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Will the Vaccine-Autism Saga Finally End?

Not likely. You can retract a scientific paper, but not a mass movement.

A medical assistant prepares a vaccination for a two-month-old during a wellness check at Children's Hospital in Minneapolis, Monday, Dec. 18, 2006. SOURCE: AP/Ann Heisenfelt A single, small study stirred a mass anti-vaccine movement that threatens public health. Now that the paper has been declared totally invalid, advocates and the medical establishment need to talk. Above, a medical assistant prepares a vaccination for a two-month-old during a wellness check at Children's Hospital in Minneapolis in 2006.

I caught the news on the treadmill yesterday, so it must really be getting around. The Lancet, the prestigious British medical journal, has now gone to the extreme of fully retracting a notorious 1998 paper by gastroenterologist Andrew Wakefield and his colleagues, purporting to show a shocking new cause of autism—the MMR (measles, mumps, and rubella) vaccine. Wakefield and his team studied digestion in 12 children with various types of behavioral disorders, nine of whom were autistic, and found inflammation in the intestines. The vaccine was blamed for letting toxins loose into the bloodstream, which not only caused the intestinal problems but, it was conjectured, then also affected the children’s brains.

The 1998 paper hit the British public like a thunderclap, triggering a decline in use of the MMR vaccine as well as a resurgence of the measles. It was the opening shot in the vaccine-autism controversy that still rages today (albeit in varied forms, not all of which still focus on the MMR vaccine). But the credibility of Wakefield’s work has since taken a steady stream of hits, culminating in this last devastating blow.

On a scientific level, the most severe undermining of Wakefield’s study came in the form of a 2004 analysis by the Institute of Medicine, one wing of the U.S. National Academy of Sciences. The IOM examined no less than 16 separate studies on the purported dangers of the MMR vaccine, in addition to Wakefield’s. The latter they found “uninformative with respect to causality”; overall, they concluded that “the evidence favors rejection of a causal relationship between MMR vaccine and autism.”

Even prior to that, ten of Wakefield’s original coauthors (out of twelve in total) had backed away from the work in a 2004 letter to The Lancet. “We wish to make it clear that in this paper no causal link was established between MMR vaccine and autism as the data were insufficient,” they wrote. “However, the possibility of such a link was raised and consequent events have had major implications for public health.”

Meanwhile, a series of investigative stories published in The Times of London unearthed Wakefield’s undisclosed ties to vaccine litigation in the U.K. The full Lancet retraction that occurred yesterday builds on all of these developments, including, most recently, an investigation into Wakefield by the U.K.’s General Medical Council which declared him “irresponsible” and questioned, among other matters, the risks imposed upon children in the original study.

Let’s pause for a moment here. We’re talking about a single, small study—on just 12 children—that stirred a mass anti-vaccine movement and a trend away from vaccination that threatens public health in some wealthy counties. Already, you should be wondering how it could be possible to build so much upon such a slender reed. But if you then consider the subsequent fate of the study, and the scandal that has attended it, a reasonable person would surely conclude that the original scare about the MMR vaccine and autism had no serious foundation whatsoever.

Here’s the thing, though. It seems obvious to all recent commentators—myself included—that the latest Wakefield news will have virtually no impact on Wakefield’s passionate followers, the anti-vaccine ideologues in the UK and United States who have long cheered him on, and will continue to do so. If anything, it will probably only make them still stronger in their convictions.

Following its original efflorescence in 1998, modern vaccine skepticism has taken many other forms than a focus on the MMR vaccine. In the United States, there has probably been much more concern about the mercury-containing preservative thimerosal, which used to be in many vaccines (however, thimerosal has long since been removed from most vaccines, and autism rates have not dropped). The movement is much bigger than Wakefield; but the continuing allegiance to Wakefield, despite all that has occurred, shows that we’re really dealing with something very irrational here, what Michael Specter calls “denialism.”

In a feature story for Discover magazine a year back, I surveyed the vaccine-autism debate and tried to pose a question I felt few others had adequately considered. What would it take—beyond the overwhelming scientific evidence, which already exists—for this battle to finally go away? A Lancet retraction isn’t going to do it, that’s for sure. For vaccine skeptics, that’s just more evidence of corruption and collusion in the medical establishment. Indeed, I doubt any individual scientific development has the strength to move these folks—because we aren’t dealing with a phenomenon that’s scientific in nature.

Instead, I believe we need some real attempts at bridge-building between medical institutions—which, let’s admit it, can often seem remote and haughty—and the leaders of the anti-vaccination movement. We need to get people in a room and try to get them to agree about something—anything. We need to encourage moderation, and break down a polarized situation in which the anti-vaccine crowd essentially rejects modern medical research based on the equivalent of conspiracy theory thinking, even as mainstream doctors just shake their heads at these advocates’ scientific cluelessness. Vaccine skepticism is turning into one of the largest and most threatening anti-science movements of modern times. Watching it grow, we should be very, very worried—and should not assume for a moment that the voice of scientific reason, in the form of new studies or the debunking of old, misleading ones, will make it go away.

Chris Mooney is the author of several books, including The Republican War on Scienceand Unscientific America: How Scientific Illiteracy Threatens Our Future, co-authored by Sheril Kirshenbaum. He and Kirshenbaum blog at “The Intersection.”

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