Oh yippee. The congresswoman from the Minnesota 6th has hatched a new canard about vaccines. Michele Bachmann would like you to know that you should vote for her for president because the vaccine against Human Papilloma Virus (HPV) causes “mental retardation.” What, you don’t see the connection? During last night’s Republican debate, Wolf Blitzer brought up the fact that while Republican frontrunner Rick Perry was governor of Texas, the Lonestar State added Gardasil to the list of vaccines which are required for children unless their parents opt out. Perry is pro-vaccine, see, so if vaccines are bad, Perry is bad. And vaccines are bad because…Michele Bachmann made something up on TV:
For someone like Michele Bachmann, there are no consequences to throwing this kind of misinformation around. And why shouldn’t it be a political winner? In addition to its dog-whistle value for the conservative base (the vaccine that lets girls have sex! Obama’s health care act!), Bachmann’s tactic exploits the mistrust of mainstream medicine that unites the fringe left with the fringe right, and plenty of people in between.
And, you know, medicine has earned some mistrust over the years! So, yes, it is correct that no mainstream medical group supports Bachmann’s claim, nor do any support the far more famous claim that vaccines cause autism. But pointing that out is not really a sufficient argument for vaccination. If you basically expect doctors to be power-drunk robots who are conspiring with pharmaceutical companies to get rich on the backs of your children, you are not likely to discount Bachmann just because the American Academy of Pediatrics says to. Readers of this blog probably know by now that the article that got this whole mess started was rescinded by the journal that published it, and later revealed to have been based on fabricated data, but neither of these developments have exactly bolstered confidence in the medical community.
So let me give some of the background on the non-link between vaccines and autism. I’d give you more background on the claim that vaccines cause cognitive disabilities, but there is none to give* because Bachmann made it up. The purported link between vaccines and autism has rested on the fact that the differences between neurotypical children and children with autism tend to become detectable around the time of their vaccinations. Hence you have a parent, for example, who will say “My daughter got her vaccine, and then she ran a high fever, and then the symptoms started.” It is entirely understandable why a parent might make that connection.
It’s a fallacy known as post hoc ergo propter hoc if you are feeling fancy, and Rooster Syndrome if you are not. The Latin phrase means “After this, therefore because of this,” (Thanks, Wikipedia)–the sun only rises after the rooster crows at dawn, therefore the rooster’s crowing must make the sun rise***. The 12 children in Andrew Wakefield’s original case series developed abnormalities after getting their vaccines, so the vaccines gave them autism (yes, there were only 12, and bonus points for anyone who got “My Name is Jonas” in his head as soon as he read the word Wakefield). But some proportion of children just get sick. They have seizures that cause brain damage (perhaps that’s what Bachmann was alluding to??). Some proportion of children have autism. Since the medical establishment has no real answer for what causes autism, it’s natural for parents to grope for any explanation that is offered.
The best way to test the hypothesis that vaccines cause autism would be to randomly assign a large group of children to vaccination and another large group to a placebo and then wait to see which group gets a higher rate of autism**. That study will never be done because it would be unethical to withhold vaccines from children, and the harm to them would outweigh the benefit to children at large in answering this question. The best we can do is follow large groups of children and see whether their risk of autism can be predicted by their vaccination status. The answer, so far, appears to be no. That is, most research to date suggests that about the same proportion of children develop autism among vaccinated and non-vaccinated children, after some other factors are taken into account.
Now, full disclosure, for a year and a half or so I made the California minimum wage working as a clinical research assistant for a small company that ran drug trials. The company contracted with Merck to be one of the sites of the Phase III trials for what would be sold as Gardasil. Having worked for one, I think public skepticism about drug companies is only smart. I would be thrilled if NIH funded vaccine and drug research so well that these companies could be out-competed by scientists with no financial conflict of interest. Given that anti-spending Republicans like Bachmann have made that scenario unrealistic, though, it’s pretty cool how Merck has demonstrated that prevention can be as profitable as treatment. Vaccines have historically been such a money loser such that the federal government has to go around begging someone to manufacture the flu vaccine each year. You know what’s a great way to discourage vaccine research and development? Make vaccines as controversial as possible.
That being said, any clinician or scientist who pooh-poohs parents fears about vaccines is making everything worse, because there are real risks. Complications are rare, but that’s cold comfort when it’s your own child you’re talking about. Autism however? Mental retardation? Not on the list.
Even if they were on the list though, I would still have my son vaccinated. People with autism suffer tremendously from living in a world whose expectations are so poorly matched to the diversity of human brains, but autism is not fatal. It does not cause infertility (like mumps) or liver failure (like Hepatitis B). There is an unspoken ablism in the cost-benefit analysis that suggests people would be better off dead from cervical cancer than alive with autism or “mental retardation.”
The only interesting thing I heard all night was Rick Perry’s answer. He said, “At the end of the day, I am always going to err on the side of life.” It appears that did not win over the crowd. Based on their applause to Ron Paul’s suggestion that people who choose not to pay for health insurance deserve to die for lack of medical care, we have to wonder. Are we still a nation that errs on the side of life? Call me starry-eyed, but I do believe most people don’t think other people should die for lack of medical care. Not for lack of insurance, and not for lack of unbiased information on vaccines.
*Seriously, I just did a lit search, and came up with squadoosh. Unless you count the extensive literature on the association of cognitive disabilities and prenatal exposure to Rubella–which is preventable by vaccination.
**Some other time I’ll give you a primer on randomized trials.
***Googling “rooster syndrome,” I happened upon BackYardChickens.com, and a forum thread titled “Is Butthead Rooster Syndrome Contagious?”