Will This Doctor Hurt Your Baby?

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A few years ago, Paul Offit found himself in a small room with a bob-haired American mother of three who was so mad at him she had tears in her eyes, and she was standing above him, sort of rearing up — this is his recollection — as if she was preparing herself, mentally, physically, to call him something cutting and mean, “like ‘a piece of shit,’” Offit remembers thinking, “or ‘an arrogant jackass.’” That’s what Offit was bracing himself for. An epithet. But this woman didn’t say anything like that. Instead, she said, “You’re an elitist.”

Compared to some of the other names Offit’s been called, “elitist” is a tongue-kiss. But it got under his skin anyway. He still talks about it. He’s still trying to figure it out.

It had begun so calmly. There he was, at the National Academy of Sciences in Washington, D.C., doing what he does best, which is talk about vaccines. Offit is the world’s number one vaccine pundit. He writes opinion articles about vaccines. He writes books about vaccines; Offit just published his fifth book, Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure. He recently helped convince a famous Hollywood actress, Amanda Peet, to become a spokesperson for vaccines. He even invented a vaccine. If you’re reading this, and you have a baby, and your pediatrician has followed the U.S. Centers for Disease Control and Prevention’s recommended vaccination schedule, Offit’s strain is most likely coursing through your kid’s bloodstream. Offit is basically Mr. Vaccine. Even his day job is vaccine-related; Offit runs the infectious-diseases division at the Children’s Hospital of Philadelphia, where he roams the colorful wards and pokes his head into the rooms of three-year-olds laid up with complex staph and strep infections, and engages in gentle patter like, “Trent, we’re just gonna look at you, sweetie, we’re just gonna look,” and prods gently at little Trent’s bandages, hoping to kill whatever bugs have slipped through Trent’s protective vaccine “net.” And Barbara Loe Fisher, the woman who called him an elitist, runs a grassroots organization called the National Vaccine Information Center, whose website features a quote from her decrying the State’s ability to “tag, track down and force citizens against their will to be injected with biologicals of unknown toxicity.”

They’re ideological opposites. Offit thinks vaccines are heroically staving off death and suffering, and Fisher thinks vaccines are causing death and suffering.

So when the conversation that day in D.C. turned to the flu, and the safety and desirability of flu vaccines, especially in light of a potential pandemic of avian flu — broadly, the meeting was about pandemic flu preparation, but this was a smaller “breakout” session — Offit and Loe Fisher were bound to clash. At one point in the session, Offit said that flu kills 35,000 to 40,000 Americans every year, according to the CDC. That’s a lot of people. And since the chance of dying of the flu is far greater than the chance of suffering an extremely rare serious allergic reaction to the vaccine itself, the vaccine is a pretty good bet, and parents everywhere should try to get past their (irrational) fears and let their pediatricians do their jobs and vaccinate their kids.

Loe Fisher said she thought the CDC’s numbers on flu deaths were inflated.

The breakout session’s moderator, another scientist, asked Loe Fisher something like, “You don’t really think that the CDC is lying?”

Here, memories diverge. Offit remembers Loe Fisher growing more and more upset — “Just my being upset her” — and Loe Fisher remembers the same about Offit, his rage. Still in that session, she started talking about freedom and choice. What about that? Parents might not have white coats and medical diplomas, but they’re not stupid. They’re bright, college-educated and passionate, and now they’ve got the Internet, “basically the library of the world,” and they should have the freedom to make their own informed choices about vaccines for their own kids. Offit responded that he actually agreed, in theory, but the problem was, where do you get your information to make that free choice? If you go to certain websites, you can read about how vaccines cause autism, but that’s wrong, vaccines don’t actually cause autism, and so “You’ll be badly informed, and you’ll make a decision that will hurt the child.”

And that’s when Loe Fisher — who correctly guessed that Offit was talking about her website — said that Offit had “an elitist attitude, and a paternalistic attitude, and an authoritarian attitude, and it’s just not appropriate in America.”

“Oh, gosh, and I just couldn’t help myself,” Loe Fisher tells me. She adds, “I remember when he walked into the room and saw that I was in there, he goes, ‘What is she doing here? Why would you put us in this room together?’”

I ask Offit if he remembers saying this.

“No, I never said that,” he says, flatly.

Offit has a remarkable, distinctive voice. It’s the voice of a natural storyteller, nimble and fluid, with speed settings from Pregnant Pause to Warp 9.

“What are you doing here?”

He lets the quote wash over him. He can’t believe Loe Fisher said he said that. He’s going into warp. “I never said that. You think I’m crazy? Like, suicidal? … Why would I ever say this? My colleagues are here? I’m going to say this in front of my colleagues? Also, I don’t like confrontation, actually.”

There’s a pause. “Although I seem to have immersed myself in it.”

And then, laughing slightly: “Did she say anything nice about me at all?”

Vaccine-makers. Germ-slayers. They used to be the good guys. But if the last decade of Paul Offit’s life is any guide, the culture no longer has much use for pragmatic doctors who know how to treat microbes with appropriate brutality. Nobody ever wrote Jonas Salk at his good old polio lab to say “I will hang you by your neck until you are dead!” — which is what a man in Seattle threatened to do to Paul Offit in the late ’90s. (At that time, Offit was serving on the committee that makes vaccine recommendations to the CDC; an armed FBI bodyguard began to tail Offit at the meetings.) Nobody ever typed messages to Dr. Salk that read, “You have blood on your hands” or “Your day of reckoning will come,” which are both e-mails from Offit’s inbox.

Offit isn’t saying he’s the reincarnation of Jonas Salk. Just that he’s not, you know, evil. And he certainly doesn’t look the part. He’s 58. He’s a suburban dad. Two kids, two dogs. He’s six feet tall, and he goes to work in lumpy Polartec fleeces and khakis, and he’s got these wide, bright, owlish eyes and a springy, tousled head of graying hair. This is what nerds resemble when they start to get old. Not at all scary or imposing or evil-seeming. But there are those who see something malevolent in those owlish eyes, who view Offit as a symbol of everything they’re up against: a dark and powerful man who would literally harm their children for fun and profit. On the Internet, they call him “Darth Offit,” “Madoffit,” “Dr. Proffit,” “The Voice of Sauron,” and worse. Invoking Offit’s name in the right context and with the right crowd can produce a totemic power, akin to walking into an ACLU meeting and screaming “DICK CHENEY!” It happened at the “Green Our Vaccines” rally on June 4, 2008, in Washington, D.C. The rally was organized by Jenny McCarthy, the plasticine actress and former Playboy Playmate, and her boyfriend, actor Jim Carrey. McCarthy has an autistic son, Evan, and she claims to have cured him with a special diet she invented. She has written best-selling books about it, promoting the books in exuberant appearances on Larry King Live, Oprah and The View. “My science is Evan,” she has said, “and he’s at home.” Other parents of autistic kids have rallied around McCarthy, and so have environmental activists more generally — people who see vaccines as mere toxin-delivery systems, directly analogous to lead-laden Chinese toys and coal-burning power plants.

One of the speakers at the rally that day was Bobby Kennedy’s son, Robert F. Kennedy Jr., a lawyer specializing in environmental litigation. Standing in front of the Capitol in a bristlingly white shirt, sleeves rolled up to his elbows, Kennedy said, “This guy Paul Offit — you guys know him?”

“BOOOOOOOOOOO!” jeered the thousands of assembled parents of autistic children, many of them jabbing their thumbs toward the grass on the Capitol lawn. It was a sunny day, and they held water bottles, and pictures of their kids mounted on signs. They all knew about Paul Offit.

Kennedy continued: “And he is the poster child for the term ‘biostitute.’”

“Biostitute” is a word Kennedy pronounces so it rhymes with “prostitute.” In the past, he mostly applied it to scientists with ties to oil and coal companies who wrote studies downplaying the threat of global warming. Now he was expanding the term to encompass biologists with ties to drug companies — biologists like Paul Offit, who worked side by side with the drug company Merck to develop his vaccine. Kennedy said of Offit, “This is a man who has made himself the spokesperson for the vaccine industry. He portrays himself as an independent scientist. … He does not disclose the millions of dollars of transactions.” Kennedy was followed at the rally by Carrey, who compared McCarthy to a Biblical prophet. (“The source of all that is good is doing some of its best work through her.”) Then McCarthy, wearing an emerald-green t-shirt, delivered a short speech decrying “the frickin’ mercury” she claimed was in vaccines, at the end of which she asked the parents in the crowd to hold up the pictures of their kids “and turn around and face the media, please,” and she linked arms with Carrey and grinned as photographers angled for shots.

Here’s what the culture of science dictates that Paul Offit should say in response to the Green Our Vaccines rally:

These conclusions are not supported by the data.

Then he should walk you through that data, patiently, bloodlessly. He should explain how scientists have gone looking, 18 times now, in 18 separate studies, for any link between vaccines and autism. And they’ve come up empty, however they slice it, whether they’re looking at the measles, mumps and rubella (MMR) shot or the mercury-derived chemical preservative called thimerosal. It does not logically follow that the frickin’ mercury could cause autism, because the frickin’ mercury was removed from U.S. children’s vaccines in 2001, except for some flu vaccines, and rates of autism keep going up and up and up anyway. As for broader fears of “vaccine overload” — the idea that moms and dads today are being asked to give their kids more vaccines than their kids’ immune systems can handle, as many as 26 inoculations over two years — Offit should acknowledge your worries with a sympathetic phrase or two (“I get it, I get that that’s hard to do”) before pointing out that vaccines have become so pinprick-precise, so laser-targeted, that whenever a kid gets the slightest paper cut, and some portion of the trillion or so bacteria sitting around on the surface of that kid’s skin infiltrates that kid’s immune system, the kid is “vaccinated” in quantities that dwarf the comparatively minuscule load of those 26 inoculations.

Offit should say all of that — and stop.

But of course, he doesn’t stop. Because if he stops, he loses. And if he loses, kids die. Maybe yours.

ONE DAY IN 1991, when Offit was a young attending doctor at CHOP, he was called in to consult on three or four patients. They were behind Plexiglas at the hospital’s intensive care unit. They were slung across stretchers, with plastic breathing tubes down their throats, which fed them maximal concentrations of oxygen. The kids were obviously in bad shape. There was almost no viable tissue left in their lungs. They were dying.

The parents of these children, Offit later learned, belonged to a church community in North Philly that practiced faith healing. None of the kids had been vaccinated against the measles or any other disease. Their parents didn’t believe in vaccines. This was unfortunate, because the measles virus is not really affected by human belief. The measles has never been eradicated completely, like smallpox. It’s still around, lurking — a spark looking for the right tinder. That summer, a particle of the measles virus happened to catch in that church community, blazing rapidly through its unvaccinated kids, and there was nothing Offit could do. It was too late. Offit saw those kids every day, as they slowly drowned in their own fluids.

The experience would have transformed anyone. “You can’t watch that happen and not be affected by it,” Offit says. But he took the deaths of those children especially personally, because he knew the man who had invented the shot that would have saved them. His name was Maurice Ralph Hilleman, and he was one of Offit’s mentors. But more than that, he was a hero to Offit. You can’t understand Offit — the choices he’s made, the sharp, irreverent, earnest way he talks — without understanding Hilleman.

Hilleman had many admirable qualities. He was a loving father and husband, and he was a brilliant scientist, and he was pathologically modest. But he was not what you would call a “nice guy.” He had the dark, stormy eyebrows of a mafiosi. He kept shrunken heads representing the people he had fired on his desk as morbid trophies. He was caustically funny. He once said that while it seemed he was a bastard on the outside, “If you looked deeper inside, you still saw a bastard.” The first time Offit met Hilleman, in the late ’80s, Offit tried to make small talk by chatting about a prominent Philadelphia lawyer who had been in the news. “He’s a good lawyer,” Offit said. “Good?” Hilleman shot back. “He’s the prince of fucking darkness.”

Offit loved him instantly: “He was such a character.” He was also the greatest vaccine-maker of the 20th century. Hilleman made Jonas Salk look like a lightweight. He invented vaccines to prevent measles, mumps, rubella, hepatitis A and B, HiB, chicken pox, pneumococcus, and meningococcus. He also invented the MMR combination shot. He accomplished all of this despite working at the suburban Philadelphia labs of Merck, and not inside academia, like most of his vaccine-making colleagues. Hilleman used to refer to himself, half bitterly, half mischievously, as a bastion of “dirty industry.”

“He knew how he was perceived,” Offit says. “Anything that’s a financial connection is viewed as dirty. Right? Pure science doesn’t have a financial connection. It’s just the pure academic seeking of truth. … Well, you know, strangely, only the pharmaceutical companies have the resources and expertise to make a vaccine. We can’t make it in our garage.”

Offit says “we” because he’s a Merck vaccine-maker, too. The vaccine he co-invented now sells as RotaTeq. It’s a prevention for a diarrheal disease called rotavirus that kills as many as 2,000 kids a day around the world. Last year, CHOP sold its royalty stake in RotaTeq for $182 million, and Offit received an unspecified chunk: his share of the intellectual property, “in the millions,” a life-changing windfall. Offit discussed the patent money with me on several occasions, the last time while he was laid up in bed, recuperating from a recent knee surgery that “didn’t go very well.” He said that he was drawn to vaccine-making not by any financial motive, but by “the same thing that draws you to trying to explain the science of vaccines to the public”: a fascination with vaccine technology and its potential to save lives. To Offit, getting the money felt like “winning the lottery,” because he never expected his research to amount to anything more tangible than journal articles. Publish or perish. “I know it sounds counterintuitive,” he said. “But you don’t really believe it. You don’t believe it’s going to become a vaccine. Because how many vaccines are there? Twenty? In the last century?” Offit added, “It’s not embarrassing to make a vaccine for Merck. It’s a good thing. I’m actually getting an award tomorrow, if I can get out of this fucking bed.”

But when Offit tries to explain his logic here, he doesn’t get a lot of sympathy. His enemies want to impose a virgin-whore dichotomy on science: Either a scientist is a pure truth-seeker, or he’s a corporate slut, a “biostitute,” and there’s nothing in between. To Offit, this is silly, and you don’t have to think that Offit is a good person to agree. Just look at Maurice Ralph Hilleman’s career — the ultimate refutation of the idea that a scientist who works with a drug company is therefore evil. As much as one man can save the world, Hilleman did. In 1900, the life span of an average American was 49 years. Today it’s 78 years. That’s in large part because of vaccines — Hilleman’s vaccines. And yet by the time Offit really got to know Hilleman well, in 2004, the great man was dying, along with his legacy. Vaccination rates were dropping. Some people were more afraid of the vaccines than of the diseases, more skeptical of scientists than of microbes.

Hilleman was saddened and confused by this trend. On a snowy day toward the end of Hilleman’s life, Offit asked him, “Do you think we can stop this? Are people going to have to die?” Hilleman, struggling to breathe, said, “Yes.”

“Maurice was right a lot,” Offit says.

OFFIT SHARES HILLEMAN’S cynicism about the likelihood of coming plagues. But he’s not dark or sphinxy like Hilleman was. His default mode is bemusement. Sometimes when you talk to Offit, he has this look like he’s scanning your words for wisecrack material. A reporter asked him once if he was the Antichrist, and he replied, “I’m just one of the Devil’s many humble servants.” Offit’s favorite TV show is Fox’s Family Guy, which is like a raunchier version of The Simpsons — a screwball cartoon about an infantile, obese suburban dad. Offit once asked me if I had ever seen The Ruling Class, a Peter O’Toole movie from 1972 in which O’Toole plays a character with “the mental age of a five-year-old,” Offit said. “He moves from this very playful, childlike demeanor to a much smarter, more formal businessman, and although he’s more functional in the adult world, you watch this transformation come about, and you feel sad.”

Offit’s own personal arc has been a little like this, a process of gradual emergence from one world, sort of a protected and safe world — the world of science — into another world with utterly different rules. And what’s remarkable about Offit is that he’s interested in the process of this. He’s willing to make his thought process so transparent that you can see his logic circuits whirring in real time, as he’s trying to think about how to remain a good and respected scientist while also being a good public communicator who Changes Minds and Saves Lives, and without becoming what he never wanted to be, which is a salesman, or a bullshitter.

Offit grew up with bullshitters, see. He grew up in Baltimore, the son of a tough Jew who made and sold men’s shirts for a living, and Offit remembers going to his father’s sales meetings. They were full of these amazing characters who lived by their wits and filled the air with their chaotic jokes and tales — “I mean, I loved them, they made you want to be around them, because they were such great storytellers” — but all the same, “They were just, you know, bullshitters.” Science was the opposite of that meeting room. It was “pure and clean-lined and symmetrical,” and “The rules are clear.”

And one of the clear rules in science is that you’re supposed to avoid the public arena. There’s no control in the public arena. It’s too messy and heated. Even though it’s where all the important decisions and currents are being decided and hashed out, and it’s where all the weird vehemence is, and it’s where Jenny McCarthy and Robert F. Kennedy are winning friends and influencing people with their plays to emotion and their rallies and their stinging indictments of Offit and his ilk, Offit isn’t supposed to fire back by saying something as baldly and factually true as “Vaccines don’t cause autism.” And the reason is, in science, “You can never prove never,” Offit says. “I can never prove that if I go in my backyard and, you know, try and fly like Superman flew, that I can’t fly. I can try it a billion times and not fly. That doesn’t prove I can’t fly. It only makes it all the more statistically unlikely.” But when a parent hears “statistically unlikely,” the parent thinks the jury’s still out, when it’s not.

So Offit finds himself in a paradoxical and somewhat impossible position: To defend science, he has to subvert it. Not the data itself, but the culture of science — what science teaches a scientist about what he can say and write. This means that Offit is always dealing with this low-level friction and discomfort, this voice in his head that says he’s going to get struck down by “the science gods,” even though he’s doing this, all of it, to please and redeem those same gods. And even when other scientists — the ones who would never dream of saying what he says — are cheering him on, as loudly as they can, behind closed doors.

OFFIT’S SITTING IN a chair before a roaring hearth, comparing U.S. parents who don’t vaccinate their kids to child abusers. He’s dressed up. This is rare. He hates dressing up. Still, he’s not wearing a tie. Just a blue blazer and khakis.

It’s a chilly evening in December, and Offit’s at his own book party, giving a speech. The party is outside of Princeton, at the home of one of his doctor friends. About 60 Princetonians — doctors, lawyers, astrophysicists — are slung across couches, some drinking wine, others munching on little lamb chops. They’ve come here to listen to Offit speak about his book, but the discussion has veered and shifted in a free-form and fluid way, and people have asked Offit good and smart questions, and one question in particular, about the informed-consent laws regarding vaccines, has gotten Offit thinking. In 21 states, including Pennsylvania, parents can decline vaccines for their children based on mere “personal belief” that vaccines are harmful. Offit has written about this legal regime as a “fatal exemption.” What Offit’s questioner wants to know is, does he think there will ever be a backlash against parents who opt out? And Offit says, “Well, see, that’s interesting.”

Let’s imagine, Offit says, that “a parent makes a choice not to vaccinate their child.” The doctor asks the parent to reconsider. The doctor says, look, this is a standard of care. And the parent says, “I’ve decided not to give my child the pneumococcal vaccine.” And then the kid gets pneumococcal meningitis and dies from it.

“I mean, is that — is that child abuse?” Offit asks. “Is it negligence on the part of the parent? It certainly sounds like it. But, you know, I just don’t think you could get that — I would be surprised if that ever happened in this country.”

He means that no legislator would ever pass a law like that, for obvious reasons. And Offit doesn’t really think that non-vaccinating parents are child abusers. It’s just a thought experiment. A hypothetical. The other side can put forth its hypotheticals, so why can’t he?

That’s what Autism’s False Prophets is about. It’s a dramatization of a different set of risks — the risks of believing wrong things about vaccines. Also, the book doesn’t just show that the anti-vaccine activists are wrong; it attempts to explain why, in our culture, they tend to win. It’s everything Offit’s been thinking and feeling about the culture in the past 10 years, with the anger and cutting edge of bitterness taken out (in part by Offit’s editor, who “made me a nicer guy”), distilled down to witheringly restrained prose. It marks Offit’s transformation from a germ-slayer to a quack-slayer, because it’s fundamentally a book about people, and institutions, and the media, and lawyers, and, well, everything; and it unfolds like a mystery novel, beginning with the tale of the man who started the whole vaccine-autism panic back in 1998, a British gastroenterologist named Andrew Wakefield.

During Offit’s talk, he gets a question about MMR and launches into the Wakefield saga. “Right, so,” he says. “Wakefield, this British gastroenterologist … who believed — and I mean that in the way that people believe in religious things — he believed that the MMR vaccine caused autism. And that was wrong. He’s certainly been shown to be wrong.”

“But what was the basis?” asks a young woman in the audience.

Offit says, “He made. It. Up.”

Everyone in the room laughs, hard. It’s the laughter of tension release — not mean or spiteful laughter. It’s the cathartic laughter of people who aren’t allowed to say this stuff in their everyday jobs, but think it all the time. “He was on 60 Minutes,” Offit continues. “Ed Bradley looked at him and said, ‘Would you give [your] children the MMR vaccine?’ This guy is good-looking. He’s very verbal. He sort of has that ruddy complexion. He has an English accent, which we all die for in this country. And he said, ‘I certainly would not.’ Quote. ‘I certainly would not. I would separate the vaccine into its three component parts’ — springing ex cathedra from his head. …

“And people blindly believe that?” asks the woman.

“Yes. That’s correct. People blindly believe that.”

During a couple stretches in Offit’s spiel, I let my eyes wander around the room, and at some point it hits me that if I were an anti-vaccine crusader, I’d basically be staring out at my own personal vision of what the Devil’s corner office might look like. This is where all the truly evil shit is supposed to happen. Ivy League doctors! In actual tweed jackets! With actual elbow patches! Drinking wine! Scheming, in secret, to screw over the People! But in fact, the dominant vibe here isn’t exultation or condescension. It’s more like rank bewilderment. It’s fear. After Offit’s done speaking, I interview a guy who researches autism. He’s waiting in line to get an autograph from Offit, and while he waits, he holds Offit’s book in a weird way — horizontally, with one hand flattened on top and one hand supporting it from the bottom, like the book’s a pancake he’s trying to flatten. He tells me, “Oh yes. I know all of the people in this book very well. [Offit] helps me to be a little less angry at the people in this book. Who are very difficult.” He looks me straight in the eye. “It’s important that you’re writing this story,” he says. “We’re struggling to keep the society sane.”

OFFIT IS MOSTLY quiet on the ride home from the party. The only sound for miles is the GPS navigator, issuing directions in a metallic coo. At one point, Offit half whispers, to himself, “They should have, like, a life GPS system. ‘Take the job in New York.’ ‘Get the biopsy.’ ‘The biopsy is … malignant.’”

Finally, when we’re almost back in Philly, Offit says, “I feel like I become a vaccine performance artist, you know? You feel like you’re part of a show. A show. Because you want to convince people about the data, but the data first of all don’t speak for themselves, and secondly, I think the more entertaining and fun and exciting you make it, the more it’s accepted.”

The bridge tiles thump underneath us as we cross the Ben Franklin.

“I think for all my protests, not wanting to be anything like my father, in terms of selling men’s shirts, I think that’s what I’ve become,” Offit says. “A salesman.”

This is fine, though. Because the better Offit sells the science, the more time he can spend actually applying the science. The sooner he slays the quacks, the quicker he can get back to slaying the germs, back at CHOP, where he’s most comfortable, where he has an easy mastery. Where he can sit in his office, as he did in late December, and discuss with his colleagues the vagaries of methicillin-resistant staph infections and the intransigence of pseudomonas and the effectiveness of Clindamycin versus Cipro in the IV drip of one particular kid on the ward — and then, after discussing the battle plan, he can go out and survey the battlefield and see the carnage. He can see his patients healing and getting better. Offit moved through CHOP with speed that day, in khakis and a dark fleece. It was almost Christmas, and the hospital was full of color and light, pinks and yellows and greens and ­purples — “Isn’t this amazing? These rooms? They’re full of windows, they’re so bright” — and the kids had made these cute thank-you notes to their nurses that lined the walls (“YOU’VE DONE A TREE-MENDOUS JOB!”) and Offit was happy, you could tell, because for one afternoon, at least, the humans were all on the same page, and evil was pretty clearly defined, and we were not the evil ones, and we were winning.

Source URL: https://www.phillymag.com/news/2009/05/27/will-this-doctor-hurt-your-baby/