Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Friday, March 18, 2005

Fear Itself

Fear Itself
What are the real risks of vaccinating--or not vaccinating--your children?

by M.D Steven Novella - March 17, 2005


The disaster genre of film owes much of its popularity to the basic human dramas it presents. Each such film has a predictable cast of characters, from the practical hero to the greedy villain. My favorite, however, is the hapless hysteric: the person who ignores the sound advice of the hero and, motivated by terror, dashes directly to his or her doom. The moral is clear: Fear will help you survive, but hysterical terror will get you killed.
There is much to fear in modern society. Almost every day we are faced with mini versions of this classic disaster movie dilemma. As our civilization becomes increasingly technologically sophisticated, so do the decisions we must make for ourselves and our families. One such decision is whether or not to vaccinate our children. Even though the law requires vaccinations against polio, measles, and other diseases that used to kill, paralyze or damage millions, there is a growing number of people who skirt or try to opt out of these laws--and to convince others to do the same. There are, in other words, hysterics telling us to wait trembling in the burning building, rather than risk the dangers of the helicopter that has come to rescue us.

Vaccination hysteria spreads through many routes. The media is often to blame for sensationalizing the apparent risks of vaccines, while information is still new and uncertain. Vaccination fears also spread through the internet, increasingly the first source of information for the public, one lacking filters to provide quality control. Well-meaning but ultimately misguided groups of parents opposed to vaccination have also sprung up.

Some people oppose vaccination on religious grounds, others because they adhere to alternative medicine philosophies. For example, the chiropractic community still wallows in a bias against vaccination. Even though chiropractic organizations do not officially condemn vaccination, they do not officially recommend it. Rather, they emphasize the risks of vaccinations and support the public's right to refuse this public health intervention. Naturopaths also have a poor history with regard to vaccination, and they are happy to substitute their own unproven and fanciful concoctions.

The most prominent anti-vaccination claim these days is that the mumps-measles-rubella vaccine (MMR) is linked to autism, a spectrum of developmental disorders that have their onset in childhood. This fear is based on a study published in the British medical journal The Lancet in 1998. Despite the fact that the study was small (only a dozen subjects) and its conclusions doubtful, it was enough to spark a fury of media attention calling into question the safety of the MMR vaccine--a sensational issue to be sure. Autism is a frightful disease for parents, and it is easy to see why some would not want to take such a risk. The result was a decline in MMR vaccination--and a subsequent increase in these diseases.

In 2004, the scientific controversy over a connection between MMR and autism was finally put to rest. A series of compelling studies (involving thousands of subjects) showed no MMR-autism connection, and the editor of The Lancet even retracted the conclusions of the original study that launched the controversy. Unfortunately, news that there turns out to be no link between MMR and autism did not garner the media attention of the original claim.

There also continues to be a great deal of misinformation out there to confuse the public. For example, one group, the Allergy Induced Autism Organization--a name that implies it has wed itself to one particular scientific conclusion--still proclaims on its website that there is a link between MMR and autism. Previously it put out shrill press releases (which are still online) disputing negative studies, even calling for the public humiliation and resignation of study authors who suggest there is no MMR-autism link. The group has since toned down its website, coyly claiming that it is not anti-vaccination--but then discussing the "apparent" connection between vaccines and autism, without mentioning the new scientific studies that disprove that claim.

Major scientific, medical and academic institutions (like the American Academy of Pediatrics and the Centers for Disease Control) all now agree that there is no MMR-autism link, and they have made efforts to educate the public accordingly. But misinformation persists, and there has been measurable damage to the faith that the public places in the government and health organizations when it comes to vaccines.

Although vaccines are not without any risk (no medical intervention is), they are a very safe and effective public health measure. They have dramatically reduced the incidence of many diseases, extending our lives and reducing the suffering of humanity. But to work they require public support and compliance, and that means the public needs to have accurate information about the risks and benefits of vaccination, and faith in the institutions that offer them. Rumors, disinformation and hysteria undercut the rational and well-informed decision-making the public needs.

Remember, in disaster movies, the hysterics lure many other people to their doom as well.

Steven Novella is an assistant professor of neurology at the Yale School of Medicine and president of the New England Skeptical Society, theness.com. He can be reached at snovella@theness.com.

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