To hear his enemies talk, you might think Paul Offit is the most hated man in America. A pediatrician in Philadelphia, he is the coinventor of a rotavirus vaccine that could save tens of thousands of lives every year. Yet environmental activist Robert F. Kennedy Jr. slams Offit as a \u201cbiostitute\u201d who whores for the pharmaceutical industry. Actor Jim Carrey calls him a profiteer and distills the doctor\u2019s attitude toward childhood vaccination down to this chilling mantra: \u201cGrab \u2018em and stab \u2018em.\u201d Recently, Carrey and his girlfriend, Jenny McCarthy, went on CNN\u2019s Larry King Live and singled out Offit\u2019s vaccine, RotaTeq, as one of many unnecessary vaccines, all administered, they said, for just one reason: \u201cGreed.\u201d<\/p>\n
Thousands of people revile Offit publicly at rallies, on Web sites, and in books. Type pauloffit.com into your browser and you\u2019ll find not Offit\u2019s official site but an anti-Offit screed \u201cdedicated to exposing the truth about the vaccine industry\u2019s most well-paid spokesperson.\u201d Go to Wikipedia to read his bio and, as often as not, someone will have tampered with the page. The section on Offit\u2019s education was once altered to say that he\u2019d studied on a pig farm in Toad Suck, Arkansas. (He\u2019s a graduate of Tufts University and the University of Maryland School of Medicine).<\/p>\n
Then there are the threats. Offit once got an email from a Seattle man that read, \u201cI will hang you by your neck until you are dead!\u201d Other bracing messages include \u201cYou have blood on your hands\u201d and \u201cYour day of reckoning will come.\u201d A few years ago, a man on the phone ominously told Offit he knew where the doctor\u2019s two children went to school. At a meeting of the Centers for Disease Control and Prevention, an anti-vaccine protester emerged from a crowd of people holding signs that featured Offit\u2019s face emblazoned with the word terrorist and grabbed the unsuspecting, 6-foot-tall physician by the jacket.<\/p>\n
\u201cI don\u2019t think he wanted to hurt me,\u201d Offit recalls. \u201cHe was just excited to be close to the personification of such evil.\u201d Still, whenever Offit gets a letter with an unfamiliar return address, he holds the envelope at arm\u2019s length before gingerly tearing it open. \u201cI think about it,\u201d he admits. \u201cAnthrax.\u201d<\/p>\n
So what has this award-winning 58-year-old scientist done to elicit such venom? He boldly states \u2014 in speeches, in journal articles, and in his 2008 book Autism\u2019s False Prophets \u2014 that vaccines do not cause autism or autoimmune disease or any of the other chronic conditions that have been blamed on them. He supports this assertion with meticulous evidence. And he calls to account those who promote bogus treatments for autism \u2014 treatments that he says not only don\u2019t work but often cause harm.<\/p>\n
As a result, Offit has become the main target of a grassroots movement that opposes the systematic vaccination of children and the laws that require it. McCarthy, an actress and a former Playboy centerfold whose son has been diagnosed with autism, is the best-known leader of the movement, but she is joined by legions of well-organized supporters and sympathizers.<\/p>\n
This isn\u2019t a religious dispute, like the debate over creationism and intelligent design. It\u2019s a challenge to traditional science that crosses party, class, and religious lines. It is partly a reaction to Big Pharma\u2019s blunders and PR missteps, from Vioxx to illegal marketing ploys, which have encouraged a distrust of experts. It is also, ironically, a product of the era of instant communication and easy access to information. The doubters and deniers are empowered by the Internet (online, nobody knows you\u2019re not a doctor) and helped by the mainstream media, which has an interest in pumping up bad science to create a \u201cdebate\u201d where there should be none.<\/p>\n
In the center of the fray is Paul Offit. \u201cPeople describe me as a vaccine advocate,\u201d he says. \u201cI see myself as a science advocate.\u201d But in this battle \u2014 and make no mistake, he says, it\u2019s a pitched and heated battle \u2014 \u201cscience alone isn\u2019t enough \u2026 People are getting hurt. The parent who reads what Jenny McCarthy says and thinks, \u2018Well, maybe I shouldn\u2019t get this vaccine,\u2019 and their child dies of Hib meningitis,\u201d he says, shaking his head. \u201cIt\u2019s such a fundamental failure on our part that we haven\u2019t convinced that parent.\u201d<\/p>\n
Consider: In certain parts of the US, vaccination rates have dropped so low that occurrences of some children\u2019s diseases are approaching pre-vaccine levels for the first time ever. And the number of people who choose not to vaccinate their children (so-called philosophical exemptions are available in about 20 states, including Pennsylvania, Texas, and much of the West) continues to rise. In states where such opting out is allowed, 2.6 percent of parents did so last year, up from 1 percent in 1991, according to the CDC. In some communities, like California\u2019s affluent Marin County, just north of San Francisco, non-vaccination rates are approaching 6 percent (counterintuitively, higher rates of non-vaccination often correspond with higher levels of education and wealth).<\/p>\n
That may not sound like much, but a recent study by the Los Angeles Times indicates that the impact can be devastating. The Times found that even though only about 2 percent of California\u2019s kindergartners are unvaccinated (10,000 kids, or about twice the number as in 1997), they tend to be clustered, disproportionately increasing the risk of an outbreak of such largely eradicated diseases as measles, mumps, and pertussis (whooping cough). The clustering means almost 10 percent of elementary schools statewide may already be at risk.<\/p>\n
In May, The New England Journal of Medicine laid the blame for clusters of disease outbreaks throughout the US squarely at the feet of declining vaccination rates, while nonprofit health care provider Kaiser Permanente reported that unvaccinated children were 23 times more likely to get pertussis, a highly contagious bacterial disease that causes violent coughing and is potentially lethal to infants. In the June issue of the journal Pediatrics, Jason Glanz, an epidemiologist at Kaiser\u2019s Institute for Health Research, revealed that the number of reported pertussis cases jumped from 1,000 in 1976 to 26,000 in 2004. A disease that vaccines made rare, in other words, is making a comeback. \u201cThis study helps dispel one of the commonly held beliefs among vaccine-refusing parents: that their children are not at risk for vaccine-preventable diseases,\u201d Glanz says.<\/p>\n
\u201cI used to say that the tide would turn when children started to die. Well, children have started to die,\u201d Offit says, frowning as he ticks off recent fatal cases of meningitis in unvaccinated children in Pennsylvania and Minnesota. \u201cSo now I\u2019ve changed it to \u2018when enough children start to die.\u2019 Because obviously, we\u2019re not there yet.\u201d<\/p>\n
The rejection of hard-won knowledge is by no means a new phenomenon. In 1905, French mathematician and scientist Henri Poincar\u00e9 said that the willingness to embrace pseudo-science flourished because people \u201cknow how cruel the truth often is, and we wonder whether illusion is not more consoling.\u201d Decades later, the astronomer Carl Sagan reached a similar conclusion: Science loses ground to pseudo-science because the latter seems to offer more comfort. \u201cA great many of these belief systems address real human needs that are not being met by our society,\u201d Sagan wrote of certain Americans\u2019 embrace of reincarnation, channeling, and extraterrestrials. \u201cThere are unsatisfied medical needs, spiritual needs, and needs for communion with the rest of the human community.\u201d<\/p>\n
Looking back over human history, rationality has been the anomaly. Being rational takes work, education, and a sober determination to avoid making hasty inferences, even when they appear to make perfect sense. Much like infectious diseases themselves \u2014 beaten back by decades of effort to vaccinate the populace \u2014 the irrational lingers just below the surface, waiting for us to let down our guard.<\/p>\n
Before smallpox was eradicated with a vaccine, it killed an estimated 500 million people. And just 60 years ago, polio paralyzed 16,000 Americans every year, while rubella caused birth defects and mental retardation in as many as 20,000 newborns. Measles infected 4 million children, killing 3,000 annually, and a bacterium called Haemophilus influenzae type b caused Hib meningitis in more than 15,000 children, leaving many with permanent brain damage. Infant mortality and abbreviated life spans \u2014 now regarded as a third world problem \u2014 were a first world reality.<\/p>\n
Today, because the looming risk of childhood death is out of sight, it is also largely out of mind, leading a growing number of Americans to worry about what is in fact a much lesser risk: the ill effects of vaccines. If your newborn gets pertussis, for example, there is a 1 percent chance that the baby will die of pulmonary hypertension or other complications. The risk of dying from the pertussis vaccine, by contrast, is practically nonexistent \u2014 in fact, no study has linked DTaP (the three-in-one immunization that protects against diphtheria, tetanus, and pertussis) to death in children. Nobody in the pro-vaccine camp asserts that vaccines are risk-free, but the risks are minute in comparison to the alternative.<\/p>\n
Still, despite peer-reviewed evidence, many parents ignore the math and agonize about whether to vaccinate. Why? For starters, the human brain has a natural tendency to pattern-match \u2014 to ignore the old dictum \u201ccorrelation does not imply causation\u201d and stubbornly persist in associating proximate phenomena. If two things coexist, the brain often tells us, they must be related. Some parents of autistic children noticed that their child\u2019s condition began to appear shortly after a vaccination. The conclusion: \u201cThe vaccine must have caused the autism.\u201d Sounds reasonable, even though, as many scientists have noted, it has long been known that autism and other neurological impairments often become evident at or around the age of 18 to 24 months, which just happens to be the same time children receive multiple vaccinations. Correlation, perhaps. But not causation, as studies have shown.<\/p>\n
And if you need a new factoid to support your belief system, it has never been easier to find one. The Internet offers a treasure trove of undifferentiated information, data, research, speculation, half-truths, anecdotes, and conjecture about health and medicine. It is also a democratizing force that tends to undermine authority, cut out the middleman, and empower individuals. In a world where anyone can attend what McCarthy calls the \u201cUniversity of Google,\u201d boning up on immunology before getting your child vaccinated seems like good, responsible parenting. Thanks to the Internet, everyone can be their own medical investigator.<\/p>\n
There are anti-vaccine Web sites, Facebook groups, email alerts, and lobbying organizations. Politicians ignore the movement at their peril, and, unlike in the debates over creationism and global warming, Democrats have proved just as likely as Republicans to share misinformation and fuel anxiety.<\/p>\n
US senators John Kerry of Massachusetts and Chris Dodd of Connecticut have both curried favor with constituents by trumpeting the notion that vaccines cause autism. And Robert F. Kennedy Jr., a scion of the most famous Democratic family of all, authored a deeply flawed 2005 Rolling Stone piece called \u201cDeadly Immunity.\u201d In it, he accused the government of protecting drug companies from litigation by concealing evidence that mercury in vaccines may have caused autism in thousands of kids. The article was roundly discredited for, among other things, overestimating the amount of mercury in childhood vaccines by more than 100-fold, causing Rolling Stone to issue not one but a prolonged series of corrections and clarifications. But that did little to unring the bell.<\/p>\n
The bottom line: Pseudo-science preys on well-intentioned people who, motivated by love for their kids, become vulnerable to one of the world\u2019s oldest professions. Enter the snake-oil salesman.<\/p>\n
When a child is ill, parents will do anything to make it right. If you doubt that, just spend a day or two at the annual conference of the nonprofit organization Autism One, a group built around the conviction that autism is caused by vaccines. It shares its agenda with other advocacy groups like the National Autism Association, the Coalition for SafeMinds, and McCarthy\u2019s Generation Rescue. All these organizations cite similar anecdotes \u2014 children who appear to shut down and exhibit signs of autistic behavior immediately after being vaccinated \u2014 as proof. Autism One, like others, also points to rising rates of autism \u2014 what many parents call an epidemic \u2014 as evidence that vaccines are to blame. Finally, Autism One asserts that the condition is preventable and treatable, and that it is the toxins in vaccines and the sheer number of childhood vaccines (the CDC recommends 10 vaccines, in 26 doses, by the age of 2 \u2014 up from four vaccines in 1983) that combine to cause disease in certain sensitive children.<\/p>\n
Their rhetoric often undergoes subtle shifts, especially when the scientific evidence becomes too overwhelming on one front or another. After all, saying you\u2019re against all vaccines does start to sound crazy, even to a parent in distress over a child\u2019s autism. Until recently, Autism One\u2019s Web site flatly blamed \u201ctoo many vaccines given too soon.\u201d Lately, the language has gotten more vague, citing \u201cenvironmental triggers.\u201d<\/p>\n
But the underlying argument has not changed: Vaccines harm America\u2019s children, and doctors like Paul Offit are paid shills of the drug industry.<\/p>\n
To be clear, there is no credible evidence to indicate that any of this is true. None. Twelve epidemiological studies have found no data that links the MMR (measles\/mumps\/rubella) vaccine to autism; six studies have found no trace of an association between thimerosal (a preservative containing ethylmercury that was used in vaccines until 2001) and autism, and three other studies have found no indication that thimerosal causes even subtle neurological problems. The so-called epidemic, researchers assert, is the result of improved diagnosis, which has identified as autistic many kids who once might have been labeled mentally retarded or just plain slow. In fact, the growing body of science indicates that the autistic spectrum \u2014 which may well turn out to encompass several discrete conditions \u2014 may largely be genetic in origin. In April, the journal Nature published two studies that analyzed the genes of almost 10,000 people and identified a common genetic variant present in approximately 65 percent of autistic children.<\/p>\n
But that hasn\u2019t stopped as many as one in four Americans from believing vaccines can poison kids, according to a 2008 survey. And outreach by grassroots organizations like Autism One is a big reason why.<\/p>\n
At this year\u2019s Autism One conference in Chicago, I flashed more than once on Carl Sagan\u2019s idea of the power of an \u201cunsatisfied medical need.\u201d Because a massive research effort has yet to reveal the precise causes of autism, pseudo-science has stepped aggressively into the void. In the hallways of the Westin O\u2019Hare hotel, helpful salespeople strove to catch my eye as I walked past a long line of booths pitching everything from vitamins and supplements to gluten-free cookies (some believe a gluten-free diet alleviates the symptoms of autism), hyperbaric chambers, and neuro-feedback machines.<\/p>\n
To a one, the speakers told parents not to despair. Vitamin D would help, said one doctor and supplement salesman who projected the equation \u201cNo vaccines + more vitamin d = no autism\u201d onto a huge screen during his presentation. (If only it were that simple.) Others talked of the powers of enzymes, enemas, infrared saunas, glutathione drips, chelation therapy (the controversial \u2014 and risky \u2014 administration of certain chemicals that leech metals from the body), and Lupron (a medicine that shuts down testosterone synthesis).<\/p>\n
Offit calls this stuff, much of which is unproven, ineffectual, or downright dangerous, \u201ca cottage industry of false hope.\u201d He didn\u2019t attend the Autism One conference, though his name was frequently invoked. A California woman with an 11-year-old autistic son told me, aghast, that she\u2019d personally heard Offit say you could safely give a child 10,000 vaccines (in fact, the number he came up with was 100,000 \u2014 more on that later). A mom from Arizona, who introduced me to her 10-year-old \u201crecovered\u201d autistic son \u2014 a bright, blue-eyed, towheaded boy who hit his head on walls, she said, before he started getting B-12 injections \u2014 told me that she\u2019d read Offit had made $50 million from the RotaTeq vaccine. In her view, he was in the pocket of Big Pharma.<\/p>\n
The central message at these conferences boils down to this: \u201cThe medical establishment doesn\u2019t care, but we do.\u201d Every vendor I talked to echoed this theme. And every parent expressed a frustrated, even desperate belief that no one in traditional science gives a hoot about easing their pain or addressing their theories \u2014 based on day-to-day parental experience \u2014 about autism\u2019s causes.<\/p>\n
Actually, scientists have chased down some of these theories. In August, for example, Pediatrics published an investigation of a popular hypothesis that children with autism have a higher incidence of gastrointestinal problems, which some allege are caused by injected viruses traveling to the intestines. Jenny McCarthy\u2019s foundation posits that autism stems from these bacteria, as well as heavy metals and live viruses present in some vaccines. Healing your child, therefore, is a matter of clearing out the \u201cenvironmental toxins\u201d with, among other things, special diets. The Pediatrics paper found that while autistic kids suffered more from constipation, the cause was likely behavioral, not organic; there was no significant association between autism and GI symptoms. Moreover, gluten- and dairy-free diets did not appear to improve autism and sometimes caused nutritional deficiencies.<\/p>\n
But researchers, alas, can\u2019t respond with the same forceful certainty that the doubters are able to deploy \u2014 not if they\u2019re going to follow the rules of science. Those tenets allow them to claim only that there is no evidence of a link between autism and vaccines. But that phrasing \u2014 what sounds like equivocation \u2014 is just enough to allow doubts to not only remain but to fester. Meanwhile, in the eight years since thimerosal was removed from vaccines (a public relations mistake, in Offit\u2019s view, because it seemed to indicate to the public that thimerosal was toxic), the incidences of autism continue to rise.<\/p>\n
In the wake of the latest thimerosal studies, most of the anti-vaccination crowd \u2014 even Autism One, despite the ever-changing rhetoric on its Web site \u2014 has shifted their aim away from any particular vaccine to a broader, fuzzier target: the sheer number of vaccines that are recommended. It sounds, after all, like common sense. There must be something risky about giving too many vaccines to very young children in too short a time. Opponents argue that for some children the current vaccine schedule creates a \u201ctoxic overload.\u201d<\/p>\n
\u201cI\u2019m not anti-vaccine,\u201d McCarthy says. \u201cI\u2019m anti-toxin.\u201d She stops just short of calling for an outright ban. McCarthy delivered the keynote address at the Autism One conference this year, just as she had in 2008. She drew a standing-room-only crowd, many of whom know her not from her acting but from her frequent appearances on TV talk shows, Oprah Winfrey\u2019s Web site, and Twitter (@JennyfromMTV). McCarthy has authored two best-selling books on \u201chealing\u201d autism and is on the board of the advocacy group Generation Rescue (motto: \u201cAutism is reversible\u201d). With her stream-of-consciousness rants (\u201dToo many toxins in the body cause neurological problems \u2014 look at Ozzy Osbourne, for Christ\u2019s sake!\u201d) and celebrity allure, she is the anti-vaccine movement\u2019s most popular pitchman and prettiest face.<\/p>\n
Barbara Loe Fisher, by contrast, is indisputably the movement\u2019s brain. Fisher is the cofounder and president of the National Vaccine Information Center in Vienna, Virginia, the largest, oldest, and most influential of the watchdog groups that oppose universal vaccination. At the Autism One conference, Fisher took the podium with characteristic flair. As she often does, Fisher began with the story of her son Chris, who she believes was damaged by vaccines at the age of two and a half. A short film featuring devastating images of sick kids \u2014 some of them seemingly palsied, others with tremors, others catatonic \u2014 drove the point home. The film, accompanied by Bryan Adams\u2019 plaintive song \u201c(Everything I Do) I Do It For You,\u201d ended with this message emblazoned on the screen: \u201cAll the children in this video were injured or killed by mandatory vaccinations.\u201d<\/p>\n
Against this backdrop, Fisher, a skilled debater who often faces down articulate, well-informed scientists on live TV, mentioned Offit frequently. She called him the leading \u201cpro-forced-vaccination proponent\u201d and cast him as a man who walks in lockstep with the pharmaceutical companies and demonizes caring parents. With the likely introduction of a swine flu vaccine later this year, Fisher added, Americans needed to wake up to the \u201cdraconian laws\u201d that could force every citizen to either be vaccinated or quarantined. That isn\u2019t true \u2014 the swine flu vaccine, like other flu vaccines, will be administered on a voluntary basis. But no matter: Fisher\u2019s argument turns vaccines from a public health issue into one of personal choice, an unwritten bit of the Bill of Rights.<\/p>\n
In her speech, Fisher borrowed from the Bible, George Orwell, and the civil rights movement. \u201cThe battle we are waging,\u201d she said, \u201cwill determine what both health and freedom will look like in America.\u201d She closed by quoting the inscription above the door of the Holocaust Memorial Museum in Washington, DC: \u201cThe first to perish were the children.\u201d And then she brought it home: \u201cIf we believe in compassion, if we believe in the future, we will do whatever it takes to give our children back the future that is their birthright.\u201d The audience cheered as the words sank in: Whatever it takes. \u201cNo forced vaccination,\u201d Fisher concluded. \u201cNot in America.\u201d<\/p>\n
Paul Offit has a slightly nasal voice and a forceful delivery that conspire to make him sound remarkably like Hawkeye Pierce, the cantankerous doctor played by Alan Alda on the TV series M*A*S*H. As a young man, Offit was a big fan of the show (though he felt then, and does now, that Hawkeye was \u201cmuch cooler than me\u201d). Offit is quick-witted, funny, and \u2014 despite a generally mild-mannered mien \u2014 sometimes so assertive as to seem brash. \u201cScientists, bound only by reason, are society\u2019s true anarchists,\u201d he has written \u2014 and he clearly sees himself as one. \u201cKaflooey theories\u201d make him crazy, especially if they catch on. Fisher, who has long been the media\u2019s go-to interview for what some in the autism arena call \u201cparents rights,\u201d makes him particularly nuts, as in \u201cYou just want to scream.\u201d The reason? \u201cShe lies,\u201d he says flatly.<\/p>\n
\u201cBarbara Loe Fisher inflames people against me. And wrongly. I\u2019m in this for the same reason she is. I care about kids. Does she think Merck is paying me to speak about vaccines? Is that the logic?\u201d he asks, exasperated. (Merck is doing no such thing). But when it comes to mandating vaccinations, Offit says, Fisher is right about him: He is an adamant supporter.<\/p>\n
\u201cWe have seat belt rules,\u201d he says. \u201cSeat belts save lives. There was never a question about that. The data was absolutely clear. But people didn\u2019t use them until they were required to use them.\u201d Furthermore, the decision not to buckle up endangers only you. \u201cUnless you fly through the window and hit somebody else,\u201d he adds. \u201cI believe in mandates. I do.\u201d<\/p>\n
We are driving north (seat belts on) across Philadelphia in Offit\u2019s gray 2009 Toyota Camry, having just completed a full day of rounds at Children\u2019s Hospital. Over the past eight hours, Offit has directed a team of six residents and med students as they evaluated more than a dozen children with persistent infections. He pulls into the driveway of the comfy four-bedroom Tudor in the suburbs where his family has lived for the past 13 years. It\u2019s a nice enough house, with a leafy green yard and a two-car garage where a second Toyota Camry (this one red, a year older, and belonging to his wife, Bonnie) is already parked. Let\u2019s just say that if Offit has indeed made $50 million from RotaTeq, as his critics love to say, he is hiding it well.<\/p>\n
Offit acknowledges that he received a payout \u2014 \u201cseveral million dollars, a lot of money\u201d \u2014 when his hospital sold its stake in RotaTeq last year for $182 million. He continues to collect a royalty each year. It\u2019s a fluke, he says \u2014 an unexpected outcome. \u201cI\u2019m not embarrassed about it,\u201d he says. \u201cIt was the product of a lot of work, although it wasn\u2019t why I did the work, nor was it, frankly, the reward for the work.\u201d<\/p>\n
Similarly, the suggestion that pharmaceutical companies make vaccines hoping to pocket huge profits is ludicrous to Offit. Vaccines, after all, are given once or twice or three times in a lifetime. Diabetes drugs, neurological drugs, Lipitor, Viagra, even Rogaine \u2014 stuff that a large number of people use every day \u2014 that\u2019s where the money is.<\/p>\n
That\u2019s not to say vaccines aren\u2019t profitable: RotaTeq costs a little under $4 a dose to make, according to Offit. Merck has sold a total of more than 24 million doses in the US, most for $69.59 a pop \u2014 a 17-fold markup. Not bad, but pharmaceutical companies do sell a lot of vaccines at cost to the developing world and in some cases give them away. Merck committed $75 million in 2006 to vaccinate all children born in Nicaragua for three years. In 2008, Merck\u2019s revenue from RotaTeq was $665 million. Meanwhile, a blockbuster drug like Pfizer\u2019s Lipitor is a $12 billion-a-year business.<\/p>\n
To understand exactly why Offit became a scientist, you must go back more than half a century, to 1956. That was when doctors in Offit\u2019s hometown of Baltimore operated on one of his legs to correct a club foot, requiring him to spend three weeks recovering in a chronic care facility with 20 other children, all of whom had polio. Parents were allowed to visit just one hour a week, on Sundays. His father, a shirt salesman, came when he could. His mother, who was pregnant with his brother and hospitalized with appendicitis, was unable to visit at all. He was 5 years old. \u201cIt was a pretty lonely, isolating experience,\u201d Offit says. \u201cBut what was even worse was looking at these other children who were just horribly crippled and disfigured by polio.\u201d That memory, he says, was the first thing that drove him toward a career in pediatric infectious diseases.<\/p>\n
There was something else, too. From an early age, Offit embraced the logic and elegance of the scientific method. Science imbued a chaotic world with an order that he found reassuring.<\/p>\n
\u201cWhat I loved about science was its reason. You have data. You stand back and you discuss the strengths and weaknesses of that data. There\u2019s just something very calming about that,\u201d he says. \u201cYou formulate a hypothesis, you establish burdens of proof, you subject your hypothesis to rigorous testing. You\u2019ve got 20 pieces of a 1,000-piece puzzle \u2026 It\u2019s beautiful, really.\u201d<\/p>\n
There were no doctors in the Offit family; he decided to become the first. In 1977, when he was an intern at the Children\u2019s Hospital of Pittsburgh, he witnessed the second event that would determine his career path: the death of a little girl from a rotavirus infection (there was, as yet, no vaccine). The child\u2019s mother had been diligent, calling her pediatrician just a few hours after the girl\u2019s fever, vomiting, and diarrhea had begun. Still, by the time the girl was admitted, she was too dehydrated to have an intravenous line inserted. Doctors tried everything to rehydrate her, including sticking a bone marrow needle into her tibia to inject fluids. She died on the table. \u201cI didn\u2019t realize it killed children in the United States,\u201d Offit says, remembering how the girl\u2019s mother, after hearing the terrible news, came into the room and held her daughter\u2019s hand. \u201cThat girl\u2019s image was always in my head.\u201d<\/p>\n
The third formative moment for Offit came in the late 1980s, when he met Maurice Hilleman, the most brilliant vaccine maker of the 20th century. Hilleman \u2014 a notoriously foulmouthed genius who toiled for years in the Philadelphia labs of Merck \u2014 invented vaccines to prevent measles, mumps, and rubella (and later came up with the combination of the three, the MMR). He created vaccines for hepatitis A and B, Hib, chicken pox, pneumococcus, and meningococcus. He became Offit\u2019s mentor; Offit later became Hilleman\u2019s biographer.<\/p>\n
Offit believes in the power of good storytelling, which is why he writes books, five so far. He dearly wants to pull people into the exciting mysteries that scientists wrestle with every day. He wants us all to understand that vaccines work by introducing a weakened strain of a particular virus into the body \u2014 a strain so weak that it cannot make us sick. He wants us to revel in this miracle of inoculation, which causes our immune systems to produce antibodies and develop \u201cmemory cells\u201d that mount a defense if we later encounter a live version of that virus.<\/p>\n
It\u2019s easy to see why Offit felt a special pride when, after 25 years of research and testing, he and two colleagues, Fred Clark and Stanley Plotkin, joined the ranks of the vaccine inventors. In February 2006, RotaTeq was approved for inclusion in the US vaccination schedule. The vaccine for rotavirus, which each year kills about 600,000 children in poor countries and about 40 children in the US, probably saves hundreds of lives a day.<\/p>\n
But in certain circles, RotaTeq is no grand accomplishment. Instead, it is offered as Exhibit A in the case against Offit, proving his irredeemable bias and his corrupted point of view. Using this reasoning, of course, Watson and Crick would be unreliable on genetics because the Nobel Prize winners had a vested interest in genetic research. But despite the illogic, the argument has had some success. Consider the CDC\u2019s Advisory Committee on Immunization Practices, which reviews new vaccines and administration schedules: Back in the late \u201990s and early \u201900s, Offit was a member of the panel, along with experts in infectious diseases, virology, microbiology, and immunology. Now the 15-person panel is made up mostly of state epidemiologists and public-health officials.<\/p>\n
That\u2019s not by accident. According to science journalist Michael Specter, author of the new book Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet and Threatens Our Lives, the controversy surrounding vaccine safety has made lack of expertise a requirement when choosing members of prominent advisory panels on the issue. \u201cIt\u2019s shocking,\u201d Specter says. \u201cWe live in a country where it\u2019s actually a detriment to be an expert about something.\u201d When expertise is diminished to such an extent, irrationality and fear can run amok.<\/p>\n
Hence the death threats against Paul Offit. Curt Linderman Sr., the host of \u201cLinderman Live!\u201d on AutismOne Radio and the editor of a blog called the Autism File, recently wrote online that it would \u201cbe nice\u201d if Offit \u201cwas dead.\u201d<\/p>\n
I\u2019d met Linderman at Autism One. He\u2019d given his card to me as we stood outside the Westin O\u2019Hare talking about his autistic son. \u201cWe live in a very toxic world,\u201d he\u2019d told me, puffing on a cigarette.<\/p>\n
It was hard to argue with that.<\/p>\n
Despite his reputation, Offit has occasionally met a vaccine he doesn\u2019t like. In 2002, when he was still a member of the CDC\u2019s advisory committee, the Bush administration was lobbying for a program to give the smallpox vaccine to tens of thousands of Americans. Fear of bioterrorism was rampant, and everyone voted in favor \u2014 everyone except Offit. The reason: He feared people would die. And he didn\u2019t keep quiet about his reservations, making appearances on 60 Minutes II and The NewsHour with Jim Lehrer.<\/p>\n
The problem with the vaccine, he said, is that \u201cone in every million people who gets it dies.\u201d Moreover, he said, because smallpox is visible when its victims are contagious (it is marked by open sores), outbreaks \u2014 if there ever were any \u2014 could be quickly contained, and there would be plenty of time to begin vaccinations then. A preventive vaccine, he said, \u201cwas a greater risk than the risk of smallpox.\u201d<\/p>\n
Ah, risk. It is the idea that fuels the anti-vaccine movement \u2014 that parents should be allowed to opt out, because it is their right to evaluate risk for their own children. It is also the idea that underlies the CDC\u2019s vaccination schedule \u2014 that the risk to public health is too great to allow individuals, one by one, to make decisions that will impact their communities. (The concept of herd immunity is key here: It holds that, in diseases passed from person to person, it is more difficult to maintain a chain of infection when large numbers of a population are immune.)<\/p>\n
Risk is also the motivating idea in Offit\u2019s life. This is a man, after all, who opted to give his own two children \u2014 now teenagers \u2014 the flu vaccine before it was recommended for their age group. Why? Because the risk of harm if his children got sick was too great. Offit, like everyone else, will do anything to protect his children. And he wants Americans to be fully educated about risk and not hoodwinked into thinking that dropping vaccines keeps their children safe. \u201cThe choice not to get a vaccine is not a choice to take no risk,\u201d he says. \u201cIt\u2019s just a choice to take a different risk, and we need to be better about saying, \u2018Here\u2019s what that different risk looks like.\u2019 Dying of Hib meningitis is a horrible, ugly way to die.\u201d<\/p>\n
Getting the measles is no walk in the park, either \u2014 not for you or those who come near you. In 2005, a 17-year-old Indiana girl got infected on a trip to Bucharest, Romania. On the return flight home, she was congested, coughing, and feverish but had no rash. The next day, without realizing she was contagious, she went to a church gathering of 500 people. She was there just a few hours. Of the 500 people present, about 450 had either been vaccinated or had developed a natural immunity. Two people in that group had vaccination failure and got measles. Thirty-two people who had not been vaccinated and therefore had no resistance to measles also got sick. Did the girl encounter each of these people face-to-face in her brief visit to the picnic? No. All you have to do to get the measles is to inhabit the airspace of a contagious person within two hours of them being there.<\/p>\n
The frightening implications of this kind of anecdote were illustrated by a 2002 study published in The Journal of Infectious Diseases. Looking at 3,292 cases of measles in the Netherlands, the study found that the risk of contracting the disease was lower if you were completely unvaccinated and living in a highly vaccinated community than if you were completely vaccinated and living in a relatively unvaccinated community. Why? Because vaccines don\u2019t always take. What does that mean? You can\u2019t minimize your individual risk unless your herd, your friends and neighbors, also buy in.<\/p>\n
Perceived risk \u2014 our changing relationship to it and our increasing intolerance of it \u2014 is at the crux of vaccine safety concerns, not to mention related fears of pesticides, genetically modified food, and cloning. Sharon Kaufman, a medical anthropologist at UC San Francisco, observes that our concept of risk has evolved from an external threat that\u2019s out of our control (think: statistical probability of a plane crash) to something that can be managed and controlled if we just make the right decisions (eat less fat and you\u2019ll live longer). Improved diagnostic tests, a change in consumer awareness, an aging society determined to stay youthful \u2014 all have contributed to the growing perception that risk (of death, illness, accident) is our responsibility to reduce or eliminate. In the old order, risk management was in the hands of your doctor \u2014 or God. Under the new dispensation, it\u2019s all up to you. What are the odds that your child will be autistic? It\u2019s your job to manage them, so get thee to the Internet, and fast.<\/p>\n
The thimerosal debacle exacerbated this tendency, particularly when the American Academy of Pediatrics and the Public Health Service issued a poorly worded statement in 1999 that said \u201ccurrent levels of thimerosal will not hurt children, but reducing those levels will make safe vaccines even safer.\u201d In other words, there\u2019s no scientific evidence whatsoever, but you never know.<\/p>\n
\u201cWhen science came out and said, \u2018Uh-oh, there may be a risk,\u2019 the stage was already set,\u201d Kaufman says, noting that many parents felt it was irresponsible not to have doubts. \u201cIt was Pandora\u2019s box.\u201d<\/p>\n
The result is that science must somehow prove a negative \u2014 that vaccines don\u2019t cause autism \u2014 which is not how science typically works. Edward Jenner invented vaccination in 1796 with his smallpox inoculation; it would be 100 years before science, such as it was, understood why the vaccine worked, and it would be even longer before the specific cause of smallpox could be singled out. Until the cause of autism is discovered, scientists can establish only that vaccines are safe \u2014 and that threshold has already been met.<\/p>\n
The government is still considering funding more research trials to look for a connection between vaccines and autism. To Kaufman, there\u2019s some justification for this, given that it may be the only way to address everyone\u2019s doubts. But the thimerosal panic suggests that, if bungled, such trials could make a bad situation worse. To scientists like Offit, further studies are also a waste of precious scientific resources, not to mention taxpayers\u2019 money. They take funding away from more pressing matters, including the search for autism\u2019s real cause.<\/p>\n
A while back, Offit was asked to help put together a reference text on vaccines. Specifically, his colleagues wanted him to write a chapter that assessed the capacity of the human immune system. It was a hypothetical exercise: What was the maximum number of vaccines that a person could handle? The point was to arm doctors with information that could reassure parents. Offit set out to determine two factors: how many B cells, which make antibodies, a person has in a milliliter of blood and how many different epitopes, the part of a bacterium or virus that is recognized by the immune system, there are in a vaccine. Then, he came up with a rough estimate: a person could handle 100,000 vaccines \u2014 or up to 10,000 vaccines at once. Currently the most vaccines children receive at any one time is five.<\/p>\n
He also published his findings in Pediatrics. Soon, the number was attached to Offit like a scarlet letter. \u201cThe 100,000 number makes me sound like a madman. Because that\u2019s the image: 100,000 shots sticking out of you. It\u2019s an awful image,\u201d Offit says. \u201cMany people \u2014 including people who are on my side \u2014 have criticized me for that. But I was naive. In that article, I was being asked the question and that is the answer to the question.\u201d<\/p>\n
Still, he hasn\u2019t backed off. He feels that scientists have to work harder at winning over the public. \u201cIt\u2019s our responsibility to stand up for good science. Though it\u2019s not what we\u2019re trained to do,\u201d he says, admitting that his one regret about Autism\u2019s False Prophets is that it didn\u2019t hold scientists accountable for letting fear of criticism render them mute. \u201cGet out there. There\u2019s no venue too small. As someone once said, it would be a very quiet forest indeed if the only birds that sang were those that sang best.\u201d<\/p>\n
So Offit keeps singing. Isn\u2019t he afraid of those who wish him harm? \u201cI\u2019m not that brave,\u201d he says. \u201cIf I really thought my life was at risk or my children\u2019s lives were at risk, I wouldn\u2019t do it. Not for a second.\u201d Maybe, he acknowledges, he\u2019s in denial.<\/p>\n
Later, I ask his wife the same question. When it comes to her husband\u2019s welfare, Bonnie Offit is fiercely protective. A pediatrician with a thriving group practice, she still makes time to monitor the blogosphere. (Her husband refuses to read the attacks.) She wants to believe that if you \u201ckeep your finger on the pulse,\u201d as she puts it, you can keep your loved ones safe.<\/p>\n
Still, she worries. On the day I find myself sitting at her dining room table, every front page in the nation features an article about George Tiller, the abortion doctor gunned down at his church in Wichita, Kansas. When her husband leaves the room, Bonnie brings up the killing. \u201cIt upsets me,\u201d she says, looking away. \u201cI didn\u2019t even tell him that. But it absolutely upsets me.\u201d<\/p>\n
Her husband, meanwhile, still rises every morning at 4 am and heads to his small, tidy study in a spare bedroom. Every morning, he spends a couple of hours working on what will be his sixth book, a history of the anti-vaccine movement. Offit gets excited when he talks about it.<\/p>\n
In 19th-century England, he explains, Jenner\u2019s smallpox vaccine was known to be effective. But despite the Compulsory Vaccination Act of 1853, many people still refused to take it, and thousands died unnecessarily. \u201cThat was the birth of the anti-vaccine movement,\u201d he says, adding that then \u2014 as now \u2014 those at the forefront \u201cwere great at mass marketing. It was a print-oriented society. They were great pamphleteers. And by the 1890s, they had driven immunization rates down to the 20 percent range.\u201d<\/p>\n
Immediately, smallpox took off again in England and Wales, killing 1,455 in 1893. Ireland and Scotland, by contrast, \u201cdidn\u2019t have any anti-vaccine movement and had very high immunization rates and very little incidence of smallpox disease and death,\u201d he says, taking a breath. \u201cYou\u2019d like to think we would learn.\u201d<\/p>\n
Offit wants the book to be cinematic, visually riveting. He believes, fervently, that if he can hook people with a good, truthful story, maybe they will absorb his hopeful message: The human race has faced down this kind of doubt before.<\/p>\n
His battle is, in at least one respect, probably a losing one. There will always be more illogic and confusion than science can fend off. Offit\u2019s idea is to inoculate people one by one, until the virus of fear, if not fully erased, at least recedes.<\/p>\n
Source: Wired [http:\/\/www.wired.com\/magazine\/2009\/10\/ff_waronscience\/all\/1]<\/p>\n","protected":false},"excerpt":{"rendered":"
To hear his enemies talk, you might think Paul Offit is the most hated man in America. A pediatrician in Philadelphia, he is the coinventor of a rotavirus vaccine that could save tens of thousands of lives every year. Yet environmental activist Robert F. Kennedy Jr. slams Offit as a \u201cbiostitute\u201d who whores for the…<\/p>\n