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Sunday, May 02, 2010

Fronline Reports on Anti-Vax Manufactuversy

I just wanted to repost a couple of other stories/blogs that I saw as a result of the Frontline episode that was on PBS.

The Vaccine War: Telling it (mostly) like it is about the anti-vaccine movement

Category: Antivaccination lunacyEntertainment/cultureMedicinePopular cultureQuackeryTelevision
Posted on: April 28, 2010 3:00 AM, by Orac

Yesterday, I expressed concern about a FRONTLINE episode that was scheduled to air tonight entitled The Vaccine War (which, by the time you read this, should be available for online viewing in case you missed it). My concern was that there was going to be a heapin' helpin' of false balance, based on the promotional materials. My concerns were later somewhat assuaged based on the pre-airing reaction of the anti-vaccine movement, which was fairly wary, if not hostile even. Of course, any television show that doesn't conclude that their view that vaccines cause autism is at plausible or even likely is virtually guaranteed to have an infiltration of anti-vaccine loons in the comments attacking relentlessly, but I was heartened to see a review like this proclaiming the documentary to be very much science-based and intolerant of the misinformation, pseudoscience, quackery, and lies of the anti-vaccine movement. I could only hope.

Another indication that The Vaccine War might be OK from a science-based perspective was that the antivaccine crank blog Age of Autism (AoA) preemptively set up a post in which the merry band of antivaccinationists proclaimed that they would be live blogging and live Tweeting the special. Conveniently enough, they included links to the PBS Ombudsman, links to FRONTLINE, its Facebook page, and its Twitter stream, presumably to facilitate said influx of anti-vaccine loons to those locations to protest most piteously being mistreated by a television show pointing out that there is no evidence that vaccines cause autism and, even worse, pointing out that anti-vaccinationists are endangering children. Then there's a convenient post full of links to AoA misinformation, cherry picking, and distortions, presumably to provide said anti-vaccine loons with links to use when they protest most piteously their treatment on FRONTLINE.

So I decided to wait until the show aired, watch it, and report back to you, my readers, in the meantime savoring a couple of characteristic reactions, first from the grand macher of the anti-vaccine movement, reclaiming his place now that Jim Carrey has apparently dumped Generation Rescue's spokescelebrity Jenny McCarthy, your bud and mine J.B. Handley:

I personally spent 2 hours with Jon Palferman and Kate McMahaon, the producers of the piece. The whole point of my meeting was to explain that this was not Parents vs. The Science and that our community takes its cues from doctors and scientists. I encouraged them to interview Jon Poling, Bernadine Healy, Boyd Haley, and many others.

When Jenny was interviewed, Jay Gordon sat next to her the entire time and was also part of her interview - let's see if they show him.

I told Frontline, "Get all the people from the other side you want, just be fair in telling the totality of our story, and don't turn this into a Parents vs. the science" like the NY Times did."

My response back from Kate McMahon:

"FRONTLINE will carry out a detailed and even-handed investigation including voices from all sides of the controversy including parents, activists, physicians, scientists, lawyers, politicians and vaccine manufacturers. We will examine the evidence relating to an association between increases in the prevalence of autism and hypothesized causes such as MMR vaccine, thimerosol and other toxins associated with vaccines."

Here's hoping they live up to what they said they would do.

Here's hoping they don't, I thought. But clearly J.B. wasn't too happy, which gave me hope that The Vaccine War would be science-based. Then I saw these Tweets from everybody's favorite pediatrician to the stars, apologist for the anti-vaccine movement, and pediatrician to Jenny McCarthy's son Evan Dr. Jay Gordon:

PBS show about vaccines. Don't bother to watch it.

And:

A number of scary articles in newspapers today to augment PBS' scary vaccine show tonight. They interviewed me for 2 hrs and cut it all.

Gee, sounds like sour grapes, doesn't it? It's also interesting that Jenny McCarthy had Dr. Gordon sitting next to her the whole interview, probably because she's so prone to saying incredibly stupid things. Of course, Dr. Jay is also fairly prone to saying pretty stupid things, too; so I don't know if he's much of a safeguard to the message. I guess we won't get to find out.

So how did the show turn out? Here follows my impressions and semi-live blogging. Feel free to watch the show (embedded at the top of this post) and check it out for yourself.

The Vaccine War (viewable online)

The opening montage did a bit too much of the whole "balance" thing in that it included J.B. Handley blathering and Jenny McCarthy spewing her same brain-dead false dilemma of measles versus autism. (She'd choose the measles, of course.) I was able to forgive that, because it's very much setting up the story. The show then launched straight into a birth and a list of the vaccines that children get, with Melinda Wharton of the CDC and Paul Offit pointing out how much good vaccines do, how we no longer see diseases that once killed thousands or even milions.

Then it's straight to Ashland, OR and the woo and a mother named Jennifer Margulis, who is a writer for that "natural" repository of woo Mothering Magazine and spewing nonsense about "natural immunity" versus vaccines, claiming that it is better than vaccine-induced immunity. Dr. Donna Bradshaw-Walters was then introduced, and she describes how 28% of Ashland's children are missing some or all of their vaccines, pointing out that it is only a matter of time before there is an outbreak there. It was refreshing to note that there are pro-vaccine parents, one of whom predicted that it would get ugly if there were an outbreak in which vaccinated children started to get sick because of unvaccinated children forming a repository for disease that can spread to vaccinated children whose vaccines didn't "take," for whatever reason. The show then described the SSan Diego measles outbreak and how unvaccinated children are a vector for infection, even to the vaccinated, who are less likely to be infected but not immune, as no vaccine is 100% effective.

There was then a segment at Pfizer. This may not have been the best idea strategically, given how it feeds into the distrust of big pharma, although the scientist interviewed, Dr. Emilio Emini, did a good job of pointing out how vaccines prevent disease. Still, right there, I could envision doubting parents becoming suspicous. Then, of course, there is Dr. Paul Offit, who, although he is the Dark Lord of Vaccination to the antivaccine movement, who is nonetheless the one of the most effective provaccine voices. Happily, Offit makes no apologies for having gotten rich from a vaccine. He is enormously proud of it, as he should be.

One thing this show revealed that I didn't know was that bioethicist Arthur Caplan had actually contracted polio in his youth. No wonder he is so effective when he argues for vaccines. Equally effective is a scene in which paramedics are being trained, part of their training being to watch videos of children with pertussis and rotavirus. The video of the child with pertussis is horrifying; the suffering of such children is incredible. This class even pointed out that chickenpox can actually be fatal, showing a child with staph sepsis in the pox lesions.

Unfortunately, Margulis demonstrates the burning stupid by asking why we are still vaccinating for polio as polio has become more rare. This woman was truly irritating and moronic. Worse, she kept popping up throughout the show, sadly enough. But that wasn't enough. There had to be Barbara Loe Fisher, too, spewing her usual anti-vaccine line. Unfortunately, here's where FRONTLINE falls down. The show seriously represents BLF as a "vaccine watchdog," rather than what she is, an anti-vaccine propagandist. Bad FRONTLINE!

Similarly, the interview with Jenny McCarthy is infuriating, as usual, but there was a rather interesting tidbit in the complete online interview:

How long after the MMR was that first seizure?

You know, a lot of people think, and probably from me saying in some interviews, that it was after the MMR I noticed changes.

I don't think it was just the MMR shot that caused any kind of trigger with autism. I think it was a compilation of so many shots to a kid that obviously had some autoimmune disorders. So I would say maybe a couple of months, a month or so after the MMR, I started to notice some physical ailments such as constipation, rashes, eczema. That was like the first little sign. And then the train just kind of descended from there.

This is very different from the stories she was telling around the time she released her first book, and she even seems to be acknowledging it as she dances around a very simple question. Indeed, I remember McCarthy saying in interview after interview how she saw the "light go out of Evan's eyes" right after the shot. For example, anti-vaccination activist Ginger Taylor cites what Jenny McCarthy said in her 2007 interview with Oprah:

Jenny says even before Evan received his vaccines, she tried to talk to her pediatrician about it. "Right before his MMR shot, I said to the doctor, "I have a very bad feeling about this shot. This is the autism shot, isn't it?' And he said, 'No, that is ridiculous. It is a mother's desperate attempt to blame something,' and he swore at me, and then the nurse gave [Evan] the shot," she says. "And I remember going, 'Oh, God, I hope he's right.' And soon thereafter-boom-the soul's gone from his eyes."

Notice how Jenny appears to have changed her story from its being the MMR to its being a gradual process due to too many vaccines. Truly, her story shifts more than the sands of the Sahara.

This segment ran right into an interview with J.B. Handley. There was really nothing new there in that J.B. claims that "tens of thousands" of parents tell him that their children were "never the same" after vaccines, combined with his simplistic mantra: Vaccines cause brain damage and autism is brain injury. Ergo, to him, vaccines cause autism. Of course, it is not really true that autism is "brain injury." It is a difference in the brain, but there's no good evidence that autism is primarily due to "brain injury," although there's all sorts of quackery out there that purports to treat "vaccine injury" to the brain.

Here's another point where the FRONTLINE special drops the ball a bit. The show immediately goes into the MMR fear mongering provoked by Andre Wakefield. The problem is that J.B. Handley wasn't about MMR. Generation Rescue until recently said that autism is a "misdiagnosis for mercury poisoning." But the MMR has never had mercury in it, ever. In conflating these issues, FRONTLINE confuses two related issues that are not really the same thing, particularly when it starts showing a speech by Robert F. Kennedy, Jr. at the Green Our Vaccine rally from two years ago. As someone who knows about the anti-vaccine movement and its history, this was irritating, and it is more than just a nit to pick.

That being said, I do like how, right after a segment in which Jenny McCarthy claims that scientists won't study whether vaccines cause autism, the show immediately goes on to show that that she is either mistaken or lying, take your pick. (Personally, I think she's too stupid to realize how wrong she is about this.) The issue has been studied extensively in multiple countries, and no link between vaccines and autism has been found. Moreover, FRONTLINE did a good job of explaining how correlation does not necessarily mean causation. Just because a diagnosis of autism is made soon after a vaccine does not necessarily mean the vaccine caused autism. It finished this middle part of the documentary by documenting the fall of Andrew Wakefield, in particular pointing out how some of the children in his studies had been referred through lawyers suing vaccine manufacturers.

The beauty of this segment is how FRONTLINE showed that, no matter how much evidence, with J.B. Handley saying, "I don't give a fuck about the MMR in isolation in one study." (Yes, he did use the F-word, although it was bleeped out and turned to "crap" in the online transcript.) This was rapidly followed by a demonstration of Barbara Loe Fisher shifting the goalposts asking for more epidemiological studies and basic science studies. It is, as Dr. Offit put it, a classic shifting of goalposts, with Jenny McCarthy blathering about her "mommy warriors" and how "Evan is her science."

Unfortunately, this segment depressed me, because it shows just how much science doesn't matter in trying to persuade these parents and how the web perpetuates not just the old vaccine myths, but facilitate the spread of new ones. It demonstrates just how much the Internet's "democratization" of knowledge devalues knowledge, expertise, and science. The forces of pseudoscience proliferate and infiltrate, and, quite frankly, those of us who promote science-based medicine are way behind the eight ball in trying to counter these messages. One thing I had no idea about was just how effective the Desiree Jennings story had influenced high school students not to vaccinate. Roughly half of one class who hadn't taken the H1N1 vaccine said that the reason they didn't take the vaccine was because they saw Desiree Jennings on YouTube. This makes me think, more than ever, that blogs such as this one and others are essential in tearing apart such bad information. The result of this information is people like the mothers in Ashland that I discussed last time who ask, "If vaccines work, who am I hurting by not vaccinating?"

The result was shown in the story of a baby who came down with pertussis and almost died. Her situtation was so bad that a chaplain was brought in for possible last rites.

Near the end of the show, there was presented a focus group of people who discuss vaccination. What was interesting is how much vaccination is viewed as a parental choice rather than a societal duty. This in and of itself is not necessarily a bad thing. The problem is that this choice is being increasingly undermined by misinformation on the Internet and out there. The message of the anti-vaccine movement that the days of "paternalism" are over echoes very strongly with the whole "health freedom" movement. It's very difficult for anyone to make a well-informed choice when most of the information that pops up when you search the Internet is from the anti-vaccine side.

In the end, I was mostly relieved by The Vaccine War. It was science-based, and it pulled no punches in asserting that there is no good scientific evidence that vaccines cause autism. True, it did confuse the issue of the MMR vaccine and thimerosal-containing vaccines, and that's more than a minor mistake. It also was far too kind in its treatment of Barbara Loe Fisher, calling her organization, the National Vaccine Information Center a "vaccine safety" advocacy organization, when it is an anti-vaccine organization, plain and simple. It did a little better with Generation Rescue, showing a bit of the sheer insanity behind the organization and how, no matter how much evidence there is against its position, it never looses sight of its founding principle, namely that it's absolutely, positively always the vaccines. Always. Those complaints aside, FRONTLINE did a far better job than I expected in deconstructing the anti-vaccine movement. It didn't compromise on the science, although it may have compromised a bit in how it describes, for example, the NVIC and Generation Rescue.

Will The Vaccine War change minds? Maybe. There's no way it's going to change the minds of hard core antivaccinationists of J.B. Handley's ilk. Almost nothing I can think of can. But it might--just might--reassure parents on the fence that all that horrible stuff they're hearing on the radio, seeing on TV, and, above all, reading on the Internet about the evils of vaccines are not based in science. That's actually quite an achievement.

Frontline - Jenny McCarthy Changes her Story Again

I watched PBS’s Frontline on vaccines last week, and thought it overall pretty good. Not perfect (what is?) but the numerous howls of protest from the crank Age of Autism blog (I lost count of the number of their posts) and on the Huff Post, should be enough to tell you it hit the right marks. Orac has a detailed review, The Vaccine War: Telling it (mostly) like it is about the anti-vaccine movement, so I really don’t need to review it in detail.

There is just one thing I want to highlight, though. It wasn’t on the actual TV program, but on PBS’s full online Jenny McCarthy interview. It was this:

[Questioner:] How long after the MMR was that first seizure?

[Jenny McCarthy:] You know, a lot of people think, and probably from me saying in some interviews, that it was after the MMR I noticed changes.

I don't think it was just the MMR shot that caused any kind of trigger with autism. I think it was a compilation of so many shots to a kid that obviously had some autoimmune disorders. So I would say maybe a couple of months, a month or so after the MMR, I started to notice some physical ailments such as constipation, rashes, eczema. That was like the first little sign. And then the train just kind of descended from there. [My bold.]

Jenny is saying that her son’s autism didn’t start immediately after just one shot (the MMR), but that “some physical ailments” of autism appeared over “a couple of months.” This was just “the first little sign.” (Note, just a “little” sign at that point.) But, here’s the thing, as I wrote in The Two J.B. Handleys, Jenny had, only three years ago, stated quite clearly and unambiguously something very different:

"Right before his MMR shot, I said to the doctor, 'I have a very bad feeling about this shot. This is the autism shot, isn't it?' And he said, 'No, that is ridiculous. It is a mother's desperate attempt to blame something,' and he swore at me, and then the nurse gave [Evan] the shot," she says. "And I remember going, 'Oh, God, I hope he's right.' And soon thereafter -- boom -- the soul's gone from his eyes. [My bold.]

Note, not “some physical ailments” or just a “little sign” – back then it was “the soul's gone from his eyes” which, I think you’ll agree, is completely different. Also not over “a couple of months,” but “boom.” Different story.

Why does this matter? Well, Jenny, Handley and the rest have been telling us for years that the reason they know vaccines cause autism is that their kids got autism “boom” right after the vaccine was given. (With Handley it was after a shot containing Thimerosal, while with Jenny it was MMR which never had Thimerosal, but we’ll gloss over that for now.) Now that Wakefield’s MMR hypothesis has been discredited, and numerous epidemiological studies have failed to find a link with Thimerosal, the only way to keep their vaccines-cause-autism claims alive is to move the goalposts. And you see that in the Frontline program – Jenny says it’s not MMR, or Thimerosal, or too many vaccines at once – it’s “all of the above.” She actually says she doesn’t know what it is that’s causing autism, but she knows it’s the vaccines, somehow. But the thing is, if they’re now saying the signs of autism appeared gradually over several months, on what basis are they saying vaccines cause autism? If autism appeared gradually, and not “boom” after one shot, then they don’t even have the correlation (vaccine immediately followed by autism) to rely on.

And what’s more, they know they’ve changed their story and they know they’ve moved the goalposts. Why do I say that? Well, when I wrote The Two J.B. Handleys less than ten weeks ago, I included a link to the interview with the Jenny “boom” quote on Jenny’s own Generation Rescue site, Jenny: Evan's Story. Check that link now. Search Generation Rescue for any part of that interview. It’s gone. Disappeared. Never happened. Not part of the official anti-vaccine history any more. (And I know Handley read that post and saw the link because he appeared in the comments four days after I wrote it in an attempt to defend himself.) If you needed any more proof of the dishonesty and intellectual bankruptcy of Generation Rescue and the anti-vaccine kooks, there it is. Fortunately for us, there is one thing that George Orwell didn’t imagine when he wrote his famous 1984 novel, and that’s the Wayback Machine – the cache that never lets anyone completely disappear inconvenient facts they want you to forget. Courtesy of the internet, here again is what Jenny said in 2007, Jenny: Evan's Story – “and soon thereafter -- boom -- the soul's gone from his eyes.”

The hallmark of the pseudo-scientist and the kook, is they they won’t change their beliefs no matter what the evidence, instead they devise ad hoc explanations and move goalposts to accommodate contradictory evidence. Jenny and Handley have been caught, again, doing just that. Rather than re-evaluate their beliefs, they just change their previous story so that it fits the currently known facts. And they try to cover their tracks by deleting the now embarrassing things they said before. Rather strangely, they fail to notice that, with their new story, there is no longer any reason to link vaccines to autism. Either autism occurred “boom” just after the shot (and so they can point to correlation), or it didn’t. Which is it? They want it both ways.

Funnily enough, there was one thing in that PBS interview with Jenny, that I though she got right. It was this:

…that night went on Google and typed in "autism." And on the corner of the screen, in the sponsored links, it said, "Generation Rescue." And I decided to click on it, because right underneath it, it said, "Autism is reversible." And I thought to myself, well, this must be a load of crap, because if it was true, why didn't the best neurologist in the world tell me there's something I could do to reverse autism?

Precisely. And if she’s only stopped right there she could have avoided making a complete fool of herself.

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