Did Jenny McCarthy Help Cause the Worst Whooping Cough Outbreak in 50 Years? Did Science?

California is in the midst of what looks to be the worst whooping cough outbreak recorded in the past 50 years, which was when we got serious about vaccination and essentially eradicated many severe childhood illnesses from the country. From the Silicon Valley Mercury News:

A statewide whooping cough epidemic has made its way to the Bay Area, with local counties reporting a sharp increase in cases of the highly contagious respiratory disease.

State health officials declared the epidemic Wednesday – with 910 confirmed cases as of June 15 – more than four times as many cases as this time last year. The numbers put California on pace for its worst pertussis outbreak in 50 years.

As mistermix observed over at Balloon Juice:

Is is just a coincidence that California is having an epidemic of whooping cough after years of autism-related vaccination freak-outs? Perhaps following the vaccination schedule of an ex-Playboy-model celebrity instead of the CDC’s might not be the awesome plan it appeared to be at first blush.

While authorities note that Whooping Cough is a cyclical disease, and often spikes, it now looks like they’re right in the middle of one of the worst spikes in recent history. And, this isn’t happening in a vacuum either. It comes right on the heels of the World Health Organization announcing that measles is making a “rapid comeback” which they linked directly to the campaign against vaccination and funding cuts for childhood vaccination programs

The disease’s resurgence in Britain follows a sharp drop in immunization rates in the late 1990s sparked by the publication of a flawed paper linking autism to the combined measles, mumps and rubella vaccine.

Britain has reported 1,000 cases in each of the last two years — more than 10 times the figure a decade ago.

And, of course, there have been a number of mumps outbreaks over the past few years. Mumps outbreaks are a particularly interesting development, because scientists predicted that mumps would be the first disease to experience a resurgence following decreasing vaccination rates.

And, of course, all of this is for nothing because vaccinating your children does not cause autism. The British medical journal, The Lancet, that originally published the paper by Dr. Andrew Wakefield that started the whole autism-vaccination scare actually just recently formally withdrew the article after an exhaustive 10-year ethics review. And they didn’t pull any punches about their reasons either:

Wakefield was found to have acted unethically and conducted irresponsible research in coming to his—now thoroughly discredited—conclusions. According to Dr. Richard Horton, editor of The Lancet, “It’s the most appalling catalog and litany of some the most terrible behavior in any research and is therefore very clear that it has to be retracted.”

In this case, the actual paper contained no conclusive evidence, merely the suggestion that bowel leakage in children with gastrointestinal problems could cause the measles vaccine to spread into other parts of the body and affect the brain, possibly resulting in autism spectrum disorders.

It was in a subsequent press conference where Wakefield stated that he believed that the measles, mumps, and rubella (MMR) vaccines should not be given as a single shot, and instead be broken up into three shots given a year apart to reduce the chances of autism. The British media had a field day with this, and inaccurate reports spread across the pond to the US, where parents feared that the MMR vaccine could be the cause for the dramatic rise in autism cases.

But yet, despite all of the hard scientific evidence disproving this supposed link, Jenny McCarthy and her ilk continue to push the false link using faulty, discredited science and anecdotal “evidence” in place of real studies. “Believers” in the link tend to willfully disbelieve any evidence to the contrary, and Immunologists who stand up and try to speak the truth are routinely attacked, vilified, and even subjected to death threats:

Immunologists were hardly the target of such wrath when Offit, 57, entered the field almost 30 years ago. But today, frustrations and fears about a mysterious brain disorder that strikes up to one in 150 kids have given rise to the most angry and divisive debate in medicine: do vaccines trigger autism? Offit, a vaccine inventor, says “no.” His critics, who vilify him routinely on autism Web sites, say the question is still very much open. They think he’s arrogant and a mouthpiece for Big Pharma. One recent post: “Offit should be prosecuted for crimes against our children.” After the death threat—a man wrote, “I will hang you by your neck until you are dead”—an armed guard followed Offit to lunch during meetings at the Centers for Disease Control and Prevention.

In a wonderful article in the Public Library of Science’s Biology Journal, Liza Gross dubs this an “Evidence-Resistant Theory”, bringing to mind the “debate” over Climate Change and Evolution.

Parents treated theoretical risk as fact even as scientists tested, and ultimately rejected, the possibility that thimerosal might harm children. Thinking the institutions that were supposed to protect them from risk failed, Kaufman says, people now do their own research. But instead of leading to more certainty, she explains, “collecting more information actually increases doubt.”

With the explosion of “contrary” expertise online, Kaufman says, “many parents see even the most respected vaccine experts’ perspective on the issue as just one more opinion.” The bulk of antivaccination Web sites present themselves as legitimate sources of scientific information, using pseudoscientific claims and emotional appeals, according to a 2002 study in Archives of Disease in Childhood. Making matters worse, the study found, nearly all sites adopted an “us versus them” approach, casting doctors and scientists as either “willing conspirators cashing in on the vaccine ‘fraud’ or pawns of a shadowy vaccine combine.” Parents’ intuitive views about vaccines were elevated above “cold, analytical science.” Accounts of children “maimed or killed by vaccines” were common—a finding that may help explain why those who advocate immunization receive death threats.

Her entire article is really worth a read, if you’re interested in this subject at all, because it traces the history of the Vaccine-Autism myth, and examines how sometimes well-meaning scientists can exacerbate the situation when dealing with communicating with a public not well versed in how science works. A perfect example can be found embedded in one of the anecdotes on a vaccine skeptic’s webpage:

When my son was set to begin his routine vaccination series at age 2 months, I didn’t know there were any risks associated with immunizations. But the clinic’s flyer contained a contradiction: my child’s chances of a serious adverse reaction to the DPT vaccine were one in 1750, while his chances of dying from pertussis were one in several million. When I pointed this out to the physician, he angrily disagreed, and stormed out of the room mumbling, “I guess I should read that [flyer] sometime…”

Assuming that this anecdote is true, it is actually a quite understandable that the doctor would have become frustrated in this situation. Consider the fact that most pediatricians routinely deal with well-meaning parents who scour the Internet looking for health tips for their children, and often come to them with a confused mix of real information, snake oil, and intentional disinformation. Then, consider that we vaccinate children at very young ages, when the parents are often inexperienced at dealing with their child’s health care, and are often intensely involved at this stage of child rearing. So, you take an inexperienced but very concerned parent, mix in some random information from “the Internet”, and then add in the natural attitude that a doctor (who has spent his or her life studying medicine) will have when dealing with someone like this. It isn’t surprising at all that parents might come away with mixed signals and frustration.

Of course, in this example, the doctor could have explained that the reason the statistics were so low for pertussis is precisely due to the 50 year long vaccination campaign in this country. If everyone stops vaccinating, that likelihood will climb quite sharply. He or she also could have explained that there is a massive difference between the chance (even if slim) of your child dying from whooping cough, and that of a “serious adverse reaction” to the MMR vaccine. Even assuming that the 1 in 1750 figure the author of this story provides is accurate, severe allergic reactions in pharmacological parlance generally includes things like rashes and temporary intestinal discomfort. Truly severe allergic reactions, like anaphylactic shock and death, actually occurs at a rate of well less than 1 in a million. The MMR vaccine is among one of the most thoroughly studied and widely deployed treatments in current use in the world.

And, of course, all of this is actually killing children.

Despite overwhelming evidence that vaccines don’t cause autism, one in four Americans still think they do. Not surprisingly, the first half of 2008 saw the largest US outbreak of measles—one of the first infectious diseases to reappear after vaccination rates drop—since 2000, when the native disease was declared eliminated. Mumps and whooping cough (pertussis) have also made a comeback. Last year in Minnesota, five children contracted Hib, the most common cause of meningitis in young children before the vaccine was developed in 1993. Three of the children, including a 7-month-old who died, hadn’t received Hib vaccines because their parents either refused or delayed vaccination.

John Timmer at Ars Technica wrote another great article last year about the issue which is worth a read. He does a great job summing up some of the points of the PLoS paper, and makes some important observations of his own:

Oddly, despite these obvious conflicts of interest, it’s the medical community that’s frequently the target of accusations that it’s too cozy with the pharmaceutical industry. Vaccines are manufactured products, and public health officials often assist in their development and/or advocate their use, so it’s difficult to avoid these perceptions to a degree. What the article doesn’t note, but should be said, is that the medical community as a whole has hurt its credibility through various practices that allowed doctors to extract cash from pharmaceutical companies. Even though these issues are not related to vaccines, they contribute to a general sense of corruption and undermine public confidence, which spills over to vaccination programs.

The second is that the public health community was unprepared to discuss this issue via the popular press. Reporters often attempt to present scientific issues with the same “balance” they use for political ones, even though it’s wildly inappropriate. Vaccine advocates needed to be prepared to handle this. In several cases, they also chose to make no response to stories that appeared in the places like Rolling Stone which ran a misinformation-filled article penned by Robert F. Kennedy, Jr.

This is absolutely true. The blame for this situation, just like the situations with climate change and evolution, does not rest entirely with the “deniers”. There is plenty of culpability to go around, and some certainly falls on the insular and isolated world of science. If we are to make real progress with many of these issues, we will need real public support. There was a time, not that long ago, when science was viewed in a positive light by the public. If we are to get back some of that “mojo”, the entire global scientific community needs a serious change in attitude, and they need to completely re-think their methods of interacting with and communicating to the public. Otherwise, we can expect a continually growing “anti-science” sentiment in this country and around the world. And we can expect more children to die because of it.