Book Review

Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure

N Engl J Med 2009; 360:1159-1160March 12, 2009

Article

Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure
By Paul A. Offit. 298 pp., illustrated. New York, Columbia University Press, 2008. $24.95. ISBN: 978-0-231-14636-4

In recent years, the public has been increasingly concerned about adverse events that have been attributed to vaccines. Although such safety concerns have existed since the days of Edward Jenner, modern-day opponents of vaccines are waging a particularly aggressive and personal campaign against advocates of vaccines. Paul Offit notes in the opening lines of his book that he has been the target of such personal attacks, partly because of his public support for the safety and efficacy of vaccines and partly because of his relationship with the pharmaceutical industry in the licensure of his rotavirus vaccine.

It is understandable that Offit has chosen to personalize his discussion of the controversy that surrounds vaccines and autism. He focuses less on the conventional scientific presentation of disease burden and incidence rates and instead spotlights people who are involved in the heated debate about autism and vaccines. Understanding that the debate is driven by human interest and emotion, Offit begins with a personal account of two experiences that strongly support his respect for vaccines — his experience as a child with a clubbed foot recuperating in a polio ward, and his experience as a young resident unable to save a dehydrated infant with rotavirus disease. He uses the same personal approach throughout the book to discredit the “false prophets” of autism with scientific reasoning and, more prominently, with an investigation into the motivations of those who claim to hold the answers to the mystery of autism.

Although a number of theories of the cause of autism exist, Offit focuses on the two most publicized theories that relate to vaccines: that autism occurs when the live attenuated virus in the measles vaccine infects children's gastrointestinal tracts, causing toxins and viruses to be absorbed into the brain, and that mercury, which was once contained in the vaccine preservative thimerosal, is a neurotoxin. Offit outlines numerous scientific studies that refute both claims, but he devotes much of the book to revealing the dubious affiliations and fraudulent practices of the promoters of these two theories.

A particular strength of the book is the chapter in which Offit outlines the basic principles of causality, probability, and the scientific method. In the course of this chapter, Offit also highlights the difficulty of communicating science to the public. He provides disconcerting examples of the media giving equal coverage and credibility to scientists and celebrities in the discussion of medical research. He cautions, “Another challenge of those communicating science to the public is explaining the difference between coincidence and causality. Because we're always looking for reasons for why things happen, this isn't easy.”

Offit attributes blame to every segment of society in the propagation of falsehoods and false hopes regarding vaccine safety. Scientists communicate ineffectively and fail at the game of public relations. Politicians and journalists win favor by attacking the medical and pharmaceutical establishments. The public remains poorly informed and cannot distinguish credible from unreliable sources of information on the Internet and in the media. Finally, his harshest criticism is leveled at physicians who exploit the desperation of the parents of autistic children by offering unfounded therapies that are at best ineffective and expensive, and at worst harmful and life-threatening.

As a clinician who specializes in pediatric infectious diseases and as a vaccinologist, Offit strongly and effectively advocates for vaccines and successfully dispels the myth that vaccines cause autism. There are several diversions in the book, such as the discussion of Dow Corning breast implants and the nuances of conference calls regarding thimerosal, but overall it will be a very helpful book for both medical personnel and parents. A number of other theories about the causation of autism remain and should be rigorously evaluated using the scarce research funds that are currently available. This message of hope would have been an excellent conclusion to the book.

Kathryn M. Edwards, M.D.
Kayvon Modjarrad, M.D., Ph.D.
Vanderbilt University School of Medicine, Nashville, TN 37232
kayvon.modjarrad@vanderbilt.edu

Dr. Edwards reports receiving funding from the National Institutes of Health and the Centers for Disease Control and Prevention to study vaccines and evaluate vaccine safety and from CSL Biotherapis, Wyeth, and Novartis to evaluate vaccines.

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