As the name of this blog makes clear, the authors believe that the public is best served when the institutions of medicine and health care are science-based. The basis of medicine has many levels and institutions in our society. They include not only the practitioners of medicine, but hospitals, medical schools and other academic institutions, government and regulatory agencies, industry, insurance companies, the legal system, media, and (last but not least) the public. Defending science-based medicine requires advocacy at every level.
Arguably, the acceptance of science-based medicine at all levels is influenced greatly by public opinion (too much, in my opinion, as a profession, almost by definition, should rise above the lowest common denominator of public opinion), and public opinion is influenced greatly by the mainstream media. There is one issue, however, for which public opinion has a direct and measurable effect on the efficacy of a medical intervention and that is the vaccination program. Therefore we pay particular interest to how the media deals with the issue of vaccines, especially the recent false controversy over an alleged link between vaccines and autism.
It is my observation (and also supported by a recent study) that the quality of mainstream science reporting has been generally low, attributed to the scaling back of dedicated science journalists. On this issue I have found the reporting to be mixed, with both good and bad examples, but with the highest quality outlets generally getting the story right. This week Time magazine’s cover story is The Truth About Vaccines by Alice Park. The article is excellent – it covers the controversy without pandering and without pretending that there is more of a scientific controversy than there is. She states quite succinctly that the evidence has been evaluated by scientific organizations and there simply is no credible evidence for a link between autism and vaccines.
She hits many of the highlights of the important points against the antivaccinationist claims. For example:
- Proponents of a vaccine-autism link claimed that the mercury-based preservative in some vaccines, thimerosal, was responsible for the link to autism. However, thimerosal was removed from all routine childhood vaccines in the US by 2002 (with only trace amounts in some flu vaccines, which are optional). After the removal of thimerosal autism cases continued to rise unabated, obliterating any claim to a significant link.
- Vaccine critics say the increased vaccine schedule overwhelms the immature immune systems of young children. However, while the number of vaccines has increased, they are more targeted due to improved technology and scientific knowledge. Today’s vaccine schedule contains about 150 antigens (immune stimulating proteins), which is less than the 200 proteins that older vaccines contained.
- Widespread compliance is critical for “herd immunity” to be effective. This is critical because some people cannot get vaccines for medical reasons and they depend on the rest of us to be vaccinated. Voluntary refusal of vaccination has led to outbreaks of diseases like measles that vaccines effectively protect against.
- Vaccines partly suffer from their own success. Parents today never had to live through polio or small pox epidemics.
Overall an excellent article. There are still more points that are critical to the debate that she did not cover, but it is difficult to capture them all in a single article (I assume there were length limitations). For example:
- The “autism epidemic” is likely not real but an artifact of increased surveillance and a broadening of the definition of autism, which is now called “autism spectrum disorder.”
- While parents may first notice the symptoms of autism around the time that vaccines are being given, new studies show that signs are present much earlier, perhaps as early as 4-6 months. If the signs of autism are present before the vaccines are even given, that, of course, falsifies the vaccine-autism hypothesis.
- Evidence is increasingly pointing in the direction that autism is predominantly a genetic disorder or group of disorders. This does not rule out environmental influences entirely, but is argues against autism being primarily due to a toxin.
The scientific debate has largely been fought and resolved – there is no credible and significant link between vaccines and autism. But the public relations battle still rages, and the anti-vaccine side has been doing remarkably well recently. They have a good slogan (green our vaccines) and have been very energetic. In the battle between science and propaganda, propaganda has the short term advantage. While I think science has the long term advantage (because in the end legitimate science is more likely to be correct), a great deal of harm can be done in the meantime.
Park’s article in Time does a good job of pointing that out – irrationally rejecting vaccines causes harm, not only to your own children but to others. It is critical that we continue to point that out to the public. This is not just an abstract battle over how to interpret arcane medical data. Medicine is an applied science and the science behind vaccines has direct public health implications. The subtitle on the cover of Time puts it very succinctly:
Worried about autism, many parents are opting out of immunizations. How they’re putting the rest of us at risk.