Good Shots: From scare tactics to straight reporting, 2 endorse vaccinations

Book Review: "The Panic Virus: A True Story of Medicine, Science and Fear," by Seth Mnookin. Simon & Schuster, $26.99. "Deadly Choices: How the Anti-Vaccine Movement Threatens Us All," by Paul. A. Offit. Basic Books, $27.50



Scientists understand now better than ever how vaccination works and how to make it safe. Still, whispers among parents spread quickly:

Do vaccines cause autism? Epilepsy? Is there mercury in them? A live virus?

A recent study in Pediatrics reported that 25 percent of parents believe vaccines can cause developmental disorders in children, despite overwhelming evidence to the contrary, Seth Mnookin writes in "The Panic Virus."

It is an angry, hurtful topic to breach. Both sides have devastating anecdotes about sick children and families forever changed. Who can challenge that?

So in many ways, it is brave of Mr. Mnookin, a magazine journalist, and Paul A. Offit, an infectious disease specialist, to tackle the issue, as they do in their new books.

One could easily flounder in the ocean of research, conjecture and anecdote that surrounds the vaccine controversy, surfacing years later a madman or worse.

Mr. Mnookin and Dr. Offit share the same premise: The vast majority of reliable research shows vaccines cannot cause disorders such as autism. They approach their arguments in radically different ways, though, producing works as different as their backgrounds.

To read either book is to receive an education. Both summarize the extensive research done on the issue. Both chronicle the growth of a market behind anti-vaccine advocates; personal injury lawyers and people selling cures for autism make money off vulnerable families, a practice Dr. Offit calls "the cottage industry of false hope." And both outline what Mnookin calls the "vexing paradox" about vaccines:

"The more effective they are, the less necessary they seem," he writes.

But Dr. Offit's book is, as the title suggests, a polemic, often written in the style of a thriller.

"The Panic Virus" is a far broader project, a lively story about bad science, reactive policy and shoddy journalism, told by a curious narrator. While "Deadly Choices" will please a more limited audience -- likely people who already agree with Dr. Offit -- "The Panic Virus" has the potential to entertain and enlighten many.

Dr. Offit goes to great lengths to describe in his book the horrors inflicted by diseases that are now prevented by vaccinations. He also demonstrates well the impact that anti-vaccine programs had on vaccination rates, linking drops in vaccination to outbreaks of disease.

Despite his obvious views, he does not sugarcoat the history of vaccines. He discusses some low points, such as a 1950s episode when 120,000 children were injected with an incorrectly manufactured vaccine devised by Dr. Jonas Salk that contained live polio virus. Two hundred were paralyzed and 10 died.

But he clearly believes in one truth, plain and moral:

The benefits of vaccines far outweigh their risks, and that anyone who tries to convince the public otherwise is guilty of circuitous murder.

Dr. Offit's most compelling argument comes in a chapter where he compares the choice to not vaccinate with the tragedy of the wider dimension:

"As more and more people have chosen not to vaccinate, herd immunity has broken down."

In later chapters, though, he oversimplifies the controversy.

Ultimately, his tendency to attack those who disagree with him will leave a bad taste in many readers' mouths. His tone undercuts the weight of his evidence, turning the book into a missed opportunity. As someone who has received death threats from anti-vaccine advocates, Dr. Offit has legitimate reasons to feel under siege. But if he wants to defend himself, why not do so openly?

Particularly troubling is the way he reveals the financial interests of others to discredit them, but does not discuss his own as the co-inventor of a rotavirus vaccine. This does not automatically color his arguments, but when he discusses the vaccine without disclosing his role, it invites skepticism.

Mr. Mnookin is more interested in how flawed information spreads than he is in laying blame, though he certainly does that, too. As a result, his book is a more expansive work than Dr. Offit's.

"The Panic Virus" dips into Aristotelian philosophy and explores conspiracy theories. In one chapter, a broad discussion of scientific progress, Mr. Mnookin writes about Newtonian mechanics and Einstein's theory of relativity, yet manages to squeeze in a footnote about true love.

One of the most telling differences between the books is the way he includes a fuller spectrum of parental views, presenting them with nuance. He acknowledges, unlike Dr. Offit, that parenting is about gut decisions, not rational evaluation. He is respectful of and sympathetic to parents who believe their child's autism was caused by vaccines, even as he dismantles their evidence.

Mr. Mnookin also outlines basic scientific knowledge that Dr. Offit perhaps wrongly assumes of his readers, explaining principals such as nature vs. nurture, correlation and causation and the impossibility of disproving a negative.

Finally, he provides a much deeper history of vaccines than Dr. Offit, reaching back to eighth-century India and Puritan New England, where a slave of Cotton Mather described being inoculated as a child in Africa.

Mr. Mnookin eventually makes an argument and plea. Unfortunately, the first half of his book is stronger than the second. He ends with a provocative chapter titled "Casualties of a war built on lies," a phrase that sounds more like Dr. Offit's than his own.

Still, his argument is more complex than that title lets on; he outlines a messy problem, one with no easy answers.

Both books are worth reading, but to read "The Panic Virus" after "Deadly Choices" is to discover the larger story.

For a related story that ran Jan. 23 on how the medical community and some patients are starting to push back against the anti-vaccine movement, go to www.post-gazette.com.


Vivian Nereim: vnereim@post-gazette.com or 412-263-1413. First Published February 6, 2011 5:00 AM


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