Posted by: littlez2008 | September 14, 2010

The Latest Study Showing No Link Between ASD and Vaccines…and How We Present Information to Friends Without Unfriending

First, let’s just get to the links. A recent study, published in Pediatrics, shows no association between thimerosal and autism:

CONCLUSIONS In our study of MCO members, prenatal and early-life exposure to ethylmercury from thimerosal-containing vaccines and immunoglobulin preparations was not related to increased risk of ASDs.

This was apparently a long awaited study. Here are some links with comments about the study by doctors whose blogs I like to read. Their posts might help to understand the study. The first post by Steven Novella explains the background of the study as well. Actually, if you read any of these links, that’s probably the one to focus on. (It’s the shortest and easiest to read.)

And here’s Orac’s take on it.

And here are a whole bunch of other links you can read, if interested. This list is courtesy of Orac. Well, not exactly courtesy. I’ve simply swiped the link to Liz Ditz’s blog from his blog.

While I found Steven Novella’s post very helpful, I was slightly depressed to read his conclusion:

No one study, especially an observational study, is ever very compelling. I don’t think this one new study changes the scientific picture of vaccines or thimerosal and autism. But it is one more study that fails to show any correlation between thimerosal exposure and risk of developing autism or ASD. This comes on top of multiple independent lines of evidence all pointing away from the notion that vaccines or thimerosal are a significant cause of autism.

The scientific community is likely to see this as further confirmation of a lack of association between vaccines and autism – just one more piece of the big picture. The anti-vaccine community is likely to dismiss it as either hopelessly flawed or as part of the conspiracy. In other words – this study is unlikely to change anyone’s mind on this issue.

Sure, maybe not. I haven’t been trying to be a spokesperson for vaccines for very long, so maybe I’m not jaded yet. I’m still sorting out how to talk to people about this issue without offending them or freaking out myself, which is what I’d like to discuss in this post.

Colin gave me some props lately for speaking up on Facebook about vaccines. And well, thanks, but honestly, I’ve screwed up as a skeptical spokesperson a few times, too. It has been really hard to find my voice, and I’ve unfriended two people over this issue. But I think I’ve finally achieved some kind of competence after some trial and error. Here are my basic rules for presenting information without devolving into bad feelings.

1. Give information–links, studies, or what have you–in writing. Email is good. Facebook works. Posting comments is fine. Debating verbally is absolutely pointless for me. I just say, “I can email you some information if you’d like to read it.” I’m not a doctor or a scientist. I’m just a geek who reads a lot about vaccines, so I’d rather let the information do the talking. I am on two mommy support boards, and of course there are tons of woo types on both. Anti-vaccine loons, people advertising amber teething necklaces–oy. It’s tough. Rather than go head to head, I just try to present the facts in writing–other people’s writing.

2. This advice is actually from the moderator of one of those blogs, and I think it’s good, although I balk somewhat at the compromise-like quality of this language. Use “It is my understanding that” or “From what I have read” when presenting information. This kind of toning down of facts does tend to take the emotional charge out of your statements. I think it kind of waters them down, but it pisses people off less, which might make them actually look at what you’re presenting. And in all honestly, it’s just the truth. This is what I have read and understand to be true. To claim any more than that is a little arrogant really. Speaking or writing this way also implies that you’re open to additional information and willing to read and understand more. The moderator was actually posting this information to cut off a thread about homeopathy in which I apparently offended some people by saying that homeopathy doesn’t work. On the sly, many people from the support board emailed me to say thank you for having the “courage” to speak out against the “homeopathic vaccinations” that were being touted by one poster. But these people were too scared to speak up themselves and face the vitriol they might incur. I got more supportive responses than mad responses, but let me tellya’, the mad responses are pretty daunting. People can be super mean, and I don’t enjoy conflict like that. I spoke up because I didn’t want anyone to get a homeopathic vaccination and then have their kid get measles. I felt a responsibility to say something, so I did.

3. This point is my own, and it’s really hard for me, but I’m getting better. Be prepared to walk away from a debate without winning. When you’re posting on blogs or mommy boards, you’re in front of an audience, and I think it’s important to make your point and get the heck out without getting upset. The two boards I post on are for emotional support, so bringing up topics that are polarizing just wrecks everyone’s mood. So I try to make it clear that I’m posting for everyone’s information and that I understand everyone can read and make their own decisions. I do believe that people (like the people who emailed me about my homeopathy posts) are grateful for the information, and I might sway someone who is mostly quiet on the boards. But the regular posters who are all about the woo and the conspiracy theories–meh, it’s best to just respond politely but briefly with links and factual information and leave it at that. Debate isn’t helpful, and people are watching. I try to handle myself politely and respectfully (even if I feel not at all polite or respectful). I suppose it’s a good rule of thumb for many situations anyway, but my point here is that in the end it is probably more persuasive to those who are sitting on the sidelines and reading. At least I hope so.

4. Try to remember when you didn’t have the information either. This one is tough for me, too. I’ve done so much reading at this point that it is almost impossible for me to believe that other people haven’t done the same reading, but they haven’t. A friend with a new baby asked me if I spaced out my shots, and why was there so much autism when there were more vaccinations, and it was all I could do not to scream in frustration. This is a guy from a great school, so why doesn’t he know what’s up? But I took a breath and remembered having a newborn myself and facing all those fear mongering rumors, the terrifying videos of autistic kids on YouTube, the first Google searches that turned up the wackaloon, misguided information–look, that stuff is scary. When I think about it now, it’s actually amazing that I didn’t freak out and do the “alternate schedule.” I live in the epicenter of that kind of thinking. But I have a lot of skeptical friends, so I found the good information and followed the vaccine schedule without fear. (Well, almost. I admit I was somewhat nervous when we went to get the MMR–and I’m embarrassed to admit that now, but that’s where my friends are probably at, too, so it’s good to remember my own twinges of fear.) When I think about how scared I was, it helps me to be reassuring when I say I feel totally comfortable with the vaccine schedule. And it’s better to be helpful and reassuring than to be mind meltingly frustrated that this topic still even comes up. At least, that’s what works better for me.

Any other advice from those of us who are on the front lines of rationalism? I am really hoping that in some small way, I can contribute to my son’s elementary school actually not being at risk for a measles outbreak, which according to an LA Times Article from last year, it is. Vaccination rates have dropped so low that herd immunity is now at risk. Oh California, I love you but you frustrate me.

What do you keep in mind while trying to be a skeptical spokesperson?

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Responses

  1. I had to manage this yesterday when a close friend posted a link to the CBS News article with the headline that the government is paying millions for the first case of vaccines causing autism. The article was actually about Hannah Poling, whose case is more complicated than what was presented in the article. Since I’m known as the debunking guy, this is how I handled it…

    “Forgive me. I can’t help myself.

    Sharyll Attkisson is a CBS news reporter who leans heavily on the side against vaccines. Hannah Poling was born with a rare mitochondrial disorder that was aggravated by fevers induced by vaccines. These fevers could have been caused by a common cold under different circumstance, but because they might have been caused by vaccines, she was awarded compensation. Her symptoms were “regressive encephalopathy with features consistent with an autistic spectrum disorder, following normal development”, but she was never officially diagnosed with autism. It’s a fine distinction between having autism and having features consistent with autism. If my hands are shaking, I have features consistent with Parkinson’s, but that doesn’t mean that I have Parkinson’s. I know that comes across as pedantic, but it’s an important clarification.

    Six of the best test cases in the omnibus proceedings failed to prove that MMR and/or thimerosal-based vaccines caused autism. If we grant Hannah Poling’s victory, we must also grant the hundreds of cases in the omnibus that were dismissed due to insufficient evidence. Poling’s case proves that the vaccine court will compensate a vaccine-injured child, and the omnibus proves that children with autism are not vaccine-injured.

    Sorry. I should just keep my mouth shut. I know it’s a sensitive topic.”

    The comment thread did not turn into a bitter debate, and the commenter even mentioned that he was baiting me into replying because he was interested in my perspective. Very nice.

  2. I have a question that I am hoping someone here can help me with. Two and a half years ago when I had my son I got caught up in the fear of vaccines causing autoimmune disorders mostly but I will admit the fear of autism was there too (I worked with children with special needs just as it was being really hyped and most of the parents saw a correlation). In addition, I have a history of fairly severe local reactions to 3 separate vaccines so I had some (in my opinion) legitimate concerns about him getting multiple vaccines at one time. I was so caught up in this fear, along with many others about being a good parent, that I let it rule me and refused several vaccines for my son and started on a delayed schedule for others. I am a physician and even with all my training and natural skepticism the fear allowed the pseudoscience to win over reason.

    Fast forward a year and we moved to a place where family physicians don’t give vaccines and no pediatrician will provide vaccines on anything other than the CDC approved schedule. By this time I had educated myself on the vaccine issue and had come to the conclusion that they were generally safe and that I needed to do my best to get my son UTD on his vaccines.

    I checked with a few physicians and the public health clinic in the area and they want to give him all the shot to get him current (minus boosters) in a single visit and will not do it any other way. With my reaction history and his already overactive allergy responses to other things this seems foolish. So I am trapped, I want to get him up to date but i am not willing to bombard him with everything at once. It seems like I have no options. I am trying to correct my mistake without putting my child at undue risk.

    I am wrong to be concerned because of my history with vaccines? What about his allergic history? I am trying to identify if these are valid concerns or if I should just do as they want and get them all at once and hope for the best?

    • Just sent you a private message, but I thought I’d reply publicly too. I forwarded Kela’s question to John Cmar of the CDC. This was his response…

      Here are my thoughts:

      The concerns expressed are all reasonable, given the commenter’s history. Certainly, giving all the vaccines at once is an ideal approach – there won’t be any decrease in efficacy due to giving multiple does at once; the immune system will be able to easily respond to all of the vaccines and generate protective immunity to the same degree that it would if it the patient received each vaccine at separate times.

      As to the allergy/reaction question, giving all of the shots at once might give a worse response then each individually, although it won’t be nearly as bad as a purely additive response; that is, if the patient reacts to getting a shot with a bump that’s 3 centimeters across, that doesn’t mean that giving 4 shots at once is going to give a bump 12 centimeters across, or cause a major reaction. How I would proceed would be based on how bad prior reactions have been, but in the end, having a history to a local reaction to a vaccine doesn’t mean that one can’t get multiple vaccines at once. It might make sense to take an antihistamine while getting the vaccines – it would reduce any true allergic reaction, and would not prevent the immune system from appropriately responding to the vaccines. A consultation with an allergist prior to getting the shots might also be reasonable.

      I hope this is helpful – please let me know if there’s anything to address further.

  3. Kela, we are all parents but not doctors, so we can’t give medical advice like this. I wouldn’t know how to advise someone who hasn’t followed the vaccine schedule and might have concerns about allergies.

    In general, if my doctor said it was safe, I would trust his / her opinion. And if I didn’t trust it, I’d see a second doctor.

    Best of luck getting your son up to date on his shots!

  4. Hi there Skeptical Parents! The link to my blog doesn’t work, so here it is

    http://lizditz.typepad.com/i_speak_of_dreams/2010/09/important-new-paper-again-maybe-finally-no-link-between-vaccination-and-thimerosal-in-vaccines-not-c.html.

    I guess when I talk about vaccines and autism, I’m pretty dogmatic. I will try to follow the suggestions above with more vigor…

  5. Link fixed!

    Please don’t become less dogmatic on my account. Maybe that’s the right approach. I’m still experimenting!

  6. This is a timely post. I was aware of your site via Liz’s Blog Roll, but I hadn’t had a chance to visit previously. I sought this site out when another mommy questioned the use of science in guiding parenting decisions, specifically potty training. The mommy seeking advice was getting a lot of pressure from family and friends to force her 2.5 year old to use the potty. She was frustrated because the potty training techniques weren’t working and she didn’t know if she should try harder or leave it alone. She felt that if she left it alone, she was being “lazy” and not doing her job as a parent. My daughter is a few days younger than hers and I used my personal experience to reassure her that her daughter is doing just fine and she might not be ready to use the potty just yet, my daughter is in the same place and science supports that only 40-60% of kids are trained by 3 and the rest by age 4. Another mommy took issue with the upper limit and felt 4 was way too old because after all, she was fully trained at 18 months. I responded by posting a medical review article that supported my statement and asked her what she used to support her position. I took an opportunity to explain the difference between science and ancedotes. Well…..suddenly I was calling her stupid because she didn’t grasp the concept of ranking of evidence. Then several other mommies get on the bandwagon and why was I such a b-word by calling her stupid? The best irony was when they disagreed with the mommy they were defending and repeated back my advice. LOL.

    Dr. Phil’s talk at TAM raises some good points, but it is very discouraging when I do take care to follow the guidelines you mention above and still get gang banged because these women cannot follow an argument and are science phobic. It was very interesting for me to note that they thought I was awesome until they found out I had a PhD. Now I’m not so popular. My posting style hasn’t changed, just their perception of how they rank with me. Their low self-esteem prompts them to insert degrading comments as they read my posts consistent with their perceptions of themselves. For example, because they think they are stupid, they’ll read that I called them stupid even when I did not. So while I can control what I type, I cannot control the reader’s comprehension. I’ve actually realized that they use my posts to reconfirm their negative self-perceptions and then project their digust with themselves onto me. It really is somewhat fascinating when I learned to not take their hatred directed at me personally.

    I’m leaning to agree with Dr. Phil and I’m not participating to convince the opponent but more to address the audience. There are parents that value different view points and want to learn more about parenting. I think blogs like this are awesome as an opportunity to attrack like minded parents. I’ve started my own blog too, but have little time to update it as much as I like.

    I’ll leave you with this comment from the thread I mentioned above:
    “While scientific evidence may come into some parenting decisions, I truly believe that the best parents will make their decisions based on love and instinct. There is a reason that the OP came here looking for advice rather than doing a medical literature search. She was coming here for anecdotal advice from people that she has learned to trust and respect. To imply that that kind of information is less valuable than a scientific study is absurd.”

    Pretty much sums up the prejudice that I’ve faced. I should note that I’ve been a member of that community since 2003, so I’m not posting there as a noobie. I was actually there before most of my critics. With the potty training, I actually built my advice based on anecdote (this was my experience with my daughters) and further supported it with the medical literature. Another example of not understanding the ranking of evidence or being to follow an argument. I also think it is interesting that she equates using science to make a decision as not loving and providing additional material that a parent might not of been aware of as “absurd”. Thought you might want to use that as fodder for a future blog post. 😉

    I’ve bookmarked your site and I’ll be a more frequent vistor in the future. Thanks for providing such a great site!

    PS I also half-expected my child’s head would explode when she got her MMR after reading all the anti-vax material. I laughed at myself because I knew it was bunk and I was still nervous. I can only imagine how a parent that doesn’t have my training must feel!

  7. […] advice, and I’ve come up with a few rules of my own, which I elaborated upon here.  I’ve gone from unfriending people on Facebook to being able to speak civilly and then walk […]


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