PBS Frontline aired an updated version of their 2010 documentary "The Vaccine War" last night, during which doctors, nurses, public health experts, bloggers and others discussed the show on Twitter. For the most part, the documentary presented facts about vaccines that were based in fact and included a range of experts who explained the benefits and risks of vaccines clearly, honestly and accurately. Similarly, the majority of those tweeting during the broadcast, which began at 10 p.m. ET, were clearly on the side of science with anti-vaccine advocates few and far between.
That was actually a little surprising, though, since Frontline made a concentrated effort to invite individuals who reject the science of vaccines to participate in the Twitter discussion. To be sure, they also invited a wide range of public health officials, doctors, science-based bloggers, researchers and others who do accept and promote the science of vaccines. In fact, they invited me to participate. But I declined for reasons I explain on my personal blog, including the fact that they were explicitly seeking participants who believe, inaccurately and against the consensus of scientific evidence, that the risks of recommended childhood vaccines outweigh the benefits. There were others who were invited but declined for similar reasons, such as epidemiologist René Najera, a PhD candidate at Johns Hopkins University who explained his reasons here.
But those who did participate did a wonderful job of discussing the benefits of vaccines and their success at beating back vaccine-preventable diseases. And they did something else that heartened me greatly: they pointed out how damaging, inaccurate, inappropriate and polarizing the show's title and hashtag were. I storified the tweets which best characterized the problem with the title, but science journalist Maryn McKenna aptly summarized it:
MDs, public health workers object to false balance in @frontlinepbs #VaccineWars and use PBS’s hashtag to criticize, rebuke.
— Maryn McKenna (@marynmck) March 25, 2015
I have railed against the problem of false balance in reporting on vaccines before. Many, many times actually. False balance is presenting "both sides" of an issue in a way that makes it appear as though both are weighted equally, when, in fact, one side carries the heft of all the scientific research behind it and the other carries only anecdotes and cherry-picked, non-replicated studies and case studies in lousy medical journals. I'm certainly not the only one who has pointed out the negative impact of false balance in vaccine reporting. A feature in Columbia Journalism Review by Curtis Brainard in mid-2013 placed substantial responsibility for vaccine fears squarely on the shoulders of an irresponsible press.
What did the show do right? Well, the overall point of view was clearly on the side of science. Their first interview was pediatrician, author and rotavirus vaccine co-inventor Dr. Paul Offit – who later in the show describes how anti-vaccine advocates regularly move the goalposts in their pseudoscientific objections to vaccines – followed by Dr. Melinda Wharton, director of the CDC's National Center for Immunization and Respiratory Diseases. They also brought in Panic Virus author and science journalist Seth Mnookin, another good call. They conveyed the seriousness of the current measles outbreak traced to Disneyland and the 2008 San Diego outbreak. They clearly stated, "The mainstream medical establishment speaks with one voice: vaccines are a public health miracle far too valuable to put at risk."
They answered the "too many, too soon" concern with an explanation of antigen load from Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases. Immediately after Jenny McCarthy said "they" won't study concerns about autism, the documentary explained how extensive those studies are and how many countries have done them. They make it clear that infamous former gastroenterologist Andrew Wakefield was stripped of his medical license after his fraudulent study about the MMR and autism was retracted. They reveal anti-vaccine advocate J.B. Handley for who he really is, using profanity on television to say he doesn't care about a study that shows clearly no correlation between developmental disorders and vaccines. They feature an adorable kiddo with leukemia whose health largely depends on herd immunity and a young girl who narrowly survived a horrific bout of pertussis (whooping cough) in infancy. And they feature a pediatric intensivist, Dr. Cynthia Cristofani, who points out that scarce research funds that could have gone toward autism research were diverted to needlessly show again and again that there was no link to vaccines.
Yes, they did all that right. But they still had way, way too much false balance, and they irresponsibly perpetuated this idea of a "war" that only further alienates parents who seek answers but don't want to feel caught in the vitriol. The introductory narration states "the debate has erupted again" in "the latest chapter in the bitter vaccine war." But fears about vaccines in no way resemble an actual debate, the "bitterness" is there largely because the media keeps fanning those flames, and the issue hasn't just popped up again out of nowhere. Public health officials and health care providers will tell you it's been chugging away all along.
Perhaps the greatest mistake they make is legitimizing an anti-vaccine point of view by calling anti-vaccine advocate Barbara Loe Fisher a "vaccine watchdog" and her influential anti-vaccine organization, the National Vaccine Information Center, an "independent watchdog organization dedicated to vaccine safety issues." No, it's not. It's an anti-vaccine lobbying organization that misleads parents with fear-mongering advertisements and campaigns against laws that facilitate the childhood immunization schedule found safe by the independent Institute of Medicine. They leave her claims of her son's disability's cause unchallenged and play a selection of her video framing anti-vaccine legislative efforts as standing up against "limiting parents' freedom" – never mind others' right to freedom from vaccine-preventable diseases.
They also feature journalist and parent Jennifer Margulis, whose children are only partly vaccinated (as stated in a letter that has mysteriously vanished just today from the PBS site along with other statements), multiple times so that she can play up the value of children getting sick with diseases such as chickenpox and to challenge the benefit of vaccines against rotavirus and hepatitis B. They do not correct her inaccurate assertion that hepatitis B is only a sexually transmitted infection (it's a blood-borne pathogen with other transmission possibilities), and they include her needlessly impugning the rotavirus vaccine immediately after hearing from Offit how many lives it's saved and hospitalizations it's averted.
They also allow inaccurate, offensive statements about autism spectrum disorders to go unchallenged. At one point just before a fade to the next scene, they show a computer screen stating that "Autism is preventable and reversible." This comes from Handley, who also says "Autism is a brain injury," yet they neglect to include anyone pointing out that these statements are inaccurate (it's neither preventable nor reversible) and offensive. Autism a neurological difference that most often is a disability requiring accommodations and support. Autistic individuals are not "injured," and saying as much is deeply offensive to millions of autistic individuals and their family members. Speaking of Handley, as Science-Based Medicine pointed out when the documentary first aired, J.B. Handley initially blamed thimerosal in childhood vaccines for his child's autism, not MMR, yet the documentary conflates these issues. And why did they feature so much of Handley in the first place? Oh, yeah. Because they want it to be a war.
They were other problems – listing scary-sounding vaccine ingredients without explaining them, mentioning the bizarre dystonia of a Washington Redskins cheerleader after a flu shot without explaining that the shot did not cause her problem, playing up a political division about vaccines that doesn't actually exist – but really, the biggest problem remains casting the entire issue as a war, instilling doubt in parents for the sake of ratings, as Dr. P. Mimi Poinsett pointed out, when, in reality, as pediatrician Nathan Boonstra put it, the only war is us against dangerous viruses and bacteria.
Journalist Delonte Harrod asked the most pertinent question:
I wonder if there could have been a better way to foster healthy dialogue about vaccines? #VaccineWar
— Delonte Harrod (@delonteharrod) March 25, 2015
