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Review of Frontline’s The Vaccine War

29 Apr

The Vaccine War has aired. Judging by the responses, one might consider it a success. Pro vaccine groups like Every Child By Two were telling people to watch it. The Autism Science Foundation “highly recommends” watching it. On the other side, the organizations represented by the Age of Autism blog (Generation Rescue, the National Autism Association, SafeMinds, the Autism Research Institute and TACA) are very upset. Jenny McCarthy has gone to the Huffington Post with her side of the story, as has Dr. Jay Gordon, whose entire interview was cut from the program.


An unofficial (and incomplete) transcript is here.

That all said, I both appreciated the program and had my fears realized. In this case, my fears were that people would be given a platform to spread misinformation. And it happened. Jenny McCarthy and others made statements that were, in my view, misinformation. But, I appreciated the fact that Frontline took the time to counter much of the misinformation with actual experts discussing real science.

Frontline describes the show as:

In The Vaccine War, FRONTLINE lays bare the science of vaccine safety and examines the increasingly bitter debate between the public health establishment and a formidable populist coalition of parents, celebrities, politicians and activists who are armed with the latest social media tools — including Facebook, YouTube and Twitter — and are determined to resist pressure from the medical and public health establishments to vaccinate, despite established scientific consensus about vaccine safety.

I think the show accomplished this. There was some cost in terms of allowing Generation Rescue’s misinformation message in TV once again. But, this time, this time they are the problem.

If you watch the introductory 2 minutes of this video, you will get some idea of how the show is presented

Parents, both pro vaccine and not, activists, public health workers and researchers like Dr. Offit telling various sides of the story, with the narrator tying it together.

Narrator: Tonight on Frontline: They’re hailed as medicine’s greatest triumph: conquering smallpox, diphtheria, polio and more. But today, some Americans question if all those vaccines are worth the risk.

The show is in four segments. The titles for these segments should, again, give you an idea of the tone of the show.

1. A visit to Ashland, Oregon. In some American communities like this one, parents are hesitating to vaccinate their children, despite their doctor’s advice.

2. Eroding faith in vaccines. Skeptics target Paul Offit, inventor of the rotavirus vaccine. And many parents are wary of vaccines because they no longer see the diseases.

3. Fearing vaccine risks, especially autism.. Vaccine skeptics like celebrity Jenny McCarthy have organized a community of parents concerned about a vaccine-autism link.

4. The science that launched the movement. A British doctors ’98 study theorized that the measles vaccine causes autism. Soon vaccine critics began questioning other additives in vaccines.

5. What epidemiological studies reveal. No link is found between autism and the MMR shot or thimerosal. And the British doctor’s ’98 study is discredited, but critics demand more studies.

6. Vaccines, what’s at stake. The debate goes beyond the medical risks-benefits: it involves parents’ rights to make choices v. the needs of the community.

In the first segment, they interview a pro-vaccine mother in Ashland. She notes that if there is an outbreak, the response may get contentious. It may get ugly.

Beyond the direct human cost, one of my worries: how much blowback will there be to the autism communities? How much blame will be applied and what will it cost?

As part of the introduction, The Vaccine War discusses the story of Desiree Jennings. She was a Washington Redskins cheerleader who claimed dystonia as an adverse reaction to her vaccine. Her story broke out not through the TV news show that covered her story, but through YouTube. Jenny McCarthy is quoted about how Generation Rescue took Ms. Jennings to see Dr. Rashid Buttar and how chelation and HBOT cured her.

What makes the Desiree Jennings story even more interesting is the possibility that the vaccine-injury/dystonia story may not be real. As noted on LeftBrainRightBrain, Ms. Jennings was later followed by cameras from a TV program and shown to be driving and walking normally.

The possibility that Generation Rescue is using the story even though it may not be true was probed by Frontline. Here is a part of an interview from Frontline with one of Generation Rescue’s founders:

[Frontline]Talk about the viral spread of an image over the Internet, like [Redskins cheerleader] Desiree Jennings’ flu shot story, for example.

It’s remarkably powerful what an image or an idea can do in today’s day and age, and for a group of parents who feel completely outmatched — because think for a moment about who our enemy is; our enemies are the largest pharmaceutical companies on the planet, making billions of dollars in net profit a year — you’d think that we could never compete with that. But an idea can transmit itself powerfully and very cheaply for millions to see.

So in the case of Desiree, here you have an image of this beautiful woman who’s been severely disabled that literally tens of millions of people view overnight, and imagine the chilling effect that has on a flu vaccine that she attributes as the cause of her condition. It’s remarkably powerful.

[Frontline] Does it matter whether it’s true or not?

Truth always bears out in the end, so I’m a firm believer in that. Are there moments in time where truth is exaggerated or expanded? Absolutely. But truth bears out in the end. …

Perhaps I missed it, but it appears to this reader that Frontline’s question was completely dodged. Does it matter whether the Desiree Jennings story is true or not? I think so. But what seems important to Generation Rescue is not the truth of the story, but the fact that it is a gripping narrative that sells their message.

The Vaccine War has a rather large cast, if I may call them that. Parents both pro and anti vaccine, a writer from Ashland who is anti-vaccine, Paul Offit, bioethicist (and polio survivor) Arthur Caplan, Jenny McCarthy, Anthony S. Fauci (immunologist from NIAID), Cynthia Cristofani (pediatric intensivist), Alvaro and Myrian Fontan (a family who almost lost their daughter to whooping cough) and J.B. Handley, Barbara Loe Fisher–plus more.

In some ways, “The Vaccine War” takes the same approach that Dr. Offit uses in books like “Autism’s False Prophets”. Let the skeptics make their points, ask their questions, then respond. Sometimes this is quite jarring.It is tough to sit back and listen to someone spread information and wait for the response.

The Vaccine War is well researched. Even though people like Jenny McCarthy got some air time for their ideas, they are quite upset about the Frontline episode.

Perhaps I am the only one who will find this ironic. In response to this episode, one which discusses how groups like Generation Rescue use social networking on the internet to get their message out, they are taking to social networking. Twitter, blogging…

As noted above Jenny McCarthy and Dr. Jay Gordon have taken to the Huffington Post to respond to the show. the Age of Autism is being very critical. They are attempting to “poll mob” the Frontline website. (humorous aside–they haven’t figured out that the survey doesn’t record their answers. It only shows you how your responses compare to the actual survey.)

If you have friends, family who are wondering about the vaccine/autism “controversy”, this is a good show to refer them to. It gives both sides. It allows people like Jenny McCarthy to give her viewpoint–and it gives the response.

Watch Frontline’s Vaccine War online

28 Apr

I’ve only been able to watch the first few minutes so far, but I wanted to make this available.

(I’ve emailed asking if there is a captioned version)

If you want to read–written interviews:

Jenny McCarthy
She’s an actress, celebrity and activist. Her son was diagnosed with autism following a series of vaccinations, and she’s helped organize a movement of parents concerned about a vaccine-autism link.

Cynthia Cristofani, M.D.
A pediatric intensivist who takes care of children who need critical care, Cristofani decided to start documenting the rare cases of vaccine-preventable illness that turned up in her Portland, Oregon ICU.

Anthony S. Fauci, M.D.
He is an immunologist and the director of the National Institute of Allergy and Infectious Diseases [NIAID].

Alvaro and Myrian Fontan
They watched in anguish as their 40 day-old baby Vanessa — not yet old enough for the pertussis vaccination — fought for her life.

J.B. Handley
A businessman whose son was diagnosed with autism, Handley co-founded with his wife the autism advocacy site Generation Rescue.

Paul Offit, M.D.
Co-developer of a vaccine for rotavirus, the leading cause of severe diarrhea in children, Offit is chief of the infectious diseases division at The Children’s Hospital of Philadelphia.

Frontline Vaccine War episode on in the US tonight

27 Apr

I’ve written about the upcoming Frontline episode, The Vaccine War, a few times already.

Reviews are in the press already. It looks to be an interesting show. Jenny McCarthy, Generation Rescue, the (self-named) National Vaccine Information Center will get some air time. But, they are there to demonstrate the current problem. It is not a program about how they are fighting the good fight.

That said, don’t expect a full body slam. Don’t expect a Respectfully Insolent takedown of those who oppose vaccines.

Because of that, I expect some groups to claim some level of victory from tonight’s show. I expect to hear how they got their message out to a few more families. How they are that much closer to instilling fear and “bringing the vaccine program to its knees”.

The fact of the matter is this: So far, the U.S. hasn’t seen the large outbreaks of diseases like Measles. But if there are in the future, the “autism community” and, specifically, groups like Generation Rescue will carry some blame. Future editions of shows like “Frontline” will be harsh.

One review in on the Frontline episode is at Entertainment Weekly: Should kids be vaccinated? ‘Frontline’ and science say ‘yes’; Jenny McCarthy and a lot of selfish Gen X’ers say ‘no’.

Intro paragraph:

Tonight on Frontline, “The Vaccine War” presents both sides of the controversy over whether young children should be vaccinated for diseases such as measles and polio, and in a rare display of TV-news common sense and independence, one side is shown to be — sorry — wrong. Frontline‘s documentary will, I hope, leave any sensible viewer feeling that you’d have be deluded or selfish not to have your kids vaccinated.

conclusion:

What makes this Frontline — “The Vaccine War” is written, produced, and directed by Jon Palfreman — so compelling is seeing the smugness of the vaccine-deniers contrasted with the facts and figures of the historical record and current studies being down about the efficacy of things like the MMR triple shot.

Other reviews are not so harsh on the vaccine rejectionists.

But, this is a wake-up call for the army working to “bring the US vaccine program to its knees”. If successful, don’t expect to avoid blame.

It is a wake-up call. I expect they will hit the snooze alarm.

Frontline excerpt: Ashland Oregon

22 Apr

The PBS show Frontline has an upcoming episode called “The Vaccine War”. They recently posted a video excerpt of the episode. In this segment they follow a public health worker in Ashland Oregon, a community with one of the highest vaccine refusal rates in the US.

So, how is that vaccine refusal working out in Ashland? That’s in Jackson County, Oregon. I’m not alone in asking that question. One of the founders of Generation Rescue asked the same question recently

The Centers for Disease Control reports that 15 percent of children in Jackson County, Ore., are unvaccinated, Handley said. Someone needs to find out how these kids look comparatively. “It’s in the pockets of the unvaccinated kids where the first truths may be found,” he said.

Ashland appears to have an even higher vaccine refusal rate than the rest of Jacknson County. From the Frontline press release:

With an estimated quarter of the town’s children entering kindergarten not fully immunized, Ashland is one of the least vaccinated places in America.

So, Jackson County has a refusal rate of about 15% and Ashland about 25%. Let’s see what the Ashland City Council has to say. Here is a proclamation from the City of Ashland proclaiming Autism Awareness month

PROCLAMATION

“AUTISM AWARENESS MONTH”

• Autism is a complex neurobiological condition that appears at birth or typically before age three and occurs in one out of every 150 births each year in the United States.
• Autism affects the areas in the brain that regulate pragmatics of speech and perceptions of others, affecting how people with autism assimilate and express verbal and non-verbal communication, and sensory processing.
• Oregon has one of the highest rates of autism in the United States, with the Oregon Department of Education reporting 1 in 98 students on the autism spectrum, and in Ashland, 1.1 percent of students have been diagnosed which is the highest rate in Jackson County.
• While there is no precisely identified cause and cure for autism, Autism Centers of Excellence and institutions for education such as Oregon Health & Science University, and the Southern Oregon University Masters in Special Education program offer hope for recovery, and treatments to lead a rich and fulfilling life.
• Early Intervention services such as those provided by Asante Early Childhood Development can alter the course for children living with autism and their families in their ability to interact and communicate not only wants and needs, but dreams and aspirations.
• Adults living with Autism and Asperger’s Syndrome can find a warm and welcoming home and community in Ashland.

NOW THEREFORE, the City Council and Mayor, on behalf of the citizens of Ashland, hereby proclaim the month of April 2008 as:

“AUTISM AWARENESS MONTH”

and call upon the citizens of the City of Ashland to observe the month by learning about people with autism, their strengths, abilities, and the programs which serve their needs.

Dated this 4th day of March, 2008.

Barbara Christensen, City Recorder
John W. Morrison, Mayor

Keep in mind that the above proclamation involves educational data, which are not the same as real autism prevalence. That is especially problematic in Oregon, which has a very vague criterion for an educational diagnosis. But, that said, Ashland (with a vaccine refusal rate of 25%) had 1.1% of their students with educational diagnoses of autism, the highest in Jackson County and higher than the Statewide average.

Again, education data are fairly weak to begin with, and Oregon has a very loose definition of “autism”. But, that said, there isn’t evidence in the educational data that vaccine refusal is helping Ashland avoid autism.
In other words it looks like vaccine refusal is not protecting Ashland from autism.

Professor Peter Bearman on vaccines and autism revisited

21 Apr

I’ve posted a few pieces on the work of Prof. Peter Bearman recently. I mentioned his work on vaccines and autism in one post but the lecture was not one that could be embedded and the part on vaccines is only a relatively short bit towards the end of the lecture.

So I took that section of the lecture out and put it on YouTube so I could embed it. This is discussing data from what I assume is an upcoming paper by Prof. Bearman’s group.

Prof. Bearman notes that vaccine refusal rates in California are higher in areas where autism organizations have a presence. However, vaccine refusal rates are *not* higher in areas with high autism prevalence.

In other words: autism isn’t scaring people away from vaccination. But, autism organizations are.

can be as much as 7 times higher if there are autism organizations in a given area. The baseline refusal rate in California is about 1.6% (in 2003). In other words, there are pockets of vaccine refusal of 10% or more in California, correlated with autism organization presence.

There are those who gloat about increasing fear of vaccines. It is too bad that time, money and effort didn’t go into something valuable to the autism communities. Let’s hope it doesn’t backfire on us in the form of infectious disease outbreaks blamed on the autism community.

Prof. Peter Bearman interviewd by Tom Insel

21 Apr

Prof. Peter Bearman is a sociologist at Columbia University who has undertaken a monumental task: figure out what is behind the increase in autism prevalence. He has chosen (at least so far) to work with California Department of Developmental Services data. This dataset is no where near the “gold standard of autism epidemiological data” that some have touted it to be. But it remains as one of, if not the best, dataset in the US.

I wrote about his most recent paper in Social influences on the rise in autism prevalence and Diagnostic change and the increased prevalence of autism.

Given the importance of this work, I thought it worthwhile to present this short interview of Prof. Bearman by the NIMH Director and IACC chair, Dr. Tom Insel. It is significantly shorter than the full lecture I linked to, and it is possible to embed it:

Prof. Bearman’s team is working on analyzing the California Department of Developmental Services (CDDS) dataset to see what trends can be identified.

Ascertainment, change in diagnostic criteria, increases in parental age, socio-demographic changes are factors in the increase in prevalence.

For example, in the past, it was wealthy families who were more likely to obtain an autism diagnosis for their child. Now that socio-economic divide is disappearing. This is a sign that ascertainment has been an effect.

Professor Bearman notes that some effects have been quantified:

25% of the increase is diagnostic change on the border between autism and mental retardation
16% of the increase is diagnostic change on the other border–between autism and other disorders
3% spacial clustering
11% increased parental age

Prof. Bearman suggests that the increased parental age factor is likely genetic in origin. Increased parental age leads to more copy number variations (CNV), leading to more autism.

I don’t expect this to change the “there can’t be a genetic epidemic” slogan. At this point it isn’t proven that this large factor is genetic. But it is possible.

There is still a large fraction of the increase which is unaccounted for. Prof. Bearman warns at the end that a search for a “quick and dirty” answer may not be advancing science.

I take “quick and dirty answer” to mean vaccines.

The problem is highly complex. The next steps in this study will be very difficult. The social influences on increasing autism prevalence can amplify other factors. Finding possible causes for a real increase in autism incidence will be complicated by other factors. But unless someone quantifies and understands those factors, the likelihood is very low of ever finding causes of autism which might drive part of the increase in prevalence.

Does autistic enterocolitis exist?

20 Apr

The piece below is from the blog justthevax, where it ran as “Independent” the Wakefield way (really something for the fail blog). I like this piece because, frankly, I wish I had done it. Catherina takes a look at the exact claims made by Dr. Wakefield’s supporters and shows that they are clearly false.

“Independent” the Wakefield way (really something for the fail blog).

One of the claims that keeps reappearing in the comments sections under articles covering the GMC ruling on Andrew Wakefield and colleagues is that

The key finding (chronic colitis found in ASD children) of Dr. Wakefield’s early case report published in The Lancet in 1998 HAS been independently confirmed by medical researchers in five different countries.

That is a very significant claim. After all, independent confirmation of a recent finding, would make the validity of a finding more likely, and if 6 independent laboratories found the same gut changes in autistic children, then then likelihood that this was a) a fluke or b) made up by Andrew Wakefield would be drastically reduced.

Finally, one of those commenters has posted those ‘independent confirmations’ – so I thought it might be worth having a look at them.

Krigsman, A. (Assistant Professor of Pediatrics, New York University School of Medicine Director of Gastroenterology Services), et al.,Ileocolonoscopy in Children with Autistic spectrum Disorder and Chronic Gastrointestinal symptoms. Autism Insights 2010:2 1-11.

Gonzalez, L., et al., Endoscopic and Histological Characteristics of the Digestive Mucosa in Autistic Children with gastro-Intestinal Symptoms. Arch Venez Pueric Pediatr, 2005;69:19-25.

Balzola, F., et al., Panenteric IBD-like disease in a patient with regressive autism shown for the first time by wireless capsule enteroscopy: Another piece in the jig-saw of the gut-brain syndrome? American Journal of Gastroenterology, 2005. 100(4): p. 979-981.

Balzola, F., et al., Autistic enterocolitis: Confirmation of a new infammatory bowel disease in an Italian cohort of patients. Gastroenterology 2005;128(Suppl. 2);A-303.

Galiatsatos, P., et al., Autistic enterocolitis: Fact or fiction. Canadian Journal of Gastroenterology. 2009;23:95-98.

Let’s look at number 1, Krigsman et al. The name sounds vaguely familiar. In fact, anyone who has read a little about the MMR-autism affair will know Arthur Krigsman as the clinical director of Thoughtful House, which happens to be the same Texas Clinic out of which Andrew Wakefield practises. One editor of “Autism Insight”, the journal in which this “independent confirmation” was published, is Andrew Wakefield (another one the senior author of the study, Carol Stott). Gosh, I bet peer review was harsh for this one.

Gonzales et al, number 2, has been published in “Arch Venez Pueric Pediatr” which stands for Archivos Venezolanos de Puericultura y Pediatría. It was a bit tricky to get my hands on the paper, especially since the citation was not quite right, but I did manage and was not surprised to find that indeed the authors cannot replicate Wakefield’s 1998 “findings” of a distinct autistic enterocolitis, although they do report a higher incidence of gastrointestinal problems in their autistic group.

Balzola et al, number 3, is a case report of one adult autistic patient with inflammed bowel.

Similarly, Balzola et al, number 4, is a meeting abstract (if anyone has access, could they email me that abstract, please) that never saw the light of day as a peer reviewed study.

Finally, number 5, Galiatsatos et al., is a case report, featuring two adult patients with gastrointestinal problems and an ASD diagnosis. The authors call for “more investigations” in their discussion.

So what do we have here? Three (3) genuinely published cases of autistic adults who had consulted a doctor for gastrointestinal problems and were found to have gastrointestinal problems. One conference report from April 2005 that has not gone through peer review and has not appeared in a real journal in the 5 years since the conference. One real study looking at over 50 autistic children which does not confirm Wakefield’s findings. And finally, one study by Wakefield’s buddies in a freshly founded journal run by Andrew Wakefield and his buddies, to say that their buddy Andy was really right all along – how is that for “independent” confirmation?!

Frontline: The Vaccine Wars

20 Apr

Frontline: The Vaccine War. I’ve already discussed this upcoming episode of Frontline.

Below is an extended press release they have for this episode.

I am very wary of giving groups like Generation Rescue any more media coverage than absolutely necessary. Their fake study, created for their appearance on the TV show “The Doctors” was a clear example of them using the media in what their own founder calls their effort to bring “… the U.S. vaccine program to its knees”.

With less than a half-dozen full-time activists, annual budgets of six figures or less, and umpteen thousand courageous, undaunted, and selfless volunteer parents, our community, held together with duct tape and bailing wire, is in the early to middle stages of bringing the U.S. vaccine program to its knees.

But how do you discuss the “vaccine war” without those very people waging war on vaccines? How can you leave out Barbara Loe Fisher who has not only spent 20 years attacking vaccines, but has recently tried to silence Dr. Paul Offit with a baseless lawsuit?

That said, here is the press release for the Frontline episode:

Vaccines have changed the world, largely eradicating a series of terrible diseases, from smallpox to polio to diphtheria, and likely adding decades to most of our life spans. But despite the gains—and numerous scientific studies indicating vaccine safety—a growing movement of parents remains fearful of vaccines. And in some American communities, significant numbers of parents have been rejecting vaccines altogether, raising new concerns about the return of vaccine-preventable diseases like measles and whooping cough.

In The Vaccine War, airing Tuesday, April 27, 2010, at 9 P.M. ET on PBS (check local listings), FRONTLINE lays bare the science of vaccine safety and examines the increasingly bitter debate between the public health establishment and a formidable populist coalition of parents, celebrities, politicians and activists who are armed with the latest social media tools, including Facebook, YouTube and Twitter, and are determined to resist pressure from the medical and public health establishments to vaccinate, despite established scientific consensus about vaccine safety.

“Scientifically, I think the matter is settled,” says Anders Hviid, an epidemiologist at the Statens Serum Institut in Denmark. In one of the largest and most comprehensive epidemiological studies available, Hviid and colleagues analyzed data on more than a half million children and found no link between the MMR “triple shot” for measles, mumps and rubella and an increased rate of autism—a link that’s been strongly asserted for years by anti-vaccine activists. Similar epidemiological studies in Denmark also failed to reveal a link between the mercury preservative thimerosal and autism. In fact, around the world, peer-reviewed epidemiological studies have found no link between autism and either the MMR shot or thimerosal.

But vaccine skeptics like celebrity Jenny McCarthy, whose son, Evan, was diagnosed with autism following a series of vaccinations, including MMR, are convinced that further study into the other 15 pediatric vaccines and their additives will ultimately reveal a link. “Something happened. And when I say something, I mean a behavior, a trigger,” McCarthy tells FRONTLINE. “Is it mercury? Is it the schedule? Is there just too many? My answer to people and what I’ve been telling them is, ‘It’s all of the above.’ We don’t know for sure, which is why we keep saying, ‘Study it.’”

Further vaccine safety research is what businessman J.B. Handley, who founded the autism support group Generation Rescue, has been calling for, too. Handley tells FRONTLINE he has little doubt that vaccines are responsible. “There is no real-world study that shows me that those six vaccines didn’t cause my son’s autism.”

Nowhere has The Vaccine War grown more heated than in Ashland, Ore.—an area that FRONTLINE learns is of high concern to the Centers for Disease Control and Prevention. With an estimated quarter of the town’s children entering kindergarten not fully immunized, Ashland is one of the least vaccinated places in America. Despite the best efforts of local pediatricians like Dr. Donna Bradshaw-Walters, many parents are simply not convinced that vaccines do more good than harm, and they’ve been using Oregon’s religious and personal-belief exemption to get out of the state vaccine mandate. “I think a child’s immune system is so immature,” says Jennifer Margulis, an Ashland writer and mother of four who chooses vaccine exemption. “If you read the list of ingredients about what you’re putting intramuscularly into your child, it’s scary.”

According to public health workers, however, Margulis’ decision puts the entire community at risk. Vaccines don’t work for everyone, and in some kids the effects wear off, so it’s only when everyone—or almost everyone—is immunized that “herd immunity” is effective. “There are hundreds of thousands of people in this country who cannot be vaccinated,” says Dr. Paul Offit, the chief of the Division of Infectious Diseases at The Children’s Hospital of Philadelphia and the inventor of a vaccine for rotavirus. “They’re getting chemotherapy for their cancers, or they’re getting immunosuppressive therapy. They depend on those around them to be vaccinated.”

Bioethicist Art Caplan argues that society has the right to coerce its parents to vaccinate their children even if vaccines carry a small risk. “Parents don’t have unlimited rights with respect to the welfare of their children. You can’t kill them. You can’t put them at risk of fatal disease. You can’t put them at risk of devastating disability.”

Surveys reveal that America’s conversation about vaccines is complex, involving not only medical risks and benefits but also ideological beliefs about parental choice and the limits of government. “This is true even of individuals who see the benefits of vaccines as substantial,” political scientist Hank Jenkins-Smith tells FRONTLINE. “They still want it to be a choice. They don’t want it to be compulsory.” Government control over individual choice is another factor fueling the anti-vaccine backlash, despite the peer-reviewed science that vaccines are safe.

“People now have a way to get the information they couldn’t before, to communicate it to other people, and to have a robust public debate that is not controlled by money or political power or by government policy,” says Barbara Loe Fisher, president of the National Vaccine Information Center. “Physicians are going to have to get over the idea that they tell people what to do, and people are going to do it without questioning.”

Audience Engagement:
?Beginning one week before broadcast, Wednesday, April 21, visitors to FRONTLINE’s web site can interact with medical experts who will be responding to comments and answering questions. Visitors can also take a survey featuring five key questions about their attitudes toward vaccines, and find out how well their responses match responses from a nationwide survey.

The Vaccine War is a FRONTLINE co-production with the Palfreman Film Group. The writer, producer and director is Jon Palfreman. FRONTLINE is produced by WGBH Boston and is broadcast nationwide on PBS. Funding for FRONTLINE is provided through the support of PBS viewers. Major funding for FRONTLINE is provided by The John D. and Catherine T. MacArthur Foundation. Additional funding is provided by the Park Foundation and the FRONTLINE Journalism Fund. FRONTLINE is closed-captioned for deaf and hard-of-hearing viewers and described for people who are blind or visually impaired by the Media Access Group at WGBH. FRONTLINE is a registered trademark of WGBH Educational Foundation. The senior producer of FRONTLINE is Raney Aronson-Rath. The executive producer of FRONTLINE is David Fanning.

here, again, is the video clip Frontline has:

Social influences on the rise in autism prevalence

19 Apr

How much does “awareness” affect the increase in autism prevalence? Awareness has many aspects. News reports. Getting doctors to look and test for autism. One way is when someone in your neighborhood has an autistic kid. Does that have a measurable effect? The answer is yes.

In their paper, Social Influence and the Autism Epidemic, Ka?Yuet Liu, Marissa King, and Peter S. Bearman of Columbia University look into this using data from the California Department of Social Services (CDDS).

You may recall that I recently blogged on a paper where Marissa King and Prof. Bearman recently took a look at how diagnostic changes have affected the autism counts in the CDDS. The paper is Diagnostic change and the increased prevalence of autism.

Luckily, Steven Novella has already discussed this paper in detail in Social Factors in Autism Diagnosis. Also, the Autism Natural Variation blog has discussed this and extrapolated the current trends in The Administrative Prevalence of Autism is a Bass Distribution.

All this intro aside, what did Liu, King and Bearman find?

Despite a plethora of studies, we do not know why autism incidence has increased rapidly over the past two decades. Using California data, this study shows that children living very close to a child previously diagnosed with autism are more likely to be diagnosed with autism. An underlying social influence mechanism involving information diffusion drives this result, contributing to 16% of the increase in prevalence over 2000–2005. We eliminate competing explanations (i.e., residential sorting, environmental toxicants, and viral transmission) through seven tests and show that information diffusion simultaneously contributed to the increased prevalence, spatial clustering, and decreasing age of diagnosis.

In other words, if you live in California and you live near a family with an autistic child, you are more likely to obtain services from the CDDS for autism for your own child and be included in the CDDS count.

I’ve been meaning to blog this for a while. Prof. Bearman discussed this in a talk he gave at NIH, Understanding the Increased Prevalence of Autism. The link will take you to a page where you can watch the lecture. Sorry, I can’t figure out to embed the talk.

The talk was very interesting. Prof. Bearman discusses the autism cluster they found. He also discusses this social awareness effect.

A few notes from the lecture:

Prof. Bearman can account for much of the increase in the CDDS count. Four contributions he found are:

with diagnostic change–about 27% of the increase
advanced parental age–about 11% of the increase
spatial structure–about 2-3% of the increase
social mechanisms–about 16% of the increase

About 40-50% of the increase is still unaccounted for in his team’s analyses.

For those who are wondering:his team has not ignored vaccines. He doesn’t discuss them much,

One thing Prof. Bearman did find: vaccination rates go down in areas where autism organizations exist. For every autism organization in a given zip code, the exemption rate for personal beliefs increases by 24%.

One could ask whether this is just a sign that higher autism rates are the factors? In other words, is the presence of an autism organization a proxy for autism rate? The answer is no. The vaccine exemption rate does *not* depend on autism prevalence, just the presence of autism organizations.

In other words, autism doesn’t scare people out of vaccinating. Autism organizations do that.

Prof. Bearman’s group has two more papers I await: “Autism and the Hispanic Puzzle” and “Autism and Vaccines, revisited”. At the time of the lecture, the vaccine paper was “under review”.

The CDDS data are far from the “Gold Standard” dataset that some people have claimed. However, it is a valuable dataset and it is good to see a group like Prof. Bearman’s take on a serious, detailed look at it. If there is a real increase in the autism prevalence, it will take teams studies like this to find it.

PBS Frontline: The Vaccine War

16 Apr

I first heard that the show Frontline, from the Public Broadcasting Service (PBS), would be doing a show on “The Vaccine Wars” by reading comments posted online by supporters of groups like Generation Rescue. I was somewhat taken aback that they were happy to hear this was coming as Frontline is a very evidence-based show. I couldn’t see it being very supportive of Jenny McCarthy.

Frontline’s website had this to say about the show:

Public health scientists and clinicians tout vaccines as one of the greatest achievements of modern medicine. But for many ordinary Americans vaccines have become controversial. Young parents are concerned at the sheer number of shots–some 26 inoculations for 14 different diseases by age 6–and follow alternative vaccination schedules advocated by gurus like Dr. Robert Sears. Other parents go further. In communities like Ashland, Oregon, up to one-third of parents are choosing not to vaccinate their kids at all. And some advocacy groups, like Generation Rescue, argue that vaccines are no longer a public health miracle but a scourge; they view vaccines as responsible for alarming rises in certain disorders, including ADHD and autism. This is the vaccine war: On one side sits scientific medicine and the public health establishment; on the other a populist coalition of parents, celebrities (like Jenny McCarthy), politicians and activists. It’s a war that increasingly takes place on the Internet with both sides using the latest social media tools, including Facebook and Twitter, to win the hearts and minds of the public.

I guess I am not on the “latest” social media tools, but I am blogging on the topic so I figure I count as a small part of the “war”.

Reading the above I felt that “The Vaccine Wars” was not going to be the Jenny McCarthy friendly show some were expecting. Being put on the side against “scientific medicine” is usually not a good thing. Also, Generation Rescue tries to pitch itself as being “pro safe vaccine” rather than anti vaccine. I doubt they would like to see themselves as being characterized as arguing “that vaccines are no longer a public health miracle but a scourge”. Then again, times may be changing with the founder of Generation Rescue stating:

With less than a half-dozen full-time activists, annual budgets of six figures or less, and umpteen thousand courageous, undaunted, and selfless volunteer parents, our community, held together with duct tape and bailing wire, is in the early to middle stages of bringing the U.S. vaccine program to its knees.

That’s hard to fit into a “pro safe vaccine” image.

One way to tell for certain if Generation Rescue and other groups are afraid of upcoming media attention is when they start attacking spokespeople like Paul Offit (chief of infectious diseases at the Children’s Hospital of Philadelphia, and co-inventor of the RotaTeq vaccine against rotavirus). When that happened (recent blog posts on the Age of Autism, resurrecting old, incorrect information) I knew it was likely that “The Vaccine Wars” was not going to be a pro-Jenny program.

As it turns out, a video clip has been added to the Frontline website for “The Vaccine Wars”:

And, guess what, Dr. Offit was interviewed by Frontline for the piece.

The show airs on April 27th, and will be available online then as well.

Perhaps it is time for those who support the vaccine-causation idea to re-evaluate their position. I can’t tell how many times I’ve been told I need to be “open minded” about the subject. Open minded includes being willing to admit that your ideas on vaccines-causing-autism were wrong.

Let’s see–

One of the main proponents of the idea, Dr. Andrew Wakefield, was found to be unethical and dishonest
The two main theories, really the only two theories, have failed (“not even close”) in the courts
The media is moving away from giving the vaccine-causation idea much weight.

Of course, maybe I’m wrong. Maybe FrontLine will finally tell the story the vaccine-causation groups believe. Maybe they will uncover the vast conspiracies that are hiding the truth. Maybe. I doubt it.

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