Dangers of the Anti-Vaccine Movement

May 3, 2011

Offit on the Dangers of the Anti-Vaccine Movement

http://www.medscape.com/viewarticle/741343?src=mp & spon=24

Eli Y. Adashi, MD; A. Offit, MD

Eli Y. Adashi, MD

Professor of Medical Science, Brown University, Providence, Rhode Island

Disclosure: Eli Y. Adashi, MD, has disclosed the following relevant

relationship:

Serve as a director for: Alere, Inc.

Interviewee

A. Offit, MD

Professor, Department of Pediatrics, University of Pennsylvania School of

Medicine; Chief, Division of Infectious Diseases, The Children's Hospital of

Philadelphia, Philadelphia, Pennsylvania

Disclosure: A. Offit, MD, is the co-inventor of the RotaTeq® vaccine, but

he receives no financial remuneration for sales of the vaccine from either the

manufacturer or his employing institution.

Posted: 04/27/2011

Eli Y. Adashi, MD: Hello. I am Eli Adashi, Professor of Medical Science at Brown

University and host of Medscape One-on-One. Joining me today is Dr. Offit

to discuss his latest book, Deadly Choices: How the Anti-Vaccine Movement

Threatens Us All. Dr. Offit is the Maurice R. Hilleman Professor of Vaccinology

and Chief of the Division of Infectious Diseases at the Children's Hospital of

Philadelphia. Welcome.

A. Offit, MD: Thank you.

Dr. Adashi: It's great to have you. What led you to undertake this significant

project?

Dr. Offit: I think we're at a tipping point and it worries me. The tipping point

is evidenced by outbreaks, the likes of which we haven't seen recently. For

example, we have a whooping cough outbreak in California that's bigger than

anything we've seen since 1947. We've had mumps epidemics in the Midwest in

2006. Again, in the Northeast this past year the most recent [mumps outbreak]

involved 1500 people, leaving several people deaf. We've had outbreaks of

bacterial meningitis, the preventable kind (Haemophilus influenzae type ,

because parents chose not to vaccinate their children. We had a measles epidemic

in 2008 and continue to have sporadic measles epidemics, most recently in

Minnesota, because people are choosing not to vaccinate their children. You're

starting to see these vaccine-preventable diseases come back; these once

historic diseases come back. It's hard to watch. I'm trying to sound a warning

bell.

Dr. Adashi: So it's an ongoing advocacy effort really in support of vaccinating

children. Do you sense that we're gaining, that you're having an impact? Are we

turning the tide? How do you feel about that?

Dr. Offit: I think there is good news and bad news. The good news is that the

media, certainly the mainstream media, has gotten much more responsible about

covering this subject. I mean, it used to be that they would tell 2 sides of the

story when only 1 side was supported by the science. This was, for example, the

vaccines-cause-autism debate. That's not true anymore.

Mainstream media is much better about this. Even entertainment television, [for

example] Larry King Live and Oprah, have started to back away from this. The

problem is that there has been a lot of residual damage. A recent study that was

reported at the Pediatric Academic Society meeting showed that 4 of 10 parents

now are choosing to delay or withhold one or more vaccines for their children. I

think that's the fallout from all this.

Dr. Adashi: What was it that triggered the anti-vaccine movement in the first

place? Was there a seminal event, a point in time that launched this new effort?

Dr. Offit: I think there was. I think the birth of the modern American

anti-vaccine movement occurred on April 19, 1982. That date was associated with

a 1-hour documentary. It appeared on a local NBC affiliate in Washington, DC. It

was called " DPT: Vaccine Roulette, " and it was made by Lea who went on

to have sort of a meteoric career at NBC.

Her contention was as follows: She showed a series of parents whose children

were fine. Then they get the whooping cough vaccine (the DPT vaccine), and then

they weren't fine anymore. You saw these children with withered arms and legs,

with spastic limbs, who were seizing. They were staring vacantly up at the sky

and had bicycle helmets on and were drooling. I think anybody who was human who

watched that show couldn't help but be moved by it.

But it was wrong. The whooping cough vaccine didn't cause permanent brain

damage, but it had tremendous fallout. It really gave birth to the notion in

this country that vaccines might be doing more harm than good.

Dr. Adashi: So we're talking about a debate that is now about 30 years old.

Should we be thinking about the anti-vaccine movement as a purely grassroots

effort or is it more than that today?

Dr. Offit: It's much more than that. I think certainly there are dedicated

groups like the National Vaccine Information Center, which used to be called

Dissatisfied Parents Together, and others such as Moms Against Mercury, Safe

Minds, and Generation Rescue. These are the professional anti-vaccine groups,

but I think the bigger group, frankly, is made of parents who become scared.

They're not sure who to trust. They're not sure what to believe. They have this

vague sense that maybe pharmaceutical companies have too much influence and

maybe doctors aren't to be trusted, and they're choosing to delay or withhold

one or more vaccines at their children's risk.

Dr. Adashi: But there is, from the sound of it, an infrastructure out there --

offices in Washington, DC and people who make a living in the context of this

movement. Is that a correct assumption?

Dr. Offit: That's a correct assumption.

Dr. Adashi: Has the anti-vaccine movement targeted one particular vaccine or

another, or is it a relatively global type of a focus?

Dr. Offit: It's relatively global. Certainly, the vaccine that started the

modern American anti-vaccine movement group was clearly the whooping cough

vaccine, the pertussis vaccine. I think the vaccines that have been hardest hit

have been the hepatitis B vaccine, I think in large part because it's given to

children in the first day of life. The human papillomavirus vaccine has been a

big target because it prevents a sexually transmitted disease, and I think at

some level people see that as dirty and don't like to give it to adolescents. I

think hepatitis B vaccine suffered the same thing. I think there are some

vaccines that suffer more than others, but I think at some level when one

suffers they all suffer.

Dr. Adashi: When did you first get involved in this 30-year debate?

Dr. Offit: What got me interested in this was the fact that I worked with a team

at Children's Hospital of Philadelphia to develop the rotavirus vaccine. I'm a

basic scientist -- an immunologist and a virologist. That's how I grew up.

That's how I was trained in all this. For the 10 years that I worked with the

group at Children's Hospital of Philadelphia to do the research that created the

strains that ultimately became a licensed rotavirus vaccine, I learned about

what it took to do the research. I think the real education came with the

15-plus years that it took to do the research of development to make that

vaccine. When you see what exactly is required to get a vaccine into children

it's just daunting. I had no idea. Then when you see it so easily and wrongly

dismissed by people who have really little idea of what vaccines are or how they

work or how they're made it was hard to watch.

Dr. Adashi: So in essence, obviously, your awareness increased over the years.

Were you called upon to speak up at some point? Was there an interview that was

considered the first congressional hearing perhaps? When did you first

physically get involved in the debate?

Dr. Offit: I certainly wasn't called upon. Nobody has ever asked me that

question -- I'll tell you exactly what got me in. There was an article in the

Philadelphia Inquirer about the chicken pox vaccine, the varicella vaccine. It

has just come out in 1995. Here was a vaccine that had the capacity to protect

against the 10,000 hospitalizations and roughly 70-100 deaths that occurred from

chicken pox every year. This article in the Philadelphia Inquirer actually was

sort of that typical " he said, she said " story. Here are people, researchers at

the CDC, who say this about the vaccine, which is that it is safe and effective.

[And] here is just the local guy who says it's not.

I just couldn't believe that, and I called up the reporter and I said this is

not balanced. There's no perspective here. This is just not the way to cover

this story. There are not 2 sides to this story. Do your homework. Read the

original papers if you're going to comment on this. It just made me angry that

this vaccine that had been worked upon so hard was so easily dismissed by the

paper because that's where people were getting their information. It just really

upset me that that's where people were going to get this information, that they

wouldn't believe the CDC was correct in its statement that the vaccine was of

value.

Dr. Adashi: And was it left at the level of a phone call or did you follow it up

with an op-ed perhaps, or other advocacy efforts?

Dr. Offit: Yes, it was followed up with a letter to the editor, actually. Then I

was in. Then I found myself getting angrier and angrier and calling these

generally local reporters. Eventually Fox News did an awful story that I

remember, and I just found myself calling people and writing op-ed pieces and

being angry about all this.

Dr. Adashi: So you've been at it for about 15 years, based on my quick

calculations, about half the duration that the controversy seems to have been

swirling. In reading your book, you appropriately devote a significant amount of

space to one of the major protagonists in the debate, Dr. [] Wakefield.

Could you share with our viewers the role that Dr. Wakefield played and where

that role has come to?

Dr. Offit: He's an interesting guy, Wakefield. What he did was he

published a paper in 1998 in a general medical journal called The Lancet, which

is a very well-respected journal. It was really a case report. It was a case

series of 8 children who had recently received the combination measles, mumps,

rubella vaccine or MMR vaccine. They all, according to the parents, had

developed symptoms and signs of autism within a month of receiving that vaccine.

He also believed that when he looked by endoscopy at their intestines that they

had something called ileal lymphoid nodular hyperplasia, which is to say, a

swelling of groups of lymphoid tissue like the Peyer's patch or mesenteric node.

He believed he had found something. He believed he identified an important

syndrome. Get the MMR vaccine, develop intestinal symptoms, and then get autism.

Now, that was wrong --

Dr. Adashi: Based on 8 cases.

Dr. Offit: Based on 8 cases. Obviously, to his credit, in the discussion section

of that paper he actually said, I cannot say that this vaccine caused autism

because this is not a controlled study; I haven't looked at large groups of

children who did or didn't receive the vaccine. He did say that in the

discussion section, but that was the last time he said it. I mean, the next day

with the lights shining and the cameras rolling, he said exactly that -- that he

feared the MMR vaccine caused autism.

Now what is interesting about Dr. Wakefield is a few things. One is that since

that study or that case series was reported there have been many, many studies

-- about 14 -- that looked at large groups of children who either did or didn't

receive MMR to see whether the risk for autism was greater in the vaccinated

group. Clearly, it wasn't -- again and again and again. What makes Dr. Wakefield

interesting is that he simply holds onto this belief. It's like a religious

belief, which is remarkable for a scientist, and that's why he can do so much

damage. He's convincing because he's convinced. I've never seen anything like

him.

In many ways, though, he has actually helped the cause of getting good

information to the public. What has since been found out is that much of what he

had published was fraudulent -- that he had misrepresented those cases and that

he'd misrepresented the so-called PCR data looking at measles virus genome in

the intestines. That, in fact, 5 of the children in that paper (actually their

parents) were in the midst of suing pharmaceutical companies. He received

hundreds of thousands of pounds from a personal injury lawyer to arguably make

their claims more valid by publishing it in a paper.

When the fraudulent nature of that paper came out, it did a lot of harm to the

anti-vaccine movement because people saw it as fraudulent.

Dr. Adashi: As we speak about it today, where do Dr. Wakefield's claims stand?

Dr. Offit: They're on the fringe. They're gone. There is no mainstream reporter

who carries this as fact anymore or even a controversy. I think because he was

found to be fraudulent he's been dismissed, which is a little upsetting in some

ways, because it doesn't matter whether he was wrong or whether he was wrong and

fraudulent. It really only matters that he was wrong. I think people more easily

dismiss him because he was also fraudulent, but the fact that he was wrong, and

studies have shown that he was wrong, should have been enough. It seemed that

the fraud made it easier to dismiss him.

Dr. Adashi: Has Dr. Wakefield ever gone beyond those 8 cases? Has he published

follow-up papers, a larger number of cases, controlled studies of any kind?

Dr. Offit: Controlled studies, no. I mean, he has published a larger number of

cases in what he believes to be a syndrome, but his syndrome has not been

supported by large, excellent, controlled epidemiologic studies. He was wrong.

MMR doesn't cause autism. It never made sense that it did, and now we know that

it doesn't. Yet he still holds on to this fact. Now he's in Minnesota trying to

talk to these Somalis who are in the midst of a measles epidemic. It's all just

so horribly unconscionable and hard to watch.

Dr. Adashi: In reading your book one other impression one is left with is the

ever present role of celebrities in public debates. Now that you've been exposed

to it, what can you share with our viewers as to the role of celebrities in such

public debates, positive and not so positive?

Dr. Offit: Well, largely not so positive. I mean, I think it's remarkable. We

look to people like McCarthy, who is a parent of a child with autism, to

give us information about autism and its treatments. I think McCarthy,

because she has a child with autism, certainly is a sympathetic figure and she's

certainly an expert on her child, but that doesn't make her an expert on the

disease. It's just remarkable to me.

I remember watching a Larry King Live episode where he had McCarthy on. He

also had Holly Peete, who is an actress and also a mother who had a

child with autism, and then a noncelebrity mother. He looked at each one of them

and said " What do you think causes autism? " What do you think causes autism?

You're watching this show thinking " Why don't you get an autism expert on the

show and ask that person what they think causes autism because that's what they

do for a living? " It's as if because one has a child with this disease that you

have some special insight into all the research that has been done in that area,

and that's not true.

Dr. Adashi: Some of the celebrities were physicians. Dr. Oz comes to mind. Have

you interacted with him and/or spoken with him about the issue?

Dr. Offit: Yes. I was actually on his radio show not too long ago. He is of the

belief that vaccines may be doing more harm than good, that children shouldn't

get as many as they do as soon as they do. He has a book with Roizen

called YOU: Having a Baby, which is interesting because he's a cardiovascular

surgeon and Roizen is an anesthesiologist. I'm not sure why they have any

specific expertise that teaches them about how to handle children who are young

but so be it. He's an interesting guy. First of all, he's a graduate of Penn's

medical school right here, so I guess we take responsibility for this. Then he

goes to Columbia where he rises in the ranks to become a full professor in

cardiovascular surgery.

He is a brilliant man, a brilliant well-spoken man, who has become a brand, a

commodity. Yet, he feels strongly against vaccines. I don't know why....

Obviously, Mehmet Oz has been very disappointing in this. He has a platform. He

could educate people about science and good science and chooses, at least in

this case, not to.

Dr. Adashi: So you had a conversation but he was left unconvinced at the end of

that interaction?

Dr. Offit: Apparently so.

Dr. Adashi: In your book, in fact, in the very first sentence you describe the

conflict between pro- and anti-vaccine proponents as a war. How would you

describe the state of the war to date?

Dr. Offit: Again, I do think we're largely winning. I do think that in some ways

the professional anti-vaccine people made a big bet and it was a bad one. The

big bet that they made was that vaccines cause autism because what has happened

now is that every time they've raised this, whether it's MMR causes autism or

thimerosal and ethyl mercury-containing preservative in vaccine causes autism or

too many vaccines too soon causes autism, there have been studies that have come

out that have largely refuted that notion.

I think the mainstream media is getting a little tired of trying to follow this

basically bad lead that was given to them by the anti-vaccine people. I do think

we're largely winning. It'll never go away. I mean, certainly those who are

firmly entrenched in believing that vaccines hurt their children will always

believe that. There is no amount of data that will convince them otherwise.

There certainly will always be some in the media who will be an advocate for

them, but the fact of the matter is it's hard to sustain a movement that doesn't

have science on its side. That's certainly true here.

Dr. Adashi: Moving to the practical for a moment, what advice would you give

physicians who encounter parents who are disinclined or, in fact, are opposed to

vaccinating their children?

Dr. Offit: I feel sorry for people in that position. I think it's an impossible

position to be in because you could argue this one of 2 ways. My wife is

actually a perfect example of this. She's a general pediatrician in mainline

Philadelphia trying to deal with this all the time. What she used to do is

whatever she could to try to get children vaccinated. She would give parents as

much information as she could. She would spend time with them and try and say

" Look, here is why vaccines are good. Here is why a choice not to get a vaccine

is a risky choice, a choice that you shouldn't make for your child. " She felt

that she probably had about 25% of parents gradually getting the vaccines that

they needed.

Then, she had had it. She felt like " I can't send you out into a world where I

know that there's an increased risk now of getting these diseases. Let me love

your child. Don't put me in a position where I have to practice substandard care

that could result in harm. I can't do it. I cannot do that, so I can't see you

[as a patient]. I can't see you unless you can get vaccines according to the

schedule. " She feels now actually that she convinces more people because they

see just how strongly she feels.

Dr. Adashi: On a personal note, if I may ask, you dedicated this book to Maurice

Hilleman and Stanley Plotkin. I believe most of our viewers would be very

interested in knowing why and what these individuals meant to you.

Dr. Offit: Well, they were my heroes. I mean, Stanley Plotkin was the Division

Chief when I first came into the Children's Hospital of Philadelphia's Division

of Infectious Diseases. He is the developer of the current rubella vaccine, the

so-called RA 27/3 strain of vaccine, and has done really important work in

cytomegalovirus. He was an important member of the team at Children's when we

developed the rotavirus vaccine. He was an important member of the team at

Wistar that developed the rabies vaccine. He's just a brilliant, thoughtful man

who was just, to me, the epitome of reason. I just never met anybody quite as

logical and ordered as he was.

I think Maurice was an unappreciated hero. He is really arguably the developer

or the primary researcher on 9 of the 14 vaccines that we have. I would argue

Maurice Hilleman's work has saved more lives than any other scientist, and yet

few know him, I think in part because he worked for a company. We don't like our

heroes to come from companies. We like them to come from academia. He was a

unique combination of brilliant and profane. He was both profound and profane.

Maybe it was his army experience, but I've never seen anybody curse as much as

he does who was as brilliant as he is. He was just a very tough smart guy who

got a lot done quickly and it was still never enough. He was an amazing guy,

Maurice Hilleman.

Dr. Adashi: Is there another book in the making?

Dr. Offit: Yes, I think I'm going to write a book about alternative medicine. I

think the subtitle of that book is going to be something like " How Alternative

Medicine Hurts Us and Why We Let It Happen. " The current working title is

" Killing Them Softly. " A number of people have actually taken on quackery and

health fraud, but I sort of would like to try my perspective on taking that on.

Dr. Adashi: So one war is not enough. Thank you.

Dr. Offit: Thank you.

Dr. Adashi: On that note, sincere thanks to Dr. Offit and to you, our viewers,

for joining Medscape One-on-One. Until next time, I am Eli Adashi.

May 3, 2011