Offit and Mnookin: Vaccine Science, Realities, and Fears in the Popular Mind
Last Tuesday, I attended an event, sponsored by History of Vaccines, at The College of Physicians of Philadelphia – home of the Mutter Museum. Seth Mnookin, contributing editor for Vanity Fair and published author, and Dr. Paul Offit, creator of the Rotavirus vaccine and chief of the Division of Infectious Diseases for CHOP, spoke about the dangers of not vaccinating and what we can do to hopefully right the wrongs.
Before the lecture, I had a chance to sit down with Seth Mnookin and pick his brain. I’ll admit that I was intimidated at first, but he was very down-to-earth and friendly, which eased my nerves immensely. Also, it’s entirely possible that our children will get married one day. Just sayin’.
Without the support of celebrity activists, do you think as much damage would have been caused through the anti-vax movement as there has been?
I think that, in the case with Jenny McCarthy, who I think is probably the big celebrity activist, I really think Oprah had more to do with that than Jenny McCarthy did. Obviously, she sort of had her book launched on Oprah and she got a lot of subsequent attention. But there are lots of celebrities who get attention for things but it doesn’t catch on. I think it was really Oprah and Larry King and other press outlets that legitimized that in a way and I think that could have happened if it hadn’t been a celebrity. Even if it had just been peoples’ stories, that was what sort of caught people about that. The thing about Jenny McCarthy is that so often she’s referred to so dismissively as just a Playboy Playmate. She’s very articulate and well spoken and I think her initial appeal in the 90′s had as much to do with the fact that she was outspoken and frank as it did with the fact that she was naked. So I think her ability to communicate effectively had a lot to do with it. But I think the press’ role in legitimizing that was just as important.
Why do you think society puts so much credit on celebrities? Like, “If she says so, it must be true”.
I think in this case, specifically around vaccines, a big issue has been that whole sense of narrative. Jenny McCarthy and anti-vaccine activists have a story that makes a lot of sense on a sort of intuitive level. Especially when you’re in a historical period where a lot of these diseases have become sort of notional. Where the fear of them has become notional. Ten years ago, five years ago, even now, even with the fact that there was a measles outbreak in California a couple years ago and obviously these whooping cough outbreaks, I think still for the vast majority of the population, those diseases are… it’s sort of hard to imagine your own child getting them. Autism is something that even if someone doesn’t have a personal connection to it, it’s much easier to put yourself in the position of a family who’s affected by it. I think more than celebrities it’s stories. I think that humans look for stories that make sense to us. Immunology doesn’t necessarily make a lot of intuitive sense.
—-Dr. Offit enters, I hold back fangirl squees, and Seth spills his water bottle on a ‘measles’ Giant Microbe—-
How did you become interested in the whole vaccine “debate”?
It was before I was a father or a father-to-be and it kept coming up as a topic with my friends. What struck me was that they kept discussing it terms and language that they would have been very dismissive of if it had been a discussion about the environment or creationism. If someone said to them, “Well it was freezing cold this winter,” or “There was 8 feet of snow, how could there be global warming? It just doesn’t feel right to me.” To a lot my peers that would seem like the most ridiculous thing. How could you not pay attention to the evidence? Yet here there was this issue about which they were saying, “Well, it just doesn’t feel right.” When I started I hadn’t looked into it at all, so I wasn’t thinking their instinct was right or wrong, it just struck me as interesting that that was how they were making their decisions. I had studied the history of science in college, so the sort of sociology of knowledge and information, the psychological way in which we’re understanding more about decision making through neuroscientific imaging… all of those were things I had been interested in. It all sort of dovetailed around this.
Dr. Offit has been through hell with the anti-vaxxers. Aside from a certain level of crazy, have the anti-vaxxers given you any reason to be concerned about your safety or the welfare of your family?
No. I took some prophylactic measures in terms of my home address and pictures of my son not being readily available, but no I don’t think I’ve had to deal with something like what Paul has had to deal with because he’s been active and vocal about this for so long and because I think a lot the anti-vaccine movement sort of views him as the embodiment of the enemy.
—-”Evil!” chimed in by Dr. Offit, to which I responded that he looked like he was made of pure evil. He doesn’t. I kind of wanted to hug him.—-
When I get messages in all caps or when they quote the Bible, those are the ones I tend to be kind of concerned about, and any specific threats. But most of the messages I get are, you know, “you’re stupid” or “you’re gullible” or “you were taken in”. And a fair amount of “you’re a Pharma shill patsy”.
How much are they paying you, by the way?
I think they have my bank routing number wrong!
—-”As much as they’re paying me!” – Dr. Offit—-
But no, I don’t think I’ve had to deal with anything like what Paul’s had to deal with on that level. And hopefully won’t.
Talking about your son, have you been screening playdate friends and have you had any concerns like daycare?
No, I mean I know people who are on delayed vaccination schedules or haven’t given their children all of their vaccines. When he was very young I certainly was very conscious of that. My mother actually caught Pertussis last year and was unaware that she didn’t have her booster and I was unaware that I didn’t have my booster, so I got it from my pediatrician. But she got incredibly sick and broke 4 ribs and it was misdiagnosed for a period of time. So on a personal level I’ve had more experience with what can happen with under-immunized adults. It’s something I’ve been conscious of but not overly so.
As a relatively new parent – he’s only 15 months old – what kinds of unskeptical advice did you receive?
The term “skeptic” is so interesting because people who disagree with the facts, in this case, say that they’re skeptical. No, it was more talking about the topic of my book. When I said I was writing about vaccines and autism, I was surprised at the number of people who said, “Oh I know, can you believe that vaccines cause autism?” I think most of the people who knew me by the time my son was born knew where I was coming from, so they weren’t advocating homeopathic treatments or anything. There was one time when I went to the pediatrician and I had questions about something, and so I had some print outs. I’ve never seen such fear in a doctor’s eyes as when she saw those papers, like she was thinking, “Oh no! Another internet print out!” But then she saw they were from the AAP and a look of relief washed over her. But no, I think most of the people who would be talking to me about my son on a personal level know where I’m coming from on this.
What advice might you give to a new or uninformed parent who may not know how to differentiate between reasonable questioning and full on misinformation?
Definitely read my book! My feeling is that if you don’t trust your pediatrician, you have a sort of fundamental problem with the care you’re getting for your child. I’ve never really understood the sort of buffet approach to health, like I’ll listen to some things my doctor says but not others. If you’re saying they went to 7-12 years of training and schooling, where is this sort of arbitrary place where this I choose to believe and this I don’t? You should talk to your doctor about it and if you don’t have the kind of relationship with your doctor that you can discuss that, then that’s a problem. I know that when you have a 15 minute appointment and you’re rushing to get through all of your concerns, it can be very difficult to do and I think that’s when parents tend to feel the most patronized to. When they have these concerns and they’re being told not to worry about it because there’s a crying kid in the waiting room. At my son’s 9 month check up, there were some questions I had so I called the office before hand and I said in addition to our normal checkup, there are some things I’d like to go over and I want to make sure that there’s time to actually discuss them. So that appointment was scheduled for a little bit longer. Some pediatricians have been doing the equivalent of office hours, where maybe one night a month they’ll let parents come in and ask questions and not have to worry about getting kicked out in 10 minutes.
But I think that really people should talk to their doctors about these things. And when you were asking me earlier about celebrity involvement, I think another big factor here was that the medical establishment and the public health establishment was incredibly behind the curve in realizing they had to have a way to effectively communicate with the public. These fears, specifically about autism, started cropping up 12 or 13 years ago and for years the general attitude could be described as, “That’s silly, no one’s going to believe that”. I think that did a lot of harm. Now the CDC and the AMA and the AAP and state health departments are much more aware of the need to have easily digestible, easily accessible information. Today if you go to the CDC website and have questions about vaccines or autism and vaccines, they have information that’s easy to navigate. You can go online and find reliable information. I’m a reporter so I always assume the government is out to screw me and big business is evil, but here you can go to the CDC, AMA, AAP or state health departments so it’s not like we need to say we’ll go look at Merck’s website for information on vaccines.
How do you feel about groups like Women Thinking Free with their ‘Hug Me I’m Vaccinated’ campaign? Do you think that we need to create more of a grassroots effort to spread the message further?
Yeah. Another thing that was happening from the outset of this was it was one of those issues where there was a very polarized group of people at one extreme that felt extremely strong about this. At the time you didn’t have a group of people on the other side that were equally engaged because we hadn’t seen the effects of the anti-vaccine movement and with the Hug Me I’m Vaccinated campaign, now there’s a grassroots effort with people who are equally engaged and equally passionate about it. One of the reasons I think that’s so important, and I’m sure you’ve experienced this, is that so much of this debate is dictated by word of mouth. You know, “I was at the playground talking to so-and-so’s parents or my friends or this group of people.” Our peers are a very powerful influence, so the more people in general who come in contact with people that they know who can talk to them about the science and the facts and why vaccinations are important and know enough about the issue that they can address some of those concerns and not just say “don’t be stupid” and explain why those concerns are things people shouldn’t really have to worry about, I think that’s really important.
I’ll make this my last question. What do you hope to accomplish through the publication of your book? What message, over all, do you want to send?
The thing that I hope my book can do, and it would be great if this happened because people were reading it, but also if they’re just talking about it, is… so much of the discussion about this came from people who I think the general public viewed as already having a stance on this before they started their work. Paul Offit, obviously. Jenny McCarthy, obviously. I think that when people saw doctors or public health officials, for a lot of people there was this circular logic loop where they thought, “well if I can’t trust the medical establishment because they might be lying to me about vaccines, then why should I trust this medical professional?” and it just became self perpetuating. One of the things I hope my book can do is people can look at it as a resource from the perspective of someone who had no horse in the race. I didn’t have a child, I didn’t know anyone who had been seriously affected by a vaccine preventable disease, or no one in my family was directly affected by autism, I’m not a doctor (despite many of the emails I get, I’m not getting paid by pharmaceutical companies). So that’s a thing I really hope it can do is for people to see it as a resource coming from their perspective if they had 2+ years to do nothing but research it.
Talking with Seth was refreshing. He didn’t come into the picture with intent to prove anyone wrong, but simply from a position of interest. Sometimes getting an outside opinion is all it takes to renew the passion that was dulled by in-group monotony.
After a quick cup of coffee and a danish with my lovely friend Liz, we returned to the college for Seth and Dr. Offit’s lecture. There were a decent number of folks there, and I found myself wondering if any of them were anti-vax and what kind of ruckus they’d be capable of starting. If they were, they didn’t vocalize it. However, we were told before the interview that there would be a police officer on site in the event that an issue arose. Because people are goddamn crazy.
The lectures were great. Dr. Offit was engaging, informative and matter-of-fact. In discussing the multiple attempts people have made to condemn immunology, from Jenner’s smallpox vaccine to the new wave of anti-vaccinationists, he stated, “We’ve failed to learn from history and have been condemned to repeat it”. A sad truth. However, he remains hopeful that we can change the outcome we’re headed towards. I hope he’s right.
Seth was a little less optimistic, but is also not convinced that we cannot fix things. His point: that when a fear is released into the population, it’s extremely difficult to unscare people. People aren’t going to just forget that they were told, and adamantly believed, that vaccines caused autism. Even if we could educate all of the people on the opposing side that the science is right, these aren’t people who are basing their beliefs off of fact. As he said in the interview, they are going by intuition and feeling. That being said, the more we fix now in terms of education, the more we are fixing for the future by not perpetuating misinformation in coming generations. One of the things he feels is necessary is to start being more honest about the repercussions of our actions, in that one family deciding not to vaccinate doesn’t only effect their family.
As much as I love a good lecture, my favorite part of the evening was the discussion with questions from the audience. I kind of almost hoped that someone would write in a ridiculous question about why there’s antifreeze in vaccines, just so I could watch them get taken to school, but I was also relieved that nobody did. I did learn things, though! The very first question was in relation to vaccine-preventable illnesses that cause conditions like autism. If a woman is infected with Rubella during her first trimester of pregnancy, her child can be affected by Congenital Rubella Syndrome. In the laundry list of manifestations is autism. Another question was asked about the HPV vaccine and why people who may otherwise be pro-vax may feel weary about it. Dr. Offit and Seth talked about how people are a little more hesitant to get things like the HPV vaccine and Hepatitis B vaccine for their children because they’re uncomfortable with the subject of their child and any STI. The term “anal warts” was mentioned at least 10 times in the following few minutes, which is probably the most times I’ll ever hear it in my life.
Anyone interested in this topic should check out The Panic Virus, and if you get the chance to go see Seth Mnookin speak, please do so. I’m honored that he took the time to sit down with me. Also, Philadelphia area residents, keep your eyes peeled for any speaking appearances by Dr. Paul Offit. If I see any coming up, I’ll add it to the Skepchick Calendar.