Greg Kaebnick, the editor of the Hastings Center Report (and, full disclosure, a former student of mine!) kindly invited me to offer some comments on my decision to publicly challenge Congresswoman and presidential candidate Michele Bachmann’s comments on the safety of the HPV vaccine. I am happy to do so. It lets me tell a story that might be of interest to the bioethics community and to offer a few comments about my own thinking about the public work in which some bioethicists engage.
Yesterday, Bachmann abandoned her claim that the vaccine was dangerous, saying she was only repeating a story she had been told. Of course, rumor-mongering is hardly a defense. Moreover, she has apparently decided to make an antivaccination stance a key part of her campaign to dislodge Texas Governor Rick Perry from his position as the GOP’s leading presidential candidate.
In running against vaccines, Bachmann is willing to dissemble and lie about vaccine safety to try and score political points. She is also apparently willing to sacrifice the lives of young women in the U.S. and around the world to cancer, as well as others who may die of whooping cough or flu to her political ambition by impugning the safety and efficacy of vaccines and vaccine mandates. This stance should not only disqualify her from selection as the GOP candidate for any national office, but it should also lead her Minnesota constituents to think about whether she belongs in Congress at all.
The HPV flap to date
On Tuesday, September 13, the day after the GOP presidential candidates debate, Bachmann claimed on various media outlets that the HPV vaccine was dangerous and could cause “mental retardation”. Bachman told Matt Lauer on the “Today” show that she had met a woman who said her daughter had “suffered mental retardation from the vaccine.” She went on to say that the HPV vaccine has "very dangerous consequences" and that it puts "little children's lives at risk."
The whole off-the-wall discussion during the debate about Perry’s push to promote the HPV vaccine through an executive order had me angry. Bachmann’s fear-mongering about vaccine safety to gain an edge on Perry pushed me over the edge. Within hours, I wrote an impassioned column trying to get the facts straight. I posted it on my Facebook page and tweeted it as well. The column got some attention, and I got a number of requests for radio and print interviews about it on Tuesday.
On Wednesday I happened to see a Facebook post by my friend and former colleague at the University of Minnesota, Steve Miles. He, too, was angry about Bachmann’s lies about vaccine safety and had posted this item: “I am offering $1,000 for the name and medical records release of the person who Michele Bachmann says became mentally retarded as a consequence of the HPV. Please share this message.”
The American Academy of Pediatrics also issued a strong statement, and a few commentators and fact-checking items in the newspapers noted that her remarks were not true. Still, I worried that the stench of fear was going to linger around vaccines yet again, and I decided I should take on Bachmann’s untruths, too. I did not want Bachmann to give more fuel to anti-vaccinators or to risk the lives of children whose parents might not get them vaccinated because of fears she was continuing to stoke.
Although I thought Steve’s $1,000 wager would get some attention, I thought we needed to up the ante. We needed a gimmick to debunk the Bachmann blarney. So I tweeted and e-mailed my own challenge: If Bachmann could produce a person within a week who had been made “retarded” by the HPV vaccine, and if that claim could be verified by three doctors that she and I agreed upon, then I would give $10,000 of my own money to a charity of her choice. If not, she would give $10,000 dollars to a charity of my choosing.
I repeated the challenge on the radio interviews I had that Thursday morning and said the clock had started ticking. Pretty soon, my phone was ringing and e-mails were coming in from journalists. Steve let me know he did not agree with the terms of my challenge but that he was on board with me and would add his $1,000 dollars to it. So there was an $11,000 throwdown.
During interviews that Thursday, I pointed out again and again that there was no evidence at all that the HPV vaccine caused “retardation,” that the CDC/VAERS Web site had never received any such report, that there had been no report I knew of in any other country in the world of any such side-effect despite more than 35 million doses administered, and that it was reprehensible that the same sort of fear-mongering that was causing infants to die of pertussis, flu, rotavirus, measles, and polio around the world was being offered up about HPV vaccine by a serious contender for the presidency of the United States.
I then received a request for an interview on “Anderson Cooper 360” on CNN about my challenge. The power of TV in American culture is still impressive. After the Anderson Cooper interview, the issue of Bachmann’s vaccine fear-mongering became national news, splashed all over the print, radio, and Internet. Bachmann was being held accountable, and lying about vaccine safety was costing her. By Saturday she had dropped in the polls.
Her campaign has not responded to Steve or me. An NPR reporter told me that her press person said she would not respond because she had not received “a letter” from me challenging her views about the HPV vaccine. That response is absurd on its face.
On taking a public stand
Part of the reason I was angry about Bachmann’s comments is that I have been working on vaccine ethics long enough to be acutely aware of the harm caused by vaccine misinformation. In 2004, I had been asked by a Pennsylvania official for help in determining how best to allocate the then-scarce supply of flu vaccine. I told him I did not know anything about vaccines, but that I was sure some bioethicists were working in this area. It turned out that I could not find any to recommend.
I began wondering why that was, since vaccines are the single most effective medical intervention ever mounted against disease, with at least one major scourge of humanity, smallpox, eliminated due to vaccines and another, polio (which I had as a child), close to eradication. Long story short, I ended up launching a project at Penn on vaccine ethics and a related project, which I run with the able help of Jason Schwartz. I signed up for a course on how to make vaccines; sat in on lectures on vaccine issues; and met Paul Offit, of our Children’s Hospital and department of pediatrics, who had been waging a one-man war against anti-vaccination propaganda for years. I got deeply involved in the subject and wound up publishing quite a bit on vaccines in general and on HPV vaccine in particular.
Having been involved in a highly visible way in other situations where politicians, zealots, or advocates have tried to advance misinformation in the name of a political or medical goal – including the Terri Schiavo case, the battle over federal funding of embryonic stem cell research, the claim that a Belgian man had “woken up from a 23-year coma” to use facilitated communication to reveal the horror of his experience, and crackpot offers of cures with untested adult stem cell therapies, among others – I knew a few things about the importance of speaking up, the need to have scholarship in place to back up one’s comments, and the price that often has to be paid for doing so.
The need to speak from an ethical perspective in public forums and outlets about inaccurate, misleading, or outright false claims about bioethical issues should be self-evident. While it is important to publish one’s views in the peer-reviewed literature and to share them in the seminar room, it is equally important for those who have the skills and the facility to communicate with broader audiences to do so. Like economics, political science, climate science, agriculture, and engineering, bioethics is not a purely theoretical field. To do what nearly all of those in the field claim it seeks to do – advance patient interests, enhance the prospect for justice for the least well-off, correct abuses of patient and subject rights – some in the field must engage in policy and public dialogue. At the same time, of course, if one is going to speak up, then it is important either to have published on the matter or to have mastered the relevant subject area at least to the point where one is comfortable teaching and lecturing about it.
The danger in advancing civic debate and public understanding is that your own peers will not know your scholarly work on a topic and will see any highly visible public activity as self-promotional pandering – or at best as popularizing, although that is little better on the academic scale of value. The duty to get involved surely overwhelms the price.
It is also true that entering the public arena means interaction with the media. Time and again, I have seen my comments distorted, misstated, or simply misused, even by highly respected journalists. It has already happened in the HPV vaccine story. The Internet only makes matters worse, given its immense power of repetition.
I think my decision to call out Michelle Bachmann on her comments about vaccine safety and vaccine mandates with my $10,000 challenge was the right one. I believe it is having the effect I intended. The lack of evidence behind nearly all of the claims of vaccine dangers and risks remains in the news. There may even be a better understanding of what is involved in creating different types of vaccine mandates. And women and men in America may be more willing to get their children vaccinated against a disease that kills and maims thousands and to support efforts to get the HPV vaccine to poor women worldwide to prevent many of the hundreds of thousands of deaths that occur every year from cervical cancer.
If vaccination is going to be a key part of the winnowing process of those who want to be president, then the framing of that debate has been reset in a much more positive mode.
Arthur Caplan is the Emanuel & Robert Hart Director of the Center for Bioethics and Sidney D. Caplan Professor of Medical Ethics at the University of Pennsylvania, and a Hastings Center Fellow. Follow him on Twitter @ArthurCaplan.
Caplan’s references and writings on vaccines:
Boom and bust-have we learned what we need to from the flu vaccine shortage?” Johns Hopkins Advanced Studies in Medicine, 2005: 522-3.
“Off the grid: Vaccinations among home-schooled children,” The Journal of Law, Medicine & Ethics, 35, 3, 2007: 471-77. (with D Khalili).
“Lessons from the failure of human papillomavirus vaccine state requirements”, Clinical Pharmacology and Therapeutics, 82, December, 2007: 760-3, (with JL Schwartz, RR Faden and J Sugarman).
“Leveraging Genetic Resources or Moral Blackmail? – Indonesia and Avian Flu Virus Sample Sharing,” American Journal of Bioethics, 7, 11, 2007: 1-2 (with DR Curry).
“Ethics” in: S. Plotkin, W. Orenstein and P. Offit, eds., Vaccines, 5th ed., 2008: 1677-1684 (with JL Schwartz).
“Genital warts: mountains or molehills?” The Lancet Infectious Diseases, 8, 5, 2008; 277-8 (with SC Hull).
“A proposed ethical framework for vaccine mandates: Competing values and the case of HPV”, Kennedy Institute of Ethics Journal, 18,2, 2008: 111-124. (with RI Field).
“Is Disease eradication unethical?” The Lancet, 373, 2009: 2192-3.
“Disease eradication – a response,” The Lancet, 374, 2009: 1144 (letter).
“The case for vaccinating boys against HPV,” Public Health Genomics, 12, 2009:362-7 (with S Hull).
“Unlicensed Pandemic a (H1N1) Vaccines: Explicit ethical rules of the road are needed in public health emergencies,” The Lancet, 2009: 375, 2010 444-45.
“Physician attitudes toward influenza immunization and vaccine mandates,” Vaccine, 28, 2010: 2517-22 (with J Desante and A Behrman, F Shofer).
“Influenza vaccination of healthcare personnel,” Infection Control and Hospital Epidemiology, 31, 2010: 987-995 (with TR Talbot, H. Babcock, D Cotton, LL Maragakis, GA Poland, DJ Weber).
“Clinical trials of drugs and vaccines in poor nations -- ethical challenges and ethical solutions,” Clinical Pharmacology and Therapeutics, 88, 5, 2010: 583-4.
“Health care worker support of an influenza vaccine mandate at a large pediatric tertiary care hospital” Vaccine, 29, 9, 2011: 1762-9 (with K Feemster, S Coffin, P Offit, C Feudtner and M. Smith).
“Vaccination: facts alone do not policy make,” Health Affairs, 30, June 2011: 1205-8.
“Ethics of vaccination programs,” Current Opinion in Virology, 1, 2011: 1-5. (with Jason Schwartz).
“Time to mandate influenza vaccination in healthcare workers,” The Lancet, 378, 2011: 310-311.
“Vaccination refusal: ethics, individual rights and the common good,” Primary Care Clinics Office Practice, 2011, in press. (with Jason L Schwartz)