About book Autism's False Prophets: Bad Science, Risky Medicine, And The Search For A Cure (2008)
As a pediatrician I am honestly getting exhausted trying to argue good basic science against celebrities, the media and a culture where people feel the internet teaches them the equivalent of my degree. Paul Offit spells out all the arguments clearly and succinctly. If you don't believe that vaccines don't cause autism after reading this you never will. I will recommend this book to all my patients. Overall, I was pretty happy with the book. I’d read Offit’s 2013 critique of alternative medicine, Do You Believe in Magic, and I felt his work on Autism was much better. DYBIM was a bit scattered and included so many pot shots at wacko straw men that the whole book took on a bit of a derisive tone. At the same time, that book gave only a passing glance at fields like mainstream chiropractors (the ones who limit themselves to musculoskeletal problems), where most of us could really use a medical expert to sort out medicine from quackery. Anyway, AFP avoids those pitfalls by concentrating on the two major vaccine-autism theories and takes advantage of Offit’s genuine expertise on vaccine issues (he co-developed the rotavirus vaccine). This is not a book about Jenny McCarthy. She isn’t even mentioned until the very last chapter, which shows that Offit really is interested in getting to the root of the autism-vaccine myth, with a real focus on the science.The book opens with a discussion of older non-vaccine examples of causes and cures that drew widespread attention but couldn’t stand up to scientific testing. Facilitated communication is easily the most gripping and heart breaking of these examples. Offit details how this unproven technique of using “facilitators” to translate messages from autistic children convinced parents and professionals that all autistic individuals had a fully developed (insightful, sensitive, brilliant) non-autistic personality “trapped” inside a body that couldn’t communicate. These parents joyed in discovering who their children “really” were, only to later learn that the facilitators were unconsciously providing all the communication. Devastating. Offit also details hormone, chemical, nutritional, and other treatments that all gave hope, soaked up money/time/attention, and then flamed out (but usually held on to devoted advocates). In most cases those involved had good intentions, but formed emotional and financial commitments to unproven theories that were often based on the simple truth that autistic children (and indeed all small children) develop in unpredictable spurts. Eventually your kid is going to learn to say mommy, and if you try a new treatment every week, one of them is going to correspond to that breakthrough. Multiply this by thousands of autistic families and you get a mountain of conflicting anecdotes that create confusion and uncertainty. Offit’s very reasonable conclusion? We need to stay hopeful but skeptical and rely on the scientific process to vet new theories before we make personal and policy decisions.This is the frame for Offit’s excellent account of the MMR & Thermisol vaccine controversies (to be clear, that’s really the subject of the book). What was most striking to me about the furor over vaccines and autism is that it was so very contingent on a few key statements/actions by a handful of individuals. Wakefield’s research on the MMR vaccine was clearly the spark that ignited everything, but it was contingent upon a) his early groundbreaking work on Chrone’s disease that gave him credibility, b) his mistaken/disproved work showing MMR caused Chrone’s, which focused him on MMR, c) the British government’s decision to spend millions funding vaccine plaintiffs’ scientific research on vaccines and autism d) vaccine injury lawyers hooking up with Wakefield and providing funding and subjects for new research on MMR and autism, e) Wakefield ignoring initial in-house testing that was across the board negative, f) Wakefield relying on diagnostic testing at a company set up just to provide evidence of vaccine injuries for lawsuits, which suffered massive contamination problems and produced false results, and g) finally, Wakefield’s decision to overstate his measles/gut findings in terms of a causal link between MMR and autism despite any causal evidence. All these pieces were necessary for Wakefield to hold a news conference saying MMR vaccines were the likely cause of autism. Once that genie was out of the bottle, the public/media/parents/advocacy groups would never let it be put back in (even today). But even a slight change in events could have channeled the vaccine injury focus onto a different vaccine or onto a different diagnosis (ADHD? Asthma? etc.), or left it entirely stillborn and ignored.The origins of the thermisol scare are less well publicized and in many ways more unfortunate. The follow had to happen: a) congress had to pass an unremarkable amendment requiring all products containing mercury be reported to the fda, b) nobody had been paying any attention to the use of mercury derivatives as a vaccine preservative, which meant there was no scientific literature (especially on the type of mercury in vaccines) to rely on when the vaccine amounts were reported, c) Neal Hasley was stepping down as head of the American Academy of Pediatrics Vaccine Advisory Committee and pushed and pushed for immediate action before he stepped down (within 3 weeks of the FDA report!), d) a number of key voices from the AAP, CDC and FDA were unavailable for emergence meetings and Hasley dominated the hasty teleconferences that occurred, e) when Hasley found himself alone seeking to pull vaccine recommendations he threatened going to the media, which forced a muddled recommendation leaving the public unsure of vaccine safety, and f) two mothers of autistic children (with no scientific background – though one was a nurse) did a google search of mercury poisoning that led them to believe the symptoms are identical with those of autism, and g) a two-bit medical “journal” published a paper by these two mothers which would lead lawsuits, the chelation industry and the founding of Safe Minds and later Generation Rescue. Had government and nonprofit regulators taken their time studying the issue (which had existed with no known health consequences for decades) there would have never been a mercury-vaccine scare. If not for two moms googling, along with trial lawyers and advocacy groups trying to bolster their flailing MMR claims, the scare would not have been associated with autism.My favorite part of the book was Offit’s discussion of the Onmnibus Autism-Vaccine trial. It was gripping and informative and brought the previous accounts about MMR and thermisol into clear focus. What is remarkable is that Offit’s book came out before the rulings in the case, but those rulings confirm all his interpretations of the proceedings (I actually went and read some of the rulings). For me really gave me confidence in Offit’s interpretation and presentation of all the material. It also presented the clearest contrast between the science and scientists disproving ANY autism-vaccine links and the hack “experts” pushing such claims. It was a slaughter and was really embarrassing how thin and distorted the plaintiff’s case was.In the end, Offit shows that the only science supporting a vaccine-autism connection was based on laboratory error, an inappropriate in vitro model, an inappropriate rat model, and either willful blindness to negative results or unscrupulous dishonesty. From almost the very beginning epidemiology (i.e. large studies of actual people) did not find any connection. Vaccinated and unvaccinated (or those vaccinated one way vs. another) children showed the same rates of autism in study after study. And removing thermosol from vaccines did nothing to slow the rate of diagnosis. Case closed.While the remainder of the book does a nice job chastising the media for its bias towards controversy and its practice of giving equal time to fringe scientific positions (to be “balanced”), the last few chapters are a bit dry and anticlimactic. Still, it’s a worthwhile read and it still feels fresh six years after publication. It’s a good primer for people like myself, who have only started paying close attention to the issue recently. It’s also a good summary/refresher for anyone who has been involved in autism issues so long they take the vaccine controversy for granted. Finally, it’s a good read for those of us who know on a rational level that the vaccine-autism link didn’t pan out, but need that little boost to banish the tiny “but what if” from the back of our minds.
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Highly readable account that effectively debunks the myth that thimerosal causes autism.
—9111978nl
Very well written and detailed look into this important topic.
—Nancyy25
Great book, very informative yet entertaining to read.
—jimmy
