- © 2009 msnbc.com
Matt Lauer and NBC have continued the ignominious media tradition of feigning to bring “balance” to the issue of vaccine safety. In the Dateline episode A Dose of Controversy, which aired on Sunday night, Matt Lauer interviewed Andrew Wakefield, the originator of the MMR-causes-autism myth, and highlighted his work at Thoughtful House, the autism treatment center he created in Texas after he was exiled from the U.K. He also interviewed (as “balance”) Dr. Paul Offit, a renowned expert on vaccines and pediatric infectious disease, and Brian Deer, the British journalist whose investigative reporting on Wakefield revealed the true, dark underbelly of the story. Of course, no balance was required to cover this story, since there is no balance from a scientific perspective. There is the evidence – that there is no causal association between the MMR vaccine and autism, and there is the myth, belief, and dogma (and a smattering of fraud) backing the notion that there is. A good piece of journalism covering this topic would have discussed Wakefield only as reference in the narrative of the story. But then that wouldn’t be nearly as good for ratings. Tension, controversy, personalities, that’s what makes for a good story. And that’s just what Dateline provided it’s viewers. Unfortunately, what it probably didn’t do was ease the fears of parents who have been thrown off course by misleading media stories and the speed-of-light trajectory that has characterized this myth. Worse, by simply shining light on the debonair Dr. Wakefield, the show may have misled even more parents into believing this dangerous myth.
For those who may not know, Dr. Wakefield is the individual who single-handedly ignited the firestorm of fear about the MMR vaccine with his 1998 case report of 12 children which, somehow, got published in the British medical journal Lancet in 1998[1]. This single, terribly flawed article, and the subsequent, unwarranted media frenzy, led parents around the world to believe the MMR vaccine was a cause of autism. Many have written about the dangerous trend of parental vaccine refusal and childhood underimmunization brought about by Wakefield’s publication. So I won’t discuss (at length) the original paper here, or the large volume of subsequent studies that have refuted its assertions. Suffice it to say, science has condemned Wakefield’s hypothesis, and good investigative journalism (i.e. Brian Deer) has revealed the ethical breaches and fraud underlying his involvement in this issue. But you wouldn’t learn this from watching A Dose of Controversy. The show did give its viewers some glimpses into the truth behind the Wakefield myth, so let me get those out of the way. Yes, both Paul Offit and Brian Deer were interviewed briefly and allowed to make good points. The show did discuss Wakefield’s enormous conflicts of interest (which he still denies), like receiving $750,000 from the legal fund set up for the very patients he used in his paper to sue the maker of the MMR vaccine. And, yes, it did mention that he paid children at a birthday party for allowing him to take their blood, and then showed him laughing about it at a conference. It showed disturbing footage of Arthur Krigsman (one of Wakefield’s colleagues) performing invasive procedures on children (although it didn’t make it clear that these procedures were entirely unnecessary and hence profoundly unethical). 
However, what the Dateline piece mostly accomplished was to give Wakefield a platform and lot’s and lot’s of air time to make his case. What the show didn’t do was give a “fair” allotment of time to the actual science behind this issue. If it had, it would have pointed out that Wakefield’s original paper wasn’t only tainted by astronomically enormous conflicts of interest (as discussed in the show) but that it was riddled with fatal flaws and biases. I realize that it’s difficult to wow a television audience by reviewing medical literature, but it would not have been difficult to show, in dramatic fashion, just how flawed this paper was. As I said, I will refrain from a detailed critique of the paper here, since it has been done many times by those more equipped than I. However, to make my point about this particular show’s lack of appropriate focus on the science, I’d like to point out just a few items that could easily have been covered.
Actually, the first bias starts well before the 1998 Lancet article. In the early 1990’s, Wakefield had been trying to link measles infection with inflammatory bowel disease[2]. He believed that measles exposure at a critical age, along with concurrent exposure to other viruses, produced a persistent measles infection that could lead to Crohn’s disease. When numerous investigators, using more sophisticated methods, were unable to replicate his findings[3][4][5][6][7][8], Wakefield turned to the measles vaccine. In 1995 He published a study, again in Lancet, that purported to show an increased risk for developing Crohn’s disease in children who had received the new, live attenuated monovalent measles vaccine[9]. Again other, better-performed studies, found no such risk from the vaccine[10][11][12][13]. Unable to produce convincing data linking measles or measles vaccine to Crohn’s disease, Wakefield turned his attention to the MMR vaccine. When a group of parents, who believed their children had developed autism from receiving the MMR vaccine, hired the attorney Richard Barr, the table was set for Andrew Wakfield to finally have his day in the sun. The infamous 1998 Lancet paper claimed that these children received the MMR vaccine, and almost immediately developed a unique bowel disorder, which he later labeled autistic enterocolitis (but which doesn’t actually exist). He conjectured that these children then regressed into autism as a result of a chronic MMR-induced measles infection, which triggered an auto-immune bowel disease, which caused their intestines to become leaky to unnamed autism-causing “toxins”. If this sounds crazy to you, there’s a reason. There is not one single iota of evidence to support this hypothesis. This chronology is already beginning to sound like interesting TV.
Looking more closely, it becomes apparent that there are many more problems with Wakefield’s 1998 paper. Which brings us to the next set of biases. As mentioned in the show, the children in this series were self-referred by parents who already believed their children were harmed by the MMR vaccine, and who were, in fact, plaintiffs in a law suit against the vaccine manufacturer. Additionally, they self-referred to a doctor who had already been trying to link the vaccine to inflammatory bowel disease. This selection bias is in itself a fatal flaw. But there’s more. The parents were questioned about the timing of their child’s regression with relation to the vaccination up to nine years after the fact. This resulting recall bias is again a major problem. It is extremely difficult to precisely date the onset of a disorder like autism. It is human nature to find patterns where there are none, and to attempt to relate something like autistic regression to an unusual event, such as a vaccination. It has also been demonstrated that prior knowledge or beliefs about the purported link between the MMR vaccine and autism affects parents’ perception of this temporal association. This could easily have been discussed in the show, but it wasn’t.
The show also failed to mention that Wakefield’s subsequent studies, purporting to demonstrate the frequency with which autistic children have “autistic enterocolitis”[14], and that these children have measles virus DNA in their intestines[15], have been contradicted by other investigators using better methods[16][17][18][19]. The notion that “autistic enterocolitis”, central to Wakefield’s hypothesis, even exists has been thoroughly debunked by science[20][21]. Again, had the Dateline show spent more time on these very important points, it would have helped parents to better understand the facts behind the myth. It would also have had significantly more impact had the show spent a little more time actually discussing the volumes of excellent data refuting the MMR-autism link[22][23][24][25][26][27][28][29][30]. This wouldn’t need to be dry and boring, as the shear volume is dramatic enough.
The Dateline show also dropped the ball by not delving into the absolute lack of scientific evidence to support the Thoughtful House treatments for children with autism. Performing invasive endoscopic procedures on children, diagnosing meaningless intestinal “inflammation”, and then prescribing dietary therapies and colonics should be viewed as unscientific at best, and malpractice at worst. To quote the Thoughtful House website:
Treatment directed at correcting immune system abnormalities is imperative, and includes supplying nutrients key in normal immune function, supporting the detoxification pathways, and breaking the inflammatory cycle.
This is wholly unsupported by science, and has all the hallmarks of quackery. It should have been highlighted by Dateline but it wasn’t.
Ironically, although Wakefield’s conflicts of interest were discussed in the story, just as much time was spent by Matt Lauer grilling Paul Offit about his alleged conflict of interest. Unbelievably, the anti-vaccine movement (and many misinformed parents) believes Dr. Offit is tainted by the pharmaceutical industry because he spent 25 years slaving in a lab to develop a rotavirus vaccine. This is a vaccine that has already spared many children from horrible illness, and that has the potential to save the lives of 2000 children around the world each and every day. Because Merck subsequently bought the rights to the vaccine (the patent for which is owned by Dr Offit), Dr. Offit is forever labeled a shill for big Pharma. Somehow, Wakefield’s true and serious conflicts of interest have been “balanced” by Dateline with the absurd notion that Dr. offit has one too. This is false balance at its worst.
Ultimately, the most glaring omission from the Dateline story was the failure to discuss the devastating consequences of Wakefield’s folly, and the media’s shared responsibility in it. As the U.K. media went full throttle with the “MMR causes autism” story, vaccination rates dropped precipitously. Soon after, and as expected, outbreaks of preventable childhood diseases occurred, and some children died. It didn’t take long for the media stories and the fear to hit our shores. Although the story hit over a decade ago, it still remains a daily challenge for pediatricians to convince parents that to fully vaccinate their children in the recommended fashion is an immensely important step for safeguarding them from serious and deadly diseases. That is the story that needs to be told.
To be fair, there have been much worse media pieces on vaccines than this Dateline episode. I first learned of Andrew Wakefield one night in 1998, just after the publication of his infamous paper. The program I saw that night was World News Tonight with Peter Jennings, and it featured an “expert panel” to discuss the risks of the MMR vaccine in response to Wakefield’s publication. The panel consisted of Dr. Bart Classen, who heads his own anti-vaccine organization, and Barbara Loe Fisher, the founder of the original anti-vaccine group, the NVIC. That was it. No balance there, but you can guess where that story went. My next media encounter with this issue occurred on November 12, 2000. This time it was 60 Minutes. The header for that story was,
The MMR Vaccine: Controversy surrounding British study that showed a link between autism and the vaccine for measles, mumps, and rubella.
The story highlighted the maverick Dr. Wakefield and his newly discovered cause of autism. It offered dramatic images of devastated children and their parents, but not a shred of science. That was good television. But when the fear of the MMR vaccine really began to set in here in the US, the better story was the “controversy”. And for that story, dramatic tension was needed. The media’s principled approach of presenting a “fair and balanced” perspective provided a ready-made framework from which to launch this new wave of vaccine stories. What followed was an avalanche of media pieces, both in print and on TV, that pitted “main stream” doctors and scientists against the “mavericks”, the lonely outsiders struggling to be heard. While this journalistic methodology is appropriate, and in fact laudable, for many types of stories, it isn’t usually so when it comes to matters of science. There are two main problems with using the “fair and balanced” approach in the case of the MMR and autism issue. The first, as I discussed above, is that there really is no balance as far as the science is concerned. There’s Wakefield and a handful of his colleagues, who have nothing but poor or non-existent studies to support their beliefs, and then there’s the volume upon volume of excellent, peer-reviewed studies that contradict them. The second problem is that the word “fair” is often confused with “equal”. The media will often provide equal time covering different sides of a story or different views, even though fairness would dictate that the amount of time and focus given should be proportionate to the validity and strength of the evidence supporting that view. A more appropriate way, then, to cover the MMR-autism story would be to look closely at the weight of the evidence contradicting a link, by interviewing the authors of the studies and other experts equipped to decipher them for the public. That information would then be held up against the paucity of science supporting such a link. That would be a “fair”, and appropriately unbalanced way to cover the story. Going one step further, a truly good piece of journalism would then frame the story in light of the sociological context that permitted this myth to spread and affect parental decision-making. But I digress from reality….
The media tends to do a poor job reporting on vaccines and other science issues for a variety of reasons. One is the complexity of scientific studies and the language in which they are written. They’re difficult to read and interpret even for some scientists, let alone for journalists. Another big challenge is to understand and explain the fundamentals of the scientific method in general. This is not something that is amenable to a 30 second sound bite or a 30 minute TV show. For example, the most fundamental concept of the null hypothesis is often totally misunderstood by those reporting on science. It’s difficult for the media and the public to understand the inability of science to “prove the MMR doesn’t cause autism.” The best it can do with that statement is not reject it. That sounds kind of wishy-washy when it’s put before the public, as exemplified by the U.K. Medical Research Council’s statement in 2001 regarding the lack of scientific support for the MMR-autism link:
We recognize that, as with most epidemiological studies of causation, this remains a theoretical possibility
Although this is a scientifically true statement, it is unlikely to convince the public. This is particularly true when the media fails to understand it as well, as demonstrated by this subsequent coverage by the Telegraph:
Lastly, as I mentioned above, a major problem with reporting on science, and particularly on vaccines, is the problem of false balance. A 2002 survey by the Cardiff School of Journalism asked over 1000 people what they thought and knew about the MMR vaccine. The results were combined with a detailed media analysis of print, TV, and radio content and revealed:
- The profound weakness of the claim linking MMR and autism was not addressed in the media.
- Nor was the seriously flawed nature of the “science”.
- Nor the complete lack of a scientific rationale for recommending that children receive separate MMR components.
- Only 25% of media stories mentioned Wakefield at all.
- Only 15% of media stories mentioned Wakefield’s financial ties to the lawyer representing the children in his study.
- Only 31% of broadsheet press reports mentioned that the overwhelming volume of evidence supports the safety of the MMR (50% for TV reports).
- When mentioned, it was used mainly to balance the opposing view.
To quote the Cardiff study,
Although almost all scientific experts rejected the claim of a link between MMR and autism, 53% of those surveyed at the height of the media coverage assumed that because both sides of the debate received equal media coverage, there must be equal evidence for each. Only 23% of the population were [sic] aware that the bulk of evidence favored supporters of the vaccine.
Even when good points are made in a news report on vaccines (such as were made in this Dateline), in the end what people absorb are the main themes, not the details. The main themes are that a link has been made between the MMR and autism, and that scientists are divided over the issue. From this, people draw conclusions and make extremely important decisions for their children.
When I sat down to watch this Dateline episode on Sunday night, I had a pretty good idea what to expect. The title of the episode, A Dose of Controversy, was a dead giveaway to the underlying motive of the show. That motive was to fan the flames of fear about the MMR vaccine by generating a false sense of controversy. In the world of science, there is absolutely no controversy about whether the MMR vaccine causes autism. The science is as clear as can be, and the answer is a resounding “NO!” But by using the word controversy in the very title of the show, it was evident that this was to be yet another attempt to capture ratings at the expense of truly informing the public. In so doing, NBC has given further legitimacy to a fraud and a myth. While this wasn’t the worst of the vaccine stories the mainstream media has produced in the recent past, it fell far short of what should have been its goal of setting the record straight about this extremely dangerous myth. Nancy Snyderman, the chief medical editor at NBC, recently confronted Matt Lauer about this very issue during an appearance on the Today Show about Paul Offit’s outstanding book, Autism’s False Prophets. Mr. Lauer’s use of the term “controversial” to describe the vaccine-autism issue, and Snyderman’s appropriate frustration at his lack of understanding, is best left to the transcript itself:
Dr. Nancy Snyderman: Its time for everyone to redirect the questions toward finding the cause of autism. It is NOT, however, vaccinations.
Matt Lauer: Controversial subject, Nancy.
Snyderman: NOT controversial subject!
Lauer: Well but controversial for parents who still believe.
Snyderman: It is not controversial, Matt! It’s time for kids to get their vaccines.
Lauer: If it weren’t controversial you wouldn’t be ambushed.
Snyderman: No! It’s not controversial. I really mean that. The science is the science. We are going to start to see outbreaks of polio and measles in this country if we don’t start talking about the real problem. It’s NOT controversial.
It seems that neither Matt Lauer, nor NBC, have learned much since this exchange. We can only hope that by giving Andrew Wakefield the national stage, NBC hasn’t further confused parents and deepened Wakefield’s path of destruction.
References:
1. Wakefield, S. Murch, A. et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 1998; 351: 637-641.
2. Ekbom, A, Wakefield, A J, Zack, M, Adami, H O. Perinatal measles infection and subsequent Crohn’s disease. The Lancet. London: Aug 20, 1994. Vol. 344, Iss. 8921; p. 508
3. Liu Y, Van Kruiningen HJ, et al. Immunocytochemical evidence of Listeria, Escerichia coli, and Streptococcus antigens in Crohn’s Disease. Gastroenterology 1995;108:1396-1404
4. Iizuka M, Nakagomi O, Chiba M, et al.Absence of measles virus in Crohn’s disease. Lancet 1995;345:199
5. Haga Y, Funakoshi O, et al. Absence of measles viral genomic sequence in intestinal tissue from Crohn’s disease by nested polymerase chain reaction. Gut 1996;38:211-215
6. Katayama Y, Kohso K, et al. Detection of Measles Virus mRNA from Autopsied Human Tissues. J Clin Microbiol. 1998 January; 36(1): 299-301
7. Afzal M, Armitage E, et al. Absence of detectable measles virus genome sequence in inflammatory bowel disease tissues and peripheral blood lymphocytes. J Med Virol.1998 Jul;55(3):243-9.
8. Iizuka M, Chiba M, Yukawa M, et al. Immunohistochemical analysis of the distribution of measles related antigen in the intestinal mucosa in inflammatory bowel disease. Gut 2000;46:163-169.
9. Montgomery SM, Morris DL, Pounder RE, Wakefield AJ. Measles vaccination and inflammatory bowel disease. The Lancet. London: Dec 13, 1997. Vol. 350, Iss. 9093; p. 1774
10. Feeney M, Clegg A, Winwood, et al. Lancet 1997; 350:764-766
11. Davis RL, Kramarz P & Bohlke K. Measles-mumps-rubella and other measles-containing vaccines do not increase the risk for inflammatory bowel disease: a case-control study from the Vaccine Safety Datalink project. Arch Pediatr Adolesc Med 2001; 155:354-359
12. Patja A et al. Serious adverse events after measles-mumps-rubella vaccination during a fourteen-year prospective follow up. Ped Inf Dis J 2000; 19:1127-1134
13. Morris DL, Montgomery SM, Thompson NP, et al. Measles vaccination and inflammatory bowel disease: a national british cohort study. Am J Gastroenterol 2000; 95:3507-3512
14. Wakefield AJ, Anthony A, Murch SH, et al. Enterocolitis in children with developmental disorders. Am J Gastro. 2000. 95;2154-2156.
15. Uhlmann et al., Potential viral pathogenic mechanism for new variant inflammatory bowel disease. Molecular Pathology 55:84-90, 2002
16. Chadwick N, Bruce IJ, Schepelmann S, Pounder RE, Wakefield AJ Measles virus RNA is not detected in inflammatory bowel disease using hybrid capture and reverse transcription followed by the polymerase chain reaction. J Med Virol. 1998 Aug;55(4):305-11
17. Afzal MA, Armitage E, Begley J, Bentley ML, Minor PD, Ghosh S, Ferguson A J Absence of detectable measles virus genome sequence in inflammatory bowel disease tissues and peripheral blood lymphocytes. Med Virol. 1998 Jul;55(3):243-9
18. D’Souza Y, Dionne S et al.No evidence of persisting measles virus in the intestinal tissues of patients with inflammatory bowel disease. Gut 2007;56:886-888
19. D’Souza Y, Fombonne E, Ward B. No Evidence of Persisting Measles Virus in Peripheral Blood Mononuclear Cells From Children With Autism Spectrum Disorder. Pediatrics 2006; 118: 1664-1675
20. Taylor et al. Measles, mumps, and rubella vaccination and bowel problems or regression in children with autism: population study. BMJ 324:393-396, 2002
21. Black C, Kaye J, Jick H Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database. BMJ 2002; 325: 419-421
22. Peltola H, Patja A, Leinikki, et al. No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study. The Lancet, May 2, 1998, Vol. 351:1327-8
23. Taylor, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet 353:2026-2029, 1999
24. Dales, et al. Time Trends in Autism and in MMR Immunization Coverage in California. JAMA 285:1183-1185, 2001
25. Kaye JA, Melero-Montes M & Jick Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. H BMJ 2001; 322:463
26. Frombonne E; Chakrabarti S No Evidence for A New Variant of Measles-Mumps-Rubella-Induced Autism. Pediatrics 2001 Oct 108;4(e58):991
27. Madsen KM et al. A population-based study of measles, mumps and rubella vaccination and autism. NEJM 2002, 347: 1477-82
28. Taylor et al.,Measles, mumps, and rubella vaccination and bowel problems or regression in children with autism: population study. BMJ 324:393-396, 2002
29. Smeeth L, Cook C, Fombonne E, et al. MMR vaccination and pervasive developmental disorders: a case-control study. Lancet 2004; 364: 963-69
30. Honda Hideo, Shimizu Y, Rutter M. No effect of MMR withdrawal on the incidence of autism: a total population study. Journal of Child Psychology and Psychiatry 46 (6) 572-579, Jun 2005