![]() Many snippets of wisdom that have permeated our culture are routinely quoted in social media such as the one from the Irish playwright George Bernard Shaw featured in the image above that states that all progress depends on the unreasonable man. Everyone seems to have an affinity with this particular trope. After all, who doesn’t love the story of the little guy fighting against the establishment? It seems that most of us, within reason, are programed to root for the underdog. The mavericks, the misfits, the fringe-thinkers, the outcasts: why do these characters have a place in our hearts? Is it perhaps because in the daily tedium of our lives, as we persevere overburdened by challenges at work, in our homes, and in society, we sometimes wish we could upturn the established order and restart anew? Perhaps we have considered going against the current, challenging the system, rocking the boat, but then deemed the risks of doing so too dire and just bowed our heads and kept on going. So maybe when one of these colorful characters that actually dares to challenge the powers that be comes along, we live vicariously through their plight a fantasy that we ourselves are too cowardly to bring to reality. Be that as it may, in the field of science many of these characters have captivated the public’s imagination. Take the case of Dr. Barry Marshall who proposed the hypothesis that stomach ulcers are not caused by excessive acid secretion due to stress, as was thought by most experts, but by infections with a type of bacteria called Helicobacter pylori. Dr. Marshall failed to convince the scientific establishment. He was not able to develop an animal model of the disease, and could not obtain funds to perform a human experiment. So what did he do? He experimented on himself! He drank a broth infected with the H. pylori isolated from a patient who had developed severe gastritis. Within days he developed the same symptoms the patient had, and he was able to cure himself using antibiotics. It took another decade of struggles, but gastroenterologists were eventually convinced of the truth of his claim, and Dr. Marshall won a Nobel Prize in 2005. Isn’t that a great story? And like this story, there are many other such stories of the unreasonable man battling the system and prevailing in the end. However, the popularization of these stories has generated several notions in the public consciousness that are not accurate. The first is the notion that the only way science makes progress is when one of these characters upends conventional wisdom and triggers a revolution. This is not true. Most of the time progress in science occurs incrementally as thousands of scientists perform vital work within the system developing new knowledge, methodologies, procedures, and applications. The backgrounds and expertise of these scientists are fundamental to driving any new or old area of science forward. Without these individuals working within the system there would be no science. The notion that ALL progress, at least in science, depends on the unreasonable individual is simply false. The second notion is that just because you are one of the unreasonable individuals you must be right, and the scientific establishment must be wrong. It must be understood that for every individual who has challenged the established order successfully, there have been dozens to hundreds of other individuals who have challenged the established order and were proven to be wrong. The stories of these individuals are normally not of interest except, if at all, to those whose write historical descriptions of the development of a given scientific field, and they are barely mentioned in the popular press. Finally, the last (and probably most troublesome) notion is that when the scientific establishment lashes out at one of these unreasonable individuals, this is taken as proof that there is a bias within the scientific community motivated at best by intellectual conformity and closed-mindedness, or at worse by corrupt influences tied to granting agencies or corporate interests. However, what the public may interpret as an unfair treatment of a scientist by the scientific community is more often than not due to the fact that science is a very conservative enterprise, and the bar to overturn or reinterpret established science is set pretty high. Science is biased towards established knowledge; as it should be! When you go against established science, you’d better have some exceptional evidence and arguments or else you are going to be given a very hard time! Even scientists with Ph.Ds. can propose things that are wrong, misguided, or just plain stupid. Not all ideas deserve to be treated equally, not all evidence is sound, and not all interpretations of the data are correct. What most individuals seeking to change the prevailing scientific paradigm do is address the criticism made by their peers, generate more evidence, and reformulate their ideas or their presentation. Convincing other scientists that you are right is the warp and woof of science. However, a disturbing phenomenon has emerged. Today those individuals who have been rebuffed by the scientific community can take their case to “the people” arguing that they are victims of a corrupt scientific establishment that is hell bent on silencing them and discrediting their ideas. Such is the case of Dr. Andrew Wakefield who, when his views that vaccination was linked to autism were rejected by the medical community, took his case directly to the public. He actually succeeded in convincing many parents to avoid vaccinating their children leading to a spike in infant deaths from some diseases that are preventable nowadays. Established science is called that for a reason. Scientific theories are constructs that have grasped important aspects of the realties they seek to explain, and they cannot be overturned on a whim. The quixotic quest of the unreasonable man must not be romanticized. These individuals are wrong most of the time, and established science must be protected from them. If you want to upend established science, the burden of proof is on you! The image of George Bernard Shaw was modified from a photograph in the George Grantham Bain collection at the Library of Congress and has no known copyright restrictions.
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The near eradication of many diseases by vaccination is one of the greatest scientific and public health achievements of the twentieth century. And this was not merely a result of better hygiene and sanitation as claimed by some. One by one, smallpox, diphtheria, pertussis, tetanus, polio, measles, mumps, rubella and other scourges of mankind were beaten back as scientists discovered how to coax our immune systems to make antibodies against the pathogens that cause these diseases. Among the chief beneficiaries of this improvement in the health of our population were children. If you go to old cemeteries and check the graves, you will find a much larger number of children’s graves compared to modern cemeteries. Therefore it seems somewhat paradoxical that nowadays in our society and others a significant group of parents have refused to vaccinate their children claiming among other things that vaccines cause autism. This in turn has led to a resurgence of some of these diseases such as the measles outbreaks in California in 2014, Arizona in 2016, and the recent outbreak in Minnesota. What is happening here? First of all, what is autism? Autism, or more accurately autism spectrum disorder (ASD), is a neurodevelopmental disorder where the afflicted children exhibit a lack of social interaction. Autistic children are withdrawn as if living in their own world, and many exhibit mental retardation, hyperactivity, irritability and repetitive behaviors. The specific cause of ASD is not known but it seems to encompass both genetic and environmental factors. Now, how did autism ever become associated with vaccines? The strongest catalyst for this association was an article published in 1998 by Dr. Andrew Wakefield and 12 other researchers in the medical journal the Lancet which suggested a link between the measles, mumps, and rubella (MMR) vaccine and autism through a mechanism that involved a type of gastrointestinal disease. The study was small (only 12 children), did not include a control group, and the nature of the evidence was correlational without any evidence of causation. However, the study was picked up by the media and widely publicized. As a result of this vaccination rates against measles, mumps, and rubella began to drop due to parents being concerned about vaccines and autism. This led to an increase in cases of these diseases in children resulting in several deaths. In 2004, investigations by a journalist revealed that Dr. Wakefield had perpetrated fraud by altering the facts of the patients’ medical histories for what appeared to be financial gain. Ten of the original authors of the paper retracted the interpretation of the findings making it clear that they had not found any causal association with the MMR vaccines and autism. Also in 2004, the journal carried out an investigation that absolved the researchers of the paper of charges of ethical misconduct that had been levied against them only to retract the paper 6 years later when additional investigations by the British General Medical Council found evidence of scientific misconduct. As a result of these investigations, Dr. Wakefield was removed from the United Kingdom’s Medical Registry and he now cannot practice medicine. In response, Dr. Wakefield has claimed that he is being targeted by the medical establishment in collusion with vaccine manufacturing companies, and that he has never committed fraud. Wakefield has moved to the US where he has developed a following among anti-vaccination groups who consider him a hero. The whole autism/vaccine topic has become mired in endless controversy with one side accusing the other of ignoring scientific findings and the other side retorting that the truth is being manipulated by “the system”. ![]() What is a concerned person to do about this issue? How do we determine who is right and who is wrong without getting bogged down in technical details? The answer is: studies. Studies are the warp and woof of science. It is through studies that we determine the truth. But here is the thing; you need several of them. You can’t rely on just a couple, and you can’t quote selectively those studies that favor your pet theory. You also need the studies to have a large enough sample size. Small studies are notorious for producing erroneous results. Finally, some studies may be of greater quality than others. Therefore you need enough studies to accumulate so reviews of the studies can be performed (a study of studies if you will). This is normally a process that can take many years, but fortunately the issue of the MMR vaccine and autism has generated enough interest that many researchers have investigated it. So what are the results? An 2012 review as well as a more recent update of some of the best studies evaluating, among other things, any possible link between the MMR vaccine and autism reached the conclusion that there was no significant association between the two. These studies were conducted in many countries and, unlike Wakefield’s original study with 12 children, these studies all in all included hundreds to hundreds of thousands of children. Are these negative results part of a vast international conspiracy of scientist who have sold out to some sort of evil conglomerate of pharmaceutical companies spanning the whole world? Do you know about the “war” that scientists waged against the claims of the cigarette companies that smoking was not hazardous or that whether it was or not was not settled science when study after study demonstrated otherwise? Are you aware of the current struggle of scientists worldwide to counter the claims that there is no global warming when all evidence points in that direction? Why do we presume bad faith is involved on the part of all scientists that come to the conclusion that the MMR vaccine is not linked to autism? Do you think these scientists don’t vaccinate their children? Let me explain something. The history of science is full of individuals that, like Wakefield, discovered something and had to fight to get their voice heard. But, unlike Wakefield, these individuals discovered something real that other scientists were able to duplicate in their studies and became convinced. Paradigms and ideas switch all the time in science. Just consider the proposals or discoveries of evolution, deep time, deep space, plate tectonics, the germ theory of disease, the deficiency theory of disease, relativity, DNA, prions and many others. Very few scientists would walk away from being associated with discovering a solid causative factor for autism. The truth is that the available data has convinced scientists that the link between the MMR vaccine and autism is nonexistent. Scientists have lost interest in this theory and they have moved on to explore what other factors can be responsible for autism, and this is an important and active area of research nowadays. I understand that the autism issue can be a very emotional one, and it is really frustrating for parents to hear scientists say they don’t know what causes it. I also understand how in the midst of their despair many parents can be swayed by those who claim to have a simplistic answer along with an evil to fight against. If anything, the current political climate in the U.S. has demonstrated that this strategy works admirably well! However the best way to move forward is not to demonize scientists, but to join ranks with them and cooperate in finding the truth. This happens with many other diseases where families, clinicians, and scientists are actively involved in finding a cure and developing treatments. The photograph by the US army is in the public domain. |
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