There is a trend in the media when presenting a contentious topic to provide balance.  For topics not founded upon objective facts this serves the media well; provide both sides of the argument, and let the viewer decide.  The problem is that not every issue is evenly balanced, particularly in science.  Covering the discovery of a new extra-solar planet by giving equal airtime to astronomers and astrologers, for example, would be the height of absurdity, yet this is precisely how the media approaches scientific topics with frightening regularity.  You need look no further than the coverage of evolution, or 2012, or global climate change (that list should derail the comments nicely) for excellent examples of the same type of false balance in mainstream media outlets.

It was with trepidation, then, that I waited to see how PBS’s Frontline handled the topic of vaccination.  I was pleasantly surprised.  “The Vaccine War” introduced the most common concerns expressed about vaccination, and then presented the evidence addressing each concern in turn clearly and concisely.  It gave airtime to some rather prominent anti-vaccine personalities, but the bulk of the program was dedicated to the data, the science, the evidence, and where answers are available it did not hesitate to present them baldly and clearly. “The Vaccine War” was not a comprehensive review of every perspective, every theory, every vaccine and study, but it did provide a fair discussion balanced by the science.

My first clue that Frontline had acquitted itself well was when Dr. Jay Gordon, pediatrician to Jenny McCarthy’s son, tweeted his opinion of the show:

PBS show about vaccines. Don’t bother to watch it.”

Dr. Gordon wasted no time venting his outrage at the show’s message, its tone, and the fact that he was cut from the program at The Huffington Post.  I encourage you to read the original at The Huffington Post, and to post your own comments.  I will discuss his points here in detail, providing the periodic reality check.

Dear Kate,

The Frontline show was disgraceful. You didn’t even have the courtesy to put my interview or any part of the two hours we spent taping on your web site.

Dr. Gordon was interviewed, and his contribution was not felt to provide value to the  program.  He was cut.  That is the prerogative of the producers, and they are under no obligation to include Dr. Gordon just because he was interviewed.  If he is unhappy with his treatment, he is more than welcome to decline the next interview.  In fact, I think that would be an excellent idea.

You created a pseudo-documentary with a preconceived set of conclusions: “Irresponsible moms against science” was an easy takeaway from the show.”

Dr. Gordon needs to review the definitions of “pseudo” and “documentary.”  Is a WWII program on the History channel a pseudo-documentary because it covers the war from the Allied perspective?  Of course not, it provides facts within a context, a narrative; this is essential in a documentary, and it is precisely what the producers of this program have done.  That the producers decided to provide a story based upon facts and science determined the conclusions they presented.

Did you happen to notice that Vanessa, the child critically ill with pertussis, was not intubated nor on a respirator in the ER? She had nasal “prongs” delivering oxygen. I’m sorry for her parents anxiety and very happy that she was cured of pertussis. But to use anecdotal reports like this as science is irresponsible and merely served the needs of the doctor you wanted to feature.”

This objection by Dr Gordon is petty, appalling, and hypocritical.  So what if she wasn’t intubated?  This is a suffering infant who is critically ill and will remain so for weeks.  Is her suffering not worth preventing just because she didn’t die?  Is that how low Dr. Gordon sets his threshold for a child warranting medical care?  This is appallingly callous.

The segment that portrayed vaccine preventable diseases, including the segment with pertussis, was explicitly stated by the program to demonstrate what these diseases look like to a population that, on the whole, has never seen them.  How else would Dr. Gordon propose to provide this information to the public?  This is an entirely appropriate use of an anecdote, as an example of the evidence, rather than as the evidence itself.

Furthermore, by Dr. Gordon’s own admission, the producers did not provide the worst-case scenarios of each of these diseases, all of which can be fatal, though they could easily have done so if their goal was purely emotional manipulation, rather than education of legitimate risks of these diseases.

No one pursued Dr. Offit’s response about becoming rich from the vaccine he invented. He was allowed to slide right by that question without any follow up. Dr. Paul Offit did not go into vaccine research to get rich. He is a scientist motivated by his desire to help children. But his profiting tens of millions of dollars from the creation of this vaccine and the pursuit of sales of this and other vaccines is definitely not what he says it is. His many millions “don’t matter” he says. And you let it go.”

I am glad to read Dr Gordon acknowledge that Dr Offit’s motivation to research and produce vaccines was not financial.  He is a professional who produced an excellent and badly needed vaccine to prevent a nasty disease.  Excellence in our society is usually rewarded with financial compensation.  So what?  The research that lead to Offit’s rotavirus vaccine, the data supporting its safety and efficacy before licensure, and the volume of post-licensure safety and efficacy data replicated by other researchers stands on its own whether Dr Offit is penniless or a billionaire.

Jenny McCarthy resumed being a “former Playboy” person and was not acknowledged as a successful author, actress and mother exploring every possible avenue to treating her own son and the children of tens of thousands of other families.”

Frontline is not obliged to present a full CV on each person appearing in its program, and Ms. McCarthy’s role as a former Playmate is both factual and the original source of her fame.  Dr. Gordon’s perspective heavily biases his description of her as a “mother exploring every possible avenue to treating her own son and the children of tens of thousands of other families”.  She could just as easily (and perhaps more accurately) be described as a mother who, in pursuing her own ill-founded beliefs, has undermined the care of her child, placed him at higher risk of preventable disease, subjected him to worthless therapies while ignoring known serious risks, used her celebrity to disseminate misinformation and fear to the public while simultaneously diverting research time, energy and funds away from fruitful avenues of study, and delaying the time when the tens of thousands of families can better understand autism and be provided with more viable therapies.  Oh, and Frontline could have mentioned her foray into the embarrassing “Indigo Child” nonsense.  Perhaps describing her as a “former Playboy” isn’t so bad.

I trusted you by giving you two or three hours of my time for an interview and multiple background discussions. I expressed my heartfelt reservations about both vaccines and the polarizing of this issue into “pro-vaccine” and “anti-vaccine” camps. I told you that there was at least a third “camp.” There are many doctors and even more parents who would like a more judicious approach to immunization. Give vaccines later, slower and with an individualized approach as we do in every other area of medicine.”

This is a straw man.  No one, even the most staunch vaccine advocates, advocate the identical vaccination regimen for every child.  There are uncommon but clear reasons to deviate from the vaccination schedule due to a child’s individual medical history.  However, these are based upon evidence, not the arbitrary judgment of individual physicians.

What evidence does Dr. Gordon provide that later, slower, individualized vaccination schedules do anything but reduce the herd immunity of a community, increase the number of doctor visits, decrease the likelihood that a child will be fully immunized, or increase the time for which a child is unprotected?  No such evidence exists, so one must wonder on what he has based this recommendation.

The “individualized approach” to medicine warrants a series of posts all to its own. Suffice to say that while there are uncommon times when a patient’s care must deviate from the usual approach, standardization of care is one of the most effective ways of improving patient outcomes, and is one of the pillars of evidence-based (and science-based) medicine.  “Every other area of medicine” is making its best advances through the standardization of medical care, not capricious, evidence-free judgment calls of individual physicians.

What did you create instead?

“The Vaccine War.”

A war. Not a discussion or a disagreement over facts and opinions, but a war. This show was unintelligent, dangerous and completely lacking in the balance that you promised me — and your viewers — when you produced and advertised this piece of biased unscientific journalism. “Tabloid journalism” I believe is the epithet often used. Even a good tabloid journalist could see through the screed you’ve presented.”

And I believe this is one of the better examples of “projection” that I’ve come across.  I touched on the idea of “balance” in journalism at the beginning, and will not rehash it here.

You interviewed me, you spent hours with Dr. Robert Sears of the deservedly-illustrious Sears family and you spoke to other doctors who support parents in their desire to find out what went wrong and why it’s going wrong and what we might do to prevent this true epidemic.”

Dr. Gordon sets up a false-dichotomy here.  He pretends that only physicians who believe vaccines cause autism support parents of autistic children, or want to find the root cause of autism, or to find viable treatments or ways to prevent it.  This is absurd.

How deserving Dr. Sears is of his popularity we have addressed on SBM in the past, and can be found here.

Not a measles epidemic, not whooping cough. Autism. An epidemic caused by environmental triggers acting on genetic predisposition. The science is there and the evidence of harm is there.”

Autism diagnoses are higher than they have been in the past, and they are unsettlingly common, warranting a large-scale research, therapeutic, and support system that is currently lacking.  This is due in large part to increased awareness and broadened definitions of what places someone on the autism spectrum, though the possibility of a smaller scale true increase in the incidence of autism has not yet been confirmed or ruled out.  To label this as a “true epidemic” is inaccurate on several fronts.

Dr. Gordon is correct that autism has an indisputable genetic predisposition.  However, to what degree environmental triggers play a role, and which triggers these may be have not been established.  The science is there, but it does not come remotely close to supporting Dr. Gordon’s statement.

Most importantly, the evidence of harm, of vaccines causing autism, is not only not there, but overwhelmingly demonstrates no evidence of correlation between vaccines and autism.

Proof will come over the next decade.”

Oh, so Dr. Gordon doesn’t have proof now.  Thank you for clarifying.

The National Children’s Study will, perhaps by accident, become a prospective look at many children with and without vaccines. But we don’t have time to wait for the results of this twenty-one year research study:”

“We don’t have time to wait” The same can be said of every single medical condition suffered by a human being.  This doesn’t minimize their suffering, it drives home the point that we must perform the highest quality science possible and reject hypotheses that have been found to be without merit.  The proposed vaccine/autism link is one such hypothesis.

We know that certain pesticides cause cancer and we know that flame retardants in children’s pajamas are dangerous. We are cleaning up our air and water slowly and parents know which paint to buy and which to leave on the shelves when they paint their babies’ bedrooms.”

Where such statements are true they were found and confirmed by scientific inquiry, and when they are false they are refuted by the same method.  Belief and opinions are irrelevant when objective data is available, and the above paragraph is an irrelevant distraction to the topic of Dr. Gordon’s letter.

The information parents and doctors don’t have is contained in the huge question mark about the number of vaccines, the way we vaccinate and the dramatic increase in autism, ADD/ADHD, childhood depression and more. We pretend to have proof of harm or proof of no harm when what we really have is a large series of very important unanswered questions.”

That we don’t have the answers to everything does not mean that we don’t have the answers to anything, nor does it give us license to ignore the evidence we do have.

In cased you were wondering, as I practice pediatrics every day of my career, I base nothing I do on Dr. Wakefield’s research or on Jenny McCarthy’s opinions. I respect what they both have done and respectfully disagree with them at times. I don’t think that Dr. Wakefield’s study proved anything except that we need to look harder at his hypothesis.”

Case in point.  We have looked harder at Dr. Wakefield’s hypothesis, and it has failed catastrophically.  With no evidence in its favor and much against, Dr. Gordon has yet to reject Dr Wakefield’s hypothesis.

Of equal interest, is Dr. Gordon willing to acknowledge that the original paper Dr Wakefield published in The Lancet is at best a scientific embarrassment?

I don’t think that Jenny McCarthy has all the answers to treating or preventing autism but there are tens of thousands of parents who have long needed her strong high-profile voice to draw attention to their families’ needs: Most families with autism get inadequate reimbursement for their huge annual expenses and very little respect from the insurance industry, the government or the medical community. Jenny has demanded that a brighter light be shone on their circumstances, their frustration and their needs.”

I actually agree with Dr. Gordon here.  Autism is indeed a widespread problem badly in need of high-quality research, and families are in dire need of support.  It is unfortunate that the advocate they have found was so badly misguided by her pediatrician.  Dr Gordon was in the position to guide her, to educate her, connected her with experts in childhood development and autism and enabled her to use her enthusiasm and desire to help her son and the rest of the autistic community.  Unfortunately, Dr Gordon squandered this opportunity, to the detriment of us all.

I base everything I do on my reading of CDC and World Health Organization statistics about disease incidence in the United States and elsewhere.”

Dr. Gordon claims that he bases his decisions on evidence.  Yet he has come to different conclusions from those who generated the evidence, and those who are experts in the field.  Only one group can be right, and neither the evidence nor the odds are in his favor.

I base everything I do on having spent the past thirty years in pediatric practice watching tens of thousands of children get vaccines, not get vaccines and the differences I see.”

Experience has value, but it is little more than a long series of anecdotes, and as such it can also be a trap.  Nearly every modern physician can make a similar statement, as can every homeopath, acupuncturist, phrenologist, faith healer and shaman.  Placing personal experience, no matter how vast, above solid objective data is a hallmark of someone practicing pseudoscience, and it is precisely this sin that Dr. Gordon commits.

Vaccines change children.”

An assertion made without evidence can be rejected with the same.  Dr. Gordon clearly feels he has discovered new information, a previously unidentified pattern, yet he has not even bothered to publish a simple case series to try to convince the medical community of his claim.  Making such a statement without evidence is irresponsible.

Most experts would argue that the changes are unequivocally good. My experience and three decades of observation and study tell me otherwise.”

Again, Dr. Gordon feels his experience trumps evidence.

Vaccines are neither all good–as this biased, miserable PBS treacle would have you believe–nor all bad as the strident anti-vaccine camp argues.”

This is another straw-man by Dr. Gordon.  The program clearly acknowledges the presence of adverse events from vaccines, including extremely serious ones.  No one, including the producers of “The Vaccine War,” claim that vaccines are “all good.”  But the benefits do clearly outweigh the risks.

You say the decisions to edit 100% of my interview from your show (and omit my comments from your website) “were purely based on what’s best for the show, not personal or political, and the others who didn’t make it came from both sides of the vaccine debate.” You are not telling the truth. You had a point to prove and removed material from your show which made the narrative balanced. “Distraught, confused moms against important, well-spoken calm doctors” was your narrative with a deep sure voice to, literally, narrate the entire artifice.

You should be ashamed of yourself, Kate. You knew what you put on the air was slanted and you cheated the viewers out of an opportunity for education and information. You cheated me out of hours of time, betrayed my trust and then you wasted an hour of PBS airtime. Shame on you.”

As Dr. Gordon draws his rant to a close, he returns to telling a PBS producer how to do her job.  He does not, however, at any time provide any evidence to contradict a single pertinent point or piece of evidence made in the entire hour of “The Vaccine War.”

The way vaccines are manufactured and administered right now in 2010 makes vaccines and their ingredients part of the group of toxins which have led to a huge increase in childhood diseases including autism. Your show made parents’ decisions harder and did nothing except regurgitate old news.

Parents and children deserve far better from PBS.”

How can Dr. Gordon write the preceding paragraph and then claim to be anything other than anti-vaccine? PBS is not the one to be ashamed; our children deserve better stewardship than that of Dr. Jay Gordon.