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As hard as it is to believe, 2009 started out very promising from the perspective of actually countering the misinformation of the antivaccine movement. Antivaccine hero Andrew Wakefield, who with the help of the credulous and sensationalistic media started the entire MMR-autism scare in the U.K. a decade ago, was revealed as not just having been in the pocket of trial lawyers suing vaccine manufacturers and having been an incompetent scientist but as a scientific fraud, thanks to the investigative tenacity of Brian Deer. Thanks to Wakfield, the measles, once declared conquered in the U.K. in the mid-1990s, has come roaring back to the point where it has been declared endemic again by the ealth Protection Agency (HPA), the public health body of England and Wales. This was rapidly followed by the rejection by the Special Masters of the Vaccine Court of the claims of all the test cases in the Autism Omnibus case. It was a one-two body blow to the antivaccine movement.

Unfortunately, the antivaccine movement is nothing if not resilient. After all, the science has consistently been against each of its favorite claims, namely that the mercury in the thimerosal used as a preservative in vaccines or that the MMR vaccine causes autism. They simply move the goalposts and pivoted effortlessly to much harder to falsify ideas, such as blaming “toxins” in vaccines or proclaiming that our current vaccine schedule is “too many too soon.” After scientific setback after scientific setback that have revealed the antivaccine movement to be nothing more than the 2009 equivalent of creationists or the flat Earth movement, why would it matter to them that Andrew Wakefield has been thoroughly discredited and their signature legal action, the Autism Omnibus, has gone donw in flames? It doesn’t. Certainly it didn’t stop David Kirby from duping Keith Olbermann into chastising Brian Deer for nonexistent conflicts of interest; a group proclaiming loudly “We Support Dr. Andrew Wakefield” with a petition; David Kirby, Generation Rescue, and Robert F. Kennedy, Jr. from trying to distract attention from the defeat of the antivaccine movement in the Autism Omnibus ruling; or Andrew Wakefield himself from “complaining” to a press board about Brian Deer’s alleged misbehavior and errors. After all, science doesn’t matter to the antivaccine movement.



So, right on schedule to coincide with the start of Autism Awareness Month, as it has done every year since at least 2007 the antivaccine movement has begun a propaganda tour in order to coopt the term “autism awareness” for its own purpose of blaming vaccines for autism and proclaiming that various forms of quackery can “cure” autism. Indeed, this movement clearly wants to corrupt the term “autism awareness” to mean “antivaccine awareness,” and unfortunately it appears to be succeeding. Key to this effort in 2009 is a brand spankin’ new book by Jenny McCarthy and her “biomedical” guru Dr. Jerry Kartzinel, entitled Healing and Preventing Autism: A Complete Guide. The media blitz started even before Autism Awareness Month began, and I’ve already alluded to the despicable new message that appears to have become Jenny’s mantra (and thus that of the antivaccine movement for which she is the spokesmodel), namely, “It’s not my fault if vaccine-preventable diseases come back; it’s the pharmaceutical companies’ fault for not making ‘safer’ vaccines. Oh, and, by the way, we decide what’s ‘safe.’” Never mind that what makes vaccines “unsafe” to Jenny is based on a discredited idea that scientific study after scientific study has roundly refuted, namely that they cause autism.

Unfortunately, that isn’t all. As the U.K. media aided and abetted the MMR scare in the late 1990s until today, the U.S. media is aiding and abetting the antivaccine scare being promoted by Generation Rescue through its celebrity spokespersons Jenny McCarthy and Jim Carrey. The TIME Magazine interview to which I referred was just the beginning. Get a load of her on Larry King Live last Friday, along with Dr. Kartzinel and J.B. Handley, the same venue where almost exactly a year ago, in her arrogance of ignorance, McCarthy shouted down vaccine scientists on the air, yelling “bullshit!” at them three times. Truly, Larry King is as credulous as they come. The transcript is here, and J.B. Handley wrote a guest post for the Larry King Live blog, entitled Autism is Preventable and Reversible.

There is so much misinformation in the interview and in J.B. Handley’s blog post that it’s hard to know where to start. In fact, I could write a whole series of blog posts, like co-blogger Kimball Atwood, on just this interview and the new misinformation added to the old misinformation being peddled by the antivaccine movement; instead, I’ll be more selective, and readers should feel free to chime in with anything I’ve missed. Now, let’s start with two of the antivaccine movement’s favorite propaganda points:

KING: But you had a major effect, big story in the “L.A. Times” last week, the number of kids not being vaccinated in the public schools in Los Angeles. However at the same time, doctor friend told me today. Mumps are up and measles are up. CARREY: We are not saying don’t vaccinate. That’s the thing we want to get really clear right now with … KING: Let’s make it clear. MCCARTHY: Yeah, we’re not. CARREY: This is the thing. There’s a lot of misdirection going on. We hear the Campbell Browns and people like this that are saying, you can’t not vaccinate. No one has ever suggested not vaccinating. MCCARTHY: Go back to 1989 schedule when shots were only 10 and the MMR was on that list. I don’t know what happened in 1990, there was no plague that was killing children that we had to triple the amount of vaccines. CARREY: What happened back in 1989 that warranted 26 more vaccines? MCCARTHY: Greed. CARREY: Are all of them absolutely necessary? KING: Because they want to make money? MCCARTHY: Of course.

The first antivaccine propaganda point is the claim that Generation Rescue, Jenny McCarthy, Jim Carrey, and J.B. Handley (and by association, the entire antivaccine movement) are not “antivaccine.” That is easily demonstrated to be false (1, 2, 3). Another thread arguing for the disingenuousness of Jenny and Jim in proclaiming themselves to be “not antivaccine” is how the mouthpiece of Generation Rescue (excuse me, “Jenny McCarthy and Jim Carrey’s Autism Organization“), the Age of Autism blog, has such a major, unrelenting focus on vaccines. Indeed, Age of Autism blogger Kim Stagliano recently rejoiced on that very blog that vaccination rates are falling in other parts of the world, crowing that “an educated consumer may be a vaccine company’s worst customer.” (More like a miseducated consumer is the antivaccine movement’s best dupe.) In a similar vein, another Age of Autism blogger, Kent Heckenlively, today asks “Are We Winning the Vaccine-Autism War?” and concludes that the antivaccine movement is winning, as he, like Stagliano, rejoices that the pockets of high levels of vaccine resistance recently reported in Sonoma and Marin counties in California occur in areas where the population is educated and aflluent. Both he and Stagliano seem to labor under the common delusion that education and affluence somehow guarantee an understanding of science; sadly, they do not. They also seem blissfully unaware that the Bay Area is a hotbed of New Age woo and that credulous acceptance of “alternative medicine” appears to be highly correlated with antivaccine views. Even more notably, in his discussion Heckenlively doesn’t even bother to repeat the usual Age of Autism/Generation Rescue mantra that “we are not antivaccine”; rather, he appears to embrace his inner antivaccinationist, in essence equating antivaccine views with the educated and affluent..

Finally, there’s the old “big pharma greed” gambit. No one here at SBM , arguably least of all me, believes that big pharma is on the side of angels, but I can’t help but make one observation. If vaccines are such a huge profit source, then one wonders why the number of pharmaceutical companies manufacturing vaccines has fallen so precipitously over the last two decades. It couldn’t be the low profit margins and fear of litigation, could it, a large part of that fear having been fueled by the antivaccine movent? Perish the thought! And if vaccination rates fall, big pharma is a convenient scapegoat. Perish forbid that anyone would blame the falling vaccination rates in parts of the country on the efforts of Jenny and her merry band of antivaccinationists:

KING: Isn’t the problem here, Jenny, that people sometimes listen with one ear are going to panic. And not vaccine at all? MCCARTHY: Probably. But guess what? It’s not my fault. The reason why they’re not vaccinating is because the vaccines are not safe. Make a better product and then parents will vaccinate. CARREY: We’re not the problem. The problem is the problem.

“The problem is the problem”? How Zen of Carrey.

Actually, the problem is Mr. Carrey and Ms. McCarthy, who are both so full of the arrogance of ignorance that they think they understand the science and medicine of autism and vaccines after studying at Google University; indeed, they seem to think they understand it better than scientists who have spent their entire adult life studying such questions. They’re also completely unwilling to take responsibility for their actions.

Clearly, we’re going to be hearing a lot more of this, as this appears to be the standard Generation Rescue talking point for Jenny to parrot whenever anyone asks her if she feels any responsibility for declining vaccination rates, which in California has produced pockets of vaccine noncompliance that are poised to result in huge outbreaks of vaccine-preventable disease. That’s why this is a mantra that needs to be rebutted at every opportunity. To a large extent, the declining vaccination rate is Jenny’s fault, and J.B. Handley’s fault and Jim Carrey’s fault and Andrew Wakefield’s fault and that of every other antivaccine activist who uses misinformation, pseudoscience, and logical fallacies to frighten parents into thinking that vaccines cause autism. The only reason they try to deny that it is is because they are finally realizing that their actions have consequences and that one of those consequences will be to be seen as the cause of the return of vaccine-preventable disease. Truly, renaming the antivaccine movement to the pro-disease movement sounds more and more appropriate to me.

The most important revelation on JJJ’s appearance (Jenny, Jim, and JB’s appearance) on Larry King Live is that Generation Rescue has come up with one more brand new antivaccine propaganda tool. Before I discuss it, I’d like to take a trip down memory lane to an ad that Generation Rescue placed in USA Today in 2008. The ad showed the vaccine schedule in 1983 and compared it to that of 2008, while making the claim that the increase from 10 vaccines to 36 is the cause of the “autism epidemic. My “friend” Orac had something to say about this claim:

A lot of other things have happened since 1983 as well. For example, in the early 1990s, the diagnostic criteria for autism were broadened, and campaigns for greater awareness were begun. Diagnoses of autism in 1983 were made using the DSM-III, where the criteria for an autism diagnosis were much more restrictive than those in the DSM-IV, released in the early 1990s. Moreover, in 1983, categories of Asperger’s and pervasive developmental disorder-not otherwise specified, both of which are lumped into the 1 in 150 figure for 2008, weren’t recognized in the DSM-III. Of course, if I wanted to be snarky (and perish forbid that I would ever be snarky), I could point out that 1981 was the year that the IBM PC was released, followed by the Apple Macintosh in 1984, both of which led to the exponential growth of households owning and using personal computers. That’s it! It must be computer use that led to the increase in autism in the 25 years since 1983! Wait, what about the compact disc? It just so happens that 1983 is the year that the CD was first released in the American market. Ergo, it must be CDs that cause autism. I could go on, but you get my point. A lot of other things have happened since 1983, but to Jenny McCarthy, J. B. Handley, and their assorted antivax fanatics it has to be those evil vaccines. It just has to be.

I consider Generation Rescue’s new gambit to be simply a cleverer version of the very same fallacy, with a heaping helping of the “correlation equals causation” fallacy thrown in for good measure:

MCCARTHY: The vaccine schedule is too bloated right now. Thirty six shots right now. Back in 1989, the shot schedule was 10 shots given. CARREY: Ten shots given. KING: When I was a kid, what did we get, three? CARREY: It’s twice as many as anywhere else in 30 countries in the Western World. We give twice as many shots as any of those countries. Why is that?

This point is made in more detail in J.B. Handley’s guest post:

Few parents appreciate that American kids are the most vaccinated on the planet. Generation Rescue just released a study called “Autism and Vaccines Around the World” which will surprise many. We looked at the vaccine schedules of 30 other first world countries to compare how many doses of vaccines children receive. What did we find? Compared to our 36, the average for the rest of the first world is 18, or half of the U.S. schedule. Perhaps more shocking, we looked at countries with the lowest rates of mortality for children under 5 (the U.S. ranks a disappointing 34th, behind Cuba and Slovenia). How many vaccines do the 5 countries with the lowest under 5 mortality rates give? Well, Iceland, Sweden, Singapore, Japan, and Norway give 11, 11, 13, 11, and 13 vaccines respectively – all less than 1/3 the number of vaccines the U.S. mandates! How do autism rates compare in some of these other countries? Iceland’s rate is 1 in 1,000, Finland’s 1 in 700, and Sweden’s 1 in 800. These countries give 1/3 the vaccines we do and have autism rates that are as little as one-tenth of ours? Something isn’t right.

Indeed, this is the very theme of a “study” posted on the Age of Autism blog entitled Autism and Vaccines Around The World: Vaccine Schedules, Autism Rates and Under 5 Mortality. If you look at the actual PDF containing the report, you’ll see that it’s obviously intentionally designed to look very much like an actual research report. The type, the format, and the style very closely mimic that of a real research paper. Of course, it is not anything of the sort, and if it were submitted to any halfway decent peer-reviewed journal of psychiatry or–even more so–of epidemiology it would find its way into the cylindrical file, possibly even before being sent out for peer review. It’s nothing more than the logical fallacy of confusing correlation with causation taken to a ridiculous extreme and then prettied up with all sorts of “science-y”-sounding jargon in an attempt to put the proverbial lipstick on the proverbial pig. Whoever put this “study” together at Generation Rescue clearly has no clue how to write such a study up, much less how to do one.

The first thing that struck me about this “study” was how poorly written it was. It looked slapped together, and, although it states that a “full publication and literature review was completed to determine vaccine schedules and under 5 mortality rates for 30 countries. What, exactly, does that mean? If you read any meta-analysis or serious review, you’ll see a careful and precise description of the criteria used to choose studies to include. No such description is given here. One is left with the distinct impression that a bit of cherry picking is going on here.

The second thing that leapt out at me is that there was absolutely no attempt to control for confounders. Indeed, one commenter on Age of Autism, responding to another commenter who pointed out that zero controlling for confounders was even attempted said:

Confounding factors? Since when is that ever a consideration? Perhaps you watch too much television and, based on dispropotionately biased coverage, think every parent in America whacks their kids on the head then stuffs them in the trunk. These are babies under five.

Against such ignorance, the gods themselves contend in vain. The very reason it’s so easy to confuse correlation with causation, even in epidemiological studies that are testing a hypothesis rather than trying to support a preordained conclusion, is because of confounders, and, yes, it is completely irrelevant that these children are under five.

The reasons why the U.S. ranks 34th in childhood mortality is a topic of some controversy and considerable study and discussion. Of course, one wonders why Generation Rescue used the UN World Population Prospects The 2006 Revision when the 2008 Revision is easily available. (Apparently Generation Rescue can’t Google). (It couldn’t be because the under-five mortality rate in the U.S. fell from 7.8/1,000 live births to 7.3 between 2006 and 2008, could it?) Be that as it may, while the Generation Rescue “study” appears to be claiming that vaccines don’t have any relationship to overall childhood mortality, that’s completely the wrong question to be asking because vaccines do not prevent anything other than infectious disease. If we take a look, for example, the 2008 State of the World’s Mothers Report issued by Save the Children, we find some very interesting things, among which is the effect of disparities in health care among the poor, mostly black and Native American, and the better off sustaining our high child mortality compared to that of other developed nations. That’s one huge confounder. Another huge confounder is access to health care; many of the nations mentioned in the Generation Rescue report are nations with universal health care. Whether that drives the difference is a matter of controversy (given the politically charged nature of the discussions of universal health care, how coudl it be otherwise?) but it is yet another huge potential confounder. Of course, the biggest confounder of all is that childhood mortality has been falling in the U.S. for the last two decades. Add to that gun violence and other causes of childhood mortality that are elevated in the U.S. compared to other industrialized nations, and there are so many confounders as to make any inference from these raw numbers utterly meaningless. Again, vaccines only prevent death from infectious disease.

There is also at least one curious omission in the last table (Table 3), which was pointed out, surprisingly enough, by a commenter on Age of Autism. (And when a commenter in the antivaccine echo chamber that it Age of Autism points out a glaring hole in a Generation Rescue propaganda release, you know it’s a really huge hole! This commenter also pointed out that there was not even the most rudimentary attempt to control for counfounders. Truly, this propaganda stinkpile of a “study” is too stinky for any but the most brainwashed of Generation Rescue’s adherents.) Specifically, the U.K. was left out, which is listed as requiring 20 vaccines. That is close to France, which is listed as requiring 17 vaccines. One wonders if this omission is because the U.K. has an autism prevalence comparable to that of the U.S., possibly even higher. I wonder why Generation Rescue left the U.K. out of its last table, purporting to show the relationship between the number of vaccines a nation mandates and its autism rate. After all, the paper claims that it picked countries based on “materially lower levels of mandated vaccines and published autism prevalence data.” I could see where it might be hard to find publications with estimates of autism prevalence in, for example, Cuba, but it’s not as though recent estimates of autism prevalence in the U.K. aren’t readily available. Some “complete” literature search! Given the blatant “forgetting” of an example that most definitely does not support the “hypothesis” of the Generation Rescue paper, I also now wonder why only eight out of the 30 countries examined were chosen for inclusion in Table 3. You don’t think that Generation Rescue left the U.K. out of Table 3 because it didn’t fit with its hypothesis, do you? Unfortunately, I didn’t have time to go searching for all the prevalence data for the countries left out, but it wouldn’t surprise me at all if there were a few more U.K.’s in there.

Even curiouser (well, not really) are the sources used for all the prevalence data. Specifically, the dates of the studies are what stood out to me. Many of them are from the 1990s, and most are from before 2001. Given the increases in awareness, the broadening of the diagnostic criteria that occurred in the 1900s, using these prevalence estimates is meaningless. I could also point out that in the 1990s, the U.S. had a vaccination schedules with considerably fewer vaccines. Table 1 shows that! It would appear that Generation Rescue can’t even keep its story straight in its own study. In any case, comparing a vaccine schedule in 2006 (which is what Generation Rescue did in all cases) with prevalence rates from 5 to 10 years earlier taken from a period of time shortly after the diagnostic criteria had been changed is clueless at best and intellectually dishonest at worst, particularly when it’s done in the context of no effort to control for confounders, no statistical analysis, in essence nothing that any scientist or epidemiologist taking a serious look at the question would consider a minimum effort. In essence, because whoever at Generation Rescue passionately believes that (1) vaccines aren’t nearly as protective as we know them to be and (2) vaccines cause autism, this report ignores all other possible explanations for the numbers and, in fact, doesn’t even pick the right numbers to answer the question. I suppose that if these numbers had been properly picked for valid comparisons one might be able to view them as hypothesis-generating, but so many other studies have specifically looked at the question of whether vaccines cause autism using sufficient numbers to have the power to detect even a weak association and the correct epidemiologial and statistical techniques to analyze the data that throwing this sort of whole population data out as though it were “proof” of anything shows nothing more than how completely ignorant of science whoever wrote it is.

Of course, Generation Rescue isn’t really interested in accurate estimates of autism prevalence, as Sullivan has pointed out:

One of the problems with the vaccines-cause-autism groups is that they really don’t advocate for people with autism. They have abandoned entirely people of low income and minorities (except where they can be used for political gain). It isn’t just that groups like SafeMinds, Generation Rescue and the rest can’t be bothered to spend the time worrying about minorities or adults. It’s the fact that the data those groups use to support the “epidemic” makes ZERO sense when you consider minorities. Consider this: the “rate” of autism is 0.3 per 1,000 for Hispanics in Wisconsin, but 10.6 for Whites in New Jersey. Why isn’t Generation Rescue calling for an investigating the Hispanics of Wisconsin? Shouldn’t they want to know what is “protecting” that subgroup from autism? They don’t care, they don’t want to bring attention to the Hispanics in Wisconsin (or the under represented minorities across the nation), because it blows a big hole in the “epidemic”. Obviously we still aren’t counting all the people with autism in our prevalence estimates. How can we rely on the historical data that shows an “epidemic” if we aren’t doing a good job even now?

The Generation Rescue “study” is another instance of this very phenomenon, except that it even ignored a wealthy nation (the U.K.) because its autism prevalence data didn’t fit in with its conclusion that vaccines cause autism and that nations with lower numbers of mandated vaccines should therefore have lower autism prevalence. The study also completely ignored the far more likely reason why the United States has such an embarrassing level of childhood mortality: Poverty and disparities in care. That’s because, as Sullivan points out, groups like Generation Rescue are not interested in the poor or minorities, except when they are useful to their cause (Somali immigrants in Minnesota, for instance). All they are interested in is proving that vaccines cause autism. Whenever an antivaccinationist finds differences in autism prevalence, he ignores any other possible cause aside from the vaccines. That’s because, to J.B. Handley, Jenny McCarthy, Jim Carrey, and the rest of the antivaccine movement, first and foremost, it’s still all about the vaccines. It’s always been all about the vaccines. It always will be all about the vaccines. Always.

And when their efforts drive down the vaccination rate leading to outbreaks of vaccine-preventable diseases that cause children to suffer and even sometimes die, antivaccinationists will blame it on the pharmaceutical companies and governments for not having indulged their delusions to their satisfaction.

ADDITIONAL READING (chosen for addressing some of GR’s other canards) :

ADDENDUM: A reader was kind enough to point out to me that Bernadine Healy herself pointed out a lot of reasons why comparing childhood mortality in the U.S. with that in various European countries is fraught with confounders, making head-to-head comparisons of dubious value in many cases. The irony! I guess she must have forgotten her Newsweek article from two and a half years ago.