Bad Advice is full of good advice. The author, Dr Paul Offit, is a paediatrician, a scientist and a science communicator. He was one of the first medical professionals to take on the pseudoscientific quackery, especially around vaccines and autism, that dominated the public debate at the turn of the century.
Andrew Wakefield had published a paper in the Lancet, that has since been retracted, that argued for a new form of enterocolitis that was associated with autism. He went much further in the press conference that launched the paper and claimed that the MMR vaccine compromised the immune system, leading to a weakening of the lining of the gut. This, he said, allowed undigested toxins to enter the bloodstream. These toxins crossed into the brain and caused autism. He called for an end to the MMR vaccination programme and for the individual components of the vaccine to be administered separately.
He was wrong. And scientists responded with studies that proved him wrong. Dr Offit refers to seventeen such studies in his book. End of argument? No. Wakefield may have lost the argument with his peers but he triumphed in the court of public opinion. He was the brave maverick doctor challenging the establishment on behalf of a devoted following of parents, who, with some justification, felt that their concerns for their children had been shrugged off by professionals. I can understand that. My son is autistic. And our experience was of a constant battle to get the authorities to take our concerns seriously and make adequate provision to meet his needs.
“The Establishment” has history here. In the 1950s and 1960s we were told that autism was caused by bad parenting, the infamous era of the so called “refrigerator mother.” Children were taken into care to “recover” them from autism using psychodynamic therapies. It was parents that proved them wrong, led by Lorna Wing in the UK and Bernie Rimland in the USA. Then we were told that autism was innate and our children were ineducable. Parents responded by establishing schools for autistic children who thrived in a specialist environment. So when parents who believed that dietary problems and vaccines were implicated in their children’s autism found a champion in Andrew Wakefield they clung to him despite all the evidence.
It was only when the efforts of investigative journalist Brian Deer at the Sunday Times, British Medical Journal editor Fiona Godlee and a disciplinary hearing before the General Medical Council combined to demonstrate that Wakefield was not only wrong, but knew he was wrong and had seriously breached medical ethics to propagate fraudulent research that his reputation waned. By then the damage was done. Vaccination rates had fallen and diseases like Mumps and Measles were once more on the rise in the USA and becoming endemic in parts of Europe. As Dr Offit points out, direct experience of diseases that had been consigned to history has finally consigned Wakefield and his cult followers to the margins.
But that was a long time coming. Until then the truly brave and maverick doctors were those like Paul Offit and our own Mike Fitzpatrick in the UK, who entered the bearpit of public opinion to defend science and medicine. When you step into a bearpit expect to be mauled. With a self deprecating wit Dr Offit recounts a number of his maulings in this book.
The key to this book is in the title. Why is bad advice so readily taken? Why do the good guys like Dr Offit get mauled so often and what can we do about it? The simple answer is read this book. It is a manual for any scientist or doctor who wants to engage with the media and avoid all the mistakes that Dr Offit freely admits to. But he goes further by exploring the reasons why he was mauled and how you can avoid a similar fate. I recommend this book as a training manual for any medical or scientific organization that has to engage with the public or the media.
Finally, and understandably, given the death threats and the campaign of vilification against him, Dr Offit takes time to answer his critics by explaining his motivation in standing up for children, his probity in pursuing a vaccine to guard against childhood diarrhoea and to absolutely refute any suggestion that he is somehow in the pocket of the drug companies. I can understand why he feels compelled to do this while regretting that it is still necessary.
Dr Offit deserves to be remembered alongside his own personal heroes like Jonas Salk and Stanley Plotkin for his contribution to science and to human health. But perhaps his greatest contribution may turn out to be raising our understanding of science and alerting us to the false prophets who would lead us back down the paths of ignorance and superstition.