Communicating Vaccine Science to the Public Paul A. Offit, MD The Children’s Hospital of Philadelphia The University of Pennsylvania School of Medicine

Vaccines are easily damned

MMR Causes Autism

Wakefield, A.J., et al. Lancet 351: , 1998.

MMR-Autism: Scientific Studies I Taylor, B, et al. Lancet 1999;351: Dales L, et al. JAMA 2001;285: Kaye JA, et al. Brit Med J 2001;322:460-3 Madsen KM, et al. N Engl J Med 2002;347: Peltola H, et al. Lancet 1998;351:

MMR-Autism: Scientific Studies II Makela A, et al. Pediatrics 2002;110: DeStefano R, et al. Pediatrics 2004;113: Farrington CP, et al. Vaccine 2001;19: Fombonne E, et al. Pediatrics 2001;108:e58 Taylor, B, et al. British Med J 2002;324:393-6

Impact of Wakefield paper u Hospitalizations and deaths in the United Kingdom and Ireland u Parents of more than 125,000 children in US choose not to vaccinate—outbreaks in US u Current outbreak in the European region

Thimerosal Causes Autism

Thimerosal-Autism: Scientific studies Hviid A, et al. JAMA 2003;290: Andrews N, et al. Pediatrics 2004;114: Herron J. Pediatrics 2004;114: Verstraeten T, et al. Pediatrics 2003;112: Barbaresi W, et al. Arc Ped Ado Med 2005;159:37-44 Schecter R, et al. Arch Gen Psychiatry 2008;65:19-24

Too Many Vaccines Given Too Soon Causes Autism

Too Many Vaccines: Scientific study Smith MJ and CR Woods, “On Time Vaccine Receipt in the First Year Does Not Adversely Affect Neuropsychological Outcomes,” Pediatrics 125 (2010):

Defeating Epidemiology

The journalistic mantra of balance

Epidemiological studies cannot detect rare events

“Vaccines might cause autism in a small group of genetically susceptible individuals.”

Power of epidemiological studies u Paralysis (GBS) and swine flu vaccine u Intestinal blockage and rotavirus vaccine u Omnibus Autism Proceeding

Epidemiological studies don’t prove anything

Epidemiological studies and proof u Null hypothesis: MMR does not cause autism u Reject or not reject the null hypothesis  Cannot accept the null hypothesis

Epidemiological studies and proof u Flying like Superman u WMD in Iraq  Traveling to Juneau, Alaska

Anecdote trumps epidemiology

Cultural Biases

Media’s job is to entertain, not educate

20/20 story about HBV u Sylvia Chase told story of how HBV caused SIDS, rheumatoid arthritis, and MS u Studies had already been performed u Confrontation with executive producer

The media defends the weak against the powerful

Players in vaccine-autism controversy  If you care about children with autism, you support the notion that vaccines are the cause. Lawyers, politicians, fringe scientists, and journalists care. u Doctors, public health officials, mainstream scientists and pharmaceutical companies don’t care.

Players in autism controversy are miscast  Doctors and scientists who oppose notion that vaccines cause autism are standing up for the little guy u Those who claim that vaccines cause autism hurt children by scaring parents about vaccines, proffering dangerous therapies, and diverting limited resources

The media loves mavericks

 “ While Galileo was a rebel, not all rebels are Galileo.” Norman Leavitt

The media falls into the single-study trap

Wakefield, A.J., et al. Lancet 351: , 1998.

The media doesn’t understand science

What is Science?  Science is the systematic enterprise of gathering knowledge about the world and organizing and condensing that knowledge into testable laws and theories Wilson, Edmund O. in Consilience

What is Science?  Formulate a hypothesis and establish burdens of proof. Proofs are subjected to statistical analysis. u Science includes rigorous controls that allows one to isolate the effects of one variable.

What Science Isn’t  Science isn’t scientists or scientific bodies or accumulated knowledge u Science is a way of thinking about or approaching a problem u Although scientists get it wrong all the time, science is enormously self-correcting; but fluidity of science can be disconcerting

Explaining Cause and Effect

The Lay of the Land BeliefPercent of population Astrology50 ESP46 Witches19 Aliens already landed22 Commune with dead42 Ghosts35

Causality u Inability to accept randomness u Whole-cell pertussis vaccine and the birth of the modern American anti-vaccine movement u Nature of coincidence (The Occult)

Conflicts of interest

Ad hominem attacks u If you don’t have the data, discredit the messenger u Appeal to personal considerations rather than logic or reason u Science vs. politics (this isn’t a game)

Easy appeal to toxic, environmental hell

Easy to scare people; harder to unscare them

What’s at Stake

Beyond scientific illiteracy u Scientific denialism u Global warming, fluoridation, evolution

Some suggestions u Stand up for science (not easy) u No venue too small u Don’t let bad information go unchallenged u Don’t assume other people are doing it u We are paid by the public