Respectful Insolence

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgVacation time! While Orac is gone recharging his circuits and contemplating the linguistic tricks of limericks and jokes or the glory of black holes, he’s rerunning some old stuff from his original Blogspot blog. This particular post first appeared on December 21, 2005 Enjoy!

When you blog about a certain topic long enough and post strong opinions about it often enough, you start to gain a reputation as one of the go-to bloggers on that particular topic, whether you originally intended it that way or not. Consequently, I wasn’t too suprised when a reader sent me a piece by another blogger regarding vaccines and autism asking my opinion about it. What did surprise me (but, in retrospect, shouldn’t have) is the identity of the blogger posting more nonsense about vaccines and autism.

Who is this blogger? I’ll give you three guesses. Here are some hints first, though. He’s claimed that women shouldn’t have the right to vote because “too many” of them are “fascists at heart.” He’s also made excuses for rape and compared feminists unfavorably to Hitler and the Nazis.

Yes, sad to say, it was Vox. You probably thought that, after Vox had his brain chomped by the Hitler Zombie yesterday, you wouldn’t have to hear from him anymore.

So why was I surprised that Vox is also antivaccination? I don’t know. I shouldn’t have been. Perhaps some optimistic part of me just can’t believe that there could be so much looniness and bad reasoning in one individual. (I should listen to my pessimistic side more.) Originally, a few days ago, when I first became aware of it, I had decided to defer addressing this particular piece of poorly justified antivaccination fear-mongering because, well, it came from Vox Day. Besides, I had been debating whether or not to do a Hitler zombie piece on his ridiculous comparison of feminists to Nazis since it appeared, but had held off because my readers seemed to have tired of the rotting dictator with a hankering for brains, and because, well, the article came from Vox Day. Then, the other day, fortuitously (or not, depending upon your point of view), Vox’s fellow Wingnut Daily columnist Erik Rush provided just such an opportunity. Sure, it was three months late, but better late than never, even in blogging, I say.

Predictably, Vox was unhappy and trashed me without linking to me. So I figured, what the heck. I might as well address his other fallacies before once again ignoring him for many months. Besides, two Vox debunkings in one week are about all I could ever subject my readers to with a clear conscience.

In any case, Vox revealed his credulity when it comes to evidence that supports his viewpoint, citing a UPI report that claims that a population of unvaccinated children in Illinois has almost no cases of autism and attributes this allegedly low incidence to–surprise, surprise!–the lack of vaccination in this population. Dan Olmsted, a senior editor at UPI and someone who’s seemingly never seen an antivax argument he doesn’t like, used some of the shoddiest antivaccination arguments I have seen, and Vox swallowed them whole without the slightest trace of skepticism:


Now, a second large group of unvaccinated children has been shown to be free of the very issues which the vaccine advocates claim cannot be caused by vaccines. The vaccine-free practice is somehow missing the 114 autistic children that the Illinois Education Department’s statistics would predict, so it’s clear that someone cannnot telling the truth here; Occam’s Razor strongly suggests is that it is the side which is dependent upon selling and administering vaccines to maintain an important revenue stream.

Vox sounds pretty convinced that Olmsted’s article represents good evidence that vaccines are associated with or cause autism. There’s just one problem. It doesn’t, as should be evident to anyone with a modicum of critical thinking skills. The article does not show a “large group of unvaccinated children” who are “free of the very issues that the vaccine advocates claim cannot be caused by vaccines.” What the article does show is that a few physicians in an unconventional medical practice in Chicago believe that autism is associated with vaccination, a belief that Olmsted’s article, ironically enough, unintentionally shows to be based on poorly described and undocumented anecdotal evidence.

Here’s a lesson, Vox: In science, unlike religion, belief alone is never enough. Data is required, and there just ain’t any in Olmsted’s article.

Olmsted has shown similar credulity before when writing about the claims of antivaccination advocates. Prometheus described well this tendency on his part several months ago, after Olmsted had published an article about the supposed “Amish anomaly” in which he reported (again in a nearly completely data-free manner) that there was a very low rate of autism among the Amish in Lancaster County, Pennsylvania. Naturally, Olmsted honed right in on vaccines without considering other more plausible factors that might account for the difference in autism rates between the Amish and the general U.S. population (if difference there actually even is, given that no verifiable data was presented). For example, the Amish live a simple life on farms out in the countryside. Perhaps the difference could be explained by different environmental exposures from that lifestyle rather than vaccines. Wouldn’t that be just as plausible, if not more so, than vaccines? Also, the Amish are a genetically inbred group, and, given that autism has a strong genetic component, that inbreeding alone could explain any difference, again if there even is a difference. In other words, there are many potential causes for such an observed difference (if there is one), but Olmsted honed right in vaccines as having to be the one true cause, ignoring all the other equally or more plausible alternatives.

Now, it looks as though Olmsted is at it again with a group practice called Homefirst Health Services in metro Chicago. According to Olmsted, the medical director of Homefirst, Dr. Mayer Eisenstein has made a startling claim:

But thousands of children cared for by Homefirst Health Services in metropolitan Chicago have at least two things in common with thousands of Amish children in rural Lancaster: They have never been vaccinated. And they don’t have autism.

“We have a fairly large practice. We have about 30,000 or 35,000 children that we’ve taken care of over the years, and I don’t think we have a single case of autism in children delivered by us who never received vaccines,” said Dr. Mayer Eisenstein, Homefirst’s medical director who founded the practice in 1973. Homefirst doctors have delivered more than 15,000 babies at home, and thousands of them have never been vaccinated.

The few autistic children Homefirst sees were vaccinated before their families became patients, Eisenstein said. “I can think of two or three autistic children who we’ve delivered their mother’s next baby, and we aren’t really totally taking care of that child — they have special care needs. But they bring the younger children to us. I don’t have a single case that I can think of that wasn’t vaccinated.”

“I don’t have a single case that I can think of”? Can anyone say “selective thinking” or “confirmation bias“? Sure, I knew you could. I’m sure Dr. Eisenstein sincerely believes that he has never seen a case of autism in an unvaccinated child, but in reality he produces no data to support his assertion. In fact, he even admits as much:

Eisenstein stresses his observations are not scientific. “The trouble is this is just anecdotal in a sense, because what if every autistic child goes somewhere else and (their family) never calls us or they moved out of state?”

In practice, that’s unlikely to account for the pronounced absence of autism, says Eisenstein, who also has a bachelor’s degree in statistics, a master’s degree in public health and a law degree.

If Eisenstein’s observations are not scientific, then why on earth should I take them seriously as any sort of evidence for a link between vaccines and autism? The history of medicine is littered with beliefs based on no rigorous observation that were later shown not to hold water. Also, if Dr. Eisenstein has a bachelor’s degree in statistics and a master’s degree in public health, then why doesn’t he look at–oh, say–the actual numbers in his practice, rather than simply speculating based on his anecdotal observations, which are prone to many confounding biases? Because humans are fallible and can easily mislead themselves unintentionally into believing in correlations that don’t exist or in treatments that don’t work, outside of incredibly strong effects of a predisposing factor (fairly rare in medicine), only rigorously designed clinical and epidemiological studies have any hope of identifying the factors that predispose to various diseases from all noise, and even then it can be difficult. As I wrote before:

Science itself and randomized clinical trials are designed to combat such biases. In preclinical studies, the scientific method uses the careful formulation of hypotheses and testing of those hypotheses with experiments that can either confirm or falsify the hypothesis, experiments that include appropriate control groups to rule out results due to factors other than what the researcher is studying. The scientific method, rigidly adhered to, helps investigators protect themselves from their own tendency to see what they want to see, to correct mistaken results, and recover from stupidity faster.

So what are we left with from Olmsted’s article, if there are no scientific observations reported? Not much. Just some “impressions” of doctors who practice a lot of “alternative” medicine and who apparently either don’t keep statistics regarding which of their patients were vaccinated and which were not that might provide data that could be used to correlate cases of autism with vaccinations, if such a correlation exists, or haven’t bothered to look at their cases systematically. Indeed, one of Dr. Mayer’s partners, Dr. Paul Schattauer, admits as much:

Schattauer, interviewed at the Rolling Meadows office, said his caseload is too limited to draw conclusions about a possible link between vaccines and autism. “With these numbers you’d have a hard time proving or disproving anything,” he said. “You can only get a feeling about it.

“In no way would I be an advocate to stand up and say we need to look at vaccines, because I don’t have the science to say that,” Schattauer said. “But I don’t think the science is there to say that it’s not.”

In other words, Dr. Schattauer just plain doesn’t know if there is a correlation between vaccination status and autism, and he doesn’t have the data to say one way or the other! All he has is a “feeling” that there must be a link. Whether his “feeling” is correct or not is impossible to say, because there is no evidence to support it.

Olmsted’s article also leaves us with assertions about vaccines and autism from Dr. Jeff Bradstreet (again with no supporting evidence from well-designed clinical trials or studies presented), a known vaccine “skeptic,” plus additional claims that Homefirst’s unvaccinated children suffer from very low rates of asthma, a claim based on the same amount of clinical data as Homefirst’s autism claims: zero. Not surprisingly, in his article Olmsted happily and credulously laps up these assertions without any further investigation. For example, he could have fairly easily confirmed independently Dr. Eisenstein’s claim that Homefirst has such a low rate of asthma among its patients that it has been noticed by Blue Cross. All he had to do was to contact Blue Cross or ask Dr. Eisenstein to provide him with documentation from Blue Cross supporting this claim. He appears not to have bothered even to try. Some “investigative journalist” he is, if a lowly surgeon apparently knows how to verify an interviewee’s claim better than he does.

Countering the “feelings” of the Homefirst doctors, we do have recent studies that suggest that vaccination might–I emphasize, might–actually protect against asthma or decrease its severity, for example, a Spanish study, and a French study. They are not without their flaws, but they are far superior as data to any “feelings” expressed in Olmsted’s article. We also have several studies that show no correlation between vaccination and autism. One example is a Japanese study that showed that rates of autism did not decrease as vaccination rates with MMR decreased, as would be expected if MMR contributed to autism. In fact, autism rates increased somewhat, suggesting that it was highly unlikely that vaccination with MMR contributed to autism and autism spectrum disorders. (And, yes, I realize that MMR never contained thimerosal. I picked this example because the Homefirst doctors were blaming vaccinations in general; there are several other studies about thimerosal-containing vaccines that show no correlation between vaccination and autism, for example, the Danish study showing that autism rates did not decrease after thimerosal was removed from vaccines in Denmark in the 1990′s.) Finally, the alleged “epidemic” of autism is most likely not due to primarily vaccines, but rather primarily to a broadening of the diagnostic criteria for autism and autistic spectrum disorders. Taken in its totality, the preponderance of evidence from clinical trials strongly supports the conclusion that vaccines are not correlated with autism, and newer studies are even less supportive of a link. There may be a very small risk of complications from vaccination, but autism almost certainly isn’t among them.

Does any of this mean that the Homefirst doctors are incorrect or deluding themselves? Of course not. It’s always possible that they could be correct in their initial impressions, even though the presently existing scientific literature makes that rather unlikely. After all, the paths to quite a few great discoveries in medicine have begun based on the initial impressions of a single active clinician. But just initial impressions are not enough. Such discoveries require confirmatory data that is as objective and scientific as possible, and the Homefirst doctors definitely have not presented any convincing clinical data to support their speculations (and let’s face it, that’s all that was presented in Olmsted’s article–speculations). As we say in the scientific research biz, data talks and bullshit walks. Until Drs. Eisenstein, Schattauer, and Bradstreet produce some actual data from well-documented, well-designed clinical trials, or even any objective data, even if it doesn’t rise to Level I clinical data (such as a pilot study consisting of a rigorous and objective chart review of all the autistic children in their own practice over a certain time period, for instance), I would consider it unscientific and medically irresponsible to give much credence to their speculations at all, especially since at least one of them has an axe to grind and since there are a number of studies out there that contradict their self-admittedly unscientific impressions. And let’s not forget that the reporter writing this story has revealed himself to be anything but objective on this topic.

Apparently, however, when it comes to antivaccination conspiracy-mongering that fits in with his own admitted opposition to vaccination, speculation is evidence enough to convince Vox. Data? Just like Bill Maher, Vox don’t need no stinkin’ data!

But I do, and so should you.

(That ought to do it for dealing with Vox Day for a while. Any more, and I fear for my critical thinking skills.)