The Panic Virus: The True Story Behind the Vaccine-Autism Controversy

As most of the Amazon reviewers have noted, this book is rare gift---thoroughly documented and wonderfully written, using references to the primary literature for statistical support, yet always inserting the human element. If all you want is an account of the "vaccines cause autism" controversy from the viewpoint of a supporter of the scientific establishment, then you can stop here, buy the book, and enjoy. If you also want to understand the viewpoint of the "other side," the quick way is to (a) read the several one-star review of this book on Amazon (all are opponents of the scientific evidence for one reason or another), and (b) read positive reviews of the book online (e.g., New York Times, Salon) and their negative comment-providers. If this is not enough, there are plenty of publications by Andrew Wakefield, Jenny McCarthy and others.My purpose in reading this was different. I come from a theoretical position in behavioral science that takes the so-called rational actor model seriously as a tool for understanding human behavior. The model assumes people have certain beliefs (called subjective priors) which they use to maximize an objective function that reflects their personal values, needs, likes, and dislikes. The model is very well ensconced in traditional economic theory, and describes human behavior extremely well, as long as we recognize a few "provisos." First, people don't literally "maximize" anything, any more than does a baseball player chasing down a fly ball or a fox chasing down a rabbit.The theory says that if peoples preferences are consistent, we can model them "as if" they were maximizing, just as we act "as if" a thermodynamical system is maximizing entropy---it's an innocuous short-hand expression. Second, individual wants and desires are not perfectly attuned to individual well-being. People engage in all sorts of harmful practices, such as smoking cigarettes and eating unhealthy foods. Third, people are generally not selfish, but rather exhibit other-regarding preferences and prefer in many circumstances to behave morally even when this is costly in terms of forgone alternatives. Thus, the sort of rationality embodied in the rational actor model is rather thin, but it is sufficient to enable economists (and biologists who use the model in studying animal behavior and epidemiology) to get lots of things right lots of the time.The core problem with the rational actor model is that, while it deals with risk rather well, it has absolutely no handle on genuine "uncertainty," as the famous Ellsberg Paradox so well illustrates. When a situation has a probabilistic outcome but the probabilities are clearly known, as for instance in flipping a fair coin, people behave different than in a situation in which they are not sure of the probabilities.The standard axiomatic of rational choice cannot deal with such a situation. Of course, we may treat uncertainty by positing that we live in one of several "possible worlds," in each of which the probabilities are known. But then we must know the probabilities assigned to being in each of these worlds. If we know these probabilities, it is a simple exercise to calculate the meta-probabilities for our situation. This is absolutely nothing new. However, suppose we don't know the probabilities for each of the possible worlds. Then we must posit a universe of higher-level worlds, in each of which the probability distribution over the lower-level worlds takes some determinate form. Once again, however, we can perform simple calculations (so-called "compound lottery" calculations) to get determinate probabilities ("risks") for our world. And so on, up the ladder of meta-possible-universes.The central fact is that people do not engage in such infinitely recursive reasoning. This is not a failure of rationality, but rather a weakness of the whole recursive possible worlds framework, which is really a device for reducing uncertainty to risk.What do people do when there is fundamental uncertainty? This is the question that has haunted me for many years. I do not claim to have a scientifically acceptable model of human behavior under uncertainty yet, but I'm looking around, for sure (Joni Mitchell once wrote "Everybody's saying/Hell's the hippest way to go/Well, I don't think so/But I'll take a look around it though.") Here is a brief summary of where I am at, and I invite commentary.The first reaction to fundamental uncertainty is to delay making a choice. This is basically Keynes' explanation of boom and bust investment cycles---when they don't have a clear idea what is going to happen, businesses "pull in their horns" and wait for the situation to clarify itself. However, sometimes one cannot delay without incurring huge costs. Parents of autistic children, for instance, must decide on the efficacy of the array of alternatives open to them. Doing nothing is, basically, one of these alternatives.The second reaction is to lay out a search plan: try out several alternatives, and let your experience clarify the risks and the payoffs of each. This is fine for some things, such as what brand of wine to drink. But it will not help in situations where (a) it is very costly to try out alternatives (e.g., how many occupations do you want to experience) or (b) the choices are irreversible (e.g., how many levels of education do you want to try out? If you get too much education, there is often no way back).The third reaction is to see what other people have done in your situation, with a heavy emphasis on the choices have been successful and the people making the choices are a lot like you. To my mind, this is perhaps the most important choice mechanism. There are several models of such behavior, but none has the generality the phenomenon deserves. Itzak Gilboa and David Schmeidler, A Theory of Case-Based Decisions (Cambridge: Cambridge University Press, 2001) is in the ball-park, but they only allow the decision-maker to range over previous personal choices. Their model should extend rather easily and insightfully to the more general case, where there is uncertainty concerning the success of others as well as the "distance" between successful others and the decision-maker.I expect such a model would exhibit the following properties, depending on the parameters of the situation. For situations in which success is public information, there would be a Nash equilibrium with some "experimenters" who try out new ideas and "traditionalists" who stick with the known and true until the success of the experimenters is sufficiently clear. There are papers in the literature that model this phenomenon: John Conlisk, "Optimization Cost", Journal of Economic Behavior and Organization 9 (1988):213-228; Robert Boyd and Peter J. Richerson, "Group Beneficial Norms Can Spread Rapidly in a Cultural Population", Journal of Theoretical Biology 215 (2002):287-296.Within the same category of imitation, there can be "bandwagon" effects, as modeled in Sushil Bikhchandani, David Hirshleifer and Ivo Welsh, "A Theory of Fads, Fashion, Custom, and Cultural Change as Informational Cascades", Journal of Political Economy 100 (1992):992-1026; B. Douglas Bernheim, "A Theory of Conformity," Journal of Political Economy", University of Chicago Press 102,5 (1994):841-877; Abhijit V. Banerjee, "A Simple Model of Herd Behavior", Quarterly Journal of Economics 107 (1992):797-817. In these models, difference social groups can settle on distinct decisions, and there is little tendency for groups to switch to the decision of another group because the distinct decisions increase the social distance between members of different groups, for a variety of reasons. This is stressed in a very nice paper: Joseph Henrich and Robert Boyd, "The Evolution of Conformist Transmission and the Emergence of Between-Group Differences", Evolution and Human Behavior 19 (1998):215-242. For this reason, several distinct religions can persist among spatially and social distanced groups, each holding firm to its own beliefs.A key element in the rational actor model is that of "Bayesian updating." What this means is that with a given set of subjective priors, when new evidence comes in, there is exactly one "rational" way to transforms beliefs in light of the new information. Many beliefs, however bizarre, have little to fear from Bayesian updating, because there is virtually never new information that impacts on these beliefs. The intellectual/scientific problem is that individuals often update the credibility of the evidence in light of their beliefs rather than the other way around. For instance, when Christians discovered that the Earth was millions of years old, not the six thousand odd years portrayed in the Bible, and the humans are the product of Darwinian evolution, many revised their cosmologies and their scientific preconceptions (including the Catholic Church), while others mounted vicious attacks on the scientific community, calling them a group of atheists who were colluding with the Devil to thwart the will of God. In terms of the rational actor model, the strategy of the second group is no less Bayesian updating that that of the first.There are also situations in which people are collectively unsure what to do, and where they must make a choice that will commit them collectively to a single decision. This is the setting for the emergence of ideological divisions and cultural politics so characteristic of the socialism/capitalism debates of the past, or the current global warming debates.Science has no secure position of authority in dealing with natural events. For one thing, despite their pretentions to objectivity, scientists have been known to be collective incorrect. One horrible example close to home was the psychoanalytic theory of childhood autism, which for many years in the US was blamed on inadequate mothering. The pain that this stupid but virtually universally promulgated theory imposed on the parents of autistic children was incalculable. Not only were these parents forced to with the frightful problems of having an autistic child, but they were forced to live in ignominy in a society that held the parents to blame. I do not know of a comprehensive historical account of this affair, promulgated by Bruno Bettelheim, Leo Kanner, and other psychoanalysts who never bothered to check the facts.Another more recent affair of this type is the "recovered memories" movement among professional clinical psychologists. The "expert testimony" put many innocent people behind bars, and clinical psychologists misled many patients seeking psychological relief into attributing their mental problems to childhood molestations that in fact did not take place. This is well recounted in Elizatheth Loftus and Katerine Ketcham, The Myth of Repressed Memory: False Memories and Allegations of Sexual Abuse (St. Martin's Press, 1996).The vaccination model of the origins of autism is quite a different story. In this case there is no doubt but that the scientific community very carefully studied, and rejected, the claims of frantic parents misled by a few demagogic physicians, in the context of a network of newspapers, magazines, and TV shows eager to exploit the controversy rather than come down firmly on the side of science (which they should have in this case, because the empirical evidence was clear).I think the autism controversy is one instance of a large category of situations in which human nature leads people to make decisions that are not in their interest. These situations all involve serious threats to our health and well-being, where traditional science and common cultural practices offer us no hope. The evil turns in life can be much better supported if we can conjure up some reason for hope and optimism, however far-fetched. This is why it has been necessary to place draconian restrictions on the ability of the public to seek health advice and purchase the medications of their choice. And because people generally realize that this is the case, even in the most democratic countries, however devoted to the free market, the local version of the Food and Drug Administration is widely supported.In terms of the rational actor model, it is the Sour Grapes axiom that is violated. Rational choice depends on our evaluation of the probility of an event being independent from the desirability of the event. In particular, we should not think an outcome more likely just because we like the outcome more. But, when there is no hope, or all "traditional" remedies have been sought, it is part of human nature to ease our pain by elevating the probabilities of the theretofore hopeless. Thus the quack miracle cures for terminal diseases and chronic conditions.However, where medicine provides neither cure nor an understanding of the disease, the collective action of sufferers (in this case parents of autistic children) can lead to serious social breakdown. In the autism case, the social practice of refusing to inoculate young children against infectious diseases spread far beyond the autistic community, to the point where outbreaks of deadly communicable diseases are now occurring in several countries. This natural human predilection is amplified by predatory religious and political doctrines in some countries (opposition to measles vaccination in some Muslim communities in Africa comes to mind) and to anti-scientific fads in others (Postmodernism in the United States is the major culprit here, inducing the affluent and highly educated to turn away from even proven policies, such as universal vaccination against some diseases).Parents want absolute proof of the vaccine's non-harm, as the following, taken from an Amazon review of Mnookin's book: "It is not up to people who do not wish to vaccinate their children to prove that vaccines are unsafe or fail to provide their recipients with a healthier, longer life. It is up to the salesmen, the CDC & NIH and the pharmaceutical manufacturers to PROVE that they do." However, the fact is that vaccination is often a social benefit that has a small individual cost that, in very rare cases, can be a devastatingly large cost. Individual parents who may be perfectly willing to run such risks for themselves may be unwilling to impose such risks on their children, and it is hard to fault them for this.My own (tentative) position on this is that we should remove from parents the onus of choice. When an inoculation is required to protect herd immunity, is should be required of all parents, without the possibility of opting out for personal or religious reasons. Much of the time, this will also benefit the individual child, but in cases where the gains are social and the expected costs are individual and very small, and where the ratio of benefit to harm is great, coercion should be vigorously defended, although in a democratic society, the defense of coercion is a very delicate affair.

I was very tempted to give this book 4 stars, instead of 5 like I did, mainly because of the 'stridency' of the author. I do not disagree with the author's point of view. In fact, as a rubella baby from the 1950's who managed to get measles, mumps, and other infectious diseases during the '60s which are not seen any more thanks to vaccines, and as a professor who teaches nurses and pre-med students, I have my own reasons for being horrified that the U.S. and other civilized countries are losing their 'herd immunity' due to people not vaccinating their children.I immediately knew how strongly the author felt concerning anti-vaccinators and the fake scientists who were spreading junk and bad science about the vaccines. The Title of the book, and some of the information concerning the book, did make it obvious what the book was going to be about, but the author was almost rabid in his opinions. I totally understood his impatience with these people who have ears, 'but do not hear' as the scriptures say. Normally, I try to avoid books that enter into a discussion that seems one-sided, but I wanted to read a book on this topic that provided all the necessary research, that Mr. Mnookin did. The amount of research that he included in this book from all areas involved in this current health crisis was phenomenal. I appreciated that he did all of the research and provided where that information came from. I'm planning on looking into some of the research farther.I get so frustrated sometimes with people who choose not to get their children vaccinated. I understand the worry that parents go through concerning autism. I had three children, and I got them all vaccinated because I didn't want them to go through what I did due to these diseases. I have 6 grandchildren, and I also have a nephew that is high-functioning Asperger's. But the doctors who started this, Wakefield and others, were not doing correct experimental and objective science. They went into their 'studies' already decided on their hypothesis, and you just don't do that. I worked in labs on Alzheimer's and HIV for 6 years. You do not decide what you are going to find in your work prior to doing the experiments. You certainly do not allow money to influence your findings, and this is what these doctors did. Wakefield and company should be ashamed of themselves, because of their greed, children throughout the world continue to die needlessly.Mnookin did express compassion for the parents of those children suffering from autism. I feel for them too. My sister's son is great, we love him a lot, and he's smart and a good kid. But his parents struggled all of his childhood to get him adequate medical care, and social learning. And we all worry about him. So I can't imagine what other parents are going through with children who are much worse off than my nephew. I understand the need parents have to find someone or something to blame for this autism crisis. But too many of them are being blind to the truth, and some of them are putting their children at increased risk of invasive medical care just to somehow prove their point. You do not put a child through a medical procedure such as drawing spinal fluid needlessly. I've been through that...it's extremely painful, and you only do it as an adult if you are trying to rule out something like cancer. I certainly would never put a child through it if you can avoid it.I'm Deaf due to rubella. We've gotten so far away from these diseases, that current parents have no idea what kind of damage they caused. I also have numerous autoimmune diseases from undergoing exposure to these viruses 'naturally'. I read inn Mnookin's book that parents and some doctors say natural exposure to measles, mumps and rubella is better than the vaccines. Are they nuts? I want to tell these people to talk to me and other rubella babies that have been through so much due to natural exposure to these diseases. Believe me, if they listened to me they wouldn't be in such a hurry to expose their kids!This is a necessary addition to the writings on the state of vaccination in the world. Hopefully, more people will read it and do the right thing by their children. Their kids will thank them for it.

A highly readable account of the way in which emotionally charged theories about the causes of autism, which were actually contradicted by the scientific evidence, were promoted by their advocates and sections of the media highly effectively and with little regard for actual evidence or the harms and deaths that might (and did) result from reduced vaccinations.At the time of the early hysteria, circa 2002/3 I questioned whether my son should have the MMR vaccine. There seemed to be a strong argument against, but this fell apart when I looked into the matter more deeply. The evidence seemed clear - not vaccinating came with many dangers, to my son and to others who couldn't be vaccinated. By contrast the 'arguments' about the risks of vaccination were speculations based on anecdotes and the reasoning fallacy 'post hoc ergo proptor hoc' (after this therefore because of this). The question had been asked and answered by robust, reputable studies; there was no evidence for a causal link between vaccination and autism.This book explains why the 'controversy' emerged, but does much more: it helps explain why a combination of widespread misunderstanding of science (and indeed reasoning), self reinforcing conspiracy theories and lazy, sensationalist reporting can create controversies where there should be none, and in the process generate angst and even real harm. A book everyone should read.

It's very interesting but a bit of a difficult read, one must be very dedicated to actually finish it reading quickly. I am reading a chapter a week, so it's going to take some time to finish. There are a lot of names used, and I struggle to follow who is who.

This is an exceptionally well written, scrupulously researched book. As a parent with a child on the autistic spectrum, like many others I worried at one point that giving him the MMR vaccine might have triggered his autism, but this book has now completely put my mind at rest. More importantly, it has made me aware of how dangerous not vaccinating children can be, not just for my kids but for everyone. I urge anyone, but especially parents with young children, with any questions about vaccines to read this book thoroughly. It completely debunks all the myths, lies, and snake-oil pseudo-science, and represents and exemplary work of research.

Using this book to help with research into my EPQ (extended project qualification) and it's incredibly interesting and well-written. Centre mainly around the history of vaccines in the USA but also mentions the effects in the UK especially concerning Andrew Wakefield!Only half way through but thoroughly enjoying the read! Great for anyone interested in or researching the anti-vaccine movement!

Interesting account of the anti vaccine movement.