Q&A with Amy Wallace, author of Wired’s autism/vaccination article An Epidemic of Fear

Amy Wallace

I knew as I started reading Amy Wallace’s “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All” in Wired, that I wanted to know more about the story and how Wallace assembled it. Wallace chronicled the history of the anti-vaccine movement through a profile of Dr. Paul Offit, a scientist whose work in vaccines has made him a flash point in the discussion. Scientists like Offit find the motives of their work questioned by Oprah, Jenny McCarthy, Jim Carrey and thousands of other parents who believe vaccines cause autism. As soon as Wallace’s story came out, hundreds of scientists, readers and parents began writing her and sharing their own stories. I asked Wallace if she would do a Q&A with me about her story and those reactions, and she was kind enough to agree. Here it is, conducted by email (bolds for emphasis are mine)

Smalera: Plenty of people are questioning your motives in writing this story. They’re accusing you of being a pharmaceutical lobbyist, a shill, or as being in the pocket of the government or Dr. Paul Offit, the scientist you profiled, who serves as the spine of the article. They’ve attacked you personally. So how did you decide to write about vaccines, autism and Dr. Offit? And once you started diving into such a heated issue, did you expect this level of vitriol in the feedback?

Wallace: I must give credit to my great editor, Mark Horowitz (ED: sadly laid off the day this piece was published). He and I were batting around ideas and he told me about Dr. Offit. Every one of us knows or is related to several people on the autism spectrum. I’m no different. So I was immediately interested. Add to that the way families’ struggles with autism intersect with vaccine panic, and I was even more intrigued. So I called Dr. Offit and asked if we could meet.

Anyone who reads Dr. Offit’s book, Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, finds out in the first few pages the kinds of threats he has experienced. So it would be naive to write about this issue and about Dr. Offit without knowing there was a good possibility I’d field some vitriol. That said, what’s been really surprising is how voluminous the feedback has been — and the vast majority of it positive. I just heard from the 473rd person to write me (ED: As of 11/1) — an immunology professor at Johns Hopkins who said he’s going to hand my Wired piece out to his students.

S: I just read your tweet that positive feedback is outnumbering negative 4 to 1. If that number is representative of anything, it seems to indicate that a vocal minority, those who believe autism comes from vaccination, can gain an incredible amount of credence based on emotional responses and ‘correlation rather than causation’ (a point you make about signs of autism appearing around the same time many vaccines are administered, not because of vaccines but the normal cycle of childhood development) In the meantime, science is challenged to prove a negative, something, as you write, it is ill equipped to do. Do you think part of the reason this story existed for you to cover was because the channels of Internet and celebrity have bestowed a bizarre kind of credibility on the anti-vaccine crowd? A sort of “Oprah effect” that hasn’t existed in years past?

W: The Internet lets all of us do research late into the night in the privacy of our own darkened studies. And of course, what we learn there is a mish-mash of valid and invalid. But I don’t think the Internet is the only thing at work. Also important is the fact that much of the traditional media finds it easier — and more sensational — to present what is known about vaccine safety as a debate, with two sides of equal merit. Larry King sets up this kind of scenario all the time. The goal is riveting television — people lambasting each other live and in color. Confusingly, such shows masquerade as a search for truth. But they are anything but.

Oprah has been roundly criticized for endorsing Jenny McCarthy and Suzanne Somers. Newsweek ran a whole cover story on Oprah’s embrace of pseudo-science. So yes, the entertwining of celebrity and the way people get their “news” complicates this issue. The world would be a better place if hyper-smart cultural icons like Oprah were more responsible about how they wield their power.

S: A key part of your story revolves around thimerosal, a vaccine preservative that many in the anti-vaccine crowd point to as a cause of autism. The Public Health Service, as you wrote, botched a 1999 statement on thimerosal’s proven safety, opening a line of argument for the opposition. You make a point in your last answer that a false debate on vaccine safety is being presented by the mass media, mostly because it’s good ratings. What, in your reporting or opinion, led control over the conversation on vaccines to get away from scientific authority and into the camp of media like Oprah and Larry King and celebrities like Jenny McCarthy? It’s arguable that people taking polio immunizations fifty years ago had more faith in science than their descendants do today. How did we get here? Is some of it simply that vaccines have shielded us too well from the horrors of diseases like Polio that Dr. Offit’s generation saw firsthand?

W: Yes, I think the irony is that vaccines have done such a good job of eradicating disease that we are now more afraid of the risk of vaccines (which is minimal) than the risk of virulent illness (which, while hidden, remains a big threat). Your question about how control of the conversation shifted to celebrities and celebrity journalists I think opens up a bigger discussion about journalism and media and the way people get their news (or their “news”) today — an evolving issue that transcends this topic. I think more and more, people prefer to get their current events predigested by pundits — whether it’s Oprah or Jon Stewart. But where it relates to my story is this: the more complicated the material, the more vulnerable it is to misinterpretation or false simplification. And immunization and herd immunity — how it works, why it’s necessary — is not a simple topic.

S: So how do the relevant authorities, especially in this time of intense skepticism of government, regain control of the conversation? The Public Health Service, for example, is barely visible on the spectrum of government agencies. Chronic diseases like obesity, diabetes, heart disease and cancer are at the forefront of the national conversation on health care and preventative medicine. Will it take an outbreak, something like, knock on wood, a swine flu pandemic, to remind people of the importance of vaccinations? Or is there another way to get Larry, Jenny, Suzanne and Oprah to present vaccines as a success story of public health, rather than the leading edge of some paranoid conspiracy?

W: I guess I don’t think this is a conversation you “get control” of. The horse is out of the barn, Elvis has left the building. But that doesn’t mean people who believe in science and who think vaccines are one of the great accomplishments of modern history should give up. I think it all comes back to story telling. Scientists need to tell a more compelling story. (ED: For those playing at home, Wired’s Erin Biba wrote a fact guide on “how to win” an argument about vaccines.) While [scientists] are trained to argue using data, not anecdote, they should not be afraid to tell stories — as we did in Wired — of the risks of falling ill. Dying of Hib meningitis is not pretty. And the measles? As we note in the story, it’s no walk in the park, either — not for you or those who come near you:

In 2005, a 17-year-old Indiana girl got infected on a trip to Bucharest, Romania. On the return flight home, she was congested, coughing, and feverish but had no rash. The next day, without realizing she was contagious, she went to a church gathering of 500 people. She was there just a few hours. Of the 500 people present, about 450 had either been vaccinated or had developed a natural immunity. Two people in that group had vaccination failure and got measles. Thirty-two people who had not been vaccinated and therefore had no resistance to measles also got sick. Did the girl encounter each of these people face-to-face in her brief visit to the picnic? No. All you have to do to get the measles is to inhabit the airspace of a contagious person within two hours of them being there.

S: One of the other players in the story are the pharmaceutical companies. It’s undeniable that they translate medicine into a profit motive–that’s why the exist. But as you point out, vaccines aren’t much of a profit center compared to, say, Rogaine or Viagra. Yet there’s a lot of animosity directed at big pharma. Do they care to engage the anti-vaccine crowd and attempt to convince them of the efficacy, safety and importance of vaccinations. Or is this a case where the minuscule impact on the bottom line is part of the environment that lets a fringe line of thought gain traction?

W: Pharmaceutical companies want very much for people to be convinced of vaccines’ efficacy, safety and importance. Not because they hope to make gobs of money, per se (because as you note that we noted, vaccines are hardly Big Pharma’s meal ticket), but because vaccines are what they regard as one of their positive contributions to the planet — their good works. It takes a chunk of change to research, develop and test vaccines, and Big Pharma invests that money. Given that, I think some who work at pharmaceutical companies are mystified by the grief they get about vaccines.

That said, and again as we note in the story, Big Pharma has played an active role in eroding the public’s trust in medicine, science and expertise in general. Just this past September, federal prosecutors hit Pfizer Inc. with a record-breaking $2.3 billion in fines and called the world’s largest drug maker a repeating corporate cheat for illegal drug promotions that plied doctors with free golf, massages, and resort junkets. A lot of people hear about that and say: if the products they make are so effective and safe, why do they have to bribe doctors? And it’s a good question.

S: Finally, as a journalist, what was the hardest part of the story to report out? Maybe it overlaps with the most rewarding part, but if not, can you share that too?

W: I guess I don’t really have a single “hardest part” to report. Every story has it’s challenges and this one was no different. The thing I worked the hardest on, though, was double- and triple-checking (with the help of researchers at Wired) to make sure we were not just factually but contextually accurate. Nobody likes an error, no matter what the story is. But this story, I knew, would likely be subjected to all kinds of scrutiny. And it was arriving at a time when swine flu put vaccines top of mind. It was our responsibility, perhaps now more than ever, to get it right.

What’s been most rewarding has been the feedback I’ve gotten from readers. More than 500 people have written to me personally from around the world, sharing their stories, their worries, their questions. Parents of autistic children, adults with autism, pediatricians, educators. I’ve heard from scientists who said the story made them vow to speak up in ways they’ve previously shied away from. I’ve heard from parents who said the story had convinced them to vaccinate their kids. I’ve heard from scores of people who believe the story, potentially, could save some lives. I’ve never had so much response to a story. People took time out of their busy lives not just to read the story, but to tell me how it made them feel. That has been very gratifying.

PS: A compendium of responses from around the web, pro and anti, is available here.