Andrew Wakefield's Vaxxed: Scary Music and Specious Claims

Andrew Wakefield's Vaxxed: Scary Music and Specious Claims

June 21, 2016 Karie Youngdahl

Vaxxed in Philadelphia
Vaxxed in Philadelphia

I've been hosting an internal debate about whether to ignore the Del Bigtree/Andrew Wakefield documentary Vaxxed or to see it. On the one hand, the documentary is rehashing a false narrative about the MMR vaccine having a causal role in autism development that has been countered time and again with solid epidemiological evidence. On the other hand, I hate to dismiss something without investigating it more closely for myself. But up until now, the film hasn't been accessible to me and I could ignore it. That was no longer the case beginning this past weekend, when Vaxxed began showing for a few days at a local Philadelphia multiplex. In spite of my trepidation, and at the prodding of one of my colleagues, I went out yesterday to see it in the middle of the afternoon. This being downtown Philly, in the historic district, lots of tourists and museum visitors were walking near the theater. A mother and her two preteen kids were in front of me, across from the marquee prominently advertising that Vaxxed was playing. I heard her say to her kids, “Oh, I can’t believe Vaxxed is here – it’s this amazing movie that explains how the CDC is hiding evidence that vaccines cause autism.” The rest of her analysis trailed away as they made their way up Walnut Street.

True story.

Others, including Paul Offit, have dissected the movie effectively, and so I’m not going to get too detailed here. The crux of the film is situated in the so-called CDC whistleblower controversy, which involves questions apparently raised by a CDC senior scientist and psychologist, William Thompson, PhD. His claim, as expressed by others in the film, is that the CDC changed its analytic methods to hide a finding in a case control study that African American boys who received MMR vaccine late but before age 3 had higher rates of autism than expected.

But, as Matt Carey of Left Brain/Right Brain points out, the analysis plan, which the researchers adhered to, was developed before the seeming effect in African American boys was revealed. There was no cover up or attempt to hide a legitimate finding.

There’s also a claim in the film that many participants were excluded from the study in order to hide an MMR-autism association. A smaller sample size can lower the statistical power of study and turn a finding from significant in a large sample to non-significant in a smaller sample. Yet the analysis plan clearly originally intended to analyze a smaller subgroup of children who had Georgia birth certificates in order to include covariates in the analysis that were only available from the birth certificate data. Again, this plan was produced before the analysis was performed. 

If you knew little about epidemiology or statistics (or about the background of the filmmakers) and had an inclination to mistrust authority figures like the CDC, you would have very little reason to question the claims made in the film. With all of the parental tales of autism appearing immediately after vaccination, scary music, and confusing graphs displayed quickly on screen, a viewer really can’t make sense of the information presented, let alone begin to question it. Certainly, many of the dozen or so people in the audience with me seemed sympathetic to the filmmakers' perspective: they tsk'ed and gasped many times.

But any information countering the dominant narrative in the film is available only to those who are inclined to dig deeply into the blogosphere and read closely into the claims. Nor does the film note that both Andrew Wakefield's original study claiming an association of MMR receipt with autism and Brian Hooker’s reanalysis of the CDC cohort study have been retracted. And it certainly doesn't include this quotation from Thompson: “The fact that we found a strong statistically significant finding among black males does not mean that there was a true association between the MMR vaccine and autism-like features in this subpopulation.” Nor this one: "I want to be absolutely clear that I believe vaccines have saved and continue to save countless lives. I would never suggest that any parent avoid vaccinating children of any race. Vaccines prevent serious diseases, and the risks associated with their administration are vastly outweighed by their individual and societal benefits."

Perhaps the most damaging moment of the film occurs at the end, after Bigtree has presented Rachael Ross, MD, PhD, a family medicine doctor and frequent host on “The Doctors,” and Jim Sears, MD, with what he says are the original study documents. Of course, we don’t know what he’s showing them. But he comes back to them after showily leaving them in a room alone with the papers and asks them what they think. They both express surprise and shock at what(ever) they’ve read and seem willing to believe in a CDC coverup. The film ends with the pregnant Dr. Ross stating that if parents ask her about the MMR vaccine, she’ll say “I’m not going to give the vaccine to my babies, and here’s why….” She also says something about the vaccine damaging babies’ brains, but I was too shocked to have written that quotation down. It’s an unfortunate coda to the film for people who want to protect babies from the harmful effects of infectious diseases.

I won’t say much more about the film except to encourage people to read the many discussions of the film and the Thompson affair on Respectful InsolenceScience-Based Medicine, and Left Brain/Right Brain. Though few people are likely to see the film, those who do may have questions that we are obligated to try to understand and answer. Many more people will have a vague awareness of the “CDC whistleblower” story, and we all should be prepared for that, too. 

Finally, and this probably isn’t surprising, the language that people in the film use to describe people with autism is disturbing and dehumanizing. Let’s all read Steve Silberman’s Neurotribes if we haven’t already and try to counteract these depictions of people with autism.

Comments

Posted by Lisa C (not verified)

"If you knew little about epidemiology or statistics (or about the background of the filmmakers) and had an inclination to mistrust authority figures like the CDC, you would have very little reason to question the claims made in the film."

What an incredibly arrogant statement to make! I don't profess to be a genius when it comes to epidemiology or statistics, but I do have enough common sense to ask some pointed questions regarding the safety of vaccines and skyrocketing rates of autism.

1. Mercury and aluminum have been used as stabilzers in vaccines and both are neuro toxins that cause "autistic like" symptoms to develop when administered to rodents. Why would they not cause the same symptoms in humans?

2. We are told that mercury and aluminum (formaldehyde, etc.) are only present in trace amounts in vaccines. What is the definition of a "trace amount" and where is the science that definitively tells us what trace amounts are safe amounts for the human brain?

3. Incidence of autism is increasing at an alarming rate. It is inconceivable that this is due to genetics. The time frame is too short. One then must look to environmental causes. Why are people loathe to consider vaccines as a possible culprit? And why is the question so black and white? Should we vaccinate or not? That question is blatantly designed to engineer divisiveness. The question really should be twofold: do we need so many vaccines and can we make the vaccines safer.

4. There's a legal argument that basically boils down to this: if a number of people come forward with the same story, there is probably some truth to it. Why is the same logic not being applied here? Hundreds of thousands of parents all over the world with frighteningly similar stories regarding vaccines and autism, but we're supposed to dismiss it as what? Mass hysteria?

5. Insofar as "an inclination to mistrust authority figures like the CDC is concerned, why shouldn't we mistrust authority figures? They tell us that vaccines are safe and efficacious, yet there has been documented evidence of measles outbreaks in populations that were 98 percent vaccinated. The CDC authorized inclusion of the mumps vaccine into the childhood vaccination schedule despite the fact that mumps are an innocuous childhood disease. What's worse, the mumps vaccine is NOT efficacious and Merck knew that when they introduced it. Hardly efficacious!

And insofar as safe is concerned, this from PubMed:

A mass immunization campaign with a Urabe-containing measles-mumps-rubella vaccine was carried out in 1997 in the city of Salvador, northeastern Brazil, with a target population of children aged 1-11 years. There was an outbreak of aseptic meningitis following the mass campaign. Cases of aseptic meningitis were ascertained through data collected from the records of children admitted to the local referral hospital for infectious diseases between March and October of 1997, using previously defined eligibility criteria. Vaccination histories were obtained through home visits or telephone calls. Eighty-seven cases fulfilled the study criteria. Of those, 58 cases were diagnosed after the vaccination campaign. An elevated risk of aseptic meningitis was observed 3 weeks after Brazil's national vaccination day compared with the risk in the prevaccination period (relative risk = 14.3; 95% confidence interval: 7.9, 25.7). This result was confirmed by a case series analysis (relative risk = 30.4; 95% confidence interval: 11.5, 80.8). The estimated risk of aseptic meningitis was 1 in 14,000 doses. This study confirms a link between measles-mumps-rubella vaccination and aseptic meningitis. The authors discuss the implications of this for the organization and planning of mass immunization campaigns.

While that's sad, what's sadder still is that the U.K. sold that vaccine to Brazil after experiencing its own spike in meningitis after introducing that particular vaccine. Even more sad, Canada knew of the correlation between meningitis and the vaccine and warned the U.K not to introduce it.

This is the tip of the iceberg, but the point I am trying to make is that the public will only trust "authority figures" like the CDC when they earn the public trust by operating in a transparent manner that is overwhelmingly in the public interest.

I have three boys, all of whom were vaccinated and none of whom have autism. I am going to see Vaxxed tonight not because I've been scared or misled or have been taken in by the hype; I'm going to get more information. I'm going because in 1998 I met a child with autism and I thought to myself, autism, hmmm, I've heard of it, but admitted to another mom that I really didn't know anything about it. Today I know five moms whose children have autism. I'm not a conspiracy theorist. I'm just a mom whose children will one day be having children and I want answers.

Posted by Martin (not verified)

The first thing that strikes me is you have the essential,facts wrong

1- no they are not stabilisers. Mercury is not in any vaccine. You mean Thimerosal which is a compound that contains Mercury. It is a preservative. Methyl Mercury is not ethyl Mercury is not elemental Mercury. They all have different chemical properties. Thimerosal is not in any childhood vaccine and there is no evidence it is harmful anyway

Aluminium salts (not aluminium) are used to stimulate an immune response. We quickly excrete them. Your serum levels of aluminium are form environmental sources not sporadic vaccines

2- the definition of trace amount depends on the substance. None are present in toxic doses. Your own body makes formaldehyde in vastly greater amounts than in vaccines.

3- the incidence of autism is not in fact increasing. This has been shown in a number of studies. Diagnosis is increasing but the underlying rate is constant. Studies that look at the rate of undiagnosed autism in adults find it is about the same rate as current diagnosis of autism in children

4- many people believing the one thing does not make it true. We have reliable methods for finding patterns in complex data. Our brains are great at finding patterns even where none exist. The issue here is we have analysed the data and the claims simply are not true. Vaccines are demonstrably safe compared to the diseases they prevent.

5- 80 - 90% of all measles cases occur in the unvaccinated. In the rare occasions that an outbreak has occurred in a highly vaccinated population (e.g.boarding school) the unvaccinated still are more likely to catch the disease, but simply represent far smaller percentage of the total,population. You are seeing a pattern where none exists.

Incidence of measles is 99% lower now than the ore vaccine era. Nearly all cases of measles occurs in the unvaccinated.

Posted by Rene Najera (not verified)

1. They're not neurotoxins in the concentrations found in vaccines. This is where knowledge of chemistry comes in handy.
2. Package inserts will tell you how much of these chemicals are in vaccines. We know they're safe because, for example, the human body produces much more formaldehyde than what is found in vaccines. If it's safe for our cells to make it, then it must be safe in the concentrations found in vaccines. And, no, it's not a different kind of formaldehyde. (Again, high school chemistry covers this.)
3. Wrong. Prevalence of autism is increasing. Incidence has remained the same. Incidence is the new number of cases divided by the number of people at risk. Prevalence is the existing number of cases divided by the population at risk. This is where knowledge of epidemiology, in order to tell what is incidence and prevalence, comes in handy.
3.5. Yes, we need that many vaccines because there really are that many diseases out there. I know it's hard to imagine living in a developed nation. In the developing world, these diseases are killers, and it is up to us to vaccinate to keep them under control and keep downtown Anywhere, USA, from becoming an epicenter of something as preventable as meningitis, Hepatitis A, or polio.
4. Legal arguments are not the same as science arguments. Otherwise, we'd still be saying that the Earth is flat, that the sun goes around the Earth, or that Black people are biologically different from us. No, it's not mass hysteria. It's a wide collection of anecdotes perpetuated by anti-vaccine people, like yourself, who have sold these folks on the ideas that vaccines cause autism and that autism is some sort of scourge that should be avoided like the plague. Wrong. The plague should be avoided like the plague.
5. There are always going to be vaccinated children involved in outbreaks because there are a lot of vaccinated children out there. What counts is the proportion (or the relative risk). (Again, epidemiology comes in handy here.) If 1,000 children are vaccinated and 1,000, and the vaccine is 95% efficacious, then that means that 50 of the vaccinated children are not immune. This means that there are 1,050 non-immune children. If there is an outbreak, and the vaccine works as expected, we could have 50 vaccinated children who get sick and 10 unvaccinated ones who also get sick. You can see that it may seem like the vaccine doesn't work, but it worked just as expected. Vaccines are not about giving immunity to everyone who gets them. They're about giving immunity to the maximum number scientifically, biologically, and statistically possible who get them.
5.5. The reason why you didn't hear of autism in 1998 and you do a lot now is because we've become better at recognizing it in all its forms. It's also because people got so scared of it that more of them took their children to be screened. Now there is more acceptance and more diagnoses.

So I'll be arrogant and tell you that, yes, you need to know epidemiology and biostatistics in order to completely grasp the concept of vaccine science, especially in light of the statements you've made. Each point you tried to make resoundingly shows your lack of knowledge in the subject and that you seem to find your answers only in anti-vaccine talking points.

Posted by Vincent Iannelli, MD (not verified)

"Incidence of autism is increasing at an alarming rate. It is inconceivable that this is due to genetics. The time frame is too short. One then must look to environmental causes. "

There are several different explanations for the apparent rise in the number of children being diagnosed with autism, including:

better recognition among health care providers and parents

diagnostic substitution

broadening of the criteria used to diagnose autism

social influences

All together, these explanations help explain what has been confirmed by numerous studies, that the true prevalence of autism hasn't changed over time.

Posted by Karie Youngdahl

Hi Lisa,
Thank you for your comment. I'm sorry you find my statement arrogant. I'm trying to point out that to truly understand the minutiae of the arguments in the documentary, a person would have to have had a great deal of specialized training in epi and biostatistics. The filmmakers are counting on their audience not having that knowledge.

Regarding your points 3 and 4, people have not been loathe to consider a possible connection between vaccines and autism. Rather, that question has been asked and asked again in study after study and we continue to find that no association exists. I think the better question is why people are loathe to accept the preponderance of evidence that vaccines are not involved in autism. The AAP and the VEC at CHOP have compiled helpful lists of such studies, all of which are more rigorously conducted and more highly powered than the fringe studies that purport to show otherwise.

And why does the fact that the MMR vaccine is not 100% effective mean the CDC is concealing something? We all, including the CDC, know it's not 100% effective, but we use it anyway because it's the best we have. The mumps component is moderately effective -- maybe those who are so concerned about its effectiveness should work to fund research for a more effective vaccine.

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