'Er' Uproar

Last week's "ER" made a small group of people sick. The Feb. 15 episode, which touched on the current debate over childhood immunizations, was seen as extremely one-sided by antivaccine activists. On the show, a young mother brings her ill child to the hospital. When asked by hospital staff if he's had his vaccinations, she responds, "No ... he hasn't had any immunizations, none of our children have." Dr. Chen (Ming-Na) looks away in disgust. Later, the child dies of measles. It is, ostensibly, the mother's fault.

Over the past few years, some parents have come to believe there may be a connection between childhood vaccinations and autism. Though studies have yet to prove a correlation, a small number of parents have stopped giving their kids immunizations, especially the common MMR (measles/mumps/rubella) shot.

The episode angered some in the autism community. But what further infuriated them was a commercial for Prevnar, American Home Products's new vaccine for preventing bacterial meningitis, which ran directly after the scene in which the mother learns her kid has measles.

As it turns out, American Home Products bought the spot last May. When the company learned of the episode's story line through a "screening report" last week, the ad buyers asked to have their commercial placed specifically after that tense scene. (NBC says it's common practice to let advertisers know the content of shows beforehand, in case they want to pull out of controversial programming. "A screening report is basically used to make sure an ad is not running in an inappropriate place," says NBC spokesman Cory Shields.)

NEWSWEEK's B. J. Sigesmund spoke about the episode and the ad with Jonathan Shestack, a cofounder of the Cure Autism Now (CAN) foundation (www.cureautismnow.org). Shestack is also a Hollywood veteran; he produced "Disturbing Behavior" (1998) and "Air Force One" (1997). One of Shestack's three sons, his eldest, has autism.

NEWSWEEK: When did the "ER" episode first come to your attention?

Jonathan Shestack: ["ER" star] Anthony Edwards, who's on the CAN board of directors, had told us about it a couple weeks ago. A week or so before, everyone in the autism community seemed to be aware of it.

What did Anthony Edwards say?

I don't like to speak for Anthony, but he felt pretty strongly that this was an extremely one-sided and dismissive look at the issue. But, of course, he is an actor on the show. He doesn't write the stories. This is a story John Wells wrote and directed. Obviously, he felt very strongly. You will notice that Anthony's character doesn't figure at all into the story.

What did you think of the episode?

I was dismayed. I fully understand the public-health issues behind universal vaccination. And I understand why it's so important that people get vaccinated. On the other hand, there are very legitimate concerns and questions about vaccines and vaccine safety. And the show was terribly dismissive of the parent who had those concerns. In fact, basically the subtext of the show was, "Don't question conventional wisdom about vaccination, and if you do, you're an idiot and the punishment will be that your child could die."

Tell us how vaccines and autism could be related.

There are many different views about vaccination in the autism community. Some people believe absolutely that their child's autism was a reaction to a vaccine. Many feel it wasn't. Some people believe it was the immune load of so many shots during such a short period of time, in particular the MMR vaccine, that may be a factor in autism. Other people believe that thimerosal, a mercury-based additive that's been in vaccination formulas for years-and is now being removed-is the guilty factor. But what everyone can agree on is it's an issue that needs to be looked into. If in fact there is evidence that there's a connection in some cases of autism with vaccination, this is something that can be addressed, either by changing the formula of the vaccine or my vaccinating a little later, or by splitting the vaccines into several injections.

Do many parents in your community feel dismissed by doctors?

Yes, and that dismissiveness is so hurtful and insulting. And what you should keep in mind is people have a long history of getting bad advice from the medical establishment. In the 1940s, autism was blamed on bad parenting or trauma and thought to be the fault of the mother. Treatment, when there was any, consisted of separating the children from the parents, or psychoanalysis for the parents, to figure out why they'd screwed up their kid. So you can understand why families might be a little upset to have their concerns and fears dismissed in such a high-handed fashion.

Are incidences of autism on the rise, or is it just being better diagnosed?

It's pretty clear [to CAN] there's been a dramatic rise in autism in the United States in the last 10 years. California reports a 273 percent increase. Florida, a 500 percent increase. These numbers are not all due to changing diagnostic standards or better reporting. There must be something else involved. Families look for an environmental cofactor, something that works with genes. One of the things they've come up with is vaccines. The vaccine schedule has intensified. Kids get more vaccines spaced more closely together than they used to 15 years ago. At CAN, we don't have an opinion on this. We have no idea if there is a connection between the vaccination and autism. But we're certain it's something that bears serious study. The fears of the families should not be dismissed. It seems more than possible with good research, and a reasonable amount of money spent, to get an answer.

Was it irresponsible of the producers of "ER" to air this episode?

On the show, there's a good mother, an educated parent who did her best to understand the issues, but the show treated her like an idiot. This is another hot button for families with kids with autism. The typical experience is they take their kid to the pediatrician and say "he's not talking, we're concerned." The typical response from doctors is, "he's fine, you don't know what you're talking about." The parents aren't idiots, but pediatricians in America are not trained in how to diagnose autism. Any parent of an autistic kid can walk into a nursery school and in 20 minutes pick out the kids at risk.

What do you think of the commercial for Prevnar and its placement?

Advertisers get advances. It was an unfortunate coincidence that made the families feel worse and the network feel sillier. But I don't think it was part of a vast conspiracy, other than the vast conspiracy of the world we live in, which is first sell product, then do no harm.

Any final thoughts on the matter?

[We feel] the Feds are a little bit hiding their heads in the sand. Their fear is that if they really look into this seriously, and open it up at all for discussion, families will fail to vaccinate in droves, and that will cause a national health emergency. But the problem is we've all looked at the same facts and they've come to the wrong conclusion. By not dealing with this seriously and finding the answer in the solution, they're risking many more people declining vaccination than might happen if they just got the answers and made the changes accordingly.