Autism's False Prophets: Second Essay (Offit)

Dr. Offit is a vaccinologist, a pediatrician and a medical academic. He isn't an historian. Though it isn't helpful to score a neurosurgeon because he can't dunk a basketball, for example, you can take him on "one on one" if he shows up to play ball. Thus when Offit "shows up" to play "history," by talking about Kanner and Bettleheim, one expects him to spend at least a few pages on autism research in the 1970s-1990s, three crucial decades in which we developed our "modern" understanding of autism. But he doesn't. He lurches unsteadily from Kanner to Bettleheim, to an explanation of the rise in numbers of autism diagnosis, to an "expose" of some of autism's earliest charlatans. When he gets to one of his true nemeses in the book, Dr. Andrew Wakefield (p. 18), he has finally found his footing. Yet, since he entered into history, it might have behooved him to provide a more nuanced view of history of autism research. Such a history doesn't easily permit you to tell the good guys from the bad guys. Indeed, if there is one story that emerges from autism research in the 1950s-1990s, it is as if all researchers were trying to climb Everest without air tanks. They became disoriented quickly, and new theories emerged as quickly as dandelions after the spring rains. But Offit has an axe to grind in the book, and the moderating breeze of good historical narrative wouldn't make for a good grindstone.

Introducing the "Villains"

There is no question that the biggest villains for Offit are Andrew Wakefield, an English doctor who first suggested a possible link between the MMR vaccine and autism (1998) and David Kirby, a freelance writer/columnist for the NY Times and other papers, whose 2005 book on mercury and autism (Evidence of Harm) helped propel this issue out of the narrow world of autism professionals/parents to the general intellectual culture "out there." He sees both as mountebanks who hyped their case based on little evidence and then continued to represent their approaches after they had been discredited. But he goes further than that. He produces matieral that he says supports the notion that Wakefield, a charismatic, bright, energetic researcher, violated numerous ethical canons of good medicine and scholarship in not reporting the sources of his funding, in performing invasive procedures on children without ethics committee approval, and otherwise understating the possible link between his research and pending litigation for which his research was vital. At present Dr. Wakefield is being investigated by the (English) General Medical Council; a decision isn't expected any time soon.

Though Dr. Offit tries to paint Dr. Wakefield in the worst possible light, one gets the impression that what really ticks off Dr. Offit is that Dr. Wakefield seemed to challenge his medical colleagues on the vital point that medical practice is actually more about service to parents and patients than service to the "medical establishment." I look forward to the day when Dr. Wakefield tells his own story, not just of this decade-long controversy, but also that makes clear how his understanding of medicine is at stake. In the meantime, Dr. Wakefield has "landed on his feet" in America (he directs Thoughtful House, a multi-disciplinary autism treatment and education facility in Austin TX).

In trying discredit Wakefield, Offit also takes on the idea that the MMR vaccination "causes" autism. I, who only entered into this complex and fascinating field a few years ago, have always been skeptical that one could speak of a "cause" of autism with any degree of confidence at the present level of our knowledge. Arguing for a direct link between this vaccine and autism in most or all cases is not convincing to me. What is convincing to me, however, and this is a point that Offit never really gets around to addressing, is that many parents, indeed, thousands of parents, believe that they saw their beloved children descend into autistic behavior shortly after receiving the MMR vaccine. That reality just won't go away and hide, even if the epidemiological studies don't show a "link." Many parents know that in the case of their child, there is a link between the MMR and their child's autism. They don't know the biochemical "pathways" that led to the child's autism; they don't know what it is about the vaccine that did it; they can't explain why their "Johnny" was affected while their neighbor's "Ryan" seeminging went through the MMR with flying colors, but they know, nevertheless, that something with respect to that vaccine damaged their child. I, for one, am not willing to dismiss this kind of testimony, as Offit seems to do.

It seems much more "scientific," a term that Offit sometimes wields like a cudgel against those with whom he disagrees, to take seriously the reports of parents as well as the epidemiological and biological studies in the labs. This is especially important to do, especially if the parents seemingly tell consistent stories and haven't been "coached" by some "greedy class action lawyer" waiting in the wings (another class of people whom Offit doesn't seem to like).

There seems to be a growing consensus that there is something in that vaccine that, in a minority of cases, triggers something in some children, that leads them to states of autistic withdrawal. It could very well be that many of these children are only "injured" slightly--i.e., even though their autistic symptoms are real, they can more easily become "cured" or "neurotypical" through regimens of diet, shots or other therapies. For some children, however, the black veil might have forever been drawn across their eyes as a result of the MMR vaccination. Let's be "scientific," Dr. Offit, and take seriously the stories of parents. Not every parent is so emotionally distraught that s/he can't see straight. Most parents of autistic children, in fact, see a lot straighter, I would claim, than the average parent... or maybe even the average physician.

David Kirby

He also directs some pretty stinging punches against author David Kirby. His major point is that Kirby is fundamentally not a journalist--a disinterested reporter on facts--but is a partisan guy masquerading under the title of journalist in order to further his deceptive practices. Kirby is more like a public relations officer (he actually had a PR firm, Offit says) than a journalist. Offit argues that Kirby's 2005 book was nothing more than the presentation of material funneled to him by Lyn Redgrave and those who were convinced of the mercury-autism link. Offit further argues that Kirby eagerly threw around his "NY Times connection" with people whom he wanted to interview while, in fact, never having been employed as a staff writer for the times (he sometimes sold his stories to the Times). For Offit, Kirby is simply an alarmist, a person who will do almost anything to fire up the "troops" even after the battle (on the connection of autism to mercury poisoning) has been lost. I do not know if David Kirby either is planning a response to these allegations or will ignore them. They certainly make Offit look a little petty, however...

Conclusion

There is a lesser array of villains for Offit, consisting of people from Generation Rescue, Safe Minds, and Defeat Autism Now! (DAN!) physicians, the last of whom he sees as the primary peddlers of false hope out there. He makes unsubstantiated allegations about the last group when he says, without footnote:

"Many DAN doctors have been disciplined by their state medical boards for practicing medicine unethically or illegally, and several have had their medical licenses suspended or revoked," p. 123.

A statement like this, without citation, is dangerous for an author to make...

I need one more essay for final comments on the book and the future of what I call the Autism Wars.

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