is something else. For instance, millions get the MMR vaccination; a few will develop autism. A few will develop other childhood medical problems. Research can neither prove nor disprove the MMR-autism link but the causal link is not evident when millions of vaccinations are studied. That’s why it’s so difficult to win claims against the science-based U.S. National Vaccine Injury Compensation Program. It’s also why any successful claim makes headlines and renews controversies over vaccination.
Which brings me back to the role journalists play in a controversy where all sides are so passionate that no amount of media coverage or education is going to change minds. So how much attention should we give to such discredited claims as MMR causes autism? Do we risk a validation of sorts with even critical coverage? “The Times thinks there must be something there or they wouldn’t spend so much energy trying to debunk it,” so the argument goes.
Put another way, should the objectivity-addicted mainstream news media take sides and embrace the best contemporary evidence mustered by science, medicine and epidemiology and ignore claims that MMR causes autism? Faced with undeniable evidence, should we stop giving both sides equal time and passively promoting an argument that could endanger unvaccinated children . . . and adults? We’ve done it on the role tobacco plays in myriad crippling and lethal illnesses.
Similarly, does our reporting suggest a controversy where none exists except in the minds of those who reject the evidence-based scientific/medical consensus? We did it for years by ennobling critics of automotive seat belts, air bags, cycling/motorcycling helmets and anti-tobacco campaigns. We still do it with Creationist claims that science supports their “young earth” beliefs and their rejection of evidence of a much older planet, Grand Canyon and human evolution.
Complicating our response is the American bias toward bad news. I forget who said it, but it was a veteran TV newsman who asked who’d watch reports on cats that didn’t get stuck in trees? It’s firefighters rescuing a cat that we want to see. We consume news stories about crimes and accidents that happen to others, people sickened or killed apparently by medicines meant to strengthen or cure them, medical devices so badly designed, made or maintained that they can be lethal.
A recent op-ed essay in The New York Times helps put this in context. Only after about 150 years did vaccines win general acceptance with the eradication of smallpox and elimination of polio in most countries after World War II. Until then, vaccination had an iffy history, buffeted by deaths of children from careless and badly regulated manufacturing and anti-vaccination riots.
In parts of sub-Saharan Africa and Pakistan, some Muslim religious leaders reject polio vaccination as a genocidal Western plot with predictable results: Dead and crippled people and a “home” from which the virus can spread again. The few people worldwide who reject or are missed by smallpox vaccination are protected by the rest of us. That’s the “herd immunity” so beloved of medicine and epidemiologists.
Annual flu deaths and less frequent swine flu pandemics created demand for effective vaccines and news stories of real and imagined reactions to vaccinations. That’s why providers still want to know if you’re allergic to eggs with which flu vaccines are made. There is an alternative vaccine now to avoid that egg-allergy problem. Fears of mercury compounds in vaccines have abated as substitutes are being used. No medicine powerful enough to be effective is 100 percent risk-free; given to enough people, someone will be sickened and possibly die.
The question then is whether the medicine caused the death or was death coincidental to taking the medicine? And do the benefits to all of us justify the risks to some individuals? Mandated or strongly-urged vaccination also triggers American bred-in-the-bone suspicion of and resistance to government, science and medicine, The Times notes.
The need to blame is powerful. That bad things happen to good people is no explanation. I covered a long trial in which hundreds of mothers blamed their newborns’ birth defects on Bendectin they took for nausea during pregnancy. Most children born to tens of thousands of Bendectin users did not show physical birth defects. Jurors rejected the mothers’ claims that Bendectin caused birth defects; evidence showed the frequency and type of birth defects didn’t change significantly before, during and after sales of Bendectin.
In short, it was coincidence.
Dailybeast.com contributor Seth Mnookin recalls prepublication doubts about Wakefield’s 1998 Lancet paper. “After an initial peer review raised questions about the quality of Wakefield's research and the soundness of his reasoning, the editor of The Lancet demanded the paper be rewritten and slapped an ‘Early Report’ label above the title and on the header of each page. He took the even more unusual step of asking Robert Chen and Frank DeStefano, two American vaccine specialists at the Centers for Disease Control, to prepare an evaluation of Wakefield's paper that would appear in print.
“Usually, when they publish a commentary, it's to extol the study, or show how it's advanced the field,” DeStefano says. “That was obviously not the case here.”
Moreover, Mnookin wrote, it wasn’t long after 1998 publication that “the dean of research at the London School of Medicine called the study 'probably the worst paper that’s ever been published in the history of (The Lancet),' (and) he was merely verbalizing what many scientists had thought all along.”
Deniers won’t let go. NPR’s Science Friday recently interviewed Paul Offit. He’s chief of the Division of Infectious Diseases and the director of the Vaccine Education Center at Children's Hospital of Philadelphia. He's also a professor of vaccinology at the University of Pennsylvania School of Medicine, and is author of the new book, Deadly Choices: How the Anti-Vaccine Movement Threatens Us All.
Offit is frustrated by adults endangering children in their rejection of MMR or measles-only vaccinations. These opt-outs endanger the “herd immunity ” where almost universal vaccination denies measles a foothold that can become epidemic. Callers challenged or rejected his evidence last month and in a Science Friday appearance three years ago.
Offit, however, welcomed a new angry voice: Parents whose children have been sickened by rejectionists’ children with measles.
He recalled a recent segment on NPR's This American Life called "Ruining it for the Rest of Us." In it, a mother chose not to vaccinate her children. “She went to Switzerland. The seven-year-old got measles, comes back to the United States, proceeds to infect a series of people, certainly expose about 900 people, but while waiting in the doctor's waiting room, exposed three children who . . . hadn't gotten the measles vaccine because they were too young. All three got measles, all three were severely infected. One of them was hospitalized and almost died. And they had that mother on the show, who was angry. You know, she said ‘That mother who chose not to vaccinate her child made a decision for my child that almost killed him.’ And that's a voice you had never heard before (but) you're starting to hear because we're starting to see these outbreaks come back again.”
• Plagues of shark bites, dog bites, suicides or other phenomena usually amount to little more than the news media adding up events in a given, brief period and concluding that something special happened.
That’s what falling blackbirds and dying fish amounted to in recent news reports, according to naturalists who study these things all of the time. “The reality, say biologists, is that these mass die-offs happen all the time and usually are unrelated,” wrote AP’s Seth Bornstein. “Federal records show they happen on average every other day somewhere in North America,” he added. “Usually, we don't notice them and don't try to link them to each other.”
In the past eight months, the U.S Geological Survey (USGS) has logged 95 mass wildlife die-offs in North America and that's probably a dramatic undercount, wildlife disease specialist LeAnn White told AP.
The list includes 900 some turkey vultures that seemed to drown and starve in the Florida Keys, 4,300 ducks killed by parasites in Minnesota, 1,500 salamanders done in by a virus in Idaho, 2,000 bats that died of rabies in Texas, and the still mysterious death of 2,750 sea birds in California.
On average, 163 such events are reported to the federal government each year, according to USGS records. And there have been much larger die-offs than the 3,000 blackbirds in Arkansas. Twice in the summer of 1996, more than 100,000 ducks died of botulism in Canada. It’s about as newsworthy as “Freshmen arrive” or “Seniors graduate,” those perennial breaking news stories so loved by editors.
• London’s Independent went to Munich for what might be the last trial of an accused World War II war criminal: Northern Ohio’s John Demjanjuk.
An immigrant and retired auto worker, he’s accused of complicity in the slaughter of 27,900 Jews at the Sobibor death camp in occupied Poland. For years, his case bedeviled the federal appellate court in Cincinnati. Eventually, his citizenship was revoked. He was extradited to to Israel where a war crimes conviction was overturned. Now, he’s on trial in Germany.
“(L)ying prone on a hospital bed wrapped up in a green prison coverlet, Mr Demjanjuk often falls asleep as evidence against him is read out in court,” reporter Tony Paterson wrote. “Were it not for the gravity of the crimes that Ukranian-born defendant is alleged to have committed, his appearances in court, would qualify as material for a television farce. The trial often degenerates into stand-up shouting matches between Ralph Alt, the presiding judge, and Ulrich Busch, Mr Demjanjuk's defence lawyer . . . Every shred of evidence read out in court has to be simultaneously translated into Ukranian by a court translator to enable Mr Demjanjuk to comprehend what is going on. Yet the accused says nothing and only ever opens his mouth to emit moans or strange gurgling sounds.
“The proceedings have been slowed . . . by the aged and apparently ailing defendant's state of health,” the article continues. “Doctors have ruled that . . . he is only fit to appear in court for two days a week for a maximum of three hours a day. They are by no means certain that he will live long enough to witness the end of his own trial. Proceedings often grind to a halt as soon as they start with doctors proclaiming that their patient is 'not well enough to attend court today.' Mr Demjanjuk is then driven back to his cell in Stadelheim prison, Munich, where he has been incarcerated since his extradition from the U.S. in May 2009.”
Demjanjuk denies any role in the Holocaust, saying he was a prisoner of war captured while fighting in the Red Army against the Germans. He claims an identity card placing him at Sobibor is counterfeit and someone else was “Ivan the Terrible,” a guard who tortured Jews being driven into gas chambers.
It was uncertainty over that identification that led to Israel’s Supreme Court reversing his conviction there.