Bad Medicine

Seth Mnookin's new book asks, are vaccine fears endangering our health?
January 25, 2011

The Panic Virus: A True Story of Medicine, Science, and Fear | By Seth Mnookin | Simon & Schuster | 448 pages, $26.99

“A lie told often enough becomes the truth,” warned Vladimir Ilyich Lenin, who pressed this adage into service on more than one occasion. In The Panic Virus, Seth Mnookin starkly exposes the social architecture supporting one such lie: the pervasive and destructive myth that certain vaccines—those laced with a mercury-based preservative called thimerosal—are responsible for rising rates of autism in the United States.

Mnookin first offers a quick history of vaccines, beginning with “variolation,” an early approach to inoculating patients against smallpox. He moves on to the triumph of the polio vaccine—and to the disastrous “Cutter incident” of 1955, in which a tainted batch of the vaccine led to fifty-seven cases of paralysis.

Next comes the resistance to water fluoridation, wherein Mnookin pinpoints the hazy science of the opposition: “When they asserted that there is some hypothetical quantity of drinking water that would contain enough fluoride to be toxic to humans, they did so confident that nobody in the media would point out that that amount was fifty bathtubs’ worth.” The author then touches on the 1976 swine-flu fiasco and problems with the DPT vaccine, before veering off into the evolution of autism.

In the second section of his book, Mnookin turns to dismantling the causation theories that link thimerosal and autism. As he explains, this link was promulgated by such scientists as Andrew Wakefield, a physician whose 1998 Lancet paper castigated the measles, mumps, and rubella (MMR) vaccine as a possible trigger for autism. Here was the first major study to set off alarm bells—even though it was later retracted, and Wakefield himself subsequently struck off the British medical registry. What followed the initial publication was a flood of lawsuits, high-profile articles, books, televised debates, and even rumblings against a government conspiracy to protect the pharmaceutical industry.

As readers of The Panic Virus will soon grasp, the thimerosal theory has no credibility. And in any event, the preservative has long since been removed from all but a few vaccines. The FDA found no evidence that miniscule levels of thimerosal caused autism or other harms, but since the government did think it prudent to end the use of mercury and its derivatives, it was gradually phased out.

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In the meantime, substantial numbers of parents hesitated to have their children vaccinated. As Mnookin explains, these holdouts put the health of others at risk, because even a small pocket of the unvaccinated may lead to an outbreak. He writes: “The notion that people should base medical decisions on what is ‘right for them’ is particularly problematic in a public health context, where individual choices cannot be cordoned off from each other.”

To drive home this point, Mnookin gives several wrenching examples of children injured or killed in this manner. Take Julieanna Metcalf, a fifteen-month-old, fully vaccinated girl, who caught Hib, or Haemophilus influenzae Type B, from her unvaccinated peers in 2008. By the time she got out of the hospital a month later, Julieanna had suffered multiple seizures and had had a buildup of fluid in the brain so dangerous that it required emergency surgery. She’d also lost all her motor skills—including the ability to swallow—and will require multiple immune globulin injections each week for the rest of her life.

Even with her weakened immune system, Julieanna might not have caught Hib if everyone around her had had their shots…. The outbreak that ensnared Julieanna also resulted in the hospitalization of four other children.

In a chapter titled “A Conspiracy of Dunces,” Mnookin mercilessly dispatches an array of vaccine skeptics, including Robert F. Kennedy, Jr., who contributed articles touting the autism-thimerosal connection to Rolling Stone and Salon. He is no less sardonic about various autism advocacy groups, including the one initiated by the actor (and, as we are relentlessly reminded, former Playboy centerfold) Jenny McCarthy.

Yet Mnookin’s take-no-prisoners approach to his subject has some major drawbacks. As I’ve already suggested, he does a brilliant job amassing the evidence that thimerosal poses no danger of triggering autism in children. He launches an equally powerful assault on the intellect, motivations, and credentials of anyone who thinks otherwise.

In doing so, however, he neglects a big piece of the story: the cultural complexities and stubborn medical mythologies that bedevil both the pro-vaccine and anti-vaccine camps. As Mnookin sees it, the pro-vaccine faction consists of scientists—rational figures who are swayed only by evidence-based medicine. Members of the anti-vaccine faction (whom he also calls the “vaccine denialists”) are swayed by hysteria, ignorance, junk science and its prophets—and the news media.

In other words, he proffers a binary world in which his prosecutorial skewering of the anti-vaccine camp is contrasted to the pure, inexorable, infallible domain of “science.” He dwells on the venality, gullibility, and profiteering he encounters among parents, patients, and the news media. Yet Mnookin fails to adequately address the scientific and ethical failings of vaccine design and testing as it has been practiced for more than two centuries.

Take, for example, the author’s treatment of Onesimus, the African slave who introduced smallpox variolation to Boston (and to the U. S.) in 1721. Mnookin describes the popular and at times violent opposition to this early and effective technique. He neglects to mention that this opposition was led not by uneducated laypersons, but rather by the city’s physicians, including the eminent William Douglass, the only doctor in town to possess an actual medical degree. These pillars of the American medical establishment condemned variolation as an occult African practice, both ridiculous and “unchristian.”

Mnookin can’t completely ignore the scientific and ethical missteps that have contributed to vaccine skepticism. For the most part, though, The Panic Virus confines itself to such chilling but hoary examples as the 1955 Cutter incident or the 1976 swine-flu fiasco, in which some recipients of a vaccine for an epidemic that never materialized were felled by the Guillain-Barré virus. These twice-told tales have long since been eclipsed by more contemporary dramas, which are very much part of the current debate over whether vaccines can be trusted.

Between 1989 and 1991, for example, mostly poor black and Hispanic children in Los Angeles were given an unapproved, experimental Edmonton-Zagreb vaccine without their parents’ consent. This vaccine had been implicated in the deaths of children in Haiti and other parts of the developing world. Meanwhile, in 1998, the Department of Defense’s Anthrax Vaccination Immunization Program (AVIP) forced 2.4 million soldiers to be injected with an experimental anthrax vaccine without their consent. Many were blinded or permanently injured, and the drug’s manufacturer, Bioport, was repeatedly censured by the FDA.

One final example: in 2006, the FDA approved Gardasil, Merck’s vaccine against some strains of the human papilloma virus (HPV) that causes cancer. The manufacturer sought to corner the market quickly by having Gardasil vaccination deemed mandatory for schoolchildren as young as nine, causing an outcry in the District of Columbia, Florida, Georgia, New Mexico, Texas, and other states.

These are more recent triggers for vaccine skepticism than swine flu, and certainly more pertinent ones than Morgellon’s disease, a hotly debated disorder to which Mnookin devotes a chapter. The difference is that they hinge upon errors made by the medical establishment—so they are more or less omitted from the narrative of The Panic Virus.

Indeed, the book’s very division of the nation into two camps lacks evidence and nuance. Mnookin suggests that we have rational, disinterested, and fully credentialed scientists on one side, scientifically illiterate, crystal-peering, aura-perceiving rabble-rousers on the other—and nothing in between. Instead, there is at least one other group: those doctors, patients, and members of the media who approve of some or even most vaccines but question the timing, adulteration or ethics of others. The Panic Virus also asserts that those who cast a jaundiced eye on vaccines are likely to occupy the educated upper class, and the author discusses few if any vaccine dissenters who do not fit that mold. Yet such skeptics can be found at all socioeconomic strata of the U.S.

And then there is the role of Americans’ plummeting ability to understand science, which Mnookin argues is making Americans ever more susceptible to vaccine fears. The problem is, according to a Michigan State University researcher, U. S. scientific literacy is actually rising, not falling. The numbers are certainly low (only 28 percent of Americans can understand the science section of The New York Times: ouch), but scientific literacy in this country has nearly tripled within the decade, and compares favorably to that of Europe and Japan.

It’s not only the public, of course, that Mnookin blames for phenomena like the thimerosal-autism panic. He’s equally hard on the news media, which he regards as too credulous, uninformed, or lazy to carry out the investigations that would drive a stake through the heart of this voodoo science. His book refers to journalists “parroting” junk science, and Mnookin recently told Publishers Weekly that “[j]ournalists don’t have the training to get things right.”

As he explains in The Panic Virus, the number of dedicated science journalists is declining (which is true), so editors give science stories to generalists who are unequipped to understand what they’re writing about. (Presumably the editors are also unequipped to edit the stories.) However, publications without dedicated science teams or reporters tend to rely on national wire services, which still retain sophisticated science reporters. Also, as National Press Foundation president Bob Meyers once reminded us, “The media are plural”—in focus, perspective, and in sophistication. Surely between The Washington Post, The Wall Street Journal, and the National Enquirer, somebody will get it right.

So where does this leave us? Mnookin’s searing indictment of the deeply flawed science peddled by some vaccine skeptics may have been intended as the definitive postmortem on a seductive delusion. Instead, it falls short of the mark—haunted by its failure to maintain balance, and by its reluctance to portray medical science not as it is idealized, but as it is practiced. In the end, The Panic Virus offers an informative and entertaining sojourn through the history and science of the vaccine-autism controversy. It is a good place to start understanding that mess—but certainly not the last word.

Harriet A. Washington won the 2007 National Book Critics Circle Award for Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Her next book, Deadly Monopolies: The Shocking Corporate Takeover of Life Itself, will be published this year.