Wednesday, October 01, 2008

Book Review: Autism's False Prophets by Paul Offit

I recently received and read Autism's False Prophets: Bad Science, Risky Medicine, and The Search for a Cure by Paul Offit through the ScienceBlogs Book Club. Offit first details the history of various attempts at defining the cause of and curing autism, focusing the most on first the MMR vaccine and then thiomersol (which contains mercury), which is contained in many vaccines (though not MMR).

In general I found this book interesting and educational (all I knew going in was that the "vaccines cause autism" nonsense was both quackery and dangerous), and I recommend it to anyone interested in the so-called controversy—there is no controversy as far as the science is concerned—as well as for the book's interesting discussion on the interaction between science and the public via the media. People distrust science and its authority figures all the time; usually this just leads to ignorance, but in the case of "let's not vaccinate our kids" it can lead to death. Which isn't cool.

Summary: Autism's False Prophets begins by offering a pre-vaccine history of autism and attempts to cure it. A pattern is established: people come up with some desperate theory, put a lot of time and effort and money in trying to "cure" their children, some of the "cures" wind up doing severe damage, parents move to next theory. Then enters the vaccine theory, which is actually two-fold. It begins in England with Andrew Wakefield announcing that the Measles, Mumps, and Rubella (MMR) vaccine increases rates of autism; he's even got an (unsupported) idea as to why this should be the case. (People seemed to not mind that he's had it out against MMR since the 1980s.) Meanwhile, as the MMR-autism link isn't able to be reproduced in independent studies and Wakefield is exposed as a fraud, a panel in the US realizes that the amount of ethylmercury in vaccines (used as a preservative, which makes the vaccine both cheaper and safer to use) is higher than the amount of recommend safe-levels of methylmercury. Spurred on by parents who have decided that their kids got autism after getting their vaccines (most austism symptoms become the most apparent about a year or so of age, right around when kids get many of their vaccines, so the emotional causal link isn't unsurprising), the panel figures that there isn't any harm in being cautious. So they announce that while there isn't any reason to be afraid, they will be looking into the situation. And all hell breaks loose.

Offit traces this aftermath right up to the Omnibus Autism Proceedings, a huge court case of thousands of parents claiming that vaccines caused autism in their children; the court's decision is due out early 2009. Offit then discusses how this controversy is a classic example of fear, scandal, and headlines driving the media narrative more than responsibly informing the public of the facts: the scientific case showing no linkage between vaccines and autism has actually been established for some years now. But, Offit argues, the public equates going online and reading what shows up on a Google search with scientific literacy, and our culture likes to buck authority, and so the result is kids dying of measles. The book closes with a short look into what actually does cause autism (it's genetic), and how a few parents of autistic children who know vaccines weren't the cause—and who don't like having their children referred to as "mad," "damaged," or "soulless"—have been responding to this whole fiasco.

Review: In general, I liked this book and found it easy to read. However, there were several stylistic points which were downright annoying. (I get the impression that while the author did his job, the editor did not.) First, there are several simultaneous storylines weaved throughout the text, yet as the story is not always told chronologically, it's difficult to keep any of the dates and the relative orderings of different "plots" straight. In this same vein, the book is written with the understanding that vaccines do not cause autism, but often the story is told like it is a story, a thriller: the case against vaccines-cause-autism isn't made strongly and irrevocably until well into the book, so someone could easily read halfway and think "zomg! conspiracy!!!" Also, as this is a book talking about how important believing the scientific consensus is, I would have appreciated it if the end notes listed at the back of the book were actually marked in the text itself. The organization of the book is also somewhat shaky, causing some interesting points get a bit buried in the text. For example: if vaccines-cause-autism really is this big conspiracy, then how come the scientists, etc. supposedly perpetuating this conspiracy vaccinate their own kids? Or that kids absorb more methylmercury from breast milk and baby formula than from vaccines in their first few months of life anyhow, a fact which is just mentioned in an off-hand kind of way in the middle of some chapter.

The two chapters towards the end of the book on science and the media and how the general public portrays science were both interesting and elucidating. I can't come up with solutions to these problems, but Offit at least lays out the issues well.

14 comments:

Quark said...

Thanks for posting this review.

mandydax said...

You reversed methyl- and ethyl-mercury in your third paragraph, but it is a wonderful overview. I think that a time-line showing when each thing happened relative to the others would have helped a lot. I did get confused as to chronology a bit, too.

mollishka said...

Thanks for the catch, mandymax. You're right of course; it's fixed now. This is the sort of thing that happens when I write reviews without the book nearby .... Are you following the discussion on ScienceBlogs as well?

You're welcome, quark.

Stephen said...

Excellent review.

Of late (well after your post), Wakefield has been accused of faking his data. Will this stop the anti-vax crowd? I doubt it. But it's a start.

As there have been deaths involved, this is serious. I wonder if Wakefield will get prosecuted? I'm firmly ambivalent on this issue.

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Daphne said...

Social deficits distinguish autism and the related autism spectrum disorders from other developmental disorders. People with autism have social impairments and often lack the intuition about others that many people take for granted. Noted autistic Temple Grandin described her inability to understand the social communication of neurotypicals, or people with normal neural development, as leaving her feeling "like an anthropologist on Mars and this problem is very difficult to people with this disease and I suffer this problem and when I feel sad I take a Caribou Coffee and I feel better.

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Stephanie said...

I dont know anything about what vaccines contain but i dont believe they are the source of autism. My mother always told me that those children are born with the condition. Im reading some books for my senior project on this subject but i havent read anything that i actually believe, but maybe it because some of them are outdated.

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