One of the most engaging and clearly-written pieces of science journalism over the last year or so was published in Wired magazine last week. Now in the midst of a firestorm of attention, Amy Wallace’s, “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All,” is part interview with rotavirus vaccine developer, pediatric infectious disease physician and immunologist, Dr Paul Offit, and description of the anti-vaccination movement in the United States.

Wallace’s work is the centerpiece of a masterful collection of smaller articles providing science-based information about vaccination that also refuts common anti-vaccination myths including “How To Win An Argument About Vaccines” and “The Misinformants: Prominent Voices in the Anti-Vaccine Crusade”.

Wired’s follow-up discussion of the issue includes, “A Short History of Vaccine Panic,” for those of us who “have a day job” and not enough time to read Paul Offit’s 2008 book, “Autism’s False Prophets.”

On a personal note, I have to admit that it wasn’t until I began blogging four years ago that I realized just how vocal the anti-vaccination movement was in the United States. I come from a time (just on the tail end of the Baby Boom) where I still have relatives who were afflicted with polio and other now-preventable infectious diseases. From my hometown of Wallington, NJ – a stone’s throw from New York City – Bill Michalski writes in “Poland On The Passaic” how the fear of polio spread through town during the 1930s and 40s, with white flags hung out on front porches to warn away visitors. The devastation of these childhood illnesses makes the risks (yes, I agree there are some risks) of vaccination itself inconsequential.

Vaccination is a risk-benefit proposition but one where someone else’s view affects us all. Lack of vaccination compromises “herd immunity” that keeps us all safe, for example, from diseases like smallpox that have been eliminated from the face of the earth. Your vaccination is also important to others who may be immunosuppressed from cancer drugs, HIV/AIDS, or, in the case of someone close to me, immunosuppressant drugs to prevent organ transplant rejection.

Others have commented widely on Wallace’s article for its scientific and medical accuracy. However, I wanted to focus more so on the effectiveness of the writing as a scientific communication tool because much of the article gives the reader a concise view of issues and psychology that often take typical bloggers thousands of words to express (and still less effectively!).

Why is Paul Offit Perceived as Evil?
Wallace does a terrific job of showing us just how scary life is for Paul Offit and his family (with death threats reminiscent of those by animal rights and anti-abortion activists). He is a doc at the Children’s Hospital in Philadelphia and, as mentioned earlier, is one of the developers of a vaccine for rotavirus sold commercially as RotaTeq®. While not particularly deadly (although the parents of the 20-60 dead US infants and toddlers annually may beg to differ – as well as those of the half million worldwide), rotavirus causes a severe form of acute diarrhea in several hundred thousand US children annually under age 5. If you’ve had a kid with it, you wish they didn’t have to endure it if a vaccine would prevent the infection and sequelae.

Wallace also describes how Offit was in the hospital with kids suffering from polio in the mid-1950s. Hence, unlike many of today’s anti-vaccination advocates, Offit was influenced deeply and early by witnessing firsthand the devastation of now-preventable infectious diseases. That’s the world in which my parents and grandparents lived.

“It was a pretty lonely, isolating experience,” Offit says. “But what was even worse was looking at these other children who were just horribly crippled and disfigured by polio.” That memory, he says, was the first thing that drove him toward a career in pediatric infectious diseases.

Wallace goes on to describe a case in 1977 where, as an intern, Offit observed the death of a child from rotavirus, being surprised that the disease still killed kids. I’d say that many of us in science and medicine were influenced similarly by watershed events in our lives that led to pursuit of our respective career tracks.

Anti-vaccination advocates often criticize Offit for being in the pocket of Big Pharma (whatever that really means) because he made $50 million from the development of the RotaTeq vaccine. Offit admits to it being several million – a much more realistic number given what I know about deals made by institutions vs. remaining payouts to individual scientists – and he has every right to benefit from the intellectual property he has developed from his hard work. Offit has a four-bedroom house with his wife (who is also a pediatrician) and they each drive a Toyota Camry. He does not appear to have an extravagant lifestyle and, to be honest, why should we begrudge him if he did?

Offit acknowledges that he received a payout — “several million dollars, a lot of money” — when his hospital sold its stake in RotaTeq last year for $182 million. He continues to collect a royalty each year. It’s a fluke, he says — an unexpected outcome. “I’m not embarrassed about it,” he says. “It was the product of a lot of work, although it wasn’t why I did the work, nor was it, frankly, the reward for the work.”

There are plenty of us who have our kids vaccinated for rotavirus and I’m perfectly happy for Offit to collect a royalty. (I’d even encourage him to buy a more comfortable vehicle because I know how unnerving the Philadelphia commute can be.). Does this make him evil? In fact, last week the CDC published that the vaccine is already responsible for reducing cases and hospitalizations for rotavirus. If that’s the definition of evil then I aspire to be evil.

Wallace also notes indirectly that the anti-vaccination movement is doing just what they accuse Offit of doing: making money off of the situation:

At this year’s Autism One conference in Chicago, I flashed more than once on Carl Sagan’s idea of the power of an “unsatisfied medical need.” Because a massive research effort has yet to reveal the precise causes of autism, pseudo-science has stepped aggressively into the void. In the hallways of the Westin O’Hare hotel, helpful salespeople strove to catch my eye as I walked past a long line of booths pitching everything from vitamins and supplements to gluten-free cookies (some believe a gluten-free diet alleviates the symptoms of autism), hyperbaric chambers, and neuro-feedback machines.

Yes, where the science is not yet complete, pseudoscience (and the attendant hucksters and vultures) seem to fill the void. The difference between them and Offit: the product Offit developed has extensive scientific data to back up its effectiveness.

Efficiency of Words
But getting back to what impressed me most about Wallace’s article was how concisely she presented her content. Here, she sums up one of my discussion points above:

Today, because the looming risk of childhood death is out of sight, it is also largely out of mind, leading a growing number of Americans to worry about what is in fact a much lesser risk: the ill effects of vaccines.

To describe the hypocrisy of an Offit opponent:

Hence the death threats against Paul Offit. Curt Linderman Sr., the host of “Linderman Live!” on AutismOne Radio and the editor of a blog called the Autism File, recently wrote online that it would “be nice” if Offit “was dead.”

I’d met Linderman at Autism One. He’d given his card to me as we stood outside the Westin O’Hare talking about his autistic son. “We live in a very toxic world,” he’d told me, puffing on a cigarette.

To describe the logical trapping of pseudoscience believers:

. . .the astronomer Carl Sagan reached a similar conclusion: Science loses ground to pseudo-science because the latter seems to offer more comfort. “A great many of these belief systems address real human needs that are not being met by our society,” Sagan wrote of certain Americans’ embrace of reincarnation, channeling, and extraterrestrials. “There are unsatisfied medical needs, spiritual needs, and needs for communion with the rest of the human community.”

Looking back over human history, rationality has been the anomaly. Being rational takes work, education, and a sober determination to avoid making hasty inferences, even when they appear to make perfect sense. Much like infectious diseases themselves — beaten back by decades of effort to vaccinate the populace — the irrational lingers just below the surface, waiting for us to let down our guard.

To describe how people evaluate, incorrectly, perceived vs. actual risks:

Perceived risk — our changing relationship to it and our increasing intolerance of it — is at the crux of vaccine safety concerns, not to mention related fears of pesticides, genetically modified food, and cloning. Sharon Kaufman, a medical anthropologist at UC San Francisco, observes that our concept of risk has evolved from an external threat that’s out of our control (think: statistical probability of a plane crash) to something that can be managed and controlled if we just make the right decisions (eat less fat and you’ll live longer).

We scientists can do well to be students of Ms. Wallace’s efficiency with words.

Most recently, Wired demonstrates that, like the rest of us who employ the scientific method to evaluate data, it’s okay to admit (as well as the responsible thing to do) when one makes a mistake and then describe the consequences, or lack thereof, of the misstatement. For example, Wallace’s article did mistakenly state that vaccines no longer contain thimerosal (ethylmercury), an anti-microbial preservative that has proven safe in over a dozen studies:

An earlier version of this story suggested that no childhood vaccines contain thimerosal; in fact some versions of the influenza vaccine, which is not typically mandated for children’s admission to school, does contain the preservative. Go here for a further explanation.

Amy Wallace the Journalist
Finally, what I think also impresses me is Amy Wallace herself and her approach to this article. Wallace is not your typical science journalist. The majority of her portfolio is comprised of works on Hollywood and the entertainment industry. She is not a lobbyist or otherwise a representative of the pharmaceutical industry – as you might guess, she is already being accused of being such by anti-vax advocates, In fact, Wired has published a follow-up on Ms. Wallace’s background in response to a misinformation campaign about her that has already developed. (Nor this hasn’t stopped the anti-vax commenters from stating that the entire Wired feature is a paid hit job for the pharmaceutical industry.)

When the facts don’t support an opponent’s view on a pharmaceutical or therapeutic issue, the tendency is an intellectually lazy cry of “Pharma Shill.”

Wallace’s approach to Offit himself is, I think, so effective because she is supremely experienced at writing about personalities, their inner workings, and how they are viewed by the public. As an entertainment writer, she also has to delve into the truths behind the motivations of people and get past appearances and hype. She went above and beyond in giving time and publicity to anti-vaccination advocates, and their websites, and pretty much gave the reader all they need to make up their own minds about the issue.

But most importantly, all of scientists with whom I communicate on blogs and Twitter have agreed that the science reported in Wallace’s article is almost entirely valid and supported by solid, published data. Dr. Gorski has, for example, registered his support here at SBM back on October 20th.

But the combination of scientific validity, her engaging writing style, and historical/psychological commentary on pseudoscience comes together to create an example of what science journalism can and should be.

The record-setting pageviews for Wired and froth in the comments from anti-vaccination activists tells us all we need to know about how influential Ms. Wallace’s article is already – and will continue to be.

I encourage SBM readers to follow Ms. Wallace on her Twitter feed @msamywallace. Beginning last evening, she began writing about the e-mail she has received, both hateful and supportive, regarding her story. She notes that in 25 years of professional journalism (NYT, LATimes, etc.), she has never received such volume and vitriol of communications on any other topic.



Posted by David J Kroll