You're being duped. Here's how to spot it.

It struck me recently that anti-vaxxers, quacks, dictators, populists, and other would-be autocrats all follow the same playbook. They all want to sell you something for their own personal gain, and all of them are willing to lie to get what they want.

These lies have a purpose, and it’s rarely good.

Let's look at a few of the most damaging lies from recent events, starting with medicine and then moving on to politics. (Lies are in italics.)

If you believe that vaccines don't work, you've been duped.

If you believe that vaccines cause autism, you've been duped.

Vaccines are the greatest invention in the history of medicine. They've saved billions of lives, dramatically increased human life expectancy, and in many ways enabled the growth of civilization itself. The Covid-19 vaccines are more than 90% effective, and without them we'd have no chance to end the pandemic.

And yet many anti-vaxxers claim that vaccines don't work. They also claim there's a massive conspiracy to hide the (extremely rare) harms caused by vaccines. 

The anti-vax movement is led by people like Andrew Wakefield, Robert F. Kennedy Jr, Joe Mercola (whom I wrote about  in 2010, in 2014, and last year), and other members of the Disinformation Dozen who use social media to spread vaccine misinformation. They make a great deal of money selling books, seminars, and (in the case of Mercola) bogus treatments for the diseases that vaccines prevent. These people simply make stuff up and then demand that scientists devote time to disproving it. 

Science doesn’t work that way. If you make a claim, you first have to prove it, by producing evidence and rigorously-done studies that go through peer review. You can't just throw out garbage claims and insist that other people do the work of disproving them. Nope.

If you believe that ivermectin is a cure for Covid-19, you've been duped. 

As I’ve explained in this column, ivermectin doesn’t help at all in treating Covid-19, and it’s dangerous if you take too much of it. But if you prefer to get medical advice from right-wing zealots like Tucker Carlson, go ahead.

If you believe that hydroxychloroquine is a cure for Covid-19, you've been duped.

The misinformation about hydroxychloroquine started with an egocentric French microbiologist, who posted an over-the-top video claiming he had the solution to Covid-19, a claim that was quickly debunked. That didn’t stop politicians and right-wing television pundits from promoting it, even as evidence emerged that it was nonsense.

Hawkers of ivermectin, hydroxychloroquine, and other fake Covid-19 cures have profited by claiming, first, that the government is lying and that vaccines don't work, and second, that they have a truly effective treatment that they can sell you. This is a double lie, but a necessary one, because if they can't convince you that vaccines don't work, then they won't be able to sell your their snake oil. 

For instance, a sketchy right-wing group called America’s Frontline Doctors (which is not, despite the name, a group of doctors working on the front lines of any disease) was selling $90 online “consultations” where they provided prescriptions for ivermectin. The $90 didn’t include the cost of the drug: it’s just a fee that went straight into their pockets.

By the way, if you've been duped about a Covid-19 cure, you’re in good company. Early in the pandemic, doctors at Yale Medical School were duped into believing that hydroxychloroquine was an effective Covid-19 treatment, as I explained at the time. They figured out their error eventually, but not before they boldly advertised their treatment protocol on their website and via Twitter.

Now let’s look at a few examples in the political realm.

If you believe that Trump won the 2020 election, you've been duped.

This is utterly false, of course: Biden won by over 7 million votes, and he won the Electoral College 306-232. Trump is a loser, and his Big Lie is possibly the worst case of being a sore loser in the history of politics. And yet, according to some polls, 60% of Republicans believe his latest lie (or at least that's what they tell pollsters). They’ve been duped.

Trump lied over 30,000 times during the course of his presidency, as was documented, painfully, by the Washington Post, and he's still doing it. This frequent lying is part of a strategy to "flood the zone with shit," as Trump minion Steve Bannon openly boasted a couple of years ago. The idea is to make up lies far faster than the opposition can shoot them down. After all, it's easy to make up a claim when you don't have to produce any evidence, and it takes much longer to disprove it. If you take these people seriously and try to play their game, they will always win–because by the time you debunk one lie, they've produced ten more.

If you believe that Ukraine is threatening war against Russia, you've been duped. 

As I write this, Vladimir Putin is flooding his own citizens with a huge lie, trying to convince them that Ukraine is threatening war against Russia, when just the opposite is true: Russia has sent over 100,000 troops to its border with Ukraine, while Ukraine has done nothing of the sort.

If you don't believe that Russians helped shoot down Malaysia Air flight MH17 in 2010, you've been duped.

A few years ago, after Putin's soldiers near the Ukrainian border shot down a civilian Malaysian Airlines plane, killing hundreds of innocent civilians, he used the Russian media to publish multiple confusing theories, all of them simply made up, to convince his audience that Russian soldiers had nothing to do with it. An independent investigation concluded that a Russian missile, shot from a base in Russia, downed the plane. And yet many Russians today are still unaware of this.

If you believe any of Putin’s claims about Ukraine, you've been duped. 

And yet because Putin controls all the media in Russia, it is likely that many Russians do believe him. He's also claiming, falsely, that many Ukrainians actually want Russia to take over their country.

Politicians, quacks, and pseudoscientists are all con artists. They lie to gain money, power, and fame. Some of them lie without any sign of discomfort whatsoever, a trait that is characteristic of sociopaths. To people who find lying uncomfortable–which is most people–the boldness of these lies in itself is convincing.

In skeptical circles, this strategy is called the "Gish gallop," named after a creationist who used this strategy in debates where he challenged the theory of evolution. His idea was to put out so many lies and half-truths that his opponent would simply be overwhelmed. In a live debate, this tactic can be particularly effective when the audience doesn't know the topic well. 

One way to combat con artists is to expose how much they’ve gained at other people’s expense. Vladimir Putin is not only powerful, but he’s also incredibly wealthy, as a result of stealing many of his own country's assets. Putin’s biggest political foe, Alexey Navalny, released a video that showed a $1.35 billion palace that Putin built for himself, paid for with money that Putin had stolen from his own people:

Navalny got very popular in Russia. Putin first poisoned and nearly killed him, and now is holding Navalny in prison. It’s not likely Navalny will survive.

Here in the U.S., Donald Trump profited in countless ways, documented in excruciating detail by the Washington Post and the New York Times, by using the tools of government to direct business to his hotels and resorts. As just one example, hundreds of companies and foreign officials stayed at the Trump Hotel in D.C. during Trump’s presidency, in what was essentially an open bribe to the sitting President.

How can one avoid being duped?

First, always ask what the person has to gain. If they’re making money or gaining power from their claims, we should be skeptical.

Second, look at the reliability of the source. When someone lies constantly, we really can’t believe anything they say. At this point, virtually nothing claimed by some of the people I’ve highlighted in this column (Trump, Putin, Wakefield, Mercola) can be trusted.

Third, question the expertise of the source. When Tucker Carlson spews out claims about ivermectin, you shouldn't believe a word of it. When politicians make claims about science and medicine, they rarely know what they're talking about. (There are exceptions, but they are infrequent.) 

Even when the claims come from a scientists, there are plenty of reasons to be skeptical. Modern science has thousands of specializations, for good reason: biology, medicine, physics, chemistry, and other disciplines are amazingly complex. So if you want to know about global warming, don't ask a doctor. If you want to know about vaccines, don’t ask a biophysicist, even if he has a Nobel Prize, and certainly don’t ask a surgeon who’s running for political office. And for answers to any of these questions, don't ask a politician.

Would you trust your kids with this man? No? I didn't think so.

Today I want to shine a bit of light on the conspiracy theorist behind the film "Vaxxed" and its recent sequel, "Vaxxed II." I'm not going to provide any links to the movie, or to describe it, except to say that it's a slickly-produced conspiracy theory masquerading as a documentary. Don't watch it.

Anti-vax activists often use conspiracy theory tactics, which work like this: they simply make up a claim, out of thin air, that a secret cabal of doctors (or government scientists, or pharma companies) is out to harm patients by giving them vaccines, and is hiding the "truth" about the risks of vaccination. Never mind how irrational this is, and never mind that there's not a shred of evidence behind it: if you try to argue with the anti-vaxxer, you're part of the conspiracy.

So rather than try to disprove something that was never proven in the first place, let's look instead at the source of the anti-vax propaganda film, "Vaxxed." The source is one man: Andrew Wakefield. Who is this guy, and why is he so obsessed with vaccines?

Wakefield was once a doctor, before he had his license revoked a decade ago. In his former life, he was a gastroenterologist, with no special training in vaccines or infectious diseases. He first gained fame–a lot of fame–for a 1998 paper in a medical journal, The Lancet, in which he claimed to have discovered a link between the MMR vaccine (that's the one that covers measles, mumps, and rubella) and autism.

Here are some things you need to know about Wakefield before watching his movie:

1. Wakefield's 1998 paper, it eventually turned out, was "an elaborate fraud." Wakefield defrauded the public, his patients, and even his own co-authors on the paper, most of whom were unaware of his elaborate conflicts of interests.
2. Before he published his 1998 study, Wakefield was hired by a lawyer, Richard Barr, who was trying to build a lawsuit against vaccine makers. Barr paid Wakefield £435,000 (equal to $750,000 US dollars at the time) to help him build his case. Wakefield's co-authors were unaware of this contract.
3. The study claimed that 8 out of 12 children had been diagnosed with autism soon after getting the MMR vaccine. It described these children as "a consecutive series" of admissions to the hospital where Wakefield worked. That was a lie. It turned out, as investigative journalist Brian Deer revealed, that all 12 children and their parents were referred to Wakefield by Barr–the lawyer who was paying Wakefield to conduct the study, and who was trying to sue vaccine makers.
4. Wakefield also falsified data on all 12 of the children in his original study.
5. Wakefield conducted "invasive and distressing procedures" on the children without approval from his hospital's ethics board.
6. After learning some of the back story, 10 of his 12 co-authors tried to retract the paper in 2004. Wakefield refused to join them, so they published a partial retraction, signed by the 10 co-authors. The Lancet itself later fully retracted the paper (over Wakefield's objections), but it took until 2010 for them to act. By then, the anti-vax movement had spread widely.
7. Prior to publishing his paper, Wakefield filed a patent claim for a "safer" vaccine for measles, one that would have profited him greatly once he discredited the (perfectly safe) MMR vaccine.
8. After losing his license in the UK, Wakefield moved to Austin, Texas where he ran an organization called Thoughtful House, through which he paid himself a salary of $280,000. (Perhaps coincidentally, Austin is now a hotbed of anti-vaccination activism.)

For more than 20 years, Andrew Wakefield has made money off false claims that vaccines cause autism, first put forth in his discredited 1998 paper. He gives talks, writes books, conducts seminars, and now makes movies, of which make him money. Since the publication of his paper, dozens of studies involving literally millions of children have shown, time and again, that vaccines do not cause autism. Wakefield has denied every one of those studies, and continues to push his bogus claims.

(Why, you might ask, have scientists conducted studies looking for a link between autism and vaccines, if there was never any evidence for such a link? The answer is simple: anti-vaxxers have been so successful at scaring people about a nonexistent threat that scientists and public health experts felt it necessary to conduct those studies, in order to reassure people. Literally millions of dollars have been spent to prove something we already knew.)

Meanwhile, measles outbreaks have appeared with increasing frequency in the U.S., the UK, other European countries, and around the world, including the deadly outbreak in Samoa late last year, which caused 5,700 infections and 83 deaths in a population of just 200,000. Wakefield's new movie was released in the middle of that outbreak.

So to anyone who watched the movie Vaxxed and is now having doubts about vaccines, I ask: would you trust your children with this man? I wouldn't.

Are you "vaccine hesitant"? You may be in a cult

Edward Jenner, who pioneered vaccination, and two colleagues
 (right) seeing off three anti-vaccination opponents, with the dead
lying at their feet (1808). I Cruikshank/Wellcome Images/Wikimedia
Commons, CC BY-SA

The World Health Organization recently declared that "vaccine hesitancy," as they called it, was one of the top 10 threats to global health. That's right: it was up there with air pollution, climate change, influenza, Ebola, and other threats.

For the WHO, "vaccine hesitancy" is a polite phrase designed to engage the public and highlight how serious the problem is, without angering those who are guilty of it. I'm not going to be quite so polite here: "vaccine hesitant" means anti-vax. The anti-vax movement, which aggressively spreads fear and misinformation about vaccines, has become a major, worldwide threat.

It also resembles a cult, as I'll explain.

The most recent anti-vax nonsense centers on the new coronavirus that originated in China, and that has led the Chinese government to impose a massive quarantine affecting millions of people. This is a genuine public health crisis, and it has nothing to do with vaccines. Nonetheless, some anti-vaxxers are claiming, without evidence, that the new virus originated from a failed effort to create a coronavirus vaccine. I don't have time to get into that here, but Orac has a lengthy, detailed takedown of that bogus claim.

"Vaccine hesitancy" sometimes refers to parents who are just learning about vaccines for the first time, and who rely on the Internet to search for information. Unfortunately, these new parents are likely to be flooded with anti-vax messages, especially on Facebook. (In recent years, Google has taken steps to lower the priority of anti-vax sites, which has improved things considerably. Sites such as healthychildren.org now appear near the top of searches for "vaccine safety.") It's entirely reasonable to ask your doctor about the benefits and risks of vaccines.

But the answers that parents hear should be clear: vaccines work. As physician ZDoggMD (a pseudonym, obviously) explains in this video:

"Anti-vaccine sentiment is a poisonous scourge.... There's no debate about vaccines. Let's get over that nonsense that the media and celebrities have created, okay? There is nobody in the medical community of any actual reputation who believes that there are two sides to this."

The problem is that anti-vaxxers are continuously creating new websites, Facebook groups, and even movies to spread misinformation about vaccines, particularly the long-debunked claim that vaccines cause autism.

Why do I suggest that anti-vaxxers resemble a cult? Because they have several of the key features of cults, such as:

1. Members of the cult have special insights that outsiders cannot comprehend. With anti-vaxxers, this means they are completely convinced that they know that vaccines cause harm, despite mountains of evidence to the contrary.
2. The group and its leaders are the exclusive means of knowing "truth" or receiving validation, and no other process of discovery is credible. The anti-vax movement has had several prominent leaders, whose followers flock to their speeches and events. These include Andrew Wakefield, the disgraced former doctor who lost his medical license after it was revealed that he had committed fraud. His followers, though, either don't know or ignore his fraudulent past, and regard him as a hero. He makes a living from his books, a movie, and speaking fees, all based on spreading fear about vaccines. An even more prominent anti-vax leader is Robert Kennedy, Jr., who also sells books and gives speeches proclaiming the harms of vaccines. Thanks to his famous name, and despite the fact that he has no medical or scientific training, some people believe him.
3. Unreasonable fear about the outside world, such as impending catastrophe, evil conspiracies and persecutions. Conspiracy theories are the core of many anti-vax arguments. The most common version holds that the "medical establishment" (whoever that is) are hiding the dangers of vaccines so that they can make money. This is utter nonsense. All of doctors I know in the infectious disease community are motivated by a wish to cure disease. In any case, most doctors make little or no money from the vaccines they administer.
4. No meaningful financial disclosure regarding budget or expenses. Some anti-vaxxers profit handsomely by selling bogus, ineffective supplements as alternatives to vaccines. (I'm looking at you, Joe Mercola.) Because supplements are largely unregulated, they get away with it. They'd prefer you to think they're "just in it for the children."

I've no doubt that anti-vaxxers like Wakefield, Kennedy, and others would deny that they are conspiracy theorists, because that's how conspiracy theorists operate. If you question them (they argue), you must be part of the conspiracy. By their own reasoning, they can never be wrong.

So if you encounter someone, either on the sidelines at your kid's soccer game, on Facebook, or elsewhere, who is spreading claims that vaccines are harmful, pause for a minute and ask: what is the source of this information? Is it coming from someone who is profiting from this fear-mongering? There's a good chance the answer is yes.

It's ironic that when the world is faced with a true health emergency, such as the Ebola virus or the Wuhan coronavirus, the first thing that public health experts start to work on is a new vaccine. That's because vaccines provide our best protection against infections. We now have effective vaccines for 16 diseases that used to harm and even kill children in large numbers around the world. We've eliminated smallpox worldwide, and we've nearly eliminated polio, thanks to vaccines. Their very effectiveness is what has allowed the anti-vax message to take hold: many people are no longer frightened of dying from infectious diseases.

We're still a long way from conquering infections, but there's no reason for the world to slip back in time to an era when large numbers of people died from preventable infections. Vaccines work, if we'll let them.

Germany takes action to stem measles outbreak. Anti-vaxxers to blame–again.

Measles is on the rise in Europe, driven by "vaccine gaps" which in turn are due to misinformation about the benefits of vaccines. Vaccines are possibly the single greatest contribution to human health in the past century. Literally millions of people are alive today who would not be, thanks to vaccines.

And yet: vaccine rates have dropped in recent years in multiple countries. In March, the BBC reported that measles had become endemic (meaning that it is self-sustaining, continuing to spread within the country) in France, Germany, Italy, Poland, Romania, Switzerland and Ukraine. The worst measles outbreak is in Romania, which reported over 3,400 cases and 17 deaths in just the first 3 months of this year.

Now measles is spreading in Germany, which is scrambling to contain it. Germany had 504 cases through mid-April, versus just 33 cases for the same period last year. At least one person, a young mother of three children, has died. The primary reason for the spread of the disease, as reported by the German news outlet RT, is unvaccinated individuals, and the reason their numbers are growing is simple: the anti-vaccine movement.

In the U.S., the anti-vaccine movement caused the worst measles outbreak in 20 years in 2015. The outbreak in Germany appears even worse, despite the fact that parents can be fined as much as €2500 ($2800) for failing to vaccinate their children. In a remarkable effort to try to get this outbreak under control, the German parliament has decided to require kindergartens to report parents who don't vaccinate their kids. Let's hope this works.

Vaccination is safe and remarkably effective, but the anti-vax movement is furiously trying to convince parents not to vaccinate. Their latest gambit is "Vaxxed," a conspiracy-mongering anti-vaccine screen produced by Andrew Wakefield, the notorious ex-doctor who published a fraudulent (and later retracted) study claiming that MMR vaccines caused autism. Nearly 20 years later, despite Wakefield losing his medical license because of his "elaborate fraud," he continues to push his debunked claims.

Fortunately, many people are now pushing back. Just last week, noted New Zealand physician Dr. Lance O'Sullivan jumped up on stage at a screening of "Vaxxed" to warn people in the audience that they were being defrauded. O'Sullivan was named New Zealander of the Year in 2014 for his efforts to bring health care to disadvantaged people in rural areas. I will close with his words from a Radio New Zealand story describing the dangers of vaccine refusal:

"We are trying to save a child's life, we put it on a helicopter, it flies to Starship Hospital. The kidneys are failing, its heart's failing, its lungs are failing. All because we didn't put a bloody $7.50 meningococcal vaccine into that child's thigh."

Anti-vax movement helps create worst year of mumps in a decade

The year isn't quite over yet, but we've already had 4,258 cases of mumps in the U.S., more than any year since 2006, when we also experienced a dramatic spike in cases. As the chart here shows, before 2006 we only saw a couple of hundred cases per year, but the numbers have been trending higher since then. After two years with about 1200 cases each, this year looks to quadruple last year's total when the final numbers come in.

Source: CDC, Morbidity and Mortality Weekly Report (MMWR), Notifiable Diseases and Mortality Tables

Just as in 2005, the outbreaks were centered in a few states, mostly on college campuses in the middle of the country, especially Iowa, Illinois, and Indiana. (The 6500+ cases in 2005 were mostly in or near Iowa and Illinois.)

Why are we seeing this increase?

At least some of the blame, if not all of it, belongs to the anti-vaccine movement. Despite overwhelming evidence that vaccines save lives, and that the risks are miniscule compared to the enormous benefits, the anti-vaxxers remain in denial. They claim that the government–usually the CDC–and pharmaceutical companies have been conspiring for years to hide the so-called harms of vaccines, and they spread misinformation and fear in a continual effort to get parents to withhold vaccines from their children.

The main harm claimed by the anti-vax movement is autism. This belief, though fervently held by many anti-vaxxers, is absolutely false. It was originally proposed in a now-retracted, discredited 1998 study by Andrew Wakefield, who was later shown to have fraudently manipulated data, hidden his secret payments from lawyers who wanted to sue vaccine makers, and treated the children in his own study unethically. In 2010, Wakefield was stripped of his UK medical license. As the BMJ editors wrote in a 2011 editorial:

"Who perpetrated this fraud? There is no doubt that it was Wakefield."

Nonetheless, Wakefield he continues to promote his bogus claims (most recently with an anti-vax movie, which I won't name here to avoid promoting it), and remains a hero to the anti-vax movement, who seem blind to his flaws.

This is reprehensible–and frightening. If all parents followed the anti-vaxxers advice, we would see massive surges in vaccine-preventable illnesses, sometimes leading to permanent harm or even death in helpless children. Fortunately, most children are still getting their vaccines, but the anti-vaxxers have succeeded in reducing vaccination rates in many communities around the country, illustrated most recently by the 19-fold increase in vaccine exemptions in Texas.

Twenty years ago, we had under 200 cases of mumps per year, and it was no longer endemic in the United States. In other words, the only cases in the country were imported by people traveling here from other counties. The same was true for measles, which is much deadlier than mumps. Fortunately, rates of measles are low again this year, after the major outbreak that started in Disneyland in 2015, but if anti-vaxxers have their way, more outbreaks are in our future.

This amazing progress was all thanks to the mumps vaccine, which today is part of the MMR vaccine, which also protects you from measles and rubella. Before the vaccine program started in 1967, we saw about 186,000 cases of mumps annually in the U.S. The vaccine led to a 99% reduction in mumps (and measles). It's not perfect: the mumps vaccine is about 88% effective, but when everyone is vaccinated, "herd immunity" prevents the disease from spreading, even if a few people get sick. As the CDC explains,

"outbreaks are much larger in areas where vaccine coverage rates are lower."

Perhaps more alarming than the surge in mumps cases is that the U.S. has just elected the first anti-vaccine President in history. Others have documented Trump's "long, sordid antivaccine history," so I won't attempt to describe it here. We can only hope that reason will eventually prevail, and Trump's ignorance about vaccines won't lead to thousands of unnecessary cases of measles, mumps, whooping cough, and other diseases that vaccines can prevent.

MMR vaccine (still) doesn't cause autism, new study finds

Nope.

We’re still spending vast amounts of time and money trying to counter the ill effects of a discredited, retracted paper from 1998 that claimed to find a link between the MMR (measles, mumps, and rubella) vaccine and autism. Even after the The Lancet retracted the study, and even after the British Medical Council revoked the medical license of its lead author, Andrew Wakefield, many people continue to withhold vaccines from their children because of a fear that somehow, despite all the evidence to the contrary, vaccines might cause autism. Vaccines, I hasten to add, have saved millions of lives and are probably the greatest medical advance of the past two centuries.

Now another study has appeared to add more weight to the evidence about the safely of the MMR vaccine. The new study by Anjali Jain and colleagues, just published in the Journal of the American Medical Association, looked at a huge number of children–95,727–for evidence of any link between autism and the MMR vaccine.

The results were not surprising, to those who have been following the science. To quote the conclusions directly: 

“Receipt of the MMR vaccine was not associated with increased risk of ASD [autism spectrum disorder], regardless of whether older siblings had ASD. These findings indicate no harmful association between MMR vaccine receipt and ASD even among children already at higher risk for ASD.”

That should settle it, right? But then, dozens of previous studies should have already settled this question. Unfortunately, due to the ongoing activism of anti-vaccine groups such as Age of Autism, (who already attacked this new study) and to conspiracy theorists such as Robert F. Kennedy Jr. (whom I wrote about last summer, and who was campaigning against vaccines in Vermont just last week), misguided claims that vaccines cause autism or neurological problems persist.

Here are the numbers from the new study. The authors compared vaccinated children to unvaccinated children, using a huge database of medical claims that included at least 5 years of followup. (This was an "observational" study, by necessity–it would be unethical to withhold vaccines from children on purpose.) The relative risk for autism in children who had 2 doses of the MMR vaccine (the recommended amount) compared to unvaccinated children was 0.74. In other words, a child was somewhat less likely to be diagnosed with autism if he or she were vaccinated. 

Even more surprising was the relative risk among children who had an older sibling with autism: in this smaller group, children with 2 doses of MMR were just 44% as likely to be diagnosed with autism as unvaccinated children. This statistically significant finding indicates, unexpectedly, that vaccines might actually protect children from autism.

The authors were quick to note that there are other good reasons for this apparent protective effect of vaccines: in particular, if parents of autistic children withheld vaccines from their younger children, this could explain the effect. Why? Because we know that autism has a genetic component, and that if one child has autism, his younger sibling is more likely (because they share many genes) to have autism as well. Jain and colleagues explained that if these parents withheld vaccines–because of fears spread by the anti-vaccine movement–then their children could contribute to the apparently lower rate of autism in children who were vaccinated. The authors couldn’t rule out a protective effect of vaccines, but scientifically it seems unlikely, and they wisely offered an alternative explanation.

So: once again we have a large, carefully conducted study showing that the MMR vaccine does not cause autism, and even finding evidence that vaccinated children have lower rates of autism. Let's hope this study helps to end the anti-vax movement, so that we can soon stop spending time and money trying to refute their long-discredited hypotheses and instead focus on trying to understand the true cause.

Anti-vaxxers are to blame for a new epidemic of measles in the U.S.

Measles is now spreading outward from Disneyland in California, in the worst outbreak in years. The epidemic is fueled by growing enclaves of unvaccinated people. 

The CDC reports that in just the past month, 84 people from 14 states contracted measles, a number that is certainly an under-estimate, because the CDC doesn’t record every case. California alone has 59 confirmed cases, most of them linked to an initial exposure in Disneyland. A majority of people who have gotten sick were not vaccinated.

For years, scientists (including me) have warned that the anti-vaccination movement was going to cause epidemics of disease. Two years ago I wrote that the anti-vaccine movement had caused the worst whooping cough epidemic in 70 years. And now it’s happening with measles.

Finally, though, the public seems to be pushing back. Parents are starting to wake up to the danger that the anti-vax movement represents to their children and themselves. 

What's sad about this – tragic, really – is that we eliminated measles from the U.S. in the year 2000, thanks to the measles vaccine. As this CDC graph shows, we've had fewer than 100 cases every year since. 

But we had 644 cases in 27 states in 2014, the most in 20 years. And 2015 is already on track to be worse. Measles may become endemic in the U.S, circulating continually, thanks to the increasing numbers of unvaccinated people. Until now, each outbreak was caused by someone traveling from abroad and bringing measles to us. The anti-vaccine movement has turned this public health victory into defeat.

Anti-vaxxers have been relentless in the efforts to spread misinformation. Despite overwhelming scientific evidence that vaccines are beneficial, they endlessly repeat a variety false claims, such as

• Vaccines cause autism. They don’t.
• The preservative thimerosal in vaccines causes autism. It doesn’t.
• Natural immunity is all you need. It isn’t. Measles infects 90% of people exposed to it unless they are vaccinated.
• A healthy lifestyle will protect you from measles. It won’t.

Now, finally, some parents are pushing back. Parents and schools in California, where the epidemic began, are concerned that their children will be exposed to measles from unvaccinated children in schools. And the schools are starting to do something they should have done long ago: send the unvaccinated kids home.

The problem arises from California’s vaccine exemption policy: although public schools require kids to be vaccinated, parents can exempt their kids simply by saying they have a personal objection to vaccination. It’s not just California: only two states, Mississippi and West Virginia, don’t allow parents to claim a philosophical or religious exemption to vaccines  And Colorado has the worst rate of vaccination, at just 82%, primarily due to parents claiming a “philosophical” exemption.

These parents are the anti-vaxxers. Thanks to them, we now have large pockets of unvaccinated children through whom epidemics can spread further an faster than we’ve seen in decades. The CDC reports that in 2014, 79% of measles cases in the U.S. involving unvaccinated people were the result of personal belief exemptions.

Anti-vaxxers don't recognize the threat their behavior poses to others, especially to children whose immune systems aren’t functioning properly. CNN reported this week on the case of Rhett Krawitt, a 6-year-old California boy who has gone through 4 years of chemotherapy for childhood leukemia. His leukemia is in remission and he’s back in school, but the treatment wiped out his immunity, and he’s still not ready to get vaccinated. If Rhett gets measles, he might not survive. His father Carl wrote to school district officials to ask them to ban unvaccinated children from school.

Krawitt expects the schools to deny his request.

Meanwhile, the parents who refuse to vaccinate their kids aren’t budging. The New York Times reported on one mother, Crystal McDonald, who refused to vaccinate any of her four children, after “researching the issue” by reading anti-vaccine websites. When their high school sent her daughter home for two weeks, the daughter asked if she could get the measles shot so she could return. As quoted in the Times, McDonald told her daughter “I said ‘No, absolutely not.’ I said I’d rather you miss an entire semester than you get the shot.’”

Where does this breathtaking science denialism come from? It’s been building for years, as I and many others have written. The wave began with a 1998 paper published in The Lancet by Andrew Wakefield, claiming that the MMR vaccine was linked to autism. Wakefield’s work was later shown to be fraudulent, and his claims about the vaccine "dishonest and irresponsible." After lengthy investigations, the paper was retracted and Wakefield lost his medical license. Despite this very public repudiation, Wakefield has stuck to his claims, though, and has spent much of the past 15 years speaking (or perhaps “preaching” would be a better term) to anti-vaccine groups, to whom he is a kind of folk hero.

It’s not just Wakefield, though. Anti-vaccine messages have been broadcast aggressively by the group Generation Rescue, led by former Playboy playmate and MTV host Jenny McCarthy, and by Age of Autism, a group dedicated to the proposition that vaccines cause autism. (Age of Autism is doing it again right now.) And just last summer, Robert F. Kennedy Jr. published a new book further promoting the long-discredited claim that thimerosal causes autism. 

Most of the anti-vax crowd have no scientific training or expertise, which might explain (but doesn't excuse) their complete ignorance of the science. Over the past 15 years, dozens of studies involving hundreds of thousands of people have shown convincingly that neither vaccines nor any of the ingredients in them are linked to autism. Vaccines are not only safe, but they are perhaps the greatest public health success in the history of civilization.

Measles, though, is dangerous. The CDC’s Anne Schuchat had a message for parents this week:

“I want to make sure that parents who think that measles is gone and haven't made sure that they or their children are vaccinated are aware that measles is still around and it can be serious. And that MMR vaccine is safe and effective and highly recommended.”

Make no mistake, measles is a very dangerous infection. In the current outbreak, 25% of victims have ended up in the hospital. And it is extremely infectious: the CDC’s Schuchat explained that 

“You can catch it [measles] just by being in the same room as a person with measles even if that person left the room because the virus can hang around for a couple of hours.”

Perhaps the Disneyland epidemic, which has now spread to 14 states, will finally convince parents, schools, and state legislatures that they need to insist that children get vaccinated before going to school. Perhaps it will also convince parents to stop listening to nonsense, and choose wisely by getting their children vaccinated against measles. We won this battle before, and we can win it again.

Cashing in on fears of autism

Autism has been the subject of much controversy in recent years.  Rates of diagnosis are rising, and many parents-to-be are understandably worried.  Despite the efforts of many good scientists, we still don't have an explanation for most cases, although we do know that vaccines have nothing to do with it. Many unscientific claims are out there, some of them designed to take advantage of vulnerable parents who are desperate for answers. In this climate, any new claim to have found "the" cause of autism ought to be stated very, very carefully, and backed up by solid evidence.

Just recently, scientists at the UC Davis Mind Institute published a study that described 6 antibodies found in the blood of some mothers of autistic children, and much less often found in mothers of normally developing children.  They suggested that these antibodies somehow got into the brains of developing fetuses, causing autism in the children.  They even gave a name to this form of autism: maternal autoantibody-related, or MAR autism.

If true, this study suggests that a test for these antibodies might predict whether or not a child will have autism.

The study seems plausible, and it was published in a respectable journal called Translational Psychiatry.  Unfortunately, though, the study and the way it has been promoted are plagued with problems.

Perhaps the biggest red flag is that the two lead authors, Daniel Braunschweig and Judy Van de Water already have a patent on the proteins described in their paper, and Van de Water is involved with a company, Pediatric Biosciences (PBI), that is already marketing a test to predict autism based on this study.  Van de Water is the Chief Scientific Advisor for the company, which has licensed her patent for this specific test.  The company website claims

"To date, the test has demonstrated 100% accuracy - meaning if a mother or prospective mother has developed the antibodies, then her child will later be diagnosed with AU [autism] or ASD [autism spectrum disorder]."

Wow. This sounds incredibly accurate. This test is apparently the sole product of PBI, and they trumpeted the new study with a press release claiming that

"PBI is developing a diagnostic test based on these findings that will provide physicians with a reliable set of biomarkers for pre-conception … diagnosis of this Maternal Autoantibody-Related (MAR) form of autism."  

PBI is marketing the test to all "women over 30 who are at least 2 times more likely to give birth to an autistic child" as well as other women.

So, with all this hype, and despite the major conflicts of interest of the lead authors, did the study show what they are claiming?  Is this a test that mothers should take?

In a word, no.

First, the study doesn't even answer the right question.  The study looked at antibodies found in the blood of mothers some years after their pregnancy, not during or before pregnancy. Therefore it doesn't tell us whether a test of a pregnant mother will predict anything at all.  Post hoc analyses like this are notoriously inaccurate: for example, it's easy to find factors that predict every presidential election for the past 50 years, but many of them will perform poorly at predicting future elections.  Similarly, finding 6 proteins that distinguish some mothers of autistic children from mothers of normal children, all measured after the fact, tells us nothing about whether we can predict autism in advance.

Second, their striking claim of 100% accuracy is false.  (Their press release only claimed 99%: "A positive result would mean that they have a 99 percent likelihood of having a child with autism if they proceed with a pregnancy.")  But the study provides no such evidence.  What it did show was that 56 mothers (out of 246) had antigens to one of 12 combinations of 3 antigens that they selected.  [Aside: there are many other combinations of antigens that they did not report, and no indication that they properly adjusted their statistics to account for this.] But the study failed to say whether these 56 mothers also had non-autistic children.  If they did, then even the mothers in their own study had a much lower chance than 99% of having an autistic child.  Given that many families with autistic children also have other, non-autistic children, touting an accuracy number like this, without proof, is outrageous.

The study isn't completely worthless: it points to a possible link between antibodies in the blood of the mother and autism in a child.  If Van de Water were truly interested in the welfare of autistic families, she would be focusing on the obvious next step: test a large, randomly sampled collection of pregnant women for the same antibodies.  Then follow them up, over the next few years, to see if the test can predict the likelihood of having an autistic child.  Meanwhile, no one should be selling a test before studies can show that it has some predictive value.

But Van de Water and her friends at Pediatric Biosciences seem far more interested in making money off the fears of prospective parents.  PBI is planning to charge about $800 for their test, which they'll begin selling next year. Stanford University biostatistician Steven Goodman says that they are "peddling false hope that giving birth to autistic kids can be avoided."

A news article in Science last week raised many serious questions about Van de Water's study and its claims.  Several scientists quoted in that article questioned the premise of the study: that antibodies from the mother somehow get into the brain of the developing fetus. Yale scientist George Anderson said the data are too preliminary and the statistics too weak to support a clinical test (essentially the same argument I'm making here).

And what about that 99% claim?  In their interview with Science, Van de Water and Jan D'Alvise (president of PBI) said it

"was not meant to convey likelihood in the statistical sense, but rather the 99% accuracy with which the study demonstrated specificity of the biomarkers for ASD."  

This is unadulterated poppycock. As of this writing, the company website still claims that the test has "100% accuracy--meaning if a mother or prospective mother has developed the antibodies, then her child will later be diagnosed with AU or ASD [autism]."  That claim couldn't be any more clear - or any more wrong.

With all the controversy over the causes of autism, and with the medical community still struggling to correct the tremendous damage caused by Andrew Wakefield's fraudulent study linking vaccines to autism, the last thing we need is an erroneous claim that someone has found the cause of autism.  And it's far too soon to start offering moms a test that tells them they're going to have an autistic child.

Congress holds an anti-vaccine hearing

I was in my car yesterday listening to C-SPAN (yes, I do that sometimes), when to my stunned surprise I heard Congressman Dan Burton launch into a diatribe on how mercury in vaccines causes autism.  No, this was not a replay of a recording from a decade ago.  The hearing was held just a few days ago by the Committee on Oversight and Government Reform.

Congressman Burton used this hearing to rehash a series of some of the most thoroughly discredited anti-vaccine positions of the past decade.  Burton is a firm believer in the myth that vaccines cause autism, and he arrogantly holds the position that he knows the truth better than the thousands of scientists who have spent much of the past decade doing real science that proves him wrong.  

In a classic political move, the committee called on scientists Alan Guttmacher from the NIH and Colleen Boyle from the CDC to testify, but in fact the committee just wanted to bully the scientists.  Committee members lectured the scientists, throwing out bad science claims, often disguised as questions, thick and fast.  Alas, Guttmacher and Boyle weren't prepared for this kind of rapid-fire assault by pseudoscience.

Burton himself was the worst offender, offering anecdotes and bad science with an air of authority.  He stated bluntly: 

“I’m convinced that the mercury in vaccinations is a contributing factor to neurological diseases such as autism."

No, it isn't.  Dozens of studies, involving hundreds of thousands of children, have found the same thing: there is no link whatsoever between thimerosal and autism, or between vaccines and autism.  And Burton went off the deep end with this: 

"It wasn’t so bad when a child gets one or two or three vaccines… Mercury accumulates in the brain until it has to be chelated.” 

Bang bang, two false claims in 10 seconds.  First he claims that mercury from vaccines "accumulates in the brain", a statement with no scientific support at all. Then he claims that chelation therapy is the solution - a radical, potentially very harmful treatment that no sensible parent would ever force on their child.  Unfortunately, some quack doctors have experimented with chelation therapy on autistic children, despite that fact that it can cause deadly liver and kidney damage, and one of them caused the death of a 5-year-old boy in 2005.

Burton also claimed that single-shot vials would "eliminate the possibilty of neurological damage from vaccines" - a claim that was invented out of thin air by the discredited anti-vax doctor Andrew Wakefield, whose fraudulent 1998 study was the spark that started the current wave of anti-vax hysteria.

Congressman Bill Posey from Florida was just as bad as Burton, demanding a study of vaccinated versus unvaccinated children, a standard talking point of the anti-vax movement.  (Congressman Posey: do you even realize that your question is almost identical to what Jenny McCarthy asked five years ago, on the Larry King Live show?)  Here's his question to the CDC's Boyle:

"I wonder if the CDC has conducted or facilitated a study comparing vaccinated children with unvaccinated children yet - have you done that?"

Dr. Boyle wasn't prepared for this.  She tried to point out that many studies have been done looking at the relation between vaccines and autism, but she didn't get very far before interrupted, thus: 

Rep. Posey: “So clearly, definitely, unequivocally, you have studied vaccinated versus unvaccinated?” 

Dr. Boyle: “We have not studied vaccinated versus unvaccinated." 

Posey: “Never mind. Stop there. That was the meaning of my question. You wasted two minutes of my time."

Dr. Boyle simply wasn't prepared for a Congressman who was parroting anti-vax activists.  It's too late now, but her response should have been this:

Congressman Posey, only an extremely unethical scientist would consider conducting such a study.  To compare vaccinated versus unvaccinated children in the manner you suggest, one would have to withhold vaccines from young children.  We know from decades of evidence, involving tens of millions of children, that vaccines save lives.  Few if any medical interventions are more effective than vaccines. 

But Congressman, the scientific community has done observational studies of vaccinated versus unvaccinated children, comparing autism rates in children whose parents chose not to vaccinate.  Those studies show that autism rates were slightly higher in unvaccinated children.  That's right, vaccinated children had autism at a lower rate. 

So no, Congressman Posey, the CDC hasn't done a study of vaccinated versus unvaccinated children.  Only a corrupt dictatorship could impose a study like that on its people.  Is that what you want?

To make matters worse, the House committee invited Mark Blaxill to testify.  Blaxill is a well-known anti-vaccine activist whose organization, SafeMinds, seems to revolve around the bogus claim that mercury in vaccines causes autism.  His organization urges parents not to vaccinate their children, and giving him such a prominent platform only serves to spread misinformation among parents of young children.  

Blaxill's central claim is that that we're in the midst of an autism epidemic: 

"For a long time, reported U.S. autism rates were low, estimated at about 1 in 10,000. Then around 1990 something new and terrible happened to a generation of children. Autism rates didn’t just rise, they multiplied," claimed Blaxill in his written testimony.

His entire argument builds on this.  Yet multiple studies, looking carefully and objectively at the data, indicate that all or nearly all of the rise in autism cases is due to increasing diagnoses, which in turn is due to multiple factors: a dramatically broading of the definition of autism in the early 1990s, a greater awareness of the condition, and a greater willingness of doctors and parents to accept the diagnosis.  For an objective summary of the evidence, see the articles by neurologist Steven Novella here and here, which summarize a dozen epidemiological studies.  The weight of the evidence shows that the actual incidence of autism is either stable or possibly rising very slowly.  There is no "autism epidemic."

It's also worth pointing out that Blaxill is a conspiracy theorist who claims that the "CDC has actively covered up the evidence surrounding autism’s environmental causes."  

Congress has every right to conduct oversight into medical research at the NIH and the CDC.  But when Dan Burton, Bob Posey, and others decide in advance what the science says, and abuse their power to demand "answers" that validate their badly mistaken beliefs, people can be harmed. Over the past decade, the anti-vaccine movement has successfully convinced millions of parents to leave their kids unvaccinated, and the result has been serious outbreaks of whooping cough, haemophilus, measles, chicken pox, and mumps around the U.S. and Europe.  

Some anti-vax parents claim that these childhood illnesses aren't so bad.  I wish they would talk to the parents of young children who have died in recent whooping cough outbreaks.  These illnesses can be deadly.

Message to Congress: science isn't easy, and autism is complicated.  Don't criticize science when it doesn't give you the answer you thought you knew.  That's not how science works.  Thousands of scientists are now trying to identify the causes of autism, and they've made progress, especially on the genetic front.  The answer might not be simple, but we will find it.