Never dare to sell your soul for money, because no amount of wealth will buy you an air conditioner in hell.
—EDMOND MBIAKA
One strategy used by anti-science activists to discredit scientists is to claim that scientists are in it for the money—that they are simply parroting the message of a for-profit industry.
In 2013, while standing on the steps of the Capitol Building, Robert F. Kennedy Jr. said that I “should be put in jail, and the key should be thrown away.” Then he called me a “biostitute.” (I’m not exactly sure what that means, but it didn’t sound good.) Jim Carrey, in an article written for the Huffington Post, called me a “profiteer.” Jenny McCarthy tweeted, “Lemon girl scout cookies recalled, so says tweets. Can’t we recall bad people? Like Paul Offit?” To which Chelsea Handler responded, “Who the fuck is Paul Offit?” (My children loved this. They couldn’t believe that Jim Carrey, Jenny McCarthy, and Chelsea Handler had taken time out of their busy, celebrity-filled lives to vilify me. It was one of those rare moments when your children look at you with genuine pride.)
Indeed, not a week goes by when I don’t receive at least one mean-spirited personal attack that includes the phrase “Pharma shill” or “Pharma whore.” For example: “You are the spawn of Satan. I don’t care about your cars, your money, or anything else. But I’ll be damned if you think you can take away my rights so you can buy the world.”
To explain what I have done, why I have done it, and why I persist in trying to educate the public about science, I’ll start at the beginning.
I was born at Sinai Hospital in Baltimore, Maryland. My father manufactured men’s shirts, and my mother taught adult education in the Baltimore City school system. Despite claims to the contrary, nothing about my birth suggests that I was the spawn of Satan. When my mother first held me, she didn’t scream, “What have you done to it!? What have you done to its eyes!?” (Sorry. Everything I know about spawns of Satan comes from the movie Rosemary’s Baby.) My father didn’t turn away, knowing that he wasn’t my real father, knowing that he had made a deal with the devil. And no one in the delivery room shouted, “Satan is his father! He came up from Hell and begat a child of mortal woman. He shall redeem the despised and wreak vengeance in the name of the burned and the tortured.” At least not as far as my mother can remember. When I had my DNA checked by Family Tree DNA, I found that my background is mostly eastern European, as is that of my parents and their parents and their parents. Plus, I look like my father. All of which leads me to conclude that I’m not the spawn of Satan, Prince of the Underworld. I’m the spawn of Shirley and Morton Offit, a middle-class couple from suburban Baltimore. They also spawned my brother and sister.
••••
WHEN I WAS FIVE YEARS OLD, TWO EVENTS SHAPED MY LIFE.
While playing on a slide one day when I was in kindergarten, I fell about twelve feet, landing face down. I lay at the base of the slide for about thirty minutes, not moving. Eventually, one of the other children went inside to find a teacher. When I was more easily aroused, the teacher put me on a school bus and sent me home. That afternoon I complained of pain in the upper left side of my abdomen. So my mother took me to the pediatrician’s office. Unfortunately, my regular pediatrician, Dr. Milton Markowitz, was out of town. One of his partners examined me, but couldn’t find anything wrong.
One day passed.
The following evening, Dr. Markowitz returned. After sifting through his partner’s notes, he called my mother to see how I was doing. She said that I was still complaining of pain. So he drove to our house, examined me, and explained that I had ruptured my spleen and required immediate surgery. My father called my grandfather, who came to the house and asked Dr. Markowitz if he wouldn’t mind getting a second opinion. Dr. Markowitz said that there wasn’t time and that he would drive me to the hospital himself. I sat in the back seat next to my grandfather. (I remember being excited that I got to ride in a car at night in my Baltimore Colts pajamas.) The surgeon found a ruptured spleen, a quart of blood in my abdomen, and impending shock. Dr. Markowitz had saved my life. Had he not come back to the office that night, reviewed his partner’s notes, called my mother, driven to our house, insisted on surgery, and resisted my grandfather’s request for a second opinion (which would not have happened that night), I would in all likelihood have died in my sleep.
I idolized Dr. Markowitz; I wanted to be just like him. When he came to our house, he always took time to show me all of the marvelous tubes, devices, syringes, and medicines in his big black bag. After tapping on my chest, he tapped on the wall above my bed to demonstrate how the sound changed from hollow to dull, indicating the presence of a stud. This, he explained, was the principle he used to see if I had pneumonia. My mother often took my sister, brother, and me to Dr. Markowitz’s house to get our vaccines, which he pulled out of his refrigerator. Vaccines were a family affair: our family and Dr. Markowitz’s family.
I will always remember Milton Markowitz as the kind, generous, thoughtful hero who had saved my life. This was my image of a pediatrician, which no doubt played a role in my choosing pediatrics as a specialty. Dr. Markowitz eventually left private practice to pursue a career in academic medicine, rising through the ranks to become chair of the department of pediatrics at the University of Connecticut School of Medicine. In 2005, he passed away at the age of eighty-seven years. A few years later, I was asked to deliver the annual Milton Markowitz Lecture in Farmington, Connecticut. With his photo on a large screen behind me, I began by telling the story of my ruptured spleen. Although I knew some of the pediatricians in the audience, none was aware that I had actually known Milton Markowitz or that he had saved my life.
The second influential event occurred as a consequence of being born with clubfeet, meaning that my feet turned awkwardly down and inward. When I was one day old, both feet were placed in casts. The left foot healed; the right foot didn’t. When I was five years old, an orthopedist operated on my right foot in an attempt to straighten it. The operation should never have been performed. At the time, foot surgery was the stepchild of orthopedics. Surgeons were reluctant to operate on feet, often referring patients to podiatrists. (Clubfoot surgery would not be perfected until the late 1990s.) Nonetheless, my parents were able to find a young surgeon willing to do it. The surgery didn’t go well, and I have walked with pain and a slight limp ever since.
I recovered from my clubfoot repair at Baltimore’s Kernan Orthopaedics and Rehabilitation Hospital in a ward with twenty other children, all of whom had polio. Children’s hospitals today feature iPads, play therapists, in-hospital television stations, and friendly therapy animals, like dogs. They also feature pullout beds so parents can sleep in their children’s room. But this was 1956. No play therapists. No entertainment. No beds for parents to stay with their children. Only the fear that people might catch polio from visiting a polio ward. For that reason, access to the ward was severely restricted. My parents were allowed to visit me on Sundays from 2:00 p.m. to 3:00 p.m. only. My mother, who had experienced a medical complication from her pregnancy with my brother, never visited me. I don’t remember any of the nurses befriending me. I don’t remember talking to the other children. All I remember is staring out of the window next to my bed, which overlooked the front door of the hospital. I was waiting for my parents to come and rescue me. For weeks I looked out that window, hoping for something that never happened.
When I was a medical student at the University of Maryland School of Medicine in the 1970s, we rotated through Kernan’s Hospital. During the rotation, I walked into the polio ward in which I had stayed as a child. It had been converted into an office. Secretaries and administrators looked up, wondering what I was doing there. The room had changed: different color, different moldings. But that window was still there. And the view from the window was the same. It was overwhelming. I’ll come back to this later.
The passions created by my childhood experiences drove me into pediatrics and later into infectious diseases. The person who shaped my academic career was Dr. Stanley Plotkin.
In 1980, I began a three-year training program in pediatric infectious diseases at the Children’s Hospital of Philadelphia. When I first met Dr. Plotkin, he was reading a journal published by the CDC called Morbidity and Mortality Weekly Report. He wanted to know the current incidence of a disease called congenital rubella syndrome.
Rubella, or German measles, was a mild infection of children, causing fever, rash, and swelling of the lymph nodes behind the ear. But when the rubella virus infected women early in their pregnancies, it could cause severe permanent birth defects of the ears, eyes, and heart. Indeed, in the early 1960s, one of every hundred pregnancies in Philadelphia was complicated by congenital rubella syndrome. It was that common. (Of interest, natural rubella virus infection during the first trimester of pregnancy is a known cause of autism. Which means that the MMR vaccine prevents one cause of autism.)
In 1979, the year before I first met him, Dr. Plotkin had invented the rubella vaccine. He was reading Morbidity and Mortality Weekly Report to see how his vaccine was doing. I had just finished a three-year residency program in pediatrics at the Children’s Hospital of Pittsburgh, taking care of a few children at a time. While I had been doing that, Dr. Plotkin had been taking care of entire populations of children, both in the United States and other countries. Such was the power of vaccines. Indeed, by 2005, the rubella virus, which had caused as many as twenty thousand cases of birth defects and five thousand spontaneous abortions every year, was eliminated from the United States.
During the first year of my training, Dr. Plotkin introduced me to Dr. Fred Clark. Fred had just started a program to study rotaviruses. Fred and Stan asked me if I would be interested in working on this virus the following year. Before deciding, I met with Dr. Clark in his laboratory, which was lined with dead snakes in jars. Fred was a veterinarian who had studied snake viruses. A tall, lanky man with an ironic sense of humor, Fred explained what he hoped to accomplish, spending much of the meeting talking about the impact of rotavirus on children in the developing world and about his frequent visits to Haiti. Hanging on the wall above Fred’s desk was a picture of Dag Hammarskjöld. When he saw me looking at it, Fred explained how much he admired this great statesman, a former Secretary-General to the United Nations, and one of only two people to have won the Nobel Prize posthumously. It was an interesting experience. Between the snakes, Dag Hammarskjöld, and Fred’s commitment to children in the developing world, I was convinced. I signed on to the rotavirus program the next day.
In 1981, when I first I started working in Fred’s laboratory, little was known about rotavirus, which had been found to cause human disease only eight years earlier. Veterinarians, on the other hand, were way ahead of the game; they had known rotavirus to be a cause of disease in animals since the 1940s. For this reason, most of the researchers in the field were veterinarians studying large animals, like pigs, sheep, and cows—all with an interest in increasing food production. Rotavirus, as it turns out, infects the young of many mammalian species. But species barriers are high; for example, cow rotavirus causes diarrhea in calves but not human infants; and human rotavirus causes diarrhea in human infants but not calves. My job was to figure out which parts of the virus made children sick and which parts evoked protective immunity. The ultimate goal was to retain the parts of the virus that elicited immunity and remove the parts that caused disease. (Which is how all vaccines are made.)
Rotavirus is fairly easy to study because its genome, the blueprint that instructs the virus how to reproduce, is segmented, which makes it easy to rearrange the genes. For example, if you take two different strains of rotavirus and infect the same cells at the same time, some genes will come from strain A, and some will come from strain B. If strain A causes diarrhea and strain B doesn’t, then you can figure out which genes are the diarrhea-causing genes. Similarly, if strain A evokes antibodies that neutralize strain A but not strain B, you can figure out which genes induce protective immunity. Obviously, you can’t do these studies in children. You can do them only in experimental animals. When I first started working on rotavirus, the only animal models available were large, like pigs and cows. The problem with large animals, in addition to the fact that they’re expensive and that we had nowhere to put them, is that they’re outbred, meaning that they vary widely in their genetic makeup. This makes it harder to study certain aspects of the immune response. The best experimental animals in which to do our studies were inbred, genetically defined mice. But, at least until this point, no one had been able to induce diarrhea in mice with strains of rotavirus that could easily be grown in the laboratory.
At the end of my first year of research, Fred, Stan, and I found a strain of rotavirus that could grow in the laboratory and caused diarrhea in baby mice. I remember the day. After gently palpating the mouse’s abdomen, a thin stream of liquid diarrhea emerged. This was great. Now we had a small-animal model to answer the questions we needed to answer. At least theoretically, we should have been able to create strains of rotavirus that didn’t cause diarrhea but did evoke protective antibodies. First, we had to find an animal strain that didn’t cause diarrhea in infants. To do this, we drove to the large-animal facility at the University of Pennsylvania School of Veterinary Medicine in Kennett Square, Pennsylvania, to collect diarrhea from calves that were sick with rotavirus. Then we collected diarrhea from infants infected with rotavirus. For the next ten years, we made combination viruses between these cow and human strains and, after studying what amounted to thousands and thousands of mice, created five combination viruses that we thought could be a vaccine for children. (It’s depressing to me that I can actually summarize ten years of work in one paragraph.)
During the years we did these studies, our mice were housed in the Wistar Institute, located on the campus of the University of Pennsylvania in Philadelphia. On weekends, when my wife worked, I brought the kids with me. One day, while I was working with the mice, Will, who was about three years old, was petting a baby mouse in the corner. Baby mice are about the size of chickpeas. Just as I looked up, he was putting one into his mouth. Fortunately, I stopped him before he ate it. (This would have played out well at home. “Hi, honey. I’m home. Will had a great time with the mice today. I think he really loves them. Oh, by the way, he ate one.”)
Fred, Stan, and I were hopeful that what we had found in mice would also be true in children. But we also knew that this might not be the case. “Mice lie and monkeys exaggerate,” said the Wistar Institute vaccine researcher David Weiner. In 1988, we submitted a patent application for our vaccine to the Patent and Trademark Office in Crystal City, Virginia. Stan had explained that no pharmaceutical company would advance our vaccine unless the technology was protected.
I don’t want to create the impression that we were alone in doing these studies. Researchers at Baylor University, the Children’s Hospital of Cincinnati, the National Institutes of Health, Stanford University, and research laboratories in Australia, England, France, Germany, Italy, Portugal, and Spain had also been studying rotavirus and finding the same things we had found. Indeed, one of the many wonderful aspects of science was getting to spend time with these other researchers, all of whom were invariably excited to talk about their work and share their findings—an international brotherhood and sisterhood.
In 1988, Dr. Plotkin left the Children’s Hospital of Philadelphia, leaving Fred and me to take the next step on our own. We had to find a pharmaceutical company willing to see if what we thought was a rotavirus vaccine actually was a rotavirus vaccine. Merck was the most interested. For the next sixteen years, Merck scientists performed studies in adults, then older children, then younger children, and then infants, proving that all five strains of our cow–human rotaviruses needed to be in the vaccine (these were called proof-of-concept studies); that we had inoculated children with the right amount of each vaccine strain (dose-ranging studies); that the vaccine viruses didn’t break down (real-time stability studies); and that, by creating the right vial, the vaccine could easily be squirted into the mouths of babies. These studies, which cost a little more than $1 billion in total, ended with a four-year prospective, placebo-controlled trial that took place in eleven countries and studied more than seventy thousand children, and which cost about $350 million. This so-called Phase III study showed that the vaccine worked and was safe. Nonetheless, during the sixteen years that it took to do this research of development, we faced many “go–no go” decisions. Could the vaccine strains be mass-produced efficiently? Would the vaccine have a shelf life long enough to effectively immunize children in the United States and around the world? And on and on. The vaccine, and we, died a thousand deaths.
After the results of the Phase III trial had been tabulated, I was satisfied that what we had found in mice had been confirmed in children. The vaccine appeared to be safe and effective, at least as far as it had been tested. I was, however, nervous about the next step: giving the vaccine to tens of millions of children in the United States and other countries. For several reasons, these concerns were well founded. An earlier rotavirus vaccine, made by combining a simian rotavirus with human rotaviruses, had been used in the United States between 1998 and 1999. The vaccine, developed by researchers at the National Institutes of Health in collaboration with Wyeth, had been found to be a rare cause of intestinal blockage. Called intussusception, this blockage occurs when the small intestine telescopes into itself and gets stuck. One child died as a consequence. This problem was found only after the vaccine had been licensed and recommended for all infants. Also, while studies performed in tens of thousands of children pre-licensure can rule out uncommon side effects, they can’t rule out rare side effects. As Dr. Maurice Hilleman, the Merck researcher who developed nine of the fourteen vaccines currently given to infants and young children, famously said, “I never breathe a sigh of relief until the first three million doses are out there.”
The notion that we could have the same problem as the previous rotavirus vaccine was frightening. As our vaccine got closer to licensure, Fred and I became obsessed with the fact that we might be missing something. Was it possible that one of the rotavirus proteins in our vaccine mimicked other proteins in children, like ones that sit on the surface of pancreatic cells that make insulin? If that were the case, our vaccine could cause diabetes. Or, if rotavirus proteins mimicked proteins on the surface of cells that line joints, wouldn’t it be possible that our vaccine could cause arthritis? Fred and I scanned gene databases looking for any similarities between rotavirus proteins and human proteins. Although one would imagine that a seventy-thousand-person trial that showed that the vaccine was safe would bring relief, it didn’t. The previous rotavirus vaccine had been distributed for about ten months and given to a million children before scientists found the problem, which occurred in about one of every ten thousand children inoculated. Would ours be any different? “When the gods are angry, they grant your wish,” warns an ancient Chinese proverb. We had been granted our wish.
In February 2006, the Food and Drug Administration licensed our vaccine, called RotaTeq, for use in the United States. That same month, the CDC recommended that children receive the vaccine at two, four, and six months of age. Since licensure, the number of children in the United States hospitalized for dehydration caused by rotaviruses has declined dramatically. At the Children’s Hospital of Philadelphia, during the winter months, we would typically admit about four hundred children with dehydration caused by rotavirus. Now it is rare for us to admit any child to the hospital with rotavirus infection. Indeed, some young pediatricians have never seen a case of rotavirus, a disease that had previously affected about four million children in the United States every year. In 2013, the World Health Organization recommended that rotavirus vaccines be included in all childhood immunization programs. Now, in Africa, Asia, and Latin America, rotavirus vaccines are saving hundreds of lives a day.
RotaTeq is the professional accomplishment of which I am most proud. But I was lucky. I was in the right place at the right time. Stan Plotkin, the inventor of the rubella vaccine, the principal investigator on the clinical trials of the modern rabies vaccine, and the senior editor of the definitive textbook on vaccines, is the single most respected, most accomplished vaccine researcher in the world. I was fortunate to train with him. Fred Clark, with his background in veterinary medicine, was the perfect person to work on a vaccine that included both human and animal strains. Also, Fred had an uncanny sense of judgment. When things went wrong in the lab, he invariably found the problem. And Fred was enormously patient. I had had no laboratory experience before working with him. But he calmly taught me how to be successful. When I wrote my first paper, he patiently crossed out every sentence and rewrote it. (I’m not kidding. Every sentence.) As I got better at writing—which is to say when I finally learned to write like Fred—he would cross out fewer and fewer sentences. Stan wasn’t quite as patient. While reading my first paper, he started to cross out every sentence, eventually giving up and writing, “Read Strunk and White’s Elements of Style!”
I’ve received many accolades for my work on the rotavirus vaccine. I’ve been elected to the National Academy of Medicine, honored by Bill and Melinda Gates as part of their Living Proof Project, and elected to the American Academy of Arts and Sciences in the same class as the Nobel Prize winners Holland Cotter and Brian Kobilka, the astrophysicist Neil deGrasse Tyson, the novelist Tom Wolfe, the Tony Award winner Audra McDonald, the Nike cofounder Phil Knight, and the singer-songwriter Judy Collins. The point being, I’m overrated. I’m not saying that I didn’t work hard or that I didn’t do the doable. I’m just saying that anyone could have stepped into the situation with Stan Plotkin and Fred Clark and do what I did. So whenever I’m asked to receive these honors, I feel like they’re undeserved. At the very least, Stan and Fred should always be standing there next to me. And in a sense they always are. (Fred passed away in April 2012.)
••••
AFTER SPENDING TWENTY-SIX YEARS WORRYING ABOUT GETTING papers published and grants funded, worrying about whether what had worked in mice would also work in children, and worrying about what would happen after our vaccine had been given to tens of millions of infants, the project was over. What happened next was something that I hadn’t thought about, but which would become—at least in the minds of those who vilify me—my defining characteristic. I became financially secure. Although Fred, Stan, and I owned the patent on the rotavirus vaccine, the Children’s Hospital of Philadelphia (CHOP) and the Wistar Institute owned the rights to any intellectual property we created or developed. So, for all practical purposes, CHOP and Wistar owned the patents. Therefore, when CHOP sold out its rights in 2008, Stan, Fred, and I were subject to CHOP’s patent policy.
Because I am the inventor of a patented medical product, the notion that I have been unduly influenced by the pharmaceutical industry will no doubt follow me for the rest of my life. There is simply no getting around it. To anti-vaccine activists and certain members of the media, I will always be the poster child for conflict of interest—even though any compensation that I received for co-inventing a vaccine ended in 2008. According to them, I am being paid by pharmaceutical companies to say that vaccines don’t cause autism or a variety of other illnesses. I am the lowest form of human being: someone willing to sacrifice children for personal gain. There are, however, a few problems with this logic.
First, apart from the fact that I don’t have a financial tie to any pharmaceutical company, accusations of conflicts of interest would make a lot more sense if scientific studies didn’t consistently support my position. Seventeen studies have shown that the MMR vaccine doesn’t cause autism; seven studies have shown that thimerosal-containing vaccines don’t cause autism; and two studies have shown that the many vaccines given in infancy don’t cause autism. The reason that I say that vaccines don’t cause autism is that vaccines don’t cause autism. Further, many other studies have shown that vaccines don’t cause the wealth of other problems claimed by anti-vaccine activists. I wasn’t an author on any of those studies. I’m simply reporting what scientific studies have shown to be true. Although anti-vaccine activists argue that I am a Pharma shill in the same way that people shilled for the tobacco industry, there is one critical difference. Cigarette smoking does cause lung cancer. Vaccines, on the other hand, don’t cause the diseases claimed.
Second, the logic of my alleged nefarious alliance with the pharmaceutical industry is at best tortured. Let me see if I’ve got this right. I worked for twenty-six years to make a vaccine that helps children so that I could make money so that I could lie about vaccines and hurt children. Does that make sense? Sadly, at least to the hard-core anti-vaccine activists, it does.
Third, how should I have handled this differently? Assuming that preventing hundreds of thousands of deaths in children every year is a good thing, that only pharmaceutical companies have the resources and expertise to make a vaccine, and that the only way that companies will make a vaccine is if the technology is protected (meaning patented), then how should I have proceeded? Should I have just been satisfied with publishing papers about rotaviruses and getting grants and left it at that? And why should I disqualify myself from the public debate about vaccines just because I am the co-inventor of one? It seems to me, given that I have participated in shepherding a vaccine from early research into a medical product, have published almost two hundred papers in the field of viral immunology, have received a series of competitive grants from the National Institutes of Health, am the co-editor of the definitive textbook on vaccines, and have published five medical narratives about vaccines, I am a reasonable person to educate the public on the subject.
Finally, if I’m a shill for the pharmaceutical industry, I haven’t been very good at it. When I headed the CDC working group on polio vaccines, I pushed to eliminate the oral polio vaccine in the United States; as a consequence, the makers of that vaccine lost millions of dollars. Also, I was a lone voice against the use of the smallpox vaccine in the early 2000s, going on 60 Minutes and PBS NewsHour with Jim Lehrer to make my case. In 2016, I made a video for the website Medscape decrying the ineffectiveness of the nasal spray influenza vaccine FluMist, which at the time was also eliminated for use in the United States, costing the company tens of millions of dollars a year. The point being, I’m not a vaccine cheerleader. I’m a pro-science advocate, wherever the science falls.
Although I would argue that I have never had a real conflict of interest, the minute the media asks you if you have any connection to a pharmaceutical company, you’ve lost. Transparency has morphed into bias.
Ed Asner (who starred in The Mary Tyler Moore Show and Lou Grant) tells a story about John Wayne when they were filming the movie El Dorado. Wayne asked, “Where is that New York actor?” which Asner took as a mildly anti-Semitic comment. Then, in one scene, Asner throws a saddlebag at Wayne in such a way that he can only look awkward catching it. When members of the media ask me about my association with a pharmaceutical company, it’s like Ed Asner throwing that saddlebag at me. I can only look awkward answering. Almost anything I say will sound defensive. I’ve said, “Only pharmaceutical companies have the resources and expertise to make vaccines. What other choice did I have?” (Which sounds like I’m agreeing that vaccine makers are evil.) I’ve said, “Were we supposed to make tens of millions of doses of the vaccine in our lab?” (Which is too glib.) I’ve said, “I’m proud of our association with Merck. The scientists there were outstanding, and we made something that has clearly benefited children.” (Which, although true, sounds like a statement written for me by the company.) The point being, there is no winning.
The important thing for scientists who are asked this unanswerable question is to know that they have done the right thing for the right reasons. This, I’m afraid, will be your only solace.
Among the celebrities and politicians who have attacked me as a shill for the pharmaceutical industry, no one has been more persistent, more mean-spirited, or apparently better funded than Robert F. Kennedy Jr. I’ve never met RFK Jr., but I talked to him by phone in 2005.
Kennedy left a message on my voice mail. He wanted to talk about vaccines; specifically, he wanted to know more about thimerosal, the ethylmercury-containing preservative. Later, he sent me an email signed “Bobby.” This was completely cool. One of Robert F. Kennedy’s children had called me. His father, RFK, was a hero to me. I had read his book Thirteen Days, about the Cuban Missile Crisis and loved it. In fact, I often recited a statement that RFK had paraphrased from Dante: “The lowest reaches in hell are reserved for those who, in times of moral crisis, are ambivalent.” That quote was a call to arms. Stand up for what you believe in. I couldn’t wait to talk to Mr. Kennedy’s son on the phone. This was going to be great. (If you’re thinking that this is another I’m-an-idiot story, you’re right.)
I talked with RFK Jr. for a long time. He said that several parents had recently approached him worried about mercury in vaccines. He wanted to know whether their concerns were valid. He gave me plenty of time to answer his questions about mercury. He also wanted to discuss how vaccines work and how they’re made. I talked about my work on a rotavirus vaccine. And I talked about how much I had admired his father. He seemed amiable and accepting. After I hung up, I thought I had done a pretty good job.
In July 2005, Rolling Stone magazine published an article by Robert F. Kennedy Jr. It was titled “Deadly Immunity.” Kennedy had sandbagged me. He wasn’t interested in learning about thimerosal. He just wanted to paint me as yet another industry insider who didn’t care about children—someone who was trying to explain away thimerosal as harmless when Kennedy believed the opposite to be true. He wrote that I had defended thimerosal because, as the co-inventor of a rotavirus vaccine, I stood to make money off of it. The reason, he said, was obvious: The rotavirus vaccine was “laced with thimerosal.” (No rotavirus vaccine has ever contained thimerosal, including the one we developed at the Children’s Hospital of Philadelphia.) The article also stated that “by the age of six months, [babies] were being injected with levels of ethylmercury that were 187 times greater than the EPA’s [Environmental Protection Agency’s] limit for daily exposure to methylmercury.” (Children didn’t receive 187 times the EPA limit for methylmercury; they received 0.4 times the limit. Or, said another way, were well within the EPA limit.) The point of Kennedy’s article was that doctors and public health officials knew that thimerosal was harming children but had chosen to cover it up—all part of a massive conspiracy to hide the truth. Doctors like me didn’t care about children. All we cared about was our own pockets, children be damned.
After I read “Deadly Immunity,” I called an editor of Rolling Stone magazine. I wanted to know why he hadn’t fact-checked the article. But he just kept saying to me, “We stand by our story.” I couldn’t believe it. I asked him to just look at the package inserts of the various vaccines to learn about the quantities of thimerosal, to look at federal guidelines that showed that Kennedy was off on his calculations, and to look at the clinical trials of the rotavirus vaccine (which had been published in the New England Journal of Medicine) to see that the vaccine didn’t contain thimerosal, as Kennedy had claimed. I told him that no live weakened viral vaccines have ever contained thimerosal. But he just kept saying, “We stand by our story.” (I suspect that the Rolling Stone editor was trying to channel Ben Bradlee, the executive editor of the Washington Post who had said exactly the same thing in the movie All the President’s Men. Bradlee had been standing behind the stories of the Watergate cover-up written by Bob Woodward and Carl Bernstein. The difference between Ben Bradlee and the Rolling Stone editor was that there actually had been a cover-up of the Watergate break-in. The Rolling Stone editor, on the other hand, was defending something that was not only wrong, but could have been shown to be wrong in a matter of minutes.) I told the editor that these were facts that could easily be checked. I got angrier and angrier until he started to call me “Sir” (never good). Then he threatened to hang up.
Before Kennedy published “Deadly Immunity” in Rolling Stone, it was published on Salon.com. However, just days later, the editors at Salon realized the story was wildly inaccurate and amended it to correct several factual errors, which the editor-in-chief, Kerry Lauerman, said “went far to undermine Kennedy’s exposé.” Continued criticism of the story “further eroded any faith we [at Salon] had in the story’s value,” however, and the piece was removed from the Salon website with an apology to readers.
Robert F. Kennedy Jr. isn’t alone in using ad hominem attacks to lessen the credibility of those who have stood up for science.
Although several members of the media have been willing to paint pro-science activists as shills for industry, one instance that stands out is Sharyl Attkisson’s vilification of me, the American Academy of Pediatrics, and the wonderful vaccine advocacy group, Every Child By Two. Attkisson’s segment, “How Independent Are Vaccine Makers?,” aired on CBS Evening News on July 25, 2008. The show began with a teaser: “For years, some parents and scientists have raised concerns about vaccine safety, including a possible link to autism and ADD [attention deficit disorder]. Many independent experts sided with government officials and other scientists who say there’s no possible connection. But how ‘independent’ are they? CBS News investigative correspondent Sharyl Attkisson shares what she found.”
Attkisson told her viewers that both Every Child By Two and the American Academy of Pediatrics had received funds from pharmaceutical companies. Regarding my illicit behaviors, she said, “Then there’s Paul Offit, perhaps the most widely quoted defender of vaccine safety. He’s gone so far as to say babies can tolerate ten thousand vaccines at once.” (Lord, I wish I’d never said that.) “Offit was not willing to be interviewed on this subject, but like others in the CBS News investigation, he has strong industry ties. In fact, he’s a vaccine industry insider. Offit holds a $1.5 million research chair at Children’s Hospital, funded by Merck. He holds the patent on an anti-diarrhea vaccine he developed with Merck, RotaTeq, which has prevented thousands of hospitalizations. And future royalties for the vaccine were just sold…. Dr. Offit’s share of vaccine profits? Unknown.” (For the record, the inventors’ share of my hospital’s royalties is publicly available.)
Attkisson then implied that I was unwilling to admit my shameful association. “This is how Offit described himself in a previous interview,” she said, with a figurative raised eyebrow. “I’m the chief of infectious diseases at Children’s Hospital of Philadelphia and a professor of pediatrics at Penn’s medical school,” I said.
Neither the American Academy of Pediatrics nor Every Child By Two has ever hidden the fact that they have received unrestricted grants from pharmaceutical companies to educate the public about vaccines. The goals of both groups are clear. The better educated the public is about vaccines, the more likely they will be to vaccinate their children, and the more likely it is that those children won’t suffer diseases that could hurt or kill them. Attkisson never showed how these unrestricted educational grants had caused either the American Academy of Pediatrics or Every Child By Two to say something that wasn’t true. Further, I have never denied the fact that a pharmaceutical company made our vaccine or that I was awarded an endowed chair given by Merck to the Perelman School of Medicine at the University of Pennsylvania in the name of the vaccine researcher Maurice Hilleman. Not surprisingly, I’m proud of this.
Regarding her takedown of me, Attkisson made two mistakes: one out of ignorance, the other that I believe bordered on journalistic malpractice. Endowed chairs are analogous to unrestricted educational grants. As the recipient of the Hilleman endowment, I don’t have to report to Merck about how the money is spent. I have to report only to the Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine. Indeed, I don’t have to spend the money on anything related to vaccines. Endowments, which abound in academic medicine, allow for academic freedom. For example, academics working at the Mattel Children’s Hospital in Los Angeles aren’t expected to defend plasticizers in children’s toys any more than those who work at the Icahn School of Medicine in New York City are expected to support hostile takeovers or those who work at the David Geffen School of Medicine at UCLA are expected to promote movies like Beetlejuice or Little Shop of Horrors.
The aspect of Attkisson’s story that I felt had crossed the line from bad reporting to misrepresentation was the quote she had used from me. As she stated correctly in her report, I had refused to be interviewed, as had representatives from the American Academy of Pediatrics and Every Child By Two. We knew that this was going to be a hit piece. The way the segment was framed, Attkisson makes it sound that by simply stating my name and where I worked, I was denying any association with a pharmaceutical company. But I was never asked to respond on camera to what Attkisson had claimed were my illicit associations. The clip of me was taken months earlier. During that particular interview, the producer asked me to state my name and where I worked. So I stated my name and where I worked. Years later, when people from CBS Evening News came to my office to interview me about a measles outbreak, I told the producer what had happened during the Attkisson piece. She apologized and said that those were darker days. Attkisson currently hosts a public affairs program called Full Measure with Sharyl Attkisson, which is operated by the conservative Sinclair Broadcast Group.
I never told my parents about Attkisson’s CBS News segment before it aired, hoping that they wouldn’t see it. But they did. My mother called me later that night. She was thrilled. “I thought you looked good,” she said. My mother has a very low bar for what is considered a successful television appearance.
Because Sharyl Attkisson was a known anti-vaccine journalist, I was prepared for her. The television interview that I wasn’t prepared for was with Matt Lauer on Dateline NBC. Lauer has a disarming, friendly manner; he doesn’t appear to be someone with an agenda or someone who is going to ambush his guest. So when I agreed to appear on Dateline NBC to talk about the MMR–autism controversy, I thought we would be talking about the studies that had exonerated the vaccine. But I was wrong. Lauer wanted to talk about me.
“You have been called some horrible things,” said Lauer. “They have called you a baby killer. They’ve said you have blood on your hands.”
“It’s been pretty brutal,” I said. “But…I think that if they knew me, they wouldn’t feel that way.”
“You have had threats made against you,” said Lauer, “legitimate threats.”
“That’s right,” I said, alluding to an episode in which a telephone caller indirectly threatened my children by revealing that he knew where they went to school. “That was the one time I considered stopping all of this.”
Lauer pressed on: “Some of the people who believe Dr. Wakefield look at you, and they say, ‘Wait a second…here’s a guy who created a vaccine, so of course he’s not going to say anything that would call into question other vaccines; it’s just against his DNA.’”
“I worked for twenty-five years to create a vaccine that has the capacity to save two thousand lives a day,” I said. “What motivated me to do that and the reward from doing that was of course not financial. My interest [now] is trying to represent the science of vaccine safety so that parents can understand it so that they won’t make bad decisions that put their children at risk.”
Matt Lauer wanted me to admit that, at the very least, given that I was the co-inventor of a vaccine—and that I had been compensated for that invention—I could understand how people could hate me. But the truth is that I don’t understand it. I don’t understand how anyone can believe that there is a conspiracy to hurt their children with vaccines and that people like me are part of it.
Given the level of anger that I seem to evoke, friends and coworkers have asked me why I persist in trying to educate the public about vaccines. Why do I continue to subject myself to so much anger? I give two answers, both of which are accurate but incomplete. I say that I do it because every year children suffer and die from vaccine-preventable diseases, invariably because their parents had chosen not to vaccinate them. (That’s the moral-high-ground answer.) Or I say that I can’t abide professional anti-vaccine groups, like Generation Rescue, Moms Against Mercury, the National Vaccine Information Center, and SafeMinds, because they are often lawyer-backed and politically connected. That I see them as evil—a sort of cottage industry to hurt children—and that they shouldn’t be allowed to get away with it. (That’s the moral-low-ground answer.)
But I think the real answer lies somewhere else. And it’s far more selfish. Sometimes when I give talks, I find myself fighting back tears when I tell stories of children suffering from preventable diseases or from a parent’s misplaced reliance on alternative remedies or from faith healers who refuse children medical care. Indeed, all the books I’ve written are about child advocacy. Where is all of this emotion coming from? I think that it might have something to do with seeing myself in all of these children—seeing in every story a little boy staring out of that hospital window. A little boy who was vulnerable and helpless and alone.
But what do I know? I’m not a psychiatrist. Maybe I just hate to see the bad guys win.