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Defending Vaccination Once Again, With Feeling
By ABIGAIL ZUGER, M.D.
Published: March 28, 2011
Does the reading public really need yet one more rundown of the repeatedly debunked claims linking childhood vaccinations and autism? The positions of those who uphold vaccine safety and those who assail it have at this point thoroughly saturated the news media; what more is there to say?
• ‘The Panic Virus’ (March 29, 2011)
Or so I thought before opening Seth Mnookin’s new book. Barely a dozen pages in, I began to reconsider, and by the end I had completely changed my mind: Mr. Mnookin’s passionate defense of vaccination may be just what the public needs, in equal parts because of what it says and because of who is saying it.
Mr. Mnookin is no expert in the field — at least he wasn’t when he entered the fray. Neither a doctor nor a scientist, he has no vested interest in upholding the medical status quo (thus avoiding an accusation regularly flung at vaccine proponents). He hails instead from what might be called, sadly enough, exactly the opposite demographic: he is young and hip, got a good liberal arts education, lives in an upscale enclave and works in another, as a contributing editor of Vanity Fair. He is the father of a young child.
And it is people of precisely this description who are slowly picking apart the safety net that protected their own childhoods, prompted by a well-intentioned mixture of arrogance, ignorance and confusion.
It is not that these parents buy into some of the more lurid accusations out there, like the one floated by a British doctor that all pediatric vaccinations cause some degree of neurologic damage. It is more that the parents are alarmed by the hubbub and prefer to play it safe — but wind up defining “safe” in exactly the wrong way. In some communities no vaccination rates have hit the double digits — well into the danger zone.
Expert opinion seems to have oddly little influence over these parents, but perhaps an analysis by a peer, rather than an expert, will change some minds. It certainly doesn’t hurt that Mr. Mnookin has put it all together in a readable narrative encompassing celebrity high jinks worthy of Vanity Fair at its snarkiest.
But those come at the end. Mr. Mnookin doggedly begins at the very beginning, with the first vaccine consisting of fresh smallpox pus. Subsequent vaccines were refined, first with the use of less dangerous germs and then with non infectious germ fragments. The first great triumph of mass vaccination, the Salk polio vaccine, made its debut in 1954, promptly followed by the first great vaccine-associated disaster: a sloppily made batch that paralyzed several dozen children in California.
One shudders to think of the fallout from such an event today, but back in the ’50s parents were still familiar with the toll of childhood diseases, and vaccine momentum barely stumbled. Now, Mr. Mnookin reflects, cases of vaccine-preventable disease have become so uncommon that in 2003 one desperately ill infant (too young to be vaccinated) managed to cough the unmistakable “whoop” of whooping cough in the faces of dozens of baffled medical professionals before the disease was correctly diagnosed — too late to save her life.
Autism, meanwhile, was first named during World War II, and since then rates have skyrocketed. The first to claim a vaccine-autism link was a British physician named Andrew Wakefield, in a small study published in 1998. Dr. Wakefield ultimately lost his medical license for a variety of misbehaviors, and this flagship study, under investigation for years, was formally discredited several months ago.
Dr. Wakefield held that measles virus from the measles-mumps-rubella vaccine spread through the intestinal tracts of vulnerable children and then caused brain damage. Meanwhile, separate speculation focused on the mercury-based preservative thimerosal (used not in the M.M.R. but in other vaccines up until 2003); the idea here was that toxic mercury levels damaged the brain. Neither notion has stood up to careful analysis and studies have repeatedly failed to confirm any clear association between these vaccinations and autism.
Mr. Mnookin traces out all these separate threads (with the footnotes of a true scholar), even venturing away from the tangle long enough to explain how scientists are trained to think about causation and how profoundly this measured approach is bound to infuriate a distraught parent with a suddenly altered child.
But he really hits his stride when he turns to the social history of autism advocacy; his section on the actress Jenny McCarthy is a tour de force. To promote her 2007 book describing the purported vaccine-induced autism of her young son and his subsequent cure, Ms. McCarthy staged a media blitz, a medical tent show writ large. Blond and charismatic, she waved away the science, energized the people who wanted to believe her message (the not inconsiderable “I feel, therefore it is” segment of our society, as Mr. Mnookin puts it) and managed to do quite nicely for herself as well, netting a deal with Oprah Winfrey’s production company.
I suspect that it was never among Mr. Mnookin’s goals in life to become the de facto sparring partner of such an individual, but this book sealed his fate, and he has acquitted himself nobly. Parents who want to play it safe, but are not altogether sure how, should turn with relief to this reasoned, logical and comprehensive analysis of the facts.
A version of this review appeared in print on March 29, 2011, on page D5 of the New York edition.