Smoke, mirrors and Robert Kennedy Jr.’s vaccine safety panel

You may have heard by now: President-elect Donald Trump apparently is appointing Robert F. Kennedy Jr. to a commission on vaccine safety and scientific integrity, with a particular focus on autism.

I am trained as an epidemiologist and health services researcher and have conducted autism research for almost 20 years. I am confident that the president-elect could not have found someone less qualified for this role. But please don’t let this appointment distract us from fighting the many policy changes the incoming administration is proposing that could have dire consequences for people with autism and other disabilities.

Kennedy is an anti-vaccine conspiracy theorist. In 2005, he wrote “Deadly Immunity,” jointly published in Rolling Stone magazine and salon.com. The article claimed that thimerosal, which until 1998 was used to preserve vaccines, causes autism. Kennedy went on to claim that the U.S. Centers for Disease Control and Prevention worked with pharmaceutical companies to hide the risks associated with thimerosal. Rolling Stone and salon.com retracted the article in 2011 because of factual errors, but Kennedy continues to spread his theories.

The president-elect linked vaccines to autism during the second Republican presidential debate using a vague anecdote, thereby giving undeserved life to this discredited theory. As Paul Offit, one of the world’s leading vaccine experts, points out, of all the tremendous expertise available to Mr. Trump, he has selected the remarkably unqualified Kennedy to advise him.

The American Academy of Pediatrics states that vaccines save lives and are among the most important medical innovations of our time.

Why would the president-elect engage with a conspiracy theorist and a thoroughly discredited pseudoscientist to reopen a settled question? His decision has the potential to put millions of children’s lives in danger, should their parents choose not to have them vaccinated.

Let’s call this ploy what it is: a distraction from the real policy proposals from Trump’s team that have the potential to destroy the system of care for millions of people with autism.

Thin link:

As writer Julie Beck said in a September 2015 article in The Atlantic, it is no longer interesting or useful to debate the connection between vaccines and autism. Myriad well-conducted studies show that vaccines don’t cause autism, and that the risk of vaccine injury is overwhelmingly outweighed by the lives vaccines save. Even a study funded by Safe Minds, an anti-vaccine group, found that vaccines cause no autism symptoms or autism-like neuropathology.

Despite this plethora of scientific evidence, one-third of American parents think that vaccines can cause autism. This in and of itself suggests that scientists and medical professionals have much more work to do in publicizing high-quality science. But by drawing further attention to this discredited link, Trump creates the illusion that he is investing in keeping our children safe and supporting individuals with disabilities and their families. In fact, the agenda he has proposed and the stated positions of his cabinet picks point to exactly the opposite.

For example, Trump has proposed dramatically reducing funding for Medicaid, which is the single largest payer for healthcare for individuals with autism. He also proposed to change Medicaid funding to a state block grant, which means that states would not have to follow regulations from the Center for Medicaid Services, such as the one stating that Medicaid should cover behavioral treatments for autism.

States of danger:

Trump also proposes to open up healthcare insurance markets across state lines. If that happens, out-of-state insurance companies would not have to follow state mandates. States would have significant incentives to repeal their mandates to stay price competitive, sparking a race to the bottom. The mandates that require healthcare insurers to cover autism services would be in danger of being gutted, especially if employers choose to offer insurance plans only from companies in states with no mandate.

The Individuals with Disabilities Education Act guarantees children with disabilities a free and appropriate public education. It may be the single most important civil right afforded children with autism. Senator Jeff Sessions, Trump’s pick for attorney general, has called this law “the single most irritating problem for teachers throughout America today” and “a big factor in accelerating the decline in civility and discipline in classrooms all over America.” What will it mean to have an attorney general who won’t enforce this right?

Betsy DeVos, Trump’s pick for secretary of education, is a staunch proponent of charter schools, which have no mandate to support children with disabilities. My own work in public schools suggests that many charter schools initially enroll children with disabilities and then send them back to their neighborhood public schools as soon as the charter school receives payment for that student.

Eyes on the prize, people. Although we should call out all fake science, please remember that there are very high stakes here, and that we should put the bulk of our energy into fighting for the healthcare and education that people with autism and all disabilities deserve.

David Mandell is professor of psychiatry and pediatrics at the University of Pennsylvania and director of the Center for Mental Health Policy and Services Research.