Autism is a brain disorder. Neuroscientists are learning more and more about what is different about autistic brains from more typical brains. One feature seems to be reduced communication among neurons in the brain. Autism is diagnosed clinically. It is usually first recognized by the parents, who then bring their child to medical attention and after an evaluation the diagnosis is made. At present there are no supporting laboratory tests – we don’t diagnose autism by an MRI scan, EEG, or blood test. It is diagnosed by clinical observation and some standardized questionnaires and cognitive tests. At the more subtle end of the spectrum the diagnosis may not be made right away, not until the child is a bit older and can be more thoroughly evaluated.

The median age at diagnosis was 4.4 years in 1992. This has steadily decreased, to less than 3.4 years by 2001. This effect is greater in higher socioeconomic status (SES) groups. Low SES children are diagnosed later than higher SES children, and this gap has widened in the last 20 years. There has also been a linear increase in the number of autism diagnoses since 1992, aggregating in birth cohorts, with a greater effect for higher functioning children with autism. This suggests that more diagnoses are being made at the milder end of the autism spectrum, and at a younger age, with a strong social influence.

The current dominant interpretation among experts (I’m not sure it’s robust enough to call it a consensus) is that the increase in autism diagnoses over the last 20 years is due to increased surveillance, widening the definition, diagnosing children at younger ages, and diagnosing milder cases. A number of studies have also looked for signs of autism at younger and younger ages, with several showing differences between children who will go on to be clinically diagnosed on the autism spectrum from other children as early at 6 months of age.

Now another study has been published also demonstrating these results. Researchers looked at infants aged 6-10 months old and showed them pictures of faces with the eyes either looking toward or away from the infant. The researchers recorded brain wave activity with EEG, looking for differences in brain response between these two stimuli. A typical child should respond differently to the two images, as a human face looking toward the infant should evoke more of a response.

They found that there was indeed a difference in brain response between the two stimuli, but in those children who would later be confirmed to have autism the response was generally diminished compared to children who were not later diagnosed (at 36 months). The effect was robust, but not with sufficient sensitivity and specificity to be very useful clinically. This is an important distinction to make. The results were statistically significant, meaning that there is very likely a real effect here.

In other words, even as early as 6 months the brains of children with autism respond differently than children without autism in a way that one might predict from the symptoms of autism (diminished social responsiveness). But there were still false positives and false negatives, limiting such a test’s usefulness when applied to an individual child. The false positives and negatives may be due to the heterogeneity of autism as a spectrum of disorders, or to limitations of the diagnostic technique itself. Probably this technique (in addition to being refined) will have to be combined with other methods of early diagnosis before application to the individual will be practical.

There are several implications of this research worth discussing. The first is that early diagnosis of autism will improve early access to intervention, which seems to make a difference in outcome. Laboratory confirmation can help to reduce doubt or confusion as to the proper diagnosis, and lead more quickly to services for young children. There are also implications for our understanding of autism as a brain disorder. What, exactly, is happening in the brain of children with autism? This study has indirect implications for this question, but still adds to our pathophysiological knowledge of autism as a disorder.

Finally, there are implications from this research regarding the ongoing social (but not scientific) controversy of the role of vaccines and other environmental factors in autism. If the signs of autism are present at 6 months of age, then vaccines that are given after 6 months cannot be implicated as a cause of autism. This unavoidable implication, however, is unlikely to move the anti-vaccine community.

As with any single study, this new study is not definitive. Follow up research is required, and it seems that this technique will likely have to be combined with other techniques to be clinically useful. It adds to existing research, however, increasingly pointing to the detection of differences in the brains of children with autism as early as 6 months of age.

This also fits with the dominant view that autism is likely a complex set of genetic disorders. Environmental factors cannot be entirely ruled out, but genes seem to be playing a dominant role in autism. If this is true it may be theoretically possible to push early detection of autism to even younger ages. Then again, perhaps not – perhaps the brain has to develop to a certain point before the differences in brain function are there. Six months, so far, seems to be the point of earliest detection, and this new study supports that (although they did not study younger children).

It would be interesting to apply these techniques to 2-6 month olds to see if the differences continue to show. In any case – this and other studies like it are pointing the way toward much earlier diagnosis of autism spectrum disorders.

No one study can ever be definitive, but now we have a large body of evidence from multiple studies showing a lack of association between thimerosal and autism. This won’t stop the dedicated anti-vaccinationists and mercury militia from continuing their anti-vaccine propaganda, but hopefully it will further reassure those who actually care about the science.

Background

This has been a long and complex story, so let me review some of the background. Diagnosis rates of ASD have been climbing for the last 20 years, prompting some to search for an environmental cause. The existing anti-vaccine community, not surprisingly, blamed vaccines. This was given a tremendous boost by the now-discredited study by Andrew Wakefield concerning MMR (which never contained thimerosal) and autism. When the evidence was going against MMR as a cause, attention turned to thimerosal in some vaccines. This notion was popularized by journalist David Kirby in his book, Evidence of Harm.

However, this important premise of a correlation – rising ASD rates – is not as simple as the anti-vaccine crowd assumes. In fact there have been many studies of autism prevalence and the consensus at this time is that most of the increase in ASD is due to a broadened diagnosis, diagnostic substitution, and increased surveillance. There may be a real small increase, but most if not all of the increase is an artifact of diagnosis, not a real increase. (Side note – I have written about this topic many times before, and the links I will provide for background are to my previous reviews and summaries, not the original research. But of course, the links to the original research can be found in my prior articles.)

As further support of this a recent NHS study found a consistent prevalence of autism of about 1% in all age groups. If autism rates were truly increasing we would expect a lower prevalence in older age groups, but that is not what they found.

Another line of evidence is the younger and younger identification of signs of autism. Formal diagnosis is often made around 2-3 years old, after many vaccines are given. But numerous recent studies have documented signs of autism as young as 6 months of age. This makes it difficult to blame vaccines given after 6 months.

Holdouts for vaccines as an important contributor to autism rates have pointed to prenatal vaccines given to the mother, but a study finds no correlation there either.

Where the “mercury militia” gains their only support is from the fact that mercury is indeed a known toxin, and a neurotoxin. However, there are still problems with the notion that mercury toxicity from thimerosal causes any neurological damage or specifically contributes to autism rates. The first is that thimerosal contains ethylmercury, which is not nearly as toxic as methylmercury, the form that is found in fish and other environmental sources. Second, the doses given is vaccines is well  below safety limits. Anti-vaccinationists argue that the cumulative dose is high enough to cause damage, but there is no evidence for this. What there is evidence for is the fact that infants excrete mercury very efficiently, and therefore likely clear their mercury load after one vaccine and before the next, so it does not accumulate. And finally – mercury toxicity does not resemble autism (despite the false claims of the anti-vaccine crowd).

Another line of evidence that presents problems for the vaccine hypothesis of autism is the massive and growing evidence that autism is dominantly a genetic (not environmental) disorder. Of course, genes interact with the environment, and there may be environmental factors, but the dominant factor is genetic.

In addition to the multiple independent lines of evidence all arguing against a link between vaccines in general and thimerosal in particular to ASD, there is the ecological and epidemiological evidence which looks specifically at if there is any correlation between thimerosal exposure and risk of autism. Here the answer is a clear – no. There have been multiple such studies in multiple countries (summarized here) showing no correlation.

In addition, A recent Italian study showed no link between the amount of thimerosal exposure and autism risk. Another study showed no correlation between blood levels of mercury and risk of autism.

But the most compelling evidence against a link came from the removal of thimerosal from the routine childhood vaccine schedule in the US. By the end of 2002 all thimerosal, except for insignificant trace amounts, was removed from all vaccines given routinely to children. Only some flu vaccines still contained a small amount of thimerosal, but this is an optional vaccine with thimerosal-free options. The result was a dramatic plummet of thimerosal exposure in the US childhood population. If thimerosal were a significant contributor to autism incidence then we should have also seen a plummet in autism rates. David Kirby predicted this, and the anti-vaccine movement agreed. They gloated about the day they would be proven undeniably correct.

But now it has been 8 years – and autism rates continue to rise at the same rate, without so much as a blip. They tried to move the goalposts for a while, and make some desperate arguments to rescue their failed predictions, but there is no hope. There is no rational conclusion remaining except that thimerosal in vaccines is not a measurable contributor to autism rates.

The CDC Studies

Three years ago I wrote about a CDC study that looked at thimerosal exposure and 42 different neurological outcomes (but not autism). What they found was that there were a few scores that were worse among those exposed to more thimerosal, but there were also a few scores that were better. There was a random distribution of slight positive and negative effects that essentially average out to no net effect. It’s all just noise.

The bottom line is that this study showed no correlation between thimerosal exposure and adverse neurological outcomes.

At the time we were promised a follow up study of similar design that looked specifically at autism – and now, after a three year wait, we finally have those results. This is a case-control observational study that looked at managed care organization (MCO) members for their history of vaccination, including pre-natal vaccination, as well as exposure to thimerosal through immunoglobulins. They correlated thimerosal exposure from these sources to later diagnosis with autism, autism spectrum disorder, and regressive autism. They found:

RESULTS: There were no findings of increased risk for any of the 3 ASD outcomes. The adjusted odds ratios (95% confidence intervals) for ASD associated with a 2-SD increase in ethylmercury exposure were 1.12 (0.83–1.51) for prenatal exposure, 0.88 (0.62–1.26) for exposure from birth to 1 month, 0.60 (0.36–0.99) for exposure from birth to 7 months, and 0.60 (0.32– 0.97) for exposure from birth to 20 months.
CONCLUSIONS: In our study of MCO members, prenatal and early-life exposure to ethylmercury from thimerosal-containing vaccines and immunoglobulin preparations was not related to increased risk of ASDs.

The strengths of this study are the large numbers, the thorough assessment of ethylmercury exposure, and the confirmation of diagnosis. However, this is not a perfect study – it suffers from the limitations of observations studies, as the authors point out in their discussion. The primary weakness was the fact that of 771 potential case-children and 2760 controls they ended up with 246 cases-children and 752 controls. Around 12% were not eligible for various reasons, and the rest were not able to participate for various reasons (because they could not be located, for example), but most of the drop out was simply because potential subjects did not wish to participate.

This high percentage not participating in the study opens the door wide for bias in the final results. The authors were fairly thorough in exploring possible sources of bias from this fact. They found that study participants did not differ significantly from those not participating in various key aspects – such as having an older sibling with autism. Also most case-children were diagnosed with autism after their infant vaccines, so this unlikely to have affected vaccination rate.

But of course it is always possible for there to be unknown confounding factors biasing the results.  A protective effect from thimerosal is biologically implausible, so these results are due to either random chance or some bias in reporting or participation that is not apparent.

Even still, if there were a significant causal effect from thimerosal it should be apparent in this type of study, and it wasn’t.

Conclusion

No one study, especially an observational study, is ever very compelling. I don’t think this one new study changes the scientific picture of vaccines or thimerosal and autism. But it is one more study that fails to show any correlation between thimerosal exposure and risk of developing autism or ASD. This comes on top of multiple independent lines of evidence all pointing away from the notion that vaccines or thimerosal are a significant cause of autism.

The scientific community is likely to see this as further confirmation of a lack of association between vaccines and autism – just one more piece of the big picture. The anti-vaccine community is likely to dismiss it as either hopelessly flawed or as part of the conspiracy. In other words – this study is unlikely to change anyone’s mind on this issue.

The Thoughtful House agreed to the interviews because they figured they would get fair treatment from the likes of Matt. I’m interested to see what kind of a program NBC has put together on this very sensitive subject.

Depending on how this major media outlet writes the script, it could either be a major affirmation of what many within the science community already know, or it could increase the divide between anti-vax’ers and science.

Please, Matt… don’t go Jenny McCarthy on us. Don’t do the usual journalistic job of being “fair-and-balanced”. This is not a “he said, she said” issue. This is science. Do tell the world what the science supports.

About 10 years ago, Wakefield published a study dealing with children who were autistic, developing symptoms shortly after getting their shots, and linked this with irritated intestinal tracts. This study came under a lot of fire, and eventually most of the authors retracted the conclusion that autism was associated with "environmental factors", that is, vaccinations. By then, though, it was too late, and the modern antivaccination movement was born.

The Sunday Times investigated Wakefield’s original research, and alleges that the symptoms Wakefield reports in his research do not match hospital records of the 12 children studied at the time. In only one case were there symptoms that arose after the injection; in many of the other cases symptoms started before the children had been vaccinated (in fact, there have been allegations for some time that neurological issues occurred in the children before they had actually been vaccinated, casting doubt on Wakefield’s work). Also, hospital pathologists reported that the bowels of many of the children were normal, but Wakefield reported them as having inflammatory disease in his journal paper.

If these allegations are true, then it means that Wakefield out-and-out lied in his original work. He has denied this, according to the Sunday Times, but won’t make further comments.

This may cause a firestorm in the antivax community, but there are two things I will guarantee: the first is that in the end antivaxxers will stick to their beliefs that vaccines cause health problems like autism, because this is not and never has been, for them, about the facts and evidence. It’s a belief system, and like most other belief systems, it is impenetrable to evidence. If you have any doubts, I suggest you read the comments to the post I made the other day about measles being on the rise in the UK. One commenter on that post is saying all manners of outrageous things, and ignores the evidence that I (and a pediatrician) have left in the comments to him.

Second, and somewhat related, this hardly matters. Many, many independent tests have shown that vaccines are unrelated to the onset of autism. There is vast evidence that vaccines are very safe, and what small risk they pose is massively outweighed by the good they do. Whether Wakefield faked his results or not, he’s still wrong.

The good news is that if this pans out, then perhaps there will be a net loss of people from the antivax side of the argument. The ones who are true believers won’t waver in their faith, of course, but anyone with doubts may finally see reality for the way it is.

I will be very interested indeed on following this story. If anyone finds more information, please send it along.

Tip o’ the syringe to BABloggee Todd Cissell.

While anti-vaccine cranks have been around as long as vaccines, it is only recently that they have captured the attention of the mainstream media and the skeptical movement and the battle has really been engaged.

Anti-vaccinationists have focused much of their recent efforts on the claim that vaccines cause autism. At first the MMR vaccine was blamed, sparked by a now-discredited study performed by Andrew Wakefield. This led to declining vaccination rates in the UK and a resurgence of measles.

As the MMR claim was in decline (although by no means abandoned), attention shifted to thimerosal – a mercury-based preservative in some vaccines. There are many flaws with the thimerosal hypothesis, and numerous studies have shown no link between thimerosal and autism or any neurological disorder. But the fatal blow to the thimerosal hypothesis was struck when thimerosal was removed from the routine childhood vaccine schedule (thimerosal, incidentally, was never in the MMR vaccine) in the US by 2002. In the subsequent 6 years the rate of autism diagnoses kept increasing at their previous rate, without even a blip. Only the most rabid (or scientifically illiterate)  anti-vaccine fanatics still cling to the thimerosal claim.So attention has shifted yet again. Now the anti-vaccine crowd are hedging their bets with the “toxin gambit.” They blame various “toxins” in vaccines for its alleged and unproven side effects. Mercury is still on the list, but they have added aluminum, which is added to vaccines to make them more effective. They cite hydrochloric acid, which they don’t understand is added to balance the pH of vaccines. They try to scare people by saying vaccines contain formaldehyde, but neglect to mention that formaldehyde is already naturally present in our blood in higher amounts than are found in vaccines. They even make up some toxins (aided by their limitless scientific ignorance) by misreading chemical names. Jenny McCarthy, for example, has repeated numerous times (despite being called on it) the canard that vaccines contain ether and anti-freeze – both untrue. They also try the scare tactic of saying that vaccines contain viral proteins – uh, yeah, that’s the point. And that they may contain fetal tissue – which is a gross distortion. Some vaccine components were cultured in cells that were derived years ago from fetuses.

(For a more thorough review of the science behind recent anti-vaccine claims you can browse through my many blog posts on the topic, or read this overview I wrote for the Skeptical Inquirer.)

The Anti-Vaccine Players

Active players on the anti-vaccine side include a number of organizations, such as Safe Minds and Age of Autism. They have been given an incredible boost by the internet, as the skeptical movement has, and have been tireless in spreading their misinformation and ideology on their websites and blogs.

Andrew Wakefield, despite being discredited, has not recanted his claim that there is a link between MMR and vaccines. He now portrays himself as a martyr to the cause. As a doctor and researcher he remains an icon of the anti-vaccine movement.

Other anti-vaccine researchers include the father and son team of Mark and David Geier. They have made a career publishing bogus studies claiming to show a statistical correlation between vaccine and autism. Their studies crumble under peer-review, however. They have also spent a lot of time as expert witnesses for attorneys suing over vaccine injury. Their worst contribution to anti-vaccine nonsense, in my opinion, is a recent study in which they are treating autistic children with Lupron and chelation therapy. They were only able to get approval for this ethically dubious study by putting together their own IRB board packed with cronies.

Dr. Jay Gordon is a “pediatrician to the stars” and prominent figure in the anti-vaccine pantheon, despite his coy and unconvincing protests that he is not anti-vaccine. He is notorious for relying upon his gut instinct as a clinician rather than actual published scientific evidence, and makes a slew of anti-vaccine claims that are completely unsupported by evidence. For example he is proponent of the notion that the childhood vaccine program gives too many vaccines too soon – without any scientific rationale or evidence.

J.B. Handley is the co-founder of generation rescue, a parent-based autism support group that is dedicated to the notion that autism is a vaccine-injury. His group also favors and promotes a number of biological therapies for autism, such as chelation therapy, all based either on the mercury poisoning hypothesis, or any dubious alternative therapy that comes along.

David Kirby is a journalist who gave the thimerosal hypothesis a huge boost with his 2006 book Evidence of Harm.  In it he puts forward the claim that there is a vast conspiracy among the pharmaceutical industry, the government (via the FDA and CDC) and the medical establishment to hide the evidence that thimerosal in vaccines causes autism. He has subsequently built his career around that book, and clings tenaciously to the thimerosal claim. He blogs for The Huffington Post, where he repeats his anti-vaccine propaganda on a regular basis. Kirby is most notorious for specifically claiming that autism rates should plummet following the removal of thimerosal from the vaccine schedule, and then subsequently moving the goalpost on his prediction.

Robert F. Kennedy Jr. is a lawyer and environmentalist who has championed the hard-core conspiracy theories surrounding the anti-vaccine claims. He wrote Deadly Immunity (published simultaneously Rolling Stone magazine and Salon.com), and followed up with a ridiculous screed called Attack on Mothers. He has been particularly shrill and paranoid in his writings, and just as scientifically clueless. This was the primary reason for the controversy that erupted when his name was floated for an Obama appointment to head the EPA.

The reigning superstar of the anti-vaccine movement is actress Jenny McCarthy.  After deciding that her son, Evan, was an indigo child (actually, she is an “indigo” and Evan is a “crystal” – divine manifestors here to save the earth, so they have that going for them) McCarthy later decided that Evan had autism caused by the MMR vaccine. So she shifted from crusading to spread the word of indigo children to the world to spreading anti-vaccine propaganda. She has subsequently been relentless in spreading her scientific illiteracy and fear mongering, and was the primary force behind the “Green or Vaccine” march earlier this year. She believes that we should listen to her “mommy instinct” rather than scientific evidence. Eager for a celebrity face to put on their movement, McCarthy was rapidly positioned as the de facto leader of the anti-vaccine crowd.

Her celebrity has indeed made her dangerous. She has also managed to rope in her boyfriend, Jim Carrey, who is also as clueless as he is famous.

Also a huge player in the anti-vaccine movement is the media. In general the mainstream media have been mixed in the quality of their approach to this issue. Sometimes a mainstream outlet does a decent job, but mostly they allow Jenny McCarthy and her ilk to have a free ride, with perhaps lame token skepticism thrown in.

But beyond mainstream media incompetence, there are several outlets that have actively promoted the anti-vaccine movement, and they deserve a large share of the blame for the harm that results. This includes the Huffington Post, which I already mentioned as the blog home of David Kirby. Larry King has also allowed his show to be used to promote anti-vaccine pseudoscience. But the queen of shilling for dangerous quackery is Oprah Winfrey. She has the largest and most adoring audience. She has promoted Jenny McCarthy and Dr. Jay Gordon on her show numerous times. She doesn’t even bother with the token science.

There are many others, but those are the names that have been prominent in the media recently.

Defending Science

The list of players opposing the anti-vaccine movement is not as long.  The most prominent opponent is Dr. Paul Offit, a pediatrician and researcher who recently published a book on the topic called Autism’s False Prophets. He has endured personal threats in order to tirelessly attack the pseudoscience of the anti-vaccine crowd. He is certainly their enemy #1. He understands the issue inside and out and is an effective public speaker and writer.

Recently actress Amanda Peet decided to go up against Jenny McCarthy in a celebrity death match over the issue (or at least that’s how the media likes to play it). She has become a spokesperson for the vaccine program, and has specifically targeted anti-vaccine propaganda. She also has made an effective swipe at McCarthy exploiting her celebrity to promote her own wacky ideas. Peet stresses that she is not an expert, and that she defers to the scientific consensus on vaccines. She is not trying to substitute her own opinion for that of experts, she is simply trying to get the word out that vaccines are a safe and effective public health measure.

But those who have been in the trenches countering anti-vaccine propaganda at every turn are skeptics and science bloggers. I have been writing about the issue since 2005, and in fact have been engaged directly by David Kirby and others. David Gorski, who blogs for Science-Based Medicine and Respectful Insolence, has also been blogging very effectively on this issue for years. Dr. Gordon, in fact, treats him as his personal nemesis. Our allies across the pond include Ben Goldacre who write the Bad Science column. Even non-physician skeptical bloggers will occasionally take on anti-vaccine nuttery. Phil Plait, for example, will take time away from astronomy to dismantle the latest anti-vaccine pseudoscience. There are others, and my apologies to anyone I did not specifically mention.

Some bloggers in the autism community, like the autism diva,  have also opposed the anti-vaccine crowd, partly because in order to bolster their fear mongering the anti-vaccinationists have portrayed autism as a universally “life sucking”disorder. It is not hard to understand why some autism parents would be offended at that characterization of their children, or why they would resent the use of autism to fear-monger about vaccines.

The government and mainstream medical community has been largely ineffective on the issue. They try, with occasional official statements about the science, but they simply don’t have the experience dealing with a dedicated pseudoscientific popular movement.

The Stakes

The consequences of this particular battle are quite high.  Obviously, everyone wants effective vaccine regulation and safety monitoring. There is broad support for the vaccine compensation program, that streamlines the process of financially compensating children and families that have suffered legitimate side effects from vaccines. On any particular claim, we want the scientific chips to fall where they may. If some vaccine ingredient is causing harm, we need to find out right away and make the necessary changes. Only a cartoonish, handlebar mustache-twisting villain would want to allow children to be harmed through compulsory vaccines. Anti-vaccine hysteria, however, hampers effective vaccine safety by diverting attention and resources to false claims.

The most direct consequence of the anti-vaccine movement, and their recent successes with Jenny McCarthy and Oprah, is stoking public fears about the vaccine program leading to declining vaccination rates. This has already resulted in increased outbreaks of measles and mumps.  Vaccine hysteria in Nigeria set back the goal of eradicating polio from the world for years.

Not having ones’ children vaccinated does not only put your children at risk but others as well. As vaccination rates drop, infectious diseases they would normally prevent are allowed to spread through the population. This puts everyone at risk, but especially those people who cannot be vaccinated because of a medical contraindication.

The anti-vaccine crowd has also opposed attempts to shield vaccine manufacturers from liability. No one is arguing that vaccine producers get a free pass – they are still responsible for their product, and are certainly tightly regulated by the government. However, if they were vulnerable every lawyer trying to make a buck off of anti-vaccine pseudoscience, it would quickly become impossible to produce vaccines. It would not be worth it for any company to sell vaccines – and of course that is the goal of the anti-vaccine movement. They want to end vaccines, and harassing lawsuits are just one method. This is partly why the government set up the vaccine compensation program – there is a small tax attached to every vaccine, and that tax goes into a pool that is then paid out to those injured by vaccines, as determined by a federal court.

This brings up another risk of the anti-vaccine movement. There are now about 5,000 cases before the vaccine injury compensation program by parents who allege that their children’s autism was caused by vaccines. The courts now have to spend time and taxpayer money legally settling a question that the scientific community already has.

Conclusion

The anti-vaccine movement is a recent skeptical battleground, and one that is still very active.  This is certainly one of the biggest issues from 2008, and likely will continue to be for the foreseeable future. Skeptics have been particularly effective in dissecting the claims of the anti-vaccinationists and pointing out the dangers of anti-vaccine hysteria. But the anti-vaccinationists have the momentum, due largely to Jenny McCarthy and Oprah Winfrey. Vaccine rates are declining.

It seems as if we may be seeing a momentum shift, however. Next year will be very telling.

One thing is clear – the skeptical movement has to keep vigilant and keep the pressure on. We have to oppose anti-vaccine pseudoscience at every turn. We need to make ourselves available to the mainstream media and be effective at the public relations end of the game. We need to get the mainstream scientific and medical communities more active and show them how it’s done.

This is a fight we can win, and I think we are making headway.