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Vol. LXIV, No. 2
January 20, 2012
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‘Hard to Un-Ring the Bell’
Vaccine Advocate Offit Learns Media Pitfalls in Quest to Educate

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Dr. Paul Offit
Dr. Paul Offit
In the myth of Sisyphus, our hero is continually frustrated when the boulder he is pushing up the mountainside rolls backward just as he approaches the summit. For veteran vaccine researcher, and now perhaps the nation’s default defender of vaccine use, Dr. Paul Offit, his Sisyphusian effort to place the boulder of vaccine safety and efficacy atop the mountain of evidence is thwarted not by the boulder’s rolling back, but by the mountain gaining a spurious kind of altitude, based largely on guff.

Offit, who is chief of the division of infectious diseases and director, Vaccine Education Center, Children’s Hospital of Philadelphia and Maurice R. Hilleman professor of vaccinology and professor of pediatrics at the University of Pennsylvania School of Medicine, did not begin his career aiming to be a weightlifter or mythological hero (although he did once yearn to fly like Superman). He spent 25 years studying rotavirus protein structure and function, eventually helping create an effective vaccine that endured a 4-year, $350 million, 72,000-child study conducted in 11 countries.

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But all of that work stood to be undone when risk of a rare but serious side effect was, for a time, felt to outweigh an ocean of benefit. Today, however, RotaTeq is recommended for universal use in infants.

At a Clinical Center Grand Rounds “Great Teachers” edition on Dec. 14, Offit explained how he made the transition from vaccine crafter to vaccine defender before a packed Lipsett Amphitheater that included—as if to underscore the hazards of his new role—an appearance by a stalker.

“I certainly was naïve when I took on this role,” he admitted. But there was no avoiding the mission once he learned two things: how hard it is to make a vaccine and “how easily a vaccine could be damned.” His outrage became the source of his advocacy.

Offit said he created the Vaccine Education Center in the late 1990s after a paper published in The Lancet by Dr. Andrew Wakefield claimed that the MMR (measles, mumps, rubella) vaccine caused autism.The study, rejected by four of the six editors who reviewed it but championed by the editor-in-chief, only included 13 subjects and overlooked the fact that almost 90 percent of the children in the U.K. had had the MMR vaccine, with no correspondingly high rate of subsequent autism.

But Wakefield, Offit said, was charismatic and persuasive and was able to frighten the public into avoiding use of the MMR vaccine for years, during which time children suffered infections that could have been prevented.

“You could argue that [Wakefield’s paper] killed children,” Offit said, adding that editors and the media who spread his claim were similarly culpable. Despite mountains of evidence indicating that MMR vaccine does not cause autism, “it’s hard to un-ring the bell.

“It’s hard to watch how bad science did the kind of damage it did,” Offit added. Thousands of parents in the U.S. and abroad abandoned the use of an effective, safe vaccine. Offit said that in Europe, from January to October 2011, there were 26,000 cases of measles and 9 deaths. In 2011, there were at least 200 cases of measles in the U.S. “It’s unconscionable, and completely avoidable.”

In a talk he titled “Communicating Vaccine Science to the Public,” Offit shared some hard-won observations from his years defending the methods and fruits of scientific investigation.

“There is much at stake,” Offit said, “and we need to get in the game. The problem is not simply a matter of scientific illiteracy. I think it’s worse than that—I think it’s denialism. Science is increasingly seen as just another voice in the room, which is a dangerous idea.”

“There is much at stake,” Offit said, “and we need to get in the game. The problem is not simply a matter of scientific illiteracy. I think it’s worse than that—I think it’s denialism. Science is increasingly seen as just another voice in the room, which is a dangerous idea.”

Photos: Michael Spencer

First, journalism’s mantra of balance—equal time for opposing views—can be irresponsible and harmful. Offit said that several years ago on Meet the Press, the late Tim Russert featured Institute of Medicine president Dr. Harvey Fineberg on the topic of vaccine safety, countered by an author who not only had no vaccine expertise, but also was a shill for an anti-vaccine group.

“In the name of balance, Tim Russert did nothing to educate his viewers,” Offit charged.

Regarding the news media, Offit said, “You think their job is to educate. It’s not. It’s to entertain.”

Offit says he often calls or writes journalists when he finds them in error and urged other scientists to do the same. He once confronted the executive producer of an ABC-TV news magazine about correcting an egregious misrepresentation of hepatitis B vaccine safety. The producer told him, “Our job is to be interesting. If it also happens to be true, great.”

Offit said scientists are “also up against the limits of the scientific method,” as it is impossible to prove the null hypothesis: “Technically, an epidemiologic study can never provide absolute proof,” he said. (Nor does the fact that, at age 5 and emulating the flight posture of TV’s Superman Offit never actually lifted off, thereby prove him incapable of flight.) “Nevertheless, I think it’s fair to say that MMR [vaccine] doesn’t cause autism—and I can’t fly.”

Offit lamented a cultural milieu in which “anecdote trumps epidemiology,” as when a famous actress can convince millions that her son’s autism was caused by a vaccine. If emotion can effectively sell false notions, then scientists better be willing to employ emotion to counter falsehood, he argued. “We need to frame what we’re saying in an emotional, impactful way,” he said.

Humor can also be used to deflate hokum, he said, as when The Colbert Report host Stephen Colbert (whose dad used to be a prominent NIH scientist, Offit pointed out) skewers hooey by embracing it so ardently.

“Our biggest challenge, however, is that the media doesn’t understand science,” Offit concluded. “It’s a fluid, self-correcting way of thinking, not a belief system.”

Concepts of causality—simple cause-and-effect—can be hard to communicate, he said, in a culture where 50 percent of the population believes in astrology, 46 percent believe in ESP and 35 percent believe in ghosts.

“There is much at stake,” Offit said, “and we need to get in the game. The problem is not simply a matter of scientific illiteracy. I think it’s worse than that—I think it’s denialism. Science is increasingly seen as just another voice in the room, which is a dangerous idea.”

Controversies over global warming, population control, pollution and fluoridation tend to be belief-based, but should be evidence-based, he said. “Vaccines are not a belief system. They stand on a mountain of evidence to support their use.”

He finished with a prescription for the profession: stand up for science, no venue is too small, don’t let bad information go unchallenged and “don’t assume other people are doing it—they’re not. Scientists have a responsibility to the public.”

During a brief Q&A, Offit urged his fellow scientists to “fight the good fight,” and “inform people of the consequences of non-vaccination. Make that come alive—the unneeded suffering and death.” Offit was also challenged by a young man identifying himself as a local graduate student who rose in defense of Dr. Andrew Wakefield.

After fielding the young man’s questions in increasingly measured tones, Offit explained, “One of the consequences of what I do is that sometimes you get hate mail, sometimes you get sued, and now I have a stalker.” This particular student, he said, “often makes disparaging comments about me at national meetings as well as on the Internet.”

Publicly identified as a nuisance, the man stormed out of Lipsett Amphitheater and slammed the door.NIHRecord Icon


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