Respectful Insolence

ResearchBlogging.orgArguably, the genesis of the most recent iteration of the anti-vaccine movement dates back to 1998, when a remarkably incompetent researcher named Andrew Wakefield published a trial lawyer-funded “study” in the Lancet that purported to find a link between “autistic enterocolitis” and measles vaccination with the measles-mumps-rubella (MMR) trivalent vaccine. In the wake of that publication was born a scare over the MMR that persists to this day, 11 years later. Although peer reviewers forced the actual contents of the paper to be more circumspect, in the press Wakefield promoted the idea that the MMR vaccine either predisposes, causes, or triggers autistic regressions. Even though over the next several years, investigations by investigative journalist Brian Deer revealed that not only was Wakefield’s research funded by trial lawyers looking to sue vaccine manufacturers for “vaccine injury” when he did his research (for which he is now being charged by the U.K.’s General Medical Council with scientific misconduct), but during the Autism Omnibus trial testimony by a world-renowed expert in PCR technology showed that he was incompetent. Even worse for Wakefield, in February 2009 Brian Deer published a news expose based on strong evidence that Wakefield may very well have falsified data for his Lancet paper.

None of this mattered. Andrew Wakefield still enjoys a cult of personality among the anti-vaccine crowd that no revelation seems able to dislodge, even the revelation that at the time he was both in the pay of trial lawyers and working on his study, Andrew Wakefield was also applying for a patent for a rival measles vaccine. Indeed, the anti-vaccine propaganda blog Age of Autism bestowed upon him last year its “Galileo Award” as the “persecuted” scientist supposedly fighting for truth, justice, and anti-vaccinationism against the pharma-funded or brainwashed minions of the “Church of the Immaculate Vaccination.” In the meantime, MMR uptake rates in the U.K. have plummeted over the last decade, far below the level needed for herd immunity, to the point where, last year the Health Protection Agency declared measles to be once again endemic in the U.K., 14 years after the local transmission of measles had been halted.

Since Wakefield’s study was released, a number of studies have shown that there is no epidemiologically detectable link between vaccination with MMR and autism, including one by a researcher who once appeared to be a believer in the idea that vaccines are somehow linked with autism, Mady Hornig. Hornig actually tried very hard to replicate Wakefield’s 1998 Lancet study, only this time with more children, and she found no link between MMR and autism using methodology similar to Wakefield’s. None of this has had any effect on the anti-vaccine movement, except to motivate them to circle the wagons even more, as J.B. Handley of Generation Rescue did when he launched a website called Fourteen Studies, whose sole purpose is to launch fallacious and pseudoscientific attacks on studies failing to find a link between vaccines and autism and to promote the lousy science that gives the appearance of supporting the hypothesis that there is a link between the MMR vaccine and autism and then sliming anyone who points out how deceptive their attacks were.

Last week, yet another study was released investigating whether there is a link between MMR vaccination and autism. Last week, yet another study failed to find a link between MMR vaccination and autism. This week, yet another study is all set to be attacked by Generation Rescue and the anti-vaccine movement. The sad and sordid history of reactions of the anti-vaccine movement to studies that do not support its belief in the unsinkable rubber duck of a myth that vaccines cause autism. This study was published online in The Pediatric Infectious Disease Journal by a group from Department of Epidemiology and Preventive Medicine, Jagiellonian University, Collegium Medicum, Krakow, Poland (a Polish group, my people!) and entitled Lack of Association Between Measles-Mumps-Rubella Vaccination and Autism in Children: A Case-Control Study. It’s yet another nail in the coffin of the myth that the MMR causes or contributes to autism. Indeed, this study not only shows that MMR vaccination is not associated with autism but that it may even be protective against autism. True, for reasons I will discuss shortly, I doubt that that latter interpretation is true, but there’s no doubt that this study is powerful evidence against the view that there is an association between MMR and autism. Unfortunately, I fear that all the nails in my local Home Depot would not be enough to keep the zombie of this pseudoscience from rising from its grave yet again.

Here’s the abstract of the paper:

OBJECTIVE: The first objective of the study was to determine whether there is a relationship between the measles-mumps-rubella (MMR) vaccination and autism in children. The second objective was to examine whether the risk of autism differs between use of MMR and the single measles vaccine.

DESIGN: Case-control study.

STUDY POPULATION: The 96 cases with childhood or atypical autism, aged 2 to 15, were included into the study group. Controls consisted of 192 children individually matched to cases by year of birth, sex, and general practitioners.

METHODS: Data on autism diagnosis and vaccination history were from physicians. Data on the other probable autism risk factors were collected from mothers. Logistic conditional regression was used to assess the risk of autism resulting from vaccination. Assessment was made for children vaccinated (1) Before diagnosis of autism, and (2) Before first symptoms of autism onset. Odds ratios were adjusted to mother’s age, medication during pregnancy, gestation time, perinatal injury and Apgar score.

RESULTS: For children vaccinated before diagnosis, autism risk was lower in children vaccinated with MMR than in the nonvaccinated (OR: 0.17, 95% CI: 0.06-0.52) as well as to vaccinated with single measles vaccine (OR: 0.44, 95% CI: 0.22-0.91). The risk for vaccinated versus nonvaccinated (independent of vaccine type) was 0.28 (95% CI: 0.10-0.76). The risk connected with being vaccinated before onset of first symptoms was significantly lower only for MMR versus single vaccine (OR: 0.47, 95% CI: 0.22-0.99).

CONCLUSIONS: The study provides evidence against the association of autism with either MMR or a single measles vaccine.

Indeed it does. It’s worth talking a bit about the methodology of the study. First of all, this is a case control study, which means that it’s retrospective and therefore not randomized. On the other hand, it was a case control study by Sir Richard Doll that was the first outside of Nazi Germany (whose scientists, oddly enough, had found evidence linking smoking to lung cancer more than two decades before the Surgeon General issued his report in 1964) to find an association between tobacco smoking and lung cancer, a finding that was subsequently followed up in cohort studies and found to be valid. Be that as it may, case control studies, instead of prospectively following a population over time, study a population of patients who already have a disease or condition and then try to identify factors associated with the development of that condition. Basically, this involves picking a control population that is equivalent to the study population, and this is how the investigators did it:

Subjects were identified using general practitioner records in the Lesser Poland (Małopolska) Voivodeship in Poland. The sample population of this study included children aged 2 to 15 years diagnosed with childhood or atypical autism, classified according to ICD 10-criteria as F84.0 or F84.1, respectively. Every diagnosis of autism was made by child psychiatrist. Dates of these diagnoses were recorded in general practitioners files. Cases with uncertain diagnosis of autism, secondary to disease state or trauma, were excluded. Two controls were selected for each affected child, individually matched by year of birth, gender, and physician’s practice. The first 2 children visited the physician after the time of the autistic child visit who met entry criteria served as controls.

This is a reasonable strategy to use to pick the control group, as it means that the children would be coming from the same pediatric practices as the autistic children and would be about as comparable as it is possible to make them in this sort of trial design. Another strength of this study is that it used physician reporting for vaccination history and the age at which each autistic child was first diagnosed, rather than relying on parents’ reporting, which is prone to serious confirmation bias. True, the parents were also asked when they first suspected their child’s symptoms might be related to autism, and their knowledge and beliefs regarding the cause of autism, but vaccination was not mentioned in order to avoid biasing the parents’ answers. Cases of autism were then analyzed and considered to have been vaccinated if they received the MMR prior to the onset of autistic symptoms. Controls were considered vaccinated if they had received the MMR before the age of onset of their matched case controls. Finally, the authors corrected for other potential risk factors for autism, including mother’s age, education, gestation time, medications during pregnancy perinatal injury, and the APGAR score of the child at birth. Those that appeared significant in univariate analyses were then subjected to multivariate analysis.

The money table is Table 4, which represents the multivariate analysis:

i-9c78c91ce6aeedd429ff252c55f80df7-Table-4.jpg

What’s surprising about these results is that the multivariate analysis found a relative risk (RR) of autism for children vaccinated with any vaccine before the onset of autistic symptoms of 0.65 and 0.28 for children vaccinated before their “official” diagnosis of autism. When looking at the single vaccine for measles or the trivalent MMR vaccine, both appeared to be protective against autism, but the MMR appeared to be considerably more protective than the single shot measles vaccine. (This comparison could be made because the Polish national health service only covered the single dose measles vaccine and not the MMR until 2004, meaning that before 2004 parents who wanted the MMR vaccine had to pay extra.) Indeed, this study even found that for children vaccinated with MMR before their diagnosis of autism the RR = 0.17, suggesting a six-fold decreased risk of autism in children vaccinated with MMR!

Is this really true? Is MMR vaccination really that protective against autism? Probably not. An effect of that magnitude would very likely been picked up in one or more of the large population-based studies that failed to find a correlation between vaccines and autism. There is also one shortcoming in this study is that it only looked at autistism and not other pervasive developmental disorders; however there is ample other evidence that MMR is not associated with PDDs other than autism, and the original claim of the anti-vaccine movement was that MMR causes autism. So how to explain such a result? One possibility is simply random chance, given that the sample size, although reasonable, is not that large. Another possibility is that there is a confounder that wasn’t adequately controlled for. Whatever the case, here’s one thing to remember about retrospective studies in general. They often find associations that later turn out not to hold up under study using prospective studies or randomized trials or, alternatively, turn out to be much weaker than the retrospective study showed. They do not so often find a result that is exactly the opposite of hypothesis tested for. In other words, when such a study is used to look for a positive association between a factor and a specific condition or disease, it is quite uncommon to find a negative association, particularly one this strong. One possible reason for this seeming protective effect observed was discussed by the authors:

The decreased risk of autism among vaccinated children may be due to some other confounding factors in their health status. For example, healthcare workers or parents may have noticed signs of developmental delay or disease before the actual autism diagnosis and for this reason have avoided vaccination.

I have speculated before that a study of “vaccinated” versus “unvaccinated” children could be similarly confounded by parents who have one autistic child, become convinced that vaccines caused it, and therefore don’t vaccinated subsequent children that they might have. The main point to remember is that, even though this study is not compelling evidence that MMR is protective against autism, at the very least, the Polish study is strong evidence against a positive correlation between vaccination with MMR or single vaccination against measles and the development of autism. It is yet another pebble in the mountain of evidence that vaccination with MMR is not associated with autism or “autistic enterocolitis.”

It’ll be fun to see how long it is before Handley adds this study to his “Fourteen Studies” website and renames it “Fifteen Studies.” Of course, at the rate studies failing to support Generation Rescue’s cultish clinging to the unsinkable rubber duck of a belief that vaccines cause autism, Handley will have to rename his site every few months at least, and I or other skeptical bloggers will have to slap down yet another scientifically ignorant attempt at discrediting each new study. So far, the silence has been deafening, even though it’s been over a week since the study was published. I figured that by now they could have trotted out Mark Blaxill or one of its other “scientific” luminaries to slime the study. Heck, even J.B. Handley could have given it a hand. I’m sure the results would have been as hilariously off base as they always are whenever J.B. Handley tries his hand at analyzing science.

On and on it goes. Meanwhile, autistic children pay the price for quackery related to anti-vaccine beliefs, and normal children face the resurgence of vaccine-preventable diseases, thanks to the efforts of anti-vaccine cranks like J.B. Handley, Jenny McCarthy, Jim Carrey, Barbara Loe Fisher, and the rest of the vaccine denialists. Meanwhile, millions of dollars are wasted to do study after study that show the same thing over and over again, diverting money in a zero-sum game from other potentially promising avenues of research.

REFERENCE:

Mrożek-Budzyn D, Kiełtyka A, & Majewska R (2009). Lack of Association Between Measles-Mumps-Rubella Vaccination and Autism in Children: A Case-Control Study. The Pediatric infectious disease journal PMID: 19952979

Comments

  1. #1 MikeMa
    December 10, 2009

    Nice writeup Orac. I believe the GMC decision on Wakefield is due out on the 19th, just in time for the holidays.

    I fear you are correct in stating that there are not enough nails to keep the zombie from rising but it is nice to see the zombie get a few hits.

    As for Wakefield receiving the Galileo award, it should have been the Nero award celebrating the tragic loss by others now that measles is endemic again, the reason for which lies solely at his feet. He planned to make money from the crap study and gave not a thought to the damage he has wrought.

  2. #2 Gus Snarp
    December 10, 2009

    I’m so confused. Having heavy deja vu. Please tell me you posted this elsewhere under your real name. In which case, BTW, you might want to note that on the post somewhere to avoid confusion like mine.

  3. #3 Todd W.
    December 10, 2009

    @Gus Snarp

    It was posted by a good “friend” of Orac’s on the other blog. I had a moment of “wait, I’ve read this before”, too.

  4. #4 BA
    December 10, 2009

    As I posted on that friend’s commentary to the article, I would consider the MMR an anti-autism vaccine. Congenital rubella is associated with an increased probability of autism.

    For example:

    J Pediatr. 1978 Oct;93(4):699-703.

    Behavioral consequences of congenital rubella.
    Chess S, Fernandez P, Korn S.

    Psychiatric and behavioral consequences of congenital rubella are reported for 243 children studies during the preschool period, and for 205 of these who were re-examined at ages 8 to 9. At preschool 37% were retarded, with the skew toward severe and profound; 15% had reactive behavior disorder and 7% had autism. At school age retardation diminished to 25%, but neurotic problems and behavioral pathology due to neurologic damage both increased. There were two remissions and three new instances of autism.

    PMID: 702254 [PubMed - indexed for MEDLINE]

  5. #5 Dianne
    December 10, 2009

    Off topic: Orac, there was a lovely bit of woo at the latest ASH meeting. They really are infiltrating everywhere…

  6. #6 Orac
    December 10, 2009

    What was this lovely bit of woo? Do tell.

  7. #7 WMDKitty
    December 10, 2009

    Orac, I always learn something new when I read your blog. Keep it up, man!

  8. #8 Dianne
    December 10, 2009

    The educational session entitled “Integrating complementary medicine into hematology care.” Description here. I must admit I didn’t actually see the session-it conflicted with a session more useful for me-but the description in the program book was…disturbing. On the plus side, at least one of the authors seems to have discussed the fact that any “alternative medicine” treatment with an effect will also have side effects and to review specific cautions concerning patients’ use of alternative medicines. On the minus side, Volker Diehl, previously a well respected researcher in lymphoma, going on about Reiki and Tai-Qi.

    I’m not sure anyone approached the basic problem of “alternative medicine” though: that any CAM that works becomes part of “standard medicine”-and is usually given in a safer and more effective manner than it was when it was “alternative”.

  9. #9 Pablo
    December 10, 2009

    Unfortunately, I am going to tell you all now that the anti-vax people won’t take this paper seriously. Of course, we all know that they wouldn’t do it on principle, but the data showing MMR to prevent autism is going to impeach the study without any further consideration. I’m telling you, if I’m reading your blog as an anti-vaxxer, my response would be,

    “Jeez, you admit that there are potential confounders that haven’t been considered. Why do you only invoke them in trying to explain away the idiotic conclusion that vaccines prevent autism? Why do you assume that the confounders stop at the point of no effect? If there really are factors you have missed, given the size of their apparent effect (come on, a factor of 6 difference? 600% is a huge difference), why isn’t it enough to mask an effect in the other direction? Why is a 6 fold effect believable, but not a 12 fold effect (which would mean that vaccinated kids are 6 times more likely to have autism)?”

    Then again, I am not an anti-vaxxer, and know enough to know that selective rationalization is a bad approach. If you conclude that “The data showing that MMR decreases autism is suspect because none of the previous studies show it, but the conclusion that MMR does not cause autism is not suspect because it agrees with the previous studies” then this study hasn’t taught us anything. I’d try to find some better explanation than, “There are possible confounders that we missed,” because that just boils down to special pleading. You really have to find them.

    BA has a start to this. For one thing, it’s easily testable (how many of each group has had rubella? If few of the autism group had rubella, then it would not account for the difference.

    That all being said, the offspring goes in tomorrow for his 1 year shots, including the first round of MMR. It’s getting complicated, though, because he still needs his seasonal flu shot, and his H1N1 booster. That is a lot of jabs with a needle. I haven’t decided whether it is going to be better to just get them all over with in one sitting, or devise a strategy to allow the soreness to subside before adding more. Then again, chronic soreness from needle jabs won’t be fun, either.

  10. #10 Gabe's Mom
    December 10, 2009

    “They often find associations that later turn out not to hold up under study using prospective studies or randomized trials or, alternatively, turn out to be much weaker than the retrospective study showed. They do not so often find a result that is exactly the opposite of hypothesis tested for.”

    I appreciate the fact that you pointed out the failings of this type of retrospective study. It is exactly this kind of rationality the anti-vaccine groups lack. But, if they were rational I guess this post would be unnecessary because the study(ies) would speak for itself.

  11. #11 Denice Walter
    December 10, 2009

    @ Pablo: I don’t know if *any* research would convince the most adamant anti-vaxxers- if you created a “Volk Register”-type study(from Denmark or elsewhere) that showed a clearly familial pattern of autism(similar to that of SMI),*totally* unrelated to vaccination,it would probably be dismissed as well.If people are irrational,arguing *reasonably* will not be effective(there *are* other ways to affect their beliefs/behavior but that’s more in the realm of therapy).We can only reach those who are (mostly) rational but ill-informed or deliberately mis-guided by others.

  12. #12 Temporarily Anonymous
    December 10, 2009

    I am autistic. I did not get the MMR as a toddler, but I did have rubella as a neonate.

    The antivax propaganda is so heavily reliant on anecdotes that I am strongly tempted to step forward as a counter-anecdote,xcept that step would be irrevocable, and invite attention into my life from a whole lot of unsavory people, and like most autistics, I do not enjoy attention even under the best of circumstances.
    Still, I might do it. We’ll see.

  13. #13 MikeMa
    December 10, 2009

    Temporarily Anonymous
    Tough call for you but I applaud you even considering it. Unsavory characters indeed but there is a lot of support here and elsewhere if it is needed.

  14. #14 Tsutsugamushi
    December 10, 2009

    Am I mistaken or did my comment regarding this article on Science-Based Medicine disappear? If it did, what did I do wrong for you to remove it? Or is there a general antipathy regarding my person?

  15. #15 Rene Najera
    December 10, 2009

    The scientists who “persecute” Wakefield are like a church? Really? And I suppose the antivaxxers don’t behave like a church… No, not at all.
    I bet that if God Himself appeared out of the sky and told them that, no, vaccines are not a bad thing, antivaxxers would say that God has a hidden agenda and wants to punish people with Autism.
    Seriously, I’d put good money on it.

  16. #16 Michael Simpson
    December 10, 2009

    It doesn’t matter how many times this type of article is published, where it clearly states that there is no link, people believe what they want to believe. There will be appeals to conspiracy. There will be strawman arguments. The debate will continue.

    Maybe a good science education will help. Probably not.

  17. #17 Gabe's Mom
    December 10, 2009

    @12
    Just wanted to thank you for your input. My husband has Asperger Syndrome, so I can see very clearly that there is a strong genetic link for our son’s autism.

    As I am learning in these threads, there is just no convincing some people of what they don’t want to believe.

    I agree with Rene Najera: “I bet that if God Himself appeared out of the sky and told them that, no, vaccines are not a bad thing, antivaxxers would say that God has a hidden agenda and wants to punish people with Autism.”

    Indeed, I would put money on it too.

  18. #18 Dave
    December 10, 2009

    Tsutsugamushi @ 14: depending on what you wrote, it’s possible that your article was flagged and is being held up in the moderation queue until Orac can pass on it. He rarely censors unless you’re a complete loon and a persistent one.

  19. #19 Calli Arcale
    December 10, 2009

    Tsutsugamushi — did you include links? If so, it may be held up in moderation. That’s to catch the twerps who use blogs to increase a particular site’s search engine ranking.

    Pablo — regarding doing the jabs all at once or spread out, I personally find it better to do it all at once. Gets it over with. Especially since the nurses are generally very experienced and can get them all done pretty quickly. Plus, if you spread them out, the kid will start to get the idea that ALL doctor’s visits involve shots, and that can make it worse.

    My 6-year-old got her first 2009 H1N1 shot yesterday. Her seasonal flu vaccine last month was fairly traumatic for her (she tensed up pretty hard, and wound up with a good-sized bruise) so this time I tried to prepare her by explaining that morning that flu shots don’t have to hurt, and this is what you do to keep them from hurting — you relax your muscles, so the needle can slip in and out without hurting you. We practiced tensing and relaxing our muscles. When the time came, she was a little apprehensive, starting to get scared when the nurse did the alcohol swab, but I used a soothing tone of voice and reminded her to relax her muscles. When she realized it hadn’t hurt (although she had felt it), she gave the most beautiful, amazed smile. ;-)

    Not all vaccines are as painless, alas, but hopefully this will make the next one easier.

  20. #20 Sid Offit
    December 10, 2009

    For children vaccinated before diagnosis, autism risk was lower in children vaccinated with MMR than in the nonvaccinated
    ———————-
    I’ve only seen the abstract but this doesn’t seem to make sense. The authors say the nonvaccinated were vaccinated before their diagnosis. How is nonvaccinated defined?

  21. #21 Scott
    December 10, 2009

    It might be clearer rearranged as

    Autism risk was lower in children vaccinated with MMR before diagnosis than in the nonvaccinated

    That is, they’re dealing with the subset of the vaccinated-before-diagnosis for whom that vaccination included MMR, and comparing that to the nonvaccinated.

  22. #22 Gabe's Mom
    December 10, 2009

    Scott,
    Sid doesn’t want it explained to him. He is a troll, only here to argue.

  23. #23 Todd W.
    December 10, 2009

    @Scott

    In addition to Gabe’s Mom’s comment, he also has a tendency to cherry pick quotes, as he’s done, yet again, in order to misrepresent the information. The full sentence makes it clear that they are comparing the risk of autism in the nonvaccinated children to the risk of vaccinated children who got the MMR and the vaccinated children who got the single measles vaccine.

  24. #24 Tsutsugamushi
    December 10, 2009

    Thanks for the response.:-) I linked to an article on the Science-Based Medicine site, it appears identical to this one, as others noted before. Just wondered about that.

  25. #25 Orac
    December 10, 2009

    Think about it a little more, and an answer will come to you.

  26. #26 Sid Offit
    December 10, 2009

    Thanks Scott.

  27. #27 Sid Offit
    December 10, 2009

    Funny, I’ve never seen this David Gorski and Orac in the same place at the same time

  28. #28 Screechy Monkey
    December 10, 2009

    I’m sure the antivaxxers will just spin it as a study showing a correlation between autism and the MMR vaccine. (Negative, shmegative — it’s a correlation!)

  29. #29 Pablo
    December 10, 2009

    Denice Walter:

    If people are irrational,arguing *reasonably* will not be effective

    Oh I agree, Denice, and as I noted, an anti-vaxxer would not accept the results of this on principle. However, I’m not talking about the irrational, I am talking about the rational. I am contending that selective rationalization of the results, like Orac is doing here, is enough to make even someone rational question it’s worth. As I said, resorting to “unknown confounders” to account for data you don’t believe but unquestionably accepting data you do believe is special pleading.

  30. #30 Scott
    December 10, 2009

    I’m quite well aware of Sid’s history, but when he actually asks a logical question that the average reader might well have, in a perfectly reasonable tone, he deserves a civil answer.

    Non sequitur personal attacks and unsupported foolishness, not so much.

  31. #31 Pablo
    December 10, 2009

    Pablo — regarding doing the jabs all at once or spread out, I personally find it better to do it all at once. Gets it over with. Especially since the nurses are generally very experienced and can get them all done pretty quickly. Plus, if you spread them out, the kid will start to get the idea that ALL doctor’s visits involve shots, and that can make it worse.

    Unfortunately, it will only be me with him at the appointment, as mom has to work. Therefore, there will be fewer comforting hands available or to provide distraction, and I will have to assist with restraint.

  32. #32 Gabe's Mom
    December 10, 2009

    Scott,
    I humbly stand corrected and apologize to Sid for my offensive tone.
    I assumed he was trying to provoke an argument. This is the only blog I have ever posted to, please forgive my novice trespasses.

  33. #33 MI Dawn
    December 10, 2009

    @Tsutsugamushi: Orac is the author of both articles. He posts under his real name on SBM but prefers to use his ‘nym on Respectful Insolence. His regular readers all know, when he refers to an article written by his “friend”, to whom he refers. He rarely (if ever…can’t recall an instance, but don’t want to say never) links to his own articles on the other site (gotta give the trolls some work to do).

  34. #34 Pablo
    December 10, 2009

    I don’t know why Orac refers to his “friend” with “friend” in quotation marks. It’s almost like he’s saying it’s not really his friend. Are they not getting along or something? Therapy can help with that, I’m told.

  35. #35 Sid Offit
    December 10, 2009

    Gabe’s Mom

    I do admit to provoking arguments when I believe I have evidence to support them. But I’m also quite willing to listen to, and learn from, the other points of view expressed on this site.

  36. #36 BA
    December 10, 2009

    I don’t think there is a therapy developed as yet that could bridge this gap between man and machine.

  37. #37 Pablo
    December 10, 2009

    I don’t think there is a therapy developed as yet that could bridge this gap between man and machine.

    The Terminator?

  38. #38 health blog
    December 10, 2009

    wow that’s some kind of news. It comes late after many years of uncertainty as well. These studies are very important to re=establish the faith vaccine all over the world. Here in the UK some people do refuse to vaccine their children because of hear say or fear and that is just plain wrong.

  39. #39 gaiainc
    December 10, 2009

    FWIW, I don’t like giving more than four shots in a single visit. That’s what I’m doing with my son and that’s what I do for my patients (except for one whom I loaded up with either 6 or 7 shots all at once… she’s 14 yo, wicked behind on her immunizations, and definitely needs them).

    That said, I’m just waiting for the response from AoA to see how they’re going to complain about this one. I agree that no study is ever going to make them change their mind.

  40. #40 FreeSpeaker
    December 10, 2009

    There is only one part of this article I would disagree with, i.e. the title. 2008 was a fairly bad year for the anti-vacs. 2009 was a terrible year for them. Not only did they lose the Omnibus, and have studies refute their claims, they seem to have lost readership at the AoA Collective. This is but one more shovel of dirt in their hole. Here’s to 2010, which should be another banner year.

  41. #41 Militant Agnostic
    December 10, 2009

    Pablo @30 – when I was a kid I got allergy shots weekly (or so it seemed). The nurse who gave the shots suggested that, on the morning of the day I got the shot, I draw a circle on my arm where the needle would go and stare at the circle periodically during the day before getting the injection. It seemed to reduce the pain of the injection. I think it was some sort of Yoga thing. Never underestimate the power of suggestion

  42. #42 Shay
    December 10, 2009

    Another bad day for the anti-vaxx movement? Tough shit. May they have many, many more.

  43. #43 shmedelle
    December 10, 2009

    It doesn’t matter how many times this type of article is published, where it clearly states that there is no link, people believe what they want to believe. There will be appeals to conspiracy. There will be strawman arguments. The debate will continue.

    Maybe a good science education will help. Probably not.
    ********
    For years, I have been baffled as to why critical thinking and logic are not taught more in middle school and high school. My husband teaches those classes at a university, but the students who sign-up for his classes are taking them as an elective. It should be a mandatory in middle school, high school, and college.

    My child will go to kindergarten next year. Is it true that children are allowed to go to school without being vaccinated? I thought parents are required to provide a shot record in order to enroll them.

  44. #44 Chris
    December 10, 2009

    shmedelle:

    My child will go to kindergarten next year. Is it true that children are allowed to go to school without being vaccinated? I thought parents are required to provide a shot record in order to enroll them.

    In the USA it depends on the state. Some states are more permissive than others. Two states, West Virginia and Mississippi, do not allow non-medical exceptions. See Nonmedical Exemptions to School Immunization Requirements – Secular Trends and Association of State Policies With Pertussis Incidence

  45. #45 shmedelle
    December 10, 2009

    Chris:
    Thanks for the link.
    A little off topic. A few weeks ago, I had a meeting with my daughter’s preschool for an I.E.P. (She recently had neurosurgery for epilepsy. She is seizure free thanks to science, and the wonderful Dr.’s) I actually asked the teacher if un-vaccinated children were in the school. She sort of rolled her eyes, and said yes. I mentioned that there is no connection between vaccines and autism. She said some people just want something to blame. I gathered that she and the principal were not to happy about the situation, because now, she said, for the first time in her 25 years of teaching, they are seeing whooping cough. That pisses me off.

  46. #46 Pablo
    December 10, 2009

    Pablo @30 – when I was a kid I got allergy shots weekly (or so it seemed). The nurse who gave the shots suggested that, on the morning of the day I got the shot, I draw a circle on my arm where the needle would go and stare at the circle periodically during the day before getting the injection. It seemed to reduce the pain of the injection. I think it was some sort of Yoga thing. Never underestimate the power of suggestion

    I can try, but I am not too optimistic that it will be too effective with my 12 mo old. Although he might find it interesting if I draw a circle on his thigh, it will be difficult for him to stare at it.

  47. #47 Phoenix Woman
    December 10, 2009

    @Gabe’s Mom: Don’t worry about it, we all make innocent mistakes. It’s when they’re not innocent that it’s a problem.

  48. #48 Chris
    December 10, 2009

    shmedelle:

    Thanks for the link.
    A little off topic. A few weeks ago, I had a meeting with my daughter’s preschool for an I.E.P. ..snip…I gathered that she and the principal were not to happy about the situation, because now, she said, for the first time in her 25 years of teaching, they are seeing whooping cough. That pisses me off.

    The same for me! My son had a seizure disorder and required herd immunity for pertussis. Back when he was a baby they only gave the DT to kids with a history of seizures. He finally got his first pertussis vaccine by getting the Tdap at the age of 19.

    Back before there was a chicken pox vaccine it swept through the school he was attending. Not only did this school have a large special ed. pop (his, plus a hearing impaired program), it is also one of the schools that kids who are living in the local Ronald McDonald House attend (which is less than five blocks from my house!). Most of the kids are siblings, but several are the ones going through active treatment.

    There were a couple of families that the nurse was not happy with. She sent home letters home saying that no child with a fever or breakout should be sent to school… yet she had at least one idiot send a child to the school with a fever and a bottle of Tylenol!

  49. #49 Pablo
    December 10, 2009

    It doesn’t matter how many times this type of article is published, where it clearly states that there is no link,

    Actually, the data clearly shows an anti-correlation, with vaccination correlating with less autism.

    But as I pointed out above, Orac doesn’t seem to have any problem discounting that part. Given that, I don’t think I could blame anti-vaxxers for discounting the rest of the paper, too. They can just say, “don’t look at us! Orac is the one who says the data are unreliable. He admits there could be missing confounders.”

    You folks know I am as anti-antivax as they come, but I think Orac’s post highlights a massive problem with this study. Until there is an identified explanation for the apparent “vaccine prevents autism” data, which contradicts what has been found previously in the epidemiological studies, then either the results of this paper must be taken with a grain of salt (and that means ALL of the results, including the ones we like), or the previous epidemiological studies must be considered flawed. Because the same “hidden factors” that could be masking no effect could just as easily be masking a positive effect in the other direction.

  50. #50 jackrabbit
    December 10, 2009

    Orac, maybe you can explain why an educated, experienced, socially responsible physician would play down the impact of Wakefield’s deceit.

    Why do doctors make excuses for each other despite repeated accounts of abuse? Why would a layperson, working in the field, have more insight into an offending doctor’s character than a medical professional would? Is it an “old boys” thing, or is it some secret code of conduct?

    The person in question is female. I have managed to sway her greatly with Brian Deer’s stuff, but she still hesitates to come right out and condemn other doctors (not just Wakefield, but some who have butchered and scarred her own patients).

    Non confrontational, or just defending the tribe? I have experienced this time and time again with various physicians.

  51. #51 Pablo
    December 10, 2009

    The person in question is female. I have managed to sway her greatly with Brian Deer’s stuff, but she still hesitates to come right out and condemn other doctors

    Would it be worthwhile pointing out that acceptance of Wakefield’s crap is an implicit condemnation of others who have found contradictory results, such as Mady Hornig?

    One of these two has to be wrong, either through incompetence or deceit. Since we have evidence for Wakefield’s deceit, it shouldn’t be hard to figure out where the problem might be.

  52. #52 Orac
    December 10, 2009

    But as I pointed out above, Orac doesn’t seem to have any problem discounting that part. Given that, I don’t think I could blame anti-vaxxers for discounting the rest of the paper, too. They can just say, “don’t look at us! Orac is the one who says the data are unreliable. He admits there could be missing confounders.”< ?blockquote>

    No, no, no, no, no.

    The data are pretty reliable. Here’s the problem. If there’s an inverse correlation that appears statistically significant, while it’s easy to find reasons why that negative correlation probably doesn’t imply that MMR protects against autism (although, come to think of it, it might), it’s pretty hard to think of a way to slice and dice the data or find confounders that would turn that correlation around and make it a positive correlation between vaccines and autism that could imply that MMR causes autism. In other words, it’s a lot farther to go from a negative correlation to a positive correlation controlling for confounders than it is to go from no correlation to a positive correlation.

  53. #53 Tybo
    December 11, 2009

    I’m still confused as to the framework for a case-controlled study… I get the general idea, inasmuch as looking at the population against a matched control, but I can’t for the life of me figure out how you get RRs out of it.

  54. #54 DLC
    December 11, 2009

    An interesting study, and certainly another nail in the “Vaccines cause autism” hypothesis. It wasn’t a good hypothesis to begin with, having no plausible mechanism of operation, but it had to be investigated.

  55. #55 Andreas Johansson
    December 11, 2009

    @Orac: Was there supposed to be any non-quoted content in #51?

  56. #56 colmcq
    December 11, 2009

    “but I think Orac’s post highlights a massive problem with this study. Until there is an identified explanation”

    Orac’s post does not highlight a ‘massive problem’ with the study, in fact, he lays out in great detail why this study suggests the “vaccine prevents autism” association may be unreliable; if you go back to the paragraph beginning “Is this really true?” you can read all about it!

    “then either the results of this paper must be taken with a grain of salt (and that means ALL of the results, including the ones we like), or the previous epidemiological studies must be considered flawed.”

    If A is flawed, then B and C must also be flawed. Right. I think you ought to retract this last bit or put up evidence telling us why you think these ‘previous’ studies are flawed.

    c

  57. #57 Dangerous Bacon
    December 11, 2009

    “An interesting study, and certainly another nail in the “Vaccines cause autism” hypothesis.”

    My reaction is “Get off the hypothesis, we need the nails.”

  58. #58 Joseph
    December 11, 2009

    Until there is an identified explanation for the apparent “vaccine prevents autism” data, which contradicts what has been found previously in the epidemiological studies, then either the results of this paper must be taken with a grain of salt (and that means ALL of the results, including the ones we like), or the previous epidemiological studies must be considered flawed.

    The authors admit there’s a possible confound, and that’s a sign the authors know what they are doing.

    Epidemiological studies where they look at autism and MMR time series (like the Japanese ones) are different, methodologically. The same confounds would not apply.

    I believe there are prior MMR/autism case-control studies. A good question is why they would produce different results. It’s possible there’s more rejection of MMR in families of autistic people, or in children with some developmental delays, than there was in the past.

  59. #59 Pablo
    December 11, 2009

    So if there are possible confounders that make some of the data unreliable, then why don’t those possible confounders make the rest of the data unreliable?

    “Possible confounders” don’t just apply to data you don’t like, they are also possible for the stuff you agree with. If your only basis for whether to believe it or not is whether it agrees with other studies, then this provides nothing new.

  60. #60 Amy Wishner
    December 11, 2009

    Re: question of whether it is more stressful for child to receive multiple immunizations at one visit versus single immunizations, in addition to the responses above and the obvious effect that parents can have on how a child experiences something, there two studies I have seen of cortisol concentration and behavioral responses of infants to vaccination comparing infants who receive 2 injections at one visit compared with infants who received one injection – their responses were similar, suggesting that a second injection does not increase stress. Ramsey DS et al “Developmental change in infant cortisol and behavioral response to inoculation. Child Dev 65;1491-1502, 1994. Also: Lewis et al. Validating current immunization practice with young infants. Pediatrics 90;771-773, 1992. (Cited in Vaccines (ed by Plotkin, Orenstein,Offit – I have the 2008 edition, p.94)

  61. #61 Pablo
    December 11, 2009

    Amy – would that apply 4 vs 5 shots?

    In the end, he got 4, and we have deferred one of his last boosters to his 15 mo appointment. He did great. He actually cried more when the doctor tried to look in his mouth.

    If vaccination anecdotes mean anything, right after getting his MMR shot, he fell asleep in the car on the way home and is still taking his nap. Then again, it is his normal naptime…

    I stopped for ice cream afterward, but we will get that for lunch.

  62. #62 Pablo
    December 11, 2009

    Oh, I forgot to mention. The offspring played with his ball in the doctor’s office for about 10 minutes after getting his shot while I was getting ready to leave. I think it is clear: the MMR shot causes kids to play with balls.

  63. #63 LK PhD
    December 11, 2009

    Really pathetic at AoA today – now they’re going after Tony Fauci, one of the most respected figures in immunology in the U.S. Guess why? He agrees with those of us with brains that this issue has pretty much been decided! Still no specific comment on the particular study cited above. However, J.B. and Kim’s love child Craig has his own “anti-Orac” blog now, and he has a rant about the MMR study and Orac’s analysis of it. It’s a typical hate-filled fact-free piece.

  64. #64 lurker
    December 11, 2009

    What incentives are there for the anti vaccine movement to keep propagating the idea that MMR causes autism in the face of considerable evidence that it doesn’t? Is it that their reputations are at stake? Or does someone’s livelihood depend on this?

  65. #65 Brian Deer
    December 11, 2009

    Hi Folks,

    Since I see that my friend Andrew Wakefield is up for discussion, I thought I might ask a favour of any lurking, time-heavy anoraks, or better-still, newbies to it all.

    I’ve just posted the shortest possible summary I can muster of my MMR investigation to date. But I wonder if, in my desire to compress (the long version is 10 times the length), it’s still as clear as the crystal pool to which I aspire.

    If anybody spots anything they think is wrong or unclear, it would be doing me a great favour to let me know. I can’t make it much longer, as this would defeat the object, but anything else is possible.

    http://briandeer.com/mmr/lancet-summary.htm

  66. #66 Dedj
    December 11, 2009

    Lurker:

    your question assumes the GOV movement are even aware of the evidence against them.

    I’ve had, and witnessed, discussions with GOV members who were unaware of the primary sources of their own arguements, unaware of basic terminology and unaware of the disjoin between their evidence and their potrayal of it, sometimes even presenting evidence to support arguement the original source has expressly said thier evidence does not support.

    This wasn’t with rank and file members, but with members who are or are going to be published authours on this subject.

    But to answer your questions.

    Yes, too many to feasably list here.
    and, yes, to the tune of millions of dollars.

  67. #67 Jen in TX
    December 11, 2009

    “What incentives are there for the anti vaccine movement to keep propagating the idea that MMR causes autism in the face of considerable evidence that it doesn’t? Is it that their reputations are at stake? Or does someone’s livelihood depend on this?”

    http://www.grc.nia.nih.gov/branches/rrb/dna/pubs/Becker%20and%20Schultz%202009.pdf

    It’s worth mentioning that several members of the Johnson and Johnson family have invested several hundred thousand dollars (I believe 1 million was donated by them to start up Thoughtful House) in Wakefield’s work at Thoughtful House. You know, the same family that has made billions from the sales of Tylenol?

    Of course, it’s entirely possible that Becker and Schultz are dead wrong and Tylenol has absolutely nothing to do with autism, and that they are funding his work out of a deep concern for autistic children.

    However, since it’s well-known within the biomed community that Tylenol is a huge no-no for autistic kids, it seems odd that they would think that Tylenol and autism have no connection whatsoever.

  68. #68 MikeMa
    December 11, 2009

    Brian Deer @64
    Nice summary. Points are all outlined coherently. The only confusion for me is in section 2:

    But Deer discovered they had been recruited and selected through MMR campaign groups, and that, at the time of their admission, most of their, anonymous, parents were clients and contacts of the lawyer: Richard Barr, a High Street solicitor of King’s Lynn, Norfolk.

    The anonymous seems out of place or incomplete.

    Great work.

  69. #69 Todd W.
    December 11, 2009

    @Brian Deer

    Overall, a good summary. A couple suggestions, though:

    1) It reads a bit self-aggrandizing. Tone it down some.

    2) In point 9, include links to original sources of Wakefield’s published reports and claims that undermined the MMR. In fact, linking to original sources throughout the summary would be a good idea, rather than only linking to articles on your site.

    3) If there is any other reporter who has corroborated your findings, it might be wise to include a link to their work, as well.

  70. #70 Visitor
    December 11, 2009

    Jen:

    So Jane Johnson is one of the Johnson and Johnson Johnsons?

    Do have more on that? Like where she fits into the family etc? Or better still, a document or source which shows the connection, or how much money she might have?

    Dr Wakefield was funded in the past by Big Pharma – especially Merck and GSK, the big vaccine makers – and I’ve sometimes wondered if he wasn’t a stooge, put up by them and supported by them because they knew that any lawsuit based on his measles virus claims was bound (after a good few years of wasted effort) to fail. They must love him.

    I’m sure we’d all be interested in a J&J connection.

  71. #71 Kristen (Gabe's Mom's real name)
    December 11, 2009

    @61
    “I think it is clear: the MMR shot causes kids to play with balls.”

    Did you know killing turkeys is also a direct cause of winter?

    Which is exactly the point; correlation /=causation. Alas, I wish that was common knowledge. (Is that how you do doesn’t equal?)

  72. #72 heh
    December 11, 2009

    TLDR? “a Polish group, my people!”

  73. #73 Todd W.
    December 11, 2009

    @Kristen

    You can write it /= or !=. There might be other ways people use, but those are the most common ones I’ve seen.

  74. #74 MikeMa
    December 11, 2009

    Kristen
    There are many ways to do “not equal” but many computer languages use != for the construction. Being understood is more important than being letter or symbol perfect.

  75. #75 Serdar
    December 11, 2009

    “For years, I have been baffled as to why critical thinking and logic are not taught more in middle school and high school. My husband teaches those classes at a university, but the students who sign-up for his classes are taking them as an elective. It should be a mandatory in middle school, high school, and college.”

    I could not agree more with this statement. Critical thinking should not be a “service pack” or “hotfix” for an existing, broken mindset; it should be part of the OS from the git-go.

    Sorry about the belabored extended metaphor, but I stump endlessly for this sort of thing whenever I can. We’ve spent a century or more teaching people basic skills like reading and math, but we haven’t complemented it with the skills that allow them to really *use* their minds; we assume they’ll just pick that stuff up on their own. The end result is a lot of people who are just too easily fooled.

  76. #76 Jen in TX
    December 11, 2009

    “I’m sure we’d all be interested in a J&J connection.”

    Really? I’ve posted on this before, and all I got in response was the sound of chirping crickets.

    Jane Johnson is Woody Johnson’s sister-in-law.

    Here is a document from TH’s website outlining their top financial contributors, which include Jane and Christopher Johnson, (Jane is the executive director of DAN!, and co-managing director at TH) Betty Wold Johnson, and the Willard TC Johnson Foundation, managed by Woody Johnson.

    http://www.thoughtfulhouse.org/annual-report-2007.pdf
    see page 11.

  77. #77 Kristen
    December 11, 2009

    @71,72
    WOW! Thank you for your prompt replies.
    I guess I just feel conspicuous among present company.
    I am just trying to add to the discussion, I don’t want to say anything stupid or unclear.
    It just seemed to be the most intuitive way to symbolize what I was trying to say, I’m feeling proud (and a little arrogant) that I was correct. :)

  78. #78 Kristen
    December 11, 2009

    Sorry. @72,73
    (darn it!)

  79. #79 Scott
    December 11, 2009

    So if there are possible confounders that make some of the data unreliable, then why don’t those possible confounders make the rest of the data unreliable?

    “Possible confounders” don’t just apply to data you don’t like, they are also possible for the stuff you agree with. If your only basis for whether to believe it or not is whether it agrees with other studies, then this provides nothing new.

    There are ALWAYS confounders. Always. So yes, data are ALWAYS unreliable to a certain extent. When a study disagrees with the established body of work on a particular question, the most likely explanation is that it was incorrect, whether due to confounders, hitting the wrong side of the 95% confidence interval, malfeasance on the part of the researchers, or what have you.

    But when it does agree with the established body of work, then it adds further weight to the point that all the different independent studies are unlikely to suffer from the same problems.

    No special pleading. Doesn’t make this study tell us nothing new. Just the completely normal operation of the scientific method, where questions are almost never decided by a single study, but rather by the accumulated weight of many independent studies.

    (Is that how you do doesn’t equal?)

    The typical ways are “!=” which is the operator used in many programming languages, or “=/=” if you’re trying to look like the way it’s written in math. “/=” is typically understood but less common. All IMX.

  80. #80 Kristen
    December 11, 2009

    Thank you Scott, although you kind of ruined my buzz.
    I don’t get to feel smart often.

  81. #81 Joseph
    December 11, 2009

    What Scott said (about confounders.) To add to that, the way I think science should work is that someone else will try to replicate, but they also improve the methodology at the same time. They might do a similar study, but also survey the parents to see if in fact vaccines were rejected because the child had developmental delays, or because of autism in the family.

  82. #82 Scott
    December 11, 2009

    Well, like I said, IMX. And apparently Todd’s experience has been different from mine. Who’s to say which is really more common?

  83. #83 Corina Becker
    December 11, 2009

    @66

    I’m now somewhat amused that another Becker is involved with this. In a “dear god, Becker is too much of a common name…” kind of way.

    oh gee, I feel a headache coming on; I guess I need to go take some Tylenol…

  84. #84 ababa
    December 11, 2009

    “<>” also works for some languages. “!” is an old C/Unix thing meaning “not”, and it is also used in Java. You can have a boolean(true/false, binary) variable such as “temp” and reference the opposite of it by using “!temp”. Therefore, “!=” translates to “not equal”, just as “!<” would mean “not less than” or more commonly “greater than or equal to”.

    You could extend that to “!JB Handley” which would mean “not moron”.

  85. #85 ababa
    December 11, 2009

    Arrgh, html ate the less than symbol. I meant you can do a “less than symbol” followed by a “greater than” symbol.

  86. #86 Kristen
    December 11, 2009

    @83
    That is pretty much how my husband would have answered my question. Save the JB Handley reference. I think I can guess what you do for a living.
    @80
    If no one can replicate your findings the only logical conclusion is that your hypothesis is incorrect. However, even if a study is not perfect in it’s methodology it is useful if it supports what many other studies have found. In effect adding to the mountain of evidence. If it went against all other reasoning on the matter, it would defiantly require more review.

    I agree with you about improving the methodology, I guess that is the whole point of studies.

  87. #87 MikeMa
    December 11, 2009

    If you need to use the less than symbol ‘<‘, try ‘& l t ;’ without all the spaces!

  88. #88 Jeb
    December 11, 2009

    deee-loooz-yuuun-alll…..answer me this: what is the motive of anti-antivaxxers unless it is money, money made from the sale of vaccines? i see no evidence that anyone here is concerned about doing good, just denying… again, why???

  89. #89 Todd W.
    December 11, 2009

    @Jeb

    I have no ties to vaccine makers, or any drug company for that matter. What I do have are friends and family who I want to make sure are safe. I want to make sure that the people I care about, and the people with whom I come in contact every day, are safe from diseases that can be prevented. I also want to make sure that research resources are not being wasted on pseudoscientific crap that not only does nothing, but has the potential to do serious harm (e.g., chelation). I want to make sure that autistic people are treated as people and have access to the support they need to excel.

    Personally, I couldn’t care less about any personal monetary benefit. Now, if you have some substantive criticism of vaccines, state it. Include citations to back up your claims, too. Also, pay a visit to Science-Based Medicine and antiantivax.flurf.net, as well as searching the archives of Respectful Insolence.

    So, yeah, I am concerned about doing good.

  90. #90 Scott
    December 11, 2009

    what is the motive of anti-antivaxxers unless it is money, money made from the sale of vaccines?

    Saving lives and preventing suffering. What, that’s not good enough for you?

  91. #91 Kristen
    December 11, 2009

    @87
    I am concerned for the lives of the infants who aren’t old enough to be protected by vaccines and the children with serious health problems who can’t be vaccinated.

    Not getting children vaccinated dilutes the herd immunity and allows children to DIE from Preventable diseases.
    Perhaps when Measles or polio start coming back with a vengence people like you will be to blame for the deaths that follow!

    And by the way, I don’t get money from the sale of vaccines. In addition my son is autistic (born with it).

    My mother went deaf from mumps, I bet she would have appreciated a vaccine.

  92. #92 Kristen
    December 11, 2009

    Sorry for the misspelling. I got worked up.
    I am zen now.

  93. #93 TemporarilyAnonymous
    December 11, 2009

    My motive, Jeb? Not so long ago I lost my newborn son, to something unrelated to vaccines. Recently I visited his grave. In my boy’s part of the churchyard, infant graves are rare. In the older areas, however, 100 years back, infant’s graves are as common as dandelions.
    That’s my motive.

  94. #94 Antaeus Feldspar
    December 11, 2009

    I’ve sometimes wondered if [Wakefield] wasn’t a stooge, put up … and supported by ["Big Pharma"] because they knew that any lawsuit based on his measles virus claims was bound … to fail.

    I try, not always successfully, to look at things in a positive way — so I’ll just say that this theory displays some flexible thinking! You’re welcome.

    Seriously, though, the theory you describe is not all that plausible. It’s well known that Wakefield didn’t do his “research” until after he had been hired by Richard Barr to generate evidence for the anti-MMR lawsuit, and Big Pharma would have had to have hired Wakefield before Barr did – so how could Big Pharma have known, before Wakefield did his research, that it wouldn’t turn up results that would support such a lawsuit?

    Even if Big Pharma already knew for sure that honest research into Wakefield’s hypothesis would reveal the basis of the anti-vaccine lawsuits to be junk, that doesn’t actually equate to any lawsuit based on his measles virus claims was bound to fail because all too often juries and judges render verdicts which defy logic and science. If Big Pharma knew that Wakefield would write junk papers pushing a junk hypothesis, why on earth would they pay money to him instead of to honest scientists who would write non-junk papers showing Wakefield’s work to be junk? The Wakefield-as-Big-Pharma-stooge theory just doesn’t add up.

  95. #95 Prometheus
    December 11, 2009

    Jeb (#87) opines:

    ” what is the motive of anti-antivaxxers unless it is money, money made from the sale of vaccines?”

    Funny thing is that nobody – not even the pharmaceutical companies – is making much money selling (or administering) childhood vaccines (or influenza vaccine). Gardisil might make a few bucks for its maker, and there might be some money to be made selling some of the other, newer vaccines (that are still on patent), but by and large, vaccine manufacturing has a razor-thin profit margin.

    Adminstering the vaccine has even a slimmer profit margin, with some insurance plans (including Medicaid and Medicare) paying less than the cost of the vaccine, let alone the overhead and personnel costs of giving it.

    On the other hand, there are BIG bucks being made by people selling homeopathic influenza remedies, “immune-boosting” supplements and the like. What’s more, these “remedies” have never been shown to work!

    It’s strange how nobody ever “follows the money” when it comes to the anti-vax movement. Look at the anti-vax doctors/practitioners and their “natural”, “homeopathic” or “holistic” treatments they promote as an alternative to vaccination. Do they work? They’ve never been shown to be effective. Are they safe? Compared to what?

    While the homeopathic remedies for influenza have fewer side effects than the influenza vaccine, they also have at least one fewer effect: they DON’T protect you from influenza. The vaccine, on the other hand, DOES.

    So, no side effects but no effects, either. That makes the “alternatives” seem less attractive, no?

    How about a straight risk:benefit analysis? Well, homeopathy and “supplements” have fewer risks than vaccines (apart from the risk of getting the vaccine-preventable disease, that is), but the “alternatives” have no proven benefit.

    That sort of screws the risk:benefit ratio for the “alternatives”.

    To recap:

    [a] Vaccines – real but small risk (less than the risk from the disease); a significantly larger (and proven) benefit. Profit margin very slim.

    [b] “Alternatives” – little risk but no proven benefit. Profit margin HUGE.

    So, what was that about money and vaccines?

    Prometheus

  96. #96 Dedj
    December 11, 2009

    “what is the motive of anti-antivaxxers unless it is money, money made from the sale of vaccines?”

    Well, personally I don’t like it when people misuse evidence and concepts. I especially don’t like anti-vaxxers as they are very prominent within the field of autism, which is my special interest.

    For the record, in the last 4 years, I have recieved the grand total of a low capacity USB stick, a few pens that I couldn’t use (why they were blue is a mystery) and a notepad from pharmacuetical companies. None of which was given directly to me.

    “i see no evidence that anyone here is concerned about doing good, just denying… again, why??”

    Why should you? Some of us choose the careers we did partly in order to do good. Some of us do good everyday because it’s part of who we are.

    Many of us just do it. For some of us here, it has the same interest value as talking about the shocking news that we fart and shit too, and is about as everyday.

  97. #97 ababa
    December 11, 2009

    Jeb, as anti-vaxers LOVE to point out, no vaccine is 100% effective. We KNOW that. Not everyone’s immune system responds with permanent immunity. Boosters may help, but not always. Heck, not even the real disease always generates immunity. People have gotten chicken pox naturally multiple times.

    That’s where herd immunity comes into play. If everyone is vaccinated, then there will be a few that are still not immune. But, the chances of someone that you run into that has the disease AND did not gain immunity from the vaccine AND has a disease in a transmissable state AND does something to pass it on is exceedingly rare. By having people intentionally avoiding vaccines you eliminate one of those “ANDs” from the equation, which thereby MULTIPLIES the effects of the other three that are not controllable.

    There are people that cannot be vaccinated, but everyone that can be and doesn’t increases the risk of those that cannot. I don’t know that the MMR made my children immune, but I know it has a high chance of having done so. If it didn’t, then by not vaccinating you have increased the risk of measles, mumps and rubella to my children. I did what I could to protect them. Yes, it irritates me that you have intentionally increased the potential risk to them (and others) because of some illogical crusade that has been proven time and again to be folly, and in many cases highly profitable to Big Alt Med pushers.

    Do you have any idea how much those natural cures advertised on AoA and GR cost? Follow that money trail for a change, and prepare to be surprised.

    I don’t have to be receiving a fat check from Big Pharma to support vaccines. I’m doing it for selfish reasons. To protect my children.

  98. #98 Antaeus Feldspar
    December 11, 2009

    what is the motive of anti-antivaxxers unless it is money, money made from the sale of vaccines?

    Yeah, right!! It’s so obvious!!

    And what possible motive could anyone have for telling us to make sure our house is equipped with working smoke detectors and fire extinguishers, except money, money made from the sale of smoke detectors and fire extinguishers??

    … it couldn’t possibly be not wanting people to suffer preventable deaths, of course.

    ITT: Jeb fails basic logic.

  99. #99 Chris
    December 12, 2009

    Jeb, dear… what is more cost effective: Preventing a disease or paying for the care of those who get the disease? Think about it, think very very hard!

    Here are a couple of papers to help you:
    Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001
    and
    Pediatric hospital admissions for measles. Lessons from the 1990 epidemic.

    Having had a kid hospitalized several times, where he was hooked up to IV drips and supplementary respiratory equipment… I know it is expensive. And this is with good health insurance!

    Oh, wait, let us not forget emergency services. While the fees for the several large firefighters tromping into my tiny house working to help my child who collapsed is paid by property taxes, I had to deal with the bills and insurance for the private ambulance they called to transport my toddler to the hospital. This experience was due to what is now a vaccine preventable disease.

    Do you really think it pays more for “Big Pharma” to prevent a disease, than to provide the multitude of medications to keep a person alive while suffering a disease?

    Seriously, dude, read the papers. Have you ever spent even one night in the hospital with a child? Our son was admitted several times between birth and age three. It was not a picnic, and even with good insurance it was costly. Especially for the Thanksgiving we took the very sick child to the hospital without calling the doctor (no time, he got very sick at Grandma’s house, and why disturb the doctor on a holiday?)… the insurance company made us pay over $500 for not getting “primary care provider authorization”).

    I am anti-anti-vax because my son has suffered from what is now a vaccine preventable disease.

    Oh, and Jeb the Pharm Shill Gambit (see scienceblogs.com/insolence/2006/09/the_pharma_shill_gambit_1.php , I am past the URL limit, so cut and paste) is really very lame. I mean knuckle dragging, moronic lame. Actually, it is quite stupid.

  100. #100 Visitor
    December 12, 2009

    Antaeus Feldspar:

    Re: Andrew Wakefield.

    No, I think you are wrong. The drug industry did know Wakefield’s claims about autism would be wrong, even before he started working for Barr. His autism theory was simply an add-on to his previous claims about Crohn’s – at the time when industry was paying him. They knew his measles virus work was all wrong, and if that was wrong, then the autism add-on would be wrong also.

    Make no mistake: they had Wakefield’s number from at least 1994. But, as I understand it, their respective lawyers met at some point and negotiated an agreement whereby they would let Wakefield and his hypothesis run, since they knew it was bound to fail, but that they wouldn’t challenge Wakefield himself.

    Deer was a 100% rogue elephant as far as the drug industry was concerned. They never believed a journalist could pull it off. Wakefield’s mistake was suing Deer. That’s what brought the roof down on the whole anti-vax movement. When Wakefield fell (as he has, irrespective of his GMC), so did the MMR claims, so did the omnibus hearings. It all follows from that.

    Thus we have Jenny McCarthy, and old timers like Rick Rollens, putting as much space between themselves and Wakefield as they can.

    I think there are good grounds to believe Wakefield is an industry shill, especially now we know that J & J money is behind Thoughtful House. It’s all through the looking glass: the whole thing.

  101. #101 trrll
    December 12, 2009

    You folks know I am as anti-antivax as they come, but I think Orac’s post highlights a massive problem with this study. Until there is an identified explanation for the apparent “vaccine prevents autism” data, which contradicts what has been found previously in the epidemiological studies, then either the results of this paper must be taken with a grain of salt (and that means ALL of the results, including the ones we like), or the previous epidemiological studies must be considered flawed.

    This is indeed how denialists of all kinds think. When a study comes out that challenges their dearly held notions, they pore through it looking for a “flaw.” Of course they find one, since pretty much all studies have limitations or caveats that can be regarded as flaws. They then use the fact that “the paper is flawed” as an excuse for dismissing the conclusions altogether, whether or not the supposed flaw has any impact on those conclusions. I have no doubt that this is what the antivaxers will do with this study.

    Nevertheless, if you think it through, it is a big problem for antivax dogma. To begin with, it shows that there is a large population of people who developed autism without the MMR. Explaining the reduced incidence of autism in the vaccinated cohort in terms of bias requires the assumption that some children did not get vaccinated because they were already showing early symptoms of autism (or perhaps because there was already autism in the family) before they were due to be vaccinated, which also doesn’t fit with the MMR hypothesis. They still may try to claim that there could be a subpopulation whose autism was caused by MMR, but who are “hidden” due to the parents who chose not to vaccinate because they suspected autism. But since we are seeing a reduction in autism in the vaccinated population, any supposed group of children with MMR-induced autism must be *smaller* that the population that do not get vaccinated because their parents suspect autism, but who develop autism anyway. So even putting the most generous (to the MMR-autism hypothesis) interpretation on the result, MMR cannot be a major cause of autism.

    Of course, many in the antivax crowd will simply retreat to blaming earlier vaccinations. The problem there is that the only real evidence for any connection between autism and vaccination is the correlation in time between vaccination and the emergence of symptoms–and the vaccine that is given around the time that autistic symptoms typically worsen or emerge is the MMR.

  102. #102 Interested Observer
    December 12, 2009

    Interesting how few vehement anti-vaxxers have shown up in this thread…maybe because the numbers don’t lend themselves to being fudged?

  103. #103 Prometheus
    December 12, 2009

    Visitor (#99) claims:

    “But, as I understand it, their respective lawyers met at some point and negotiated an agreement whereby they would let Wakefield and his hypothesis run, since they knew it was bound to fail, but that they wouldn’t challenge Wakefield himself.”

    This is interesting conjecture, but do you have any evidence that any of this actually happened? Without evidence, this story is just that: a story.

    While I’m no fan of Dr. Wakefield, I find it hard to believe (without supporting evidence) that he was “played” by a “Big Pharma” conspiracy. I find that the evidence – the data, if you will – is more consistent with Dr. Wakefield having an obsession with the measles vaccine strain and first trying to blame it for Crohn’s disease and then, when that failed, trying to blame it for autism.

    None of this requires a larger conspiracy than that of Dr. Wakefield’s ego conspiring with his morals and ethics.

    However, if “Visitor” has evidence, I am more than willing to have my mind changed by it.

    Prometheus

  104. #104 Antaeus Feldspar
    December 12, 2009

    Make no mistake: they had Wakefield’s number from at least 1994. But, as I understand it, their respective lawyers met at some point and negotiated an agreement whereby they would let Wakefield and his hypothesis run, since they knew it was bound to fail, but that they wouldn’t challenge Wakefield himself.

    Deer was a 100% rogue elephant as far as the drug industry was concerned. They never believed a journalist could pull it off.

    I believed that the theory you were proposing in your first post was simply your own speculation. You’re now writing as if it’s known to have occurred, even if some details are disputed or sketchy. Which is it?

    I’m afraid that either way I still find it implausible. You’re positing that the person who probably did the most out of anyone in the world to reduce the rate of MMR vaccinations, the person who even now still has parents around the world hailing him as the hero who showed them that Big Pharma can’t be trusted — was hired by Big Pharma to do all that? Even if they could be 100% sure beforehand that Wakefield would be exposed as the greedy, scientifically incompetent shill that he is, they still would have received a huge amount of bad publicity for the entire duration of the time from Wakefield releasing his rigged results to the time that Wakefield was shown as a fake. And even when Wakefield was shown as a fake, there would be no reason to think that Big Pharma would get any sort of good publicity out of that debunking.

    Even if we posit a Big Pharma that’s absolutely amoral and cynical and prepared to pay big bucks to get what it wants — why would it pay big bucks to get bad publicity when it could spend the same amount to get good publicity? It doesn’t make sense.

  105. #105 MikeMa
    December 12, 2009

    To carry Prometheus’ and Antaeus Feldspar’s skeptical conjecture further, it may be possible to tie a Johnson or two to Wakefield but not likely the company. It makes no sense. There has been a lot of deranged DuPont spawned money floated out in political drama that had nothing whatever to do with the company. The same seems likely here with J&J. The kids will spend their money without thought or sanity.

  106. #106 Jen in TX
    December 13, 2009

    The Johnsons know damned well that Tylenol is problematic for autistic kids. Jane herself warns parents on the TH Yahoo group (a board that she moderates) not to give Tylenol to their autistic kids because of its glutathione depleting properties. If the Johnsons know, I have a difficult time believing that J&J management doesn’t also know, especially considering of all the research linking acetaminophen to asthma and allergies.

    There is no doubt in my mind that they do not want this area of research to be explored because it would have disastrous consequences and they cannot afford another Tylenol scandal. Wakefield has shown a strong history of clinging to that vaccine theory despite overwhelming evidence to the contrary. He’s the perfect stooge. It’s all a diversionary tactic. As long as Wakefield is kept busy with his vaccine theories, they can continue to generate publicity, (even if it’s bad publicity, it’s all good for them, as long as the focus is on vaccines and not Tylenol) and research funds will continue to be wasted debunking his crank theories.

    Isn’t that exactly what’s been happening over the past decade? How many more “vaccines don’t cause autism” studies do we really need?

    J&J is just buying themselves time, and their billions can buy lots of it.

  107. #107 Antaeus Feldspar
    December 13, 2009

    J&J is just buying themselves time, and their billions can buy lots of it.

    And what, exactly, are they getting for those billions?

    Let’s think this through. Suppose, arguendo, that Tylenol was harmful to autistic children. Suppose, arguendo, that J&J discovered this through private research and managed to keep it from becoming public information (though they could not, of course, prevent other researchers from discovering it independently.) Suppose, arguendo, that J&J was an entirely stereotypical Big Pharma boogeyman, willing to defy any moral or ethical stricture in pursuit of its profit margin.

    How much sense does the “pay Wakefield to be a diversionary tactic” theory actually make?

    “Diversionary tactics” are generally only of worth if you need to divert a particular person or persons for a given time period. If you are a corrupt politician and you’ve got a scandal-laden past, you want to divert people from looking at that past until after the election. If you’re planning an invasion at Normandy, you want to keep the enemy thinking that your beach-head will be in the Pas-de-Calais — until your soldiers actually land on the beach.

    If J&J were employing Wakefield as a diversionary tactic to “buy themselves time,” what good would that time actually do them? When would it be over? You could argue that individual cases might hit statutes of limitations (although I would not bet money that the law works quite that way) but unless something happened to dissuade parents from giving Tylenol to autistic children, new cases would keep happening all the time. Moreover, if it should be discovered that they knew their product induced this harm and did not act appropriately, it would only magnify the punitive damages they would eventually face. No net gain for J&J there.

    In addition, such a diversionary tactic, in a scenario assuming all the hypotheticals we have assumed, would be giving the people J&J most wants the truth to be kept from the correct general idea, with only the specifics being wrong. Yes, Wakefield got plenty of parents to believe that “it’s the MMR vaccine that made our child autistic,” but when he was shown to be a fraud, those that moved on just moved on to similar theories of “some other product of Big Pharma made our child autistic.” Would our corrupt politician with all the shady land deals in his past really try to divert the public by suggesting that they look for sex scandals in his past? Surely he’d know that those who were trying and failing to find sex scandals would be the likeliest to discover the real scandals he actually does need kept secret.

    Employing Wakefield to demonize Big Pharma would not be a very logical way for J&J to look after its interests. Now, it might be pointed out that people don’t always do the logical thing to look after their interests. But the minute we admit that, all theories where Wakefield was trying to make himself rich and famous and merely did so in an illogical way by faking his data have to be taken into consideration, and these theories are far more probable than any in the “Big Pharma paid Wakefield to demonize Big Pharma” vein. In fact, considering how many parents still adore and trust Wakefield despite the evidence against him, one must wonder whether it is so illogical after all.

  108. #108 Richard Eis
    December 15, 2009

    -what is the motive of anti-antivaxxers unless it is money, money made from the sale of vaccines?-

    Project much Jeb?

    Yep, its confirmed, anti-vaxxers do not understand the concepts of helping others, kindness and doing good.

  109. #109 Paige
    December 15, 2009

    Jen,
    I don’t understand why Jane Johnson would tell people on the Thoughtful House yahoo group that they shouldn’t give tylenol to their children if she’s trying to protect J & J–that doesn’t make any sense to me. I just came back from a DAN conference, and I heard over and over again that I shouldn’t give my child tylenol because it depletes glutathione. If her goal is to deflect attention away from J & J, she’s doing a lousy job.
    Paige

  110. #110 Jen in TX
    December 15, 2009

    Paige,
    Does everyone else (those outside biomed circles) have access to this information?

    No, they do not. Only those who pay to go to DAN! conferences (largely composed of people who are convinced vaccines cause autism) have access to that information.

    I figure it behooves them to warn parents of already autistic kids, because one of them might just make the same mistake that I did, and give Tylenol for pain or fever, and wonder why their kid suddenly starts having behavior problems.

    Ironically, it was Jane who inadvertantly tipped me off. Last February, the day after Brian Deer’s story broke about Wakefield faking his results, I got a call from her. She was phoning the parents of kids who were patients at TH, and asking if it would be okay if she put my name on a list for the media to contact, you know, to put in a good word for Wakefield. I told her I would be happy to do so, and proceeded to tell her the story of how my son ended up there, and how I thought that it wouldn’t be too much longer until it’s figured out that Tylenol causes autism.

    The silence on the other end of the phone was deafening. There was an awkward pause, followed by a hasty, “thank you, we’ll put your name on the list, goodbye.”

    Something in her tone bothered me, so when I got home later that night, I googled her, because I really didn’t know much about her. That’s when I found out who she really was. That was the day I realized that no one there would be looking into the possibility that Tylenol was behind the spike in autism. That was the day that Wakefield lost my support.

    And no, no one from the media ever contacted me.

  111. #111 Scott
    December 15, 2009

    When even whackaloons are disassociating themselves from you because your wild speculations are so completely unsupported, a rational person would start to question those speculations.

    Jen, of course, will not.

  112. #112 Jen in TX
    December 15, 2009

    So Scott, this is all okay with you? The idea of the Johnsons on the one hand, being involved with and financially supporting a group that promotes the idea of vaccines causing autism, while on the other hand telling members of that group to avoid Tylenol, (not the rest of us) while they continue to benefit financially from the sales of that drug?

    How silly of me to be pissed about that!

  113. #113 Scott
    December 15, 2009

    I think they’re being foolish, but happening to own the company means absolutely nothing in terms of their understanding of issues. And in fact, such claims (just as yours) are soundly counter to the actual evidence.

  114. #114 Paige
    December 15, 2009

    Jen,
    What makes you think Johnson & Johnson knows or cares what the Johnsons think? It’s a giant, global corporation–I suspect the comparison to the DuPonts above is accurate.
    Paige

  115. #115 a-non
    December 15, 2009

    Forgive me, but I’m lost in all the wacky conspiracy theories. Do vaccines cause autism, or does Tylenol cause autism?

    Or does it not matter, as long as you can place blame on a large company with deep pockets that you can sue.

  116. #116 Prometheus
    December 16, 2009

    A-non,

    I understand your confusion. The number of proposed causes for autism is exceeded only by the number of proposed cures. Pretty much anything that a child under three years old might be exposed to has been championed by someone as a/the cause of autism.

    In many ways, this plethora of causes reinforces the evidence that autism is primarily a genetic disorder, since if anything can cause autism, doesn’t that really mean that nothing (apart from the genetic makeup of the person) does?

    Something to think about.

    Prometheus

  117. #117 kara
    February 10, 2012

    I don’t know much about the anti-vaccination movement but from reading the blog it seems like Wakefield used a lot of pseudoscientific claims in trying to prove that vaccines cause autism. Especially since his research was funded by trial lawers who were looking to sue vaccine manufacturers, that seems extremely biased to me. It also seems like there is some in-group bias from the pro-vaccination side.. it would be wonderful if there was proof and evidence that vaccines do or don’t cause disorders like autism. Hopefully someday..

  118. #118 Beamup
    February 10, 2012

    Given that there isn’t the faintest shred of a hint of any connection, and the idea is quite inconsistent with what we know of the mechanisms involved in autism (e.g. the effects on brain structures known to be formed prenatally), there’s no scientific need for anything further. And pursuing it would be a waste of limited resources.

    So no, it would not be wonderful.

  119. #119 Chris
    February 10, 2012

    Kara, you should read the more recent articles on this blog. Plus this list of articles:
    http://www.sciencebasedmedicine.org/reference/?p=1