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Tragic Choices: Autism, Measles, and the MMR Vaccine



Author:

Matthew P. Rowe
Department of Biology
University of Oklahoma
Matthew.Rowe-1@ou.edu

Abstract:

This case explores the purported connection between vaccines in general, and the MMR vaccine specifically, and autism. Students examine results from the 1998 Lancet article that ignited and still fuels the anti-vaccine movement; students are then asked to design a better study to test the causal relationship between the vaccine and the disorder. This case was developed to help science-phobic undergraduates understand the distinctions between good science, bad science, and pseudoscience. Most importantly, the case shows how "thinking scientifically" is a learnable skill that can empower students to make intelligent choices for themselves and their families. As such, the case would be suitable for any course introducing students to the nature of science, good (vs. not-so-good) experimental designs, appropriate interpretations of data, science as a self-correcting process, etc. Opportunities exist to expand the case to focus on issues related to research ethics, responsible journalism, and the interface between science, society, and the law.

Objectives:
  • Critically analyze and evaluate a scientific claim.
  • Identify the control group and the experimental group in a study.
  • Understand the distinctions between clinical studies and epidemiological studies.
  • Understand the importance of "sample size" in scientific investigations.
  • Understand the importance of replication when evaluating scientific claims.
  • Understand how undeclared conflicts of interest can lead to bad science.
  • Appreciate that peer-review is an important fire-wall against bias and bad science, but is not infallible.
  • Design their own experiment to test a causal relationship between vaccines and autism.
  • Appreciate the emotional, medical, and economic difficulties faced by families touched by autism, especially severe forms of the disorder.
  • Understand the importance of herd immunity in protecting communities against disease.
  • Evaluate the ethical implications of choosing whether or not to immunize one's children.
  • Employ critical thinking when analyzing media reports about a scientific claim.
  • Appreciate that "thinking scientifically" is an important (and "learnable") skill that will help them make intelligent choices for themselves, their families, and society.
Keywords: Autism; clinical study; conflict of interest; epidemiological study; experimental design; herd immunity; immunization; measles; nature of science; pertussis; sample size; spurious correlation; uptake rates; vaccination; vaccine
Topical Area: Ethics, Scientific argumentation, Scientific method, Pseudoscience, Science and the media
Educational Level: High school, Undergraduate lower division, Undergraduate upper division, General public & informal education, Continuing education
Formats: PDF
Type/Method: Analysis (Issues), Dilemma/Decision, Discussion, Interrupted, Journal Article
Language: English
Subject Headings: Biology (General)   Epidemiology   Science (General)   Science Education   Teacher Education   Medicine (General)   Nursing   Public Health  
Date Posted: 3/22/2011
Date Modified: N/A
Copyright: Copyright held by the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.

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Funny this should appear as a case study. I had debated using the same story for a case development...with a different twist.

What prompted my interest in it was an interview with Dr. Andrew Wakefield on CBC Radio (http://www.cbc.ca/video/news/audioplayer.html?clipid=1769231338 from 1:37 to 14:05) and further reading of the original Lancet article.

My plan was to use this case as a modern-day example of the resistance to change that happens in the world of science. We had discussed in class the topic of paradigm shifts and the type of attacks that scientists in history have been subject to because they presented a view of the world that was different from what was commonly accepted. I do not claim to be an expert on the topic of Dr. Andrew Wakefield or on the autism/MMR link, but as a scientist I often feel that the medical community is far less than objective and hides behind the mask of science to further their interests. After hearing this interview (above link) and reading the original article, I cannot help but feel this story is another example of just that. In short, that Dr. Wakefield was attacked and his image tainted to ensure immunization rates would remain high, and without addressing the potential that there may be something to his findings, and as he suggests, the topic "requires further study".

Perhaps the CBC interview can be added to the list of resources and/or integrated as another exercise in the case?

Thanks for sharing your hard work with us, it is much appreciated.


Mariane Ferencevic
Geography
Brock University
St Catharines, ON, Canada
mferencevic@brocku.ca
4/8/2011

Tragic Choices: Autism, Measles, and the MMR Vaccine
Author’s response to case comment

I appreciate the time and thoughtfulness Mariane Ferencevic put into her comment regarding "Tragic Choices: Autism, Measles, and the MMR Vaccine," in no small part because her suggestion permits us to continue discussing the question, "How can we do a better job of helping our students distinguish good science from bad science from pseudoscience?" This question lies at the heart of the case itself and, I would argue, provides an operational definition of what constitutes scientific literacy.

Mariane suggests there is a second side to the Andrew Wakefield saga, namely that Dr. Wakefield's hypothesis (that the MMR vaccine causes bowel inflammation. which leads to autism) is actually correct. Moreover, Big Pharma and an entrenched medical establishment have conspired to suppress Dr. Wakefield's research results, smear his reputation, and avoid conducting the studies necessary to address whether "there may be something to his findings" (Ferencevic 2011).

In support of this alternative perspective, Marianne provides a link (http://www.cbc.ca/video/news/audioplayer.html?clipid=1769231338, from 1:37 to 16:10, not 14:05 as listed in Marianne's original comment) to an interview with Dr. Andrew Wakefield conducted by Anna Maria Tremonti on the CBC radio program The Current, which aired on 27 January 2011. Ms. Tremonti's interview with Dr. Wakefield was itself a response, requested by listeners, to her interview with Seth Mnookin, which aired on 11 January 2011 (see http://www.cbc.ca/video/news/audioplayer.html?clipid=1736455338, from 0:33 to 21:43). Mr. Mnookin’s new book (2011), The Panic Virus*, is highly critical of Dr. Wakefield and the vaccine fears he fomented, to which Dr. Wakefield directly responds in his interview with Ms. Tremonti.

As Marianne suggests, good scientists can be persecuted, even prosecuted — remember Galileo. The question we must be able to help our students (and the lay public, if we care about scientific literacy) answer is whether Andrew Wakefield is a modern-day Robin Warren or Barry Marshall, medical researchers whose hypothesis that a bacterium caused ulcers was initially ridiculed by the medical establishment (Atwood 2004) but who eventually were awarded the Nobel Prize in Medicine (2005) for their pioneering, anti-dogmatic work. Or might Wakefield be a more recent version of Stanley Pons and Martin Fleischmann, two physicists who prematurely (and in the press rather than in substantive peer-reviewed publications) announced they had discovered evidence of cold fusion, results that subsequently failed to be replicated in numerous labs at a diversity of institutions (Cold Fusion 2011), rendering cold fusion a laughable example of "pathological science" (Pathological Science 2011)? Or might Dr. Wakefield actually be as deceitful and dishonest as Hwang Woo-suk, the molecular biologist whose research results on human embryonic stem cells were, by his own admission, faked (Hwang Woo-suk 2011)? Where on the continuum from liar to inept scientist to victimized genius can we place Dr. Wakefield? And why? And can we teach our students how to make these critically important judgments?

We can start by helping our students understand how bad science and pseudoscience are typically marketed to (see, for example, Pratkanis 1995; Coker 2001; Barrett & Jarvis 2005) and maintained in the popular culture (Goertzel 2011). Dr. Wakefield employs many of the tactics associated with charlatans and quacks attempting to peddle their pseudoscientific beliefs as, for example: claiming that his research findings are being suppressed by the established medical community (there is no evidence this is true); using ad hominem attacks against his critics (as, for example, his rejoinder in the interview with Anna Tremonti that Seth Mnookin isn't a scientist); taking his story to the media rather than publishing scholarly articles in peer-reviewed journals; and by relying on anecdotes rather than the results of controlled, repeatable, scientific analyses (exemplified by Wakefield's statement during the interview that "parents trust their instincts, they know this problem [of vaccines causing autism] is real"). It cannot help Andrew Wakefield's trustworthiness that he is so easily caught in his own falsehoods as, for example, when Ms. Tremonti explicitly asks whether or not he was in the process of developing an alternative measles vaccine at the time he was challenging the MMR vaccine's safety; Wakefield responded flatly, "No, absolutely not." An electronic copy of the patent application filed by Wakefield can be found at http://briandeer.com/mmr/1998-vaccine-patent.pdf. Identifying "how" to investigate the credibility of sources is certainly a skill we must help our students develop.

Most importantly, purveyors of pseudoscientific beliefs typically ignore conflicting evidence (Coker 2011; Goertzel 2011). The anti-vaccine movement certainly does. When asked by Ms. Tremonti what he plans to do next, Andrew Wakefield concludes with the statement that "I will continue to try....to answer the question do vaccines cause autism. So far, it [the necessary research] has not been done." As the numerous citations I included in the original case study should demonstrate, Wakefield's press conference in 1998 generated a tremendous interest among medical researchers, resulting in literally dozens of studies, none of which has found an association between vaccines (MMR or otherwise) and autism. Paul Offit (2011, pgs. 92-93, and see sources cited therein) sums up the consensus among scientists: "The worldwide panic following Wakefield's paper caused researchers to take a closer look. Investigators found that children with autism were not more likely to have measles vaccine virus in their intestines; and they were not more likely to have intestinal inflammation. Further, no one identified brain-damaging proteins in the bloodstream of children who had received MMR. Finally, twelve separate groups of researchers working in several different countries examined hundreds of thousands of children who had or hadn’t received MMR. The risk of autism was the same in both groups. For scientists, these studies ended the concern that MMR caused autism." Even if Andrew Wakefield was not guilty of egregious misconduct, as Seth Mnookin brings out in his BBC radio interview, Wakefield's suggestion that the MMR vaccine might cause autism was based on a sample of 12 and only 12 children. I am not trying to be insulting when I suggest that Mariane Ferencevic appears not to have digested the main point of my case when she states that "I cannot help but feel" (italics mine) that Andrew Wakefield is correct. Might vaccines cause autism in some tiny subset of children with as yet unidentified medical conditions? Possibly. Could failure to receive one or more vaccines also lead to autism in a different subset of children with a different set of medical pre-conditions? Perhaps. Have researchers looked for such connections? Absolutely. Does the current evidence hint at such linkages? No. Should the public continue to fund investigations studying the purported but scientifically unsupported link between vaccines and autism? Or should we instead fund studies more likely to lead to breakthroughs in understanding the causes of and treatments for autism (e.g., Baylor College of Medicine 2011)? How many more studies and how many tens of thousands more children are needed before rational individuals conclude that our funds can be better spent elsewhere? "Feelings" are insufficient for deciding what projects to fund, whether or not a given study is adequate, or even whether a given scientist is guilty of fraud. What matters is the preponderance and sufficiency of evidence. Currently, there is no credible evidence that vaccines cause autism, and overwhelming evidence that they don't. I apologize for failing to make this point clearly in my case study.

The "Tragic Choices" case was developed specifically for a new course we teach targeted at helping the science-phobic undergraduate student overcome their fear of critical thinking, in general, and of science, in particular. A question we frequently pose to the students is whether there is any harm in believing something that is not true. Choosing not to vaccinate one's child under the mistaken belief that vaccines cause autism can prove deadly (for a sobering estimate of the number of children harmed, see http://www.jennymccarthybodycount.com/Jenny_McCarthy_Body_Count/Home.html). My responsibility, as a science educator, is to help my students distinguish good science from bad science from snake oil. Believing in things that "just ain’t so" can lead to very tragic consequences. Helping our students sharpen their critical thinking skills is not only something we can do, it is something we must do.

*Paul Offit's new book Deadly Choices (2011) was published coincident with Mnookin's (2011). Both books cover similar ground, providing excellent summaries of, among other topics, the history of the anti-vaccine movement and the recent federal court rulings that vaccines do not cause autism. I highly recommend both books for readers interested in the ongoing vaccine wars.

References

  • Atwood, K. C. 2004. Bacteria, ulcers, and ostracism? H. pylori and the making of a myth. Skeptical Inquirer 28(6). Available online at: http://www.csicop.org/si/show/bacteria_ulcers_and_ostracism_h._pylori_and_the_making_of_a_myth/.
  • Barrett, S., and W. T. Jarvis. 2005 (20 January). How quackery sells. Quackwatch. Retrieved (23 June 2011) from http://www.quackwatch.com/01QuackeryRelatedTopics/quacksell.html
  • Baylor College of Medicine. 2011 (9 June). Genes provide landmarks on the roadmap of autism. ScienceDaily. Retrieved (24 June 2011) from http://www.sciencedaily.com/releases/2011/06/110608141522.htm
  • Coker, R. 2001 (30 May). Distinguishing science and pseudoscience. Quackwatch. Retrieved (23 June 2011) from: http://www.quackwatch.com/01QuackeryRelatedTopics/pseudo.html
  • "Cold Fusion." 2011 (22 June). In Wikipedia, the free encyclopedia. Retrieved (24 June 2011) from http://en.wikipedia.org/wiki/Cold_fusion.
  • Ferencevic, M. 2011 (28 April). Comments/Replies. Retrieved (24 June 2011) from: http://sciencecases.lib.buffalo.edu/cs/collection/detail.asp?case_id=576&id=576
  • Goertzel, T. 2011. The conspiracy meme: why conspiracy theories appeal and persist. Skeptical Inquirer 35: 28-37. Available online at http://www.csicop.org/si/show/the_conspiracy_meme/.
  • "Hwang Woo-suk." 2011 (19 May). In Wikipedia, the free encyclopedia. Retrieved (24 June 2011) from http://en.wikipedia.org/wiki/Hwang_Woo-suk
  • Mnookin, S. 2011. The Panic Virus: A True Story of Medicine, Science, and Fear. Simon & Schuster, New York.
  • Offit, P. A. 2011. Deadly Choices: How the Anti-vaccine Movement Threatens Us All. Basic Books, New York.
  • "Pathological Science." 2011 (12 June). In Wikipedia, the free encyclopedia. Retrieved (24 June 2011) from http://en.wikipedia.org/wiki/Pathological_science
  • Pratkanis, A.R. 1995. How to sell a pseudoscience. Skeptical Inquirer 19: 19-25. Available online at http://www.positiveatheism.org/writ/pratkanis.htm.



Matthew P. Rowe
Department of Biological Sciences
Sam Houston State University
Huntsville, Texas 77341
rowe@shsu.edu
6/27/2011
I have been an avid user of case studies in my advanced level biology high school course. In the past I have integrated a case study into a unit and then supplemented or supported the case with additional resources to enrich exploration and provide a more thorough experience. However, recently I switched the approach. Students self-organized into one of three topics of choice - each related to a case study (from your collection). Students were expected to demonstrate competency in the human immune system and protein synthesis as background information for their selected case study. Ultimately, they were tasked with "telling the story" they felt compelled to tell their peers regarding their case study.

One group that was examining the case study "Tragic Choices" on the autism-vaccine controversy created this video: https://youtu.be/4rXXR1gg9vQ. I wanted to share it because I think it exemplifies how the case study approach can be expanded upon from "just the case study." I asked my students for permission to share this with you - and we will be publishing it in our online academic journal as well.

Perhaps how to expand the use of case studies could be a topic at a future case studies conference.


Kimberley Berndt
Science Program
St. Mark's School
Southborough, Massachusetts

5/15/2018




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