Monday, April 18, 2016

Ex-VAX-perated

A pivot to Public Health for a change of pace.

It's been a particularly busy month for health journalism in Canada. There's the ongoing standoff in Ontario around doctors' billings, the legislation around physician-assisted death that's apparently pleased nobody, and the struggle to control provincial budgets in oil-producing regions of the country. Still, it was with a huff of dismay that this issue, which we all thought was settled years ago, reared its ugly head once more:

Robert De Niro: ‘People should see’ anti-vaccine film


And so, in the steady campaign to immunize our children against perfectly preventable diseases, using perfectly safe vaccines, the entire health care community is once more sent reeling backwards by an entertainer who just...won't...let...it...go. Yes, the man has an autistic child and is wholly deserving of understanding. But surely the ever-growing body count from measles since the anti-vaccine movement started, and the pleas of esteemed, reputable scientists should count for something. At the very least, the popular media has a duty to remind the public that celebrity does not equate to authority.

For those who might not know the story, here's as brief a rundown as I can give:

In 1998, Dr. Andrew Wakefield published a study of 12 (yes, just 12) children suggesting a link between the measles vaccine, autism, and an uncommon form of colitis. Oddly enough, you never hear anything about the bowel condition, but the autism allegation spread like wildfire. Otherwise educated parents stopped getting their children immunized against measles (and mumps and rubella, that are co-administered in the same vaccine), leading to depressingly frequent outbreaks of infections we can prevent with near 100% success. To make matters worse, a Who's Who of 1990s celebrities became champions of the (misguided) cause, albeit to varying degrees.


Wakefield was ultimately exposed as an unethical fraud. He had a financial stake in a competitor vaccine to the one he attacked, and his research was funded by lawyers for parents suing the vaccine manufacturer. His co-authors disavowed the study, The Lancet issued a formal retraction, and Wakefield himself was stripped of his license to practice.

The link between the MMR vaccine and autism was studied and refuted from a dozen different angles. Time and again the link has been disproved, in one country after another, by investigative journalists as well as scientists. Whatever the cause, including the progressive replacement of other diagnoses with a diagnosis of autism, the MMR vaccine is not to blame.
















Everything humanly possible has been done to discredit Wakefield and his research, short of actually killing him. But here we remain, almost 20 years later, unable to do away with the MMR-autism link once and for all.


There was still hope that the falsehood would fade away in the face of repeated outbreaks, and the public health community continued to tweak its message about vaccine safety. Then came the CDC Whistleblower controversy/conspiracy theory in 2014. That story sparked the production of VAXXED, which not-so-coincidentally lists Andrew Wakefield as both director and star.

The "controversy" is less than meets the eye. In 2004, the CDC (Center for Disease Control) published a study debunking the MMR-autism link in the journal Pediatrics. Ten years later, biologist Dr. Brian Hooker, himself the father of an autistic child, published a sub-analysis of the 2004 data, arguing that male children, and in particular black male children, had significantly higher odds of being diagnosed with autism after receiving the MMR vaccine. At the same time, Dr. William Thompson, an epidemiologist at the CDC, raised concerns with the CDC leadership about the failure to report these results when the data was first available in 2004.

The CDC didn't feel there was all that much going on, and the data was readily available for public access. Moreover, the journal that published Dr. Hooker's article promptly retracted it, citing questions of validity and previously-unmentioned conflicts of interest. Nevertheless, conversations between Thompson and Hooker spawned a "tell-all" book and the documentary VAXXED.


Which brings us to Robert DeNiro, who had intended to show VAXXED at his Tribeca film festival, but backed off in the wake of public pressure. Still, he let his feelings be known in a televised interview, science be damned.

And that's what we're left with. Robert DeNiro joins Jenny McCarthy and Jim Carrey as a modern-day Three Stooges, peddling the false equivalence between what they know and what science has proven, consequences be damned.



Curly, Larry, and Moe

I honestly don't know where the public health community can go from here. Revisiting and re-reporting the science clearly hasn't done much. Likewise with comedians' public shaming of the anti-vaccine movement.


From the standpoint of health policy, we need to strengthen the laws around immunizations. Let's do away with nonsensical objections and give a mightier stick than a school suspension. Immunization should be the law, a societal obligation rather than a personal choice. When objections arise, policymakers should treat them the same way they do any other conspiracy theory--by dismissing them out of hand.

It's also time to fight fire with fire. All the data in the world can't compare to a really compelling story. Let's remind any confused member of the public (and the anti-vaccine crowd) that failure to immunize can have real, devastating health outcomes, endangering the lives of at-risk children.

Once upon a time, peddling unproven medical nonsense really was a job for Three Stooges. Let's remind the public that still holds true today.








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