Why the Internet may be hurting science (and people)

Is having the world’s knowledge at our beck and call eroding confidence in medical research and its practitioners?

Recently, I was doing some reading on the whooping cough epidemic that is cutting through large swaths of the population back in my home state of California. The heartfelt anger that pervaded me as I scrolled through some of the figures on the CDC website prompted me to pose a question that might, at first, seem like a hugely unpopular thought to entertain in this day and age of Facebook-savvy science enthusiasts and tweeting Mars rovers.

Is the Internet hurting science, more specifically medical research, as currently practiced?

In 2014, California has had the worst pertussis epidemic of the last 60 years

First off, I’d like to start with some numbers: California is currently going through one of the largest epidemics of pertussis in recent history. Pertussis, also known with the common name whooping cough, is caused by a bacterial infection of the airways, which can lead to death in at-risk populations. Since the 90's, reported cases of pertussis nationwide have increased cyclically every 3 years, spiking in 2012 with the largest number of reported cases of the last 60 years.

In 1922, before Fleming accidentally discovered penicillin, there were 107'473 reported cases of pertussis in the United States. There were 48'277 in 2012 (slightly less in 2013; the numbers are still being crunched, but there seems to have been a 30% increase this year). While this suggests an overall decrease in the burden of disease from the pre-antibiotic era to today, which is definitely good news, from 1965 to 2002 there have been consistently less than 10'000 pertussis cases per year, the lowest point being 1976 with 1'010 cases. For the mathematically challenged, that means that for 37 long years from 1965 to 2002, there were four times less pertussis cases per year as reported two years ago.

This has led epidemiologists who make a living by looking at numbers like these to marvel why in the heck, since 2002, we have started to see rising numbers in reported cases of whooping cough all over the United States. Of course, demographics in the U.S. have been changing steadily for a while. Noticeably, there’s a lot more people now. Even after adjusting for population growth, however, there were about 3.4 cases per 100'000 persons in 1965, compared to 16 in 2012. In other words: if, like at least some of the parents of today’s twenty-somethings, you were conceived in 1965, the year the Beatles toured across the U.S. for the second time, you would have been about 5 times less likely to get whooping cough in your first year of life than if you were conceived in 2011.

Incidence of pertussis in the United States in different age groups, as cases per 100'000 persons.

The burden of this increased disease incidence, which comes with a low but concrete percent mortality, falls on infants less than one year of age. What could have possibly caused this upward trend in the last decade? Many suspect the elephant in the room: the anti-vaxx movement.

After anti-vaxx claims linking live virus in the MMR vaccine and thiomerosal in other childhood vaccines to autism have been thoroughly dismissed as scientifically invalid, and the investigation into the motives of Andrew Wakefield, main author of the 1998 paper linking the MMR vaccines with gastrointestinal disturbances and possibly autism, resulted in Wakefield being struck off the United Kingdom medical register (see this article by Steven Novella for a detailed account of the investigations), it is indeed surprising that some parents out there would still prefer to take heed of anti-vaxx scaremongers than their family doctors.

Maybe it is not a coincidence that the polio vaccine pioneered by Salk had just been licensed in the US at the beginning of the 37 year-long period of very low whooping cough incidence I mentioned above. Polio was en route to elimination thanks to the March of Dimes initiative established by Roosevelt, and the national trust placed in vaccines was absolute.

The Tdap vaccine for pertussis, tetanus, and diphteria (and the version for babies and little children, called DTaP) requires several administrations in the preteen and teen years. Such a complex immunization routine, and the fact that the protective effect of the acellular formulation of the vaccine in use today may wear off more quickly compared to previous versions, may be partially to blame for lack of adherence and loss of herd immunity.

That said, however, are worried parents taking to the Internet to voice their concerns regarding vaccine efficacy? Are unqualified claims regarding vaccines and immunizations causing a backlash against this important medical practice? All of a sudden, it seems like everyone you meet online talking about vaccines is an immunologist of sorts, backed by Wikipedia entries (in the best of cases), or questionable pseudoscience-peddling websites (in the worst of cases). When adults choose to not vaccinate themselves or their older children, and act as carriers of the whooping cough bacterium Bordetella pertussis, those with the weakest immunity, i.e. infants, pay the price. For a confluence of reasons, Latino babies in California have been hit especially hard.

The Internet may be acting as a resonance chamber for some of the more vocal anti-vaxx proponents, and the poor science behind their claims. That is why we, as scientists, should refrain from making broad claims when engaging with a public that is not fluent in science-speak, whether it is via traditional outlets or online social media. They deserve better.

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