For the book reviewer, just as for the author, the first thing you look for is some irony that you can tease for a telling meta-metaphor. It doesn’t take long for the reviewer to find one in Autism’s False Prophets. The author, Paul Offit, in describing the path that took him to medicine, credits the heroic physician he saw as a child. Dr. Milton Markowitz saved young Paul’s life after Paul fell, tore his spleen in half and bled nearly to death.
The irony is that Offit nearly died because of the boneheaded medical malpractice performed by the first doctor who saw him. To thousands of parents who have grown deeply suspicious of their children’s pediatricians, it doesn’t take much to sympathize with the situation: The first doctor sucked, so you go find a second one who doesn’t suck. If enough people do that, we get two parallel fields who don’t really have much to do with each other and whose highly educated opinions don’t resemble each other. The value of the expert becomes nil.
Like it or not, we can see signs of that system developing, and perhaps no modern doctor is more closely aligned with one side than Offit.
He’s the chief of infectious diseases at the Children’s Hospital of Philadelphia, and more famously the inventor of a vaccine for rotavirus. He is known as a quote machine in defense of vaccines. (Indeed, the first time I called the American Academy of Pediatrics, for a question about vaccine safety, they sent me to Offit.)
And, in a subset of the autism community, he is hated. Here’s how he opens his prologue:
“I get a lot of hate mail. Every week people send letters and e-mails calling me ’stupid,’ ‘callous,’ an ‘SOB,’ or a ‘prostitute.’” He later reveals even more serious correspondence: He’s gotten at least one death threat that was deemed credible, and had armed guards for years.
Offit’s Chapter One is called “The Tinderbox,” and it lays out the landscape that he says makes autism such fertile ground for unproven medicine. He writes of the pessimism in early autism research, and of the despicable optimism of early “cures” from Bruno “refrigerator moms” Bettelheim. He writes of parents facing “unimaginable financial and emotional stress,” “frustrated beyond reason and sanity.” And he writes of two recent treatments — facilitated communication and secretin — that were later revealed to have depended on flawed research.
(Both are still in use; many parents and some doctors believe that the research that discredited them was in fact flawed. And, for many of these treatments, it can be argued that just because they don’t work in labs for some children on the spectrum doesn’t mean they can’t work for others; autism is, after all, many different disorders that may have many different treatments.)
I don’t believe Offit’s book is going to be about him, per se, but his role in the culture is central to the theme in the prologue and first chapter. He’s not writing just about specific “bad science” that he wishes to debunk. He’s really talking about the ways we lose the ability to answer questions. I’m sure he thought that, when he went to college, then to medical school, then into the field, then developed what is generally considered a life-saving vaccine, then opened a center for vaccine education, that his credentials would strengthen his arguments. Yet he shows over and over again in his first chapter that a white lab coat doesn’t make you an expert, and he continually bumps up against people in real life who point to his white lab coat and say the same thing.
Maybe it’s just me, but this uncertainty is sort of depressing