Thanks for the measles yet again, Andy

There are many harms attributable to the antivaccine movement and its promotion of antivaccine beliefs. Certainly, the harm those of us who have been combatting antivaccine misinformation fear is the return of vaccine-preventable diseases, which is something we’ve seen in the form of outbreaks, such as the Disneyland measles outbreak two years ago and, in my own state, pertussis outbreaks. The Disneyland outbreak was a wake-up call to California legislators, who in its wake passed SB 277, a law that eliminated personal belief exemptions (PBEs) to school vaccine requirements. Now, only medical exemptions are permitted, and so far the law has worked well. In Michigan, we’re still struggling. The Michigan Department of Health and Human Services issued a new rule that requires parents seeking a PBE to attend an education and counseling session at a local county health office before the PBE is issued. Not surprisingly, local antivaxers are not happy and have managed, by painting this rule as a horrific affront to “freedom” and “parental rights,” to persuade legislators to try to pass a law that would not only revoke the rule and explicitly bar MDHHS from issuing similar rules in the future, but it would prevent local health officers from barring unvaccinated children from school during an outbreak. The law failed to pass the first time it was introduced, but Michigan legislators are nothing if not extremely persistent in pursuing harmful policies, and a new version of the same old bill is again under consideration. It matters not one whit to our stupid legislators that the rule change is starting to work to increase vaccine uptake. Unfortunately, we have a fair number of antivaccine and antivaccine-sympathetic legislators.

Although the antivaccine movement in the US has classically been associated with upper middle class and affluent white people, they are not the ones who are likely to suffer the most when herd immunity breaks down. I’ve written extensively here about how the newest (and perhaps most pernicious) antivaccine conspiracy theory, the so-called “CDC whistleblower” conspiracy theory promoted by Del Bigtree and Andrew Wakefield’s propaganda film disguised as a documentary VAXXED, explicitly targets the African-American community, complete with promotional visits featuring the Nation of Islam going to speak in Compton and being involved in protests outside the CDC. Wakefield, as you recall, is the British gastroenterologist who in 1998 published a case series in The Lancet linking MMR to autism. It has since been retracted and shown to have been fraudulent, and Wakefield has had his UK medical license stripped from him. Unfortunately, that only makes him more of a hero to the antivaccine movement, and he’s spent the last 19 years playing that role to the hilt.

The “CDC whistleblower” conspiracy theory is based on the story of CDC scientist William Thompson, who in 2013 apparently contacted biochemical engineer turned incompetent antivaccine epidemiologist Brian Thompson to vent about a study he co-authored in 2004 that examined whether there was a correlation between vaccination with MMR and subsequent risk of autism. Not surprisingly, the study failed to find a correlation. However, there was one subgroup, African-American boys, in which the unadjusted data showed a 3.4-fold increased risk of autism. (I’m simplifying for space considerations in providing background, obviously; if you want the gory details, read here and here for a contemporaneous account of the origin of a new conspiracy theory, as well as my review of the book Vaccine Whistleblower and Andrew Wakefield’s fraudumentary VAXXED.) Thompson had had disagreements with how the data were presented and how he thought the CDC has “suppressed” the unadjusted data. Unfortunately for him, Thompson didn’t realize that Hooker was recording their conversations, and Andrew Wakefield found out about it. Thus, he became the “CDC whistleblower” who seemingly validated what I like to call the central conspiracy theory of the antivaccine movement, specifically that the CDC “knows” that vaccines cause autism but covered it up. It didn’t matter one whit that the correlation was found only in a small subgroup (African-American boys), but it did matter because African-Americans already have reason to distrust the medical community based on history. The “CDC whistleblower” myth feeds into that sad history, which is why Wakefield loves to invoke the Tuskegee syphilis experiment.

This is also not the first time Andrew Wakefield has targeted people of color with his pseudoscience. By any objective measure, for the most part the CDC whistleblower conspiracy theory and VAXXED have not had much resonance in the African-American community other than in the Nation of Islam and among a handful of parents like Sheila Ealey who really believe vaccines caused their children’s autism. The first time around, unfortunately, Wakefield was much more successful. Now, nearly a decade after he first started targeting the community, they are continuing to suffer measles outbreaks. I will begin with the story as it stands now and then go back and look at how it got to this point. The story takes place among a seemingly unlikely group of people in an unexpected location. It’s also a story that I can’t believe I’ve never blogged about before, given how long it’s been going on.

Measles outbreaks among Somali immigrants in Minnesota

Before I first encountered this story several years ago, I had no idea that there was a large community of Somali immigrants in Hennepin County in Minnesota, but there is. In fact, it’s the largest community of Somali immigrants in the US that began forming over a quarter of a century ago and now numbers in the several tens of thousands. Right now, the community is the center of a new measles outbreak, which is just the latest. From the StarTribune a week ago:

As a registered nurse and a consultant to the Minnesota Department of Health, Asli Ashkir has spent nearly a decade talking with Somali parents about autism, vaccines and the importance of getting their children immunized.

Last week she redoubled her efforts. A measles outbreak in Hennepin County has sickened 12 children — all of them unvaccinated and all of them from Somali families, according to the department — throwing a spotlight on low immunization rates among Somali children.

Now state and county public health workers are doing their best to contact Somali parents and underscore the value of immunization. “I know when parents have facts, they do the best they can to make the right decision,” Ashkir said.

I note that the total number of children sickened had reached 32 by the weekend, and the toll is still growing.

The story shows why the Somali community in the Twin Cities area is so susceptible to measles outbreak. All you have to do is to look at this graph of MMR vaccine uptake by year:

MMR uptake among Somali immigrants in Minnesota: This is the effect of nearly a decade of antivaccine propaganda.

MMR uptake among Somali immigrants in Minnesota: This is the effect of nearly a decade of antivaccine propaganda.

The graph above shows what can only be described as a catastrophic plunge over the course of just one decade in MMR uptake among American-born children of Somali descent, from 92% to 42%. There is, for all intents and purposes, no herd immunity in this community. The interesting thing here, though, is that this plunge is very specific. It’s noted in the story that there is not a fear of vaccination in general among the Somali immigrant population. Rather, it’s fear of just one shot: the MMR. It is a fear that antivaxers stoked, beginning sometime around 2008, and they have unfortunately been wildly successful in inculcating fear of the MMR in Somalis in Minnesota. Indeed, a 2014 study examined attitudes towards the MMR vaccine in Somali and non-Somali children in Minnesota and found:

Somali parents were more likely than non-Somali parents to have refused the MMR vaccine for their child (odds ratio, 4.6; 95% confidence interval, 1.2–18.0). Most of them refused vaccines because they had heard of adverse effects associated with the vaccine or personally knew someone who suffered an adverse effect. Somali parents were significantly more likely to believe that autism is caused by vaccines (35% vs. 8% of non-Somali parents). Somalis were also more likely to be uncomfortable with administering multiple vaccines at one visit (odds ratio, 4.0; 95% confidence interval, 1.4–11.9) and more likely to believe that children receive too many vaccines.

It was a small survey, but it was the only one I found in the peer-reviewed medical literature thus far. Its results are not surprising, however, to anyone directly involved with the Somali community, particularly public health officials. There haven’t (yet) been studies published about this latest measles outbreak, but there was a study about the 2011 measles outbreak in Minnesota, which, to that point, was the largest such outbreak in 20 years, with 21 cases identified. Its conclusions were also unsurprising. The source was found to be a 30-month-old US-born child of Somali descent infected while visiting Kenya and then spread to the Somali and non-Somali population primarily through the unvaccinated:

Three case-patients had unknown vaccination status, 1 was vaccinated before the recommended age (11 months), and 1 was a health care worker who was thought to be immune (IgG-positive documented >10 years previously). Sixteen of 21 (76%) were unvaccinated; 7 of 16 (44%) were too young for routine vaccination. Nine (56%) children were age-eligible for routine vaccination but unvaccinated, 7 because of safety concerns owing to the misinformation that MMR vaccine causes autism; 6 of these children were of Somali descent. Two other children did not refuse but were behind on immunizations.

This is how the outbreak spread:

This outbreak began with an unvaccinated US-born child who was exposed to measles in an endemic region of Africa and developed disease on return to the United States. Low vaccination rates in the local Somali community, and subsequent exposures among susceptible homeless shelter residents, fueled ongoing transmission of measles. Delay of the source case-patient’s measles diagnosis also may have contributed to transmission before public health interventions. Although post-exposure prophylaxis, vaccination, and voluntary isolation and quarantine were implemented after the first known case, there was ongoing transmission in 1 of the 2 affected shelters. This transmission was attributable to several factors, including exposures that occurred before the first identified case, an exposure of an infant too young for MMR vaccine according to the routine schedule, as well as exposure of an infant who was too young for the early MMR vaccine outbreak recommendation. Other contributing factors were caused by the challenges of quickly assessing and documenting immune status in a large group of individuals living in a temporary, communal setting. These challenges allowed transmission to individuals who initially were assumed to be immune, but who lacked documentation. After ongoing transmission was seen, immune status testing was implemented for those who lacked documentation.

Notably, two-thirds of the cases in this outbreak were hospitalized, and many of these were hospitalized for respiratory complications in addition to dehydration, highlighting that measles is a severe infection even in well-resourced countries.

If measles is as harmless as antivaxers claim that it is, then why were two-thirds of the people stricken with measles in this outbreak hospitalized for complications? That’s a rhetorical question for antivaxers, obviously.

The first question that faces Minnesota public health officials is, of course: How did we get here? The second is: What can be done to combat MMR fear-mongering? I can’t help but note that the fear of the MMR that is so prevalent among Somali immigrants in Minnesota, while primarily about the MMR, is bleeding over to other vaccines. Some Somali immigrants are starting to show susceptibility to the “too many too soon” myth and, as a result, spacing out the remaining vaccines other than the MMR that they are willing to administer to their children, believing that early vaccination can “damage an infant’s language skills.” Basically, if you live in Minnesota, combatting antivaccine and anti-MMR views in the Somali immigrant community is imperative. Even if you don’t live there, given that the Twin Cities area is a hub of national and international transportation, measles could be as short as a quick plane flight to where you live.

So let’s look at how we got here. Andrew Wakefield has his fingerprints all over this, but it didn’t start with him. As is his usual MO, he opportunistically took advantage of a situation, as he did when he discovered that Brian Hooker had been recording telephone conversations with a disgruntled CDC scientist.

2008: Autism in the Somali immigrant community

The story of how the myth that MMR causes autism became so firmly entrenched among Somalis living in Minnesota began sometime around 2008, with a cluster of autism cases among the community and a news story, as described by Bahta et al. in Minnesota Medicine:

Parents in Minnesota’s Somali community have voiced concern that their children are disproportionately affected by autism spectrum disorder (ASD) compared with children of other ethnicities. Many in the community blame the MMR vaccine. In an August 2008 news story on WCCO-TV, one parent was quoted as saying, “It’s the vaccines.”

Shortly after the story aired, the Minnesota Department of Health reached out to members of the Somali community to gather more information. Health department staff attended meetings with Somali parents, many of whom were unfamiliar with ASD. Repeatedly, they stated that they don’t even have a word for autism in their language. In telling her story, one mother reported that in their attempt to understand ASD, she and others discovered groups that supported the claim that vaccines, particularly MMR, cause autism. Misinformation can spread rapidly in the Somali community, which has a rich oral tradition of passing information to one another. It is now widely accepted among Somali Minnesotans that MMR is to blame for autism.

The antivaccine movement was all over this story in 2008. For example, David Kirby, author of the book Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy, which was one of the early works using pseudoscience to link thimerosal in vaccines to autism was writing articles like ‘Autism May Be Caused By “Chemical Exposures”‘ specifically about the Somali community in Minnesota, with a “wink, wink, nudge, nudge” that the “idea that ‘chemical exposures’ (vaccine related or otherwise) might cause autism still brings virtual apoplexia to certain scientific circles.” He had previously hammered the same theme on the antivaccine blog Age of Autism, noting from the data presented that “rate of autism among Somali children in the public schools had been reported at 1 in 28 kids” and that the “80 or so Somali parents who attended were disappointed, by all accounts, that Dr. Punyko had no way to tell them if autism among their children was, as they strongly suspect, more common than among non-Somalis the same age.”

But was autism more than twice as common among the American-born children of Somali immigrants, as the data linked to above suggest? In early 2009, the Minnesota Department of Health released a study of autism among Somali immigrants. It is a substantial read. Here are a couple of key findings, which, as is often the case in studies of autism compared to parental perception of autism prevalence, are not as clear as the prevalent belief among the Somali community in Minnesota or as the antivaccine movement latched onto:

  • The administrative prevalence for three and four year old Somali children was significantly higher than for non-Somali children. This is consistent with the perceptions of the community that a larger number of Somali children were participating in ASD programs. Because of the study’s limitations, it is not proof that more Somali children have autism than other children; however, it does raise an important question about why Somali children are participating in this program more than other children.
  • The relative difference between Somali and non-Somali administrative prevalence decreased markedly over the three years covered by the study. It is unclear if this is an identification issue, a change in parental awareness for the need for developmental screening or some other issue.
  • Administrative prevalence rates for the Asian and Native American groups were found to be “strikingly low.” The reasons for these low rates are unknown, but they could be important to understanding whether the rate of ASD is higher among Somali children or underestimated among other children. In other words, the seemingly low prevalence rate among Asian and Native American children may artificially boost the comparative rate among Somali children, distorting a true understanding of all groups involved.

So, yes, administrative prevalence of autism was higher among Somali-Americans in Minnesota, but there were a lot of issues that made it difficult to use these data to determine for sure whether actual autism prevalence was higher, not the least of which was that as was noted in Left Brain, Right Brain, Department of Education data are not reliable for tracking autism. Jim Laidler made the same point in a publication in Pediatrics in 2005. Indeed, the most recent study of autism in the Somali-American community in Minneapolis was published in 2016 and found that Somali children were as likely to be identified with an autism spectrum disorder (ASD) as white children but that Somali children with ASD were significantly more likely to have an intellectual disability than children with ASD in all other racial and ethnic groups. Meanwhile, Steve Novella examined the cluster and proposed other potential causes for it, if even there was a cluster, such as vitamin D deficiency or a founder effect. Of course, as I pointed out above, it appears that children born to Somali immigrants are no more likely to be diagnosed with autism than white children; so there wasn’t even a cluster there. Unfortunately, it took eight years to figure that out.

By long before then, the damage had been done and the seed of distrust in the MMR and other vaccines had been planted by antivaxers. Over the next several years, as you will see, antivaxers nurtured that seed until it blossomed in the form of measles outbreaks.

Enter Andrew Wakefield

It’s not clear exactly when Andrew Wakefield first made contact with the Minnesota Somali community, but I do know that Age of Autism was on the case as early as August 2008 and that the founder of the antivaccine group Generation Rescue J.B. Handley published “An Open Letter to the Somali Parents of Minnesota” in which he told them it was the vaccines and that they can’t trust the local health authorities. He even went so far as to urge them to declare a “state of emergency within your community and create a new vaccine schedule for your kids.” Meanwhile, also as early as August 2008, David Kirby had been writing stories like ‘Is Autism an “American Disease?” Somali Immigrants Reportedly Have High Rates.’

I do know for sure from media accounts and triumphant blog posts in Age of Autism that he met multiple times with the community and its leaders between 2010 and 2011 and that he appears to be still intermittently in contact. For instance, here is one contemporaneous account in local media from 2010. It was a time when he proposed as “study” of autism in Somali immigrants and promised to raise funds for it, something he appears never to have done. At the same time he sold the study this way:

Minnesota Somalis worried about autism rates among their children recently invited controversial British researcher Andrew Wakefield to Minneapolis to talk to their community.

At a Somali community meeting in Minneapolis, Wakefield asked his audience to participate in a study. He told about a hundred people gathered at a Somali-owned restaurant that they could help find the cause of autism.

“It is solvable, it has a cause, it had a beginning and it must have an end,” Wakefield said. “We cannot accept the damage that is being done to all of these children. It is completely unacceptable and the suffering you’re going through.”

At the same talk, Wakefield claimed that there were no known cases of autism in Somalia, characterized in the story as an “anecdotal observation many Somalis confirm.” It staggers the mind that Wakefield would make such a claim (OK, actually, it doesn’t, given how big a liar Wakefield is), but it does not stagger the mind that Minnesota Somalis would find such a claim credible. Somalia is a poor country, and it does not stretch the imagination to speculate that most people living there are unfamiliar with autism. Nor does it bend credibility too much to observe that a Third World country is unlikely to have the same sort of screening and support programs for autism that we have in the US and other developed countries and that in such countries most cases of autism other than the most severe would go undiagnosed. Indeed, even the severe cases might well be diagnosed as mental retardation rather than autism.

Be that as it may, the cluster of autism in 2008 led to perceptions like this one:

She recalled a Somali mother who spoke at a public health meeting at the Brian Coyle Community Center some years ago. She had given birth to several healthy children in Africa, but her first child in the United States showed autism symptoms at an early age.

Wakefield visited Minneapolis again right in the middle of the 2011 measles outbreak to give a talk at a Somali restaurant. It was noted at the time that there were “a number of vocal pediatricians and doctors of Somali descent trying to speak out about this” but that distrust of health authorities was very high and local antivaccine groups like the Vaccine Safety Council of Minnesota were actively influencing Somalis. They still are. In 2016, for instance, the VSCM board member Patti Carroll published a warning to Somali parents that the Minnesota Department of Health “schools professionals to persuade Somali parents to give their children the MMR vaccine, despite clear opposition.”

Gee, you say that as though it were a bad thing.

That’s the problem, of course. Antivaxers are opportunistic in the extreme. If they see a population who are vulnerable to their disease-promoting message, they will pounce, and it’s always about the vaccines. They saw a story of a possible autism cluster among the children of Somali immigrants in Minnesota. Where scientists see such a story and ask “Is the cluster real and not spurious?” and “If it’s real, what might be causing it?” antivaxers see such a story and assume it absolutely, positively must be the vaccines. In this particular case, they took advantage of a newly arrived immigrant community’s lack of knowledge about autism and vaccines, its tradition in which information is primarily transmitted orally, and the distrust some of its members had for the local health authorities. The results are still playing out in catastrophically low MMR uptake and measles outbreaks.

Over the weekend, it got even worse, as a coalition of antivaccine groups gathered together to tell the Somali immigrant population that the “the epidemic is autism, not measles”:

As Minnesota confronts its second measles outbreak in seven years, public health officials are battling to contain the disease while also trying to educate parents in the face of an organized opposition.

As happened in 2011, anti-vaccine activists are reaching out to Minnesota’s Somali community, where both outbreaks have been centered, with messages that reinforce the discredited belief that vaccines cause autism.

On Sunday afternoon, a coalition of anti-vaccine organizations plans a meeting at the Brian Coyle Community Center on Minneapolis’ West Bank in an effort to bring their message to Somali families, saying “The epidemic is autism, not measles.”

Just what the Minnesota Somali immigrant community needs.

What can be done?

As every source I’ve read over the years about the Minnesota Somali community and vaccines has stated, suspicion and fear of the MMR vaccine are now very much entrenched and will be very difficult to reverse. Indeed, it’s been pointed out:

Minnesota Department of Health staff found that fear of autism was often the reason for parents’ refusal to have their children vaccinated. Highly educated Somali Minnesotans are not exempt from this fear. As one Somali educator admitted, “My children did not get the MMR; my evidence is the Somali children I see who have autism.”

Parents who cited fear of autism as the reason for their vaccine hesitancy told health department staff that they received their information mostly from other Somali Minnesotans. Being told that MMR does not cause autism was not satisfactory for many parents because no one could tell them what does cause autism. Yet, when asked whom they would trust for health information, nearly all said they trusted their health care provider. And a significant number who refused vaccinations said they would reconsider their decision if they were given more information.

Parents of children diagnosed with ASD were articulate about their belief in an association between MMR and autism and sometimes also implicated receipt of multiple vaccines as the cause of their child’s autism. Some Somali parents have come to realize that autism and vaccines are unrelated, but they are in the minority.

Vaccine hesitant Somali parents thus resemble our own native-grown antivaxers and vaccine hesitant parents in many ways. Many are highly intelligent and educated. They get their misinformation about vaccines and autism from their peers more than from medical authorities. Also, it is the parents who have children diagnosed with ASD who are the most passionate and persuasive in arguing that vaccines are linked with autism, and, because of the low rate of measles (thanks to the MMR) many Somali parents view autism as a greater threat to their children than the measles and base their decisions about vaccines on that misperception. One difference is that, unlike many of our native antivaxers, Somali immigrants generally hold the medical profession in high esteem and are thus more open to being influenced by physicians and other clinicians. Actually, I should be a bit more clear. American antivaxers generally distrust the medical profession, while American parents who are vaccine-hesitant tend to hold the medical profession in higher esteem.

Be that as it may the Minnesota Department of Health has been trying to meet the challenge of reaching Somali parents through outreach programs in the schools and day care centers aimed at increasing awareness of Somali children’s growing vulnerability to vaccine-preventable diseases. Bahta et al note:

Finding ways to leverage the respect Somalis have for doctors and other health care professionals is challenging. In studies examining how clinicians can provide effective care to Somali patients, building trust has been identified as important. Two things that contribute to trust that are repeatedly cited in the literature are the availability of a competent interpreter and not feeling rushed by the clinician. Clinic policies such as ensuring that a professional interpreter is available, adding time to appointments when interpreters are needed, and consistently scheduling families with the same clinician can support efforts to build trusting relationships with Somali patients.

At their heart, strategies like these are no different than techniques used with the vaccine-hesitant of any race or nationality, adapted to Somali parents by including an interpreter. There’s one area where the Minnesota Somali community might be a bit different, though:

They also want clear direction from their physicians. Providing parents with options may confuse them. A statement such as, “We can give your child the vaccine today, or if you want, we can wait,” may be perceived by the parent as meaning that the clinician also has reservations about vaccines or thinks that either choice is acceptable. One Somali interpreter described an interaction this way: “When the mother told the doctor that she did not want her child to get the triple-letter vaccine, the doctor said, ‘OK.’” The interpreter was worried that the parent thought the doctor agreed that the MMR vaccine wasn’t needed or that he, too, was worried about its effects.

This is different from American parents, who tend to resent being told too firmly what to do and want to make their own decisions. Again, what this shows is the importance of flexibility in dealing with vaccine hesitant parents and how strategies and messaging, although generally sharing the same broad themes, have to be adapted to the specific population being targeted. It’s also important to remember that Minnesota Somalis are not monolithic. Although anti-MMR views predominate and antivaccine views have become common, there have been (and still are) members of the community who are joining forces with Minnesota health officials to push back.

Unfortunately, progress is likely to be slow, as changing entrenched beliefs is difficult and requires a sustained, targeted effort. In the meantime, the children of the Minnesota Somali community will remain vulnerable to measles and potentially other vaccine-preventable diseases and are likely to serve as the nidus for further outbreaks until the MMR uptake rate can be raised back to what it was in 2004. Remember, it took the UK many years to lift its MMR uptake level back to somewhere near where it was before Wakefield, aided and abetted by the tabloid press, caused the MMR panic. There’s no reason to expect that a similar recovery will take any less time in Minnesota.

Sadly, measles is the gift that keeps on giving, and nobody is better than giving it than Andrew Wakefield and his acolytes. The Somali immigrant community in Minnesota is now finding that out.

Comments

  1. #1 herr doktor bimler
    May 5, 2017

    resurfaced at Journal of Translational Science

    J of Translational Science? From the bottom-feeding third-tier OMICS-wannabees at OAText?
    Jeffrey Beall’s assessment of their publication standards and peer-reviewing is archived here:
    https://web.archive.org/web/20161227042023/https://scholarlyoa.com/2015/10/08/publisher-acts-suspiciously-like-omics-group/
    — various commenters in the comment thread document the couple of ex-OMICS scammers who run it.

    If it’s from OAText, it’s not a journal, it’s a jizzmop.

  2. […] this week, I took note of an ongoing measles outbreak in Minnesota. This outbreak affects the large Somali immigrant community there, and the reason for the outbreak […]

  3. #4 Brian Deer
    May 5, 2017

    @ Julian, # 204

    The subtlety is that Walker-Smith was a clinician, so he could at least argue that clinical care was his primary motivation. In fact, it wasn’t. There are masses of documents, including his autobiography, and formal statements issued through the Lancet in response to my first reports, making is crystal clear that they were conducting clinical research.

    However, the way the GMC operates, the doctors were able to change their story after the GMC prepared its case, and now the clinicians argued that the research project was never carried out. Walker-Smith then proceeded to retrospectively diagnose clinical indications for colonoscopy, even for kids he’d never seen before they were scoped. That’s why the hearing went on for so long, when it was originally scheduled for 16 weeks.

    The GMC panel’s central failing (as the judge makes clear) was to fail to set out in their findings a clear train of reasoning by which they came to their conclusions. This doesn’t mean that they didn’t have reasoning, just that they failed to set it out, merely giving one-line decisions as the GMC had done for many years. There was a court of appeal ruling on precisely this point in between the time the GMC reached its conclusions and when it issued its strike-off sanctions.

    There were a few factual things that Mitting disagreed with, some of which could have been appealed. For example, he concluded that, since the panel said that “consecutive” had a certain meaning for the “ordinary reader”, he, the judge was an “ordinary reader” and he read it differently. The GMC could easily have appealed on the basis that it had plainly meant the ordinary reader of The Lancet: which would be a doctor or scientist, not the ordinary “man in the street” that Mitting meant.

    The panel could have reconvened after the judge’s ruling, supplied its reasoning in more lengthy statements, and struck Walker-Smith off again. However, he was 73 by this time, and there would be real issues concerning risk to his health by continuing to pursue him. The judge commended them for this decision.

    None of this is true for Wakefield – a laboratory researcher with no rights to clinical practice – whose own legal team recommended that he not be supported in an appeal. Since he wasn’t a clinician, he had no analogous defences to Walker-Smith, and there were four charges of dishonesty found proven against him, and none against Walker-Smith. There was also him buying blood from children at a birthday party, and ordering tests on children when he was not authorised or qualified to do so.

    The irony of Mitting’s judgment is that he fell into the same trap as the GMC. The material is so extensive and technical that he failed to set out the background to his own decisions, and rulings handed down from the court of appeal about the GMC’s approach to charges. By failing to cite any precedents whatsoever (which is very unusual in court judgments), he cut corners in such a way that non-lawyers would find it hard to understand quite what he was talking about: especially with regard to the reasoning issue. He would have done well to look at the work of more senior judges who have looked at such issues, and cited their precedents, so people could follow the thread.

    Nevertheless, I’m a professional journalist, and am professionally obliged to respect courts (which have always been very good to me, never criticising me or my work in any way whatsoever). In this case, my respect includes certain knowledge (including with an opinion from leading counsel) that the Mitting judgment has no application to Wakefield, who would never be allowed his license back, no matter what. His striking off is final, irrevocable, and his conduct at the time and subsequently means the chances of him ever being readmitted to the register is less than zero.

  4. #5 Chris Preston
    Australia
    May 5, 2017

    None of this is true for Wakefield

    As Justice Mitting made abundantly clear in the judgement he handed down.

    This is one of the most striking things about those who claim the challenge by Walker-Smith exonerated Wakefield. Mitting makes it quite clear that the judgement he makes about Walker-Smith does not extend to Andrew Wakefield. It is almost as if the Wakefield apologists have completely failed to read the judgement or are lying about it.

    One other point of notice is that comparing Walker-Smith’s responses to the GMC fitness to practice panel and the claims made in his appeal, it is clear that the truth changed between the two events. There is no doubt in my mind that Walker-Smith tossed Wakefield under the bus to protect himself. Given the known duplicitousness of Wakefield, it is difficult to know quite how far Walker-Smith was involved in the exercise and how much Wakefield was pulling the wool over his eyes, but I am unconvinced by Walker-Smith’s claims in his appeal.

  5. #6 Johnny
    127.0.0.1
    May 5, 2017

    It is almost as if the Wakefield apologists have completely failed to read the judgement or are lying about it.

    Can’t it be both?

  6. #7 Dingo199
    May 5, 2017

    @DangerousBacon #168

    Jake’s logic is similar to someone looking at a bank robbery case where one perpetrator is serving a 30-year sentence, and another had his conviction thrown out, arguing that the convict remaining in jail has been “exonerated”.

    Or, as I like to say:
    Charles Manson has been exonerated (because Squeaky Fromme got parole).

  7. #8 Dingo199
    May 5, 2017

    @Brian Deer #183

    Do you know, despite having probably been there, and having followed the thing so closely, I never spotted that instance with Child 12.

    I have pointed this out before.
    Walker Smith’s instruction that the child should not have a lumbar puncture (coupled with Wakefield’s deliberate countermanding of this) was a crucial point in Walker Smith’s favour when Justice Mitting was considering whether WS was acting in the childrens’ best clinical interests, and not “doing research”.
    Walker Smith was quite happy to rely on examples like this of his clinical concern, but the reality was that WS clearly knew that these kids were being investigated for research reasons.
    This one exceptional example provided “exoneration” for WS, while at the same time digging a deeper hole for Wakefield.

  8. #9 Lawrence
    May 5, 2017

    Going through the transcript of the proceedings, WS pretty much did everything he could to throw Wakefield under the bus during the trial.

    I really loved the part where WS’s attorney told the Judge that the Autism-MMR hypothesis was wrong & “settled science.”

  9. #10 Brian Deer
    May 5, 2017

    Walker-Smith also issued a statement regarding his appeal, on 12 February 2012, in which he said that the charges he’d faced “related to entirely different issues to those that concerned Dr Wakefield.”

  10. #11 Orac
    May 5, 2017

    It is almost as if the Wakefield apologists have completely failed to read the judgement or are lying about it.

    It’s the latter, and there’s no “almost” about it.

  11. #12 Joseph Hertzlinger
    Planet Earth (for now)
    May 7, 2017

    I was trying to figure how how Whole Foods had opened a supermarket in Somalia…

  12. […] Respectful Insolence: Thanks for the measles yet again, Andy […]

  13. #14 Jake Crosby
    www.autisminvestigated.com
    May 7, 2017

    “and there were four charges of dishonesty found proven against him, and none against Walker-Smith. There was also him buying blood from children at a birthday party, and ordering tests on children when he was not authorised or qualified to do so.”

    -All overturned, by extension of the W-S appeal.

  14. #15 Chris
    May 8, 2017

    Young Master Crosby: “All overturned, by extension of the W-S appeal.”

    Not for Andy! The order only applies to Walker-Smith.

  15. #16 Opus
    Q!?
    May 8, 2017

    Jake said “-All overturned, by extension of the W-S appeal.”

    Jake, I think you made a mathematical error. In order to apply the result of one appeal to another, in the judicial system, you must apply the legal constant: 0

    In this case, the result of the W-S appeal (R1) is multiplied by LC and the product of THAT calculation is used to determine the impact on other cases.

    R1 x LC = 0.

    After checking the above formula several times, I see that the W-S appeal has zero impact on clearing Andy’s name.

    I realize that your training is in the epidemiological field, and not the legal field, so it’s no surprise that you were not aware of this quirk in legal quantification.

    Hope this helps!

  16. #17 Johnny
    127.0.0.1
    May 8, 2017

    I realize that your training is in the epidemiological field, and not the legal field…

    After Jake gets his PhD there at UT, maybe mommy and daddy will buy him a legal degree. After all, we know he isn’t going to work anywhere ever.

    And just think – Doctor Jacob L. Crosby, Esq. Who better to take down Deep State Big Pharma.

  17. #18 Narad
    May 8, 2017

    All overturned, by extension of the W-S appeal.

    I hope you didn’t actually get charged by Patti “Can’t Win” Finn for that pearl of wisdon.

  18. #19 Narad
    May 8, 2017

    ^ Meh, blockquote fail again.

  19. #20 Johnny
    127.0.0.1
    May 8, 2017

    Woah… check out Jake’s fanboi Hans Litten on Jake’s latest post. I can’t decide if Jake is leading or following Hans around the U-bend.

  20. #21 herr doktor bimler
    May 8, 2017

    -All overturned, by extension of the W-S appeal.

    I wonder if this will also work on my library fines.

  21. #22 Julian Frost
    Gauteng North
    May 8, 2017

    Jake, let me spell this out for you.
    1) John Walker-Smith appealed his conviction and striking off, and only his. He did not appeal the findings against or sentences of Andrew Wakefield or Simon Murch. The appeal thus only ruled on Walker-Smith’s conviction and striking off, not on Wakefield’s conviction or striking off.
    2) John Walker-Smith threw Wakefield under a bus, claiming that he (Wakefield) had deceived him (Walker-Smith) about the nature of what they were doing. This makes things worse (not better) for Wakefield.
    3) Walker-Smith’s own lawyer in the appeal labelled the MMR causes autism hypothesis as discredited.

  22. #23 Lawrence
    May 8, 2017

    It would probably be good to put together a list of all of the times that during W-S’s appeal, his testimony or provided evidence directly contradicted Wakefield’s.

    Better yet, also include the times in which W-S through Wakefield under the bus, directly, as well.

  23. #24 WolfgangM
    Vienna
    May 8, 2017

    To all anti-vaxxer:

    From the “Illustrated Textbook of Paediatrics” Tom Lissauer, Graham Clayden (2nd ed) 2002, Mosby (an affiliate of Elesevier Sciene limited) Chapter 6 page 76 Child abuse… Types of child abuse
    Physical abuse…..
    Neglect : Cross neglect of a child`s developmental needs may present clinically as
    1) failure to thrive
    2) inadequat hygiene,….
    3) poor development of emotional attachment to the child`s care-giver
    4) delay in development and speech and language
    5) POOR ATTENDANCE FOR IMMUNISATIONS AND SCHOOL …….

    so children not properly immunised are neglected children, a form of child abuse.

  24. #25 madder
    May 8, 2017

    Poor Gnat. His train of thought runs orthogonally to the tracks of reality.

  25. #26 dingo199
    May 8, 2017

    All overturned, by extension of the W-S appeal.

    Jake, how do you think WS’s “exoneration” excuses Wakefield of the unconnected dishonesty charges, which were all proven? Some of these related to disappearance of research funding (IIRC), and one related to the birthday party.

    To refresh your memory, Wakefield got his wife to issue invitations to thier son’s friends – over the phone she said that Andy would like to take blood samples from them for a study he was carrying out. This was grossly unethjical, both in the way it was “consented”, and in the way in which it was conducted.

    Are you now saying that WS came along to the birthday party and was complicit in Wakefield’s little vampire fest?
    You must be, since I don’t know how else you think WS’s “exoneration” makes Wakefield’s actions honest and ethical.

  26. […] 92% to 42% in over a decade, the Somalis in Minnesota endured a measles outbreak in 2011 and are now at the center of the biggest measles outbreak Minnesota has seen in decades. It’s all thanks to American antivaxers who targeted this population when there was a cluster […]

  27. #28 christine kincaid
    United States
    May 14, 2017

    Regarding 3rd paragraph & “Whistleblower”:

    The ” small subgroup (African-American boys)” with the “3.4-fold increased risk of autism”?

    That’s your affected Somali group; the children over-represented in the SPED programs & more profoundly affected than their white ASD peers.They are not “only a small sub-group”; they are somebody’s child.

    You are aware;that the scientific community had been suspecting & researching a genetic suseptibility to toxicity from the MMR in the Somali immigrants since 1997, correct?

    Which pre-dates Wakefield.

    And I assume you are aware that in 2001 they found that they had misidentified a certain allele that is linked with toxicity exacerbation from the MMR?

    From the PubMed abstract:

    “We report the existence of class I HLA allele A*0103 in an ethnic group (Somali) where this allele has not been reported. This allele was discovered in a study to examine the relationship between HLA alleles and humoral antibody response to measles vaccine among recent immigrants from Somalia to Olmsted County, Minnesota.”

    Could this potentially explain why 66% of these cases have resulted in hospital admissions when historically it’s 10% & under?

    Was this the issue that was confounding Thompson’s work in the first place?

  28. #29 herr doktor bimler
    May 14, 2017

    And I assume you are aware that in 2001 they found that they had misidentified a certain allele that is linked with toxicity exacerbation from the MMR?

    From the PubMed abstract:

    There is nothing in that paper about “linkage with toxicity exacerbation from the MMR”. Nothing about “a genetic suseptibility to toxicity from the MMR”.

  29. #30 Dangerous Bacon
    May 14, 2017

    I don’t have access to the full paper, but there’s this from the abstract:

    “Our data are significant because it demonstrates that many of the previously typed A*0101 individuals are actually A*0103 as the SSP or sequence-specific oligonucleotide probes method cannot distinguish between the two alleles.”

    One supposes that if there actually was a link with “toxicity exacerbation” from the MMR, _that_ would have been cited as significant.

    Oh, and the hospitalization rate during the recent California measles outbreak was 20%. Are we to believe that a mystery allele was operating there too?

  30. #31 Brian Deer
    May 14, 2017

    But according to Google, if you put “measles”, “vaccine” and “Somali” in the search box, and spend long enough looking, there’s definitely a connection.

  31. #32 Chris
    May 14, 2017

    Ms. Kincaid: “The ” small subgroup (African-American boys)” with the “3.4-fold increased risk of autism”?”

    No. That “data” was on children who were vaccinated much later than the schedule, like closer to three years old. This is because they were low income, and had not been vaccinated. But it turned out they were diagnosed with autism, and then needed to be vaccinated to access the public school special ed. program.

    Plus out of the who study population in Georgia, that was less than ten kids. The only thing that “whistleblower” paper proved is to provide the MMR vaccine when it is recommended, at about fifteen month.

    “You are aware;that the scientific community had been suspecting & researching a genetic suseptibility to toxicity from the MMR in the Somali immigrants since 1997, correct?”

    Really? Where is that citation?

    And while you are at it, please find the verifiable documentation dated before that autism increased in the USA during the 1970s and 1980s coincident to the use of the MMR vaccine since 1971.

  32. #33 Narad
    May 14, 2017

    Was this the issue that was confounding Thompson’s work in the first place?

    In addition to the foregoing, given the likely Somali contribution to the 1996 MADDSP catchment, no.

  33. #34 Narad
    May 14, 2017

    There is nothing in that paper about “linkage with toxicity exacerbation from the MMR”.

    I presume this paper is being used as a hook to references 4–7.

  34. #35 Narad
    May 14, 2017

    ^ blockquote fail

  35. #36 Ren
    Over Minneapolis, Interestingly Enough
    May 14, 2017

    “The ” small subgroup (African-American boys)” with the “3.4-fold increased risk of autism”?

    That’s your affected Somali group; the children over-represented in the SPED programs & more profoundly affected than their white ASD peers.They are not “only a small sub-group”; they are somebody’s child.”

    No, the study in question used birth records from children in the state of Georgia. Black people are not all a genetic, ethnic, cultural, or social monolith. There is a lot of variation within people of African descent as there is for people of European, Asian, and South American descent. In other words, not all Black people are alike.

    Make inferences about Somali-American children based on Black children in the American South at your own peril.

  36. #37 christine kincaid
    United States
    May 14, 2017

    Chris (#32),
    Thank you for the clarifying information regarding the Thompson data.

    I will admit that I have not invested much time into becoming familiar with the methods used by Thompson’s group for that study, as I find the “conspiracy theory” link distracting. Which is why I ended my post with a question vs a statement; it wasn’t a rhetorical question, it was a literal question.

    I don’t read Wakefield either, again; too distracting.

    I neglected to include the actual link because I had noted other posters who indicated that citations were leading to prolonged “awaiting moderation” status & as a first time poster I didn’t want to complicate the matter.

    https://www.ncbi.nlm.nih.gov/pubmed/11182232

    Is mult-linking done here? I don’t believe I’ve seen more than one link per post so I will wait to link the 1997 study.

  37. #38 christine kincaid
    May 14, 2017

    Mr. Deer (#31),

    Oh … I used PubMed basic search with keywords ” allele-antibody-Somali”.

    Which resulted in a whole 4 studies; with the 2001 study being #4.

    So it didn’t take very long at all. I don’t type “vaccine” into Google searches, as a rule; unless I include it with more specific keywords & type “pdf” at the end. Otherwise I find it counter-productive.

    Or, are you being sarcastic? I’m not very good at identifying sarcasm & less so online than face-to-face. And I’m terrible at it face-to-face

  38. #39 herr doktor bimler
    May 14, 2017

    You are aware;that the scientific community had been suspecting & researching a genetic suseptibility to toxicity from the MMR in the Somali immigrants since 1997, correct?

    Evidence for this, please. There is no indication of such a suspicion or such research in Poland &c (2001).

  39. #40 Narad
    May 14, 2017

    Is mult-linking done here?

    No more than two links per comment to avoid automatically entering the moderation queue.

  40. #41 Narad
    May 14, 2017

    ^ Oh, and you could just skip the links and provide the PMIDs. Or actually construct an argument, rather than alluding to one.

  41. #42 Chris
    May 14, 2017

    That paper is essentially a correction of a previous study about certain genetic sequences and measles immunity. Then I poked about on papers that include the lead author’s name:
    http://www.mayo.edu/research/faculty/poland-gregory-a-m-d/bio-00078220

    He studies immune responses, so the papers were on the variation of immune responses and genetics, with a goal of improving vaccines. This is an issue because some people lose their immunity even after being vaccinated, and even getting the disease. For instance I got mumps twice as a child, others who frequent this blog have also had issues with maintaining immunity.

    His research has absolutely nothing to do with autism.

    Though there is a large research project that is trying to recruit 50,000 families. There was a very good Story Collider by its scientific director:
    https://www.storycollider.org/stories/2017/5/11/maternal-instinct-pamela-feliciano-katharine-gammon

  42. #43 christine kincaid
    May 14, 2017

    Ren (#36)
    Thank you also, for the information regarding the subjects involved in that study.

    Regarding: “Black people are not all a genetic, ethnic, cultural, or social monolith.” Agreed, you are correct.

    However, given that finding a certain agent to be oncogenic in a hamster indicates the need to determine if that agent is oncogenic in humans:

    Questioning the possibility of a pharmacogenetic similarity between two groups that share the same continent of origin can’t possibly be an irrelevant question.

    Opinions will vary, I suppose.

    I do find it somewhat validating to find a more recent study from 2006, titled ” 13th International Histocompatibility Workshop Anthropology/Human Genetic Diversity Joint Report” … has identified that same allele ( HLA-A*0101/A*0103) to be occuing with a high frequency in two homogeneous populations of Kenya (Luo and Nandi).

    And, the same study, interestingly, asserts those two Kenyan populations to be “close to African-Americans at HLA-A and C”.

  43. #44 Narad
    May 14, 2017

    His research has absolutely nothing to do with autism.

    Tish, tosh.

  44. #45 Dangerous Bacon
    May 14, 2017

    There’s a new entry in the antivax literature due to come out in July. It’s Dara Berger’s book “How To Prevent Autism – Advice From Medical Professionals”.

    At least, I’m making the logical assumption it’ll be drenched in antivax hoo-hah, given Berger’s history (including a recent lengthy AoA rant on Pro-Vaxxer Bullies) and seeing that two of those “medical professionals” are non-MDs James Lyons-Weiler and Stephanie Seneff. And it has the enthusiastic endorsement of one of today’s top medical experts on autism:

    “Through an intimate reveal of details about her own health and her family’s health tragedies and triumphs, Berger teaches the reader to build their own guidelines about how to proceed through pregnancy and through your child’s formative years with knowledge-based caution. This mama bear breaks down the medical jargon and teaches things that the average parent has never been taught. How to Prevent Autism is a must-read for anyone concerned about the neurodevelopmental health of their next generation.”

    – Jenny McCarthy

    https://www.amazon.com/How-Prevent-Autism-Medical-Professionals/dp/1510714669/ref=sr_1_3?ie=UTF8&qid=1494798981&sr=8-3

    I can hardly wait to get my hands on a copy.

  45. #46 herr doktor bimler
    May 14, 2017

    Tish, tosh.
    From a cursory glance at some of those links, it looks as if professional troll Lawrence Solomon is the source of the idea that “all black people look the same, therefore Thompson = Somalia”, and found a few comments from Dr Poland that could be changed in meaning by surgcal extraction from their context. Then AoA contributors decided to be pukefunnels.

  46. #47 Chris
    May 14, 2017

    Narad, consider the source. That one is bonkers.

  47. #48 Narad
    May 14, 2017

    Then AoA contributors decided to be pukefunnels.

    The power of Angell compels you!

  48. #49 christine kincaid
    May 15, 2017

    This is a link to a 2009 study on the “mystery allele”, as named by “DB”.

    I notice that HLA-A*0101(0103?) is not linked with Measles in this study but instead with Hepatitis B & Rubella.

    http://vaccinesafetycommission.org/pdfs/30-2010-toxicology-interindividual.pdf

    Also, to DB; While I don’t remember seeing a rate of 20%, I ended up not including Disneyland as an example because I was finding so many inconsistent rates, depending on where they were stated.

    Even so, 66% is still unusual & concerning.

  49. #50 Chris
    May 15, 2017

    That is because genetics is complicated. And those studies are not on autism.

    By the way, due to studies like SPARKforAutism.org have discovered about half of the genetic sequences that cause autism spectrum disorders. They are talked about a half hour into this video:

  50. […] how antivaxers preyed on the Somali immigrant community in Minnesota. It’s a story I’ve discussed several times now, even as recently as just last week. In brief, thirteen years ago ,the Somalis in […]

  51. #52 christine kincaid
    colorado
    May 19, 2017

    @ Narad (#44)

    What is “tish tosh” & why does it link to AoA? I didn’t find any of the allele studies on or from AoA.

    Wouldn’t a scientific consensus that found in favor of: “Genetic factor + Vaccine = Encephalopathy” invalidate the otherwise valid diagnosis of Encephalopathy as a “Table Injury”? Why would AoA want THAT?

    @Chris (#50)

    Yes, it’s complicated. Thank you for the video; I’m watching it in “pieces”.

  52. #53 Narad
    May 19, 2017

    @ Narad (#44)

    What is “tish tosh” & why does it link to AoA?

    Protip: Figure out to whom I was replying and try to sort out why before going leaping and bounding across the lea.