Respectful Insolence

The anti-vaccine movement is nothing if not plastic. It “evolves” very rapidly in response to selective pressures applied to it in the form of science refuting its key beliefs. For instance, when multiple studies looking at the MMR vaccine and autism failed to confirm the myth that the MMR causes autism or “autistic enterocolitis,” most recently late last year, it was not a problem to the anti-vaccine movement. Neither was it a major problem to the movement when multiple studies similarly failed to find a link between mercury in the preservative thimerosal that used to be in most childhood vaccines and is no more (except the flu vaccine) and autism. No problem! The anti-vaccine movement simply pivoted neatly, de-emphasized points that the evidence was so clearly against that even they couldn’t spin it to a positive anymore, and found new bogeymen. These days, it’s the “toxins” (such as formaldehyde and the latest antivax bogeyman, squalene), and “too many too soon” (a gambit given seeming respectability by Dr. Bob Sears, who’s lately dropped his pretense of not being anti-vaccine).

Evolution in action, indeed.

However, there is one trait of the anti-vaccine movement that, however its camouflaging plumage may evolve, never, ever changes. It is as immutable as creationists say that God is. That is that, whatever other claims, the anti-vaccine movement makes, at its core it is always about the vaccines. Always. No matter how much science fails to find a link between vaccines and autism or vaccines and whatever other horreur du jour the anti-vaccine movement tries to pin on vaccines, no matter how much it tries to deny and obfuscate by saying that it is not “anti-vaccine” but “pro-safe vaccine,” at its core the anti-vaccine movement is about fear and loathing of vaccines. Always. When inconvenient science doesn’t support their views, anti-vaccine activists either ignore it, distort it, or launch ad hominems against the people doing it or supporting it. And, as I said before, they evolve. Never again will the anti-vaccine movement yoke one of its major claims to a hypothesis that is as easily testable as the hypothesis that mercury in vaccines causes autism. The claim that mercury in vaccines causes autism predicted that, if thimerosal were removed from vaccines or reduced to pre-”epidemic levels” of the early 1990s, then autism rates should plummet. Thimerosal was removed from nearly all childhood vaccines (the sole exception being some flu vaccines), reducing infant mercury exposure from vaccines to levels not seen since the 1980s; yet autism rates continue to rise. This is about as resounding a refutation of the hypothesis that mercury in vaccines is a major cause or contributor to autism that even the anti-vaccine movement has backed away from the pure claim, which has now evolved to unnamed “environmental toxins,” either in concert with mercury or with other nasty things, as being the Real Cause of autism.

Evolution in action: These new claims are much “fitter” because they are much harder to falsify.

The latest favored demand of the anti-vaccine movement puzzles me, though. This demand is that the government conduct a large study of the “unvaccinated” versus the “vaccinated,” to compare them for health outcomes and, especially, the prevalence of autism. The reason I’m puzzled is because such a study has a very high risk of torpedoing virtually everything the anti-vaccine movement has been working toward in terms of promoting their message of fear about vaccines as being somehow credible (or at least not unreasonable) and based on science (more on that later). In the meantime, the drones over at the happy home for anti-vaccine propagandists, Age of Autism, are busily promoting the idea of a “vaxed versus unvaxed” study and disparaging anyone who dares to point out the difficulties, the latest target being Tom Insel of the Interagency Autism Coordinating Committee (IACC), who recently testified in front of Senator Tom Harkin’s comittee (yes, that Tom Harkin).

The misunderstanding and misrepresentation of epidemiology being trotted out to justify this study are astounding. For example, earlier this week, on AoA, a mechanical engineer named Catherine Tamaro tried to lecture scientists on statistics and the difference between observational versus experimental studies using quotes from a statistics textbook. She began:

After reading Katie Wright’s summary of the August 3 Senate Committee on Appropriations’ hearing on autism (HERE), I would like to comment on Dr. Insel’s testimony to Senator Harkin on why a study comparing vaccinated vs. unvaccinated children has not been done to date. Dr. Insel claimed that such a study would be “unethical” because, as he apparently envisions it, the study would entail dividing a large cohort of newborns into two groups, vaccinating one cohort but not the other through age two, and then comparing outcomes. This is just a bit disingenuous and I would like to explain why.

Of course, Ms. Tamaro is either ignorant or disingenuous herself in that some anti-vaccine advocates do indeed call for just such a study, even going so far as to demand a randomized, double-blinded study. J.B. Handley himself has attacked people who correctly call demands for such a study “unethical.” Apparently Ms. Tamaro isn’t aware of the strain running through the anti-vaccine movement that does want just such a study, or she herself is being even more disingenuous than she accuses critics fo being. Tamaro then continues:

Research studies are divided into two categories, observational studies and experimental studies. An observational study observes individuals and measures variables of interest but does not attempt to influence the responses. (The “epidemiological” studies to which Dr. Insel refers are actually observational studies.) An experimental study, on the other hand, deliberately imposes some treatment on individuals in order to observe their responses; the purpose of an experiment is to study whether the treatment causes a change in the response.

This paragraph just goes to show how a little knowledge is a dangerous thing. There are many flavors of “observational” studies, with varying degrees of power to detect differences and varying degrees of ease with which confounders are accounted for. These include cohort studies (both retrospective and prospective), cross sectional studies, longitudinal studies, and case series. All have their strengths and weaknesses, and the studies of vaccines and autism have used several kinds of methodology. Not that that sways Tamaro:

All studies done to date investigating a correlation between vaccinations and autism have been observational studies, but no observational study has been done comparing the prevalence of autism diagnoses in a vaccinated human population compared to an unvaccinated human population. When Dan Olmsted points out that he has identified large populations of unvaccinated children in the United States and asks why a study has not been done on them, he is actually asking why an observational study has not been done. When Senator Harkin asks Dr. Insel why a study has not been done on vaccinated vs. unvaccinated American children, he too is actually asking why an observational study has not been done to date. Dr. Insel, however, chooses to respond by saying that an experimental study would be required in order to resolve the issue.

Tamaro may have a bit of a point about Insel choosing the easiest to attack, but she is doing the same thing by ignoring the fact that there have been calls from the anti-vaccine movement for experimental studies, which, of course, would be highly unethical because they would leave large numbers of children completely unvaccinated and thus vulnerable to vaccine-preventable diseases. In any case, here’s where Tamara goes right off the deep end:

I would like to point out the epidemiological similarity between smoking/lung cancer and vaccines/autism. Smoking has been proven to cause lung cancer, yet not a single experimental study on humans was ever done – all of the human studies proving that smoking causes lung cancer were observational. The experimental studies were performed on research animals only. Attached at the end of this letter is a lesson taken verbatim from an introductory course in college statistics describing how the connection between smoking and lung cancer was made.

Point one: There have been lots of experimental studies on research animals of vaccines trying to show a link between vaccines and autism. I’ve written about some of them right here, and other bloggers have discussed them in detail as well. For example, there was the infamous Mady Hornig “rain mouse” study, in which she claimed that thimerosal at the doses infants received, adjusted for size, caused autistic symptoms. Both Prometheus and Autism Diva enumerated the numerous flaws and ethical lapses in that experiment. Then there was the more recent (and even more unethical) Laura Hewitson experiment looking at vaccinated and unvaccinated Macaque monkey infants. I was appalled at how badly designed and grossly unethical that experiment was, not to mention at the enormous undisclosed conflicts of interest of the investigators. The problem, of course, is that there is not yet a good animal model of autism. If there were, you can bet that there would be a huge amount of research using animal models. It’s not because the NIH is unshakably opposed to animal research on vaccines and autism. Rather it’s because such research is inherently not particularly useful or feasible absent a good animal model or two. Moreover, the history of such research (i.e., Hornig and Hewitson) is not exactly cause for optimism, given how badly done these studies were.

Point two: The tobacco comparison is a favorite canard of anti-vaccinationists. Certainly, it was primarily epidemiological studies that showed that smoking causes cancer. While she is correct to say that an experimental (i.e., randomized, blinded) study is not always necessary to provide sufficient evidence of causation, she’s picked the wrong example for a number of reasons. For smoking and cancer, the association is very strong, stronger than almost any environmental toxin and cancer that I can think of. Smoking results in a ten-fold increased risk of lung cancer, which is not hard to detect with an epidemiological study of even fairly weak design. But more importantly what Ms. Tamara either doesn’t know or fails to acknowledge is that the very same sorts of studies that identified smoking as a huge risk factor for lung cancer and cardiovascular disease are the same sorts of studies that have failed to find an association between either thimerosal and autism or vaccines and autism. For example, it was a case control study by Sir Richard Doll that was credited with first detecting the link between smoking and lung cancer (although actually the Nazis discovered the link with a case control study before Sir Doll did).

In any case, Ms. Tamara is also wrong when she says that a study of the vaccinated and unvaccinated has never been undertaken. In fact, Generation Rescue itself tried to do it. It was a very bad study, really no more than a phone survey, and its results were amusing in that they found that the highest rates of autism were in the so-called “partially vaccinated” children. The clear implication of the study was drolly described by Kevin Leitch:

There’s no getting away from this. This is a disaster for Generation Rescue and the whole ‘vaccines cause autism’ debacle. Generation Rescue’s data indicates that you are ‘safer’ from autism if you fully vaccinate than partially vaccinate. It also indicates that across the spectrum of autism, you are only 1% more likely to be autistic if you have had any sort of vaccination as oppose to no vaccinations at all – and thats only if you are male. If you are a girl you chances of being on the spectrum are less if you have been vaccinated! Across both boys and girls, your chances of being on the spectrum are less if you have received all vaccinations.

Ms. Tamara is also quite naive in that she clearly has no clue just how much money and how many children an observational study of the vaccinated versus unvaccinated would require to do properly, much less how tricky it would be to control for confounders, given that the unvaccinated vary in significant ways from the vaccinated. Again, Prometheus tells the tale. First, there is the issue of how few completely unvaccinated children there are, perhaps around 50,000 in the entire U.S. in the 3-6 year old age cohort. He then explains:

Let’s say – for the sake of argument – that we decide that a 10% difference in autism prevalence is enough to convince the skeptics that vaccines might cause autism and that a less than 10% difference will convince the believers that vaccines don’t cause autism. [I know, the latter assumption is pure fantasy.]

Well, plugging those numbers in – along with the current 1 in 150 autism prevalence – we find that we need over 360,000 children in each group to detect a 10% difference (you can try it yourself here). Unfortunately, that is more than the total number of unvaccinated children in the US, so that’s not going to happen.

What can we get with our “sample” of 49,652 unvaccinated children? If we manage to include each and every unvaccinated child in the US in the study, we could detect a 26% or more difference in autism prevalence.

Of course, it’s not even remotely practical to expect to get 100% of the unvaccinated children in the country into a study. How more about a practical number – say, 10% of them? That would allow us to detect a 70% or greater difference – about a three-fold difference in autism prevalence between the fully vaccinated and unvaccinated groups.

Does anyone labor under the illusion that parents who fervently believe that vaccines cause autism would ever accept negative results from a study that’s only powered to detect a three-fold difference in autism rates between vaccinated and unvaccinated children as sufficiently reassuring to accept the current vaccination as safe? Prometheus was right when he said that a study powered to find a 10% difference would probably not sufficiently reassure them. Given the religious fervor with which the anti-vaccine movement clings to the myth that vaccines cause autism, I doubt that it would accept a negative result from a study powered to detect a 1% difference in autism rates as sufficiently reassuring to abandon its fear. Moreover, as Prometheus tells us, even the study described above would be inordinately expensive and difficult to do. So he did a “back of the napkin” calculation of what a more feasible study could accomplish:

Finally, let’s “run the numbers” on a more practical study – one where we are able to enroll 500 unvaccinated children and 5000 fully vaccinated controls matched for age, sex, socioeconomic group, geographic location, urban vs rural vs suburban setting and race.

This study – which would still be very difficult and expensive to do – would only be able to detect a more than 15-fold difference in autism prevalence between the two groups. It could detect as little as a 7-fold difference, but only if we were willing to accept a beta error (chance of erroneously saying there is no difference when there is a difference) of over 50%.

I doubt this would “satisfy” the vaccines-cause-autism believers if the results were negative.

I can’t help but note that the study described by Prometheus would probably fail to find the well-known increased risk of lung cancer and heart disease due to smoking, the more so since the incidence of lung cancer in nonsmokers is considerably lower than 1 in 150, which is how many children are estimated to be autistic. Remember, the relative risk of lung cancer due to smoking is on the order of ten-fold.

The only way to get around the problems inherent in designing a study with sufficient numbers of unvaccinated children of sufficient power to detect a difference in autism prevalence between the unvaccinated and vaccinated children small enough to reassure most parents that vaccines do not cause autism would be to expand the study to multiple nations. Of course, doing such a study would be even more enormously expensive, take several years, and, because funding for autism research is pretty much a zero sum game, would divert huge amounts of money from more promising research to chasing down a highly implausible hypothesis that has virtually no credible empirical support behind it, either from basic science, epidemiology, or other evidence, certainly nowhere near enough evidence to justify such a huge expenditure and effort. Alternatively, as Prometheus points out, we could look at dose-response models:

Of course, we wouldn’t have to just look at unvaccinated vs fully vaccinated with this study, which is a large part of its superiority. We could look at a dose response of vaccination - to see if it really is “too many” – as well as the age at youngest vaccination – to see if it really is “too soon”. In fact, a few studies have already looked at those issues and found that there is no difference between the autistic and non-autistic groups. I suspect this is the reason the folks pushing to “put on a study” want to look at vaccinated vs unvaccinated – they hope that the numbers will be different (or, at least, not as definitive) the other way round.

In fact, I rather suspect that the smarter among the anti-vaccinationists know all the problems inherent in doing a study of vaccinated versus unvaccinated children. Certainly the government does, hence its reluctance to spend all sorts of money chasing a highly improbable hypothesis. (If only it would apply that reasoning to NCCAM!) In reality, the “vaccinated versus unvaccinated” gambit is just that–a gambit. The leaders of the anti-vaccine movement probably know that doing a study with sufficient power and numbers to exclude even a modest risk of autism due to the current vaccine schedule is so expensive and impractical that it would probably never be done and that smaller studies that are feasible will have too little power to reassure those who believe that vaccines cause autism that vaccines are in fact safe. Why do it then? It keeps the troops fired up thinking that there is some huge conspiracy to prevent such a study because of the fear of its results or that the government just doesn’t care enough about autistic children to do such a study.

Be that as it may, as cynical as the leaders of the anti-vaccine movement are, it’s so cute when AoA’ers try to do epidemiology and science. At least, it would be if their misinformation, pseudoscience, and utter nonsense were not such a profound threat to public health.

Comments

  1. #1 Anthro
    August 24, 2009

    Great read and great information to have at hand when next I run into one of these loonies. That said, you don’t have kids and you are smart and well-educated in science. As much as I support everything from this blog and QuackWatch and JREF, I am acquainted (for better or for worse) with some of these people and some kind of study WOULD appeal to some of them, especially the less “devout” who may have just “heard about the vax thing” and aren’t sure what to think. It doesn’t seem right to leave a void that encourages new converts.

    I have no doubt that a non-parent can be a great doctor and a great benefactor of children, but unless you have one of your own, it’s difficult to understand the instinctual thing that makes these people think that they are “protecting” their children from a grave risk. Have the inherent problems with a comparison study been made clear to them via their own communication networks? Just wondering.

  2. #2 antipodean
    August 24, 2009

    Nie post Orac.

    Sir Doll? Do you mean Sir Richard?

  3. #3 Sid Offit
    August 24, 2009

    @Orac
    Autism rates continue to rise.

    What am I missing? In 2000 the CDC says 1-150 have autism. In 2009 the CDC says 1-150 have autism. Where’s the rise?

    http://www.cdc.gov/ncbddd/autism/research.html
    The average ASD prevalence was 6.7 per 1,000 8-year-olds in 2000 and 6.6 per 1,000 8-year-olds in 2002 in several areas of the United States. That’s about 1 in 150 children.

    http://www.cdc.gov/ncbddd/autism/facts.html
    CDC estimates that between 1 in 100 and 1 in 300, with an average of 1 in 150, children in the United States have an ASD.
    Page last updated: August 20, 2009

  4. #4 Sid Offit
    August 24, 2009

    @Orac
    The very same sorts of studies that identified smoking as a huge risk factor for lung cancer and cardiovascular disease are the same sorts of studies that have failed to find an association between …vaccines and autism.

    Which studies are these? I’m aware of only studies involving one “vaccine”, the MMR.

  5. #5 Michael Ralston
    August 24, 2009

    The “rise”, Sid, is in the number of diagnoses, as you know full well.

    Indeed, the fact that surveys show unchanged prevalence despite the massive drop in thiomersal is sufficient to show that it was never the cause of the increased rate in the 90s. But … you won’t admit that, will you?

  6. #6 DrWonderful
    August 24, 2009

    I have to admit you guys are growing on me.

  7. #7 josh harris
    August 24, 2009

    @ sid

    You’re not trying to pull off the whole vaccines science is tobacco science. You’ve been at AofA too long. Let us review: Did every major health organization around the world promote smoking (no, but they do promote vaccines). Lets look at the pubs. Go to pubmed.com and type in “smoking and cancer”. Go to the earliest study, all were against smoking. There are very few studies stating that smoking is not dangerous. In fact, if you actually researched it, you would see that a majority of the major medical journals published articles against smoking and the dire consequences of it. Hardly a similarity, wouldn’t you say? In fact, where are the similarities? Thousands of publications stating smoking is harmful, and only a few saying its not – and you’re comparing this to vaccine science. I must be missing something, fill me in Sid.

  8. #8 Sid Offit
    August 24, 2009

    @Josh

    I made no reference to vaccine science as tobacco science. I simply inquired as to the existence of studies examining vaccines and autism. Orac seems to be arguing these studies have been done while at the same time arguing they can’t be done due to either ethical or logistical difficulties

  9. #9 Sid Offit
    August 24, 2009

    @Orac

    because funding for autism research is pretty much a zero sum game, would divert huge amounts of money from more promising research

    What is this mysterious “promising research” the vaccine zealots are always looking out for?

  10. #10 Sid Offit
    August 24, 2009

    @Orac
    We could look at a dose response of vaccination – to see if it really is “too many” – as well as the age at youngest vaccination – to see if it really is “too soon”. In fact, a few studies have already looked at those issues and found that there is no difference between the autistic and non-autistic groups.

    Do you intend to share any information about these studies. Prometheus offers no insight on his blog.

  11. #11 Jimbo Jones
    August 24, 2009

    The reason why the AoA goons are harping on vax vs. unvax autism studies is because they know it’s not going to happen. One of them asked, a long time ago (in Internet terms, at least) an idle question that displayed vast ignorance of scientific ethics. But the only part of the answer they heard was “never going to happen”.

    Now, because of that and public ignorance of those same scientific ethics, they continue to harp on the idea of a direct study.

    As well, most antivaxxers are True Believers(TM) and think that they’ll be proven right in the end. On that score, I think it’s time to stop engaging with them directly; you can’t argue with such people. Mockery is all that’s left.

    Case in point: Sid Offit, #3,4. Amusing for a while, but he keeps trotting out the same canards. So, in the end, why bother engaging? Especially when laughing from afar, and educating those who can be, is so much more rewarding.

  12. #12 Jay Gordon, MD, FAAP
    August 25, 2009

    I miss all of you.

    We have a real health care issue to discuss: Health Care Reform.

    Orac, could you please link me to the essay you’ve written about the disgrace which is our United States Congress. Personally, I favor a strong “public option.”

    You’re born, you get health care.

    Vaccination discussions are interesting but endless and circular. Can we all just agree that this issue is not going to be solved in open forums like this one but that the scientific muscle arrayed here could be put to good use getting universal health care coverage?

    Best,

    Jay

  13. #13 Orac
    August 25, 2009

    Why Dr. Jay, you’re back!

    You obviously haven’t been reading, have you?

    Of course, the reason the arguments about vaccines are “endless and circular” is because, my friend, you hold stubbornly to the belief that vaccines cause autism in the face of the overwhelming science that fails to support your belief.

  14. #14 DrFrank
    August 25, 2009

    @Sid #10
    What is this mysterious “promising research” the vaccine zealots are always looking out for?
    Maybe further research on things that actually exist like cancer, rather than outlaying huge amounts of money and effort simply to satisfy idiots who will just move the goalposts further even if they *were* performed.

    There is no reason to believe that vaccines cause autism except for the fact that it has become a popular bogeyman amongst the inept. An identical discussion could just as easily be had about wifi, phone masts, The Age of Aquarius or the Magic Gigantic Squid.

    I wouldn’t support the outlay of billions of pounds to fund a new expedition to the moon simply to prove the moon hoaxers wrong, and for the same reason anti-vaxxers can sod right off too.

  15. #15 Don Cox
    August 25, 2009

    Has anyone looked to see if parents with autism-spectrum disorders are more (or less) likely to have their children vaccinated than others?

  16. #16 trrll
    August 25, 2009

    What is this mysterious “promising research” the vaccine zealots are always looking out for?

    I’d say that the most promising research at the present time is research into the genetics of autism, and research into the cellular and neurochemical changes in autistic brain. These lines of research have been making clear progress, whereas research into vaccines and other environmental theories of autism causation have been a waste of money, failing to yield insights into causation, and also failing to reassure those who fear vaccination.

  17. #17 Dedj
    August 25, 2009

    It’s an interesting question Don Cox, and raises an issue I’ve never seen being even waved at in any anti-vax/vaxx skeptic literature, online or off.

    It basically can be divided into two angles:

    Are parents of an autistic child more in contact with health services (because of the autism related contact) and therefore likely to be reminded/offered age appropriate vaccines.

    or

    Are parents who have increased contact with health services (because they ensure their kids get all thier vaccines) also more likely to have an awareness of autism or more likely to be in contact with someone who does.

    Both of these angles could affect the data, yet you’ll be unlikely to see this discussion from any of the ‘put on a study’ people. For many of them it’s either vaccines first then autism. The idea of post diagnosis vaccines being accounted for doesn’t travel far for many of these people.

  18. #18 History Punk
    August 25, 2009

    “Orac, could you please link me to the essay you’ve written about the disgrace which is our United States Congress. Personally, I favor a strong “public option.”

    Orac has done this, it’s called the search engine.

  19. #19 Phoenix Woman
    August 25, 2009

    The latest favored demand of the anti-vaccine movement puzzles me, though. This demand is that the government conduct a large study of the “unvaccinated” versus the “vaccinated,” to compare them for health outcomes and, especially, the prevalence of autism. The reason I’m puzzled is because such a study has a very high risk of torpedoing virtually everything the anti-vaccine movement has been working toward in terms of promoting their message of fear about vaccines as being somehow credible (or at least not unreasonable) and based on science (more on that later). In the meantime, the drones over at the happy home for anti-vaccine propagandists, Age of Autism, are busily promoting the idea of a “vaxed versus unvaxed” study and disparaging anyone who dares to point out the difficulties, the latest target being Tom Insel of the Interagency Autism Coordinating Committee (IACC), who recently testified in front of Senator Tom Harkin’s comittee (yes, that Tom Harkin).

    They’re demanding a huuuuuuge (too huge to be properly implemented, natch) study for the following reasons:

    1) It’s a big fat bluff that they’re pretty sure can’t be called, simply because research budgets are incredibly constrained lately. When the ethical scientists like you say “sorry, can’t do it, gotta save our money for real issues”, it gives them the opening to say “CHICKEN!”

    2) If by some chance the study actually did take place, it would take years to complete, thus buying the anti-vaxers some more time to whack away at herd immunity.

  20. #20 Todd W.
    August 25, 2009

    Does anyone have a ballpark figure of how much a vax vs. unvax study would cost, even at the 70% difference range?

  21. #21 catgirl
    August 25, 2009

    Has anyone looked to see if parents with autism-spectrum disorders are more (or less) likely to have their children vaccinated than others?

    Actually, in attempting to find the cause(s) of autism, it would be better to reverse their idea and study autistic vs. non-autistic and see what the differences are. Of course, any study like this also has many confounding factors and sources of bias, but at least it doesn’t limit the study to looking at just one factor. Studies like this have been done, where children with autism had their genomes compared to children without autism, which showed that genetics play a part in autism. Your idea is on the right track, but in reality, many studies have already failed to show a link between vaccines and autism, and since those haven’t changed the anti-vaxxers minds, it’s unlikely that any study ever will.

  22. #22 Simply Hilarious...
    August 25, 2009

    Good one Orac! (you make me laugh out loud).

    The only thing cuter than that is when your own epidemiologist-for-hire Dr. Fombonne publishes a study on autism stats and can’t get out of his own way by confusing statistics from Quebec City and Montreal. That was a hoot!

  23. #23 MI Dawn
    August 25, 2009

    @ Simple…go away Sue. At least Dr Fombonne admitted to his error in what city he named. Unlike most of your “wonderful” DAN docs who lie and are never made to admit to their errors. Has Dr Wakefield lost his license yet?

  24. #24 Oh goodie...
    August 25, 2009

    “At least Dr Fombonne admitted to his error in what city he named.”

    Please post the link. I would hope that it appeared in Pediatrics where his bogus study was originally published. Any reputable researcher would require that a retraction be made on such a misleading study. I anxiously await your reply.

    As far as I am aware Dr. Wakefield has not lost his license (personally I don’t think he should). Is there a license that can be taken away from a major failure of an epidemiologist?

  25. #25 Jake Crosby
    August 25, 2009

    I hope so.

  26. #26 Prometheus
    August 25, 2009

    Todd W (#20) asks:

    Does anyone have a ballpark figure of how much a vax vs. unvax study would cost, even at the 70% difference range?

    That study would involve 5,000 unvaccinated children and 5,000 vaccinated children matched to the unvaccinated subjects in age, sex, region, income and race (possibly also parental education). These children would then need to have their medical records examined (to determine vaccinations they received) and they would have to be evaluated for autism/AS/ASD/PDD-NOS.

    Extrapolating from another study ongoing at my institution, it appears that just getting the subjects enrolled would take a couple of years and about $100,000 to $200,000 for adminstrative staff.

    Evaluating the vaccination records would take another $100,000 to $200,000, depending on how much work the parents were expected to do in obtaining and compiling the vaccination records.

    Evaluating each of the subjects for autism (etc.) would take from a rock-bottom low of $250 each (no travel allowance, graduate students doing the testing, only one test) to a more reasonable range of $500 – $1000 each.

    So, a “ballpark” cost estimate would be $2.7 million to $10.4 million.

    Of course, nobody would want to fund this study – not the “vaccines-cause-autism” groups (because it won’t help their position and might hurt it) and not the “mainstream” scientific community (because it won’t convince the only people who claim to want such a study).

    Frankly, the “vaccines-cause-autism” group could advance their cause a lot by funding a legitimate study of the question – a small, pilot study of vaccines and autism. It most likely wouldn’t show any effect (even if there were a small effect) because of its size, but it would show that they were serious about the science.

    Of course, here in this universe…..

    Prometheus

  27. #27 Jay Gordon, MD, FAAP
    August 25, 2009

    The link, please. The link to the blog about the astounding fraudulent discussions taking place about health care coverage for all Americans.

    Thanks.

    Jay

  28. #29 Eric
    August 26, 2009

    I have a similar post on my blog (link in my name) from a couple months back. I’ve always been astounded by the rather horrific lack of ethics and sheer futility of this particular “suggestion”.

  29. #30 Jay Gordon, MD, FAAP
    August 26, 2009

    Thank you.

    Jay

  30. #31 passionlessDrone
    August 26, 2009

    Hi Prometheus –

    Evaluating each of the subjects for autism (etc.) would take from a rock-bottom low of $250 each (no travel allowance, graduate students doing the testing, only one test) to a more reasonable range of $500 – $1000 each.

    We drove our son to Gainesville to participate in a study; genetic based, trying to map alleles to specific behaviors. (I wish I’d known that before we drove down).

    Anyways, I did find myself in relative amazement about how much time the primary researcher and her grad student wound up having to spend with Luke just to validate that he had autism (pretty much half a day and a whole day). We were there for six hours or so, and in the last five minutes they pulled blood. This was a cost that I never would have imagined; but pretty much for every participant, she was burning half a day of work. This, perhaps was an artifact of the study design, as they wanted to know a lot about specific behaviors he exibited for mapping purposes.

    Funny enough, I think we knew more about autism than the researcher; five minutes after we sat down my wife was explaining the difference between angelmans and prader willi syndrome. The researcher in question also practices ‘treating’ children with autism; when I asked her how, her answer was psychotropics. I started laughing, and eventually she told me, ‘I prefer evidence based medicine’. LOL!

    - pD

  31. #32 MikeMa
    August 26, 2009

    Nice to see that silly sue and deluded jake are still on the case. The saying goes, “When you are in a hole, stop digging.” Its not keep digging.

  32. #33 Todd W.
    August 26, 2009

    @Prometheus

    Thanks for the dollar figures. I figured the cost had to be pretty big, but didn’t realize how big.

    So, with that in hand, we can now suggest to anti-vaxers who are calling for those studies to start saving up.

  33. #34 Prometheus
    August 26, 2009

    Todd,

    As I’ve said before, the “vaccines-cause-autism” crowd could do a smaller pilot study to see if what they claim to believe (i.e. that vaccines “cause” most autism) is true. A study with as few as 500 children in each group would be able to show if autism were ten times more prevalent in vaccinated vs unvaccinated children (if they were willing to accept the standard beta error – the chance of mistakenly saying there is no difference when there actually is a difference – of 50%).

    This cost of a study this size – especially if a lot of people volunteered their time to do the administrative work – would be in the “ballpark” of what some of these groups have spent on deceptive advertising.

    Even if the pilot study showed no difference, they would be able to show that they are serious about looking into the issue, which would improve their chances of getting research funded.

    However, it is cheaper and much less risky to simply ask “Why won’t ‘they’ do a study?” than it is to contribute to the scientific process.

    Prometheus

  34. #35 Prometheus
    August 26, 2009

    “Dr. Jay” insists:

    “The link, please. The link to the blog about the astounding fraudulent discussions taking place about health care coverage for all Americans.”

    Is it me or is “Dr. Jay” becoming more “bossy” (and tangential) with time? His comments had a distinct “busy doctor here – no time to look for things myself” tone to them. Not only that, but he’s asking about health care reform in a post that doesn’t discuss the topic.

    I realize that the pressures of maintaining a contra-scientific posture for his boutique clientele must be wearing, but a modicum of common courtesy would suit him better.

    Note to “Dr. Jay”: We are NOT your servants, nor are we obligated to do your bidding. If I had been in Orac’s shoes (or at his keyboard), I would have deleted your comments “with extreme prejudice”.

    You, sir, are an arrogant ass.

    Prometheus

  35. #36 Saywhat?
    August 29, 2009

    1) I’m confused about why the alt-lifestyle, anti-vax, anti-evilBigPharma, granola-will-prevent-swine-flu lot wants gov’t to do a study at all. I mean, isn’t this the same gov’t that is utilizing vaccines as a tool for population control? So, any report would naturally be falsified as part of the evil plan to perpetuate the ignorance of the masses, right? At least, that’s what the paranoid buzz is at the local crunchy-mama sewing circle (and that’s sewing with organic, soy-based dyed cotton, *of course* thankyouverymuch) — a group who, by the way, are not to be included in the aforementioned “masses” because, thanks to Mothering Magazine and late night talk radio, they are “in the know.”

    2) Through my (undisclosed agency) work, I know approx. 15 families who have a child diagnosed with autism. Some are vaxed, some are not. What they all have in common is that NOT ONE parent believes the vax caused it. So, aside from pesky celebrities, who are all these vax=autism folks anyway? It seems to me that they represent a small portion of the autism community. And the families I know, who deal with autism everyday, wish they would shut up and focus their efforts towards something far more useful.

  36. #37 Herp N. Derpington
    February 4, 2011

    WHEN WILL YOU DOLTS REALIZE THAT AUTISM IS CAUSED BY THE ACTUAL PHYSICAL INJECTIONS, NOT BY THE SUBSTANCE INJECTED?? IT MAKES PERFECTS SENSE, JUST PULL YOUR HEAD OUT OF YOUR @$$3$ YOU PHARMA SHILLS

    WAKE UP SHEEPLE

  37. #38 Chris
    February 4, 2011

    Oh, wow. It is a FULL CAPS necromancer, even using the absolutely worthless Pharma Shill Gambit.

    Oh, the comedy hits just keep coming!

  38. #39 Todd W.
    February 4, 2011

    @Chris

    I think you’ve been Poed.

  39. #40 Chris
    February 4, 2011

    Perhaps.

  40. #41 Pablo
    February 4, 2011

    So, infant acupuncture would cause rapid onset autism?

  41. #42 Orac
    February 4, 2011

    When ALL CAPS necromancers start showing up in a year and a half old thread, I know it’s time to shut it down.

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