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Autism prevalence: Now estimated to be one in 88, and the antivaccine movement goes wild

Editor’s Note: Some of you might have seen this before, but it’s an important (and timely) enough topic that I figure it’s worth exposing to a different audience. It’s been updated and edited to style for SBM. Enjoy.

If there’s one thing that I’ve learned that I can always—and I do mean always—rely on from the antivaccine movement, it’s that its members will always be all over any new study regarding vaccines and/or autism in an effort to preemptively put their pseudoscientific spin on the results. It’s much the same way that they frequently storm into discussion threads after stories and posts about vaccines and autism like the proverbial flying monkeys, dropping their antivaccine poo hither and yon all over science-based discussions.

In any case, antivaxers are also known for not respecting embargoes. They infiltrate their way into mailing lists for journalists in which newsworthy new studies are released to the press before they actually see print and then flood their propaganda websites with their spin on the studies, either attacking the ones they don’t like or trying to imprint their interpretation on ones on which they can, all before the skeptical blogosophere—or even the mainstream press—has a chance to report. So it was late last week, when vaccine-autism cranks jumped the embargo on a CDC study that announced new autism prevalence numbers. This is nothing new; it’s the antivaccine movement’s modus operandi, which makes me wonder why the various journals don’t shut off the flow. The study, of course, was announced in press conferences and a number of news stories. No doubt by now many of you have seen them. The stories I’ve seen thus far have focused on the key finding of the CDC study, which is that the prevalence of autism in the U.S. has risen to approximately 1 in 88, a finding reported in the CDC’s Morbidity and Mortality Weekly Report.

This is how the CDC came up with the new prevalence:
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Posted in: Neuroscience/Mental Health, Public Health, Science and the Media, Vaccines

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Anti-anti-vax: Getting to the gist

I’m currently putting the finishing touches on a presentation for the The Ontario Public Health Convention next week, where I’ll be speaking, with occupational therapist Kim Hébert, about the anti-vaccine movement and social media (SM): how antivaccine advocates use it, and the challenges and opportunities for public health advocates. I’m pleased to see Seth Mnookin, author of The Panic Virus and someone whose work is likely known to many SBM readers, is one of the keynote speakers – his perspective will be valuable for the public health crowd which has traditionally relied on fairly static “key messages” for disseminating information on vaccine safety and effectiveness. The panel discussion of which I am a part will be an examination of challenges and opportunities presented to public health advocacy, and particularly vaccine advocacy, in a Web 2.o environment. What seems clear is that the old public health channels don’t cut it anymore: these methods are distant and insufficient to address the wide and rapid spread of misinformation in an era of social media. We all remember the anxiety over H1N1 just a few years ago – and judging by the poor uptake of the vaccine, it seemed the anti-vaccine movement had some success in propagating fear, uncertainty, and doubt. I’d almost forgotten about this chestnut from the Health Ranger himself:

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Posted in: Vaccines

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California Bill AB 2109: The Antivaccine Movement Attacks School Vaccine Mandates Again

Of all the preventative treatments ever developed through science- and evidence-based medicine, vaccines have arguably saved more lives, prevented more illness and disability, and in general alleviated more suffering than any single class of treatments or preventative measures throughout history. Given the obvious and incredible success of vaccines at decreasing the incidence of infectious diseases that used to ravage populations, it seems incredible that there would be such a thing as an antivaccine movement, but there is. Indeed, when I first encountered antivaccine zealots on the Usenet newsgroup misc.health.alternative about ten or twelve years ago, as a physician I really had a hard time wrapping my head around the fact that such people existed. No doubt the same is true of many physicians, who take the scientific evidence for the safety and efficacy for vaccines for granted. However, I am a cancer surgeon, and I do not treat children; so until I discovered antivaccine rhetoric on the Internet I was blissfully ignorant that such views even existed. Other health care professionals knew better. Pediatricians, nurses, and any health care professionals who deal with children and the issue of vaccinations know better, because they face antivaccine views on a daily basis. It is because of the incredible importance of vaccination and the danger to public health the antivaccine movement represents that we at Science-Based Medicine write so frequently about vaccines and the antiscientific, pseudoscientific, and misinformation-packed fear mongering about vaccines that is so prevalent today.

The success of vaccination campaigns has recently been endangered by a number of factors, in particular the antivaccine movement. Because of various groups opposed to vaccination, either for philosophical reasons or because they incorrectly believe that vaccines cause autism, neurodevelopmental disorders, sudden infant death syndrome, and autoimmune diseases, among others, one of the most potent tools for encouraging high rates of vaccine uptake, school vaccine mandates, have come under attack. Alternatively, increasing numbers of parents have taken advantage of religious or philosophical exemptions in order to avoid the requirement to have their children vaccinated prior to entry to school. As a result, of late some states with lax vaccination requirements have begun to try to tighten up requirement for non-medical vaccine exemptions. The arguments used by the antivaccine movement against such legislation are highly revealing about their mindset, in particular their attitude towards issues of informed consent, which I will discuss a bit. But first, here’s a little background.
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Posted in: Politics and Regulation, Public Health, Science and the Media, Vaccines

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An antivaccine tale of two legal actions

I don’t know what it is about the beginning of a year. I don’t know if it’s confirmation bias or real, but it sure seems that something big happens early every year in the antivaccine world. Consider. As I pointed out back in February 2009, in rapid succession Brian Deer reported that Andrew Wakefield had not only had undisclosed conflicts of interest regarding the research that he did for his now infamous 1998 Lancet paper but that he had falsified data. Then, a couple of weeks later the Special Masters weighed in, rejecting the claims of autism causation by vaccines made in three test cases about as resoundingly as is imaginable. Then, in February 2010, in rapid succession Andrew Wakefield, the hero of the antivaccine movement, was struck off the British medical register, saw his 1998 Lancet paper retracted by the editors, and was unceremoniously booted from his medical directorship of Thoughtful House, the autism quack clinic he helped to found after he fled the U.K. for the more friendly confines of Texas. Soon after that, the Special Masters weighed in again, rejecting the claims of autism causation by vaccines in the remaining test cases. Then, in January 2011, Brian Deer struck again, publishing more damaging revelations about Wakefield, referring to his work as Piltdown medicine in the British journal BMJ.

This year, things were different.
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Posted in: Politics and Regulation, Science and the Media, Vaccines

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SANE Vax adopts Dr. Hanan Polansky’s “microcompetition” as its own. Hilarity ensues.

One of the hallmarks of science as it has been practiced for the last century or so is that scientists share their discoveries in the peer-reviewed literature, where their fellow scientists can evaluate them, decide if they’re interesting, and then replicate them, usually as a prelude to building upon them. While the system of publication and peer review in science is anything but perfect (and, indeed, we have discussed many of its shortcomings right here on this very blog), I tend to like to view it in much the same way Winston Churchill characterized democracy:

Many forms of Government have been tried and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except all those other forms that have been tried from time to time.

I would rephrase this as:

Many forms of evaluating science have been tried and will be tried in this world of sin and woe. No one pretends that peer review is perfect or all-wise. Indeed, it has been said (by me) that peer review is the worst form of evaluating science except all those other forms that have been tried from time to time.

As mainstream medicine has become more scientific over the last century in the wake of the Flexner Report, physicians and medical researchers have similarly come to view publication in the peer-reviewed literature to be a very important component of communicating and evaluating medical discoveries. It’s not as though this is even a particularly high bar to pass, either. After all, many are the absolutely execrable papers that I (and my partners in crime here at SBM) have discussed over the last four years, nearly all of which were in peer-reviewed journals, some very prestigious. After all, if papers on “energy chelation” can find their way into decent journals and the likes of Mark and David Geier can publish in the peer-reviewed literature, while someone like Christopher Shaw can get cringe-worthy confusions of correlation with causation published, I don’t take seriously the whines of cranks who claim that they can’t publish in the peer-reviewed literature for one reason or another.

That’s why I view being published in the peer-reviewed literature as a minimum, but by no means sufficient, requirement good science. It’s also why, whenever I see a new claim, my first reaction is to see if (1) the person making the claim has published on it and (2) there are publications in the peer reviewed literature that support the claim. The first criterion helps me judge whether the person is a serious scientist; the second, whether there is any plausibility to his ideas. Sure, it’s not a foolproof scheme, but it is helpful.

I only wish antivaccinationists would do the same. That they don’t explains why they seem to be embracing someone named Dr. Hanan Polansky.
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Posted in: Basic Science, Cancer, Vaccines

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Joe Mercola: Quackery pays

We’ve written about Joe Mercola’s support for quackery on this blog several times (for instance, here and here). It’s good to see that some of the mainstream media are starting to take notice, as evidenced by this article by Bryan Smith for Chicago Magazine entitled Dr. Mercola: Visionary or Quack? It features comments from a couple of—shall we say?—familiar people.

Although this article did irk me a bit for its tendency to buy into the false “tell both sides” balance, even going so far as to claim that much of what’s on Mercola’s website is actually based in science, I do think it is nonetheless very useful in that it demonstrates just how powerful and influential Mercola has become:

According to traffic-tracking firm Quantcast, Mercola.com draws about 1.9 million unique visitors per month, each of whom returns an average of nearly ten times a month. That remarkable “stickiness” puts the site’s total visits on a par with those to the National Institutes of Health’s website. (Mercola claims his is “the world’s No. 1 natural health website,” citing figures from Alexa.com.) Mercola’s 200,000-plus “likes” on Facebook are more than double the number for WebMD. And two of his eight books—2003’s The No-Grain Diet and 2006’s The Great Bird Flu Hoax—have landed on the New York Times bestseller list.

What a depressing thought that Mercola.com draws about the same traffic as the NIH website!
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Posted in: Health Fraud, Science and the Media, Vaccines

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Ringing in 2012 with…antivaccine propaganda?

Here we go again.

In fact, I think I’m starting to see a pattern here among antivaccine organizations. You might remember that in November 2010, the antivaccine group SafeMinds bought ad space in AMC Theaters over the Thanksgiving holiday weekend, one of the heaviest moviegoing time periods of the year. This use of pre-movie time to promote antivaccine propaganda resulted in a campaign by skeptics to try to persuade AMC to see the error of its ways, a campaign that was successful.

Then, a few months later, the the grande dame of the antivaccine movement, arguably the woman who started the most recent incarnation of that hoary old anti-science movement back in the 1980s, Barbara Loe Fisher, decided to start advertising the antivaccine message she promotes through her group, the Orwellian-named National Vaccine Information Center (NVIC) using the JumboTron in Times Square. Unfortunately, despite protests from the American Academy of Pediatrics, promoters of science-based medicine, and skeptics, the ads apparently aired for the full buy.

Then, a few months later (just last month, in fact), somehow the NVIC managed to dupe Delta Airlines, through its video provider In-Flight Media into airing a more subtle “public service announcement” whose antivaccine message was cleverly muted so that it wasn’t so obvious, except to those of us who knew the NVIC (and, of course, the buzzwords used by the antivaccine movement) that its message was antivaccine. Of course, it also didn’t help that the PSA urged viewers to go to the NVIC website, which, as I’ve described many times before, is a font of misinformation, pseudoscience, and antivaccine propaganda. (Just type “NVIC” into this blog’s search box to see.) At least Fisher’s response of crying “repression” in response to the AAP’s complaint to Delta Air Lines was good for a chuckle or two. Unfortunately, the NVIC advertorials aired through the entire buy. Meanwhile, this fall a major dump of antivaccine propaganda was circulating around the country in various film festivals in the form of an antivaccine propaganda movie called The Greater Good, whose manipulativeness and misinformation would make a North Korean propagandists planning state media coverage of Kim Jong-il‘s funeral blush.

Now, it would appear, the NVIC wants to close out 2011 and ring in 2012 with a new round of antivaccine propaganda, this time revisiting Times Square at the heart of the New Years Eve celebration, an effort it’s trumpeting through a press release entitled National Vaccine Information Center (NVIC) Educates One Million Plus in Times Square on New Year’s Eve. Here, Barbara, I’ll fix that for you. It should read “National Vaccine Information Center (NVIC) Mis-Educates One Million Plus in Times Square on New Year’s Eve.”

There, that’s better.
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Posted in: Science and the Media, Vaccines

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What Is an Antivaxer?

Labels are a cognitive double-edged sword. We need to categorize the world in order to mentally capture it – labels help us organize our mental maps of the overwhelming complexity of things and to communicate with each other. But labels can also be mental prisons, when they substitute for a thorough, nuanced, or individualized assessment – when categorization becomes pigeon-holing.

We use many labels in our writings here, out of necessity, and we try to be consistent and thoughtful in how we define the labels that we use, recognizing that any sufficiently complex category will be necessarily fuzzy around the edges. We have certainly used a great deal of electrons discussing what exactly is science-based medicine, and that the label of so-called alternative medicine is really a false category, used mainly for marketing and lobbying (hence the caveat of “so-called”).

We get accused of using some labels for propaganda purposes, particularly “antivaccinationist” (often shortened to “antivaxer”). Also “denier” or “denialist”, as in germ-theory denier. Even though we often apply labels to ourselves, no one likes having an unflattering label applied to them, and so we have frequent push-back against our use of the above terms.

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Posted in: Vaccines

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The compassion gambit

I’ve spent the last three weeks writing about a “brave maverick doctor” by the name of Stanislaw Burzynski who claims that he can cure cancers that regular oncologists cannot. He uses a combination of what he calls “antineoplastons” (which, it turns out, are more or less than the active metabolites of an orphan drug known as sodium phenylbutyrate) plus a very expensive cocktail of chemotherapy and targeted agents chosen in a haphazard fashion and thrown together with little rhyme or reason. This week, I had planned to move on. However, I felt that I had to mention the Burzynski saga because it provides me with the most appropriate segue to a topic I’ve been meaning to write about for a long time, possibly since this blog began. In fact, it’s about as perfect a framework as I can think of upon which to drape the points I want to make in this post.

What I will discuss is perhaps the most effective, devastating attack that proponents of quackery, woo, and nonsense aim at supporters of science-based medicine (SBM). As far as that is the case, it is not effective because it’s fact-based, evidence-based, or science-based. Far from it. Rather, it’s effective because it appeals to the emotions and very effectively demonizes SBM proponents to the point where they often have a hard time standing their ground when it is used. Sometimes, it preemptively prevents them from even speaking up in the first place. It’s a little tactic that I like to call the “compassion gambit,” which means trying to discredit critics of “alternative” medicine by painting them as cold, unfeeling, uncaring, arrogant monsters who want to hurt or kill children (and probably get a big smile on their faces when they torture puppies, to boot).
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Posted in: Cancer, Science and Medicine, Science and the Media, Vaccines

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Vaccination mandate exemptions: gimme that ol’ time philosophy

Each of the 50 states and the District of Columbia require vaccination against certain diseases as a prerequisite to public and private school attendance, most commonly polio, mumps, measles, diphtheria, rubella, chicken pox, Heamophilus influenza type b, pertussis, tetanus, pneumococcal disease and hepatitis B. Unfortunately, mandatory vaccination for home-schooled children is rare. (1)

All states provide medical exemptions to vaccination mandates for those for whom vaccination poses a health threat. Indeed, it is doubtful that a state could constitutionally deny such medical exemptions.

Forty-eight states also allow exemptions based on religious beliefs. While it might be assumed that religious exemptions are required by the protection afforded religion under the First Amendment to the U.S. Constitution that is not the case. The opposite is true. Religious exemptions themselves are constitutionally suspect. In fact, to pass First Amendment muster, a state’s religious exemption statute may have to be so broad as to become, in essence, a “philosophical” exemption.

Vaccination mandates survive early challenges

Compulsory vaccination laws have enjoyed strong support in the state and federal courts for over a century. Early in the 20th century, the U.S. Supreme Court considered the constitutionality of a statute authorizing a municipal board of health to require and enforce vaccination, in this case during a smallpox epidemic. The Court found the legislation represented a valid exercise of the state’s police power. In a statement that proved prescient about the failed constitutional challenges to vaccination mandates which followed, the Court said that “we do not perceive that this legislation has invaded any right secured by the Federal Constitution.” Jacobson v. Massachusetts, 197 U.S. 11, 38 (1905).

In 1922, the Court specifically addressed the subject of school vaccination, holding that it is a valid exercise of the state’s police power to make vaccination a condition of attending public or private school. Zucht v. King, 260 U.S. 174 (1922).
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Posted in: Chiropractic, Legal, Politics and Regulation, Public Health, Religion, Vaccines

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