Call it fate, karma, destiny. It was written in his stars, in his professional DNA. It had to happen. Houston pediatrician and microbiologist Peter Hotez, MD, PhD, just had to write Vaccines Did Not Cause Rachel’s Autism (tma.tips/HotezBook).
Dr. Hotez is a vaccine scientist, director of the Texas Children’s Hospital Center for Vaccine Development at Baylor College of Medicine. He has spent his career developing vaccines against neglected tropical diseases, like hookworm and schistosomiasis, that kill tens of thousands each year in some of the world’s poorest countries.
Dr. Hotez is also an outspoken critic of the anti-vaccine movement, whose growth he blames on “a toxic combination of hysteria and pseudoscience.” He’s become a first-responder of sorts, speaking out on his own and sought after by the news media whenever the anti-vaccine forces make another outlandish claim or seek new “protections” from mandatory immunizations.
Finally, Dr. Hotez is the father of four children, including 25-year-old Rachel, who is on the fairly involved end of the autism spectrum. He and his wife Ann know firsthand the heartbreak and frustration that propel so many parents of children with autism to search for a scapegoat.
His life’s work, his family’s exasperation, and the absurdly nonscientific conspiracy theories of the anti-vaccination movement combined into a volatile mixture that drove Dr. Hotez — a prolific author — to write this book. It’s also a call to arms, a plea to his colleagues to join the battle against Andrew Wakefield, the defrocked British huckster, and his anti-vaccine forces.
“Their false claims and public statements more often than not go unchallenged,” Dr. Hotez writes in the book’s preface. “I hope that this book might serve as a clarion call for other scientists and physicians to speak out on behalf of science.”
Physicians with an activism bent — like an urge to reverse the surge in nonmedical vaccine exemptions in Texas schools — might want to jump straight to Chapter 12, “Science Tikkun.” (The term is an adaptation of tikkun olam, a Hebrew phrase referring to the Jewish obligation to repair the world.) The chapter is a call for scientists to step out of their academic comfort zones, to “go beyond the lab bench” and “take the time to educate leaders in all areas of business, religion, the media, the military, and government in order to help them to better understand science and scientific methods.”
Like laboratory scientists, many physicians are reluctant to take part in public engagement. The exceptions are the minority of Texas physicians who belong to TEXPAC (the Texas Medical Association’s political arm) or who take part in TMA’s First Tuesdays at the Capitol lobbying visits. Many of the others abstain because politics is dirty and the legislative process is unseemly. Unfortunately, medicine pays the price when our opponents dominate the conversations and win battles that logic and science say should have gone our way.
TMA is an advocate of a sort of “medicine tikkun,” and we need many more converts.
Back to the main thrust of Dr. Hotez’ book. Vaccines Did Not Cause Rachel’s Autism is sort of a dual-track biography. It juxtaposes the author’s scientific and medical career against his family’s struggles to understand Rachel and find appropriate treatment and educational opportunities for her.
Dr. Hotez’ training and scientific accomplishments provide the credentials for him to speak forcefully about the efficacy, promise, and safety of vaccines. Rachel gives him the moral standing to look the parents of people with autism in the eye and say, “I’m no outsider. I live in your shoes. I understand you. You’ve been misled, and your children — our children — are suffering because of it.”
I draw many parallels to my own life. While I lack Dr. Hotez’ diplomas and research record, I was a scientist before I became a journalist. As director of communications at TMA for 21 years, I have spoken out regularly against the anti-vaccine movement and have been actively engaged in planning TMA’s pro-vaccine programs and advocacy. I’ve confronted Andrew Wakefield personally and publicly. (See “Vaccines, autism, and Andrew Wakefield’s wake,” tma.tips/WakefieldWake.)
And I, too, am the father of a child with autism. Nathan, now 28, has communication and relationship problems far more severe than Rachel’s. But I’m proud to say he has held down a real job, earning competitive pay in an integrated workplace for 11 years.
Some in the autism community have accused me of being a sellout for my public pro-vaccine stance. But like Dr. Hotez, I believe that there are some things Nathan’s father can say to that community that others can’t get away with.
What I think are the two most important chapters in Dr. Hotez’ book — Chapters 8 and 9 — have nothing and everything to do with the author’s personal journey. After having bluntly debunked Wakefield’s “research” earlier in the book, Dr. Hotez methodically walks the reader through the major retrospective cohort studies and case-control studies that conclusively refute any association between the measles vaccine and autism, between the thimerosal preservative and autism, and between the alum adjuvant in immunizations and autism. The totality of this research, Dr. Hotez says, “rank[s] among the most thorough investigations in all of biomedical science.”
He closes Chapter 8 with the sad observation that anti-vaccine groups continue to reject these findings under the guise of faulty methodology and outright conspiracy. “By persisting in these actions, they are doing a disservice to children and adults with autism and their family,” he writes.
Dr. Hotez devotes Chapter 9 to the scientific evidence for what does cause autism. He reviews the neurodevelopmental literature that implicates changes in the brains of fetuses and infants who later develop autism — changes that come long before their first immunization. He outlines the growing understanding of the roles that genetics, epigenetics, and nonvaccine environmental insults play. “The bottom line is that none of the sequence of events leading to [autism spectrum disorder] relies on vaccines or vaccinations,” he concludes.
Vaccines Did Not Cause Rachel’s Autism is well researched, well written, compelling, and interesting. Dr. Hotez’ characterization of the immunizations against neglected tropical diseases as “antipoverty vaccines” is uplifting and hopeful.
But I offer two important criticisms.
First, as a professional editor and journalist, it is my opinion that Dr. Hotez is writing way above his intended audience. Especially in the critical Chapters 8 and 9, I fear that the lay public and parents of children with autism will be so overwhelmed by the scientific terminology and technical jargon that they will never come to understand and appreciate the author’s well-reasoned arguments.
I would suggest that part of “science tikkun” should be a commitment to rewriting material over and over until readers can focus easily on the concepts and not stumble on the jargon. This will not be an easy task for scientists and academic physicians who are used to writing for professional literature and delivering lectures to their peers and students. Phrases such as “found a significant level of Chagas disease transmission within the state of Texas” might seem perfectly clear to you or to Dr. Hotez, but perfectly opaque to the public at large.
My second critique is more personal and subjective. To be frank, I was saddened and sometimes angered at how Dr. Hotez wrote about Rachel, her disabilities, her obsessions, and personality quirks, and his family’s disappointment with her slow progress.
As an autism father, I feel I have the moral standing to confront Dr. Hotez here. I’m no outsider. I live in your shoes. I understand you. Having a son or daughter with a significant disability can be so disrupting to our families and our homes. I know how much easier it can be to see the negatives in our children. But for their sake, for our own sake, for individuals with disabilities everywhere, for anyone who might hear or read our words, we must focus on their abilities, not their disabilities.
What our children can do is so much larger and so much more important than what they cannot do.
Tex Med. 2019;115(3):44-45
March 2019 Texas Medicine Contents
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