Andrew Wakefield's Vaxxed: Scary Music and Specious Claims
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.
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 Insolence, Science-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.