NVIC? Know the Omissions

The National Vaccine Information Center is at it again. They have launched a two-month, multi-state billboard advertising campaign to spread their misinformation and fear about vaccines. They are calling this the "Know the Risks" campaign. For the months of March and April, billboards like this will "grace" the landscape around Austin, TX; Chicago, IL; Phoenix, AZ; Portland, OR; and Tucson, AZ:

Something seems to be missing...
Image credit: Voices for Vaccines

According to the press release, they claim their goal is to "encourage well informed vaccine decision-making". However, as we've seen before, NVIC's founder, Barbara Loe Fisher, appears to have little problem promoting blatantly incorrect information regarding vaccines. The first thing I noticed when I saw the above billboard was that something rather important to being "well informed" was missing: knowing the benefits of vaccinations. Yes, making an informed choice requires knowing the risks and failures, but the benefits are also needed. It also helps to put the risks into context by knowing how likely it is to occur, and how that compares to similar risks from the diseases that are prevented by vaccines.

Leaving important information like that out (or even just the fact that there are benefits) strikes me as a dishonest tactic. But let's take a closer look at this.

When I first heard about this campaign, I only planned to focus on the billboards and take a look at how much this was costing them (more on that later). But then I discovered that they have a web page for the campaign. Just like with the billboard, what struck me was not necessarily what was there, but what wasn't there.

Right from the beginning, they set the tone by zeroing in on the risks of vaccines: the risk that they will not work and the risk that they will cause harm. After a brief introduction of the organization, where they claim to be "advocates of informed consent" despite their past demonstrations of being opposed to informed consent, they launch into their anti-vaccine fear-mongering. They list several conditions and events they state are "acknowledged in the medical literature and by the Institute of Medicine (IOM), National Academy of Sciences":

Something missing here, too...

These all sound quite frightening, particularly to new parents worried about doing their best to protect their precious newborns. Brain inflamation, anaphylaxis...death. No one wants to expose their children to something that could cause any of those. But how likely are these to occur? How common are they? How do they compare to these complications following infection? The NVIC provides zero context for readers. The impression is that these are common. No effort is made to inform readers that the risks of complications are significantly higher following infection than following vaccinations. [Edited to Add: I mean to include this in the original draft, but also note that the references NVIC provides for this list almost exclusively focus on pertussis vaccine. And not just pertussis vaccine, but the whole-cell pertussis vaccine, which isn't used in the U.S. any more. Instead, the safer, but much less effective, acellular vaccine is now used. I suppose they're counting on readers not actually checking the sources.]

They go on to selectively quote from Institute of Medicine reports to further give the impression that vaccines are quite dangerous and use grammatical tricks to mislead readers. For instance, they write:

If that screen shot is too small, here's the text (or click to enlarge):

In 2013, the IOM published another report, The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence and Future Studies, ^[21] and stated there are significant gaps in scientific knowledge about children, who are biologically at higher risk for suffering vaccine injury and death

From a grammatical analysis, NVIC is saying that children (all children, no exclusions) are at a higher risk for suffering injury and death from vaccines. I do not see another way to interpret this passage, since the clause beginning "who are" is modifying or expanding on "children". That comma makes all the difference. To support this statement, they provide this quote from the Institute of Medicine:

“The committee found that evidence assessing outcomes in subpopulations of children, who may be potentially susceptible to adverse reactions to vaccines (such as children with a family history of autoimmune disease or allergies or children born prematurely), was limited and is characterized by uncertainty about the definition of populations of interest and definitions of exposures or outcomes.” – Institute of Medicine, 2013

The IOM is not talking about children in general, but rather about specific subpopulations. They also are not saying that these subpopulations are always at increased risk of adverse reactions from all vaccines. Rather, they are pointing out the difficulties in assessing the outcomes for certain subpopulations because the definitions involved vary.

Next, they bring up the National Childhood Vaccine Injury Act of 1986, stating:

Again, the text is transcribed below if the screen shot is too small for you to read, or you can click on it to enlarge:

In 1986, Congress passed the National Childhood Vaccine Injury Act.^[25] The law was created by Congress in response to lobbying by the pharmaceutical industry and medical trade associations to shield drug companies and doctors from civil product liability and malpractice lawsuits for injuries and deaths caused by federally recommended and state mandated vaccines.

As I pointed out before, this promotes the mistaken idea that vaccine manufacturers are shielded from product liability, with the unstated suggestion that they are shielded from all product liability, which is not true. Also, as with many other aspects of their campaign, NVIC again leaves out information. The implication from this passage is that the NCVIA was the result solely of the actions of the pharmaceutical industry and medical associations. What NVIC does not tell the readers is that Barbara Loe Fisher and her organization were also heavily involved in lobbying for the creation of this law. From the book Fisher co-wrote with Harris Coulter, A Shot in the Dark: Why the P in the Dpt Vaccination May Be Hazardous to Your Child's Health (p. 213):

NVIC was instrumental in educating Congress and the public about the need for a no-fault compensation system alternative to a lawsuit, which resulted in passage of the National Vaccine Childhood Injury Act of 1986.

There is much more on the campaign web site that I find misleading and likely to cause parents to forego vaccination based on incomplete and erroneous information. Perhaps other science-based bloggers will take a stab at this and provide further analysis.

So, how much is NVIC shelling out for this campaign? We can get a general ballpark figure by looking at Clear Channel Outdoor's advertising rates. As of March 13, 2013, their 2-month rates for bulletins (the most likely format selected by NVIC) ranged as follows (note: rates for Austin and Olympia were not available):

• Chicago: $198,000 - $831,600
• Phoenix: $86,400 - $383,400
• Portland: $115,200 - 486,720
• Tucson: $44,400 - $167,832

This gives a grand total ranging from $444,000 (for the minimum spread) to $1,869,552 (for maximum reach). That's quite a chunk of change, and that doesn't even include Austin and Olympia. Again, these are ballpark figures based on the pricing available from Clear Channel's web site. They may not reflect NVIC's actually expenses for these billboards, but they should give people a general idea of what they're spending.

 NVIC certainly has a right to purchase advertising space to spread their misinformation that has the potential to negatively impact public health. And Clear Channel has the right to sell their advertising space to whomever they choose. But reality-minded individuals also have a right to make their voices heard. For example, they might decide they want to contact Clear Channel to voice their displeasure. Take a stand for true informed consent. Speak out against those who are anti-informed consent.
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Others who are writing about this:

• Phil Plait's Bad Astronomy - Vaccines and autism: Antivaccination group advertising on billboards
• Skewed Distribution - A Call to Arms