Published on: April 14, 2016

Published in: Hastings Bioethics Forum, Health and Health Care, Media, Professional Ethics

When the Tribeca Film Festival canceled its controversial screening of Vaxxed, a “documentary” (with scare-quotes) alleging a Centers for Disease Control cover-up of the debunked vaccine-autism link, it vindicated what scientists have collectively been saying for years: There’s nothing to talk about here . Vaccines don’t cause autism , and there’s no CDC cover-up, full stop.

But the decision to accept, and then kill, the documentary raises important questions that shouldn’t be put to rest just because the film has been. The episode invites us to consider how directors can and should choose to represent a point of view, and challenges us to reevaluate preconceptions (and misconceptions) about what the word “documentary” means as a form of nonfiction storytelling.

To explore the complex issues surrounding documentary ethics, I interviewed seasoned filmmakers and producers, in addition to scholars conversant in vaccine science and politics, about what happened with Vaxxed—and what can and should be learned from the whole messy affair.

This story has presumably captured public attention not only because it involved a famous film festival flip-flopping, but because it speaks to ethical dilemmas that aren’t so easy to unpack.

The Power of Point of View

The man behind Vaxxed is, not surprisingly, the source of much of the controversy surrounding it. When a network of first responders mobilized against Tribeca’s programming decision, it was out of concern that Vaxxed left unacknowledged the polarizing and deceptive biases of its director, Andrew Wakefield. His is not a common household name, but, for vaccine advocates and bioethicists, it’s an unsavory one.

Nancy Berlinger, an ethicist at The Hastings Center who has written on vaccine exemptions, explained why the unusual director matters in this case:

“Andrew Wakefield lost his license to practice medicine in the UK after a 1998 article he published in The Lancet—which suggested a connection between vaccination and the development of autism—was discredited and retracted. The film is directed by him. It’s very much his product. In filmmaking, the director’s vision is important, and presumably this was not about the phenomenon of parents refusing to vaccinate their children, but instead his take on it.”

Berlinger explained that the scientific community lambasted the festival for giving credence to junk science by programming this film. Which begs the question: Is it possible or desirable to create a documentary film without “a take,” or a point of view?

Many filmmakers argue that it’s impossible to present a documentary without the perspectives of a director. Gordon Quinn, artistic director and co-founder of the Chicago-based production company Kartemquin Films, known for its modern classic Hoop Dreams, genially scoffed when I asked him if filmmakers aspired to be objective. “No one ever claimed we were objective—that’s absurd,” he said. “There are filmmakers who are very fly-on-the-wall, but the reality is you have to point the camera one way and not another. If you’re standing behind the police line or if you’re standing on the side of demonstrators looking at the police, it’s a different story.”

Stanford University professor and filmmaker Jan Krawitz also acknowledged that she, and every filmmaker, necessarily brings their own viewpoints to bear on what they direct. Krawitz directed Perfect Strangers, a 2013 film that followed the story of a single kidney donor to explore the philosophical themes that shape understandings of non-directed living organ donation, such as compassion, altruism, and second chances. “I felt responsible to tell (my character) Ellie’s story eloquently and accurately, but the film is necessarily different from a film that she might have made herself,” Krawitz pointed out.

But here’s the thing: As Krawitz puts it, having a point of view is a good thing—as long as it’s not pretending to be anything more than that. “I would argue that an independent documentary filmmaker presents a perspective that can and should have a point of view as long as it doesn’t masquerade as some sort of ‘objective truth,’ which ultimately is elusive,” she said in an email.

This was the problem with how Wakefield and Tribeca framed Vaxxed: Its promotion relied on camouflaging bias, presenting the film as a detached account of medical history, when it very much was not.

Which raises a secondary question: If a documentary filmmaker has a responsibility to present their bias . . . what’s the ethical way to go about doing that?

Why Transparency Matters

Polemicist filmmakers, like Michael Moore (Where to Invade Next), are careful to acknowledge their ideological points of view from the start. “There are many examples of partisan films in which the filmmaker is a participant, but they are generally foregrounded as such,” Krawitz said. “The films of Michael Moore or Laura Poitras come to mind. With both of these filmmakers, the audience is invited to share the subjectivity of the filmmaker, and there is no attempt to conceal the director’s bias.”

There was no such transparency in how Vaxxed promoted itself, and, for that reason, some filmmakers hesitate to categorize it as a polemic. For example, the film’s trailer features Wakefield as a coiffed, on-screen expert interpreting an allegedly deceitful CDC graph and concluding, “Wow, the CDC had known all along there was this MMR-autism risk.” (“MMR” refers to the measles, mumps, rubella vaccine.) Reassuring professional honorifics, “Andrew Wakefield, MB, BS Gastroenterologist,” flash alongside his name as he pontificates.

This is a misleading way to introduce someone banned from practicing medicine in Britain for unethical conduct, including conducting unnecessary medical procedures on children , no? The trailer represents Wakefield’s viewpoint as what concretely happened, and his affiliates as whistleblowers. However, there are many reasons to think his viewpoint is not accurate or truthful.

Tribeca Film Festival has also been criticized for editorializing and concealing the blemishes on Wakefield’s professional record. These actions had the effect of looking like an intentional omission that obscured the director’s point of view in Vaxxed.

When it announced the programming, the festival failed to mention that Wakefield was stripped of his medical license and had his 1998 Lancet article retracted. Perplexingly, the online 2016 film guide celebrated his research study as something that would “catapult Wakefield into becoming one of the most controversial figures in the history of medicine.”

This is a strange way to dress up the fact that the medical community excommunicated Wakefield from its ranks after he committed scientific fraud . Tribeca’s description of the film—now removed from the site, but available here —also failed to transparently recognize the position of Wakefield as someone with a great deal of skin in this game, as someone disgraced by the scientific community and presumably looking to have his name cleared.

Filmmaker Dan Rybicky ( Almost There ) imagined different scenarios in which it might have been okay to screen a movie like Vaxxed:

“While many documentaries have chosen to present only one side of a story (Michael Moore’s films come to mind), I think the bigger concern here is that the Tribeca Film Festival did not provide enough context about this particular documentary in their description of it on their website. If they had—and if they had maybe included in this year’s program another autism documentary which presents the other side of the story (if one exists)—I think Vaxxed could have remained in the festival. In a way, I wish it had, because the post-screening dialogue would have been extremely compelling and possibly revelatory.”

“Providing different perspectives to a story and its characters allows audiences to make up their own minds about who and what to believe,” Rybicky added.

Polemics aren’t necessarily dimensional in this way, but they differ from propaganda by foregrounding biases as such, while still remaining unapologetically partisan.

The Truth-Telling Burden

Filmmakers and ethicists generally agree that filmmakers have an obligation to present information that, if not objectively “true,” is at least honest in intent. But this, too, is a complicated notion.

“The responsibility that the filmmaker has is to be truthful to their vision of the world and not to intentionally misrepresent,” said Justin Schein, director and co-founder of Shadowbox Films . But intent is the operative word here, because, even if Wakefield’s film misleads people, it’s not clear that he means to mislead. He could honestly believe in his version of events, that the CDC knowingly covered up a vaccine-autism link and harmed innocent children.

“Of course, my entire conception of reality could be false in some fundamental way, and if so, all of my efforts to ‘honor the truth’ will obviously fail, even if I try to be an ethical person,” said Penny Lane ( NUTS! ), a filmmaker who recently published an open letter about Vaxxed to Tribeca Film Festival . She continued:

“I can only honor the truth to the extent to which I can know and understand it. Perhaps an ethicist would have to weigh in on this: If I intend to tell the truth, but fail to do so due to an inability to locate and/or recognize the truth, am I behaving ethically? I have absolutely no idea whether Andrew Wakefield believes his own bullshit, and therefore I haven’t a clue if when he made Vaxxed, he did his best to honor the truth as he understands it, or if he is just a plain old liar.”

Whether Wakefield believes his unbelievable version of medical history is an insoluble, albeit fascinating, question. A more gratifying thought experiment might be: How should a film representing vaccine politics, with a director as entangled in those politics as Wakefield is, disclose its entanglements? This is a question documentary filmmakers face constantly, often in the midst of production.

In his recent film, Left on Purpose , Justin Schein becomes involved in an impossible ethical dilemma while documenting the past and present of the aging peace activist Mayer Vishner. Schein made the artistic choice to incorporate that entanglement in the film for the sake of accuracy and transparency.

Subject Mayer Vishner and director Justin Schein filming ‘Left on Purpose’. (Credit: Justin Schein)

“I have come to believe that when the ethical challenges of making the film dramatically impact the course of events that it must be acknowledged in the film—otherwise the film will lose credibility in the eyes of the viewer,” Schein said in an email. Similarly, in his film Almost There, Dan Rybicky made a conscious choice to go in front of the camera after learning something surprising about his subject’s past, something that threatens and changes their relationship.

“This is one way in which I tried to remain honest and authentic about my motivation for being involved in the story I was telling,” Rybicky said in an email.

In addition to the burden of honesty placed on the filmmaker, it’s important to consider the responsibilities that festivals and viewers have to be ethical.

“I believe that part of the responsibility of a good festival is to help educate the viewer. This is done by showing films that question the illusions of film and discussing how the films are made,” said Justin Schein.

As Emmy Award-winning documentary producer Marilyn Ness ( Cameraperson and Trapped ) put it in an email:

“Of course, filmmakers and anyone else may have different truths—even discredited ones—like what was put forward in Vaxxed. But then I think the onus is on the distributors, whether it be festivals, broadcasters, or streaming distributors, not to make all ‘truths’ equal. Audiences come to festivals or broadcasts or Netflix because they believe there has been some vetting and some consideration around documentary vs. reality vs. something else. For documentaries to retain their pride of place and their earned right of trust, everyone up and down the line, from filmmakers to distributors, needs to uphold some basic presumptions of truth in the films they champion.”

Nonfiction producer Heidi Reinberg suggested that part of the problem might lie with misconceptions about what “nonfiction” means to viewers. “We live in an age where a large percentage of people feel like if a nonfiction film exists, what’s in it must be true,” she said. “We have access to more media and more information than ever before, and yet people will spread a three-minute video around or a picture that they know to be Photoshopped because it supports their own viewpoint.”

Digital-age gluts of information and misinformation propel the endurance of the anti-vax phenomenon, too. “The Internet and the media continue to imply a connection between vaccines and autism, which fuels public fears,” said Lawrence Gostin, director of the World Health Organization Collaborating Center on Public Health Law & Human Rights and Georgetown Law professor.

The endurance of anti-vax messages isn’t unique, given that other phenomena in health and medicine persist despite best evidence to the contrary. “There are others, such as genetically modified foods and climate change deniers. I think GMO foods is among the biggest and most overblown fears,” he said in an email.

The festival programmers may have prioritized the allure of controversy in selecting Vaxxed. The takeaway might be that such thinking misfires as often as it provokes thought, sometimes at great cost.

Heidi Reinberg offered a poignant and timely metaphor that best analogizes the unintended side effect of pulling Vaxxed from the festival:

“That film is the Donald Trump of nonfiction films—the maker is bucking the establishment, and the ensuing controversy is giving Vaxxed a whole lot more free publicity than it ever would have garnered on its own.”

Nonetheless, now that some of the sensationalist noise has quieted, something must be said for the emergence of a productive conversation about the intractable things filmmakers feel they owe their subjects and audiences. This is part of the disciplinary trend that Gordon Quinn and others have seen, as we move toward more open discussions of ethics in documentary filmmaking.

“We’ve struggled and talked about these issues all the time—we just didn’t name it ethics,” said Gordon Quinn about the discrete choices involved in realizing artistic vision. “But that’s what we all do.”

Chelsea Jack is a project manager and research assistant at The Hastings Center. A version of this post originally appeared in The Establishment.