There are some days when I know what my topic will be—what it must be. These are times in which the universe gives the very appearance of handing to me my topic for the day on the proverbial silver platter with a giant hand descending from the clouds, pointing at it, and saying, "Blog about this, you idiot!" Usually, it's because a study is released or something happens or a quack writes something that cries out for rebuttal. Whatever it is, it's big and it's unavoidable (for me, at least).
This is one of those days.
The reason it's one of those days is because just last Friday, as I was driving to work, I heard a news story on NPR about a study that had just been released in the Journal of Pediatrics. The story, as it was reported, noted that the study being discussed looked specifically at a certain antivaccine trope and found for yet the umpteenth time that vaccines are not correlated with an increased risk of autism. Normally the news that a study had once again failed to find a link between vaccines and autism would be as surprising as a study finding that the sun rises in the east and sets in the west or finding that water boils at 100° C at sea level. At this point, the evidence is so utterly overwhelming that there is not a whiff of a hint of a whisper of a correlation between vaccines and autism that it has become irritating that antivaccine activists keep pressuring scientists to do the same study over and over again, coming up with the same results over and over again, and then seeing antivaccinationists fail to believe those same results over and over again. Apparently, antivaccine activists think that if the same sorts of studies are done enough times, there will be a positive result implicating vaccines as a risk factor for or contributing cause to autism. By sheer random chance alone, this might happen someday, given the definition of statistical significance, but so far there has not been a single large, well-designed epidemiological study by reputable researchers that has found a link. Then, of course, antivaccinationists couldn't resist weighing in on Friday and Saturday, thus providing me with even more fodder for this post. At that point, the die was cast.
The final nail in the coffin of "too many too soon"?
Its utterly expected result notwithstanding, what makes the study reported on by NPR interesting is that it looked specifically at a common antivaccine trope that started popping up a lot five or six years ago. To my knowledge, although it had been percolating for a couple of years before that, this trope had its big debut when Jenny McCarthy led an antivaccine "protest" march on Washington, DC in June 2008, coupled with the delightfully Orwellian slogan, "Green our vaccines!" Quite honestly, I had to hand it to the antivaccinationists. "Too many too soon" and "Green our vaccines" were great slogans. They were pithy, simple, and communicated the message that vaccines were toxic and that they shouldn't be given to young children. From a scientific standpoint, they were horribly wrong, but from a propaganda standpoint they were brilliant, not the least of which because "too many too soon" was much more difficult to falsify than other antivaccine tropes, such as the roundly falsified claims that the mercury-containing preservative thimerosal causes or contributes to autism, that vaccines are loaded with "toxins," and the idea popularized by the now disgraced Andrew Wakefield that the MMR triple vaccine could result in "autistic enterocolitis" and autism itself. This study looks right at the "too many too soon" hypothesis and finds zero evidence to suggest that there is anything to it. As I said, this could be completely predicted beforehand, but antivaccinationists keep forcing scientists to do the same study over and over and over again in different ways. They're still not convinced, but we can always hope to convince the fence sitters.
The study itself was carried out by Frank DeStefano, Cristofer S. Price, and Eric S. Weintraub, from the CDC and Abt Associates, and the complete study, Increasing Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of Autism is available to all online, which is a lovely thing. It also used publicly available data from a previous study published in 2010 that looked for associations between mercury exposure in thimerosal-containing vaccines and autism by Price et al.
The previous study (Price et al) and this study (DeStefano et al) were both based on the same case control study. A case control study is a type of retrospective study in which subjects with a certain condition (cases) are matched as closely as possible with subjects without the condition under study (controls), and the two groups compared to look for factors that correlate with the condition in the cases. That’s how an earlier study from 2007 that failed to find a link between thimerosal-containing vaccines (Thompson et al) was performed, and that’s how Price et al and DeStefano et al were also performed. Being retrospective, such a study can never be quite as rigorous as a randomized controlled trial or a prospective cohort study. However, given that thimerosal has already been removed from all infant vaccines other than the flu vaccine (and there is a thimerosal-free alternative) and, more importantly, that it would be unethical to conduct a randomized double blind, placebo-controlled clinical trial, this sort of trial is the best evidence that we will be able to come up with.
I think it's worth briefly recapping the design of this study, so that you don't have to spend too much time clicking on previous links:
Basically, the two groups that ended up being studied consisted of 256 children with ASD and 752 matched controls. The authors justify the study thusly:
The initial concerns that vaccines may cause autism were related to the measles, mumps, and rubella vaccine and thimerosal-containing vaccines. In 2004, a comprehensive review by the Institute of Medicine concluded that the evidence favors rejection of possible causal associations between each of these vaccine types and autism. Nonetheless, concerns about a possible link between vaccines and autism persist, with the latest concern centering on the number of vaccines administered to infants and young children. A recent survey found that parents’ top vaccine-related concerns included administration of too many vaccines during the first 2 years of life, administration of too many vaccines in a single doctor visit, and a possible link between vaccines and learning disabilities, such as autism. All of the foregoing concerns were reported by 30%-36% of all survey respondents, and were reported by 55%-90% of parents who indicated that their children would receive some, but not all, of the vaccines on the recommended schedule. Another recent survey found that more than 10% of parents of young children refuse or delay vaccinations, with most believing that delaying vaccine doses is safer than providing them in accordance with the Centers for Disease Control and Prevention’s recommended vaccination schedule.
So basically this research was driven not so much by a scientific question as by a social imperative. Scientists have long known that there is no compelling rigorous evidence suggesting that vaccines cause autism or that "too many too soon" can result in or predispose to autism. Sadly, it can't be repeated too many times (as I'm repeating here) that antivaccinationists force scientists to keep reinventing the wheel in order to try to reassure the parents whose doubts are stoked by the misinformation and pseudoscience promoted by antivaccinationists.
Before I get to the results in detail (you already know the results in general), I'll also reiterate a point I made when discussing Price et al that this study had the strength that derives from the fact that the case and control populations were collected from three managed care organizations (MCOs) that participate in the Vaccine Safety Datalink, a collaborative effort between the CDC's Immunization Safety Office and nine MCOs that was established in 1990 to monitor immunization safety and address gaps in scientific knowledge about rare and serious events that can occur after immunization. The VSD uses a large linked database using administrative data sources at each MCO from which data are gathered on vaccination(vaccine type, date of vaccination, concurrent vaccinations), medical outcomes (outpatient visits, inpatient visits, urgent care visits), birth data, and census data. Consequently, because of the detailed records maintained by these MCOs, investigators using VSD data are able to develop a detailed and accurate estimate of vaccine exposure from the computerized databases maintained by the MCOs as well as the medical records of the cases, controls, all supplemented by standardized interviews with the parents. In addition, outcomes have been measured in clinical settings using standardized assessment tools. In Price et al, the most up-to-date standardized assessment tools used to diagnose ASDs were used to identify cases, and the same is true in DeStefano et al. In addition, in order to make sure that the controls did not include children with undiagnosed ASD, which would tend to decrease any apparent differences between the groups, controls the lifetime form of the Social Communication Questionnaire was administered as part of the interview with each mother for children who had indications of any neurodevelopmental difficulties. Several children were excluded from the control group in this manner. Finally, the detailed medical records and databases maintained by the MCOs allowed for the detailed determination of and control for many potential confounders.
Another major strength of DeStefano et al is how the investigators chose to compare vaccine exposures; basically, they estimated total antigen exposure rather than just counting the number of vaccines. They also looked at total antigen exposures from vaccines administered at single visits as well as the cumulative antigen exposure:
We evaluated antigen exposure for 3 age ranges according to 2 measures: cumulative exposure to antigens within the specified age range and the maximum number of antigens received in a single day within the specified age range. Data were collected on a large number of covariates, including child and family characteristics, maternal exposures during pregnancy, childbirth conditions, early childhood health conditions, and maternal healthcare-seeking behavior (ie, Kotelchuck prenatal care index, cholesterol, and Pap smear screenings).
For those who aren't familiar with immunology, an antigen is a substance that evokes the production of one or more antibodies. In the case of vaccines, an antigen could be a protein or polysaccharide. In the case of killed vaccines, in which extracts isolated from killed virus or bacteria are used to provoke the antibody response), there can be dozens, or hundreds, of antigens. An example is the whole cell pertussis vaccine, which is not used anymore. More modern vaccines tend not to be killed organism vaccines anymore, but rather vaccines made of recombinant proteins, protein fragments, or polysaccharides. Such vaccines contain many fewer antigens, but they are the specific antigens that produce an effective immune response against the organism. The vaccines examined in the study ranged from a single antigen antigen per dose (hepatitis B) to 3,004 antigens per dose (DTP-Hib).
Using a strategy similar to the earlier Price et al study, DeStefano et al examined antigen exposure and compared the number of vaccine antigens to which the controls and the cases were exposed to. What do you think they found? Yes, I know. I already told you what they found from the beginning: Nada, zip, nothing. No correlation between antigen exposure from vaccines and the risk of developing autism or autism spectrum disorder (ASD)—or even ASD with regression. The results are summarized in Table II from the paper, which shows that there is no correlation between cumulative vaccine antigen exposures and autism outcomes:
Nor was there a correlation between maximal antigen exposure at one session of being vaccinated and autism outcomes:
This is as negative a study as I have ever seen. There is not even a whiff of a hint of a whisper of an association between the number of antigens to which the cases and the controls were exposed and the subsequent risk of autism. Not only do the confidence intervals for the adjusted odds ratios all overlap 1.0, but they're very tight. It doesn't get more negative than this in an epidemiological study, leading the authors to conclude:
We found no evidence indicating an association between exposure to antibody-stimulating proteins and polysaccharides contained in vaccines during the first 2 years of life and the risk of acquiring ASD, AD, or ASD with regression. We also detected no associations when exposures were evaluated as cumulative exposure from birth to 3 months, from birth to 7 months, or from birth to 2 years, or as maximum exposure on a single day during those 3 time periods. These results indicate that parental concerns that their children are receiving too many vaccines in the first 2 years of life or too many vaccines at a single doctor visit are not supported in terms of an increased risk of autism.
They also note:
Considerations of biological mechanisms should be taken into account when evaluating a possible association between autism and immunologic stimulation from vaccines early in life. The infant’s immune system is capable of responding to a large number of immunologic stimuli. Beginning at birth, an infant is exposed to hundreds of viruses and other antigens, and it has been estimated that an infant theoretically could respond to thousands of vaccines at once.15 The possibility that immunologic stimulation from vaccines during the first 1-2 years of life could be related to the development of ASD is not well supported by the known neurobiology of ASD, which tends to be genetically determined with origins in prenatal development,19-22 although possible effects in early infancy cannot be ruled out completely. It can be argued that ASD with regression, in which children usually lose developmental skills during the second year of life, could be related to exposures in infancy, including vaccines; however, we found no association between exposure to antigens from vaccines during infancy and the development of ASD with regression.
In other words, from the standpoint of prior plausibility, there is no compelling reason to suspect that vaccines could cause autism because such a mechanism is not consistent with what we know about the neurobiology of autism. Consistent with this lack of plausibility, the authors failed to find any correlations between exposure to antigens from vaccines and the risk of autism. They sliced and diced the data in a variety of ways looking for correlations and didn't find any, and their data are in agreement with a study by Smith et al (discussed by my "good bud" Orac here) that failed to find a difference in non-autism neurodevelopmental outcomes between children who received all their recommended vaccines on time and those who were late, or, as I like to view it, “too many too soon” versus “too few too late.”
Yes, there were limitations to DeStefano et al in that it was retrospective. In addition, as the authors discussed, not all antigens are equal in evoking an immune response. Some have more epitopes (areas on the antigen molecule that can trigger an immune response) than others, and the study didn't weight the antigens for the intensity of the immune response that they evoke. Even so, the antigenic load has fallen dramatically, and this study is based on the vaccine schedule of the 1990s. Indeed, the authors note that the antigen load due to the vaccine schedule has fallen from several thousand in the late 1990s to an estimated 315 in 2012. This is a drop in the bucket compared to the number of antigens infants and children encounter every day, as Emily Willingham notes. Matt Carey and Christine Vara also agree.
The antivaccinationists attack
Not surprisingly, even though this study was released on Good Friday, with a holiday weekend fast approaching, antivaccinationists were sufficiently displeased that they managed to launch a series of broadsides against the study. It's instructive to look at the bad science and logical fallacies that populate such "criticisms." For instance, Dr. "Bob" Sears, who is, despite his efforts to appear otherwise, as antivaccine as they come, went to Facebook to rant against the study. His complaints reveal such ignorance about statistical methods and basic epidemiology that it's worth a quick look:
I pretty much only have one major criticism of this study. You would probably find the exact same results no matter what group of kids you studied. Pretty much all children in any given span of years receive the exact same number of shot antigens. (By the way, an antigen is simply a protein or sugar germ-related ingredient in a vaccine – some vaccines only have a few, some have many.) Virtually all kids WITH autism have had the same shots as kids WITHOUT autism. So, why would it even be useful to study this? You’ll get the same results every time, whether you study 1000 kids or 100,000 kids. They all get the same shots on the same schedule. They would have gotten the same results if they’d studies asthma, cancer, or any other chronic problem. All this study proved is that all the kids in that HMO got about the same vaccines over that 5 year time period. This doesn’t give us any useful data on how vaccines would have or would not have influenced the rate of autism.
Clearly, Dr. Bob doesn't understand the very concept of a case-control study. Rather amusingly, he says that "virtually all the kids with autism have had the same shots as kids without autism" without realizing that that very conclusion in a case control study would be pretty powerful evidence that vaccine exposure is not a risk factor for autism! In actuality, though, he's misstating the conclusion of DeStefano et al, anyway. The real conclusion was that the number of antigens from vaccines a child sees (which is a surrogate for vaccine load) has no correlation with that child's risk of autism, ASD, or ASD with regression.
But if you really want hilarity, take a look at what he proposes as an alternative:
Now, if I were to do a study (and have several million bucks to fund it), here’s how I would look at the question of whether or not an increased number of vaccines relates to an increased risk of autism: I would take a bunch of kids who had all the vaccines on the regular schedule and look at the rate of autism in that group. We know that it’s about 1 in 50 kids. Then I’d take a whole bunch of kids who were only partially vaccinated and look at the rate of autism. I would subdivide the partially vaccinated group into subgroups based on the total number of vaccines given during infancy. I would perhaps have a group that delayed vaccines. And hey, while we’re at it, let’s really go crazy and find a few totally unvaccinated kids just for fun. On the other hand, no. Let’s not. It would be totally unethical to subject a group of totally unvaccinated children to any type of medical research. Ok, back to my study. These data would then give us a true look at autism rates compared to number of vaccines given and the age at which they were given.
Now THAT would be an interesting study. Unfortunately, it’s just too logical. It’s much better to study things in a confusing and illogical manner so you can get some results that the press can really sink their teeth into.
As I said, Dr. Bob's ignorance is quite striking, because that's rather what was done in Price et al for autism and Thompson et al for other neurodevelopmental outcomes. One notes that Dr. Bob also doesn't tell us how he would compare these populations. What sort of study would he do? A case control? Oh, wait, he doesn't like case control studies, finding them "confusing and illogical." (No kidding. It's very clear that he's confused.) Maybe he would like a cohort study? Actually, that's what he seems to be suggesting. After all, case control studies starts with the outcome (presence or absence of disease or condition) and then work back to exposure, while cohort studies start with exposure and work towards outcomes. Each study type has its advantages and disadvantages, but I get no sense that Dr. Bob has any clue about when it is best to use one versus the other. One notes, for instance, that Sir Richard Doll used the case control study method to be among the earliest investigators to confirm a link between cigarette smoking and lung cancer, while A. B. Hill used a cohort design. Both produced the same results, just from a different approach. Basically, it's sour grapes. Dr. Bob just didn't like the outcome of of DeStefano et al. His criticism of the study demonstrates that he has no understanding of the issues behind case control studies, and his suggestion of an apparent cohort study doesn't address his rejection of DeStefano et al, specifically the question of why he thinks the results of DeStefano et al are so flawed that a huge new multimillion dollar cohort study is necessary to address the question of whether vaccines increase the risk of autism.
Instead, he retreats to conspiracy mongering and antivaccine fear mongering:
So, is anyone really surprised to see the Journal of Pediatrics study? What were you expecting? CDC researchers to publish as study that actually showed an increased risk of autism related to vaccines? The CDC would NEVER simply publish such a study. I doubt anyone would. Anyone at the CDC who published such a study would be fired faster than they could sell their Pharma stock.
Yawn. The pharma shill gambit. How original.
Of course, the antivaccine crank blog Age of Autism is very unhappy as well, but seems unable to muster any complaints much more coherent than those of Dan Olmsted, who basically mindlessly parrots Dr. Bob Sears' objections, and Anne Dachel, who could muster nothing more than a call for the usual "vaxed versus unvaxed" study and reinforcing my conclusion that antivaccinationists don't understand even the basics of clinical trial design, epidemiology, or ethics.
Perhaps the most amusing misunderstanding of basic epidemiology and the nature of a case control study comes from homeopath Heidi Stevenson of Gaia Health, who tries to argue...well, I'll let you see for yourself:
As initially pointed out, this study was done on the assumption that there is no connection between autism and vaccinations. Therefore, there was no reason to do such a study. Why would you do a study on whether there’s an association between autism and vaccinations before you believe that there’s been a study demonstrating such a connection? If this were legitimate science, then there’d be no reason to do it.
Uh, no. This study was done to see if there was a connection between vaccine and autism detectable as a difference in vaccine antigen exposure between cases and controls. Stevenson digs herself in even deeper in terms of showing how little she understands what a case control study is when she writes:
This study, even if well done, would be meaningless simply because it jumps the gun. It makes no sense to do a study on the relative degree of a potential toxin’s effect on autism when no study has yet been done to determine that there is one. Since no such study has been done that officially implicates vaccines as the cause of autism, as explained earlier, what’s the point in doing a study focused on the relative degree of harm? This is pure duplicity on the part of the CDC.
One notes that Sir Richard Doll's case control study was done before his and A.B. Hill's cohort study. Does Stevenson doubt that smoking is an enormous risk factor for lung cancer? No, case control and cohort studies are different methodologies that each have advantages and disadvantages compared to the other. However, if a case control study as well done as DeStefano et al is so completely negative, there is no scientific justification for proceeding to do a cohort study. Yet that's exactly what Dr. Sears and a homeopath are demanding because they think that a different study methodology will show them what this methodology didn't. No doubt if someone did a cohort study of the type they want and it was negative, they'd proceed to demand a case control study.
Stevenson also tries to nitpick aspects of the study. For instance, she complains that more controls were eliminated than cases. The reasons for this were explained in both Price et al (in more detail) and in DeStefano et al, namely that they were deemed ineligible because they didn't meet the protocol requirements. Indeed, in my previous post on Price et al, I reproduced the flowsheet that showed exactly how cases were ascertained and how subjects who fell under various exclusion criteria were eliminated. This study uses the same subjects; so the same flowsheet applies. One wonders whether Stevenson bothered to look up Price et al. Whether she did or not, Stevenson appears not to understand the concept of a case control study and how the cases and controls have to be matched as closely as possible for everything other than the condition that differentiates them.
Then, Stevenson lays down this doozy:
They looked at the number of antigens given to each child, both overall for their first two years and the number given on single days. This presumes that the number of antigens, rather than the number of vaccinations is the issue. It completely ignores adjuvants and other vaccine ingredients, including known toxins such as formaldehyde, mercury, and sorbitol 80, among others.
So which is it? "Too many too soon" or "the toxins"? I can't tell. I guess it's whatever argument happens to be convenient that day for the antivaccinationist making it.
The "evolution" of the antivaccinationist
Over the last decade or so, the reasons antivaccinationists advance for their fear and loathing of vaccines as an alleged cause of autism have "evolved" in response to what can be considered the "selective pressure" of scientific studies. It's not surprising that that evolution has involved a tendency to migrate to hypotheses (I'm being really generous using that word here, I admit) whose main trait is to become more difficult to falsify. For instance, back in the late 1990s and early 2000s, the two predominant ideas were that MMR causes autism (this idea was most common in the U.K., thanks to Andrew Wakefield) or that the mercury in the thimerosal preservative in childhood vaccines caused autism (the favored notion in the U.S.). These were straightforward "hypotheses" that could be falsified using epidemiological studies of relatively simple design. And they were falsified roundly.
Then came the "toxins" gambit, which postulated that vaccines were full of vile substances ranging from antifreeze to formaldehyde to aborted fetal tissue. This one was more difficult conceptually in that there are a number of chemicals in vaccines, but they are all present at doses that are harmless. However, saying that was a harder sell, and the idea behind the "toxins" gambit was to force scientists to have to test each chemical, each adjuvant, each ingredient individually, an difficult enough task given the number of chemicals, and then in various combinations, an impossible task. That the task was impossible was the very point, of course. No matter how many trials scientists did, antivaccinationists could always say, "What about this adjuvant or this combination of adjuvants?"
Which brings us to "too many too soon." It appeared to be a "hypothesis" that was impossible to falsify, but DeStefano et al came about as close as it's ethically possible to do to falsifying the hypothesis. No wonder that all that antivaccinationists are left with are calls for "vaxed versus unvaxed" studies and pharma shill ranting. As I'm so fond of saying, the vaccine-autism hypothesis is not "pinin' for the fjords." It is no more! It has ceased to be! It's expired and gone to meet its maker! It's a stiff! Bereft of life, it rests in peace! If antivaccinationists hadn't tried to nail it to the perch it'd be pushing up the daisies! Its metabolic processes are now 'istory! It's off the twig! It's kicked the bucket, it's shuffled off 'is mortal coil, run down the curtain and joined the bleedin' choir invisible!! It IS AN EX-HYPOTHESIS!!
There. I feel better now.
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I feel sorry for folk like Kirby and Olmsted. I mean, imagine spending the rest of your life as the author of a book claiming that thimerosal causes an epidemic of autism, when even your best buddies know that thimerosal was taken out more than a decade ago, and the numbers keep going up. Imagine that!
“Blog about this, you idiot!” I love it. I suppose nearly every reader visualized the giant finger as a a Terry Gilliam animation.
Did the voice also say, "And quit groveling!"?
And then, the rest of the post serves up the usual -- a highly nuanced, deeply sophisticated explication of the work in question, followed by a very satisfying heapin' helpin'.
You're on fire!
But not in Alabama! (I'm joking, of course. Someone teach that guy* about epidemiological surveillance.)
*Cub Scout Reporter
I'm seriously beginning to think that it's some sort of macabre fetishism, the beating of the dead horse that is the "Vaccines cause autism" claim.
I'm waiting for one, mature, intelligent person of education and integrity among them to say: 'For the sake of our children, we have to accept that we were wrong about vaccines and move on to get some answers.'
In the alternative, they might say: 'For the sake of our children, we have to accept that a great deal of the apparent increase in prevalence is an artefact of diagnosis and reporting.'
A person who denies both propositions is, at best, a crank, and, at worst, something more sinister.
"it has become irritating that antivaccine activists keep pressuring scientists to do the same study over and over again, coming up with the same results over and over again, and then seeing antivaccinationists fail to believe those same results over and over again."
It's like going to Vegas and repeatedly blowing your stake, but somehow expecting the odds will magically shift in your favor and win you the huge payday.
An antivaxer on another forum was whining that DeStefano represents "another study we didn't ask for" (only the Holy Grail of prospective vaxed vs. unvaxed will do, though the real message here is that evidence contradicting antivax claims is _really_ what they didn't ask for). Other gripes from this person (bogus methodological nit-picking, arguing that Toxin Exposure is what's important, pharma shill accusations) fell in with the consensus antivax reaction. Most amusing though was her contention that the antivax movement hasn't been arguing the "too many too soon" line and so the study is irrelevant.
Hello? This is a new tactic - throwing old debunked arguments down the memory hole and pretending they never existed.
If only they'd do that with thimerosal too.
I think Dr. Bob knows all about statistics, that's why he wants to do subgroup analysis. There's got to be a subgroup, maybe 2 year old males that got all their shots on one day in March that is 100% autistic and another that only got half their shots in March that is 100% NT. You can't argue with 100%!
Something I didn't see anyone else mention: Dr. Sears states, " It would be totally unethical to subject a group of totally unvaccinated children to any type of medical research."
Really? Why? Seriously?
It's getting to the point where, if I were the President, I'd just declare a ten-year moritorium on all marriages and vaccines. I'm getting really sick of the yammering. Sadly, I'm just not cruel enough for the latter.
But never forget that what is dead may arise again.
Like Spring itself bursting forth transsplendent from the icy grasp of dead Winter yearly;
Wasn't the Green Knight, once beheaded, but still un-hindered, able to return to fight another day?
Even Denis of Paris, also, carrying his own head in his hands, yet able to speak and thus proclaim his faith unto the heathen**
And Proserphina, able to return from Hades and walk the verdant earth again,
And Dionysus, dis-membered and re-assembled, twice born?**
Like the Phoenix, rising from its own ashes
Or a pulp fiction vampire arising from its concretised grave.
.
There is no death.. It has no sting. Because we are in the realm of religion, legend, faith, fantasy and primary process thought: you can't keep a good myth down.
** namesake.
I saw a mention of this paper a couple of days back and took a quick gander at it. One thing I happened to notice is that, right at the end of the paper, the authors acknowledge assistance from (drum roll here) Paul Offit, yes, the nemesis of anti-vaxers everywhere.
I figure the mere mention of him will send the anti-vax crowd into a screaming rage. Also, for them, this will completely invalidate the entire paper, actual content be damned.
Set aside the ethics of a prospective "vax vs. unvax" study. The practicality of it is sorely lacking. How many anti-vaxxers would be willing to take a 50% chance that their child will get the full vaccination sequence? Conversely, how many parents that accept that vaccines work and are safe would be willing to take a 50% chance that their child would not get any vaccines? You'd have an accrual rate that would make a Burzynski study look overpopulated.
Denice-- or even a bad myth!
Looks like Dr. Hooker has weighed in on the study, too.
Worst April Fools' post ever.
(I kid.)
@ Sigivald:
The Worst April's Fool's post is actually @ Thinking Moms' Revolution today, courtesy of the Professor.
@ Melissa G:
I thought I had to work in the spring/ vegetation myths because the woo-centic appear to worship the divine essence / phyto- healing substances that envigorate plants .
Free association of mythologic themes also illustrates the usual thinking process that we find @ AoA, TMR etc.
Plus, yesterday was Easter.
And "April is the cruellest month" is already taken.
Denice: you couldn't have somehow slipped "a myth is as good as a mile" in there somehow?
As someone trying to hold my nose enough to make it through Dr. Jay Gordon's new "Preventing Autism" book (sadly, parents will come in quoting his spew as fact), allow me to just say I am puking sick and tired of people confusing someone with an MD as necessarily being someone with even the most rudimentary grasp of the scientific method. Clearly Dr. Jay and Dr. Bob grasp the scientific method about as well as the Venus de Milo can grasp a hairbrush. All Dr. Jay and Dr. Bob are about are the anecdotal tale designed to help them hawk their snake oil. Or, to put it another way, if Drs. B/J are so hot for what they're selling, why don't they get off their duffs and write for a grant.? Heck, Dr. J is somehow on the faculty of a medical school, which is just stunning given his lack of appreciation for vaccines.
Just my 0.02 worth. Amen to this study. BTW, with fewer parents vaccinating, if it was the vaccines, shouldn't we have seen a decrease in autism?
Chris Hickie, MD, PhD
@ Shay:
Or hit, myth, false alarm, correct rejection?
Worse, actually. In Vegas the roulette wheel might actually hit your number next time. The antivaxers are repeatedly betting everything on the SAME spin of the wheel, with an already known outcome!
"Put all this on 20."
"15."
"OK, I want to bet on that last spin again. Put this on 20."
"But it was 15. You're guaranteed to lose."
"No, it must have come out 20."
"It was 15. Don't you see it?"
*various unintelligible gibberish ensues*
@Passing Thru #5:
They never will. Looking at them, their entire identity is tied up with the "vaccines cause autism" myth. For them to admit that they were wrong, and that some of them have subjected their autistic children to "treatments" that are child abuse, would be like having to cut off an arm or a leg. They won't do it.
Now, if I were to do a study [...], here’s how I would look at the question of whether or not an increased number of vaccines relates to an increased risk of autism:
Full marks to Sears for the use of the subjective mood; and for the admission that in *this* reality he has no intention of doing a study and dealing with evidence.
@Julian:
Not to mention if they were mature, intelligent people of education and integrity, they wouldn't be anti-vaxxers.
It is unfortunate that the author seems unable to read or comprehend the phrases "is still a possibility" or "cannot be ruled out.". Perhaps, indeed, the data itself is inadequate and there is no way, as the author states, to ethically obtain it. Parents, therefore, must be left to do what they do best; and that is to make decisions for their children based on their gut, and possibly advice from other parents.
John, the full quote is:
I notice that "is still a possibility" is not a direct quote from the paper, which leads me to believe that you actually have not read the study. Do you read many scientific papers, John? This is a common way for scientists to talk about their results. We are in the business of assigning likelihoods to various hypotheses. You'll rarely see authors making sweeping certainty claims about their results.
Unfortunately, John, this becomes a problem when a decision based on one parent's 'gut feeling' can cause direct harm to other children.
Indeed, and he overstates his position at Simpson, which lists him as an assistant, not associate, professor. (Nice typo on the CV, too, Hooker.)
I've seen this study reported on various news sites, and, predictably, the "too many too soon" gambit is not dead. They're just retreating under the conspiracy theorist umbrella. Big Pharma is behind the study, making it turn out the way it needs to, of course.
So far, they seem to have been fixating on "funded by a contract from the Centers for Disease Control and Prevention."
to make decisions for their children based on their gut
Indeed. Why would anyone make decisions based on facts or evidence when they could be consulting their intestines?
@ herr doktor bimler:
But aren't the intestines supposed to be the 2nd brain ( see Raphael Kellman, AJW et al)
Therefore SFB?
Well, with a retreat to "too many TOXINZZ too soon." I've seen quite a bit of the "nobody ever said antigens were a problem, and they don't affect neural development, anyway" (despite the fact that this is key to many of the autoimmune quasi hypotheses) routine floating around.
I think what Sears was getting at is that (because the group is small) if you placed all the unvaxxed kids (maybe 2 or 3) they would not have an over all impact on the antigen numbers. I don't know how many had the whole cell pertussis vs the current one but having one vaccine with so many more antigens than the entire schedule could be a problem.
And Mr. Schecter, you would know because of ....? Oh, wait you have no biology nor math education.
"Heck, Dr. J is somehow on the faculty of a medical school, which is just stunning given his lack of appreciation for vaccines."
You'd think it would be embarrassing for UCLA (heck, Johns Hopkins was embarrassed to even have Ben Carson as their commencement speaker, and he's eminently qualified in his field, never mind his goofball opinions on other subjects). Maybe it's so hard to get warm bodies in from the practicing physician community to teach students, that med schools have to hold their noses and tolerate some woo stench.
After all, Jay is (to quote him), "intensely interested" in breastfeeding, and there are not a lot of male pediatricians willing to serve as role models in that regard.
Darwy: I’m seriously beginning to think that it’s some sort of macabre fetishism, the beating of the dead horse that is the “Vaccines cause autism” claim.
I think it's simpler than that. They don't want to admit that they might carry genes for autism. Or they can't tolerate an imperfect child and try to blame the vaccines to keep from hating their child. Just my two cents.
"but having one vaccine with so many more antigens than the entire schedule could be a problem "
Of course, had you read the paper you would have seen that they address your question:
Because the antigen content of whole-cell pertussiscontaining vaccines is much greater than other vaccines, we performed further analyses according to the number of whole-cell pertussis vaccine doses received. These analyses adjusted for the same covariates included in the 25-
antigen increase models presented in Tables II and III. We found no statistically significant associations between number of whole-cell pertussis vaccine doses received between birth and age 2 years and any of the ASD outcomes
per http://healthimpactnews.com/2013/can-we-trust-the-cdc-claim-that-there-…
"No one is claiming that children with autism or ASD got higher doses of vaccine antigens, thimerosal, MMR or whatever. What we know instead is that when our children received the same vaccines within the ACIP recommended schedule, they reacted differently. "
Right. "Too many too soon" never happened? Generation Rescue (where he served as a science advisor) never said that if we went back to the 1980's schedule, the autism rate would drop? He's never used the phrase "ever expanding vaccine schedule"?
Clearly, the issue is neither the antigens nor the toxins; the issue is the number of needles being stuck into the kids. Thus, it should be possible to trigger vaccination with acupuncture. Of course, such a study would be entirely unethical and thus won't be done, but surely you can do a study based on the location of the vaccination... ;)
"Why would you do a study on whether there’s an association between autism and vaccinations before you believe that there’s been a study demonstrating such a connection?"
Does this make sense to anyone? Unless there's some subtle difference between association and connection, it seems to require infinite recursion: you can't do a study until you've already done the study.
@John:
Hey, I have an idea. Instead of asking a parent, who might have experience with just one or two children and is relying on (known to be fallible) memory for his or her "gut decision", why don't we ask the researchers, who have reviewed actual contemporaneous written records for hundreds or thousands of children what their decision is, based on their guts? You'll go for that, right? Right?
O/T...but is anyone having difficulty loading www.sciencebasedmedicine.org I've been offline for a few days and having been trying for several hours to use my "bookmarked" link and "google" search page, and I get a "trouble loading page" from Google.
All the anti-vaccine freaks are out on the science blogs and on the Ho-Po...including the latex adhesive salesman who blamed his son's autism on latex ports in vaccine vials..
http://scienceblogs.com/insolence/2011/05/10/anti-vaccine-contortions-t…
Yes, I have not been able to see SBM for quite a while.
Better to die from being dis-membered than to die from dis-ease...
This is really why pseudoscience and quackery are so hard to overcome; the big reason for their appeal is that their practitioners offer (a facade of) certainty. Conventional practitioners are forced, by both ethics and knowledge, to sometimes say "we don't know" or "there's nothing we can do." Alties never say such things.
Unfortunately, we have a cognitive bias that causes to give more weight to the statements of people who seem extremely certain that they're right, even though Dunning and Kruger showed that we should be doing the opposite.
Yes, I have not been able to pull it up today. I might have been on it for a little while in the morning, but couldn't get it later on.
Works for me, but it ate a comment of mine.
Yah, it's been down since around noon. It responds to pings, though. Maybe somebody forgot to pay the Rackspace bill.
@lilady
I just clicked on your link and got the weirdest Page under Construction--then I clicked my own feed link, same page. It comes up with a whole bunch of sCAM headers. I randomly clicked the acupuncture header and got a search result for acupuncture providers and clinics. Wonder if it's been hijacked??
W. Kevin Vicklund, when they talk about a vaxed/unvaxed study I think they're not talking about wanting a prospective study but a study more like this one where outcomes are looked at retrospectively.
I think the problem though is that there are so few unvaxed kids (less than 1% according to the CDC) that it would be hard to get a good sample. Even though there's a very vocal minority of people who don't like vaccines, they don't seem to have much effect on other people's behavior. Vaccine coverage is high and either stable or rising for the vaccines that young kids get.
Politicalguineapig, I may not be keeping up with the latest research, but I thought a lot of the genetic causes of autism were mutations or Copy Number Variations that are seen in the person with autism but aren't present in either parent (kind of like when a child is born with Down Syndrome. It's genetic but not something that the parent was a carrier of). Not sure about this though.
My daughter has a denovo CNV and about 30% of the kids with it end up with an ASD diagnosis (so in these kids it seems the CNV confers a genetic susceptibility to ASD). In 90% of the kids with this CNV it's new. Only 10% of the kids have a parent with the CNV. I don't know how many of the genetic causes of autism work in a similar way.
I was going to email Orac, so thanks to you all for trying to get on the SBM.org website.
I wonder if pD will pop in to tell us how wrong we all are. They've already spat their dummy out over at SBM.
The antivax mob will cling for dear life to their theories about the evil vaccines.
Rather than admit "My child has a disability" they'll continue to insist that their perfect child* was stolen away by the MMR/thimerosal/formaldehyde/polysorbate 80, and can be "recovered" if they force enough $CAM supplements into every orifice.
*It's their contention. that disabled and non-NT kids aren't perfect, not mine. Just everyday basic ableism at play, as seen in their "Better dead of VPDs than alive with autism" rhetoric.
I read Dan Olmsted's piece. He truly is clueless, isn't he? He claims that this study wouldn't pick out kids with Hannah Poling like reactions. This study wouldn't tell one the mechanism for a vaccine in increasing autism risk, but it would tell us if vaccines in general, including the supposed mitochondrial dysfunction mechanism, were significantly more increasing autism risk.
Olmsted even tries to claim that one in 50 kids have mitochondrial dysfunction (misinformation by misinterpretation by Kirby). And since 1 in 50 is the current autism prevalence, well, it's clear vaccines are the cause, right?
Does he believe his own bilge? It seems hard given how poorly put together he s arguments are.
The Vaccine Education Center at The Children's Hospital of Philadelphia has some easily downloadable sheets that discuss the research surrounding vaccine safety concerns including autism (http://bit.ly/VaccinesAndAutism) and too many vaccines (http://bit.ly/TooManyVaccines).
It makes no sense to do a study on the relative degree of a potential toxin’s effect on autism when no study has yet been done to determine that there is one.
So you can't try to find out how harmful something might be unless you already know it is.
Riiiight, that makes sense.
Is anyone else surprised that Orac would applaud this atrocious "study?" I know I'm not.
It's just a regurgitation of an older study with the data points shifted around to add legitimacy. Not to mention the selection bias, etc.
But, if it supports Orac's bias, then the study, no matter how poorly designed, no matter how weak the methodology, is scientific gold in his book.
Makes it seem as if all is right in the world, doesn't it?
The Drinking Moms have taken their April fools joke down, apparently it was freaking the choir
Another has a post praising doG and how He will make everything OK for their autistic children at His table
Funny how these types never put the finger doG for the autism when He slips in the soul
Guts = brains is something I heard a whiiile back, apparently the brain brain is still in beta
al kimeea, in the novel and film "High Fidelity", the narrator says "I've been thinking with my gut for 15 years, and it has $h1t for brains."
@John
I hope you never find yourself in front of a large fast moving grass fire. Your gut will tell you to run away from it when the correct action is to run towards it to minimize time in the flames.
@ al kimeea:
A few things-
Right, not everyone got the joke and reacted as if it had been real, etc. Perhaps reactions like this are measuring something, huh? Savvy?
But you see, g-d doesn't EVER harm innocent children or afflict them with illness. One of the moms ( BK) is ultra-Christian and proselytises. Can't blame g-d, he might get angry at you...
The GI tract as a 'second brain' shows up in woo and may be based on a partial reality- that there are connections between emotional states, etc and GI disturbances- well, OBVIOUSLY...
but some woos extrapolate far beyond data: e.g. Raphael Kellman of NY, who writes about it and treats it and of course, Wakefield got a lot of mileage out of his exaggerations which led to a surfeit of GI therapies for autism.
Right now, I'm hearing a lot about fermented foods for ASDs and just about every other condition on g-d's green earth.
TMR ( and AoA) have bought into many of the therapies from mild ones( like administering probiotics in pill form), to GFCF diets to the more dangerous "cures" like MMR enemas.
Today, TMR replays MacNeil's "Museum of Autism". It's interesting that she perseverates on Bettelheim's "murderous mothers" as Jake did ( when I conversed with him).. I said it then, I'll say it now, in the course of my graduate work in psych ( clinical and experiemental) there was only one mention of Bettelheim when a prof (psychopathology survey course) spoke about him = purely as a curiosity from eras past- there might have been a short article to read ( I forget) BUT there was hardly focus on it: Jake wrote about psycholoists being taught this as dogma or suchlike.
But what can you expect : his understanding of these things is rather abysmal.
If the antivax movement would like to use music from a decent rock group, it should dump the Refusers and pick the New York Dolls,.whose best known album is called "Too Much Too Soon".
It has a great version of "Stranded In The Jungle".
http://en.wikipedia.org/wiki/Too_Much_Too_Soon_%28album%29
@bassackwards insult #54:
Please explain why you consider this study "atrocious" and "poorly designed". Please point out the "selection bias" and the "weak...methodology".
That should be easy, right?
@TBruce
Wait, you're asking QAIO to actually explain and display understanding? But it used buzz words! How can you question buzz words?
Buzz words! Oh, well then...
One thing he does seem to have gotten right was the decor of the Orthogenic School (which is leaving its historical premises).
The worst April Fool's post has got to be this one from the Huffington Post about vaccines causing homosexuality:
ht_p://www.huffingtonpost.com/2013/04/01/vaccines-produce-homosexuality-gay-gi…
Problem is, the story is out of Italy (and the link is Italian), so there's a nagging suspicion this guy actually is flogging a vaccine-homosexuality connection.
Let's see, would it be the formaldehyde that has that effect, or the antifreeze?
@llortasi45retsop - Aww, does someone need a hug?
Are you going to deconstruct the study and explain the weaknesses, or just pout and stomp because the weak "theory" you've built your entire identity on has, yet again, been blown apart?
Problem is, the story is out of Italy (and the link is Italian), so there’s a nagging suspicion this guy actually is flogging a vaccine-homosexuality connection.
Let’s see, would it be the formaldehyde that has that effect, or the antifreeze?
According to Google Translate, it's because the "mercury or substances that are introduced vaccination in the brain" stifle the child's true personality. So some fake / changeling personality emerges instead, therefore homosexuality. Even when vaccinated children grow up hetero, the epigenetic DNA damage means that *their* children will be gay.
Other highlights from the Gian Paolo Vanoli interview:
There is no study linking AIDS and the "so-called" HIV, which I doubt exists.
For four years I've been drinking my own urine. Not the first day of the second. A glass every day.
-- When people recover from serious illness, it's not because of 'chemotherapy' or any other mainstream-medical lies, it's because the doctors steal the urine-drinking secret and convince the patients to try it. Secretly.
Hypnocontraception. Women cannot get pregnant if they having sex under hypnotism.
this one from the Huffington Post about vaccines causing homosexuality
Intriguingly, the HuffPost headlines attributes the claim to "Italian Scientist Gian Paolo Vanoli". The origin of the title "scientist" is hard to discern, as the subject of the original Italian interview only calls himself an 'investigative journalist'. Why would he call himself a scientist? He hates science and scientists. I can only suppose that the HuffPost writers feel the same way, and it was the worst insult they could think of.
Every other English-language website hosting the story repeats the HuffPost's attribution of "Gian Paolo Vanoli, Italian Scientist". Without exception. Apparently Google Translate and checking sources are too hard.
Let’s see, would it be the formaldehyde that has that effect, or the antifreeze?/i
Neither. It's the (Freddy) Mercury.
Let's hope I haven't italicized the Internets....
Shay, I'm having a Monty Python moment: I wish I'd said that!
Of course you're not; it doesn't tell you what you want to hear.
This is what we get when dunderheads try to sound scientifically-savvy. It's not a 'regurgitation', it uses the same case and controls but examines antigen exposure. As for selection bias, why don't you be a dear and tell us how the groups were subject to selection bias even though you appear to be a hit and run troll.
Why don't you be a dear again and tell us what Orac's bias is and the 'weak methodology'. It was a simple question, "Do children with ASD, including regressive autism have "too many too soon" compared to neurotypical children?" The answer is no difference. That's it.
Yes, anything that makes your lot wail and gnash their teeth is a win. You could always conduct a study of your own if you don't like this one.
I am astounded to see that "Dr. Bob" actually said something correct! The CDC would not, in fact, simply publish such a study: they'd run further studies to make sure; they'd follow up with the relevant authorities to try to minimize the harm; they'd do their best to take the action indicated by this finding. So would anyone else. I'm pleased that "Dr. Bob" recognizes this.
Oh, wait. He meant "The CDC would simply NEVER publish such a study." I should have realized this was a slur against the CDC and all other honorable researchers. My mistake.
"Dr. Bob" may know how to use the subjunctive, as herr doktor bimler pointed out in #22, but he's weak in other areas.
Any comments on Dr. Hooker's 'over-matching' complaint - link in Todd's comment at #14.
(Haven't yet read through all the comments yet, so excuse me if I've missed someone tackle this, but a search on 'Hooker' isn't turning up much ;-) )
@ Grant:
AoA has the intro and links to Health Impact News.
Denice - thanks, but what I really was looking for was an explanation for why Hooker thinks this supports his rejecting the paper. It's a confusing argument, that because case and control cohorts are closely matched, the study is flawed.
@ Grant:
I know.
My explanation is that his ulterior motives ( emotional investment in vaccines-autism hypothesis related to his being a parent of a teen with ASD) prevent him from understanding the implications of this research as well as its relationship to all of the others studies we've seen over the years. It is defensive thinking.
@Grant: he seems to be saying that if you take one autistic child and match him or her with three others who are closely matched in every way *including the vaccine schedule* then all you've shown is that you can find three such children who suffered no harm from the identical schedule. You won't find any difference in the probability of developing autism due to any schedule, because exactly one out of every four in each cohort in your study will have autism.
Of course, the paper doesn't indicate that the children *were* matched according to vaccine status, and in fact the graphs show that there were differences between the cases and the controls, though not large and apparently random. Since the control children were chosen randomly from a larger pool, this seems to suggest that cases and controls do in fact have similar vaccine schedules and this is not an artifact of selection.
Indeed, any epidemiologist worth their weight in salt knows that you never match on the variable you're analyzing. If they matched these kids on vaccine status, then they're no better than anti-vaccine MPH students. (See what I did there?)
In fact, their IRB would have laughed them out of the room if, in their proposal for the study (because there was one), they would have said that they were going to match the cases (autistic kids) and controls (neurotypical kids) on vaccine status as well. It's Epi 101.
It is my sincere opinion that Hooker, for all the fancy talk on his site and all that, is not an epidemiologist and, if he did take Epi 101, he has forgotten this very basic principle of study design and controlling for bias.
That's why the paper doesn't indicate it. It doesn't have to.
@ Grant and Ren, this: http://www.intechopen.com/books/recent-advances-in-autism-spectrum-diso…-
is the basis for Hooker's charge of "over-matching". You'll recognise the authors no doubt and I have a hard time believing that this made it into a book chapter.
Denice Walter, April 2, 2013 #58:
There is a partial reality involved. [Caution: anecdote ahead!] Some years ago, Wife was diagnosed with a carcinoid tumor in her small intestine, subsequently removed, successfully. To help her state of mind ("education is the best antidote for anxiety."), I read up on carcinoids, in the real medical literature. (I copied a review article from an oncology journal. Her hospitalist used it to learn what the surgeon was doing, and why he was doing it.)
Carcinoids are neuroendocrine tumors – they cause overproduction of hormones with neurological effects. Wife's tumor caused, as carcinoids often do, serotonin syndrome, the effect of too much serotonin at large in the system. Oops.
---------------------------------------------------------------------
Some months ago, I reported on our daughter-in-law with Gliobastoma Multiforme. DiL received initial treatment in Tacoma, WA (or somewhere in the Seattle area, anyway) and relocated back to the San Diego area for follow-up near the rest of her family.
She recently reported a comment by her oncologist: "Looks like you're going to be a long-term patient." Better a long-term patient than a deceased ex-patient.
The latest MRI reportedly shows significant reduction in tumor size: significant, of course, meaning much better than the measurement error, unlike Burzinski's style.
DiL is still hanging in there, on chemo with breaks and occasional radiation IIUC. (Reports are 3rd, or 4th hand: Doc, DiL, Granddaughter, and Wife are in the reporting chain.)
Bottom line: still iffy, but much better than it seemed last summer.
re: Hooker's "interpretation" - I guess you could say it was the dumbness of it that was confusing me :-) Matching for confounders is part of the whole point (of course) and you'd never "match" the variable you aim to test (also, of course).
It also occurs to me that he hasn't properly picked up that it's an aOR-based (adjusted odds ratio) study, not one using direct comparisons, but that's another can of worms.
I see Orac has tackled it - hope I find time to read it later.
Quite understandable. Hooker's "critique" was both hilarious and painful at the same time on so many levels:
http://scienceblogs.com/insolence/2013/04/03/brian-hooker-criticizes-a-…
I know this is really bad form and I apologise in advance. But the SBM blog is closed to comments on this topic and I responded to pD or would like to:
I disagree on the charge of "flaccid admission". It was a responsible and observant statement to make. I don't disagree at all that immunogenicity of the antigen exposure is far more important that simple antigen counting and clearly the authors know this. However, this was a study with a simple hypothesis that used existing cases and controls. Given these limitations, it is not unreasonable that the authors took this approach and did a good job of addressing limitations and controlling for confounding.
Again I disagree. You can't blame the study authors for how the study is being used. The hypothesis was, "Do children with an ASD receive a differential quantity and timeliness (more and sooner) of antigens (via vaccines) in comparison to neurotypical children". The answer is no within the confines of the parameter used. It was a well-done study for the hypothesis. A different study design could probe the question of immunogenicity.
I don't understand why pD persists in asking for "a literature based defense for the hypothesis that the number of antigens in a vaccine has a meaningful effect on immunological stimulation". There is no literature based defense because the "too many too soon" hypothesis of ASD causation is nonsense. He should ask the antivaccine activists who promote this hypothesis to provide some evidence, not SBM supporters.
@JD
It's because Sears misunderstands the ethical issues involved with doing a vaxed/unvaxed study: he misinterprets the unethical nature of not giving children vaccines just to study them (because we know they work), to mean that unvaccinated children should not be studied. He totally misses the point, and in doing so, further adds insult to injury to his own intelligence by suggesting that SBM denies studying those who don't 'fit' into 'the right category'. And it assumes that there'd be enough unvaxed kids to make up a decent enough sized group to study anyway.
@Shay
Brilliant!