Autisms False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, by Paul A. Offit (Columbia University Press, 328 pp., $24.95)
For some reason, the immunization of children has always aroused opposition of almost religious fervor. For example, a mass movement led resistance to smallpox vaccination in Britain for 70 years and was supported by intellectuals of the stature of George Bernard Shaw, who never believed in the germ theory of disease and thought that Pasteur and Lister were charlatans. Politicians have won or lost elections on their attitude to vaccination. And the extensive literature produced by the antivaccination movement attributed virtually every human ill, from general failure to thrive to the recrudescence of leprosy, to the practice. The movement also imputed the worst possible motives to vaccinators, including Edward Jenner himself, the developer of the smallpox vaccine.
Fears about immunization have reappeared with monotonous regularity. Perhaps it is the medical and social pressure to immunize that stirs up such opposition, especially in countries that pride themselves on their sturdy individualism. And while everyone agrees that prevention is better than cure, a single case of a complication wrought by immunization has more emotional impact than a million cases prevented. The former, after all, is a definite presence, the latter a ghostly absence.
The combined measles, mumps, and rubella vaccine is the latest to act as a lightning conductor for parental discontent. Paul Offits new book, as readable as a good detective novel, tells the story of how autism, a disorder of psychological development, came falsely to be blamed first on the MMR vaccine and then on thimerosal, a preservative found in several vaccines. It is a tale about bad science, worse journalism, unscrupulous political populism, and profiteering litigation lawyers.
In 1998, a young British surgeon named Andrew Wakefield published a paper in The Lancet suggesting an association between the measles component of the triple vaccine and the development of childhood autism. Though the paper stressed that no causative relationship had been proved, Wakefield took the most unusual (and self-promoting) step of calling a press conference, in which he suggested that the vaccine should be withdrawn. Panic ensued, immunization rates declined, and measles made a comeback in Britain. The panic spread across the Atlantic.
Wakefields paper, though, was a very bad one, and the editor of The Lancetone of the most prestigious medical journals in the worldshould never have countenanced publication of such rotten science. The ensuing uproar made necessary expensive and time-consuming epidemiological research that repeatedly failed to find any connection between the vaccine and autism. It seems likely, moreover, that Wakefield knowingly falsified some of his results. Those that he did not falsify were based on grossly deficient laboratory technique. An investigative journalist discovered a few years later that Wakefield had received payments from a serial litigation lawyer who hoped to mount a class-action suit against the vaccines manufacturers. Despite all this, Wakefield still has faithful followers, as do all false messiahs who survive their own predictions of the end of the world.
Closely allied with the MMR theory is the contention that thimerosal in vaccines causes autism. There is not the slightest evidence in favor of this conclusion, but it, too, has devoted believers. Parents who first notice their childrens autistic traits soon after immunization with MMR are understandably difficult to persuade that their experience is of almost no value in deciding the question of causation. Where two events, such as MMR vaccination and the development of autistic traits, are common, it is inevitable that people will mistakenly associate them with each other. But it is shameful that politicians and journalists should fail to understand this fairly simple point. I cannot make up my mind whether it would be worse if the politicians were merely cynical or actually ineducable.
False theories of causation are apt to call forth absurd or even dangerous methods of cure, and so it was in this instance. Children have been assaultedoften at great expensewith a host of special diets and medicaments in the hope of cure. One can only sympathize with the desperate parents, eager to clutch at any straw to find a satisfying explanation for the misfortune that has befallen them. But for the false messiahs, at best self-deceived and at worst outright fraudulent (and sometimes, I suspect, a little of both), one can feel nothing but outrage.
Offits book raises questions much broader than his ostensibly limited subject matter would suggest. What is the place of scientific and scholarly authority in the modern world, and how is it to be institutionalized in a democracy? Is it inevitable that the best should now lack all conviction while the worst are full of passionate intensity? What is the relation between information, on the one hand, and knowledge and wisdom, on the other? Cranks are often oversupplied with the former and deficient in the latter, not realizing that there is a difference between the two. Autisms False Prophets gives no easy answers, but it does provide a rich source of material for political philosophers and even epistemologists, who ought to assign it to their students.
A final note on the question of passionate intensity: Offit, a prominent public defender of child immunization (who recognizes that, as with any medical treatment, it can sometimes have harmful effects), has been persecuted and threatened by activists who disagree with him. He begins his book with the startling statement, I get a lot of hate mail. He has been branded on some websites as a terrorist, and he has sometimes needed police protection. I found out firsthand how deep the passions against him run when I published a positive review of one of his previous books and received abusive e-mails in reply. Readers accused me not merely of error, but of complicity in corruption and depravity. This is surely extraordinary.
Theodore Dalrymple, a physician, is a contributing editor of City Journal and the Dietrich Weismann Fellow at the Manhattan Institute.