The Democrats are the party that says government will make you smarter, taller, richer, and remove the crabgrass on your lawn. Republicans are the party that says government doesn’t work, and then they get elected and prove it.
—P. J. O’ROURKE, PARLIAMENT OF WHORES: A LONE HUMORIST ATTEMPTS TO EXPLAIN THE ENTIRE U.S. GOVERNMENT
Like celebrities, politicians can also use their considerable platforms to inform or misinform the public about science.
At the end of the biopic Hear the Silence, Andrew Wakefield, played by the actor Hugh Bonneville, receives a letter asking him to testify before the United States Congress. In the final scene, Wakefield stands on the steps of the Capitol building, then walks confidently forward. Wakefield’s letter had come from Representative Dan Burton, a Republican from Indiana, who had subpoenaed him to appear before the powerful House Committee on Government Reform. The hearing took place on April 6, 2000. I had also been asked to testify.
The title of the hearing was “Autism: Present Challenges and Future Needs—Why the Increased Rates?” I didn’t understand why I had been subpoenaed. I wasn’t an autism expert, so I couldn’t talk about the cause or causes of autism. And I wasn’t an epidemiologist, so I couldn’t talk about “why the increased rates?” I assumed, given that I was a virologist and immunologist, that Dan Burton wanted me to talk about whether the MMR vaccine could cause autism (which tells you everything you need to know about how naïve I am). I would be given ten minutes to read from a prepared statement and then, presumably, answer questions. For the next two weeks I worked hard on my speech. The real reason that Burton had asked me to testify wouldn’t become clear until later.
At 10:37 a.m. in room 2154 of the Rayburn House Office Building, Dan Burton called the hearing to order. He sat on a high dais, flanked on either side by his fellow committee members. The room was packed; the atmosphere tense, expectant, and foreboding. Although I understood the seriousness of the meeting, I felt like I was in a Monty Python skit about Judgment Day.
It didn’t take long to see where the hearing was headed. “This morning we are here to talk about autism,” said Burton. “What used to be considered a rare disorder has become a near epidemic. We have received hundreds of letters from parents across the country. [But] I do not have to read a letter to experience the kind of heartbreak that is in these letters. I see it in my own family.” Burton showed a slide of photos of his two grandchildren.
The one on the left is my granddaughter, who almost died after receiving a hepatitis B shot. Within a short period of time, she quit breathing, and they had to rush her to the hospital. My grandson, Christian, whom you see there with his head on [his mother’s] shoulder, according to the doctors was going to be about six foot ten. We anticipated having him support the family by being an NBA star. But unfortunately, after receiving nine shots in one day, the MMR and the DTaP shot, and the hepatitis B, within a very short period of time, he quit speaking, ran around banging his head against the wall, screaming, hollering, waving his hands, and became a totally different child. We found out that he was autistic. He was born healthy. He was beautiful and tall. He was outgoing and talkative. He enjoyed company and going places. Then he had those shots, and our lives and his life changed.
Burton stopped, fighting back tears.
At this point I realized that the subtitle of the hearing, “Why the Increased Rates?,” had been a ruse. We weren’t here to find out why the rates of autism had increased. Dan Burton already believed he knew why. And he had invited a series of panelists—most prominently Andrew Wakefield—to prove his point.
After Burton finished his opening statement, Representative Henry Waxman, a Democrat from California, gave his. “I believe that we need to increase our efforts to understand the causes of autism,” he said. “But in this process we must not get ahead of the science or raise false alarms. [I]n medicine the best answers come from research that can withstand the rigors of the scientific method. These standards have been developed in order to find the truth.” Where Burton had been emotional and anecdotal, Waxman was rigorous and thoughtful. I started to relax a little bit. At least one member of Congress would be on my side.
The first panel consisted of parents of children with autism. All, save one, believed that vaccines had been the cause. The parent who didn’t was Wayne Dankner, a pediatric infectious diseases specialist from San Diego, who warned, “I have seen no sound evidence linking autism to MMR or any other vaccine.”
Burton grilled Dankner, trying to find some evidence that Dankner’s daughter had worsened following a vaccine, any vaccine. But Dankner refused to budge. Burton tried to salvage the moment by performing an impromptu epidemiological mini-study. He asked each of the parents who had already testified to pinpoint exactly when after vaccination their children had developed autism. Satisfied that his theory was still intact, he moved on.
The next group to testify was the scientists. Andrew Wakefield was first. Speaking to members of Congress as if they were molecular biologists, Wakefield talked about measles virus proteins, follicular dendritic cells, ileocolonic lymphonodular hyperplasia, crypt abscesses, common recall antigens, and molecular-amplification technology. Burton nodded enthusiastically throughout Wakefield’s presentation, no doubt having little to no idea what he was talking about. Next up was John O’Leary, a pathologist from Ireland and a colleague of Wakefield’s who, like Wakefield, buried the committee in jargon. O’Leary talked about TaqMan real-time quantitative polymerase-chain reactions, RNA inhibition assays, low-copy viral gene detections, fusion proteins, nucleocapsid genes, and black signals, concluding that his detection of measles virus genes in the intestines of children with autism supported Wakefield’s theories. (Eight years later, Mady Hornig and her colleagues at Columbia University’s Mailman School of Public Health would discredit O’Leary’s initial studies.)
Wakefield and O’Leary were followed by a cavalcade of doctors offering bogus cures. Mary Megson, a pediatrician and assistant professor of pediatrics at the Medical College of Virginia, said that she could cure autism with large doses of vitamin A. John Upledger, an osteopath from Palm Beach Gardens, Florida, explained that vaccines caused an abnormal flow of spinal fluid, which could be relieved by a manual decompression technique he had developed. Vijendra Singh, an immunologist from Utah State University, said that autism was caused by an autoimmune response against the brain. Michael Goldberg, a pediatrician from Los Angeles, claimed dramatic results with minerals, antivirals, antifungals, anti-inflammatories, and immune-modifying agents. Burton was ecstatic. “That was a really good lecture,” he enthused. “I enjoyed that, and we will have some questions about whether or not any of our health agencies have picked up on your procedures.”
Not exactly a Capra-esque, Mr.-Smith-Goes-to-Washington moment. Didn’t any of the committee members notice that these theories were mutually exclusive? Shouldn’t someone have asked, “So which is it? Do vaccines cause gut abnormalities or vitamin A deficiency or an abnormal flow of spinal fluid or an autoimmune response against the brain? Is autism a viral infection or a fungal infection or a mineral deficiency? Which? Pick one. Because they can’t all be correct.” But no one questioned these obvious inconsistencies. Snowed by indecipherable jargon, they just kept nodding like a row of bobblehead dolls—as if all of this had made perfect sense to them.
I was on the next panel of scientists, the most important of whom was Brent Taylor, an epidemiologist from the Royal Free Hospital (ironically, the same hospital at which Wakefield had performed the research that had led to his later-to-be-retracted Lancet paper). Taylor had been the first to publish a study showing that children in England who had received the MMR vaccine were at no greater risk of autism than those who hadn’t. Burton tried to challenge Taylor with information he had been given by his staff, but Burton was overmatched. Failing to put a dent in Taylor’s conclusions, he eventually gave up.
I was up next.
Karen Muldoon Geus, the head of public relations at my hospital, was concerned about the controversial nature of the hearing, so she hired an outside public relations firm to work with me on my speech. The PR expert wasn’t worried about what I would say; he was worried about my collaboration with Merck on the development of a rotavirus vaccine. Even though the vaccine was still six years from licensure, he wanted to make sure that my work with Merck was front and center in my speech. So I began my testimony with what probably sounded like a mea culpa:
My name is Paul Offit. I am a practicing pediatrician. I am also the chief of infectious diseases and the Henle professor of immunologic and infectious diseases at the Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine, and a member of the Advisory Committee on Immunization Practices at the CDC…. My expertise is in the areas of virology and immunology. In addition, I have been in collaboration with Merck and Co. on the development of a rotavirus vaccine since 1992.
Despite this disclaimer, the PR guy was still worried. He wanted to know whether anything I had ever said or done could come back to haunt me. I told him that I had never been convicted of a crime, if that’s what he meant. I said it jokingly, but he didn’t laugh. He stared at me, as if looking through me, and asked again if there was anything else out there—anything that Dan Burton could use to discredit me. It’s not hard to appeal to my (or I suspect anyone’s) sense of guilt. So I thought back. Had I ever done anything illegal or immoral? I had smoked marijuana in college (and inhaled), but this was true of many people of my generation. I had never done harder drugs, like cocaine, heroin, or LSD. When I was eighteen years old, I had danced with Blaze Starr at a bar called the Red Rooster in Essex, Maryland. (Starr, Baltimore’s most famous exotic dancer, was the subject of the movie Blaze, starring Lolita Davidovich and Paul Newman.) I couldn’t imagine that this would be a problem, since it was the single greatest moment of my adolescence. During my junior and senior years in college, I had run a football gambling card that I had named “Pro Picks.” Every week I would make my own point spreads on professional football games, print up the card, and distribute it to the dorms on campus. The advantage of my card was that it came out with point spreads a day before the Las Vegas bookmakers. The disadvantage was that I didn’t know as much as the people in Las Vegas. (Although I certainly did try, spending a lot of time in the library looking through newspapers from NFL cities to find out who was injured.) Although this was no doubt illegal, it was harmless. I didn’t tell the PR guy about any of these things because I couldn’t imagine that he or anyone else would care.
Then I wondered whether events in my family’s past could be embarrassing. One of my great-uncles had supposedly killed a man in his bar, but hadn’t gone to jail. So I didn’t think that would be a problem. There was, however, one thing that worried me. My uncle, Sidney Offit, a well-known author in New York City and curator of the prestigious George Polk Awards for journalistic achievement, had published a tell-all book five years earlier. Memoir of the Bookie’s Son told the story of his father, Barney, whom everyone called Buck or Buckley. Buck Offit was without question the most successful of my grandfather’s brothers and sister, even though he had never gotten past the fourth grade. From the time he had returned from service in World War I until the early 1950s, when the Kefauver Commission’s investigation into organized crime put him out of business, Buck Offit was “among the elite of the nation’s bookmakers.” As depicted in movies like Sergio Leone’s Once Upon a Time in America or Barry Levinson’s Bugsy and Liberty Heights, Buck Offit thrived during a time when Jewish gangsters like Dutch Schultz, Legs Diamond, Meyer Lansky, Arnold Rothstein, and Louis “Lepke” Buchalter controlled organized crime in America. Buck certainly fit the part, spitting words out the side of his mouth like a Damon Runyon character. As did all of my family members, I idolized Uncle Buck. In the 1950s, Buck was arrested during a gambling raid. Although probably guilty of bankrolling the operation, he was able to bribe his way out of a conviction. I actually told the PR guy this story, even though I couldn’t imagine Dan Burton or his staff digging through notes from the Kefauver Commission or reading Uncle Sidney’s book. Not surprisingly, they hadn’t.
In addition to Brent Taylor, the other scientists on my panel included Coleen Boyle, an epidemiologist at the CDC, who talked about autism rates; Edwin Cook, a child psychiatrist from the University of Chicago, who talked about behavioral therapies and the need for support services; and Deborah Hirtz from the National Institutes of Health, who talked about future research needs. Although I wasn’t an autism expert, I had spent two decades studying viral pathogenesis, learning how viruses caused disease and how the immune system fought back. I thought I was in the best position to discuss the biological plausibility of Andrew Wakefield’s claims about the MMR vaccine. Here’s what I said:
My role in these proceedings is to explore the theories that have arisen due to concerns by the public that autism might be caused by the combination measles, mumps, and rubella vaccine known as MMR. No evidence exists that proves this association. However, three theories have been used to explain it. In the time that I have been given, I would like to explain why I think that these theories are invalid.
Everyone sat quietly. Staffers weren’t leaning forward talking to their congressional representatives. Parents in the audience seemed to be paying attention. Members of the media stopped whispering among themselves. Great, I thought. Now finally I have a chance to explain to the public why this MMR–autism controversy hadn’t made much sense:
The first theory is that children who get the measles vaccine make an immune response not only to the vaccine, but to their own nervous system. This kind of reaction is called autoimmunity. To understand why this theory is incorrect, we must first understand differences between natural measles infection and measles vaccination.
During natural measles infection, the measles virus reproduces itself many times in the body and causes disease. In contrast, following measles vaccination, the vaccine virus reproduces itself much less and doesn’t cause disease. Because more measles proteins are made during natural infection than after immunization, the immune response to natural infection is greater than the immune response to immunization.
If the immune response is greater after natural infection, then the autoimmune response would also be greater. If this were the case, then autoimmunity should occur more frequently after natural infection than after vaccination. Or, said another way, if measles virus caused autism, measles vaccination would lower, not raise, the incidence of autism.
I thought this was an important point. I wanted parents to understand the tenets of autoimmunity without resorting to jargon, so I had worked hard on these sentences in preparation for my testimony. Then I addressed the next theory:
The second theory is that the child’s immune system is simply overwhelmed by seeing three viruses in a vaccine at the same time. Some have gone so far as to suggest that it may be of benefit to divide the MMR vaccine into three separate vaccines. [This was a direct shot at Andrew Wakefield.] The rationale behind this theory is that children do not normally encounter such an assault on the immune system. However, this notion is incorrect.
Wakefield glared at me from his perch about twenty feet away.
From the birth canal and beyond, infants are confronted by a host of different challenges to the immune system. Their intestines encounter foreign proteins in milk and formula. Their lungs encounter bacteria inhaled on the surface of dust in the air. And literally thousands of different bacteria immediately start to live on the skin, as well as on the lining of the nose, throat, and intestines. So how does the infant deal with this immediate confrontation to the immune system?
Babies have a tremendous capacity to respond to their environment from the minute that they are born. The newborn has billions of immunological cells that are capable of responding to millions of different microorganisms. By quickly making an immune response to bacteria that live on the surface of their intestines, babies keep those bacteria from invading their bloodstream and causing serious disease. Therefore, the combination of the three vaccines contained in MMR, or even the ten vaccines given in the first two years of life, is literally a raindrop in the ocean of what infants successfully encounter in their environment every day.
OK. Now I had only one more theory left. And it was probably the most difficult one to explain:
The third theory is that the MMR vaccine is given by an unusual route. The rationale behind this theory is that children normally inhale measles, mumps, or rubella viruses carried on droplets from another person, and do not normally have viruses injected under the skin. However, encountering viruses or bacteria under the skin or within the muscles does occur naturally. To meet this challenge, children have collections of immune cells in lymph glands located strategically throughout the body. For example, lymph glands located behind the elbow or under the arm. Because our skin can be cut, our bodies are ready to encounter challenges at any site.
Indeed, although wondrous, the birth process is quite traumatic. Newborns commonly have small cuts on their face and body after passing through the birth canal. Because the birth canal is covered with bacteria, the child will encounter bacteria under the skin immediately. Our species survives because, from the minute we are born, we are quite capable of meeting challenges at all sites.
Then I correctly predicted the future. Twice. Although anyone could have made these predictions:
Parents testifying here today are asking a scientific question: “Does the MMR vaccine cause autism?” Questions of science are best answered by scientific studies. And the answer to this question is already available. Brent Taylor and his coworkers in London have conducted a large, meticulously designed, well-controlled study that disproved an association between MMR vaccine and autism. I believe other studies will confirm Dr. Taylor’s results.
Sixteen confirmatory studies followed.
My concern, and it should be the concern of this committee, Mr. Chairman, is that some parents listening to or reading about this hearing might incorrectly conclude that vaccines cause autism…. If, as a result of reading about this hearing, some parents choose to withhold or delay vaccines for their children, their tragedy could be profound. If many parents choose to withhold vaccines, the tragedy all across America could be devastating.
In April 2000, when this hearing took place, measles had officially been eliminated from the United States. Fifteen years later, because enough parents had chosen not to give their children the MMR vaccine—in large part because they feared that it might cause autism—measles outbreaks swept across the country. Many of the children affected in these outbreaks were hospitalized.
When I finished speaking, I looked up at the panel expectantly. I thought I had done a decent job. So I was anxious to hear what the members of Congress thought. Burton was the first to speak. “Do you do any traveling around, speaking on behalf of Merck or Merck products?” he asked.
Wait? What? This is your question? Weren’t you listening to what I just said? It wasn’t until Burton asked this question that I understood what this congressional hearing was really about. This wasn’t a scientific symposium, during which researchers share ideas and reach a consensus based on data. This was a courtroom, in which each side tries to win over the jury. In this case, the jury was the American public.
“I travel and speak about vaccines,” I responded, “and these talks are supported by unrestricted educational grants from either pharmaceutical companies or from universities.” Wrong answer. The right answer would have been, “No, I don’t speak on behalf of Merck or any other pharmaceutical company.” I had naïvely played the role of the teacher, trying to educate about how symposia are funded, instead of the role that I had been assigned at this hearing: witness. And, from Dan Burton’s standpoint: hostile witness. I had also failed to realize that Burton probably had no idea what an unrestricted educational grant was, no idea that the word unrestricted meant that the company had no say in who spoke or what was said. My realization of these things came far too late to save me. I was just treading water, trying to survive Burton’s staccato prosecutorial style.
“So they pay for your expenses and that sort of thing?” said Burton.
“They have an interest in educating physicians about vaccines,” I said, “and it is good that they do, because physicians need to be educated about vaccines.” The truth is, I didn’t really know who supported these medical and scientific symposia. I had always assumed that it was hospitals or universities or government grants or unrestricted educational grants from pharmaceutical companies, but I wasn’t sure. In any case, I knew that whoever funded them had no influence on what I said. It wasn’t until he asked this question that I realized that Burton had invited me to the hearing to paint me as a shill for Merck, despite my opening disclaimer. Burton said, “I understand. And they [Merck] produce the MMR vaccine, don’t they?”
“Yes,” I said. “They do, yes.”
“Thank you,” said Burton.
I felt terrible. I thought I had made it clear that I had been collaborating with Merck on the development of a rotavirus vaccine. I thought I had been transparent. But now Burton had implied that there was something more sinister going on. That I was hopping around the country promoting Merck products, which wasn’t true. I had worked hard on my speech. But after Burton’s questions, I felt dismissed, dirty. It was awful.
In retrospect, I realize I had been the victim of the old legal aphorism that when the law is on your side, argue the law; when the facts are on your side, argue the facts; and when neither are on your side, attack the witness. Burton couldn’t question my conclusions because he didn’t know enough to question them—so he attacked me personally.
Then one of the Democrats on the committee tried to help.
John Tierney, a Democrat from Massachusetts, upset at the way the hearing was going, gave Coleen Boyle, the CDC epidemiologist, and me a chance to stand up for vaccines, asking, “If you had young children today, would you vaccinate them?”
“I do have children,” Boyle said. “And they are both fully vaccinated. And I would vaccinate them again.”
“Dr. Offit, how about you?” asked Tierney.
“Yes,” I said. “I have a seven-year-old son, Will, and a five-year-old daughter, Emily. And they are both fully vaccinated.”
“And you would do it again?”
“Of course,” I said. “I want them to be protected against the viruses and bacteria that can cause serious disability and death. I am fortunate, actually. I was a little boy in the 1950s. And when I was a little boy, there were four vaccines: diphtheria, pertussis, tetanus, and smallpox. I was fortunate that I wasn’t killed by measles or paralyzed by polio. My son did not have to be as lucky.”
It didn’t take long for me to find out that once again I had screwed up. At the break, one of the Democratic staffers came up to me and grabbed my arm. Pulling me close to him, he said, “Never, never mention the names of your children at a hearing like this!” Having no experience testifying in front of congressional committees, I didn’t know where the potholes lay. So I kept falling into them. I had never considered that, by mentioning my children’s names, I might have been putting them at risk.
Later that morning, Burton claimed that my collaboration with Merck should have disqualified me from something far more important than speaking to his committee. The revelation occurred during his questioning of Coleen Boyle.
“I want to ask Dr. Boyle one last question,” said Burton. “And that is, Do you believe anybody who is getting funds from Merck or any of the pharmaceutical companies should be on advisory panels that are making judgments about pharmaceuticals coming from those companies? Or do you believe that it is a conflict of interest?”
Boyle hesitated. “I think that is a difficult question to answer,” she said.
Burton pressed his advantage. “Wait a minute!” he shouted. “Let me get this straight. You think it is a difficult question to answer? If somebody is getting funding of some type from a pharmaceutical company, for them to sit on an advisory panel that is approving or giving their approval to a new drug that is coming on the market, you do not see that as a conflict?”
Ben Schwartz, who was the associate director of the CDC’s Epidemiology and Surveillance Division and had an intimate knowledge of how the Advisory Committee on Immunization Practices (ACIP) worked, came to Coleen’s rescue. (Voting members of the ACIP decide which vaccines should be recommended for U.S. children.) “There are very strict guidelines regarding the participation in votes of members who may have conflicts of interest that will help assure that those potential financial conflicts do not affect the votes and the decisions of the advisory committee,” said Schwartz. “The reason why individuals who may potentially have conflicts are included in the committee is to assure that we get the best expert advice possible so that we can make the best vaccine recommendations possible.”
Dan Burton and Ben Schwartz were talking about me. I had joined the ACIP as a voting member in 1998 and had remained on the committee until 2003. The Burton hearing took place in 2000, so I was still on the committee at the time. I was brought on to the ACIP because of my expertise on rotaviruses. At that point, I had already published about eighty papers on the subject and was one of only a handful of experts in the area of rotavirus-specific immunity. Because the ACIP was on the verge of recommending a rotavirus vaccine made by Wyeth, the CDC thought it would be of value to include me on the committee. To Dan Burton, this was a clear conflict of interest. But what was the conflict? I had voted for recommending Wyeth’s vaccine, not against it. Also, and this was my fault, I should have made it clear to the Burton committee that I had never received financial compensation from Merck—not in support of my laboratory, not in support of talks, not in support of advice, and not in support of my salary. My funding had come solely from the National Institutes of Health, the Children’s Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania. Burton assumed that when I said that I had worked “in collaboration with Merck,” it meant that I had been financially compensated to do so. I should have clarified the difference between collaboration and compensation. But I suspect that it wouldn’t have mattered. Burton would probably have believed that I was lying about my funding no matter what I had said.
Dan Burton never gave me a chance to respond to his claim that I was in the pocket of industry and, as a consequence, had served my own interests at the expense of the interests of children. But Henry Waxman did. A few minutes after Burton grilled Coleen Boyle, Waxman had the floor. “Now, Dr. Offit’s integrity has been challenged,” he said, “presumably because he has a point of view that does not quite fit with the chairman’s point of view. Dr. Schwartz started to indicate why he thought your situation, even though you have a relationship with Merck, did not put you in conflict. Let me ask you directly, Dr. Offit, do you have a conflict of interest, and, if no, why not?”
There’s an old saying that a Republican is a Democrat who has been mugged, and a Democrat is a Republican who has been indicted. I had felt like I had been mugged and indicted. But at that moment, I loved the Democrats.
“I have no conflict of interest,” I said. “What I have is an apparent conflict of interest, and that is why I disclosed that at the beginning of every ACIP meeting, and that is why I disclosed it in my written report [to the Burton committee]. If I could just explain this a little bit. I have been doing research for twenty years on rotaviruses. What I have done in my laboratory is try, with my colleagues, to understand what [rotaviral] genes cause diarrhea and what [rotaviral] genes help the body fight infection…. Rotaviruses cause one of every seventy-five children born in this country to be hospitalized. It is a serious and, in developing countries, often a deadly infection. It would be an advance if we could prevent that disease. Merck and Company has made a commitment to developing that vaccine and, hopefully, if we can develop a safe and effective vaccine, we can prevent a lot of disease and death.”
This was a terrible answer. Most important, I didn’t answer the question. What I had tried to do (idiotically) was to defend the manner by which vaccines come into existence, to explain that only pharmaceutical companies have the resources and expertise to make vaccines and that we shouldn’t vilify them for doing it. Waxman had asked me to defend myself and instead I had defended the process.
Then Waxman gave me a second chance. “I think that everyone here should agree that we want a safe vaccine,” he said, “or a vaccine that is as safe as possible. Merck did not hire you to come up with a particular position, did they? Did they tell you they wanted your research to have a certain outcome?”
I said, “This work was all…funded by the National Institutes of Health, which funded my basic research. I am an immunologist. That is my expertise.” Better, but still not very good. The better answer would have been, “I have never received money from Merck. And I wish the chairman would stop saying that I have. Frankly, if the chairman had any idea why the NIH- and CDC-funded researchers in this room do what they do, he would stand up right now and apologize.” (Don’t you wish life could work this way? That you could go back in time and give the kind of impassioned speech that only actors in scripts written by Aaron Sorkin ever manage to pull off?)
It seemed to me that all the work I had done on my speech had been a waste of time. After the hearing ended, when I was standing at the back of the committee room, one mother came up to me to confirm my disappointment, saying that she hadn’t realized that I was “such a jerk.” But then a few other parents came up and asked me to explain in more detail why I didn’t think that the MMR vaccine could cause autism. They had listened carefully to what I had said and asked good questions. I felt sorry for these parents. They had come to Dan Burton’s committee hearing to get answers, hoping to learn about the latest research on the cause or causes of autism and about what could be done to help their children. Instead, they had been subjected to seven hours of testimony that did nothing but serve the financial interests of hucksters offering a bazaar of alternative therapies and the biases of an ill-informed and frankly vindictive committee chair.