One is a former Playboy Playmate of the Year. The other was once voted one of People magazine's most beautiful people. They had a spat this fall. Actor Amanda Peet used the word "parasites" to describe people aligned with Playmate Jenny McCarthy. "She has a lot of nerve," McCarthy huffed in response. This would be a bit of celebrity fluff, except that Peet was criticizing parents who don't vaccinate their children. McCarthy took up for them because she's the most visible person who claims childhood vaccines cause autism. As famous as they are, Peet and McCarthy are merely two combatants in a national controversy. The nation's most trusted scientific organizations, including the Centers for Disease Control and Prevention and the American Academy of Pediatrics, have said there's no link between childhood vaccines and autism.
Most parents believe them. More than 77 percent of children are completely vaccinated.
But the number of autism cases keeps growing, and nobody can explain why. Some people believe vaccines must be to blame. The Internet teems with frightening stories about the harm they supposedly do, and McCarthy's latest book is a bestseller.
Parents are peppering doctors with questions about vaccines, and some are opting out completely. Even a small dropoff in vaccinations can have a big effect. Earlier this year, a rare outbreak of measles was attributed partly to parents who refuse to vaccinate their children.
This is no longer principally a debate about science. The real question is whether Americans still believe in science — or at least, in the nation's scientists.
Inside a small ranch house in Tampa's Town 'N Country neighborhood, 9-year-old Nikki McDonald pulled at the penny-sized raw patch on her nose. Her mother — always alert to Nikki's attempts to hurt herself — straddled the child on the family room floor, keeping her hands from the scab. Nikki wailed.
"Are you going to be a good girl?" Janet McDonald asked.
Eventually, Nikki relaxed. She has worse moments — sometimes she bangs her head on the floor — but for her mother, every day is a trial.
Eight years ago, two of Janet's triplets, Nikki and Dougie, were diagnosed with autism, a disorder marked by difficulties communicating and interacting. She blames vaccines. After their 15-month shots, she said, the children began to change.
She doesn't know how vaccines hurt them, and she is not sure why the third triplet, Alex, wasn't affected. But she is so certain vaccines are harmful that she warns neighbors and friends not to vaccinate.
"I could just kill somebody who did this to my kids," she said, her voice breaking.
Caring for the triplets takes all her time and energy. Her husband died suddenly three years ago, leaving her struggling emotionally and financially. She may not be able to hang on to the house.
Nikki stood nearby as her mother talked about her troubles, but didn't seem to notice her mother was upset. Dougie can say a few words. Nikki can't.
"How could they take a beautiful child and make her like nobody's home?"
• • •
The debate about vaccines and autism exploded 10 years ago. A British study of a dozen children found that children with autism also had inflamed intestines. The measles vaccine was believed to have caused the inflammation.
The lead researcher, Andrew Wakefield, theorized that after these children received the MMR (for measles, mumps, rubella) vaccine, the measles virus in the vaccine traveled to their intestines, infecting and damaging them. An unknown protein then was able to travel from there to the brain, causing autism. Wakefield suggested separating MMR into three vaccines.
After the study came out, rates for MMR vaccination plunged nearly 15 percent in some parts of Great Britain. In the United States, fearful parents formed advocacy groups, and the controversy captured headlines and research dollars. A U.S. representative whose grandson had autism held a congressional hearing on the potential link.
Since then, the study has been harshly criticized. Most of the researchers involved have retracted their results. In September, researchers who conducted a similar study said they found no link between measles virus and autism.
The antivaccine forces also suggested that thimerosal, a kind of mercury used as a preservative in vaccines, could be to blame. Mercury is toxic to the brain, but poison experts say symptoms don't mirror autism, and no studies linked thimerosal to autism.
Still, by 2001, makers of vaccines removed thimerosal from most vaccines — except for the flu vaccine — as a precaution. Autism rates continue to climb.
Researchers say part of the rise comes from increased awareness and diagnosis of autism. But research also is looking at a genetic link — when one twin is autistic, the other is more likely to be — and at possible environmental causes.
In 2004, an expert panel convened by the Institute of Medicine issued what was meant to be the final word. The group said enough study had been done to reject any link to autism for either MMR or thimerosal.
What's more, the group said, money would be better spent researching other possible causes.
End of story? Hardly.
Oregon financier J.B. Handley is a leading critic of vaccines. Handley, 39, and his wife founded Generation Rescue after their son, now 6, was diagnosed with autism. Jenny McCarthy is the group's most public face.
Most pediatricians, Handley said, "are in denial and not wanting to believe" the dangers of vaccines. He speaks harshly of vaccine companies and vaccine scientists. He mentioned one scientist at the CDC who "should go to jail" for covering up the truth.
Handley is not a scientist and acknowledges he is not sure how vaccines lead to autism. Maybe it's the thimerosal that remains in flu vaccines.
"I have no doubt that injecting a potent neurotoxin into babies is a really, really bad idea," Handley said of thimerosal. "Do I think it's the only thing (that's unsafe)? I have no idea."
• • •
The alarm that Handley and others is sounding reverberates around the country.
On a recent morning, Tampa pediatrician Marcy Baker spent 15 minutes with a worried mother, explaining why a flu shot would protect her child. Baker thought she had won her over, only to learn the mother changed her mind and refused the shot.
Baker and her partners posted a letter to parents, trying to dispel fears, which they hear more and more often. When Baker talks to reluctant parents, she speaks of children she has seen hospitalized with whooping cough, meningitis and rotavirus.
"I do feel my patients trust me," Baker said. "But sometimes they think that I'm duped by 'the man.' That the government and the vaccine companies, they're all in on this big conspiracy."
Some doubting parents make their way to Tampa pediatrician David Berger. He believes vaccines may be linked not only to autism, but to asthma, allergies and other problems of the immune system.
About a third of his parents don't vaccinate, Berger said, and most of the others delay their babies' shots.
"If parents educate themselves, and they feel it's not in the best interest of their child, then who are we to tell them otherwise?" he asked.
Berger knows most doctors disagree. He also says his patients are less likely to be exposed to childhood diseases because the parents tend to breast-feed, and since they're more affluent, they keep their babies at home and out of day care for the first year.
But he thinks most government scientists aren't really listening to legitimate questions.
"There's a big incentive at the government and industry level to not let this get out," he said.
• • •
Some in the antivaccine movement call Dr. Paul Offit the Antichrist. He laughs at the name.
"I'm just one of the devil's many humble servants."
The joke might seem strange from a career pediatrician who helped develop a vaccine that health officials say could save 2,000 lives a day worldwide.
But Offit, chief of infectious diseases at the Children's Hospital of Philadelphia, lives on the front lines of the vaccine debate. Director of the hospital's Vaccine Education Center, he has written two books on vaccines and pulls no punches. He has gotten death threats.
Critics target Offit not only for his outspokenness, but also because he's making money from a vaccine he helped develop to prevent rotavirus, a disease that causes potentially fatal vomiting and diarrhea.
"I see myself as a champion of children. That's why I went into pediatrics," Offit said.
He knows parents dislike seeing children get painful shots.
"What really upsets people is that their child is pinned down and injected with a biological agent that they don't really understand," Offit said. "But in many ways, they're safer than vitamins."
So he sees why stories on the dangers of vaccines resonate with parents.
"It's very easy to scare people," Offit said. "It's very hard to unscare them."
• • •
The nation's largest medical agencies point out that vaccines have saved countless lives from diseases such as polio, diphtheria and meningitis. But even vaccine advocates acknowledge they don't say this loudly enough.
"I think they've been doing a terrible job informing parents," said Amy Pisani, executive director of the group Every Child By Two. "We want to say, 'Hey, listen to the CDC,' but we don't hear them, ever.''
When experts do speak up, their words lack the same punch for many parents as the emotional stories about families' valiant struggles against autism.
And then there's the media.
Both sides of the debate say reporters cover the issue poorly. Doctors say reporters focus too much on a relative few critics and too little on the weight of the science. Those who question vaccines say reporters don't look at flaws in such studies.
Gary Schwitzer directs the master's in health journalism program at the University of Minnesota. He said that journalists' delight in controversy and focus on objectivity have distorted the science.
"We helped create that (controversy) with this sort of tennis-match approach to covering conflicts in science," Schwitzer said. Stories often give equal weight to provaccine and antivaccine views. "This equally weighted back and forth ... usually that's not the way it is in science, but that's the way the story is told."
• • •
Autism Speaks, the international advocacy group, walks a fine line in the debate. Its constituency includes people who think vaccines are dangerous and others who say the controversy distracts from important research.
The group supports research on whether environmental factors — including vaccines — might make children with some type of genetic vulnerability autistic.
"Clearly the risk associated with getting diseases of childhood, such as measles, are very serious," chief science officer Geraldine Dawson said. "For the vast majority of children, (vaccines) are clearly safe. Our recommendation is to continue to have confidence in the vaccine program while trying to understand if there are a small minority of children who might have a problem in certain situations."
Even Handley and some others say they don't want parents to stop vaccinating.
"I am not antivaccine," said Vicky Debold, director of patient safety at the National Vaccine Information Center, a group concerned about vaccines. "If everybody in this country stopped vaccinating, we would be in a world of pain."
She opposes a "one-size-fits-all cookbook approach" and wants more studies. She thinks that parents should consider vaccine safety more carefully, and that they should talk to their doctors about spreading shots out for children who might have problems.
Handley wants to return to the vaccine schedule of about 25 years ago and separate the MMR shot into three shots. He would forgo newer vaccines, such as those against chickenpox, rotavirus and Hib meningitis.
"Life is made up of compromises," Handley said. "If it's chickenpox or autism, parents are going to make the right decision."
Before the vaccine, about 100 people died in the United States each year from chickenpox. About 1,000 children died from Hib meningitis and related disease. About 55,000 were hospitalized for rotavirus.
Tampa parent Robert Fielding says vaccine skeptics underestimate the threat from infectious disease.
"People don't remember the polio epidemics, or the pandemic flu of the early 1900s," he said. "We don't remember how debilitating some of these things were."
Fielding knows first-hand. His 4-year-old son, Joseph, nearly died from whooping cough when he was 6 weeks old. Joseph was two weeks too young to be vaccinated.
• • •
Now, some vaccine advocacy groups are switching tactics. Every Child By Two brought spokeswoman Peet on board this summer for its Vaccinate Your Baby campaign.
"We haven't been able to get anybody interested until we brought Amanda Peet forward, and that's sad," Pisani said. The tiff with McCarthy was just a distraction, she said. "Amanda wants to be a spokesperson for the science."
And just as the Internet connects the antivaccine community, it has now become a platform for provaccine parents. Florida residents Denise and Gary Palmer, who live near Melbourne, are among those telling their stories on familiesfightingflu.org.
In early December 2003, Denise Palmer took their baby daughter, Breanne, to the doctor. Because Breanne was sick, she didn't get a flu shot. Just before Christmas, Breanne's older brother got the flu. The next day, Breanne had a fever as well.
The Palmers took Breanne to the doctor. But soon, her fever soared again, and she had trouble breathing. She went to one hospital, then a second, but kept getting worse.
She was sent to a third hospital where doctors told the Palmers it was too late. The virus had attacked Breanne's brain stem.
"I think about it every day," Denise said. "I will never forget holding her in my arms as she passed away."
She thinks about what might have been. That's why she speaks out with Families Fighting Flu.
"I think about what if my child was vaccinated," Denise Palmer said. "I believe she would be alive today."
Lisa Greene can be reached at greene @sptimes.com or (813) 226-3322.
For some, a flawed vaccine creates mistrust, while others say it proves the system is safe.