Friday, November 6, 2009

Book Review: Autism's False Prophets: Bad Science, Risky Medicine, and the Search for the Cure by Paul A Offit, M.D.

This is a really well-written, timely, important book. And just thinking about it makes me tired, and sad and angry. Thinking about trying to write this review makes me tired. Because this book is well-written, timely and important, and it's completely preaching to the choir. It's not going to convince anyone who isn't already convinced, or leaning that way. The book itself contains the argument that explains why this is the case. I'm sure Paul Offit understands that he is preaching to the choir with this book, which makes it brave of him to have written it.

Some people think that brave ones are the doctors and experts who say that mercury in vaccines or vaccines themselves have caused an autism epidemic. They think these people are brave because they are going against the medical establishment and Big Pharma, who are unscrupulous if not downright evil and only care about big profits, not about the lives or health of patients.

In fact, many, if not most, of these people are surprisingly well-funded and demonstrably unscrupulous when regarded a little more closely. Andrew Wakefield, the doctor who raised the possibility of a link between the MMR vaccine and autism, is a prime example of this. On the strength of what was little better than a hunch, he published a paper in the Lancet that led to years of bitter controversy. Later it was discovered that he had claimed that his investigations were sanctioned by the Ethical Practices Committee, which they hadn't. He had also received hundreds of thousands of dollars from personal injuries lawyers who were suing the government for compensation, which he failed to reveal. He paid researchers who produced favourable results for him. He disregarded information that didn't support his claims.

Despite all this, and multiple solid scientific studies that provide no evidence that the MMR has any link to autism (in fact, when Japan discontinued the MMR on the strength of Wakefield's paper, the rate of autism continued to rise), many people still will not be convinced. One of Offit's main points is that science is unfortunately a weak match for splashy headlines and celebrities who passionately advocate for unprovable theories, and claim that the medical establishment ignores them or tries to cover up their 'proof'.

Offit refers back to the silicone breast implant 'fiasco', in which the industry was basically decimated by anecdotal, unsubstantiated claims that silicone breast implants caused connective tissue disease. Massive class action suits were settled, although people who waited in hopes of winning more money individually were out of luck, since eventually the science showed no evidence to support the claims.

One of the major 'problems' with epidemiological studies, which are the most reliable, is that they cannot prove a negative. The most scientists can ever say is that 'there is no evidence' that the MMR or mercury has any link to incidence of autism. In the face of 'miraculous' cures and improvements touted by charlatans who offer chelation therapy and other useless and sometimes harmful 'treatments', this simply isn't sexy enough for the public.

Vaccines are not without risks, and no doctor has ever claimed that they are. Offit refers to incidents where vaccines caused sickness and even deaths. In all of these cases, the CDC detected the problem and halted the use of the vaccines. There was no cover-up, and the deaths caused by vaccines are far, far fewer than the deaths caused by the diseases the vaccines prevent.

In face of the various conflicts of interest, cynicism and suspicion surrounding this issue, Offit asks "if everyone appears to be in someone's pocket, who or what can be trusted? How can people best determine if the results of a scientific study are accurate? The answer is threefold: transparency of the funding source, internal consistency of the data, and reproducibility of the findings." Wakefield's results were never reproducible, or transparently funded.

There are many reasons why parents of autistic children would accept wild theories and unproven therapies over solid science. The so-called experts who propound these theories and therapies generally have simpler aims: publicity, and money. Some of them may actually believe they're trying to help autistic children, and their parents. They aren't.

Offit has been the target of public vitriol, accusations of being paid to say vaccines are safe, and death threats against him and his family. It was brave of him to write this book. I wish I could believe it would make more of a difference.

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