I had been wondering why the anti-vaccine crank blog Age of Autism had been gearing up the slime machine against Brian Deer lately. For example, former UPI reporter turned vaccine/autism cran Dan Olmsted has been attacking the BMJ. As you recall, the BMGpublished Brian Deer’s latest revelations earlier this year when he quite pithily and correctly referred to the now infamous (not to mention fraudulent and consequently retracted) 1998 Lancet case series published by vaccine/autism quack and crank Andrew Wakefield “Piltdown medicine.” Particularly curious are the more recent articles, which try to cast doubt on Deer’s reporting about Child 11, in essence calling Brian Deer a liar when he reported that Child 11’s symptoms of autism developed before he got the MMR vaccine, hitting that theme a week ago and then again earlier this week. I had been curious why Olmsted had resurrected his putrid yellow journalism directed at Brian Deer, after not having added to the series (An Elaborate Fraud) since part 6 in August.

Now I know. It’s a preemptive strike.

Just yesterday, the BMJ published another followup article by Deer entitled Pathology reports solve “new bowel disease” riddle that further elaborate on the the real “elaborate fraud,” namely Andrew Wakefield’s fraudulent research that ignited a scare about the MMR vaccine as a cause of regressive autism. It is a scare that has not yet abated, even nearly 14 years after the publication. It was a scare based on the claim by Wakefield that he had identified a new syndrome, which he later dubbed “autistic enterocolitis” in a followup paper in the American Journal of Gastroenterology. This syndrome, Wakefield suggested, was associated with vaccination with the MMR vaccine, and The Lancet paper, which linked autism and “autistic enterocolitis” with the MMR served as the basis of Wakefield’s later claims that the MMR vaccine was a cause of regressive autism. Thirteen years and multiple studies later, no investigator not somehow associated with either Wakefield and/or the anti-vaccine movement has been able to replicate his work. Indeed, an explicit attempt to replicate Wakefield’s work failed utterly. After all that time, there remains no persuasive evidence that such a syndrome as “autistic enterocolitis” even exists. Indeed, Deer found in his investigation that the vast majority of specimens that the gut was normal but only after a re-review by Wakefield’s team were they described as abnormal.

In any case, this alleged new syndrome depended on the finding of “colitis” in ileal biopsy specimens from autistic children in Wakefield’s original case series. In his book Callous Disregard, Wakefield claimed that he “played no part in the diagnostic process at all” and:

It was decided that, in order to standardize the analysis of the biopsies, the senior pathologist with the most experience in intestinal disease, Dr. Paul Dhillon, should review all biopsies from autistic children. In turn, Dhillon decided that pathology should be graded on a reporting form designed by him to document the presence and severity of microscopic damage. Thereafter, a regular review of biopsies took place involving Drs. Dhillon and Anthony, a trainee pathologist. I was also in attendance. Dhillon’s diagnosis formed the basis for what was reported in The Lancet.

Unfortunately, as Sullivan notes, these statements have been difficult to verify, and the original pathology slides made from biopsy samples taken from the original children studied in Wakefield’s case series are missing, which obviously makes it impossible to go back and look at the specimens and see whether expert pathologists agree with Wakefield’s team or not. This does make me wonder what happened to the original pathology blocks used to make the slides. If those still existed, it would be possible to cut and stain more sections. In fact, it makes me wonder how all of these specimens, slides, blocks, and all, could go missing. Be that as it may, it’s also interesting that Dr. Dhillon’s original scoring sheets were also missing.

Until now.

Deer got ahold of the original scoring sheets, as he describes here:

Between 1988 and 2001, Wakefield was an academic researcher at the Royal Free medical school in Hampstead, north London, from which his five page paper was published. “Researchers at the Royal Free Hospital School of Medicine may have discovered a new syndrome in children involving a new inflammatory bowel disease and autism,” the school announced to promote the paper, which the Lancet retracted last year.

But the data–passed to us by David Lewis, a self employed American environmental microbiologist working with Wakefield–tell a different story, kept hidden for nearly 14 years.

The funny thing is that Lewis forwarded these reports to the BMJ because he thought they exonerated Wakefield, probably leading Wakefield now to wonder, “With friends like these, who needs enemies?”

What Deer got ahold of where Dhillon’s histology scoring sheets for 62 intestinal biopsy specimens from 11 of 12 of the Lancet children, and it turns out that Dhillon’s reports actually showed nothing particularly unusual. Deer reproduces some of the grading sheets in his article and on his website. For example, here’s the scoring sheet for Child #1 and for Child #2. It turns out that Dhillon did not find frank enterocolitis in any of the children, and in fact, quite the contrary to what was reported in The Lancet paper, what is recorded in these reports is far more consistent with normal intestinal mucosal than with any significant enterocolitis:

But Dhillon’s reports produced results that pathologists, gastroenterologists, and a gastrointestinal immunologist to whom we have shown them say are overwhelmingly normal and might be found in almost anybody’s gut.

“Most of this stuff is so close to normal that you’ve really got to question whether there is really anything there,” said Henry Appelman, professor of surgical pathology at the University of Michigan and a specialist in gastrointestinal disease. “These are the kind of things that we in our practise here would ignore completely.”

By way of background, remember that these specimens were nearly all read as normal by consultant histopathologist Susan Davies, who also challenged claims of “colitis” in a draft of the original Lancet paper withdrew her objections in favor of Dhillon’s analysis. However, as Deer reports:

But it now emerges that, although expressed as scores rather than narratives, Dhillon’s findings were largely consistent with Davies’s. “Everyone thinks I am crazy even asking them,” said King’s gastroenterologist Bjarnason, after discussing the scorings with other specialists. “All but one of the children is normal in their eyes. There is no enteritis and no colitis, simple as that.”

There was at least one other major problem, and that’s what was left out of the reports that might have put even the mild changes noted in the intestinal biopsies. What was left out was a history of severe constipation. For example, one of the patients endured failure to pass the endoscope because there was still fecal matter in the cecum, even after a full bowel prep. This is very important because pathologists, if they knew about this, would think less of even the mild changes observed, mild inflammation and lymphoid follicles, are common in biopsies of patients with severe constipation.

In a second article in the same issue of BMJ entitled MMR fraud needs parliamentary inquiry, says BMJ, as new information puts spotlight on Wakefield’s co-authors, BMJ editor-in-chief Dr Fiona Godlee goes one further than Brian Deer in that she asserts that at least six other papers by Wakefield besides the Lancet paper require “independent investigation.” She sent a letter to Andrew Miller MP arguing that Parliament must investigate University College of London, where the research was carried out, unless UCL immediately starts an independent inquiry:

“If UCL does not immediately initiate an externally-led review of its role in the vaccine scare, we believe that parliament should do it,” concludes Godlee. “After the effort and time it has taken to crack the secrets of the MMR scare, and the enormous harm it has caused to public health, it would compound the scandal not to heed the warnings from this catastrophic example of wrongdoing.”

Amusingly, Lewis, stung that his attempt to exonerate Wakefield by supplying the pathology scoring sheets to the BMJ has backfired so spectacularly and actually made the Wakefield team look even worse, is mounting a counterattack by writing a letter to the BMJ. Basically, his argument boils down to trying to claim that Wakefield was just “reporting what he was told” and had nothing to do with shaping the analysis of the bowel samples. In other words, Lewis is arguing that Dhillon and Wakefield were incompetent, although that’s not what he calls it. However, that’s not what the General Medical Council found after two years to investigate the matter. It concluded that there was fraud involved.

Hilariously, Lewis discusses learning of Deer’s stories earlier this year while at a “vaccine safety conference” with Wakefield. It’s hard not to note that if you say you’re at a “vaccine safety conference” with Wakefield, it was in actuality an anti-vaccine conference, and the conference to which Lewis refers is the infamous conference in Jamaica held earlier this year. There, Wakefield shared the bill with other anti-vaccine cranks such as Dr. Russell Blaylock (who is an all purpose medical crank and, like many all purpose medical cranks, anti-vaccine), Dr. Shiv Chopra (who is anti-vaccine to the core), and Dr. Richard Deth, Raymond Obamsawin, among others. Here’s a hint: While trying to defend and anti-vaccine crank like Wakefield, don’t bring attention to the fact that he’s an anti-vaccine crank by mentioning his having attended an anti-vaccine conference. Come to think of it, don’t mention your having attended the conference as well.

In the end, Deer’s latest findings are evolutionary, not revolutionary. It’s not clear why Lewis so wanted to exonerate Wakefield and clear his name that he was willing to persuade Wakefield to let him provide Dhillon’s scoring sheets to the BMJ, but I’m grateful that he was so clueless that he did so. In the absence of the original pathology specimens and the ability to get other pathologists to evaluate them, Lewis inadvertently provided the next best thing to help confirm once again the utter incompetence and fraud that is Wakefield.

Comments

  1. #1 blackheart
    November 15, 2011

    Jud

    That must have been quite the embarrassing moment …surprise me and lift the intellectual quality of your debate.

  2. #2 blackheart
    November 16, 2011

    TBruce

    I am not impressed.

    There’s a surprise.

    What is interesting is that any of the BMJ’s pathologist with any appreciation of scientific rigour and objectivity would never make comment on incomplete data sheets.

    They would submit a written document / evaluation signed and dated.

    In this document they would thoroughly review each and every case outlining the strengths and weaknesses of their findings and any problematic factors such as not verifying against actual pathology specimens.

    Nor would they make comment if they knew that there was additional material available through the GMC enquiry directly related to these patients. ie another set of pathology reports.

    Further as a research team member the original pathologist a Professor at a teaching hospital, no less met weekly with other team members particularly of note the three renowned paediatric gastroenterologists.

    As this witness was cross examined under oath at the GMC it seems implausible that there was any “fraud” involved.

    —————————————————

    “All intestinal biopsy tissues went through three rounds of microscopic review: the first from the duty non-specialist histopathologist, the second by Professor Walker-Smith and his team, and the third – a blinded review – by Dr Amar Dhillon, the senior pathologist with expertise in intestinal diseases.

    Statement of Dr. A.P. Dhillon to the GMC

  3. #3 blackheart
    November 16, 2011

    Lilady

    “Wakefield set up two offshore (Ireland) corporations…Immunospecifics Bioltechnologies Ltd. & Carmel Healthcare Ltd. ***”Carmel” Healthcare Ltd”

    …and you can cite the original Republic of Ireland company records showing all aspects of company ownerships including shareholders and including dates of incorporation ?

    Away you go … or is this another evidence free zone.

  4. #4 blackheart
    November 16, 2011

    Before publishing Lewis’s letter, the BMJ asked Ingvar Bjarnason, a gastroenterologist at King’s College Hospital, London, to review the materials.

    But he says that the forms don’t clearly support charges that Wakefield deliberately misinterpreted the records. “The data are subjective. It’s different to say it’s deliberate falsification,” he says.’

    Well it certainly would be seeing as we now know who undertook all three review processes and Andy Wakefield’s name isn’t in it.

    ———————————————–

    When is a fraud not a fraud when it’s a difference of opinion.

    Such conspiracies … baaaa !

    ps Of course I’m still backing the guys that actually looked at and studied those pathology slides.

    But hey … always magnanimous.

  5. #5 TBruce
    November 16, 2011

    Blackheart:

    Whatever.

    You asked me to comment on the worksheets and I did. Nothing you say changes my assessment. I would be open to changing my mind if:

    – other pathologists not associated with the study had differing views. IIRC, other pathologists have commented, with conclusions similar to mine.

    – I could have a look at the slides from these cases. Oh, yeah, that’s not possible. Funny, that…

  6. #6 Beamup
    November 16, 2011

    “So what” seems an appropriate response. Let’s suppose, for the sake of argument, that Wakefield had honestly put into the paper what he believed Dhillon had found.

    The thing is still chock-full of lies. Concealing the facts that Wakefield was being paid by the lawyers, and the patients were referred by the lawyers and were plaintiffs, would in itself be enough to completely destroy all credibility. Changing the course and timing of symptoms would still qualify as outright fraud.

    So even in the best case, the conclusion is that Wakefield committed both deliberate fraud AND gross incompetence.

  7. #7 Brian Deer
    November 16, 2011

    @TBruce

    There’s more that you would appreciate. You will hear a lot from Wakefield’s people about a “blinded review”. Indeed, his Lancet paper refers to 5 age-matched and site matched controls, and acknowledges where he says he got them.

    In fact, an earlier version of the paper refers to 10 such controls (so five went AWOL).

    And these ten were supplied by a pathologist at another hospital who says she supplied 10 “normal” biopsies, which were neither age- nor site-matched. (You’ll know all that left-side – right-side stuff. I can even do Paneth cells these days, god help me).

    So what you get for controls are not samples from non-autistic children with constipation. What you get are random normal controls which are not matched for anything (and how would you site- or age match- them against 62 ileocolonic biopsies from 11 patients anyway) and which – having been pre-selected for zero inflammatory changes – create the greatest imaginable selection bias.

    And that’s even before the number is whittled down from 10 to 5.

    So, what are we to make of Wakefield’s claim in the paper that: “None of the changes described above were seen in any of the normal biopsy specimens”?

    We published these sheets because Wakefield and his new pal claimed they vindicated him.

    I love these people.

  8. #8 brian
    November 16, 2011

    Blackheart wrote:

    [We] now know who undertook all three review processes and Andy Wakefield’s name isn’t in it.

    Blackheart, are you accusing Wakefield of lying?

    Andrew J. Wakefield wrote in the August 1997 draft of his paper:

    All tissues were evaluated by a further 3 clinical and experimental pathologists (APD, AA, AJW).

    Andrew J. Wakefield wrote in the Lancet paper:

    All tissues were assessed by three other clinical and experimental pathologists (APD, AA, AJW).

    Of course, Wakefield wrote in Callous Disregard that he was merely “in attendance” to suggest that he certainly did not “assess” or “evaluate” the tissues, so whatever was found, it wasn’t his fault; perhaps Wakefield never said a word but just made tea and fetched extra grading sheets.

    Since those statements in the draft, the final paper, and Callous Disregard cannot all be true, which of Wakefield’s statements do you think must be false? Did he or did he not “evaluate” or “assess” the tissues, as he wrote?

    Nonetheless, perhaps you are correct when you said of the review process that “Wakefield’s name isn’t in it”. Just his initials.

  9. #9 Prometheus
    November 16, 2011

    To echo “Beamup” (#206), as soon as it was revealed that the subjects of his 1998 Lancet paper were not just 12 random children who had been “…consecutively referred to the department of paediatric gastroenterology with a history of a pervasive developmental disorder with loss of acquired skills and intestinal symptoms…” but were, in fact, recruited by solicitors and on the Internet, the wheels came off the study.

    For me, everything past that point was simply “piling on”. It was apparent almost from the start that the study was not valid (because the subjects were “hand-picked” to present exactly what Wakefield’s article proposed to find) and the rest of the evidence merely elevated the failing from gross incompetence to probable fraud.

    At any rate, the legitimacy of the “findings” in Wakefield’s has been nil for years and finding that the pathology reports were also likely tampered with is just another rock landing atop an avalanche.

    What “Blackheart” appears to be arguing is that since “three pathologists” connected to this now-retracted paper (unindicted co-conspirators?) read the now non-existent pathology slides as showing “ileo-nodular hyperplasia” etc., we should ignore the only remaining evidence – the pathology scoring sheets – which seem to indicate that they saw nothing of the sort.

    Given all that has gone before with this study and these researchers, Blackheart’s efforts seem akin to insisting that the Titanic had sufficient watertight compartments when she slipped beneath the waves of the North Atlantic.

    In both cases, the suppositions are both unlikely and irrelevant. Regardless of the “adequacy” of her watertight compartments, the Titanic sank and regardless of what the “three pathologists” (Tres Caballeros?) in the 1998 Lancet study saw or thought they saw, nobody else – except people connected to the Wakefield research group – has been able to replicate their findings.

    It is a pity that the original slides and blocks have been “lost”, but the worksheets seem to indicate that what the “three patholgists” saw as “enterocolitis”, the rest of the pathology community sees as “not significant”, which might explain the failure to replicate the Wakefield 1998 findings.

    At this point, the burden is on the Wakefield researchers to show that their 1998 findings were legitimate, since they haven’t been replicated. Perhaps the “three pathologists” would consent to a test – looking at colon and ileum biopsies from 12 consecutive (truly consecutive) paediatric gastroenterology referrals with “regressive autism” and 12 consecutive referrals without autism (of any kind) to see if they can identify which have “autistic enterocolitis” and which do not.

    I think that would be very illuminating.

    Prometheus

  10. #10 Denice Walter
    November 16, 2011

    AJW may have actually learned from Sir Cyril Burt** whose mistakes included having all his co-efficients of correlation precisely equal to the *third* decimal place and inventing collaborators or subjects.

    However, at least Burt had the good sense to burn his notes and records.

    ** this is most emphatically *not* a “how to” guide.

  11. #11 blackheart
    November 17, 2011

    “You asked me to comment on the worksheets and I did.”

    I didn’t ask you to simply regurgitate … I was expecting a little more complexity and critical application.

    For instance did you take into account the age and diagnostic history of each child ?

    Did you compare it in your professional experience to other pathology that would be relevant. You don’t need control slides for that ?

    What was the diagnosis of each child then if you don’t think there is a case for microscopic colitis seen in conjunction with lymphoid hyperplasia ?

    “- other pathologists not associated with the study had differing views. IIRC, other pathologists have commented, with conclusions similar to mine”

    I was expecting you to show me where the fraud was.

    All I can see in those articles is one or two sentence comments.

    Where’s the detailed signed and dated review ?

    “- I could have a look at the slides from these cases. Oh, yeah, that’s not possible. Funny, that…”

    Where’s the Roswell alien again ?

    The pathology slides are not required. The evidence of disease pathology was confirmed through further examination of some 50 or more children

    Did you forget the elephant in the house ?

    “this mucosal abnormality has been apparent in 47/50 children within the autistic spectrum, whether or not there is any perceived link with immunisation. Thus the lymphoid hyperplasia/ microscopic colitis changes were found in over 90% of the autistic children studied. Even if there is no immunodeficiency, the lymphoid hyperplasia in many cases is remarkable, with germinal centres showing higher numbers of proliferating (Ki67 positive) cells than we have detected in any immunodeficient controls with lymphoid hyperplasia. We are very familiar with the detection of lymphoid hyperplasia in children with minor immunodeficiency, as are Lindley and Milla, and have published several reports on this topic. We were thus ideally placed to detect the exaggerated lesion found in many of these children. The colitis itself is variable, but may feature crypt abscesses, increased macrophage infiltration and unregulated class II major histocompatibility complex expression.

  12. #12 blackheart
    November 17, 2011

    Prometheus

    What “Blackheart” appears to be arguing…

    Wilfully ignorant or ignorantly wilful hard to tell which one Prometheus. Simply unable to distinguish between ‘pathologists’ and ‘gastroenterologists’

    Two layers of evidence converge to show aberrant bowel pathology that shows microscopic colitis and lymphoid hyperplasia.

    Changes were found in over 90% of the autistic children studied. 47 / 50 children

    At this point, the burden is on the Wakefield researchers to show that their 1998 findings were legitimate, since they haven’t been replicated.

    Well indeed they were … here it is again

    Changes were found in over 90% of the autistic children studied. 47/50 children

    That’s a lot of pathology you are going to have to dismiss as ‘mysteriously’ disappeared.

    I think that would be very illuminating.

    I’ll be fascinated how you dismiss 47 pathology reports, slides and all..

    Here’s some help …

    The Great Big Book of Magic Tricks: Amazing Tricks to Impress Your Friends

  13. #13 Brian Deer
    November 17, 2011

    Dr Dhillon has now made a statement. He denies the Wakefield – Lewis claim that he reported non-specific colitis, and passes the buck back to the hospital pathology service and the clinicians (who records show judged the biopsies to have been largely normal at weekly clinico-pathological meetings)

    http://www.bmj.com/comment/rapid-responses

    He also says that some of the forms which Wakefield attributes to him were not, in fact, written by him. So, now we wonder, whose handwriting is it?

    Is it “AJW”, who the Lancet said “assessed” the biospies with Dhillon?

    Or was it “AA” – Andrew Anthony – who was an unaccredited trainee at the time, and was still a trainee eight years later?

    Were the rogue sheets done at the time, or were they added later by someone who didn’t expect that the BMJ would publish them?

    Dhillon also notes that there were additions to the documents. We know that they were added by someone called “Andy” two months ago. I can’t imagine who that was.

    I love these people.

  14. #14 W. Kevin Vicklund
    November 17, 2011

    The forms that Dhillon attributes to someone else are for Children 7,8,10,&12. The first form for each of those 4 children has AA written in the top right corner, in what appears to be the same handwriting as on the rest of the form. APD appears on one of the forms Dhillon does claim as his own. Therefore, it is reasonable to conclude that Andrew Anthony was the person who filled out the other forms. Which as I understand it was already known that he did a review of the slides.

    Note that the only thing Dhillon claims was added was the Child ID. This is perfectly normal as part of the unblinding process, and in fact necessary for us to be able to interpret the results in any meaningful fashion. I have to call out Brian Deer for insinuating something more sinister.

    I will note that on several of AA’s forms, the following note is present at the top of the page:

    *nice control*

    Now that is something worth pondering.

  15. #15 Prometheus
    November 17, 2011

    I read Dr. Dhillon’s response and I found it odd that he repeatedly made mention of the fact that he had no knowledge of the clinical context of the slides he was examining. This, of course, is expected in a blinded study, so his use of this excuse is odd, at the least.

    He also claims that, in 1998 when the paper was being written, that there weren’t any guidelines for grading paediatric gastrointestinal biopsy slides (which I have to assume is true) and then – not a paragraph away – berates other pathologists for using adult criteria for assessing his worksheet notes. It seems odd to accuse others of using the wrong guidelines when he – by his own admission – used none at all.

    Although these questions are highly relevant to Dr. Dhillon’s reputation, they are completely irrelevant to the issue of “autistic enterocolitis”, since it has not been replicated.

    Even if we give Dr. Dhillon benefit of the doubt and assume that he saw real pathology, it would have been random chance (along with a non-random pre-selection of study subjects) that the pathology correlated with autism. We know this because subsequent studies have failed to find a correlation.

    Even if there had been no fraud, no “stacking the deck” by pre-selecting subjects with the “right” story, no questionable reinterpretation of pathology slides, “autistic enterocolitis” would still be a dead hypothesis because the only people who can see it are connected with Andy Wakefield. No independent research group has been able to find “autistic enterocolitis”.

    This isn’t to say that nobody has found that autistic children (or adults) have GI problems or that colitis never occurs alongside autism – those all happen. But the Wakefield group made a very specific claim of a very specific type of pathology seen – so they claimed – only in autistic children who had “regressive autism” after the MMR vaccine. That finding has not been replicated.

    I mention this last bit because I’ve been repeatedly bombarded with lists of studies that are claimed to replicate the Wakefield findings, but the listed studies are always either [a] by colleagues of Dr. Wakefield or Dr. Wakefield himself, [b] about non-specific “GI problems” in autistic people, [c] about “ileonodular hyperplasia” in non-autistic children, [d] letters to the editor or [e] completely irrelevant.

    “Autistic enterocolitis” as a hypothesis has been “mouldering in the grave” for nearly a decade. All that is left is to decide which of the members of the Wakefield group (if any) committed deliberate fraud and which members allowed themselves to be duped – separating the goats from the sheep, as it were.

    Prometheus

  16. #16 Beamup
    November 17, 2011

    I read Dr. Dhillon’s response and I found it odd that he repeatedly made mention of the fact that he had no knowledge of the clinical context of the slides he was examining. This, of course, is expected in a blinded study, so his use of this excuse is odd, at the least.

    It seemed to me that he was saying “I was not diagnosing colitis, I could not have been diagnosing colitis based solely on these slides, to assert that a diagnosis of colitis came from me is false.”

  17. #17 Brian Deer
    November 17, 2011

    @Beamup:

    Which is interesting, because you have two consultant histopathologists. One in the NHS hospital pathology service saying that she didn’t diagnose colitis, but that a research review in the medical school generated this. And the other in the medical school saying that he didn’t diagnose colitis either.

    She said that a “blinded review” (so-called, as if that makes any difference) took precedence because Dhillon looked in “minute detail”.

    He said that the pathology service diagnoses should take precedence because it had clinical information which is vital to this activity.

    It makes me think of Reservoir Dogs when they all stand in a circle and shoot each other.

    But I do love these people.

  18. #18 TBruce
    November 17, 2011

    I didn’t ask you to simply regurgitate … I was expecting a little more complexity and critical application.

    – and I expect you to read my answers for comprehension. I have interpreted the findings. If you don’t like my answers, well, tough.

    For instance did you take into account the age and diagnostic history of each child ?

    No, because it’s not provided on the worksheets. If it’s elsewhere, I’m not about to look for it. I’ll let you “multidimensional thinkers” and “multilayer cakes” do that. I am commenting on the pathologic findings, not attempting to make a diagnosis.

    Did you compare it in your professional experience to other pathology that would be relevant. You don’t need control slides for that ?

    I have examined thousands of colon biopsies in my career. I know what normal colon looks like.

    What was the diagnosis of each child then if you don’t think there is a case for microscopic colitis seen in conjunction with lymphoid hyperplasia ?

    I stated that in all but one of the cases, the colon biopsies (as described on the worksheets) were normal. I’m not in a position to “diagnose” each child.

    Did you forget the elephant in the house ?

    The room. It’s “the elephant in the ROOM”. If you’re going to stoop to using a cliche, at least use it correctly.

    Anyway, are these elephant keepers associated with Wakefield’s study, or are they independent? That does make a difference.

    Also see comment #62 from Dangerous Bacon. I concur.

  19. #19 TBruce
    November 17, 2011

    Futrher to my comment #218:

    John Walker-Smith appears to be the head elephant keeper. This is not an independent opinion and therefore is worthless as far as I’m concerned.

  20. #20 blackheart
    November 17, 2011

    TBruce

    The room. It’s “the elephant in the ROOM”. If you’re going to stoop to using a cliche, at least use it correctly.

    You just missed another multilayered reply …

    apparently this particular elephant is now rampaging through all the allegations made against John Walker-Smith and his professional colleagues.

  21. #21 W. Kevin Vicklund
    November 17, 2011

    apparently this particular elephant is now rampaging through all the allegations made against John Walker-Smith and his professional colleagues.

    You may have a point there. It’s quite possible that Walker-Smith and Wakefield are a veritable Fleischmann and Pons.

  22. #22 TBruce
    November 18, 2011

    blackheart:

    Ooh, a multilayered cliche. How kewl.

    – and you have completely missed everything I have presented, multilayered or not.
    Why should I bother?

  23. #23 blackheart
    November 18, 2011

    TBruce

    My research review of the slides in 1998 has important differences with the routine diagnostic histopathology process:

    -Routine diagnostic histopathology is done with knowledge of individual patient’s clinical details as far as they are available at the time of diagnostic reporting, and so the rendering of a diagnostic histopathological opinion in this situation is usual and appropriate (in direct contrast to the situation that pertains in a blinded research review)

    -Then there is a joint review by clinicians and pathologists to evaluate the significance of the microscopic observations in the light of additional clinical, endoscopic, radiologic, and laboratory data that has been obtained after the “diagnostic” biopsy has been reported

    -It is not unusual for the clinical significance of microscopic observations to be reinterpreted and altered by this process, and it could be that the histological diagnostic interpretation subsequently has to be corrected.

    Thus the purpose of my grading sheet observations in 1998 was not, could not have been, nor was it intended to conclude the final diagnostic assignment of colitis (which has to be made in the light of full clinical/endoscopic/radiologic/ laboratory data; and response to treatment)

    -Therefore on the grading sheets “nonspecific” means: “this microscopical appearance doesn’t remind me of any particular disease entity”, and this is why in none of my grading sheet observations have I stated “colitis”.

    Bowel disease is not diagnosed by gut mucosal histopathology in isolation:

    -I am of the opinion that the histological interpretation should never (or not very often) replace clinical judgement

    “A final diagnosis can only be made with the full clinical information and a biopsy specimen should be reported as diagnostic only if full supportive clinical information is available.” (Jenkins D et al. Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology Initiative. J Clin Pathol 50,93-105;1997).

    -Thus, at the time of submission of the Lancet 1998 publication, with the limited supplementary information available to me (which I had been prevented deliberately from knowing during the study); and in the context of a comprehensive clinicopathological review by trusted clinical colleagues, the designated diagnosis of colitis seemed to me to be plausible.

    ————————————————

    Gonzo’s Big Book of Magic Tricks isn’t working out so well….

  24. #24 LW
    November 18, 2011

    That’s such an awesome response by the aptly-named blackheart; I’ll have to remember it. Any time I say something incoherent, or mess up a commonly used cliche, I’ll say, “You just missed another multilayered reply” and everyone will be all impressed and feel stupid that they missed my pearls of wisdom.

    Or else they’ll just snicker.

    *Snicker*

  25. #25 TBruce
    November 18, 2011

    blackheart:

    Still missing my single-layered reply. Oh hell, you can’t even find the cake. Guess the elephant in the house must have eaten it.

  26. #26 Prometheus
    November 18, 2011

    The latest comment from “Blackheart” (#223) appears to be nothing more than a cut-and-paste from Dr. Dhillon’s BMJ comment. Is that part of his multi-dimenional, transwarp, multi-layered multiverse?

    “Blackheart” (#212):

    “Changes were found in over 90% of the autistic children studied. 47/50 children. That’s a lot of pathology you are going to have to dismiss as ‘mysteriously’ disappeared.”

    Although he – once again – failed to give any clues as to the study he was “citing”, I think I’ve tracked down this obscure reference to the following paper:

    Wakefield AJ, Anthony A, Murch SH, Thomson M, Montgomery SM, Davies S, O’Leary JJ, Berelowitz M, Walker-Smith JA. Enterocolitis in children with developmental disorders. Am. J. Gastroenterol. 2000 Sep;95(9):2285-95

    Not only is this not “independent confirmation” of Wakefield’s findings, you’ll find the retraction of that article in the May 2010 edition of the same journal.

    “Blackheart” is missing the Elephant in the yard – the 1998 Lancet article by Wakefield et al is dead and has been dead for over ten years. We are only just now hearing the anguished howling and gnashing of teeth from the “vaccines-cause-autism” crowd because they thought – ’til now – that it only slept.

    Prometheus

  27. #27 Denice Walter
    November 18, 2011

    @ Prometheus:

    And I suspect that the whimpering will continue for many years to come. These people are *not* going away, tail between their legs. Not at all.

  28. #28 Matthew Cline
    November 18, 2011

    @Prometheus:

    Although he – once again – failed to give any clues as to the study he was “citing”,

    Well, of course he didn’t. It’s our job to try to figure out what the hell he’s saying, not his job to communicate clearly.

  29. #29 Chris
    November 18, 2011

    Hence, blackheart’s trademark style: Interllectualis masturbatio.

  30. #30 Prometheus
    November 18, 2011

    Denise Walter,

    I have no illusions that the death of their martyred study will do anything but stiffen the resolve of fantasy-based “vaccines-cause-autism-and-all-bad-things” advocates.

    “Blackheart” (#137):

    “Often I give multilayered or multidimensional answers that expand not only on the questions asked but those “not” asked ie implied or alternatively I feel would expand on the topic. I’m that sort of fellow.”

    “Blackheart” (#187):

    “It’s not a question of being ‘dumb’ it’s a question of thinking in more complex terms. Not everyone understands it and not everyone can practice it. I’ve discussed matters pertaining to this before in terms of fluid and crystallised intelligence.”

    After reading these Sheen-esque, self-aggrandising, post-bong-hit, pseudo-philosophical ramblings, I’m reminded of an exchange in that classic film, Apocalyspe Now (1979):

    Kurtz: “Are my methods unsound?”

    Willard: “I don’t see any method at all, sir.”

    Prometheus

  31. #31 Denice Walter
    November 18, 2011

    @ Prometheus:

    Oh, but think how much *more* fun you’d be having- in reaction to the aforementioned- if you had studied how children’s and adult’s various skills and level of functioning are discernible from examples of their writing.

  32. #32 LW
    November 18, 2011

    “The latest comment from “Blackheart” (#223) appears to be nothing more than a cut-and-paste from Dr. Dhillon’s BMJ comment.”

    I initially thought that *blackheart* was claiming to have done a review of the results, and that *blackheart* was explaining them. One could wish that the multidimensional intelligence of which blackheart is so proud included the use of quotation marks, blockquote, or references. But I guess being ignorant of such niceties is just part of blackheart’s awesomeness.

  33. #33 Prometheus
    November 18, 2011

    Denise,

    I had assumed that Blackheart’s writing “style” was due to the influence of acute-on-chronic cannabis intoxication. Is there more to be discerned from his writing than that? I’m intrigued.

    Prometheus

  34. #34 brian
    November 18, 2011

    “Autistic enterocolitis” as a hypothesis has been “mouldering in the grave” for nearly a decade. All that is left is to decide which of the members of the Wakefield group (if any) committed deliberate fraud and which members allowed themselves to be duped – separating the goats from the sheep, as it were.

    It’s interesting that Nick Chadwick, who — as a graduate student — was the member of Wakefield’s team at the greatest professional risk if he failed to toe Wakefield’s line, did stand up to Wakefield and asked not to be included as Wakefield’s coauthor on a paper that he believed was not supported by the data. As Fiona Godlee indicated, some of Wakefield’s other coauthors may not be so worthy of admiration.

  35. #35 Skind
    November 18, 2011

    Of course, the whole point of participating in a discussion is to add your own answers to questions raised and to submit that other points of importance need to be raised.

    This is done in order to facilitate arriving at a more refined – and hopefully more accurate – depiction of the subject under discussion. You may not agree with the other people in the discussion, but you’re at least trying to help them understand where your coming from.

    As such, one would expect discussion to include ‘multi-layered’ answers.

    What you’re trying to do and whether or not you’re any good at it are two seperate issues in any response.

    Blackhearts excuse for his brain-shudderingly poor ‘multi-layered’ answers basically amounts to claiming ‘I’m trying to have a discussion’.

    He should consider the possiblity that the reason why a few dozen loosely connected commentators have repeatedly argued that he is a piss-poor discussion partner may be because he is a piss-poor discussion partner.

  36. #36 blackheart
    November 18, 2011

    Prometheus

    Although he – once again – failed to give any clues as to the study he was “citing”, I think I’ve tracked down this obscure reference to the following paper

    Wrong…

    Perhaps you’d like to check posts #94 and #187

    But then who would expect a sheep to be able to read and understand the implications of an important piece of primary evidence in this issue.

    Not only is this not “independent confirmation” of Wakefield’s findings

    Wrong …

    John Walker-Smith if you don’t know why then you shouldn’t be posting on this subject.

    Not only is this not “independent confirmation” of Wakefield’s findings

    Wrong …

    It’s the physical evidence that corroborates.

    “Blackheart” is missing the Elephant in the yard – the 1998 Lancet article by Wakefield et al is dead and has been dead for over ten years.

    Wrong …

    I just read something written by the BMJ … unfortunately the implications of that article are not working out as ‘skeptiks’ had planned.

    There seems to be a very subtle change …

    We are only just now hearing … from the “vaccines-cause-autism” crowd because they thought – ’til now – that it only slept.

    Wrong …

    For some it’s never been about “Vaccines cause Autism”

    It may take you some time to get your head around that one .

  37. #37 blackheart
    November 18, 2011

    Skind

    Of course, the whole point of participating in a discussion is to add your own answers to questions raised and to submit that other points of importance need to be raised.

    It seems some of the points I have raised multilayered are taking people out of their ‘comfort zone’. The well evidenced response is flight or fight.

    This is done in order to facilitate arriving at a more refined – and hopefully more accurate – depiction of the subject under discussion.

    That would tend to be more plausible if there was not a continuing held belief amongst posters of what I ‘believe’ in this matter.

    Wrong assumptions have always been the default position.

    “You may not agree with the other people in the discussion, but you’re at least trying to help them understand where your coming from.”

    There are actually many common ground areas. Unfortunately it is not always possible to elucidate these when people are undergoing psychological stress.

    There is always the opportunity to ask relevant insightful questions.

    As such, one would expect discussion to include ‘multi-layered’ answers.

    Let’s set aside the word ‘mulitlayered as it seems to promote much “angst” and perhaps use the word ‘sophisticated’.

    What you’re trying to do and whether or not you’re any good at it are two seperate issues in any response.

    I’m always open to critical appraisal from objective peers. I am unable to see any here.

    Blackhearts excuse for his ….

    I’m not sure how your cognition ‘flipped’ then ? But it was an interesting phenomenon.

    …brain-shudderingly poor

    It’s interesting you use the phrase ‘brain shuddering’. It seems to indicate a reflection of your unconscious mind as you are taken out of your own psychological schema.

    amounts to claiming ‘I’m trying to have a discussion’.

    There’s an interesting assumption.

    He should consider the possiblity that the reason why a few dozen loosely connected commentators

    Self reflection …always a healthy thing to do.

    may be because he is a piss-poor discussion partner.

    How does that change the “intellectual paucity” of the responses.

    Two way street that communication thing.

  38. #38 Denice Walter
    November 19, 2011

    @ Prometheus:

    Sorry I missed your query above…
    In short, you can tell *volumes* from a person’s writing- not just education, general intelligence,or presence/ absence of SMI- *but* more intriguing capacities about human interaction/ communication and transformation of skills into more mature functioning post-adolescence.
    Does the person use language naturally and creatively? Do they take the audience’s ability into consideration? How abstract or complex are they? Problems with metaphors? Are they trying to convince you how absolutely brilliant they are *all the time*? Trouble keeping an even keel emotionally? Oh there’s lots more.
    Thus I am often entertained by reading articles or comments by pseudo-scientists and their supporters. I do serious work- laughter is therapeutic for me.

  39. #39 blackheart
    November 19, 2011

    Denice

    I think Prometheus is rather busy trying to work out how he made another simple error.

    I think we should console him by purchasing a Gift Certificate from Salem’s Psychic Centre.

    http://www.salempsychiccenter.com/handwriting_analysis.html

    Whilst I have your attention perhaps you’d like to offer up the scientific rationalism of your craft.

    I’m sure Orac would be fascinated. Anyone else want to chip in with some phrenology.

  40. #40 blackheart
    November 20, 2011

    TW

    That’s such an awesome response by the aptly-named blackheart; I’ll have to remember it.

    Thanks TW …just in case you do forget here it is again. It’s a sad day for the magicians.

    (With additional commentary – Just like one of those DVD extra things)

    My research review of the slides in 1998 has important differences with the routine diagnostic histopathology process:

    Clarifying what real eminent research pathologists do like Professors in teaching hospitals

    (Apologies to the ‘grunts’we need you too)

    Routine diagnostic histopathology …

    It’s routine they are looking for routine disease.

    Then there is a joint review by clinicians and pathologists …. additional clinical, endoscopic, radiologic, and laboratory data that has been obtained after the “diagnostic” biopsy has been reported

    Now we’re getting to real clinical work done encompassing all the clinical knowledge we have of the patient, a solid ecological diagnosis.

    It is not unusual for the clinical significance of microscopic observations to be reinterpreted and altered by this process, and it could be that the histological diagnostic interpretation subsequently has to be corrected.

    Nothing wrong here … just good clinical practice.

    Thus the purpose of my grading sheet observations in 1998 was not, could not have been, nor was it intended to conclude the final diagnostic assignment of colitis (which has to be made in the light of full clinical/endoscopic/radiologic/ laboratory data; and response to treatment)

    Anyone who attempts to make such a diagnosis from such limited material is in serious error.

    Therefore on the grading sheets “nonspecific” means: “this microscopical appearance doesn’t remind me of any particular disease entity”, and this is why in none of my grading sheet observations have I stated “colitis”.

    It’s not something I’ve seen before … what do my colleagues think. Especially three eminent gastroenterologists

    Bowel disease is not diagnosed by gut mucosal histopathology in isolation:

    It certainly isn’t and it would make you wonder why anyone would attempt to do so.

    I am of the opinion that the histological interpretation should never (or not very often) replace clinical judgement

    A senior clinical paediatric clinician / gastroenterologist takes into account and is knowledgable of every aspect of the patient. Therefore he uses his skills and expertise to make the call.

    “A final diagnosis can only be made with the full clinical information and a biopsy specimen should be reported as diagnostic only if full supportive clinical information is available.”

    Ouch….that’s gotta hurt.

    Thus, at the time of submission of the Lancet 1998 publication, with the limited supplementary information available to me

    I am just one eminent cog in a clinical team

    in the context of a comprehensive clinicopathological review by trusted clinical colleagues, the designated diagnosis of colitis seemed to me to be plausible.

    Case closed …thank you. No joking of course there’s more … but you’re not going to like it.

    ————————————————

    Gonzo’s Big Book of Magic Tricks isn’t working out so well….

  41. #41 Krebiozen
    November 22, 2011

    Blackheart,

    “A final diagnosis can only be made with the full clinical information and a biopsy specimen should be reported as diagnostic only if full supportive clinical information is available.” Ouch….that’s gotta hurt.

    Are you the only person here who doesn’t understand that Dhillon was explaining why he made a mistake back in 1998 when he didn’t have the full information? The routine hisotopathologists had the full supportive clinical information and they concluded the biopsies were normal. You are greatly out of your depth, and continue to make yourself look foolish.

  42. #42 Prometheus
    November 22, 2011

    Krebiozen,

    “Blackheart” would be out of his depth in a parking-lot puddle. On this and other threads, he has shown a consistent inability to grasp the salient points of the discussion.

    For example, Dr. Dhillon’s “explanation” that he couldn’t make a diagnosis of colitis (or enterocolitis) without the clinical information is either an attempt to explain how he got the diagnosis wrong (as you point out) or an effort to distance himself from the “autistic enterocolitis” claims of Wakefield.

    When I read Dr. Dhillon’s statement, it seems that he’s saying – indirectly – “You can’t blame me for the ‘enterocolitis’ nonsense because I never would have diagnosed enterocolitis based solely on histopathology.”. It is very clear that Dr. Dhillon isn’t defending a diagnosis of “enterocolitis”, as he admits he never had the “full clinical information” he now says is essential to make such a diagnosis.

    He does manage to avoid seeming to stab Wakefield in the back in his statement, “…in the context of a comprehensive clinicopathological review by trusted clinical colleagues, the designated diagnosis of colitis seemed to me to be plausible.” In other words, “I trusted them to make the diagnosis; it’s not my fault!”

    I feel sorry for Dr. Dhillon, because it seems likely that he was one of the sheep in this situation. He seems to have been guilty of nothing more than excessive enthusiasm and misplaced trust. He should have heeded the timeless words of Otter (Animal House, 1978):

    “You f**ked up…you trusted us!”

    Prometheus

  43. #43 blackheart
    November 24, 2011

    Krebiozen

    Are you the only person here who doesn’t understand that Dhillon was explaining why he made a mistake back in 1998 when he didn’t have the full information?

    Some very wishful thinking there.

    It was John Walker-Smith the clinical investigator, paediatric gastroenterologist and the one that ‘tallied’ all the clinical information that described the aberrant bowel disorder found in autistic patients.

    Are you suggesting that John Walker-Smith committed fraud ?

    I’m all ears …

  44. #44 blackheart
    November 24, 2011

    Prometheus

    I simply point out… it’s not Professor Dhillon’s job to make any diagnosis.

    But then again it comes as little to no surprise that you have made another simple error.

  45. #45 Julian Frost
    November 24, 2011

    Blackheart:

    It was John Walker-Smith the clinical investigator, paediatric gastroenterologist and the one that ‘tallied’ all the clinical information that described the aberrant bowel disorder found in autistic patients.

    It was also John Walker-Smith who was found guilty of gross misconduct and struck off alongside Wakefield.

  46. #46 Denice Walter
    November 24, 2011

    @ Julian Frost:

    Do you ever get the impression that we’re in a bizarre play or performance art piece? It’s almost funny. However how do we communicate with people who have a great deal invested in believing in the intregrity of a project and an individual neither of which hold water? For some reason, a sieve comes to mind.

    AJW’s project has been thoroughly eviscerated after being placed under the microscope. It’s not “just a journalist” but an additional series of events that include having his article re-tracted, being struck off by the GMC, failing to appeal, losing a court case ( and paying up), need I go on? Obviously those who argue in his support aren’t relying upon external reality but their *feelings*. His position- and persona- resonant with their own deepest beliefs and make them feel better about themselves.

    We can argue all we like but will not make any headway with the adamantly entrenched *but* there are people “listening in” and most of those aren’t adamant supporters of AJW- in fact I suspect that their sentiments are distributed normally- speaking to them isn’t an exercise in futility. In fact, I often raise my glass in appreciation of them.

    Our friend Blackie mentions my “craft”? And which craft is that, pray tell? I think he imagines that I am a psycho-therapist- wrong. I am a liberal arts person who managed to take about 20 courses in life sciences and another 20 in social sciences, continued grad work in social sciences, predominantly psychology ( the other is a secret- guess!) including a clinical sequence, focus on cognition, life-span developmental , statistics…. worked in counselling and other dark arts. SB psychology looks at people’s abilities, ways to develop them, and how they function in the real world.

    My only craft is being an “all court player”. Look it up.

  47. #47 blackheart
    November 25, 2011

    Denice

    Thanks for the update on your CV … it was well interesting.

  48. #48 Broken Link
    January 30, 2012

    In another interesting connection, this is posted on the FB page “Get Well Carmel” which is in support of Andrew Wakefield’s wife Carmel, who was apparently injured in a car accident. It seems that David Lewis, microbiologist and whistle blower is also an ordained minister, and is willing to accept money to help out the Wakefields:
    ___

    As a friend of the Wakefield family, I would like to thank all of you for your friendship to Carmel. They are going through an extraordinarily trying time. On top of this trauma, their daughter Imogen’s car was stolen from a park this week. Another friend, Dr. David Lewis, a research microbiologist and ordained minister has established a fund at his church for Andy and his family, to help with the added financial issues related to this accident. Anyone who would like to contribute can sent a donation to:———————————————
    Donations to Andy Wakefield Family

    Checks can be made payable to Saxon Road Church (Federal Tax ID EI 58-2083521) and mailed to David L. Lewis Saxon Road Church 1310 Saxon Road, Watkinsville, GA 30677.

    Saxon Road Church is a non-profit, non-denominational community church built in Oconee County, Georgia in 1993. It provides community services and accepts donations for specific needs. It does not take up offerings during services, which are held each Sunday from 11-12:00 AM EST. Church bylaws prohibit church staff and officers from being paid for any services rendered to the church. All donations to Andy Wakefield’s family will be paid out to Andy in full.

    David L. Lewis, CEO Saxon Road Church, Inc.

    Thank you – XOXOX

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