Source: sarahmillerbooks, www.paul-offit.com
On Friday January 13, I attended the Beaumont Medical Club seminar in the Yale Medical Historical Library. That night the guest speaker was Dr. Paul Offit, a pediatrician, professor of pediatrics at University of Pennsylvania, and the director of the Vaccine Education Center at the Children’s Hospital of Pennsylvania. He is also the co-inventor of a vaccine to prevent rotavirus infection (the leading cause of diarrhea in young children), and a public proponent of vaccination.
Dr. Offit started his presentation with a brief history of vaccines: from Jenner, to Pasteur, Salk and Sabin, and finally Maurice Hilleman. Interestingly, Hilleman is not a name many people recognize, but Offit considers Maurice Hilleman to be the modern father of vaccines. In sheer number, Hilleman has contributed more to the field of vaccinology than any other single scientist. He developed a staggering nine different vaccines—including ones for measles, mumps, hepatitis A, and chickenpox, among others—and is the subject of one of Offit’s books: Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases.
Dr. Offit then discussed the current CDC-recommended vaccination schedule, highlighting not just the number of shots kids receive these days (26 doses within two years of life), but emphasizing some of the debilitating and crippling infectious diseases that are now preventable because of vaccines. Also worth mentioning, Dr. Offit laments, is the fact we now live in a society in which young parents have never encountered many of these preventable diseases and, therefore, don’t fully understand the risks associated with delaying or denying their children’s vaccinations.
Following this introduction, Dr. Offit moved quickly into the public perception of vaccines and how we’ve arrived at the forefront of medical controversy. The most interesting detail that I took away from this history was that there was actually very little opposition to vaccination in the earlier part of the 20th century. This was despite good cause for alarm, including a large-scale polio outbreak in 1955 from the Salk polio vaccine made in Cutter Laboratories (the subject of another Offit book, The Cutter Incident: How America's First Polio Vaccine Led to the Growing Vaccine Crisis). It wasn’t until the founding of the National Vaccine Information Center (NVIC) in 1982 that the anti-vaccine movement really began. Despite its name, the NVIC provides little material on vaccine efficacy and vaccine-preventable diseases. Instead, the group focuses on providing information on vaccine safety and vaccine-associated side effects and injuries. In addition to the birth of the NVIC, Dr. Offit believes that the documentary DPT: Vaccine Roulette, which was written, directed, and hosted by the actress Lea Thompson in 1982, was also partially responsible for the start of vaccine dissention. This program claimed that the diphtheria, pertussis, tetanus (DPT) trivalent vaccine caused brain damage. It featured harrowing stories of children suffering from brain damage and seizures after receiving their DPT vaccine. Offit believes this was one of the most powerful programs to ever air on national television and that it paved the way for all of the future vaccine-injury scare tactics by the anti-vaccine movement.
Following the founding of the NVIC and the airing of the DPT documentary, there was an immense rise in the number of lawsuits by individual families against vaccine manufacturers. This resulted in skyrocketing prices of liability insurance and vaccine production costs for pharmaceutical companies, leading to reduced vaccine production and ultimately vaccine shortages. Dr. Offit notes that by 1985 only one DPT vaccine manufacturer remained in the U.S. and the drastic reduction in the number of vaccine manufacturers necessitated government intervention. In 1986, Congress passed the National Childhood Vaccine Injury Act, which created a federal Vaccine Injury Compensation Program (VICP) in order to reduce the financial liability of vaccine makers. Of course this hasn’t tempered the enthusiasm of anti-vaccination advocates, but at least the pharmaceutical companies could continue to produce enough vaccine.
Then in 1998, British doctor and scientist Andrew Wakefield published a paper in the journal The Lancet in which he proposed that the measles, mumps, rubella (MMR) vaccine caused autism. He reached this hypothesis by claiming that measles virus could be found in the intestines of intestinal bowel disease (IBD) patients. IBD is quite prevalent in autism patients; therefore, he proposed that the measles part of the MMR vaccine causes autism. However, this paper was not a scientific study as much as it was a small case series of eight autistic children. This claim has been discredited by more than 14 independent scientific studies, yet the allegation remains as vigorous today as it was back then. Dr. Offit spoke quickly about the contributions of Wakefield to the anti-vaccine movement. It almost seemed as if his dislike for Wakefield was enough to keep him from persisting on the topic, but it should be noted that The Lancet paper was retracted in 2004 and the British General Medical Council revoked Wakefield’s medical license, citing numerous ethical violations and fraud.
Today, the “face” of the anti-vaccine movement has shifted to celebrities and public officials, including actress Jenny McCarthy and GOP candidate Michelle Bachmann. “I don’t know about you,” Offit said, in probably the funniest quip of the night, “but I always get my medical advice from Michelle Bachmann.” The audience chuckled, but Dr. Offit seemed wary of dwelling too long on this point. He did mention that the narration of personal stories about the suffering of children pulls at everyone’s heartstrings. “You’d have to be non-human to not feel bad for those kids on the DPT: Vaccine Roulette special,” Offit said. Because of outbreaks from vaccine-preventable diseases such as polio and measles, we now have the personal stories and emotional anecdotes in support of vaccination. It’s a sad truth that we have to use the suffering of children to make this point, but the anti-vaccine movement has been manipulating people with scare tactics for years.
During the Q & A someone asked, “What can we do when we’re not asked to give our side?” and cited the absence of a vaccine expert or scientist during Jenny McCarthy’s appearance on the Oprah Winfrey show. Interestingly, Dr. Offit nodded his head knowingly, and said, “Oh, I was invited to go on that show.” He chose not to go, he said, because “Oprah’s show is meant to entertain, and in any good story there are three roles to play: there’s a hero, a victim, and a villain. Well, Jenny is the hero, her son is the victim, and that only left one role for me.” Offit suggests that we all use emotional and personal stories like the anti-vaccine activists and get out there and share our knowledge. Another great point that I took away from the lecture was that there is no venue too small to stand up for science—and we shouldn’t let misinformation go unchallenged.
The microphone was then handed to someone behind me who started shouting quickly and energetically before I even had a chance to turn around. I didn’t catch his name at the time, but I found out later it was Jake Crosby, a young man with Asperger's Syndrome and a contributor to the Age of Autism website, which is not so much an autism awareness website as it is a venue for anti-vaccine propaganda. However, all that Mr. Crosby was allowed to say into the microphone was his name and affiliation, followed by the beginning of a question regarding Andrew Wakefield, before Dr. Offit shouted out, “Let me just stop you right there!” Dr. Offit proceeded to tell the audience that Jake was following him around the country and disrupting his seminars and that he had obviously “made it” since he now has a stalker. I agreed with Mr. Crosby’s assertion that he should be allowed to ask a question and personally thought that Dr. Offit disrupted his own seminar more than simply answering the question would have caused. Regardless, Jake Crosby got up and left under his own will. Although I appreciate Mr. Crosby's enthusiasm for increasing autism awareness, sensationalizing his interactions with Dr. Offit on his Age of Autism blog does little to further his cause.
The microphone made its way to a woman during the Q & A, whose question was more of a tirade and by the end of her rant I wasn’t quite sure where she had started or where she was going. She seemed not to be against vaccination per se, but was very concerned about autism and she appeared to be asking Dr. Offit whether he would debate Andrew Wakefield in a public forum. Dr. Offit asked for her name, replying “Ohhh, you’re Mary Holland!” after her response. Mary Holland is an attorney and co-editor of the book Vaccine Epidemic: How Corporate Greed, Biased Science, and Coercive Government Threaten Our Human Rights, Our Health, and Our Children. The book highlights the necessity for informed consent for all medical interventions, including vaccination, which I believe is a reasonable topic for discussion. However, this book is also a cover for anti-vaccine philosophy and includes chapters on and written by Andrew Wakefield and the debunked link between MMR and autism as well as a variety of other conspiracy theories. Getting back to the Q & A, Dr. Offit was very frustrated with Mary Holland’s request for debate because all the scientific evidence discredits any link between vaccines and autism. “What is there to debate about? The scientific data is the truth,” Offit replied. Mary Holland is an attorney, so she can probably debate just about anything, and she continued to push the notion that vaccines can and have caused autism, citing rulings by the federal vaccine injury compensation program (VICP) as proof of causality. What’s lost in this reasoning is the fact that the VICP is a no-fault program, meaning that the biological cause (in this case, a vaccine) of a side effect or disease does not need to be scientifically validated to provide compensation. Unfortunately, Mary Holland’s audience (outside of this particular venue) probably doesn’t realize this is an empty argument.
As for the future of vaccination, Dr. Offit was surprisingly optimistic. He thinks that despite the accessibility of misinformation, we’ve turned a corner in getting the truth out there. Besides from mandating vaccination, a program he has pioneered for all employees in his own hospital, we can only provide parents with correct, scientifically valid information. He hopes, and I do as well, that enough parents make the choice to vaccinate their kids so that herd immunity can protect us all.
-Heather D. Marshall, Ph.D.
Immunobiology Department, Yale University
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