ducksanddrakes

Last week, two pieces of news coincided. First, Toyota announced a recall of vehicles due to a dangerous malfunction in their accelerators. Second, the Lancet retracted a paper that linked vaccines with autism. The scale of the recall was sweeping. The embarrassing retraction was unheard-of in a medical journal of the Lancet’s stature.

CNN covered both developments heavily in daytime rotation, especially the second. I caught an interesting exchange between medical correspondent Elizabeth Cohen and a woman from Kentucky named Kim Stagliano, who has three children diagnosed with autism spectrum disorders, which she attributes to their childhood vaccinations.

Cohen explained the retraction:

In 1998, a researcher named Andrew Wakefield published a study that showed that there could be a link between autism and childhood vaccines. Well, as you can imagine, a lot of parents really freaked out about this. So that’s what happened in ’98.

And then in 2010, “The Lancet,” which is the folks who published that study in the first place, they retracted it. They basically said that it wasn’t done properly and they retracted it.

So this is what they said: “It has become clear that several elements of the 1998 paper by Wakefield et al are incorrect. Therefore, we fully retract this paper from the published record.”

And this was the study that kind of started it all. This was the study that got people saying, oh, my goodness, should I vaccinate my child? I mean, you can imagine how parents felt when they read about that kind of a study.

Stagliano challenged Cohen on the facts, pointing out – correctly – that the Wakefield study did not show an association between autism and vaccination, it only conjectured that measles-mumps-rubella vaccines might cause an intestinal infection that could affect the brain. Cohen explained – also correctly – that the paper nevertheless had substandard methodology (10 of the paper’s 13 co-authors had already disavowed it) and has become a touchstone for the growing anti-vaccination movement, whose members should take the announcement as grounds for reconsideration of their thoughts on the matter.

As a correspondent who has covered this issue, Cohen had experience with people who use the Wakefield paper as proof positive:

No paper ever definitively shows anything, but this study was — I mean, I had people thrusting this study in my hands over the years, saying, “Read this, read this, it shows that vaccines cause autism.” That was the way that many people saw it.

Nothing ever definitively shows anything, but case reports showing a link, it has been touted as evidence showing that there is a link.

Now, Cohen is making a fine point about the poor state of scientific and medical literacy. The irony is that a public too-eager to heed published research is not equally eager to discount that research when it turns out to be faulty according to the publishers who lionized it. A study is unimpeachable because it appears in a trusted source, so much so that it becomes more trustworthy than the source that had invested it with authority in the first place.

The Lancet‘s studies are gospel, but its retractions are balderdash.

Here is Stagliano’s response, which brings this all together for me:

Your lead-in of the Toyota story really hit me very closely to home. How would you feel if you were told by the federal government that in order to drive your children to school, tomorrow, you have to do it in a 2010 Toyota Prius? You’d be very nervous.

Now, Priuses aren’t driving off the road and crashing at an alarming rate. There may be a handful of them that have a problem. Would you want to put your child into that car and drive her to school tomorrow, and know that if you weren’t in that car, you wouldn’t be allowed to go to school perhaps?

That’s how people feel in the newly-pregnant, soon-to-have-a-baby world. It’s not the autism community.

This analogy is brilliant and devious. It’s devious because it misidentifies the crux of the dispute. In the Toyota case, there is no disagreement about the evidence of a faulty accelerator, but that is not the case with the vaccine. By making the comparison, Stagliano presupposes that everybody already agrees that the vaccine is as deadly as a runaway Prius. That characterization does not capture the situation – hence Lancet‘s retraction.

So Stagliano’s analogy is specious. But it’s also clever. By transforming the argument from a medical debate to a policy debate, she has removed it from Cohen’s realm of expertise. This argument has now ceased to be about how people ought to respond to scientific developments. Instead, it has become a narrative about who should decide what’s best for children – parents or the government – a debate in which physicians and science are peripheral. So an argument about finding the facts has become one that marginalizes the very people who seek the facts.

Now, I don’t know a thing about autism. And I don’t think Stagliano’s dishonest. I just think that if this world needs satisfactory analogies – and it does – this one should be repudiated.