A Free Man

Z’s coming up on the time for his MMR vaccine. As with most of the jabs he’s gotten to date, it’s just a thing that we do, a right of passage designed to keep my child healthy. Not something I would have thought about much at all, except that I’ve had a little bird (who shall remain nameless) chirping in my hear about the MMR vaccine and autism. It’s a link that I’d heard about once or twice, generally as being absolutely mythical based on apocryphal stories by grieving parents. But, when it’s your own child you think twice and just to quiet that little quiver of doubt in the tin-foil hat part of my brain, I decided to take a look at the science behind autism and MMR. It turned out to be quite a story.

It all stems from a single scientific publication. In 1998 a paper by Andrew Wakefield of the Royal Free Hospital in London and twelve colleagues was published in the British medical journal The Lancet purporting a link between the MMR vaccine and childhood autism. Wakefield and his colleagues hypothesized that the vaccine caused an irritation to the bowel, making it more permeable to the proteins delivered by the vaccine allowing them to leak into the bloodstream. The researchers claimed that these proteins acted as toxins and caused serious developmental brain damage, particularly autism.

Wakefield’s paper was riddled with problems and the scientific community was almost immediately skeptical. It was based on an extremely small sample, only twelve patients. While Wakefield did find histological evidence to support intestinal damage in the autistic children, there was no control group to compare against. The study noted that “onset of behavioural symptoms was associated, by the parents, with the (MMR vaccine) in eight of the 12 children.” In other words, the researchers relied on parents of autistic children’s memories of events rather than health care professionals. Parents that were understandably upset and far from objective observers. Finally, thepublished article stopped well short of concluding that there was a causal link between the MMR vaccine and autism. However, when Wakefield spoke to the press he made no such disclaimer.

Predictably, the Lancet paper set off a firestorm in the British and world media. For example, in just six months in 2002 in Britain there were over 500 stories about MMR and autism. The MMR vaccine and any other vaccines containing a mercury based compound known as thimerosol (TCV) came under scrutiny by the press. Unfortunately, these stories rarely featured a rigorous examination of the facts on the ground. Every time that one of these stories hits the press more parents opt out of vaccination. Since 1999, the number of parents in the U.S. opting out of the MMR vaccination has nearly tripled. Cases of measles, which had been eliminated in the U.S., are on the rise. There were 72 cases reported in ten states in the first half of 2008. This can be causally linked to people opting out of the vaccine. More striking however, is that nearly 900,000 people worldwide, many of them children, died from measles in 1999. That figure was down to 345,000 in 2005 due largely to an initiative by the Measles Initiative to make the MMR vaccine more available in the third world. The resurgence of measles in North America should be a cold hard reality check - this is what happens when you do not get your children vaccinated.

What makes things worse is that Wakefield lied.

Since the publication of the original Lancet paper, ten of the twelve authors have retracted the conclusions claiming that Wakefield went too far in claming a causal relationship between the vaccine and autism. Wakefield, who was sacked from his post at the Royal Free Hospital in 2001, has since been charged with professional misconduct. This is based in part on the 2004 revelation by The Times (London) that some of the parents who took part in the original study had been recruited by a UK attorney planning to file suit against MMR manufacturers. Four or five of the children were covered by the legal aid study and Wakefield had been awarded £55,000 to assist their case by finding scientific evidence of the link. Wakefield did not tell his colleagues or medical authorities about this case and personally received £400,000 for his troubles.

The effort to sort out the science that Wakefield corrupted has been intensive. Scores of papers have been published refuting Wakefield and his colleagues’ results. There have been large, well controlled epidemiologic studies in North America, Europe, Asia all of which conclude the same thing. For example, one of these studies looked at over half a million Danish children, 20% of whom were not vaccinated. Compare this to Wakefield’s study that looked at 12 children, all of whom were autistic and had been vaccinated. All of these studies come to the same conclusion - there is no significant causal link between the MMR vaccine (or and thimeresol containing vaccines) and childhood autism. There have been no studies published in reputable scientific journals that claim such a link since Wakefield’s paper. The truth is that incidents of autism are increasing and have been for the last half century or so. Autism has a genetic component, but the marked recent rise suggests that there is some environmental factor involved. The first signs of autism in children are generally detected between one and two years of age, the same time period in which most children receive their MMR vaccinations - this is one of the problems in dispelling the myth of a link. But, except for Wakefield’s compromised work all studies undertaken have concluded that the rise in cases of autism is independent of the increased use of the MMR vaccine. Yet the fear surrounding the vaccine remains.

Which brings us around to two common themes here on afreeman.org - crappy journalism and scientists inability to communicate. The fear surrounding MMR is largely being propagated by the media, whose obsession with “balance” insures that in every story about MMR and autism both sides of the issue will be presented. In this case one side is the truth - that there is absolutely no link between autism and the MMR vaccine - and the other side is the lie fabricated by one greedy and corrupt scientist and his gullible colleagues. A lie that is, presumably unknowingly, being propagated by a press obsessed with sensationalism. Thus, having made its way into our cultural consciousness (it’s been on the TV, so it must be true) it is nearly impossible to rid ourselves of the misinformation. And well meaning people suffer. This happens, as it did for me, when little birds have friends who have friends who blame the vaccine for their child’s autism. It also happens when public figures, like presidential candidate John McCain, recite as truth something they read somewhere.

The media is not completely at fault, however. They are simply doing their job to inform and entertain the public, with the latter becoming increasingly important. Most scientists fail miserably to effectively communicate the realities of their research. Take for example, this reply to a Horizon program on the MMR/autism drama. Dr. Neville Goodman, writing in the British Medical Journal, responds to this program with the frustration that a lot of scientists feel with the media still spewing this swill. He writes:

“In 2002, according to the Child Accident Prevention Trust, more than 36 000 children were hurt in road accidents and around 200 were killed… five cases annually of childhood leukaemia may be associated with power lines. But perspective is precisely what is rejected by personal experience: so we have illogical campaigns to uproot speed cameras, to move pylons, and to give single vaccines.”

Goodman’s mistake is that he callously dismissed the “five cases of leukemia associated with power lines”. A mistake that many scientists make, we are so obsessed with statistics and data that we tend to forget the individual subjects of our research, we neglect to treat them not as numbers but as human beings. The families of those five children who developed leukemia by living under power lines probably do not feel that their campaigns are illogical. Nor would parents of autistic children consider their belief that the MMR vaccine destroyed their children illogical. There is no link, but we as scientists need to endeavour to educate - loaded with the facts, but deployed with compassion - rather than mock, deride or scorn.

——-

As you may have guessed, Z will be getting his MMR vaccine next month. I feel good that I’ve done the research, that I’ve looked at the primary literature and the “other side”. (Guess that Ph.D. was good for something).

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In last week’s lively Science Tuesday comment stream, Matthew pointed out that one of the things that many scientists struggle with is communicating with the public. I think that he’s dead on target. Scientists, particularly academic scientists, don’t do themselves any favors by not learning how to talk to the average Joe or Jane. I suspect that a lot of academics fall into the trap of believing that it is their job to do the research and someone elses, like the media, to explain it to the masses. In an ideal world - where we have a thoughtful, critical and industrious mainstream media - that is a fair assumption. Maybe the problem is that scientists don’t come out of their ivory tower often enough to watch FoxNuz or read USA Today and to conclude that we do not live in an ideal world.

A paper published in the latest issue of PLoS Medicine quantifies what most of us already know - that U.S. journalists are doing a poor job of accurately reporting on science, particularly in the field of medicine. The PLoS study was carried out by Gary Schwitzer, a journalism professor at the University of Minnesota. Schwitzer established HealthNewsReview.org, a website that publishes reviews of medical new stories, two years ago based on similar sites in Australia and Canada. The study that he’s published in PLoS reports the results of two years of analysis of the mainstream media’s treatment of health news. Schwitzer’s group monitors science news by the biggest newspapers in the U.S. and watch the morning and evening news programs of the three major networks on a daily basis. (If you think you’re job sucks, imagine if you had to watch all three morning shows every single day. Good god.) The researchers then assign a rating based on how well the story covers a number of criteria.

Even without Fox to skew the stats, the results are shocking yet unsurprising. Schwitzer claims that 62 - 77% of stories failed to adequately address costs, harms, benefits, the quality of the evidence and the existence of other options when covering health care products or procedures. The issue that was ignored most often by the media was cost of products and procedures. In a country in which 16% of the GDP is spent on health care, only one quarter of new stories addressed the minor issue of the cost of the technique they were discussing. Well done. Less than a third of news stories addressed issues such as the benefits or harms of products or the quality of the evidence reported by the primary source. For me, however, the most disturbing statistics were that nearly 40% of news reports failed to reveal that one of the “experts” that were cited had a financial tie to the product being discussed and 35% of stories did not go beyond parroting a news release from the manufacturer of the product.

Schwitzer’s conclusions are basically that he’s doing good work - and that is true. Take a look at his site - the “0 Star Stories” are particularly fun. Schwitzer places the bulk of the blame on the news outlets themselves rather than the journalists. He recognizes that in the era of media consolidation many newsrooms have eliminated trained science journalists. He urges the reader to check out his site for the best health care news analysis.

The problem is that not very many people know about Schwitzer’s site. I frequently rant about how shabby and corrupt the mainstream media has become and am a scientist and I hadn’t heard of it. The problem is that most people still get their science news from the mainstream media and they are being misled most of the time. With the continued consolidiation of media outlets, most of whom are owned by conglomerates who also have interests in pharmaceuitical companies, it’s not outlandish to believe that this is intentional. I know that I’m preaching to the choir - if you’re reading a blog then you’ve already discovered the new media. But if you’re still getting your science news from the Today Show then the best case scenario is that you’re not getting all the facts. The worst case scenario is that you’re being lied to. Here are links to a few good “new media” alternatives:

• Science Daily
• Science News
• New Scientist
• Nature News

Also check out some of the sites on my “Science” blogroll.

 

 Violent Femmes - "Lies" [5:49m]: Play Now | Play in Popup | Download

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I feel like the only thing I’ve written since we arrived in Australia has been various bitching and moaning about not having an internet connection. Well, from today I’m going to endeavor to move back to the eclectic, if underwhelming, ramblings to which you’ve become accustomed here at afreeman.org

One of the luxuries in which I’ve indulged in my weeks of unemployment is the proper digestion of a daily newspaper. In my days as a productive member of society, I rarely had time to do more than scan the headlines (and examine Page 3 of The Sun in some depth). But in these halcyon days, once Z goes down for a nap I can sit down with a cup of coffee and a fat newspaper for at least 24 good minutes of news consumption. The problem, beyond my son’s tendencies to incredibly short naps, is that the papers in Australia are rubbish.

Now, I knew Rupert Murdoch came from Adelaide and so didn’t expect much from the heart of his empire, The Advertiser. And I didn’t get much - it’s essentially a tabloid in newspaper’s clothing with an unapologetic right wing agenda. The writing is poor and the editing even worse. A branching out was in order. Yesterday I picked up The Australian, a national newspaper. In fact it declares itself “The Heart of the Nation”. I’m here to to report that Australia is in need of a cardiac bypass.

First, a bit of background - the new Labour government in Oz just released their first budget. One of the new taxes that has caused a bit of controversy is an increase on the excise on “alcopops” (Bacardi Breezers and their ilk). Labour claims that this tax is designed to reduce binge drinking in teenager - their (probably correct) assumption being that the only people who would be caught drinking a Bacardi Breezer would be a fourteen year old girl. The opposition, and misnamed, Liberals claim that it’s just a tricky tax hike.

Here’s the lead from a page one story in yesterday’s Australian:

“Drinkers are already turning to full-strength bottled spirits as the Rudd Government’s tax slug on pre-mixed drinks bites, the liquor industry reports.”

Crikey, if I may use the local parlance, that’s a lead. Let’s leave aside the bizarre dialect of English they speak in the press room of The Australian. When I did my brief stint as a newsman, rule one that was pounded into me was that I was an objective observer; that my job was to report the facts in an unbiased manner. That does not appear to be the policy in the newsroom of The Australian. The lead sentence is clearly written to espouse the paper’s opinion. If you were unfortunate enough to read the rest of the story, there are no statistics or figures reported that support the authors’ claims. The only source cited are liquor company executives.

The story may very well be true. The problem is that that seems neither here nor there to the authors. This is little more than a rewriting of a press release by liquor companies. It’s shocking and lazy journalism.

Maybe this is what happens after decades of Murdoch’s shady influence on the press - it all gets reduced to the lowest common denominator. That has certainly been the case in television news in The States and is becoming the case in the U.K. Maybe our expectations as media consumers has been reduced to the point were this kind of unbalanced journalism is acceptable.

Maybe I need to get a job…

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“When the world crashes in into my living room
Television man made me what I am
People like to put the television down
But we are just good friends
(I’m a) television man…”

-Talking Heads - “Television Man”

As soon as we found out that Dr O’C was pregnant, I began a long series of decrees and pronouncements about parenting - there will be no crap music, he/she shall receive only the best education, he/she shan’t watch television (particularly not the reality programs that his father is addicted to). Well, I am here to tell you that grand decrees are a lot easier to enforce in principle than in practice. Continue Reading »

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It must be interesting to live in Bill O’Reilly’s world. It is a world with black and white and no gray. It is a world in which the only options of who can rule America are the Bush Administration or the New York Times. It is a world in which you can make up poll statistics in order to make your point. Kafka and Orwell and would be proud.

Does anyone still believe the Bush Administration’s spin? The NIE report claims Continue Reading »

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Oh, come on. On my My Yahoo home page, leading the Reuters U.S. National News this morning was this headline:

Walmart.com offering online holiday deals all week

How, exactly, is this the most important U.S. news story of the day? How is this news at all? Has Reuters been purchased by Wal-Mart? If you read the story it is what you would think it is - a Wal-Mart advert.

I’ve got a news story:

U.S. PIRG Report: Tainted Toys Still on Wal-Mart Shelves

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It was a Harry Potter filled weekend in A Free Man’s household this weekend. I finished the book in an orgy of laziness on Saturday - don’t worry, no spoiler from me. Although, Dr. O’C’s Mom spoiled it for both of us by passing along some gossip she’d heard about the ending, and people wonder why your loved ones’ mothers are hard to deal with. In addition to finishing the book, on Sunday we went to see the new Harry Potter film. It was good, what you expect from a Harry Potter movie. But what I found amazing was the number of advertisements before the movie. There were no less than 20 standard 30 second TV commercials before the previews, advertising in themselves, even started. We don’t get to the movies often, so I think that this seeping in of TV commercials before the films is stands in starker contrast than if we went every week. I don’t know what it’s like in the States, but I imagine very similar. When we were leaving in 2004, there would be a couple of commercials prior to the films, so I suspect that number has risen since then. What annoys me is that I’ve paid £7 to go and see the film and then I have to be subjected to 20 minutes of ads before another 10 minutes of ads before the film? Harry Potter is OK because product placement can’t be slipped into the film, but in a lot of cases you are then subjected to another 2 hours of advertising in the form of product placement.

Advertising is nothing new, but it’s become ubiquitous in the past couple of decades and its crept beyond the places we expect it - TV, radio, newspapers. I wonder how long the average person goes without seeing an advert. As I type this virtually any website (this one included) that I go for sourcing or information is festooned with ads. When I venture outside, I will see advertising on peoples’ clothes, cars, buses, trains, sides of buildings, and so on. When I go shopping anything that I purchase and place in a bag is like a little kick back to the shop in which I’ve just spent money. If I buy a coffee, I advertise with their takeaway cup. Can anyone in the States name a sports arena not named for some company or another? These things are often a blight, while in Crete this spring we were driving along the north coast, enjoying the rugged hills rounded a curve and were confronted with a bright red Vodafone billboard that was the size of an office building. Nice.

And one could continue. What’s troubling is that advertising is perhaps the only media (and I use the term loosely) in which deception or even outright lying is inherent. This is particularly insidious in advertising to children and there is less and less government control of advertisers. The ultimate goal is to sell the product, and any means necessary is OK. I don’t remember the last item I purchased solely because of an advertisement, but I am brand loyal. I buy Apple computers, Levi’s jeans, Sainsbury’s groceries and I could go on but I am, in effect, advertising. My point is, where does this brand loyalty come from? In some cases, maybe the brand I use is superior, but in other cases (groceries, coffee) it is not. So, despite thinking myself an intelligent discerning consumer, I am susceptible to some sort of advertising.

A few years ago a novel called “Jennifer Government” by Max Barry came out - yes I realize this is an advertisement. It’s a novel of a dystopian future, “1984″ or “Brave New World”, in which giant conglomerates run the world. People are named based on the company for which they work - Julia Nike-McDonalds, for example. The police and the NRA are publicly-traded security firms; and the U.S. government only investigates crimes it can bill for. Hmm - privatization of public services, private security contractors running war zones and parents, God knows why, are already naming their children for corporate brands. Maybe we should auction off the naming rights for Baby D, or shall we just wait until they go to work?

Image credits:

Harry Potter Bus

Jennifer Government

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