Letter from America
The decision of the Lancet to publish the original Wakefield paper which first postulated a link between the MMR immunisation and autism is regarded by many as a monumental misjudgment. Taken in context, the article's conclusions are unsustainable. But even taking the article in isolation, it does not stand up to rigorous intellectual scrutiny.
Professor Trisha GreenhalghTwo weeks ago, just before the start of the Wakefield hearing at the GMC, I wrote:
Trisha Greenhalgh is a well-respected family doctor and academic, who writes regularly in the BMJ. Her particular interest is communication, clarity of expression and scientific honesty. If you read only one article on Wakefield, read this one (in full here)
In conclusion, the Wakefield study was scientifically flawed on numerous counts. I am surprised that neither the editor nor the reviewers spotted these flaws when the paper was submitted. Had they done so, the public would have been saved the confusion and anxiety caused by false credibility conveyed by publication of the study in this prestigious journal.
Professor Trisha Greenhalgh OBE MD FRCP FRCGPNot all agree with the Greenhalgh analysis. Dr Anthony Mawson is a well-respected epidemiologist in the USA. He is Professor of Preventative Medicine at the University of Mississippi. He writes:
Dear Dr. Crippen,
I would like to point out that Trisha Greenhalgh's assessment of Andrew Wakefield's paper was itself seriously flawed!
You do a disservice to Wakefield and the scientific community by perpetuating this myth of the flawed study and the paper that should have been "rejected" by The Lancet.
The paper is actually excellent--a superb case study that will join the ranks of other famous case studies, such as the link between rubella infection and congenital rubella syndrome (Gregg 1941) and between exposure to thalidomide and embryopathy (McBride 1956).
Greenhalgh states that the paper set out to test a hypothesis that was unstated --of a causal relationship between exposure to MMR and autism -- and the design of the study was all wrong. She starts out with an incorrect assumption about the nature of the study and then continues to build on her incorrect foundational argument. Her argument may look impressive to the layman and most medical practitioners perhaps, but not to anyone who knows anything about study design, i.e. epidemiologists, and the reviewers of the paper for The Lancet, who clearly understood that the paper was not an hypothesis-testing paper but a hypothesis-generating paper. It was, in short, a case series analysis.
The paper, once understood in this light, as case series analysis, is truly remarkable, well written and brilliantly documented. It concluded by stating the hypothesis, based on parents' reports, that the children’s' signs and symptoms were temporally connected to MMR vaccination. Subsequent studies may not have substantiated the hypothesis; but that does not detract from or invalidate the merits of the paper as a case series and as, essentially, a hypothesis paper.
Anthony Mawson.
As a family doctor, my main concern is that the further publicity generated by the current Wakefield GMC hearing is going to give yet another airing of the MMR-autism myth. And I do believe it is a myth.
Dr Andrew WakefieldBut, as I have said many times before, Dr Andrew Wakefield is not mad. He is a true believer. He will not go away just because we start shouting at him. We have to defeat his case with rational analysis and with science.
Professor Mawson’s views need consideration.
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Dr. Anthony Mawson is Professor of Public Health, Director of the Institute of Epidemiology and Health Services Research, Jackson State University, and Interim Coordinator, Doctor of Public Health Degree Program. He is also Principal Investigator of the Center of Excellence in Minority Health and Co-Director of the National Center for Biodefense Communications. Full c.v. here.
And look here for a characteristically robust rebuttal of Dr Mawson's views.
Labels: autism, greenhalgh, Lancet, MMR Wakefield
98 Comments:
At the time of the Lancet publication, Wakefield knew that people in his own lab. had serious misgivings about some of the claims in the paper.
Dr Nick Chadwick started to work as a graduate student in Dr Wakefield's lab in the Royal Free Hospital in 1994. The lab started to focus on testing samples and tissue from autistic patients in 1996. Chadwick was responsible for processing the materials and looking for measles RNA. He reported that there were never any confirmed findings of measles RNA. The only positives that were obtained were rapidly shown to be false positives and he reported this to Wakefield.
Chadwick's testimony to the Autism Omnibus hearings (pdf) was devastating.
pg 10
Q [Y]ou personally tested while you were in Dr. Wakefield's lab gut biopsy material, CFS, PBMCs?
A Yes, that's right.
Q And all the results were either negative, or if they were positive it always turned out that they were false positives?
A Yes, that's correct.
Q Did you inform Dr. Wakefield of the negative results?
A Yes. Yes.
Chadwick further reported that Wakefield had decided that it would be useful to send samples to Dr Kawashima's lab because he was also working on the detection of measles virus using another methodology. Chadwick discovered that there were serious and significant reporting errors from Kawashima's lab and that, yet again, the only positive results were subsequently shown to be false positives. He had concerns about contamination. He informed Wakefield of the problem with the Kawashima results. Chadwick's results also returned negative results, with every positive being subsequently shown to be a false positive.
pg 12
Q [D]uring your time on your Ph.D. research in Dr. Wakefield's lab you only obtained nine positive PCR results for measles. Every time you did that you sequenced them.
A That's correct, yes. We sent it off to a sequencing lab to be sequenced, and the data that came back showed that they were all false positive results.
Q Every positive result you got was a false positive?
A Yes...
[pg 12 cont. to pg 14]
Q [Y]ou state that you had reservations about the immunohistochemistry done to detect measles virus, specifically the use of an antibody from Porton Down?
A Yes, that's right. The antibody seemed to cross-react.
Experiments we did in the lab seemed to show that the antibody cross-reacted with bacterial proteins, which I think is an artifact of how the antibody was made, and that led us or led me to think that it may have been cross-reacting with bacteria in the gut of patients rather than measles virus.
Q Now, that would lead to contamination?
A Well, it would lead to a false positive result. Say for instance if the antibody was binding to something in the guts of these patients, it may well have been a bacteria rather than the measles virus.
Q Okay. Producing the false positives in those?
A Yes, that's correct.
Q You also state in your affidavit that you believe Dr Wakefield was aware of all your negative results when he submitted his paper "Ileal Lymphonodular Hyperplasia, Nonspecific Colitis and Pervasive Developmental Disorder," which was published in 1998 to the Lancet.
A Yes, that's correct.
Q You were working at the lab at that time, and you had actually published some articles with Dr. Wakefield on other subjects, hadn't you?
A Yes. Yes.
Q Why isn't your name on the paper I just referenced?
A Well, my name isn't on that because none of my data went into that paper.
There was a manuscript which did use some PCR data I think from Dr. Kawashima's lab, and I asked for my name to be taken off anything that was related to PCR data because I wasn't comfortable with the quality of the data.
[My emphases.]
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It is a remarkably serious step to request that your name is taken off a paper and should not be used in reference to data. The significance of this would be apparent to any researcher, scientist or journalist.
It is well worth reading the testimony of the various experts at the Autism Omnibus Hearings. It is well worth reading the Deer summaries (links here).
Brian Deer is the must-read on this topic: MMR-autism sign was recognized for years: as a benign finding in children
What about that scary-sounding ileal-lymphoid-nodular hyperplasia that so impressed and intimidated these hardened reviewers and journalists? Wasn't this a new, terrifying, malign finding that must mean something?
Well, no. It turns out that the swelling of the glands, near the end of the small intestine and close to the appendix is a generally benign finding in children that has been known about for some time. It has nothing to do with inflammatory bowel disease and is not, of itself, an inflammatory bowel disease.
But what about the autistic enterocolitis? Well, Wakefield's colleagues have withdrawn their support for his research and retracted the publication that articulated this claim. One of Wakefield's collaborators and co-authors, Walker-Smith, has admitted that most of the children did not show signs of inflammation and that there were no unusual findings in the children's colons.
If you're not queasy about that sort of thing, do go and look at the illustrations and photographic plates on Brian Deer's site; you will learn a lot about the appearance of normal and inflamed bowel tissue.
Prof. Mawson wrote: "It concluded by stating the hypothesis, based on parents' reports, that the children’s' signs and symptoms were temporally connected to MMR vaccination."
Seemingly, even at the time, it was clear that there was some legerdemain about the temporal association between the onset of symptoms and the MMR vaccination.
Brian Deer on the shifting temporal connection of the onset of symptoms to the MMR vaccination
The solicitor Richard Barr to whom Deer refers was a key player for the plaintiffs in the MMR-autism legal case.
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Where Wakefield spoke in the paper of behavioural symptoms within 14 days of MMR, the true position was that the parents [sometimes after consultation with lawyers or activists] had generally reported [if anything] common, benign, consequences of vaccination, such as crying, fever, rash, irritability, and even sometimes [also benign] febrile convulsions. No competent doctor, acting professionally, could describe these as "behavioural symptoms", much less hold them out as potential markers for the onset of regressive autism.
In fact, Wakefield's tabulated finding - linking MMR with the sudden onset of regressive autism in two thirds of a consecutive series of 12, seen routinely at a children's bowel unit within the space of a few months - was both statistically impossible and biologically implausible. It simply could not happen.
No paper or article has ever subsequently been published proposing anything like this scenario. Indeed, faced by urgently-commissioned research, and a review of cases by the Committee on Safety of Medicines, which showed no such temporal association, the lawsuit-driven anti-MMR campaign moved off in a different direction. The argument quickly changed to allege that the emergence of autistic disorders after MMR wasn't sudden at all, but delayed and insidious. By August 2001, other retained experts, working for Barr, led by Canadian epidemiologist Walter Spitzer and British psychologist Kenneth Aitken, published a paper reporting, among other things, that they'd found only two out of 493 [0.4%] children then enrolled for Barr's lawsuit [who were vaccinated between January 1988 and November 1998, and so presumably included Wakefield's series] where MMR had been given less than 30 days before the appearance of behavioural symptoms. In striking contrast, however, Wakefield had claimed in the Lancet paper that eight out of 12 [66.6%] had received MMR within 14 days of symptoms. Moreover, Spitzer and Aitken reported that the median time to the onset of symptoms among Barr's clients was 1.1 years, while Wakefield had claimed a median time of only 6.3 days.
Wakefield's "finding" and "result" were thus abandoned by history, with only the sting of his attack remaining. In due course, he would up the stakes, manufacturing a deluge of further false claims, ranging from bogus comparisons between California and London autism data, published with Royal Free sidekick Scott Montgomery Ph.D in November 1999 [again in the Lancet], to a sham review of vaccine research, published with Montgomery in January 2001 [in Adverse Drug Reactions and Toxicological Reviews]. Analysis of these texts reveals motive: to attack MMR, with little heed for truth or consequence. But, with regard to the February 1998 Lancet paper, his claims were a charade: by a former surgeon with insufficient training in general medicine or paediatrics to realize that what he'd claimed was impossible. The link he proposed between the vaccine and autism wasn't found. It was put there - manufactured by him.
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'Subsequent studies may not have substantiated the hypothesis'
This is the part of Professor Mawson's analysis that is meaningful to me. A thoughtful, well-considered study, sadly found to be wrong and meaningless. Case closed. Next.
It does people with autism (and their carers and advocates) no good to cling to myths such as this.
Here we go again.
John, I'm surprised at you. As a long-time listener and a rare contributor, I thought that grey hair, a title, pompousness and lots of publications / letters after your name couldn't impress you.
I am an infectious diseases physician and clinical microbiologist with extensive epidemiology training, have some grey hair, well-disguised pompousness,sit on lots of committees and have quite a few publications too. As Samuel L. Jackson famously said, allow me to retort.
Do we really have to explain to the good professor that, following lessons learned from the Tuskogee disgrace and the Nazi "experiments", results of human research obtained without prior institutional ethical approval is invalid, regardless of how scientifically valid the results appear to be?
Any first-year medical student understands this concept. Perhaps Professor Mawson hasn't kept up with his continuing medical education?
Wakefield:
a)commenced this study without prior ethical approval from the Royal Free;
b) did not inform the Royal Free (or the Lancet) that he was being paid to provide a service for anti-MMR vaccine litigation at the time of the study;
c) did not declare to the Lancet that he had a patent for a single measles vaccine at the time of the study.
Any one of these would bring a rapid halt to proceedings at both the ethics committee / review or the peer-review level.
All 3 together make this manuscript stink to high heaven.
As for comparing to previous sentinel public health publications on cause - effect relationships to this paper, methinks the professor is drawing an extremely long bow. Why doesn't he mention the numerous "cancer clusters" that when investigated, turn out to be nothing more than panic, or chance? Wakefields paper has far more in common with this sort of work than the McBride example Mawson quotes. A missing limb is an easily definable "event". Aphthous ulceration and ileo-nodular lymph node hyperplasia are extremely common findings in endoscoped children,- in fact, common enough to be ignored as incidental findings to those of us who practice clinical medicine. Not being a pathologist, Mawson wouldn't know that findings of "non-specific colitis" are easy to report when you're actively looking for them, as Wakefield was - a marcophage here, a lymphocyte there, and bingo - you've got yourself some inflammation.
Oh, and don't forget the part about biological plausibility of the "MMR hypothesis", which has not only been found to be non-existent, but as above, Wakefield has been exposed as a liar and fraud regarding the presence of measles DNA in these very biopsy samples!
Wakefields' paper should be tossed on the metaphorical bonfire reserved for unethical, poorly performed research, and forgotten about. Instead of trying to desperately promote Wakefield as some kind of medical hero crying in the wilderness, Professor Mawson should use this sorry tale in his lectures as an example of how *not* to conduct research.
You can polish a turd all you like Professor, but it nonetheless remains a turd.
For a moment, Dr RJ, I thought that the Jackson comment meant that you were about go "go medieval on" etc. etc. You wrote: "Perhaps Professor Mawson hasn't kept up with his continuing medical education?"
Just to clarify, it's my understanding that Prof. Mawson is not an MD or similar? The reference to the MPH etc. - his alma mater for this offers a 45-credit hour curriculum for this course. I don't know if the requirements were different when he took it. The MPH programme focuses on the "application of management concepts in the public health sector to protect and improve the health of the community. The MPH program consists of a 45-credit hour curriculum, which focus on management at the operating level. " The DrPH seems to be a Doctor of Public Health although this seems to be between the MPH and a PhD - so I don't know if a useful analogue in UK terms would be an MPhil? And - I'm not sure that I've interpreted that correctly.
CV states: Dr. Mawson obtained his bachelor’s degree in sociology and psychology from McGill University, Canada, his MA degree in sociology from the University of Essex, UK, and both MPH and DrPH degrees in epidemiology from Tulane University’s School of Public Health and Tropical Medicine, New Orleans. He was also a post-graduate student at the London School of Economics and Political Science
Trisha Greenhalgh may well be "surprised that neither the editor nor the reviewers spotted these flaws when the paper was submitted." The reason is, is that there is evidence that The Lancet was already aware of problems with the paper before its publication.
This is from the February 27, 1998 edition of The Independent.
"When the latest paper was received by the Lancet last August it was sent to four experts for peer review, and was discussed by the editorial committee on three occasions. Critics said it should not be published because it was based on a small sample of patients attracted to a hospital department known to have an interest in their condition."
Also, it is worth bearing in mind that The Lancet were probably aware of what Wakefield might say at the press conference, since he had already leaked in 1997 (in Pulse) his views that his study would cause a rethink on vaccination policies and his views that MMR vaccine was linked to autism.
Having considerable knowledge about the thalidomide disaster and Jim McBride's joining of the dots to link thalidomide to birth defects, I have to say that his comparison is baffling. The fact is McBride's evidence justified his views at the time he made them. Wakefield's vaccine/autism hypothesis wasn't backed up by his research at all, even if it was useful for the lawyers he was working with, and his suggestion single vaccines would be safer most certainly wasn't.
Since we are on the subject, here's McBride's famous letter published by the Lancet on December 16th 1961:
http://www.adr.org.uk/images/mcbride.jpg
So, is it now acceptable to publish "hypothesis generating" papers in respected medical journals? I think not.
Dr Crippen wrote:
"Professor Mawson’s views need consideration."
Based on the above comments - why?
He's not a doctor, virologist, immunologist, autism researcher or what most people would understand as a medical epidemiologist. Am I missing something?
Here we go again.
John, I'm surprised at you. As a long-time listener and a rare contributor, I thought that grey hair, a title, pompousness and lots of publications / letters after your name couldn't impress you.
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I did not know the colour of his hair when I got the email!!
But there is a more important point. This is someone who is eminient in his own field, and well placed to express an opinion.
There is a tendancy for some in the anti-Wakefield camp (the rational and correct camp in my view) to shout and scream at all who disagree with them.
That is a mistake. It is what most of us condemn the chelators etc for.
Think carefully about the statement you made:
"I thought that grey hair, a title, pompousness and lots of publications / letters after your name couldn't impress you."
Now take a look at the photo of Professor Trisha Greenhalgh OBE MD FRCP FRCGP.
Why does the same not apply to her? Just because you perceive her to be right does that somehow validate the grey hair and the titles?
I don't think that Trisha Greenhalgh is pompous - she always strikes me as precisely the opposite. But I have no reson to suspect that Professor Mawson is pompous either.
Come on, guys, we can do better than that!
John
Dear Colleague
I must say I surely enjoy my daily dose of Crippen. As you of course know, The Lancet is a journal designed for one purpose, and one purpose only: To make other medical researchers aware of new research questions.
Nothing more.
The Lancet is not interested in publishing definitive research papers. It throws the cat amongst the pigeons and then it is up to the world medical scientific community to take up the challenge. AND for them to publish their results in OTHER journals.
The lay press journalists have no business reading The Lancet, and quite frankly, I am astounded that they are allowed to do so. It is not written for them and it is not intended for them to either understand its contents, nor to digest and transcribe any paper in any form whatsoever in order for the lay public to read. That this does happen, is the one and only reason why thousands of ill-informed mothers are now denying their babies crucial vaccinations.
It is nothing but an international public health disaster.
Dr Crippen, if you agree, and I hope you do, please take this message further in your "crusade" (if you don't mind me calling it that) to correct this fundamental wrong in lay press reporting.
Kind regards
Charles Laubscher
(Family Physician)
France
Hear hear to Shinga's, Dr rj's and Anthony Cox's comments. I think Professor Mawson is well off his ground here. He is saying, in effect "well, it looks like a case series study ought to look"
But as others have pointed out, it is a super selected case series, which lied about the selection, and omitted the conflicts of interest, and was dodgy on the ethics, and which concealed lots of negative data contradicting the basic conclusion, and so on and so on.
as I wrote in one of the previous Wakefield-related threads, the almost universal "take" in the scientific fraternity (including my clinical academic buddies in GI medicine research) on Andrew Wakefield and the paper is:
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Too much ambition, too much "fame beckons", tons of iffy data editing, not enough restraint, insight or critical analysis.
Cue TV cameras: lights! Action!
...Ka-boom.
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And apart from Dr Andrew W himself, his co-authors and the RFH hierarchy also came out looking distinctly culpable on the "suspended all critical judgement" angle.
The Lancet has no doubt been cursing Wakefield roundly to this day. As the story Anthony Cox quotes from The Indy makes clear, they were trying to "weigh up" the paper, which was clearly recognised as a potential DefCon One thing, and with the tendency of the RFH people to over-sell their special project doubtless a part of the calculation.
One suspects that ultimately the "we have a lot of doubts, but just in case they really have got something here, it ought to be out there" probably just carried the day. Imagine then how they felt when they realised they had been, in effect, conned.
Dr Crippen, is it possible you missed the humour in Dr RJ's description of himself in the same terms as he described Prof Mawson?
Lots of good reasons as to why Mawson may be misguided or not appropriately placed to comment on L'Affaire Wakefield with priviliged insight, yet you restrict yourself to a response that tells the commenters that they could do better.
Hi John,
Oh dear, you didn't pick up on the qualifying self-deprecating statements I made in the next paragraph? I thought Brits had mastered the subtle art of satire. Never mind.
Wakefield's paper was not a population-based study of a disease or syndrome - it was a best a pilot study of a tiny (self) selected group of kids who allegedly had symptoms in common, whose parents just happen to be involved in MMR injury litigation. It is therefore not an epidemiological study.
Prof Mawson is an epidemiologist. He is not a medical doctor, not a virologist, not a pathologist, not an immunologist, not a gastroenterologist and not an autism researcher. There is nothing in Professor Mawsons CV that makes me think that he is qualified to hold an opinion on this paper any more than, say, a nuclear physicist with an interest in the topic.
Prof Mawson is presumably unaware of the serious flaws behind this paper, which is understandable if you read the Lancet publication at face value without knowing the background of the authors, so effectively exposed by Brian Deer and others, and the damning testimony presented at the recent Autism Omnibus. However, if he is aware of these flaws, and wrote this comment in spite of them, then he is truly a voice crying in the scientific wilderness.
I am sure Prof Mawson is very good at what he normally does and is expert in area that he understands. However, if he claims the right to assert that this terrible paper is "well-written and brilliantly documented" then I claim the right to call him pompous - in fact I feel I'm being reasonably restrained.
I'm not trying to set up a cagefight but I rather agree with this.
"Dr Crippen is notoriously scathing towards the value of PhDs and other higher degrees when nurses comment that they have them. What would his attitude be to those BAs and MAs in sociology and psychology, or the MPH or DrPH if a nurse were to report that s/he had them and was using them as a basis to claim academic credibility or excellence for Wakefield's work? Just why are Mawson's qualifications more relevant and why do they make his opinions more deserving of consideration?"
Would this be the same Mawson whose theories about female flight attendants and breast cancer risk won him special attention from Junk Science amongst others? And for whom one of the kindest descriptions of this work was "unusual and untested" theories?
Mary P
""Dr Crippen is notoriously scathing towards the value of PhDs and other higher degrees when nurses comment that they have them. What would his attitude be to those BAs and MAs in sociology and psychology, or the MPH or DrPH if a nurse were to report that s/he had them and was using them as a basis to claim academic credibility or excellence for Wakefield's work? Just why are Mawson's qualifications more relevant and why do they make his opinions more deserving of consideration?"
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tush, tush.
Very unlike Shinga.
On what grounds to you say I am "scathing towards the value of PHds (etc) when nurses comment that they have them?"
I AM scathing about nurses pretending to be doctors. I am scathing about GPs masquerading as consultants.
I have not in fact commented on Professor Mawson's qualifications other than to point them out.
And he is an epidemiologist.
He is surely well placed to comment on the incidence and aetiology of autism, and of the effects on the community of MMRs
John
Yes, it is unlike me, so perhaps it is indicative of something in itself...
It is certainly my impression that you have questioned the value and relevance of degrees that nurses report that they have in any of the too-frequent "Mirror, mirror on the wall, who is smartest of them all" threads.
I think it is a tad disingenous to claim that you have not commented on Prof Mawson's qualifications when you introduce them with the stand-alone sentence: "Professor Mawson’s views need consideration".
I also wonder if it would have been helpful for you to comment on the qualifications for the benefit of readers who are not accustomed to de-coding the significance of some of them. I had several discussions with colleagues who did not realise that DrPH is not equivalent to a PhD. Several of those colleagues also thought that Mawson has some medical qualifications, given the context of the discussion.
You write: "He is surely well placed to comment on the incidence and aetiology of autism, and of the effects on the community of MMRs". If you can point me to some of his relevant publications in these areas, I promise that I shall look at them. In default of any - why are his comments any more worthy of consideration than any other commenter here, such as Anthony Cox or Dr RJ?
The Wakefield paper is not an epidemiological study. It is a small case series, and it was fatally flawed well before it was submitted for publication.
So why is the opinion of an epidemiologist on a paper that is clearly outside their area of expertise, and should, by the journals own admission, have never been published in the first place, of any special value in the so-called "debate" on MMR and autism?
You write: "He is surely well placed to comment on the incidence and aetiology of autism, and of the effects on the community of MMRs". If you can point me to some of his relevant publications in these areas, I promise that I shall look at them. In default of any - why are his comments any more worthy of consideration than any other commenter here, such as Anthony Cox or Dr RJ?
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I do not anywhere say that I think Mawson's views are more valid than Anthony Cox's - or anyone else for that matter. Anythony Cox in particular writes with a great deal of authority in a variety of places.
Why is it a tad disingenuous to say the Professor Mawsons veiws deserve considered?
Why should they not be considered?
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Yes, it is unlike me, so perhaps it is indicative of something in itself...
It is certainly my impression that you have questioned the value and relevance of degrees that nurses report that they have in any of the too-frequent "Mirror, mirror on the wall, who is smartest of them all" threads.
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You are being uncharacteristically unfair here. You know full well the one of the NHS BLOG DOCTOR mission statements is to fight against the dumbing down of the health service. At no stage do I say that a degree is worthless BECAUSE A NURSE HOLDS IT. Never. I do say, frequently, that a raft of qualifications, up to and including PhD's do not turn nurses into doctors. And they don't. I am also critical of some of the modern degress that are little more than applied psychobabel.
I DO agree with you that too many threads in the comments have deteriorated into "I am cleverer than you"... which is a shame.
Nonetheless, I DO believe that you need a higher degree of intellectual ability to qualify as a doctor than as a nurse. It does NOT flow from that (and I am sure you understand this, though many who read the comments don't) that all doctors are clever than all nurses. Of course they are not.
But however clever I am, if I have not trained to be a doctor, then I am not a doctor.
I shall continue to campaign against dumbing down, and every time one of my patients is inappropriately treated by someone who is not medically qualified, I shall reinforce the strength of the complaints.
The general public simply does not understand what is going on in "hospital at night"
JOhn
I'm puzzled. Why allusions to Ethics Committees and the like, when "Wakefield has been exposed as a liar and fraud"? If the latter is true, none of the rest matters tuppence, does it?
dearieme
Yes, I agree. The financial side of the Wakefield story is worrying. Trouble is, it is not possible to do medical research in this country without support from drug companies. That is a fact of life. So lines have to be drawn and doctors have to be meticulous not to stray. I find the unquantified "honararia" worrying, but everyone does that. Does common practice make something acceptable?
I don't know.
But, from what we know from Deer, Wakefield seems to have strayed beyond acceptable practice. We shall see what the GMC makes of it
John
Dr rj wrote ...results of human research obtained without prior institutional ethical approval is invalid, regardless of how scientifically valid the results appear to be?
A fine ringing statement, but you don't explain why such research is invalid. I may be obtuse, but the argument is not self-evident to me. Please could you explain.
John
As I have been repeating, scientifically Wakefield has been clearly revealed as a "data cherry picker" of the worst order; he edited the data to get the result he wanted in a way that meant the results of his lab's work could not remotely be relied on. That is the essence of Nick Chadwick's and others' testimony.
Whilst it is fair to say that all scientific and medical researchers will apply a bit of "sifting" to get sense out of data sets with a lot of "noise" in them, when a lab boss ends up basically telling the researchers what result to bring him, and promotes a clear and one-sided message the lab's own results clearly contradict, that person is a "data uber-tweaker" (at best) and a near-to scientific fraudster if one is taking the hard line.
(personally I would reserve "scientific fraud" for people who invent or alter the data, like Hwang Woo Suk, rather than just omitting anything that contradicts their preferred message, although not everyone would agree with that definition).
The point is that no objective "data analyst", given:
i. ALL the data from Wakefield's lab, including the negative stuff that Wakefield deep-sixed;
ii. the accurate info about how the patients were selected (i.e. they were the ones whose parents were suing and were convinced MMR was the autism cause);
iii. the B/G showing the endoscopy findings had been widely reported as being common in normal kids;
- could reasonably have come up with the view that Wakefield did.
To a scientist, the data are the thing that you have to stand on. They cannot simply be pictures to illustrate a story you have already written. If they are, you are guilty of the sort of cargo cult science that Richard Feynman famously skewered:
http://www.lhup.edu/~dsimanek/cargocul.htm
As Feynman would say it, Wakefield displayed a thorough lack of scientific integrity. That makes him a rotten scientist, even if his motives were sincere (i.e. he did it because he became, and still is, convinced MMR caused the kids' bowel symptoms).
With reference to Professor Mawson's analysis, what he is saying is "if we took this paper in isolation, as it stands, it meets the standard criteria for a case series study". But everything we now know about Wakefield and his methods shows precisely that we CAN'T take the paper at face value, as we now know all the back-stage sleight-of hand editing that produced something that superficially LOOKS OK.
Dr Crippen - sorry, just seen your comment in Haloscan over with me - I have a Haloscan/Blogger, never twain shall overlap thing.
I am issuing a blanket apology for any unfairness - it is unlike me and I am truly contrite for that. And yes, I am failing to distinguish between your nuanced arguments and the tendency for it to generate the playground taunting that can be not only irksome but distracts from the main issue.
-------
However, I wrote: "I think it is a tad disingenous to claim that you have not commented on Prof Mawson's qualifications when you introduce them with the stand-alone sentence: "Professor Mawson’s views need consideration"." - which is not quite the same thing as you quote. I think it is important to stay with the issue of the quality of the research but your introduction frames the way in which Mawson's qualifications are perceived. I stand by the fact that your introduction of him, in that stand-alone sentence, in such proximity to a bunch of posts/positions, and a link to a CV that you would need a certain amount of experience to interpret, would seem to confer a certain gravitas upon his opinions.
You have not addressed Dr RJ's arguments and comments which I thought were particularly well-founded - amongst several others.
I will wait to comment on the comment left on the petition by somebody purporting to be Dr Mawson - I have asked him to authenticate whether or not it is his 'signature'. However, I do have cold-water down my spine at the idea that an epidemiologist (and it is not confirmed that it is Dr Mawson) is promoting:
1 the need for "unfettered research" (see Dr RJ's comments above).
2 the idea that "autism (and related problems of children)...are undoubtedly increasing to epidemic proportions" which is in sharp contrast to the reports of noted epidemiologists in this area such as Eric Fombonne.
Yes - it has just been confirmed that both of those signatories are Prof Mawson.
I have suggested that it might be helpful if he would consider joining in the discussion on this thread.
I think that several people would be interested in his reasons for discounting issues that might appear pertinent. E.g.,:
1 the work of Chadwick, Bustin et al with reference to the presence of measles in the samples
2 the reconsideration by Walker-Smith et al. that there were no extraordinary findings in the bowel examinations (as per my ref above, PhD scientist, Dr RJ etc.)
3 the temporal association that was substantially revised
4 special insights on the brilliant documentation, particularly as we are fortunate enough to have Brian Deer's side-by-side comparison of changes to the data-interpretation of the initial and final drafts of the paper
5 the contemporaneous preparations for media announcements etc. that mean, despite the best endeavours of PoMo theorists, that this paper can not be interpreted as a stand-alone entity but what advertisers/PR people would refer to as a starburst to a media event.
re. Mawson's statement on the petition Shinga refers to, I find the statement really quite disturbing. Mawson asserts that "Dr. Andrew Wakefield is a reputable and conscientious physician and a brilliant clinical scientist of high moral character. I support this petition to allow Dr. Wakefield and all doctors -- and indeed all qualified individuals -- to vigorously investigate the causes of autism (and related problems of children that are undoubtedly increasing to epidemic proportions) and to follow clues wherever they may lead. [There is a] need for unfettered research on the causes of autism, epilepsy, learning disabilities, atopy, etc."
Given the accusations against Wakefield - including unethical research on children - it would be easy to conclude that Mawson is defendng the 'right' of 'all qualified individuals' to carry out research on issues such as autism - 'unfettered' by the normal ethical restraints. And, re. Wakefield's 'moral character', while the GMC is still discussing his case, Wakefield is on video talking about paying children for blood at a party.
I really hope I'm misinterpreting what Mawson is saying, but it's hard (for me) to see what else he might have meant...
It's a well-made point, Jon.
At which point on the Autistic Spectrum/ADD/ADHD/learning disabilities/atopy spectrum does the need for "unfettered research" give way to the need to re-implement usual ethical and experimental considerations?
Jack,
A very good point.
Ethics committees / review boards are often seen as a annoying and unnecessary bureaucratic hurdle for ambitious clinical researchers - as a researcher and a member of ethics committees, I am acutely aware of this.
There is a common misperception about their purpose. They are not there to ensure that proposed research is scientifically valid - they are there to protect the participants in the study (and to a lesser extent the institutions where the research is being performed)from harm.
I would suggest you read the excellent Wikipedia entry on the Tuskagee study (sorry, typo in my first entry) for an extreme example of what "well-intentioned" human research without ethical oversight can result in.
Imagine you were an an unknowing participant in that study. Would you want the doctors who academically profit from your dataset lauded around the world as "brave champions" who had the guts to thumb their nose at convention and not treat you for your infection, when they knew you would almost certainly develop tertiary syphilis?
Even if you did agree to this, no ethical clinician would accept the findings of such a study as scientifically valid if performed today, because we've learned the lessons of the past.
Should we use the data from human experimental studies performed *before* informed consent became standard of care? That's a very contentious issue, but most experts in the area would say no. In my clinical practice, I treat patients with tertiary syphilis, the clinical features of which were known well before the Tuskagee study, so fortunately I don't have to rely on the "tainted" data to help me treat my patients.
Mawson couldn't be more wrong. In May 1996, Wakefield described what he said was "a new syndrome", set up a study designed to "conclusively" prove its existence, got money from the British government's legal aid fund to pay for the "research", and, surprise, surprise, "found" his syndrome. He published it in the Lancet in February 1998.
This was not a retrospective write-up of cases, as Mr Mawson wrongly claims. It is true, however, that Wakefield is spreading that falsehood as part of his efforts to escape charges of serious professional misconduct before the UK General Medical Council.
What causes Mr Mawson to say these untrue things is a mystery. I expect we'll be hearing more from him.
Brian Deer
I was uncharacteristically annoyed about this piece because of Prof. Mawson's comments on the petition. The UK newspapers have carried several pieces by Dr Richard Halvorsen who has referred to the vaccination programme as an unregulated experiment with children as guinea pigs. This is not an uncommon belief/rhetorical device among both anti-vaxers and those who claim that they are not anti-vax but anti-the-immunisation-schedule.
Yet - here we have "a well-respected epidemiologist in the USA" calling for "unfettered research" on children in a petition that claims a myriad of untested, unevaluated vaccine damage is contributing to a slew of modern ills.
Private Eye
8 June - 21 June 2007
MMR
Conflict of Interest Zone
Red faces at the General Medical Council (GMC), which next month will decide whether Dr Andrew Wakefield is to be struck off for allegedly failing to declare a conflict of interest between his research and his role as an expert in the MMR litigation.
The man chosen to chair the GMC's disciplinary panel deciding Dr Wakefield's fate and that of two of his former colleagues at London's Royal Free Hospital, has an unfortunate clash of interest of his own.
Prof Denis McDevitt, a clinical pharmacologist, once sat on the government advisory committee that looked at adverse reactions to vaccinations and immunisations and considered issues of MMR safety. He attended meetings that discussed warnings from other countries about an early form of the triple jab, using the Urabe strain of mumps virus, which caused encephalitis and meningitis.
Despite warnings and the fact that this vaccine had already been withdrawn in Canada, the Urabe-containing jab was introduced in the UK in 1988. After it caused meningitis and encephalitis in children, it was finally withdrawn in 1992 and replaced with the safer - and more expensive - MMR II. (Eye readers may recall how the drug manufacturers off-loaded their dodgy vaccine to Brazil where a hospital in Salvador was said to have been "saturated" with encephalitis cases.)
Some of the 12 children whose medical history featured in the controversial 1998 Lancet paper, drawn up by Dr Wakefield and his colleagues and which suggested a possible link between the jab and bowel disease and regressive autism, had received the Urabe-strain vaccine - as indeed had some of those children in the high court litigation with manufacturers.
In fact another embarrassing clash of interest has arisen in the law courts too. Parents who claimed their children were damaged by the vaccine have complained that Mr Justice Davis, the judge who in 2004 sanctioned the withdrawal of legal aid, should never have sat on the case. His brother, Sir Crispin Davis, is a non-executive director and shareholder of Glaxo SmithKline, one of the defendant drug companies in the litigation. The loss of legal aid effectively scuppered the claims of most of the 1,000-plus families who were suing.
A spokesman for Mr Justice Davis said that "the possibility of any conflict of interest arising from his brother's position was not raised with him and did not occur to him. If he was wrong, any possible remedy must be sought from the court of appeal."
Meanwhile, back at the GMC the Eye asked if Prof McDevitt was being removed from the disciplinary panel. A spokeswoman said the composition of panels was never discussed ahead of hearings, but that "as with any case we will have satisfied ourselves that there is no conflict of interest for any of the panellists". We assume that means he will not now be sitting. Watch this space.
London Evening Standard 09/05/2007
'MMR judge faces probe over brother's link to vaccine firm'
The Londoner's Diary, Evening Standard, May 9 2007.
You might have thought that a judge presented with a case regarding MMR vaccines and the link to autism would declare that his brother was a director of MMR vaccine manufacturer Glaxo SmithKline Beecham. But you would be wrong.
Sir Nigel Davis was the judge who, three years ago, rejected an appeal by MMR vaccine litigants against the decision not to award funding for their legal campaign. But he failed to mention his interests in the subject.
Now, complaints against him are being filed to the Office for Judicial Complaints, which investigates allegations of any questionable conduct by judges, coroners and magistrates.
Davis's brother, Sir Crispin Davis, was appointed a non-executive director of drugs multinational Glaxo Smith Kline in 2003, a year before the appeal came to court. Asked why Sir Nigel did not declare this, his spokesman said: "The possibility of any interest arising from his brother's position did not occur to him."
But Sir Crispin's potential links with MMR vaccines goes back longer than that, as since 1999 he had been CEO of Reed Elsevier, the publishing company which owns The Lancet magazine.
Although The Lancet had originally published research into the links between autism and MMR by Dr Andrew Wakefield in 1998, by 2004 the magazine regretted ever having done so. The Lancet had announced its change of heart only the week before Sir Nigel was due to make his decision on the MMR litigants' appeal, sparking a sudden backlash against the theory in the media, and prompting the Prime Minister to say "There is absolutely no evidence to support this link between MMRand autism".
The quashing of the MMR litigants case would have a huge relief to the government, who could have faced massive pay outs had they successfully sued the drugs companies over the effects of MMR.
Sir Crispin Davis was knighted by Blair's government in June 2004, only four after the Lancet article was published (sic).
Thanks to both anonymouses for this info.
Welledy welledy welledy...
Divine Goddess
I think it is a matter of concern that charges short be brought forward when no parent has complained, including those who were not party to litigation. The complaint seems to stem from Brian Deer. I have to say that his labyrinthine site seems to me to be anything but a model of clarity or balance (animous towards Dr Wakefield seems everywhere present), and it is worrying that the charge sheet should be based on this.
It should be noted that neither the Lancet or Sunday Times were able to support the allegations of unethical practice in February 2004(bar the alleged non-disclosure which I see is disputed above by Anthony Cox), and these have been kept alive by the GMC hearing.
I wonder what options contributors to this blog think should be open to parents who see their children become ill and lose mental faculties after vaccine? And whether they think there should be effective legal sanction against manufacturers if things do go wrong?
I cannot see the basis for all this acrimony, which does not belong in any scientific discussion.
John Stone
I see the anti-vaccine trolls have shown up on this thread.
Wakefield's advocates, supporters and lawyers, and their friends in the media (including Private Eye, which has got MMR comprehensively wrong from the beginning) are now trying to portray the ongoing Wakefield saga as another "shady vested interests" story - as opposed to "a bad doctor and rotten reseacher and his deluded conspiracy-mad allies" - the view that is universal among the rank and file scientific and medical communities. Rank and file, note, NOT "conspiracy at the top".
John Stone (last post above) is a key member of the anti-vaccine group JABS, and, under his nom de guerre "Pluralist", haunts various Comment threads (e.g. at the Guardian Commment is Free) projecting the view that most of modern medicine is a conspiracy of powerful vested interests. Notably, he spent some time there claiming that Sir Richard Doll, the founder of modern epidemiology in the UK, was a tainted and corrupt ally of "Big Asbestos" and/or the chemical industry.
Richard Doll is better remembered as the founder of UK epidemiology and for his work conclusively demonstrating the links between smoking and cancer.
Most people with any knowledge of science and medicine will, I suspect, treat a worldview where Richard Doll was a corrupt pawn of special interests, while "Saint Andrew" Wakefield (about whose conflicts of interest Brian Deer has been so enlightening) is a wronged crusader, with the derision it deserves.
John Stone,
In Australia, the US, and presumably the UK and other developed countries, parents have access to compensation if it is found that their child has been injured by a vaccine.
For example, if there was a demonstrable fault in the process of vaccine manufacture or administration leading to a injury or loss, then there are established legal avenues to seek redress.
However, if an adverse effect occurred which is known to be associated with that vaccine, and the possibility of the adverse event occurring was explained to the parent / patient prior to vaccination, then the company that manufactured the vaccine, or the provider that administered it, will be unlikely to be considered liable for the injury. This is the basis of informed consent.
If, however, a parent/ anti MMR / thimerosal lobby group claims the child has been injured by a vaccine, but cannot provide any evidence to support this claim other than their beliefs (as per the Autism Omnibus proceedings, which were a comprehensive defeat for these groups), then neither the taxpayer nor the pharma company should be liable.
The Wakefield et al GMC hearings are based purely on the conduct of their research. Wakefield and his group proposed a new medical syndrome ("autistic enterocolitis"), then tried to build a case for it, all whilst receiving monetary support from litigants with a strong interest in a "positive" outcome of the "research".
Whilst it could be reasonably argued that this is no different from a pharma company conducting research where the funder has an interest in a positive result, the key differences are that a) on the basis of Brian Deer's work and the Autism Omnibus testimony from Wakefield's own colleagues, it is clear to anyone with an understanding of clinical research that that there was minimal to no supporting scientific evidence that this syndrome ever existed, and b) Wakefield and colleagues did not conduct the research in an ethically or scientifically valid way, and did not declare conflict of interests before commencing the research or submitting it for publication.
To suggest that the GMC is going after Wakefield because "they" want to close down access to compensation for children injured by vaccines, or to impede research regarding the aetiology of autism is a strawman argument that deflects attention from the real, and very serious, reasons why his and his colleagues fitness to practice is being examined.
It is rather pitiful to have to fend off ad hominem anonymous attacks.
The point stands that it is rather surprising that the Sunday Times gave Brian Deer a platform at all given their lack of faith in the story. They indeed only ran with conflict of interest in February 2004, and they have not been giving him much "air space" recently. The Sunday Times version of the patent story also admitted that there had been no impropriety.
I fear Richard Doll's reputation, particularly in his later career, would now be controversial even without my contribution - both as regards the safety of asbestos and Agent Orange.
The second poster answers entirely different questions to those I posed.
But when it comes to conflict perhaps Brian Deer would like to tell us how his work has been paid in the last four years? For instance, I understand that he was at the recent Washington hearing. I wonder how that was financed?
John Stone
In his orginal investigation Brian Deer was assisted by MedicoLegal Investigations (MLI):
http://web.archive.org/web/20041123004905/www.medicolegal-investigations.com/news8.htm
MLI is closely affiliated to the Association of the British Pharmaceutical Industry:
"MLI has achieved recognition for its success in tackling research fraud. The ABPI Board of Management has demonstrated its support in nominating Mike Wallace (a vice-president of ABPI) and Dr Richard Tiner (ABPI Medical Director) to join the Board of MLI. Dr Jane barrett joined MLI in February 2002 as the new consultant medical adviser and joined the Board of MLI as a Non-Executive Director on 1st April 2002."
http://www.computer.brecon.co.uk/medico/about1.htm
John Stone
I would just like to add for the benefit of 'PhD Scientist' that even when I post as 'Pluralist' (which only happens on Guardian CiF) I always make it quite clear who I am if am saying anything sensitive - unlike some people.
John Stone
John Stone's posts essentially project the view that anything funded (at any remove) by the Pharma industry must be tainted.
These kind of links can be viewed, and should be declared in peer-reviewed publications, as a "competing interest". But that does not intrinsically make suspect what the people from organisations which in part depend on such funding say.
Speaking as an academic with some involvement in trying to explain science to the public, one of the problems we have is that experts' time is not free. My University takes the view that it pays me primarily to do research and teach students, not to debunk poor science on internet forums, or even in the press. Most of the people who do a sterling job online trying to correct public misconceptions about scientific and medical evidence do it in their spare time - e.g. Ben Goldacre, Prof David Colquhoun, and the American surgeon/scientist who blogs as Orac at "Respectful Insolence":
http:/badscience.net
http://www.dcscience.net/improbable.html
http://scienceblogs.com/insolence/
They are, to repeat, doing this in their spare time, after finishing the day job, and for no financial reward. Just like Dr Crippen.
However, these folk are the exception. Most ordinary people have to earn a living. Brian Deer is a professional journalist, and as such I don't suppose he works for free, or pays his own expenses.
And then consider the need for professional lobbying to combat the media storm of disinformation generated by (e.g.) the MMR scare, or the recent spate of stories about Wi-Fi.
A set-up like Sense About Science
http://www.senseaboutscience.org.uk/
- costs a fair bit to run. Offices in London cost money to rent. Staff need to be paid.
I am pretty sure it is far harder to raise money by mass donation to reassure people about scientific issues than it is to raise money to scare them witless about MMR, or GM food, or evil doctors. And I doubt that the Legal Aid fund would give me millions of pounds to sue JABS for potentially damaging children who get measles complications by collapsing confidence in vaccines.
As a result of the need for underpinning finance, groups that combat nonsense science will typically be funded by organisations that believe in science and evidence.
Often this will be industry.
If some company were to offer me a couple of hundred grand to set up an organisation to debunk bad science, I would take the money, provided it was clear that they would have no role in setting the organisation's specific agenda. It's that simple.
I would assume their reason for giving me the money was that better understanding of why good science is good, and bad science is bad, could only aid people in making reasoned decisions about their health and about scientific issues.
Austin Elliott
University of Manchester
Austin Elliot says "As a result of the need for underpinning finance, groups that combat nonsense science will typically be funded by organisations that believe in science and evidence.
Often this will be industry."
If industry was a 'zion' of science and evidence why would so much research have been seen to be falsified and so many publications have been severely criticised?
I think Austin should open his eyes to the reality faced by recipients of so much of industries 'science' - the world is awash with the fallout. Remaining in denial does little to reassure mankind but much for said industries with their their well paid 'scientists'.
Science is merely methodology, and that methodology can be used for good or ill; a point that seems to be missed by those who see science as some kind of religious virtue.
Austin Elliot's response looks more than a little like humbug. What apart from anything else I am arguing is that any money paid to Wakefield by the Legal Aid Board or the Legal Services Commission was not uniquely tainted. We know that the £55,000 reported in Deer's original article was paid to the Royal Free Hospital not Wakefield. We know that he subsequently received a lot of money but we do not know that it went into his pocket, since by that stage research was not being funded through the hospital.
Besides I should like to know who was paying Deer - we know, after all, in Wakefield's case that he was being funded by the state. I suppose it is just possible that Deer paid MLI for their help out of his own pocket, but I would not bet on it.
But the interesting point is that it looks like a load of tosh, which the Sunday Times published but did not really back.
I gather, incidentally, that Stephen Bustin was paid £225,000 for 1500 hours work by the defendant companies through a solicitor, according to his Washington testimony. So, we ask, what is the big deal about money paid to Wakefield?
Double standards, I should say.
Incidentally, I am paid no money at all.
John Stone
Science is absolutely NOT "merely methodology", John. It is far more than that. Philosophically it is the key creation of the European Enlightenment, since it gives us a way of looking at the world (observe, construct theory, test theory eliminating all confounding influences, reject or revise theory, next iteration) which progressively gives us more accurate explanations of how the world works.
That it can sometimes be used for bad ends, e.g. "Let's come up with a more efficient way of mass killing", does not invalidate the approach. Nor does the fact that some people fiddle the data to serve a predetermined end (which is, Brian Deer's work conclusively shows, precisely what Andrew Wakefield did).
So scientists do not deny that some people apply the scientific method method imperfectly. But that's not the method's fault. IT's just that human beings are human beings.
Overt conflicts of interest in science certainly are a problem - e.g.
"Here we have a data set that if released would lead to our best-selling billion-earning product Nofoxat being taken off the market. What should we do?"
When you set people competing drives like this, no-one can deny the conflict. Sometimes we have to take measures to ensure against problems arising from this.
That is why personally I would be in favour of a compulsory public repository of (e.g.) drug trial data.
But I think you are taking conspiracy way too far if you think that the PharmaCos can actively puppet-strong control something as abstract as promoting general scientific understanding of (e.g.) the vaccine issue.
The indisputable scientific facts are that ALL the reputable science shows MMR is safe. All. And all the Wakefield stuff and other "MMR autism link" work has been comprehensively and repeatedly discredited (to the point of it being shown clearly precisely why they got the wrong answer they did).
So people saying "no link between MMR and autism" are not doing so because they have been bought, or got at. They are saying it because that is what the data says. All of it.
The US hearings on vaccines and autism have been a textbook demonstration of the difference between good and bad science. Unfortunately many people cannot tell the difference, especially when the information is refracted through the prism of misleading media reporting which stresses "scoops" and "mock balance" and "controversy".
Faced with this, many people simply fall back on proxy things like "who are these people friends with?" or "what's their agenda?". Scientists instead try and judge "whose data is accurate".
Anyway, in a world full of competing agendas, I will be sticking with the data. While it is not infallible, partly for the reasons you allude to, it is a lot more "trustworthy" than the alternatives.
Austin Elliott
This article may enlighten Austin Elliott about Sense about Science: George Monbiot, 'Invasion of the Entryists':
http://www.monbiot.com/archives/2003/12/09/invasion-of-the-entryists/
I note the name here of Michael Fitzpatrick.
Elliott may also like to have a look at the Commons Health Select Committee report on 'The Influence of the Pharmaceutical Industry' 2005.
http://www.parliament.the-stationery-office.co.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf
The committee did not make the basic error of eliding the interests of an industrial lobby with objective scientific truth.
John Stone
I do not know whether Austin Elliott is proposing to answer my challenge about double standards over funding. Meanwhile, I should just like to point that the epidemiological evidence over MMR and autism so ofted cited as conclusive (a) cannot decide individual cases (b) surprisingly flawed. Cochrane 05 gave all 5 autism related studies a poor write up before declaring that this did not matter as compared with inportance of the programme. This was then further spun in the press release to suggest that MMR was safe. Actually it had concluded that safety studies were "largely inadequate":
http://www.jpands.org/vol11no4/millerc.pdf
I note some very serious anomalies. When the Madsen study was published Prof Suissa of McGill University noted errors in the data set (also later noted by cochrane). He recalculated from the raw data that instead children who had MMR being 8% less likely to be autistic than unvaccinated they were 45% more like. New England Journal refused to publish his letter, which he later made available to Wakefield:
http://www.jpands.org/vol9no3/stott.pdf
I also recently posted this challenge to Ben Goldacre on JABS, CiF, and the Sunday Herald (to which I await a reply):
"For some time I have been trying to ascertain the basis of Dr Goldacre's alleged scientific pre-eminence in relation to MMR. This has involved contributing extensively to Guardian blogs: for instance the one last week 'Examine the data, not the author' (I have pseudonym "Pluralist") in which once again he suggested that the MMR theory was discounted statistically:
http://www.guardian.co.uk/commentisfree/story/0,,2115422,00.html
"But what, of course, what was absent from this was any data. Week after week the MMR case is cited as one of scientific absurdity in the category of lucky charms, aromatherapy etc. You suspect that despite Goldacre's minimal scientific contribution to this issue he is simply engaged in a propaganda effort, drip feeding Guardian readers. There is a mention in his column again today but unfortunately not open to comment in the Guardian blog. Either way it seems to have been decided that it is worth going on like this on the basis that only a tiny fraction of readers will pick up the critical comments, and the message will get through to the Guardianistas about what they are supposed to think.
"As it happen I have traced an article by Goldacre in which after a fashion he does discuss the data: 'Never Mind the Facts (Guardian 11 December 2003). This article was considered so excellent that it won an Association of British Science Writer's award, which at the time was funded MMR manucturer Glaxo SmithKline:
http://www.absw.org.uk/Awards/abswwinners2003.htm
"Here, then, are Ben's hard facts:
""So here we go, checking out our hunch on big populations. Dr Kreesten Madsen, of the Danish Epidemiology Science Centre, compared 440,000 children who had MMR with 97,000 children who didn't. The children who had MMR were no more likely to develop autism than the children who didn't. In Finland, one group looked at 3 million MMR vaccinations, found only 31 cases of related gut symptoms, and not one of these children went on to develop autism in the next 10 years. A group in London looked at 498 children with autism, to see if they developed it after MMR. They looked at when they had the MMR jab, and when they developed the symptoms or the diagnosis, and found no sudden blip after immunisation. Another paper shows no increase in GP consultations in the six months after immunisation. Two hundred children in London and Stafford with autism were studied to see if there was a new type of autism related to MMR, featuring bowel problems and sudden regression, a bit like in the drama: half had the jab, half didn't, and there was no difference in type of autism between the groups. In California, looking at 1,000 children a year, over 14 years, the number of cases of autism increased by 373%, while the number of children getting MMR increased by only 14% (from 72% to 82%). There's plenty more."
http://www.guardian.co.uk/life/feature/story/0,,1103958,00.html
"In fact, three of studies cited were discussed in Cochrane (2005) and found wanting:
2"The study demonstrates the difficulties of drawing inferences in the absence of a non-exposed population or a clearly defined causal hypothesis". (Re: Taylor 1999)
""The number and possible impact of biases in this study was so high that interpretation of the results was difficult". (Re: Fombonne 2001)
""The interpretation of the study by Madsen was made difficult by the unequal length of follow up for younger cohort members as well as the use of the date of diagnosis rather than onset of symptoms of autism". (Re: Madsen 2002)
"The same kinds of criticism would go for his use of the California data. Where are the controls, and if the trend was upwards why could MMR not have contributed to it? And what about all the additional mercury?
"But the most extraordinary claim of all relates to the Finnish study:
http://www.vaccinesafety.edu/mmrandibd.htm
"Three million shots, and not a single case of autism.
"How could a competent scientist spout this nonsense? The fact was that Peltola et al had conducted a study which did not have in its follow up criteria either autism or inflammatory bowel disease, so they detected not a single case of either in a million and half plus children. This letter was published in the Lancet in May 1998 (amidst international publicity) to knock Wakefield on the head, and it is cited by Goldacre as "good science". Incredible.
"So Ben, is this it?"
John Stone
John Stone claims:
"The second poster answers entirely different questions to those I posed".
The questions you posed were:
"I wonder what options contributors to this blog think should be open to parents who see their children become ill and lose mental faculties after vaccine? And whether they think there should be effective legal sanction against manufacturers if things do go wrong?"
The response provided was:
"In Australia, the US, and presumably the UK and other developed countries, parents have access to compensation if it is found that their child has been injured by a vaccine.
For example, if there was a demonstrable fault in the process of vaccine manufacture or administration leading to a injury or loss, then there are established legal avenues to seek redress.
However, if an adverse effect occurred which is known to be associated with that vaccine, and the possibility of the adverse event occurring was explained to the parent / patient prior to vaccination, then the company that manufactured the vaccine, or the provider that administered it, will be unlikely to be considered liable for the injury. This is the basis of informed consent.
If, however, a parent/ anti MMR / thimerosal lobby group claims the child has been injured by a vaccine, but cannot provide any evidence to support this claim other than their beliefs (as per the Autism Omnibus proceedings, which were a comprehensive defeat for these groups), then neither the taxpayer nor the pharma company should be liable."
i.e the respondent *did* answer your questions.
It seems that, if you don't provide the answer John Stone wants to his questions, then you haven't answered them.
Thank you Dr RJ
Anonymous gave me an answer conditional on his/her view of the problem. It was not a direct answer, it was an oblique answer. What you have done, however, is to assert something, not demonstrate it. I have an autistic son who by and large thrives physically. I am well aware that this is a different case from X round the corner who was one of Wakefield's 1998 subjects. X, apart from being cognitively impaired has been chronically ill with a gastro-intestinal disorder since MMR 13 years ago. It seems to me to be risible, being well acquainted with X and his extreme problems, to claim that this is a simple case of constipation, or that he should not have had a colonoscopy on the principle that he was autistic, and therefore did not inflammatory bowel disease.
As soon as Wakefield started to look at such cases he became the object of official opprobrium and disdain. He simply had to be wrong, completely out of order etc.
If you visit MMR the Facts NHS website you will see in question and answer form the following advice in question and answer format:
Q: "My son had a sever reaction to the first MMR jab. Does this mean that he is well protected from these diseases, or is a second dose still necessary?"
A: "If a child has responded to all the components of the vaccine the first time, he will not have a problem being exposed to the viruses again. It's like any one of us who is already immune meeting someone with the disease - the infection can't get established.
"If he hasn't made protection to all three diseases after the first time, then he would still be susceptible to those natural infections, and still needs the 2nd dose.
"Reactions after the 2nd dose are essentially the same as after the 1st dose, but if they do occur they are even rarer. There are no new side effects after the 2nd dose that do not occur after the 1st dose. The advice is therefore that it is safe for your child to have the 2nd dose in order that he is properly protected."
http://www.mmrthefacts.nhs.uk/questions/question.php?id=79
It is not unreasonable to point out that apart from being unsafe and unethical, this advice skews the evidence base: there is no follow and any parent who protests that their child has been irrevocably altered will be dismissed out of hand. We should be asking, if the system is so excellent where are the yellow cards, the monitoring, the investigation, the practices of ethical medicine?
I do not pretend to have all the answers, but I do know that the present system in relation to vaccine is one of ruthless assertion and denial, and is therefore inherently unsafe.
John Stone
Thank you Dr RJ
Anonymous gave me an answer conditional on his/her view of the problem. It was not a direct answer, it was an oblique answer. What you have done, however, is to assert something, not demonstrate it. I have an autistic son who by and large thrives physically. I am well aware that this is a different case from X round the corner who was one of Wakefield's 1998 subjects. X, apart from being cognitively impaired has been chronically ill with a gastro-intestinal disorder since MMR 13 years ago. It seems to me to be risible, being well acquainted with X and his extreme problems, to claim that this is a simple case of constipation, or that he should not have had a colonoscopy on the principle that he was autistic, and therefore did not inflammatory bowel disease.
As soon as Wakefield started to look at such cases he became the object of official opprobrium and disdain. He simply had to be wrong, completely out of order etc.
If you visit MMR the Facts NHS website you will see in question and answer form the following advice in question and answer format:
Q: "My son had a sever reaction to the first MMR jab. Does this mean that he is well protected from these diseases, or is a second dose still necessary?"
A: "If a child has responded to all the components of the vaccine the first time, he will not have a problem being exposed to the viruses again. It's like any one of us who is already immune meeting someone with the disease - the infection can't get established.
"If he hasn't made protection to all three diseases after the first time, then he would still be susceptible to those natural infections, and still needs the 2nd dose.
"Reactions after the 2nd dose are essentially the same as after the 1st dose, but if they do occur they are even rarer. There are no new side effects after the 2nd dose that do not occur after the 1st dose. The advice is therefore that it is safe for your child to have the 2nd dose in order that he is properly protected."
http://www.mmrthefacts.nhs.uk/questions/question.php?id=79
It is not unreasonable to point out that apart from being unsafe and unethical, this advice skews the evidence base: there is no follow and any parent who protests that their child has been irrevocably altered will be dismissed out of hand. We should be asking, if the system is so excellent where are the yellow cards, the monitoring, the investigation, the practices of ethical medicine?
I do not pretend to have all the answers, but I do know that the present system in relation to vaccine is one of ruthless assertion and denial, and is therefore inherently unsafe.
John Stone
Dr RJ, Austin Elliott et al.
- There is no point arguing with John Stone. Like Andrew Wakefield, he is a True Believer. Nothing will , or could, unconvince John of "MMR caused the autism." There is no experiment that could do this, because his view is a matter of Belief, not Evidence.
The quoting of studies, data and details may obscure this, but that is what is at the heart of the obsession. Nothing, repeat, nothing, can change these peoples' minds. Their psychological need, firstly to blame some agency or action for the autism (rather than random chance or a quirk of genetics), and secondly to believe that hidden dark interests conspire against them, is too strong.
The next "orbit" of the tragedy is that this misguided belief and tragic need drives the parents, and the anti-vaccine campaigners, and Andrew Wakefield, on and on in an ever tighter circle of self-sustaining fanaticism. Wakefield's need to be right is reinforced by the parents' desperate need for someone or something to blame. And so on and so on.
And all enabled, reprehensibly, by lawyers trousering fat fees, and media idiots writing scare stories and feeding their own conspiracy manias.
And so it spins out to the public, raising needless doubts about vaccines - one of the greatest achievements of modern medicine - and generating mistrust of doctors and scientists.
Truly a modern tragedy.
As an alternative-health practitioner who deals with suspected cases of vaccionation damage I believe the attempt to obtain a clear answer about this causal relation is wrong-headed.
Clearly the relation is not direct, but mediated by the sensitivity of the patient which varies immensely from case to case. A statistical analysis trying to find a causal relation will therefore fail because of the non-direct nature of the causal relation and its relative rarity.
Instead, we should pay attention to the fact that many cases of autism and other immune-mediated disturbances do trace back to a history of a negative reaction to vaccination. These reports come from doctors and parents alike, and I personally know of an conservative-minded medical doctor who stopped vaccinating all his subsequent children following the negative reaction of his eldest child which led to severe autism - this happened not recently but back in the 60s when none of the fears around vaccination were in the air!
Given that the causal relation might never be clear, but clinical data is at least suggestive of a suspicion of a link, we need to be asking whether vaccination is always a good thing: In the third-world it very likely is, but perhaps the calculus of cost-vs-benefit is different in an affluent nation in 2007. For example, we may be able to deal with measles using contemporary medical techniques far better than 50 years ago, so a vaccination might no longer be worthwhile.
Instead, the medical community persists in presupposing that the morbidity from, say, measles relative to the morbidity from measles vaccination has remained the same over time. But this is completely unproven, and though it may be problematic to test this assertion as it would require an unvaccinated control group which could affect herd immunity, it is still incumbent on the scientific community to undertake such trials if it is to claim that the practice of vaccination is scientific on a continuous basis, as opposed to a historical basis alone.
PhD Scientist
Yes, I agree that is an effective strategy for not entering into dialogue, and not answering the challenge of awkward questions. But the reality is that the several points I have made about history, methodology and ethics have only been met with patronising ad hominem disdain, and silence.
I believe if I could have had direct, convincing answers I would have done.
I do not, incidentally, think that the autism issue is simply a matter of vaccines, but I also do not believe that search and ininvestigation of environmental triggers will every easily be accepted by government, industry or the medical establishment.
Your answer to my specific challenges is essentially a social ploy. Not an answer at all.
John Stone
You've been unduly modest about not claiming to know all the answers, haven't you?
Brian Deer
"Stone is a doyen of persistent petty complainers [read an example here], most celebrated in my reckoning for having hassled the British Medical Journal into publishing a "correction" to a review of my November 2004 Channel 4 Dispatches investigation of Wakefield - only for the journal then to publish a retraction of the "correction", since what Stone had told them was bollocks."
Unfortunate, the easy resort to personal abuse. BMJ corrections are very obscure things so I do not know how to locate this point with any certainty. At the time an editor drew my attention to it, otherwise I would never have seen it. My memory is that it involved two studies and it was impossible to know which BD was referring to. Also Deer's reporting scarcely explains what the issue was here, but it was simply a good enough pretext it seems to be abusive about me.
I do not claim to be infallible. There are, however, many other issues I have raised about BD's journalism regarding which he has preferred to remain silent: some of the points above, for example. If these matters are of concern I am not sure why BD always expects his version to be undisputed.
I would like to point out that right or wrong the issues which I have highlighted here are of extreme seriousness, and not at all petty.
John Stone
So, to sum this blog up, we have people like John Stone and a alternative health practitioner asking quite relevant, clear and objective questions. We have journal reviews which the gov't and people like Brian Deer put forth as the authoritative stamp that no way could vaccines cause autoimmunity (myelin basic protein etc. etc.), autism or numerous other conditions. We see clear objective criticisms of those studies which have been put forth again and again; yet the only response to date is ad hominem attacks or to ignore them as if they didn't exist.
We see health officialesque answers put forth such as: vaccine injuries are compensated if they are proven to cause the injury. Yet, it is a known fact that the tracking of adverse reactions is pathetic. John Stone asks where is the yellow cards? I don't think vaccinators know what the color yellow is. But we're suppossed to feel all warm and fuzzy because there is a "compensation program" based on extremely poor tracking of reacionts; and suppossedly with no road blocks or legal protection for vaccine manufacturers.
We are told to believe that you bring your child in normal for these "life saving" vaccines and if your child does a complete 180 health wise within a day, week or even a month (should be tracked for at least a year) that there's this mysterious coincidence. That your child had an internal clock which was going to cause severe gut pain, inability to speak, or even die anyways and the vaccine was an innocent bystander. The internal clock program list is exponentially longer than that, however. But if they had a mild rash or other type of reaction to any other drug a red flag goes in the chart signaing to all future passers by to stay far far away from that drug. Perhaps when thinking of the herd, inverse logic applies???
All of this based upon the gold standard premise that vaccines are solely responsible for eliminating all these diseases. Inverse logic is applied by pro-vaccinators when one sees a graph that small pox vaccines and mortality have a mirror relationship (i.e. the more the vaccine was received, the more deaths occurred and vice versa...just another coincidence I suppose). Furthermore, if one looks at the passive immunity from mother to baby, one sees that vaccines have made infants more vulnerable by adversely effecting the passing of maternal antibodies. One sees that vaccine immunity is short lived and adults growing up in the vaccine era, now have these diseases (i.e. Japan universities and measles, U.S. and the call for adults to get pertussis vaccine...).
The premise was flawed and so is the monitoring of the safety of the premise.
We see the "experts" of this blog say that lay people should not be allowed to read the lancet, yet these "experts" turn around and cite Brian Deer and his apparent vested interest rubbish as the final say.
Read this article for a condensed version of the, past and current, world of vaccination. You'll see the increase in polio and Acute Flaccid Paralysis (AFP) in India attributed to better diagnosis or something other than this new (or is it new...Lancet authors and WHO don't seem to agree) vaccine. You'll see poor follow up of these cases. You see comments that the vaccine is safe because we've used it for 50 years (sounds like Cochrane review); nevermind we don't follow up the reactions. You see the Lancet and WHO scratching their head, but you won't see them go after the authors like they did Wakefield, because they support the vaccine and its so called safety:
http://www.tehelka.com/story_main33.asp?filename=Ne280707untested_vaccine.asp
And on and on and on...right PhD scientist?
DrTH
Last try, as I am feeling generous. I will try to be polite.
The scientific and medical experts who HAVE reviewed all the evidence (which to me means people like the CDC in the US) concluded, after exhaustive scrutiny, and lots and lots of extra work post-Wakefield, that there is no evidence vaccines cause autism or the (mythical - no such disease exists) "autistic enterocolitis".
John Stone, sundry alt practitioners and other anti-vaccine types popping up saying "but you DIDN'T account for this, what about this, please give me a reasoned answer?" doesn't alter this. They will always find something else to wave, but to anyone looking at the totality of the evidence the question is scientifically long settled "beyond a reasonable doubt". Well beyond. I have personally never met a scientist or doctor who thinks otherwise.
If we science and medical types get tetchy, it is because we are tired of trying to explain this reasonably to people who cannot be reasoned with, even if they pretend they can.
Nowadays I tell people who ask me about vaccination - commonly worried parents of small children among our friends - the following:
1. Talk to your GP if you are worried - I am a prefessional scientist, but not a medical doctor.
However, if you want my view:
2. Mrs PhD (who is a hospital doctor) and I gave our kids MMR, and would do so again.
3. If you want more info, a good place to start reading about MMR vaccine is Mike Fitzpatrick's book
4. Better not to read any internet forums about MMR or vaccination, as distilling sensible information from scares and conspiracy madness is too difficult.
5. If you ask an alternative practitioner, or a homeopath, they will almost certainly tell you to avoid vaccinating your kids as they make their living feeding your worries on points like this and persuading you to trust them rather than the GP.
On the subject of scientists, and experts, and arguments:
One thing that one accepts as a scientist is that one has areas of competence, and of expertise, and (conversely) areas where one is NOT expert. For those other areas, you (I) can ask questions, but you (I) have to rely on on the real experts telling you/me what the evidence is, and what it is telling us. That is why court cases use expert witnesses.
For instance, Stephen Bustin really is an experts' expert on PCR. I am not, although like thousands of scientists I have used the technique quite a bit. Andrew Wakefield is not, although he used it. John O'Leary is not, ditto. Out of the people mentioned, it is Stephen Bustin who is the real "PCR ninja", so it is his view that I would take to the bank.
One can extend this kind of reasoning, and when one does the expert consensus says Andrew Wakefield was wrong on every single point of note.
First, to recap, the consensus among PCR experts was that the claims for "we detected measles virus in the patients" were erroneous because of data picking, bad methodology and lack of appropriate controls. Several published papers show this.
Next, the consensus among gastroenterologists is that "autistic enterocolitis" does not exist, and the endoscopy findings reported purporting to demonstrate it are actually completely normal.
And: The consensus among autism experts is that there is no rise in autism, and certainly none related in any way to vaccination (see e.g. Simon Baron-Cohen's recent letter to the Observer).
And: The consensus among immunologists is that the entire idea of MMR "overloading" the immune system is total nonsense.
And: The consensus among community paediatricians, and vaccine specialists among them, is that childhood vaccination is indicated except in kids with well-described immune system problems, e.g. those who are HIV positive.
And finally, when the GMC panel delivers its verdict, we will have the experts' view on Wakefield's research and patient care ethics.
John Stone's relentless nit-picking - which is not objective, though it uses the appearance of this as camouflage for his true agenda - doesn't change any of this.
John - for the record, what experimental evidence WOULD convince you that there is NO link between MMR vaccination and autism? Do tell us.
"I think it is a matter of concern that charges short be brought forward when no parent has complained, including those who were not party to litigation. The complaint seems to stem from Brian Deer."
No, this is entirely appropriate. There are - quite rightly - ethical constraints on research on children that apply even if the parent(s) grant consent.
Whether the charges stem from Deer or elsewhere (I'd suspect that Wakefield getting caught on video admitting to paying kids for blood at a party didn't help, for example), it's quite appropriate for the GMC to consider them: there clearly is a case to answer.
PhD Scientist's post is a monument of class indignation, but it does not answer any of my substantive points, none of which are in fact trivial.
John Stone
John Stone
Don't quite see "class indignation". What I was trying to explain why scientists and doctors (who arguably should know) trust scientific and medical experts, and other what circusmtances (speaking about what they know about).
And I would say my post summarized the weight of scientific and medical knowledge, which is that the MMR-autism "connection" is hogwash.
You can keep insisting that the issue is still unclear, John. Everything I know as a scientist tells me otherwise.
Signing off.
Let’s return to the 1998 Lancet paper – for the GMC this is the crux of their allegations against Wakefield et al. No other research papers are referred to.
The main purpose of the paper was to report the presence of bowel disease in 12 autistic children. The mention of an MMR-autism link is a subsidiary part of the paper and is expressly treated in hypothetical terms requiring ‘further investigations’ (p. 641). For example, it summarises the prior environmental exposures which the parents and children’s doctors reported as associated with the onset of autism. In 8 out of 12 children this environmental exposure was MMR. For the other 4 children, parents/doctors of two referred to measles and otitis media and two were unable to identify an exposure. The summary is simply what the parents reported, which the researchers were duty bound to report given the paper’s terms of reference. Such temporal association between autism and MMR is not presented as causal. The paper clearly states that it ‘did not prove an association between measles, mumps, and rubella vaccine and the syndrome described’ (p. 641).
The distinction between the principal factual findings (the presence of bowel disease in the autistic children) and a subsidiary hypothesis requiring further research (a putative link between MMR and autism and bowel disease) is fundamental to the paper (as it is to other scientific papers recommending further research into hypotheses beyond published findings). Critics don’t refer to the principal purpose of the 1998 paper, to show findings of bowel disease in autistic children, and elevates a subsidiary hypothesis, for which no evidence is given, to the principal finding.
If this reading is accurate, then several questions follow. What endorsement for the MMR/autism link is given? What is problematic about a small case study of patients undergoing treatment? What ethical protocols have been broken by this case study? What ethical duty lay on Wakefield to declare his legal aid work to the Lancet when submitting this paper as described? Why the GMC’s fuss?
Fortunately the GMC must prove their case beyond all reasonable doubt. The slightest shadow of doubt and the case collapses – the most expensive and longest in the GMC’s history.
Anonymous 10.06 Pro-Wakefielder
One obvious dishonesty was in presenting a case study without making it clear how the cases were actually selected, and without indicating that they were part of a litigation. given this, reporting them as a group was misleading since the impression given was:
"A report on a group of patients whose parents all think they have a mysterious GI syndrome related to autism"
rather than:
"A report on a group of patients whose parents all think they have a mysterious GI syndrome related to autism, are convinced this is the result of vaccine damage, are sueing the vaccine manufacturers, and were referred to us specifically by their lawyer who is paying us to look at them in the hope that we will find something connecting their symptoms to MMR that he can use for the lawsuit"
Also omitted:
"on whom we did invasive tests on questionable medical grounds"
and:
"whose GI symptoms cannot be linked to any GI findings on endoscopy which are not part of the normal spectrum seen in children this age."
and:
"whose recognition as having a syndrome related to MMR we have a further undeclared financial interest in, since we have already tried to patent a single vaccine regime"
It has not been shown that there was selection bias. It would have been possible to select a much more homogenous group, if that was what was going on.
It should be noted that an expert in a court case is not held to have an interest. This explanation has been tendered by MMR defence witnesses, notably Elizabeth Miller. As we know Wakefield acknowledged his involvement to the Lancet in a letter of 1998, and no one thought anything of it for six years. Now the most tremendous meal is being made out of it.
The vaccine was not a commercial rival to MMR. Deer's Sunday Times report admits:
"While Wakefield was under no legal or professional obligation to disclose the patent, campaigners believe that his attack on MMR may have been viewed differently had it been known".
So it does not look like the Sunday Times lawyers thought a lot of story. Who the campaigners were apart from Deer and Michael Fitzpatrick, who is quoted in the report, is unclear. Patent lawyer Clifford Miller's assessment can be found here:
http://www.bmj.com/cgi/eletters/329/7477/1293#87155
Why it should be alright to express hatred for people who are simply asking for balanced reporting is an interesting question.
John Stone
The perception of hatred may suit your victim psychology but rather overstates the level of people's interest in your and your blether.
It is a trifle startling to see you write this, particularly if one were to look at the rhetoric of the people with whom you align yourself.
Cry Shame "Fifteen years ago Deer cut a fairly handsome if sombre figure. Now however, his drift towards middle age has left him a slightly bent and balding figure who suppurates cynicism. His appearance, apart from his lack of a cloak, resembled that of a villain in a Victorian melodrama, who is booed and jeered by the audience. He seemed to shrug off this wall of anger as if it came with the territory and was something which he accepted when he signed up as Britain's number one vaccine
defender."
Elsewhere - equally charming although it does foreshadow an upcoming excuse should the Autism Omnibus go with the science. "Brian Deer also faced his persecutors inside the building. During the morning break, two parents objected to sitting in the same public gallery space and indeed breathing the same air as him. There was nothing that the GMC could do about the air problem but ever eager to show fairness, security personnel roped off the section of the public gallery which contained Deer and the other embedded journalists.
Then at a break in the afternoon a security guard, checking under seats with the ‘wand’, thought he had found a bug under the seat next to that used by Deer. It turned out to be a fault in the machine and no device was found.
The sense of utter tedium, however, masks a very serious operation which is intent on stopping Dr Andrew Wakefield from ever again acting as a doctor in England and perhaps more exactly ensuring that he never appears as an expert witness in any cases of vaccine damaged children."
Verbal Aspects, I wouldn't count your chickens.
John Stone
Of course, were John Stone's prayers to be answered and "Saint Andy" to get off at the GMC, it wouldn't prove anything about his science being valid, as that is not the issue of the hearings.
The "court" of science is elsewhere (essentially in the consensus of scientific and medical opinion). As I have already pointed out, the verdict there is long since in, with the MMR-autism work being found to be worthless and riddled with basic errors.
A "no action" verdict from the GMC would merely prove Wakefield had not done anything grossly (and provably) unethical enough to be disciplined. However, you can be sure that, if this happens, he and his cheerleaders will be crowing about it "proving they were right all along about everything". This is a time-honoured tactic of blusterers and Snake-Oil salesmen everywhere - think Jeffrey Archer, among others.
As several people above have noted, one suspects the "loaded gun", if there is one, in the Wakefield hearings is the invasive investigations (multiple 'oscopies and lumbar punctures) that were not medically indicated and whose ethical approval appears, to say the least, well dodgy.
The last time Mrs PhD (MBBS MRCP hospital general physician) and I were discussing this, she said, quote:
"If I did lumbar punctures on children who didn't need them then I ought to be struck off"
I quite agree with PhD Scientist that there are scientific issues which the GMC hearing could scarcely resolve. However, there are serious misconceptions about the invasive procedures. As I pointed out neither the Lancet or the Sunday Times sided with Brian Deer and Evan Harris regarding these allegations - I myself have seen from FOI many or all the documents that Brian Deer has seen and it actually looks as if great care was taken over these matters. There seems to be some apriori assumption about these children but in my experience they constituted a sub-group of autistic children who were chronically ill as well as cognitively dysfuntional. I do not believe invasive procedures were ever initiated frivolously, and it certainly is not an open and shut case. No one has any basis for presuming that.
John Stone
Even aside from lumbar punctures etc., I'd love to hear Wakefield's explanation for speaking on video about taking blood from children at a party.
Um, did someone mention ethics...?
"I quite agree with PhD Scientist that there are scientific issues which the GMC hearing could scarcely resolve"
Not quite what I said, John: to repeat, I pointed out that the GMC is not looking at the science per se (which has already been utterly discredited), but at the dodgy ethics of Wakefield and his co-"defendants"
"I do not believe invasive procedures were ever initiated frivolously"
Unethical is not the same as "frivolous". I would not call doing it when the children's clinical management didn't require it, but rather for the sake of pursuing a theory, "frivolous". Following Mrs PhD, I would call it "unethical, deceitful and disgraceful". For a doctor dealing with vulnerable children with developmental problems, and their desperate parents, I would say that was worse.
John, of course, cannot believe St Andy would do such a thing.
I take a different view. Having heard about the multiple ways Wakefield finagled the data from his own lab, and the manner in which he concealed his conflicts of interest from his Lancet co-authors, I find it quite easy to believe.
Well, it is obvious that Wakefield is being transformed into a pantomime demon. The record is much more complex.
I would simply point out that I had extensive contact with the department at the Royal Free (although not with Wakefield) between 1999 and 2001. Wakefield disclosed his involvement with the litigation in May 1998 (supposing his colleagues did not know about it before then). On the basis of my own recall I know that Wakefield remained a popular figure within the department for at least three years after the disclosure. (I should add that at the time I was much more ambivalent about the MMR connection that I am now - we had other reasons for consulting.) People turned against him under political pressure later, and history is being re-interpreted.
John Stone
Austin Elliott says
“Science is absolutely NOT "merely methodology", John. It is far more than that. Philosophically it is the key creation of the European Enlightenment, since it gives us a way of looking at the world (observe, construct theory, test theory eliminating all confounding influences, reject or revise theory, next iteration) which progressively gives us more accurate explanations of how the world works”...
but Austin, you still describe science through methodology. Methods of observation, methods by which theories/hypotheses are constructed and developed, methods for testing and iterating……that does not to my mind diminish the value of science and scientific endeavour, but I do have a problem when people use the terms science and scientific as a basis for some kind of absolute truth; science does not describe truths, it may iterate/approximate towards a truth but truths are generally very elusive and to be able to describe a truth through science the methodlogy has to be capable of measuring absolute truth – as far as I can see there is no science nor scientific method that can claim to be that capable; perhaps you can describe such a science or scientific method capable of extracting or extrapolating to the absolute truth?
Regards
John
Science is not absolute truth, John, and no scientist would say so. But most scientists would say that it is the only way of interrogating the world that demonstrably moves us towards better approximations to the truth, certainly as far as understanding the natural world is concerned. Given the depressingly vast amount of irrationality around in the modern world, that is something worth hanging on to.
If one has to give it a label, I would say the central philosophical idea is empiricism. The idea of science as a kind of giant, self-correcting Wiki is also a key one; bad experiments, bad theories, inexact methods and incomplete understandings are progressively replaced by better ones – wisdom progressively replacing ignorance, if you like. But no-one claims the explanations can be 100.000% perfect, and that is not what scientists say. What they can typically do is put a realistic (usually statistical) estimate on how certain they are.
One way to exemplify this is the old joke about DNA evidence: the lawyer asks: “Professor Brainstorm, are you sure this DNA recovered from the crime scene belonged to my client, Mr X? Are you absolutely sure?” And the scientist says: “Well, I don’t know about absolutely – absolutely is not a scientific word. But I can tell you that the science shows there is only one chance in 160 million that it ISN’T his.”
Richard Feynman is always a good source of pithy quotes to sum up the beliefs. Feynman famously instructed the graduating class at one University that "The first principle [of scientific integrity] is that you must not fool yourself—and you are the easiest person to fool.”
The further danger being that once you have fooled yourself, you can, if you are a certain type of person, use that misguided certainty to justify all sorts of scientific, ethical and moral "short cuts".
I am sure this applies to some of the cases of misconduct in the Pharma industry we have seen in recent years. But it is also an obvious "fit" to Dr Wakefield. That is the consensus view about him in science, at least in my experience.
Austin Elliott
Austin Elliott
Very well, but you ignored the short cuts in the epidemiology that I pointed to in my post of 8.41 pm, 1 August. Here is another example: a more recent Fombonne paper in PEDIATRICS:
http://pediatrics.aappublications.org/cgi/content/full/118/1/e139
I note with concern the unanswered P3Rs from John Heptonstall, and I note with even greater alarm the commentary by F Edward Yazbak:
http://www.vaproject.com/yazbak/tale-of-two-cities-20070307.htm
I quote from the letter left unpublished by PEDIATRICS:
"In “Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations”...Fombonne et al reported that in a group of English-speaking Montreal children born from 1987 to 1998, the prevalence of pervasive developmental disorders (PDD) was high and increasing. They also claimed that during the same period, Measles-mumps-rubella (MMR) vaccination coverage had decreased and concluded, “Thus, pervasive developmental disorder rates significantly increased when measles-mumps-rubella vaccination uptake rates significantly decreased.”
"The MMR uptake data used “were available through N. Bouliane, BN, MSc of the Direction de Santé Publique de la Capitale Nationale” and were “routinely collected in the region of Québec among 5-year-old children attending kindergarten during 1993-2004.”
"La Capitale Nationale refers to Quebec City, located 265 kilometers from Montreal. Ms. Bouliane confirmed that the MMR vaccination rates were indeed from the Quebec City area but refused to release them to me because they were administrative internal information only intended for research.
"There are several published vaccine uptake surveys of Montreal. MMR vaccination rates of children 24 to 30 month-old in the Montreal area increased from 85.1% in 1983 (Baumgarten)...to 88.8% in 1996-97 (Valiquette)...to 96% in 2003-04 (Health Department Survey)...
"The above suggests that in Montreal PDD prevalence and MMR vaccination rates were in fact increasing in tandem during the study period.
"The readers deserve to know why the authors compared developmental data from a specific group of children in Montreal with MMR vaccination data from the city of Quebec, some distance away."
http://www.vaproject.com/yazbak/tale-of-two-cities-20070307.htm
So, I ask "Who is fooling themselves?" Is it alright to pass by when elementary flaws are pointed out? Perhaps you can enlighten us as to which the good studies are?
John Stone
The MMR was approved for use in the USA in 1971. It has been used around the world for over thirty years.
Read about this here:
http://www.amazon.co.uk/Vaccinated-Defeat-Worlds-Deadliest-Diseases/dp/0061227951/
Why did it become a problem only after being approved for use in the UK... almost 20 years since it was developed?
Most Americans who are 35 years and younger have been vaccinated at least once with the MMR. The levels of autism are pretty consistent with that of the UK, but the levels of mumps and measles are much less.
Why?
Explain this:
http://www.iht.com/articles/ap/2007/08/03/europe/EU-MED-Britain-Exporting-Measles.php
HCN
Absence of detailed information about this, however the rise in autism in the US began approximately a decade ahead of the UK (California figures), although there certainly seems to have been acceleration round (lat 80s) about the same time. I do not know whether anyone has figures for exposure to MMR before the mandated programme (which also may have varied according to locality). There are certainly many people claiming MMR related autism with gastro-intestinal complications in the US too. About 5000, as we know, claiming under the compensation programme.
I look forward to an answer from someone about the wider issues of epidemiology since this controversy began.
John Stone
HCN
In relation to your second post, no one is anyhow claiming that the autism rate is being solely driven by MMR - other environmental factors, the expansion of the vaccine programme (including accumulated mercury and other excipients, adjuvants etc), even more recognition (but surely not exclusively).
There are two question which I do not think you can answer on an a priori basis. Does it happen individual instances, and is there a detectable population effect? A lot of the epidemiology is problematic, the data too weak, the controls insufficient, other even more alarming methodological errors.
John Stone
"no one is anyhow claiming that the autism rate is being solely driven by MMR - other environmental factors, the expansion of the vaccine programme (including accumulated mercury and other excipients, adjuvants etc), even more recognition (but surely not exclusively)."
in terms of the increasing numbers of people diagnosed as being on the autistic spectrum, Prof Baron-Cohen argues that "For the moment, we should assume [any rise] is more to do with diagnostic practice."
There isn't even enough evidence to show that there are more people on the autistic spectrum then there used to be. If there are, and if environmental factors do play a part in this, MMR has been well enough researched as to be way, way, way down the list of possible causes.
Baron-Cohen's comments are complacent (in my view irresponsible irrespective of causation). In Haringey, for example, we had in July 1999 109 ASD children in the school system of which 8 were over eleven, although disability was being monitored by the same services at all ages and ASD children of secondary level would have been in trouble, and seriously disruptive if they had existed. I am told now that we officially have 370 (many more unofficially). All this happened at a time when the government were vastly hostile to the expansion of special educational needs.
And something rather perverse has happened. While the text books were saying in the mid-90s that autism was due to a combination of unidentified genetic and environmental factor, as the population began to swell dramatically (suggesting a change in environmental factors) the official emphasis on genetics seemed to increase. For a while Baron-Cohen tried to bridge the gulf with his rather silly selective mating theory, but fortunately this seems to have fallen by the way side.
But we are also now confronted with the first of this great wave becoming adult - we know that there is no precedent
amongst the over-20s for the scale of services that is going to be required in the next two decades to look after this new generation. If Baron-Cohen had made this up by over-zealous diagnosing I doubt whether it would be costing so much (the cases would simply integrate in time). Nor does such talk help us to come to terms with the crisis.
Meanwhile, I note (at least at the time I started writing this post) that no one is prepared to answer my documented criticisms of the official epidemiology, notably Austin Elliott of Manchester University's Faculty of Life Sciences (business partners includingGlaxoSmithKline, Merck, Sharp and Dohme, Eli Lilly and Co).
http://www.ls.manchester.ac.uk/business/partners/
John Stone
Autisn
I am glad you agree there is no scientific truth. Then your
"One way to exemplify this is the old joke about DNA evidence: the lawyer asks: “Professor Brainstorm, are you sure this DNA recovered from the crime scene belonged to my client, Mr X? Are you absolutely sure?” And the scientist says: “Well, I don’t know about absolutely – absolutely is not a scientific word. But I can tell you that the science shows there is only one chance in 160 million that it ISN’T his.”
Although I appreciate your reasoning i stll beg to differ in that there are those who would disagree with your enthusiasm for DNA evidence........
"Generally, courts have accepted the reliability of DNA testing and admitted DNA test results into evidence. However, DNA fingerprinting is controversial in a number of areas: the accuracy of the results, the cost of testing, and the possible misuse of the technique. The accuracy of DNA fingerprinting has been challenged for several reasons. First, because DNA segments rather than complete DNA strands are “fingerprinted,” a DNA fingerprint may not be unique; large-scale research to confirm the uniqueness of DNA fingerprinting test results has not been conducted. In addition, DNA fingerprinting is often performed in private laboratories that may not follow uniform testing standards and quality controls. Also, since human beings must interpret the test, human error could lead to false results. DNA fingerprinting is expensive. Suspects who are unable to provide their own DNA experts may not be able to adequately defend themselves against charges based on DNA evidence.
http://encarta.msn.com/encyclopedia_761579857/DNA_Fingerprinting.html "DNA Fingerprinting," Microsoft® Encarta® Online Encyclopedia 2007
http://encarta.msn.com © 1997-2007 Microsoft Corporation. All Rights Reserved.
And further, quoting another article………
"Accuracy of the Evidence :-
Neither innocence nor guilt can be adequately determined without accuracy of the evidence. Crime labs across the state from McAllen to Lubbock have revealed numerous problems. The recent debacle at the Houston Crime Lab was the most egregious. In 2002 an independent audit of the lab revealed:
♦ Lab workers insufficiently trained
♦ Equipment not maintained
♦ Lab not designed to provide adequate security and to minimize
contamination
♦ Leaks in roof jeopardize evidence
♦ Failed to calibrate equipment and instruments used in DNA testing
♦ Analysts might have exaggerated statistics in some instances
♦ Trial testimony over several years had been based on questionable lab
results
♦ Lack of basic record keeping
The evidence which could have proved the guilt or innocence of many
Houstonians has been destroyed, contaminated, or simply missing. Of the 8000
affected cases:
♦ 28 of those cases involved death row inmates
♦ 20 of those inmates have been executed, one died of natural causes
♦ 7 await execution
…………... In reexamining the DNA
evidence which Houston “experts” testified to in the original trial, it has been shown they at the very least exaggerated the evidence. Dr. William Thompson
said “the testimony made it seem as if this was an exact match, and it was not. In fact, this profile would have matched one in 8 black men in Houston.” A moratorium is needed on those convictions arising out of the troubled HPD
crime lab where there are known widespread inaccuracies. It is only fair and just for a moratorium to go into effect until a full investigation brings about clear and definitive answers.
Addition reform is needed:
♦ To create independently run crime labs with properly trained employees that are not under the control of local police departments.
♦ To investigate other state crime labs which have inaccuracies and
inconsistencies like the Lubbock crime lab that wrongly convicted Brandon Moon, an El Paso resident for rape.
♦ To create a commission to look into the problem of wrongful convictions and the use of the death penalty in Texas. Which suggests that a scientific technique, that scientists state has an excellent accuracy rate, remains fraught with potential inaccuracies due to man’s fallibilty."
Austin, one cannot exclude man/woman from the scientific equation hence any inaccuracy inherent in science or scientific techniue suffers additionally from human frailty – that’s probably what frightens the masses about scientists who refuse to accept their enormous potential for fallibility be it in vaccines, genetic manipulation, or any other methodology that invades, and might injure irreversibly, their lives. Add to the mix corruption, self/vested interests, and other such motivating factors that collude to destroy scientific integrity, science and scientific evidence are diminished.
Regards
John
I have not engaged in a debate on epidemiology because I am not an epidemiologist, John. That is what I mean by scientists "knowing their limits".
As for the inevitable "Pharma Shill Gambit" -
For the record, I have never received a single penny from any of the companies you list, or indeed from any other Pharma outfit. Not even a grant of a few quid to enable me to attend a conference somewhere. Until you found their names on the Faculty website, I had no clue they were particular "business partners" of ours. And in fact now I look at the page it doesn't say "business partners" at all, merely that we have worked with them.
So what are these links likely to be? Well, like any large University, the one I work at has many connections to businesses involved in science, including the pharmaceutical industry. We place students doing "sandwich" degrees in jobs in industry with many companies; many academics (though not me) have research collaborations with a range of companies, Pharma and non-Pharma. One specific Professorship I can think of is funded by a drug company. And companies also donate Prizes to give out to deserving undergraduate students (e.g. for finishing top of the year group).
Would it really be rational for a University Faculties of Biosciences (which do a lot of biomedical research) to have NO connections with the industry where much similar scientific research is done, simply because we will be subject to "malign influence"? This is about as sensible as saying that we should not collaborate with labs in America in case we are all thereby compelled to become supporters of President Bush's foreign policy.
John, leaven your paranoia with some common sense. If you think this kind of fairly run of the mill stuff means that means "Big Pharma" have "bought" academics' views, you don't know academics.
Austin
In regard to epidemiology we are dealing with flaws so elementary that any educated person who perseveres could understand them. Anyhow, you may not answer me but Goldacre or Fitzpatrick should, since they are supposed to understand these matters. As it is they go from year to year blanking these defects. If you look at what is being said you should be very concerned.
Please note, I chose my words carefully, and did not make any accusation about your direct involvement with any of these companies. It is not admittedly very clear what is meant by 'business partners' (it in fact sounds very grand): I just thought that people ought not to be so quick to judge Wakefield over alleged competing interests. It will not, incidentally, aid justice that the GMC will not make transcripts available. You can only find out what's going on if you have the freedom to sit at the hearing every day.
John Stone
In the past week, and within days, the source of foot and mouth disease in a cow was traced to a foot and mouth vaccine being manufactured in a facility 3 miles away from the infected herd. Proper medical examination of the cow clearly established that the strain was from a vaccine and not one naturally transmitted between animals.
I don't want to suggest that children don't matter - but if its so easy and quick to detect exactly which strain of a disease lurks within a sick animal - why are all efforts thwarted when researchers and medics seek to do the same for children?
Anon 7.15
The simple difference is that the animal actually HAD a detectable viral disease, so easy to genotype the virus. The children in Wakefield's joke studies DIDN'T have a viral disease, so none was detected.
This is the simple and logical explanation, and the one supported by all the scientific evidence. Though no doubt it will not convince John Stone and the rest of the conspiracy crazies.
There are people who, of course, who mistake common abuse for scientific argument.
The scientific world is present engaged in failing to detect the proliferation of autism or diagnose its causes. It has been fudging the issue since, for whatever reasons, it began to spin out of control 15 years ago. I have posed many questions here - mostly courteously - and I am not generally impressed by the response.
John Stone
Your questions may have the appearance of courtesy, John. But after a while the action of repeating your nagging and disinformation over and over and over again acts precisely as you intend it - as an irritant.
And yes, I am irritated.
Your last comment indicates yet again just what a load of tripe your views are, containing as it does four major lies in as many lines.
1. On the totality of the evidence, the autism "issue" is not "out of control". It is being addressed by treatment, and social provision, and research.
2. The scientific and medical consensus is firmly that there is NO "proliferation of autism"; what there is is better recognition of the condition and widening of the diagnostic spectrum.
3. Science is not "engaged in failing.. to diagnose [autism's] cause". It is actively researching the causes, which quite clearly are largely genetic, though parental age and environmental interactions in the womb or during very early life also seem to play a part:
http://pediatrics.aappublications.org/cgi/content/full/113/5/e472
4. Science is not "fudging the issues". It is addressing them by properly (and ethically) carried-out, properly analysed, and properly peer reviewed, research. Precisely the kind of research that your hero Dr Wakefield's "work" was not.
It is fringe fanatics like yourself, and your scientifically-illiterate but conspiracy-obsessed media allies like Melanie Phillips, who actually "fudge the issue" by endlessly pumping out scare nonsense, putting needless fear into worried parents. Shame on you.
PhD
More ad hominem bile. Really, I do not see a single argument here, only vigorous assertion and hostility.
I described the situation in Haringey (5 August, 9.24pm) for which there is no social or instittutional model. Any time the official designated experts are asked to explain this phenomenon it gets very short on detail.
My original concern about the persecution of Wakefield was not that he was right, but if this was the fate of anyone looking at environmental factors then there would be no progress - instead it was made into an incredible issue. Separate vaccines were withdrawn, Wakefield demonised - these were not the actions of a scientific and political establishment confident of its own rightness. But it also sends a signal to anyone else minded to look into parallel issues.
The article you cite acknowledges non genetic influences on the etiology of autism. On this basis alone you could predict that autism would wax and wain according to the presence of such influences - you would not by any means expect it to be static. So, it is fair to ask what we may have been doing wrong since the late 80s.
John Stone
Anonymous
I would be grateful if you could elaborate on your comments to John Stone, as a member of the public whose interests you appear to wish to defend:-
“1. On the totality of the evidence, the autism "issue" is not "out of control". It is being addressed by treatment, and social provision, and research.”
…..what treatment, and what social provision, is improving the blighted lives of so many people afflicted by autistic spectrum disorders that evidences your claim that the issue is not out of control?
……what research is currently illuminating the ASD phenomenon and its origins?
Your comments suggest you view the emergent social problem through rose-tinted spectacles whilst families like those of John Stone suffer its direct reality.
Your
”2. The scientific and medical consensus is firmly that there is NO "proliferation of autism"; what there is is better recognition of the condition and widening of the diagnostic spectrum”….
belies the scientific facts
Your
”3. Science is not "engaged in failing.. to diagnose [autism's] cause". It is actively researching the causes, which quite clearly are largely genetic, though parental age and environmental interactions in the womb or during very early life also seem to play a part”
……seems ti implicate genetics more widely than scientific evidence can – if genetic, where were the enormous number of those so afflicted 30 and 40 years ago, why did those of us who grew up in the 60s and 70s not see evidence of that in our towns and villages, and where are the equivalent enormous number of middle-aged afflicted now?
and your
“ Science is not "fudging the issues". It is addressing them by properly (and ethically) carried-out, properly analysed, and properly peer reviewed, research. Precisely the kind of research that your hero Dr Wakefield's "work" was not”…………
…..is precisely the kind of statement one expects from someone who appears to view science (as the rather mythical provision for autism you claim exists) through rose-tinted spectacles. Science is neutral, it is methodlogy that can be used for good or evil, it is scientists that use science to fudge or to clarify issues; fudged issues are easily spotted then refuted, as has been the case with virtually all the epidemiology purporting to extricate MMR as a cause of ASD, any 6th form science student can see that.
As for your statement
“it is fringe fanatics like yourself, and your scientifically-illiterate but conspiracy-obsessed media allies like Melanie Phillips, who actually "fudge the issue" by endlessly pumping out scare nonsense, putting needless fear into worried parents. Shame on you”
…..the tone and content are arrogant, and suggest an inability to differentiate between scientific literacy and the too regularly regurgitated (probably to feed the epidemic of vested political and commercial interests) pseudoscientific dogma.
In light of all that, your perception of what you believe exists as adequate social provision and treatment benefitting those with ASD will be most interesting
John
PhD Scientist
I would be grateful if you could elaborate on your
“1. On the totality of the evidence, the autism "issue" is not "out of control". It is being addressed by treatment, and social provision, and research.”
…..what treatment, and what social provision, is facilitating the blighted lives of so many people afflicted by autistic spectrum disorders that evidences your claim that the issue is not out of control?
……..what research is currently illuminating the ASD phenomenon and its origins?
Your comments suggest you view the emergent social problem through rose-tinted spectacles as families like those of John Stone suffer its direct reality.
futhermore, your
”2. The scientific and medical consensus is firmly that there is NO "proliferation of autism"; what there is is better recognition of the condition and widening of the diagnostic spectrum”….
belies the facts and your
”3. Science is not "engaged in failing.. to diagnose [autism's] cause". It is actively researching the causes, which quite clearly are largely genetic, though parental age and environmental interactions in the womb or during very early life also seem to play a part”
……clearly implicates genetics more widely than scientific evidence can – if genetic, where were the enormous number of so afflicted 30 to 40 years ago, where were they when I and others grew up in the 60s and 70s and never saw them in village and town, and where are the equivalent enormous number of middle-aged afflcited now?
and your
“ Science is not "fudging the issues". It is addressing them by properly (and ethically) carried-out, properly analysed, and properly peer reviewed, research. Precisely the kind of research that your hero Dr Wakefield's "work" was not”…………
…..is precisely the kind of statement one expects from someone who appears to view science (as the rather mythical provision for autism you claim exists) through rose-tinted spectacles. Science is neutral, it is methodlogy that can be used for good or evil, it is scientists that use science to fudge or to clarify issues; fudged issues are easily spotted then refuted, as has been the case with virtually all the epidemiology purporting to extricate MMR as a cause of ASD, any 6th form science student can see that.
As for your statement
“it is fringe fanatics like yourself, and your scientifically-illiterate but conspiracy-obsessed media allies like Melanie Phillips, who actually "fudge the issue" by endlessly pumping out scare nonsense, putting needless fear into worried parents. Shame on you”
…..the tone and content are arrogant, and suggest an inability to differentiate between scientific literacy and regularly regurgitated (to feed the epidemic of vested political and commercial interests) pseudoscientific dogma.
In light of that, your perception of what you believe exists as adequate social provision and treatment benefitting those with ASD will be most interesting
John
I am grateful to "John", the apppearance of whose remarks seems to have been delayed by more than 24 hours.
I would just briefly comment on my experience as a parent rep negotiating for autism services over the period of more than decade. The Government has never taken any lead on this matter: instead they delegated SEN provision entirely to local authorities while twisting their arms through Whitehall to go down an inclusionist route. The local authority's job could not have been made more difficult in this respect, but to give them credit educational statementing shot up locally when it was supposed to being pinned back. But everything about the process has been painful, and social provision is really still a decade behind. The silence of the "experts" has not been helpful.
John Stone
i am amazed by the vitriol, and ad hominem comment in some of the comments above.
The Greenhaigh article linked to in the article is nothing short of hilarious. Point 6 criticises the paper for a conclusion the authors explicitly rejected, and surmises what their unstated beliefs are !
Mawsons letter as above seems appropriate.
The greenhaigh and mawson letters are about the interpretation of the paper as published, and that must surely be a distinct issue from whether the paper contains data produced improperly, or unethically.
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