Respectful Insolence

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J. B. Handley wants to touch see Andrew Wakefield’s monkeys.

How do I know this? Well, there’s just the little matter of his entitling his most recent excretion of flaming stupidity Show me the monkeys! and repeating “Show me the monkeys!” eleven times in the course of his post. My guess is that J.B. was trying to get a vibe going, perhaps like a preacher giving a sermon with cadences leading up to repeating the same phrase over and over again, with the intended effect of getting the audence to repeat the phrase when he says it, with ever more enthusiasm and belief each time the phrase is repeated. Just like Jimmy Swaggart. Or maybe Jeremiah Wright. Or perhaps Benny Hinn. Or any number of other preachers. The two analogies do fit Dear Leader, as the anti-vaccine movement of which he is one of the leaders does have many aspects of a religion–a cult, actually.

Whatever J.B. Handley’s inspiration to use repetition as a stylistic writing choice, perhaps I’d better step back for a moment. Why on earth does J.B. Handley, anti-vaccine propagandist among anti-vaccine propagandist and founder of Generation Rescue, the group that has arguably supplanted the National Vaccine Information Center as the premier anti-vaccine propaganda group in the United States, thanks to the conversion of spokescelebrity Jenny McCarthy from Indigo woo girl to anti-vaccine autism warrior mom, want to see Andrew Wakefield’s monkeys so badly? Newbies to this blog may not recall the two times in the past that I wrote about what I like to call monkey business in autism research, first in 2008 and then a followup post a few months ago in the fall. Of course, I also alluded to these monkeys when I expressed my extreme amusement about the most excellently paranoid conspiracy theory I’ve seen in a long time, courtesy of Generation Rescue spokescelebrities Jim Carrey and Jenny McCarthy, whose ability to mangle science in the service of their belief that vaccines cause autism is as legendary as the character of Fire Marshal Bill. Basically, the spin that Jenny and Jim, dancing to the tune of their fellow travelers in the anti-vaccine movement, are trying to put on the retraction of Andrew Wakefield’s infamous 1998 Lancet study that launched the anti-MMR hysteria in the U.K, is that the retraction, hot on the heels of the General Medical Council finding that Wakefield committed various serious offenses against ethic in carrying out that research, is a big plot by vaccine manufacturers to “silence” Wakefield and prevent the publication of his complete study. Apparently big pharma is just that powerful and just that focused on poor Saint Andy’s martyrdom.

In any case, I suppose I should prepare myself for another of J.B.’s patented tirades attacking and “outing” me in order to try to annoy me. J.B. hasn’t done it for a while, probably because I haven’t given him any reason to. The reason I haven’t given him any reason to is because Handley hasn’t really given me much of a reason to take on one of his–shall we say?–less cogent posts in a while. He’s overdue. And how can I resist this time? J.B. Handley is clearly just begging for yet another loving application of not-so-Respectful Insolence, and far be it from me to deny him his apparently most fervent wish.

J.B. begins his plea:

If a scientist were dropped into the autism controversy with no previous understanding of anything, here is what they would be presented with:

  • A dramatic increase in the number of kids with autism, creating a need to find an environmental, rather than genetic, cause.
  • A vaccine schedule that has grown dramatically during a time when the autism rate has grown dramatically, representing something (vaccines) nearly every child is exposed to from their environment.
  • The knowledge that vaccines do, with certainty, cause brain damage in a certain subset of kids. As Jim Moody has pointed out, it’s certain that vaccines cause brain damage, we just need to know how many kids have been damaged.

Of course, if that scientist were dropped into the middle of the autism controversy with no previous understanding of anything, he might well think that there has been a dramatic increase of the number of kids with autism, rather than a dramatic increase in the number of kids with the diagnosis of autism. There is a difference, but it is too subtle for the likes of Handley to understand. In any case, the reason why a scientist who has no understanding of the science and history of autism might leap to the same conclusion to which J.B.Handley clings to tenaciously is because he has no previous understanding of anything. Well, not exactly. J.B. Handley does have a previous understanding of the issue of autism prevalence and vaccines. It’s just that he has a previous misunderstanding of the issue. Either way, the results would be the same: A superficial idea that, because autism diagnoses have skyrocketed over the last 20 years, that must mean that the real prevalence of autism is skyrocketing. It is not, at least as far a scientists can tell. Without knowing the history, specifically how broadening of the diagnostic criteria for autism in the 1990s, increasing awareness, how screening for a condition (be it autism or even breast cancer) will find what were formerly subclinical cases, and diagnostic substitution, it’s very easy to come to a misunderstanding like the one that J.B. Handley promotes. Add to that the classic fallacy of confusing correlation with causation, and it is very easy for someone who doesn’t know anything about the the issue or its history to come to the conclusion that there must be a link between vaccines and autism. Of course, by the same logic, I could just as convincingly conclude that the Internet causes autism, given that Internet usage started to take off around the time the “autism epidemic” did.

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“You disturb me to the point of insanity. There. I am insane now.”

Come to think of it, not having an understanding of the issue or its history is exactly how J.B. comes to the conclusion that vaccines cause autism. Or is it that autism is a “misdiagnosis for mercury poisoning“? I forget and can’t keep the anti-vaccine stories straight. Those goalposts shift rather quickly when the vaccine/autism believers discuss what they believe to be their science.

It’s also find it rather interesting that J.B. seems to be equating autism with “brain damage.” No, strike the word “seems.” J.B. is equating autism with brain damage. This simply shows more of his misunderstanding. For one thing, autism appears to begin very early in development, not due to any exogenous insult causing “brain damage.” For another thing, although encephalitis from vaccines can occur, it is very rare. Certainly, it is too rare to account for an autism prevalence of approximately 1%, depending on the study. Also inconsistent with the existence of an “autism epidemic” is the NHS study that found an autism prevalence very similar in all age groups. While it is possible that the true prevalence of autism has increased somewhat over the last couple of decades, there is copious evidence that it has not increased enough to be considered an “epidemic.” Most likely, the prevalence of autism has remained fairly stable over the last few decades, and there is no link between autism and vaccines.

J.B. then lapses into an argument that borders on incoherent:

Show me the monkeys.Thinking again about these scientists who are learning about the autism epidemic for the first time and presuming they are agnostic to the political risks of questioning the Godliness of vaccines, they would find themselves in quite a pickle for one very simple reason:

If in fact vaccines seemed like a good place to start to assess a fairly obvious risk from the environment, a risk that was known to cause brain damage and that many parents were pointing to as a cause of their child’s regression, than it would really be hard to know where the hell to start because we give so many vaccines at once.

But, J.B. I thought that autism was a “misdiagnosis for mercury poisoning.” Oh, wait. It’s not. Thimerosal was removed from childhood vaccines except for the flu vaccine back in late 2001. Only trace amounts are left, and mercury exposure due to vaccines is lower than it’s been since at least the 1980s. Yet autism rates have not started to plunge, as would be predicted from the hypothesis that mercury in vaccines causes autism. Hmmm. Maybe it was the MMR. Well, no. Multiple large epidemiological studies have not found a link between MMR and autism. Oh, wait! I know! It’s “too many too soon.” It’s a nice, vague hypothesis that is much harder to falsify than saying it’s mercury in vaccines or a specific vaccine. I will give J.B. credit, though, for abandoning his claim that we give 36 vaccines and reducing it to 26, more in line with reality. Perhaps he was embarrassed enough times that hit finally sank in.

In any case, after repeating the same old anti-vaccine canard about a “vaccinated versus unvaccinated” study, J.B. finally gets to the point, namely defending Andrew Wakefield with an evidence-free argument by assertion, with a dollop of trying to show that he really, really loves animals:

Let me say something to clear my conscience: I love animals and I hate animal testing. I feel terrible writing about these monkeys because the truth is that they were all sacrificed at the end of this study. It breaks my heart open to think about how these monkeys had to live their lives and I do think it is both cruel and inhumane to experiment on animals. We are all God’s creatures.

The only thing I can say in defense of the sacrifice of these poor monkeys is that I have a very strong feeling their deaths will not be in vain. I have this strong feeling these monkeys will in fact save and improve the lives of many, many thousands of kids, if not millions. These monkeys have made a huge contribution to the planet’s life, and I am very grateful for them.

No, these monkeys have suffered and died in vain. As an aside, I’ll also point out that I hate the term “sacrificed” to describe euthanizing experimental animals at the end of an experiment. The religious connotations bother me; it sounds as though we are sacrificing animals to the gods of science. My personal pet peeve about using the term “sacrifice” aside, the experiment, from its very inception, was incompetently designed and used too few monkeys, particularly in the control group, to come to any meaningful conclusions. Its lead investigator, Laura Hewitson, didn’t disclose a couple of doozies of conflicts of interest, namely that she had a child who was a complainant in the Autism Omnibus action and that her husband at the time was working for Andrew Wakefield. Of course, now Hewitson herself is working for Wakefield, too, somehow having left the University of Pittsburgh in the wake of publishing a couple of abstracts about this monkey study. Finally, the study was published in NeuroToxicology, a journal whose editorial standards clearly leave something to be desired. In the published report, I noted a bit of oddness with the control group, which had suddenly grown from three monkeys to seven monkeys, a feat accomplished by combining monkeys getting no vaccines with monkeys getting saline injections of the same volume as the vaccines. That was but one issue, though. Another issue was how the authors appeared not to control for multiple comparisons and how they tested the monkeys daily, producing a number of measurements custom-designed to produce false positives without proper correction for so many comparisons. Indeed, as Prometheus said, it appeared to be a study custom made to be used in a lawsuit. Even worse, the reflexes tested for, the ones whose delay in acquisition was claimed to be due to vaccines, are present at birth in human infants.

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Shocking the monkey to life?

I’ve said it before, and I’ll say it again. Wakefield’s monkey study is unethical in my opinion. I consider it unethical because the study subjected monkeys to distress and pain in the service of a highly improbable hypothesis. Even more importantly, the study was unethical because it was (and, I’m guessing, will still be after publication of its second part) bad science. The experimental design was such that even under ideal conditions the experiment had very little chance of producing meaningful and useful data, given the tiny numbers of monkeys in the control group. And if an experiment has very little chance of producing useful results, then subjecting animals to suffering as a part of that experiment is unethical. Where on earth was the University of Pittsburgh’s IACUC on this one? The committee was clearly asleep at the switch when it approved this study, and as a result, 20 monkeys (that we know of–the numbers keep changing) suffered and died for no good reason.

I must admit, though, J.B. can still amuse me with little gems like this:

On Friday, you could almost hear the collective gasp of the gravedancers when Jenny & Jim’s statement about the monkey study hit the wires. Did you notice the “their theory is dead” articles slowed to a trickle?

Confusing correlation with causation yet again in a spectacular fashion, J.B. ignores the far more likely possibilities that (1) the story had run its course, having broken three days earlier in the week and (2) it was a Friday, the day before the weekend, a natural point for a story from earlier in the week to fade away into obscurity. Unlike the case for AoA, autism and vaccine stories are not at the top of the mainstream media’s priorities. In fact, I rather suspect the expectation that news about Wakefield’s study would wane over the weekend was why Generation Rescue waited until Friday to release Jenny and Jim’s conspiracy-fest of a press release, thereby trying to keep it alive a few more days. It did, but perhaps not in the way J.B. intended. So ridiculous was J & J’s press release that even non-science blogs are dissing it. One of the best lines I heard about the whole issue came from a parenting blog:

Jenny, honey, the science has left the building. Why are you still here?

I wish I’d come up with that line. I really do.

Finally, J.B. is apparently really upset by a letter from David N. Brown to the editors of NeuroToxicology complaining about its publication of Wakefield’s monkey study. The complete text of the article is here. Personally, I don’t think it was a good idea of Brown to have written the letter the way he did. In fact, it was a bad idea. Quite frankly, were I the editor of NeuroToxicology, I would have probably responded in exactly the same way. (Of course, if I were editor of NeuroToxicology, I would not have permitted such bad science to be published in my journal in the first place, but just go with me on this one for a minute.) Bad articles and bad science are published in the scientific literature all the time. It would have been better to explain, as I have tried to do, why Wakefield’s study is such execrably bad and unethical science that doesn’t even deserve the name of science.

Much like Wakefield’s 1998 Lancet study.

The bottom line is that J.B. is not a scientist. He does not understand science. He does not need or want science, except when it can serve his purpose. He’s proven time and time again that his understanding of the scientific method, research design, and medical ethics consists of a belief that vaccines cause autism and that any study or experiment performed to “prove” that link is hunky dory with him, be it torturing baby Macaque monkeys in an experiment studying a highly improbable hypothesis that by its very design is highly unlikely to provide any useful information or promoting an unethical “vaccinated versus unvaccinated” study with no conception of the complexities involved in doing so. In contrast, Handley appears to define as “bad science” any study that fails to find a link between vaccines and autism. The evidence that this is true is overwhelming in the form of Handley’s ridiculous criticisms of large, well-designed studies that failed to find a link between vaccines and autism.

That’s because, for J.B. Handley and the anti-vaccine movement, it’s not about autism, at least not any more even if it ever was. It’s about blaming vaccines for autism. It’s always about the vaccines. It always will be about the vaccines.

And monkeys. This time.

J. B. Handley wants to touch see Andrew Wakefield’s monkeys, as though they are evidence of anything other than incompetent science in the service of the pseudoscience claiming that vaccines cause autism. His story has become tiresome. So is it now time on Sprockets ven ve dance?

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Comments

  1. #1 Phoenix Woman
    February 11, 2010

    “Or perhaps Benny Hinn.”

    Let the bodies hit the floor!

  2. #2 James Sweet
    February 11, 2010

    It’s worth pointing out that if a person strongly believes there is an autism epidemic, that ought to make them doubly pissed off at the anti-vax crowd. While there is room for debate over the real extent to which the incidence of autism may or may not have increased, there is no longer room for debate over the vaccine-autism connection.

    If autism rates have skyrocketed due to some environmental trigger, all the more reason to identify that environmental trigger!

    (Personally, while I find it very hard to wrap my head arond the idea that diagnoses could have increased as much as they have solely due to diagnostic substitution, etc., I find it even harder to discount other evidence such as the discrepancy in apparent incidence among socioeconomic groups, and the NHS study that Orac mentioned. If you believe it’s an environmental trigger that has caused the apparent increase, it has to be one that affects affluent whites and Somali immigrants, but not poor African-Americans. I just can’t buy that.)

  3. #3 Todd W.
    February 11, 2010

    @Orac

    I was wondering if you were going to comment on Handley’s article. I was sorely tempted to respond to his “Show my the monkeys!” chant with “Here’s a mirror.”

    I didn’t though. Instead, I posted a more sedate, reasoned response, which I’ve copied over at Silenced by Age of Autism (and I encourage others to comment on AoA articles and copy their comments over at Silenced – I’m trying to establish just how much they don’t let through).

    Oh, and Orac, did you notice Craig’s comment about Brown’s letter:

    Who wants to take bets that we all know who this Yahoo is? My bet is that it’s Dorkski. Anyone want in on this action?

  4. #4 Dawn
    February 11, 2010

    James:

    There was a small (California) study published a few months ago that tracked autism diagnoses across a few areas of the state. They found that high-income areas had higher rates of diagnosis. Their conclusion was that it was likely that the rates were the same in low income areas, but that low-income families couldn’t afford diagnosis and treatment and were more likely to ignore autism symptoms or misunderstand them.

    I suspect the discrepancy you see among socioeconomic groups has a similar cause. I’ve not seen any other studies done like that, and I work with kids from across the socioeconomic spectrum from trailer parks to million-dollar homes. Then again, all the kids I work with had parents who cared at least enough to get them through an intake, psych eval and insurance maze in order to get services, so I’m sure I’m missing the full picture.

  5. #5 kittywhumpus
    February 11, 2010

    Comments I have read, which bring up the “vaccinated v. un-vaccinated study,” show a sneering disregard at the idea that any such study would be unethical. Clearly, they think science is merely hiding behind ethics because science can’t handle the truth.

    But reading the comments, in particular on NPR’s recent short report on Midmorning, is frustrating. There’s no using evidence to penetrate the glassy-eyed fundamentalism of the anti-vaccination congregation, but that stuff is out there, getting into the heads of otherwise reasonable people, whether they know it or not.

  6. #6 Jennifer B. Phillips
    February 11, 2010

    Or perhaps Benny Hinn. Or any number of other preachers.

    My money’s on Cuba Gooding Junior in “Jerry McGuire” Can’t you just picture JB as he bounces around the kitchen in his sweatpants, hollering into the telephone at those desperately clueless scientists on the line? Ew.

    As to the paper itself, to me it hardly matters that Wakefield is an author. The study contains numerous, glaring problems that should be directly challenged by the scientific community

    Is there a clear plan amongst the SBM community to communicate with the editors of NeuroToxicology on what a pile of rubbish they’ve chosen to publish?

  7. #7 the_muteKi
    February 11, 2010

    I still fail to wrap my head around the fact that Jenny McCarthy thinks that catching the diseases the MMR vaccine protects against is worse than autism when she claims that she found a cure for the latter, or at least that her son’s recovered.

    Then again, knowing what passes for “cures” for autism among such incredulous parents, it makes a *little* sense…

  8. #8 justawriter
    February 11, 2010

    So, is this woo, or just poorly reported?
    http://www.boingboing.net/2010/02/10/highlights-from-ted.html
    The “angiogenesis is a property of all cancers” line makes me suspicious, as does the claim that anti-angiogenesis compounds are widespread in foods without talking about the body’s ability to absorb them when taken orally.

  9. #9 Catherina
    February 11, 2010

    So Orac, should Prometheus, you, SM and me write a proper letter to NeuroToxicology, based on our previous blog posts, concentrating on the poor study design? The editor might not know yet what she has gotten herself into…

  10. #10 Orac
    February 11, 2010

    It’s not woo, although the way it’s reported disturbs me. I’ve seen Judah Folkman say similar things, but Dr. Li seems to be overselling angiogenesis and its inhibition. Suffice it to say that inhibiting angiogenesis has not been the miracle cure that some thought it might be 12 years ago.

    If I see the entire talk, maybe I’ll blog it.

  11. #11 DLC
    February 11, 2010

    The antivax nuts keep on shifting the goalposts, to the point I’m beginning to believe they have them on ball bearings.
    Look, AoA people : It’s time to drop the vaccines cause autism thing and look somewhere else. its been 12 years, and no link has been found except in the worst of the studies — the ones which were designed to find a link no matter what.
    Please! let’s stop wasting time and effort!
    (could I get the Govt to defund NCCAM and use that money for a dozen or so R-01 grants, instead? we could use 3 or 4 of them for actual research into autism )

  12. #12 JonF
    February 11, 2010

    An n of 3 does not something statistically meaningful make. Period. I kind of wonder where the university’s IACUC was on that one, or if the researchers stacked the groups post-hoc, which is violating scientific ethics in so many ways I can’t even count.

    Also, Jim Carrey. His big career break was talking out of his ass. Enough said.

  13. #13 Rob
    February 11, 2010

    Handley wrote:

    The knowledge that vaccines do, with certainty, cause brain damage in a certain subset of kids. As Jim Moody has pointed out, it’s certain that vaccines cause brain damage, we just need to know how many kids have been damaged.

    Where does he get that from? He doesn’t link to anything, and a bit of quick googling comes up with nothing except that Jim Moody is a lawyer and senior figure at Safe Minds.

  14. #14 FreeSpeaker
    February 11, 2010
  15. #15 Hildagard
    February 11, 2010

    Whether you believe vaccines are not causing, or are causing, neurological damage in children, what clinical trial would you design? A cohort of vaccinated kids compared to a cohort of unvaccinated kids? The NIH has refused to do that. (CDC has done everything it can to prevent a retrospective comparison.)

    Thinking people would not use kids – it isn’t ethical to subject them to known harms. But certainly the use of primates would go a long way to helping resolve this issue. Let’s read Wakefield’s (an co-authors’) article and evaluate its credibility when it comes out. Then let’s allow parents to do decide how much risk they are willing to subject their children to.

  16. #16 Ana Observer
    February 11, 2010

    As an adult autistic, who also happens to be the wife, daughter, and daughter-in-law of other adult autistics — Orac, I can’t thank you enough for the work you do in debunking the “autism epidemic” and anti-vax wingnuttery. Trust me, you are appreciated.

  17. #17 Todd W.
    February 11, 2010

    @Hildagard

    Read the two links Orac included in his post that will take you to reviews of Wakefield’s monkey study.

  18. #18 Rob Monkey
    February 11, 2010

    @Hildagard – “Then let’s allow parents to do decide how much risk they are willing to subject their children to.”

    Except it’s not just their own kid’s risk we’re talking about, which is why this issue is so important. Jehovah’s Witnesses don’t want blood transfusions? Good, save my blood for someone else. Crackpot parents don’t want to vaccinate their kid? Oh crap, everyone’s kid is now more at risk, and especially immune-compromised kids or kids who actually have a medical reason for not taking vaccines (allergies and whatnot).

  19. #19 Scott
    February 11, 2010

    @13:

    As Orac noted, encephalitis is a known (rare) side effect of at least some vaccines. So technically, Handley/Moody are right on that point. They just leaves out the fact that we DO know how roughly many children are injured that way, and the number is very, very, small.

  20. #20 Cooler
    February 11, 2010

    I don’t understand Orac’s complaint about not enough control animals. In the Durban declaration about HIV that was signed by thousands of scientists there was no control monkey in the SIV study cited. In Popper’s study that proved polio was lethal there was no control animal, so this study is better desingned than those studies as far as control animals.

    For people that claim to be skeptical it is striking how much you contradict yourselves.

  21. #21 neoSprockets
    February 11, 2010

    Speaking of the Internet causing Autism

  22. #22 Smarter Than You
    February 11, 2010

    I’m having a hard time figuring out who the bigger dumbass is, ORAC or Kevin Leitch? I’m pretty sure it’s Kevin Leitch because he is one dumb pile of shit who knows absolutely nothing about the Science behind this issue. I think ORAC actaully has half of a brain but he doesn’t seem much smarter than a monkey himself. ORAC, are you really a monkey and that is why we can’t figure out what it is exactly you are? I have no association at all with J.B., Jenny, Jim, or any of the others so don’t think I am sticking up for them or even necessarily on their side, however I know I would blow you off the stage in a debate about the Science behind the cause of Autism. Your problem is that you have tunnel vision and all you do is try to disprove vaccines as the cause. You are missing the much bigger picture. The year 2010 is the year something big happens that proves the cause, and again it has nothing to do with anyone associated with Wakefield, J.B., Jenny, etc. When it comes out you are going to bury your head in shame for the rest of your life. Have fun with that!

  23. #23 Chris
    February 11, 2010

    Sure, troll, you could “blow you off the stage in a debate about the Science behind the cause of Autism” by actually posting some evidence instead of a stream of idiotic insults.

    So which troll is this? Mary “I will debate you in person because I can shout louder” Podlesak or Common Sue?

  24. #24 James Sweet
    February 11, 2010

    Dawn,

    Their conclusion was that it was likely that the rates were the same in low income areas, but that low-income families couldn’t afford diagnosis and treatment and were more likely to ignore autism symptoms or misunderstand them.

    I suspect the discrepancy you see among socioeconomic groups has a similar cause.

    That’s exactly what I mean, is that the conclusion of the California study seems a heck of a lot more plausible explanation for these types of discrepancies than for it to be some heretofore-unnamed environmental trigger that affects rich people more than poor people. The latter is certainly possible, but Occam’s Razor has me going with the former for now.

    @20: Anybody who uses “Smarter Than You” as a handle is invariably full of shit.

  25. #25 Todd W.
    February 11, 2010

    Obvious troll is obvious.

    Now that that’s out of the way, we can ignore Smarter Than You (aka, Dr. I. M. Smart, aka Medicien Man, aka Medicine Man, aka Dangerous Doctor…did I leave any out?).

  26. #26 Travis
    February 11, 2010

    Smarter Than You

    So you have inside knowledge about something big happening? Do tell. Or are you just proclaiming this must happen this year because you want that to happen?

    And of course once again you post something complaining about others without including a single bit of evidence for your position. Nothing at all indicates you could debate anyone about the science of this topic.

  27. #27 Scott
    February 11, 2010

    Hey, not only is Stupider Than You here, so’s Cooler! It’s a veritable crank convention!

  28. #28 Even Smartestier Than You
    February 11, 2010

    Vaccines bad!!1111 MRRRGGHPHH!!! Bad bad bad! Vaccines bad! Homeopathy! 9/11! Quantum mechanics! Deepak deepak deepak! BLORGGHH!!!!

  29. #29 Scientizzle
    February 11, 2010

    Vaccines bad!!1111 MRRRGGHPHH!!! Bad bad bad! Vaccines bad! Homeopathy! 9/11! Quantum mechanics! Deepak deepak deepak! BLORGGHH!!!!

    Your ideas are intriguing to me and I wish to subscribe to your newsletter…

  30. #30 cooler
    February 11, 2010

    Scott, aka crazy nerdboy who always wanted to be popular, explain the paradox between orac complaining about 3 control animals when he doent even realize he’s contrdicting himself as said in the above post.

  31. #31 Rukmini Pillai
    February 11, 2010

    Sigh…Wish you were living in India where self-styled experts promote myths and misconceptions cloaked with the garb of ‘cultural differences’ preying on those who need medical care and support.

  32. #32 Skeptico
    February 11, 2010

    I’m pretty sure it’s a riff on “show me the money” from Jerry McGuire (another line that was repeated over and over). Show me the money. Pretty funny considering Wakefield’s (and other authors of that study) numerous conflicts of interest.

  33. #33 Rob
    February 11, 2010

    Smarter Than You @ 21:

    The year 2010 is the year something big happens that proves the cause

    Your prediction is duly noted. Please return in January to tell us how that worked out. Have fun with that!

  34. #34 Orac
    February 11, 2010

    I’m pretty sure it’s a riff on “show me the money” from Jerry McGuire (another line that was repeated over and over).

    Oh, I knew that. I just wanted an excuse to show pictures of Dieter. :-)

  35. #35 Scott
    February 11, 2010

    @29:

    Never wanted to be popular, actually. And there is no paradox; the necessary control group size varies depending on the situation and what you’re trying to prove. When attempting to measure the rate of a rare reaction (as the monkey study is attempting) you need a lot. Other situations call for smaller or even no control group, depending.

    As has been explained to you dozens of times already. So I’m really not sure why I’m bothering to hit “Post.”

  36. #36 Orac
    February 11, 2010

    I was wondering if you were going to comment on Handley’s article. I was sorely tempted to respond to his “Show my the monkeys!” chant with “Here’s a mirror.”

    I purposely did not do that. I must admit, though, I was sorely tempted last night as I was writing this.

  37. #37 Todd W.
    February 11, 2010

    @Orac

    I purposely did not do that. I must admit, though, I was sorely tempted last night as I was writing this.

    Yeah. It was just too easy. And, frankly, would have given them too much ammunition to go off on a rant. (Not that not making the comment will stop Mr. Handley…)

  38. #38 Chris
    February 11, 2010

    Travis:

    So you have inside knowledge about something big happening?

    This reminds of about ten years ago when someone in the mercury militia told me that there was going to be a great development that would prove once and for all that thimersal and/or vaccines cause autism. It turned out to be this silly paper!

  39. #39 Travis
    February 11, 2010

    Chris,
    I am surprised and even a little impressed they produced a paper even if it was stupid and published in Med Hypotheses. At least they sat down and did a little work. That work might have been poorly done but it took a little bit of effort. Most of the time they are just so lazy.

  40. #40 Travis
    February 11, 2010

    Though I should say I am distinctly not impressed with the mercury militia person who thought it was a big deal.

  41. #41 Antaeus Feldspar
    February 11, 2010

    Whether you believe vaccines are not causing, or are causing, neurological damage in children, what clinical trial would you design?

    I don’t see a clear way to design a clinical trial to test the hypothesis. I also don’t see any actual need, since the epidemiological studies which purportedly were going to show correlation between vaccines and neurological damage in children have not done so. It’s a mistake to see correlation and automatically assume there’s causation; someone who sees a lack of correlation and still wants to go looking for causation is on a quest for something other than the truth.

    A cohort of vaccinated kids compared to a cohort of unvaccinated kids? The NIH has refused to do that.

    Rightfully so; to deprive kids of vaccination to study what happens to them would be medical abuse nearly on par with the infamous Tuskegee syphilis study. In fact, the only reason I can’t put it directly on a par with the Tuskegee study is that the subjects in the Tuskegee study were denied informed consent; presumably the kind of parents who would allow their children to enter a study where they have a 50% chance of being denied their vaccinations are the kind that you could inform them until you were blue in the face and they would still stubbornly refuse to comprehend the real-world consequences of their choices.

    (CDC has done everything it can to prevent a retrospective comparison.)

    I would advise that you either present evidence for that paranoid assertion or retract it.

  42. #42 Chris
    February 11, 2010

    Travis:

    I am surprised and even a little impressed they produced a paper even if it was stupid and published in Med Hypotheses.

    That paper was written with the express purpose of supporting their lawsuits. Do you notice who the authors are? The next thing they did was hire a freelance travel writer to write an entire book on the “dangers of mercury in vaccine.”

    They main authors of that paper, and that travel writer have been subjects of this blog for years!

  43. #43 I.R.Baboon
    February 11, 2010

    Dear Smarter than you-I agree something big will occur in 2010- ENGLAND WILL WIN THE WORLD CUP
    England will win the 6 nations Rugby
    Saints will retain the Vince Lombardi trophy

    But a breakthrough in Autism treatment from you is less likely

    I.R.Baboon

  44. #44 W. Kevin Vicklund
    February 11, 2010

    Question: where do we find ~10,000 pregnant women who are each willing to take a 50% chance that her child will be vaccinated? Those in favor of vaccination would fear that the child would not be vaccinated, those against vaccination would fear the child would be vaccinated.

    I doubt you could get enough participants to do a large-scale double-blind study, at which point you might as well just do a retrospective study.

  45. #45 Travis
    February 11, 2010

    Oh, okay. I am terrible with names. I thought I recognized the name of the paper but the authors, no way. I should say, I am not really that impressed. It is more that I am surprised they even went through the motions of doing this. That requires a little bit of work and I normally find people such as this are terribly unwilling to do that. They are more likely to complain about mean scientists keeping them down than to write a paper of sorts.

    But I guess if it was for a cause like supporting a lawsuit the work might have been worth it in their eyes.

  46. #46 Chris
    February 11, 2010

    Well, if it is any help: Both Mark Blaxill and David Kirby blog at Age of Autism.

    Sallie Bernard and Lyn Redwood founded SafeMinds. Sallie Bernard even consulted on a study, but rejected it when the results were not what she wanted. Orac blogged it here:
    http://scienceblogs.com/insolence/2007/09/a_bad_day_for_antivaccinationists.php

    Perhaps the little troll is on Yahoo group where these same guys are crowing about their next new paper that will prove once and for all that vaccines cause autism. I won’t be holding my breath.

  47. #47 James Sweet
    February 11, 2010

    It’s a mistake to see correlation and automatically assume there’s causation; someone who sees a lack of correlation and still wants to go looking for causation is on a quest for something other than the truth.

    Hear hear!

    It reminds me of what my wife said as she was reading the homeopathy article on Wikipedia (at this point, she had not completely made up her mind about homeopathy… because when I told her what homeopathy actually was, she thought I must be mistaken — nobody could possibly believe in anything so stupid, and yet here there was a whole homeopathy section in the supermarket):

    “Oh my god. It’s a religion.”

  48. #48 kittywhumpus
    February 11, 2010

    They say they want an answer to their question, and then they get an answer. But because it’s not the answer they wanted to hear, they either reformulate the question or say that the answer was flawed. So they don’t really want an answer. What they want is for someone to make them feel better.

    It’s like asking “Do I look fat in this?”

    You don’t want the truth.

  49. #49 cooler
    February 11, 2010

    @35
    you’re dumb, so its ok for other scientists not to use any control animals based on youre subjective requirements you just pulled out of thin air. Better off spending your time trying to be a nerd. Having a control animal or a few always helps an ecperiment be more compelling, there is no excuse for not having any. The fact that you can’t see this means you are too crazy to have a conversation with. Adios.

  50. #50 David N. Brown
    February 11, 2010

    “J.B. ignores the far more likely possibilities that (1) the story had run its course, having broken three days earlier in the week and (2) it was a Friday, the day before the weekend…”
    He also ignores the possibility that, given his penchant for suing those who criticize him, the media might see saying nothing about him to be the least of several evils.

    As to comments re my letter, I doubt whether Handley is aware of my efforts. With regard to my letter to Neurotoxicology, I would like to point out that I did NOT say it should be retracted because it was bad science. I said it should be retracted (and never should have been considered for publication) because of the evidence that Wakefield committed fraud.

  51. #51 cooler
    February 11, 2010

    That’s experiment I meant to say. So according to your standards for infectious disease you don’t need a conrol animal (popper and the SIV study in the Durban declaration) but for this study having 3 is not enough. You always need one control to see if labratory conditions paly a role, regardless of what you are studying, nice try making up new rules to protect your deeply held beliefs.

  52. #52 Orac
    February 11, 2010

    @David N. Brown

    But, as far as I know, the GMC never showed that Wakefield committed fraud for the 1998 paper, just that he behaved unethically in conducting it and withheld COI information. The allegations of scientific fraud uncovered by Brian Deer a year ago were not even addressed and therefore can’t be said to have been proven officially, although, looking at the evidence in Deer’s reporting, I think they’re almost certainly true.

  53. #53 Prometheus
    February 11, 2010

    I went back and re-read the 2009 Hewitson et al (including Wakefield) “Monkey Business” paper. Although they don’t come right out and say that they’re using the same group of macaques for a study of multiple vaccines, they obliquely refer to it in section 2.7 (“Statistical Analyses”), first paragraph:

    “This was the required day of censoring since infants received further interventions on Day 14 which would have confounded the independent effects of the HB vaccine” [emphasis added]

    If they are planning to expose all 13, 14 or however many macaques they finally settle on to the entire “vaccine schedule” (plus thimerosal, which was removed in the US almost ten years ago), then they will need to do some fancy explaining.

    For starters, since they have already “shown” (not really, but they don’t realise that) that the Hepatitis B (HB) vaccine caused “abnormal early neurodevelopmental responses” in their subjects, how will they distinguish between “abnormal neurodevelopmental responses” from the original Hepatitis B vaccine and subsequent vaccines?

    Having “shown” (again, to their own satisfaction only) that Hepatitis B vaccine + thimerosal causes neurodevelopmental abnormalities, the only way to distinguish ongoing problems from the Hepatitis B vaccine and new problems from subsequent vaccine(s) would be to split their original (rather small) group of subjects into “vaccine 2″ and “placebo” groups.

    I somehow doubt they did that. But, I eagerly await the published study.

    Prometheus

  54. #54 The Perky Skeptic
    February 11, 2010

    So… what JB Handley is saying is that Andrew Wakefield completes him? :)

  55. #55 Kate from Iowa
    February 11, 2010

    Wow…don’t know how I missed it before, but going back and reading that Indigo/Crystal nonsense. Now I’m sitting here, laughing like an idiot and all the creepy people in the IHOP are looking at me funny…

  56. #56 Tariqistan
    February 11, 2010

    “We are all God’s creatures – except for people with autism.”

    This Handley guy is really starting to piss me off.

  57. #57 Jennifer B. Phillips
    February 11, 2010

    @52: I read your letter, and while I fully share your outrage that St. Andy is still up to his elbows in this rubbish research, I agree with the essence of the editor’s response.

    I feel strongly that the paper should be challenged on it’s scientific merits. This is really the epitome of low-hanging fruit, and I fully expect that a cadre of expert researchers/clinicians will have savaged NeuroToxicology within an inch of its life before the ink is dry. As far as the authors of this excrement, Wakefield’s history is maybe marginally relevant, from the standpoint of scientific integrity, compared to Hewitson’s. Point being, his supporters are already crying ‘censorship’ and ‘persecution’! If we don’t have to go there to invalidate these findings, why risk it?

    @54:

    So… what JB Handley is saying is that Andrew Wakefield completes him? :)

    ISWYDT ;)

  58. #58 superdave
    February 11, 2010

    The vaccinated vaccinated study, would not work. I have heard people on AOA claim that their child inherited mercury damage from their mother who had been vaccinated as a child.

    I want you to know that I merely read that statement with enough of my brain to repost it here as any deeper analysis would just be too painful.

  59. #59 David N. Brown
    February 11, 2010

    “the GMC never showed that Wakefield committed fraud for the 1998 paper”
    Quite true. In fact, they made a point of saying they did not evaluate Wakefield’s claims. However, I think their repeated conclusions that tests were unjustified for specific children implied that their histories were incorrectly reported. As far as I’m concerned, the evidence unearthed by Deer and the testimony by Bustin and Chadwick were enough to justify a conclusion of fraud quite independent of any formal GMC finding. That was why I was willing to call for the retraction of Wakefield’s “monkey study” way back in November.

  60. #60 Orac
    February 11, 2010

    And I think you were very much mistaken in doing so. You feed into the persecution complex of the anti-vaccine movement.

  61. #61 David N. Brown
    February 12, 2010

    I took my position on the basis of ethical principle, and I don’t regret it. I also didn’t see it as going out on a limb. Until I heard about the Neurotoxicology paper I didn’t believe that a serious journal would take any other course of action BUT the one I recommended.

  62. #62 Jake Crosby
    February 12, 2010

    David,

    If even “Orac” here who thinks there is a New World Order plot against vaccines thinks what you did was nuts, it was nuts.

  63. #63 snerd
    February 12, 2010

    Shush, Jake, grown-ups are talking.

  64. #64 Jake Crosby
    February 12, 2010

    First of all, you’re an ageist bigot, second of all, David N. Brown and I are both practically the same age, which makes you stupid on top of being prejudiced.

  65. #65 Otto
    February 12, 2010

    And, Peggy O’Mara’s House Organ chimes in enthusiastically:

    http://preview.tinyurl.com/ybgotnh

  66. #66 symball
    February 12, 2010

    Dear Smarter than you-I agree something big will occur in 2010- ENGLAND WILL WIN THE WORLD CUP
    England will win the 6 nations Rugby

    Hmm my money is on the second coming of elvis before those two

    World cup: England out on Pens in semi final,
    6 nations: England get stuffed for the rest of the tournament- even by italy! (cue thousands of jeremy’s all flooding back to the emirates from twickenham)

  67. #67 David N. Brown
    February 12, 2010

    “If even “Orac” here who thinks there is a New World Order plot against vaccines thinks what you did was nuts, it was nuts.”

    Orac has, to my knowledge, expressed no such belief. With regard to my letter, he has question my decision and esp. line of criticism. Not exactly “nuts”. Also, I think anyone familiar with my total body of work would find many things more deserving of that description.

  68. #68 samuel black
    February 12, 2010

    Whew! I enjoy the blog, but when I lost focus several times slogging through paragraph 3 (Whatever…), I wondered if was my own fatigue, or if Orac’s writing was to blame. The paragraph has three hundred words in 6 sentences for an average of close to 50 per sentence, topping out at 86 in one sentence. Most guides recommend an average of 20 words or so. I pasted the paragraph into http://www.addedbytes.com/code/readability-score/,
    and it came back with a Flesch-Kincaid readability score of 12.6. Lower scores mean more difficult to read, and the Harvard Law Review is typically in the low 30s. The Flesch-Kincaid grade level is 23.6, and the average grade-level score (from various formulas) is 21.3. Scores like this are hardly the last word on reading ease, but in this case, they fit my impression of the text.

    The paragraph is somewhat anomalous, to be sure, but it’s near the beginning of the post. I bring it up because, unless you’re happy preaching to the choir, you may want to pitch the level a little lower, where I think most of your opposition lives.

  69. #69 Dave Ruddell
    February 12, 2010

    This post made me very sad. It reminded me of a time, long ago, when Mike Myers used to be funny…

  70. #70 Joseph
    February 12, 2010

    If even “Orac” here who thinks there is a New World Order plot against vaccines thinks what you did was nuts, it was nuts.

    @Jake: Sure, Orac is the one who’s into conspiracy theories. Keep telling yourself that.

  71. #71 Todd W.
    February 12, 2010

    @superdave

    I have heard people on AOA claim that their child inherited mercury damage from their mother who had been vaccinated as a child.

    Yeah, I was going to mention that, too. A vaxed vs. unvaxed study hasn’t even been done and already they’re moving the goalposts. IIRC, the commenter said that it would have to be a study done on second generation kids (i.e., use children whose parents had never been vaccinated). Of course, they probably wouldn’t even accept that study as valid…saying that it would have to be third generation kids…then 4th, 5th, etc.

    I doubt they’d ever accept any vax/unvax study because at some point in the past, the subjects would have had some relative that had been vaccinated. And even if you managed to get to the point of 4 or 5 generations of unvaccinated, disease would most likely be so rampant that everyone would be clamoring for vaccines!

  72. #72 Brian Deer
    February 12, 2010

    Since RI is an important blog site, I thought I’d take time to make a correction. The GMC panel did indeed denouce the Wakefield Lancet study, describing it as “dishonest”. Specifically, as Orac has previously pointed out, in concealing the prospective goal of the research, and the selection of subjects.

    Wakefield was found guilty on four counts of dishonesty. Financial, research and two counts of lying to doctors seeking answers over the finances and research.

    The most critical text from scientific point of view:

    [32] “In reaching it’s decision, the panel notes that the project reported in the Lancet paper was established with the purpose to investigate a postulated new syndrome and yet the Lancet paper did not describe this fact at all. Because you omitted correct information and wrote the final version of the paper, and omitted correct information about the purpose of the study or the patient population, the panel is satisfied that your conduct was irresponsible and dishonest.”

    That is a finding of research fraud.

    [33-34] Referrals of 4 children found not to be routine referrals… referrals of 4 children found to have involved Wakefield in the referral process…

    “The description of the referral process in the Lancet paper was therefore i. irresponsible, ii misleading, iii contrary to your duty to ensure that the information in the paper was accurate.”

    That is a finding of research misconduct (falsification).

    As I say, there are then two counts of dishonesty proven when other doctors (including at a meeting of the Medical Research Council) asked about who was paying for the work, and where he got the children.

    David, above, seems to be confusing two issues. The panel made it clear that it was not adjudicating on issues about MMR and autism. However, it very clearly did (and in terms that are bound to lead, under existing GMC sanctions guidance to erasure) rule on the scientific probity of the Wakefield paper. This is why the Lancet was bound to retract it, and, knowing this since 2004, is perhaps the biggest single reason why I gave so much of my time to ensure that this would happen.

    A lot of people have had papers in the Lancet. Well, I’ve had one out of it.

    I wouldn’t want people to get the wrong idea about the reasons.

  73. #73 KWombles
    February 12, 2010

    Something rather interesting appears to have gone quietly unnoticed through all the blogging on the “14” monkeys: the paper by Hewitson et al. has been WITHDRAWN from press. I write about it on today’s post, linked through my name.

  74. #74 Science Mom
    February 12, 2010

    KWombles @73, I was just on their website last night and the withdrawl wasn’t posted. Great find. Give the AoA brigade some time to catch their breath; they’ll be screeding about this in no time.

  75. #75 Paul Browne
    February 12, 2010

    That’s excellent news KWombles, though such a flawed paper should never have got so close to publication.

    It’s interesting that Hewitson left Pittsburgh so soon after this study, her career there up to then had been quite promising. Given how poor the experimental design in this therimosal study was and the way they modified it as the study progressed my suspicion is that it deviated from the IACUC approved protocol, which would certainly justify Pittsburgh asking her to resign.

    I am still very disappointed that a proposal which included Wakefield et al. was ever given consideration by the IACUC at all, their names should have sounded alarm bells straight off.

    Pittsburgh should now be open about what went wrong and what steps they have taken to ensure that this debacle is never repeated. I dare say that they are reluctant to expose themselves to bad publicity but the sooner they demonstrate that they have got their house in order the better. They wouldn’t be the first to have been taken for a ride by the anti-vaxers. Wakefield is a slippery customer though, no doubt his lawyers have tied Pittsburgh up in knots.

  76. #76 Sid Offit
    February 12, 2010

    The problem with doing a retrospective study is that an association between vaccines and autism could be found – either due to actual causality or to confounding variables. Either way such a study would be too dangerous since the ensuing panic, until reassuring research could be published, would lead to people hysterically refusing to have their children vaccinated. So rather than explain all this to the public it’s easier to say the studies have already been done and hope someone believes it.

  77. #77 Sid Offit
    February 12, 2010

    PS

    Loved the Sprockets reference.

  78. #78 David N. Brown
    February 12, 2010

    Todd W,
    “Oh, and Orac, did you notice Craig’s comment about Brown’s letter:

    Who wants to take bets that we all know who this Yahoo is? My bet is that it’s Dorkski. Anyone want in on this action?”

    I would be interested to learn more about this… Some people seem to have a hard time recognizing that anyone with the handle “Evil Possum” is not going to be hard to find.

  79. #79 David N. Brown
    February 12, 2010

    Brian Deer,
    “Wakefield was found guilty on four counts of dishonesty. Financial, research and two counts of lying to doctors seeking answers over the finances and research.”
    These don’t seem to be directly related to scientific fraud, in the sense of reporting things other than what was seen. His inappropriately-arranged tests could still have led to the discovery of real health problems. Instead, it was established years ago that Wakefield was at the list guilty of knowing ommission of negative findings.

  80. #80 Dedj
    February 12, 2010

    “David,

    If even “Orac” here who thinks there is a New World Order plot against vaccines thinks what you did was nuts, it was nuts.”

    Firstly, Orac certainly did not say that. That is an overwhelmingly negative misreading.
    Secondly, the stated reason for what he did say was that he believes Davin N Browns actions may “feed into the persecution complex of the anti-vaccine movement.
    Thirdly, people with presecution complexes have tendancies – amongst other things – to read negatively into what people say.

    “First of all, you’re an ageist bigot, second of all, David N. Brown and I are both practically the same age, which makes you stupid on top of being prejudiced.”

    Fourth “grown up” can also be used as a measure of maturity, not just age. You certainly have no reputation for maturity.
    Fifth, David N Brown writes with a clarity, maturity and dedication that conveys the impression that he is significantly older, if he is indeed about your age.
    Sixth, throwing insults at someone when you could have merely corrected thier error does not make you look very mature.

    In effect, your behaviour in reaction to being called immature provided the evidence that the accusation may be true.

    Have a think about that, but don’t get back to me. You can keep your thoughts to yourself thank you.

    Toodles and good luck with exams etc.

  81. #81 David N. Brown
    February 13, 2010

    Dedj,
    I’m currently 29, if it matters. I have a long, long record when it comes to writing (unfortunately no income to speak of), which I think may give people a stronger impression. I am also diverse enough that I can “compartmentalize”. That is, if I have an idea that IS bizarre, silly or flat-out stupid, I have places to work it out.

  82. #82 Antaeus Feldspar
    February 14, 2010

    The problem with doing a retrospective study is that an association between vaccines and autism could be found – either due to actual causality or to confounding variables. Either way such a study would be too dangerous since the ensuing panic, until reassuring research could be published, would lead to people hysterically refusing to have their children vaccinated. So rather than explain all this to the public it’s easier to say the studies have already been done and hope someone believes it.

    This is of course coming from Sid Offit, our resident “pure troll” (if tomorrow everyone here got convinced by the evidence that vaccines were bad, Sid would switch to the other side and start preaching about how good vaccines were, simply so he could keep annoying people.)

    Thus, it is not for Sid’s benefit, but for the benefit of others who might be reading, that I should clarify that retrospective studies have been done, contrary to Sid’s unsupported claim that such studies are “too dangerous” to do and therefore have not been done. Sid is actually correct in pointing out that retrospective studies suffer from a great drawback: because the subjects sort themselves into the study groups, there is no telling what other variables besides the one the experimenters are hoping to measure are influencing the outcome.

    The story of the Verstraeten study is actually a very good example, in this regard. Verstraeten was tasked with comparing children’s medical records from a certain database to see if there was a statistically significant difference between vaccinated and unvaccinated children, in their rates of autism or other neurological disorders. And Verstraeten’s preliminary results at first seemed to indicate that there was a correlation — not with autism, but with certain other neurological disorders. (Robert F. Kennedy Jr. published a horribly inaccurate article claiming that Verstraeten had discovered a correlation with autism, but examining the very sources RFK Jr. said he used shows that no correlation with autism was ever suggested by Verstraeten’s data, even though it had been looked for.)

    These were, as previously stated, preliminary results. They were presented at a CDC conference, where someone pointed out something that hadn’t been considered: What was being taken as different rates at which vaccinated and unvaccinated children developed neurological disorders might be different rates at which they were diagnosed. What if vaccinated children only got diagnosed more frequently — because the kind of parents who took their children in for vaccinations on schedule also brought their children in for problems that parents who didn’t vaccinate would ignore or try to treat with alternative medicine?

    They reasoned that if this second hypothesis was the case, then vaccinated children would also be diagnosed more frequently with physical problems that could not be caused by vaccinations, like club feet. If this was true and vaccination was truly causing neurological problems, then the difference in rates of diagnosed neurological problems between vaccinated and unvaccinated children should be larger than the difference in rates of diagnosed physical problems. But when they tested this hypothesis, the data didn’t support it – meaning that what had looked in the preliminary stages like a difference in incidence, correlated with vaccination, was really only a difference in diagnosis, correlated with making more sensible usage of medical resources.

    And these are the very studies that our troll Sid would try to convince people have not been done, and will not be done because they are too “dangerous.” Sorry, just not true; we faced the danger and saw it through, because the true danger is that whatever the truth may be, we will not pursue it through all the twists and turns it may hide behind.

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