Dr. Robert Sears (a.k.a. "Dr. Bob), author of The Vaccine Book: Making the Right Decision for Your Child, is definitely antivaccine. His mouth may say, "No, I'm not antivaccine," but his actions say, "Yes, yes, yes!"
There, I finally said it. I've been flirting with saying it that bluntly for some time now, but have been tending to avoid it. I really didn't want to conclude this about "Dr. Bob," but, sadly, he's left me no choice. What else can I conclude from his actions over the last three months, when he's clearly solidly allied himself with the worst elements of the anti-vaccine movement? First, back in June Dr. Bob wrote a truly nonsensical post for the anti-vaccine propaganda blog Age of Autism entitled If A Vaccine/Autism Link is Proven, Will Vaccine Policy Change?, which I duly eviscerated. In it, he fantasized that one day a definite link between vaccines and autism will be found and speculated that it wouldn't make any difference in government policy and advocacy of vaccines. In Dr. Bob's view, so entrenched in its ways are scientists and the government that they would conclude that autism is an acceptable risk. Most ridiculously, he betrayed an either ignorant or willful misunderstanding of science by complaining that the burden of proof should be on scientists to demonstrate that vaccines do not cause autism, apparently unaware that science can never absolutely prove a negative, only demonstrate an extremely low likelihood that there is a link, which is what it has already done. At the time, I noted that, while Dr. Bob craves above all else the adulation of his readers, a close second is his craving for his "alternate vaccine schedule" (nicely deconstructed by John Snyder) to be taken seriously by physicians and scientists. That's why I pointed out that one way to virtually guarantee that you will not be taken seriously is to start writing posts for the crank blog Age of Autism.
The second thing you don't want to do if you want to be taken seriously by the medical and scientific community is to agree to be a speaker at a conference of anti-vaccinationists sponsored by that "venerable" anti-vaccine organization the National Vaccine Information Center. Trust me on this one. Getting on stage with "luminaries" of the anti-vaccine movement like Andrew Wakefield, Barbara Loe Fisher, Kim Stagliano, and, to top it all off, that woo-meister supreme, Gary Null sure won't do accomplish that, but Dr. Bob seems to think that it will, given that he's going to be speaking at a conference with the aforementioned anti-vaccine activists, the ever-nutty David Ayoub, plus chiropractors who seem to labor under the delusion that there is any role for chiropractic in treating autism and homeopaths who are, like all homeopaths, just deluded about their preferred remedy.
But there's one thing that, above all else, you, really, really, really don't want to do if you want to be taken seriously by the scientific and medical community. Can you guess what it is? Sure, I knew you could. If you want to be taken seriously by the medical and scientific community, you do not--under any circumstances--start blogging your "skepticism" about the current vaccine schedule on that repository of quackery and anti-vaccine propaganda, The Huffington Post.
Which is exactly what Dr. Bob did yesterday, excreting a turd of logical fallacies and pseudoscience entitled Vaccines And Autism: What Can Parents Do During This Controversy? The stupid in there is so concentrated, under such high pressure, that it's going to turn into diamonds of ignorance, which is undoubtedly why Age of Autism is promoting it.
Dr. Sears sets the stage:
The debate over vaccine safety rages on, with no clear end in sight. On the one side is a medical establishment made up of hundreds of thousands of doctors, researchers, infectious disease specialists, vaccine manufacturers, the FDA, the Centers for Disease Control and Prevention, and our government, who all insist that vaccines are safe and everyone should comply with the standard recommended vaccine schedule. On the other side is a growing number of parents, and a small but growing number of physicians, who are questioning vaccine safety. Caught in the middle are the 5 million couples who have a baby every year and are faced with the decision of whether or not to vaccinate.
Uh, not exactly, Dr. Bob. While you're correct that we have hundreds of thousands of doctors, researchers, infectious disease specialists, the FDA, the CDC, and our government assuring us that vaccines are safe, there is also something that Dr. Bob doesn't mention right off the bat that he should have mentioned: The science. That's right; even though Dr. Bob seems to be "framing" the "other side's" argument as an argument from authority, in reality it is the science that drives the defense of vaccines as safe. What we really have is mounds upon mounds of science on the side of vaccines versus a small number of cranks, anti-vaccine advocates, pseudoscientists, quacks, and cranks (some of whom straddle more than one of these categories), who are ideologically opposed to vaccination; blinded by pseudoscience; or making money off of "biomedical treatments" for autism that claim "vaccine injury" as the basis for autism. (Again, many of these straddle more than one of these categories.) Dr. Bob is correct about one other thing, though: It is the parents who are caught in the middle. Most do not have a sufficient background in science, medicine, or epidemiology to recognize the fallacious arguments made by the anti-vaccine contingent for their sheer, stinking, steaming bogosity. I feel sorry for them. I really do. The lies of the anti-vaccine movement can sound convincing if you don't have enough background knowledge to see through them, especially when they suggest a threat to your child.
Like a politician campaigning on a populist platform, Dr. Sears further buffs his "I'll fight for you" cred by giving a bit of background. He portrays himself as "self-educated" on vaccines, while coming to the radical conclusion that:
...vaccines are effective and generally safe for most children, but that there is a small risk of a serious reaction. This may not seem like any great revelation, as most people agree that vaccines do work (although not 100%, and in some cases as low as 85%), and that most children seem to handle them just fine without harmful effects.
Well that's mighty nice of you to admit that vaccines are safe. So far there is nothing new there, but Bob can't resist painting himself as a brave maverick doctor bucking the status quo, Speaking The Truth To Power, and Being Down With The Parents in a way that all those apparently pharma shill, vaccine zombie pediatricians supposedly aren't:
The reason I viewed my conclusion as significant was that back in the 1990s, the party line within the medical community was that vaccines do not cause severe reactions. Reports of seizures, encephalitis, autoimmune reactions, bleeding disorders, and neurological injuries were just coincidence. Vaccines can't cause that. Now we know differently, and the medical establishment has acknowledged that such reactions can be attributed to vaccines (just read any vaccine product insert). So the party line has changed to the opinion that such severe reactions are so rare that the general population doesn't (and shouldn't) need to worry about them. But every parent is still going to worry that their one individual baby is going to be one of those statistics. And that's an understandable concern.
Pretty radical, Dr. Bob. Except that it's a straw man. It has always been recognized that there are a small number of serious adverse reactions to vaccines. In fact, early on in the history of vaccination, occasionally severe reactions were noted to the smallpox vaccine. Contrary to Dr. Bob's spin, that there are occasional severe reactions to vaccines is not a revelation. Read, for example, Arthur Allen's Vaccine: The Controversial Story of Medicine's Greatest Lifesaver. It describes complications from smallpox vaccines. Read Paul Offit's--yes, that Paul Offit--The Cutter Incident: How America's First Polio Vaccine Led to the Growing Vaccine Crisis. The point is not that there aren't rare serious reactions to vaccines; there are. Indeed, that's the very reason why the Vaccine Court was created over 20 years ago, in order to fairly compensate those injured by vaccines. Yet, Dr. Bob presents this as though it were some sort of revelation that he and he alone (well, maybe he and the other brave maverick doctors) has discovered and that public health authorities won't admit. The real argument being made against the anti-vaccine movement is that vaccinating is safer than not vaccinating. Vaccinating is safer than the diseases vaccinated against. It is a point that is apparently beyond Dr. Bob's ability to grasp.
It is here, after he mentions Andrew Wakefield as though he were anything more than an incompetent, biased scientist in the pocket of trial lawyers suing for "vaccine injury" who also almost certainly falsified data, that Dr. Bob descends into the deepest black hole of stupid that I've ever seen him fall into. Apparently, the supernova of stupid had already occurred and collapsed into a black hole. Or maybe Dr. Bob took care of both the creation of the black hole and the feeding of it with even more stupid. Be that as it may, here comes something that may hurt your neurons to read, a veritable gravitation wave of blithering idiocy producing a massive wave of neuronal apoptosis if you're not prepared for it, sucking all intelligence into Dr. Bob's black hole of stupid.
You were warned. Here it is:
Ultimately, I believe the vaccine/autism question cannot be answered until a very large, prospective, randomized, double-blind, placebo-controlled study is done that compares the rate of autism in a very large group of vaccinated versus unvaccinated children. That type of study is the gold standard of medical research, and until that study is done this issue cannot be put to rest for many parents; there will continue to be doubt in many parents' minds about the safety of vaccines. I know that there are dozens of studies that show there is probably no link between vaccines and autism, and virtually every doctor, government official, and vaccine manufacturer is very quick to point that out. But parents just don't believe it. And they won't believe it until the type of large study I describe above is done. But that research is many years away. Millions of parents need to know what to do with their babies now. Here is my solution: vaccinate, but do so in a manner that lowers the risks.
That's right. You heard it correctly. Dr. Bob has apparently actually bought into the concept of a "vaccinated versus unvaccinated" trial. But he did even worse than that. He bought into the idea of a prospective, randomized, double-blind, placebo-controlled study. But not just a prospective, randomized, double-blind, placebo-controlled study, but a "very large" prospective, randomized, double-blind, placebo-controlled study. Any such study would be utterly and completely unethical. No IRB would ever approve it--and rightly so, because it would violate the very tenets of clinical trials ethics in that there would be reasonable presumption of clinical equipoise. In other words, there is no way that any informed scientist could claim that, to the best of our ability to know, the two groups would be subjected to roughly equal risk. No, the placebo control group would be left unvaccinated and completely vulnerable to vaccine-preventable diseases. Children in the control group would fall ill from not being vaccinated; some might even die. That's about as unethical as it gets in human subjects research.
If Dr. Bob doesn't know that, he is too ignorant of the very basics of human subjects research to be spouting off about it. He needs to be called out for this. Loudly. Really, this is Human Subjects Research 101. Indeed, knowing about the concept of clinical equipoise is arguably the prerequisite for Human Subjects Research 101. On the other hand, if Dr. Bob does know just how unethical such a "vaxed versus unvaxed" trial would be, then he is cynical beyond belief, throwing out the excuse that parents won't be convinced that vaccines do not cause autism by anything less than a randomized clinical trial of "vaxed versus unvaxed" and using that as a justification for his "alternate" vaccine schedule "until such a trial is done." While I hope that the former is the explanation for Dr. Bob's saying something so monumentally disturbing to anyone involved in clinical research (like me), I tend to vote for the latter. Presuming the former would mean that Dr. Bob has to be even more mind-numbingly ignorant than Vox Day, who once proposed the very same thing, an RCTof vaccinated versus unvaccinated children. Come to think of it, even J. B. Handley doesn't try very hard to argue for an RCT of vaccinated versus unvaccinated children any more. Not really. Even he understands that it would never fly because it is unethical, even if he doesn't really accept the reasons why it is unethical.
Word to Dr. Bob: If you're suggesting something (or even using something in a rhetorical sense) that Vox Day advocates and even J. B. Handly realizes won't fly, you have sunk to a new low. Sadly, so has Dr. Jon Poling, father of Hannah Poling, who chimed in the comments:
You are correct that a vax-unvax study must be done to answer the open autism question once and for-all. Your summary of the Wakefield-Offit piece also astutely points out that while Wakefield acknowledges scientific uncertainly with his hypothesis, Offit is dogmatic that vaccines are always safe.
Geez. Not you, too, Dr. Poling! Surely you know that a vax-unvax study of the type described by Dr. Sears would be profoundly unethical, on the order of the Tuskegee Syphilis Study. Don't you? You do, also know, that doing an epidemiological study of vaxed versus unvaxed children would be far more complicated and expensive than the anti-vaccine movement lets on and, more importantly, that there is no good scientific justification for it, as I explained in depth here. If you don't, you should. As for Dr. Poling's comment about Dr. Sears' analysis of Matt Lauer's story on Andrew Wakefield, this is what Dr. Bob said:
This is a little pet peeve of mine, and this closed-minded attitude really came across when watching Dr. Offit's comments, and Brian Deer's, for that matter. They are so certain they are right, and that vaccines are completely safe, case closed. Whereas, Dr. Wakefield admits that he doesn't know whether he's right or wrong regarding MMR and autism, but he believes we should keep looking. He's open minded, and open to the possibility he may be wrong in the long run. He just wants to make sure.
No, Dr. Offit and Brian Deer are certain that Wakefield is a fraud, an incompetent scientist, and I agree with their opinion of him. Wakefield's "science" is not to be trusted. It's crap. Wakefield, on the other hand, oozes the unctuous poise of the con man, trying to appear "reasonable" on TV when his actions over the last decade tell a different story. His last decade does not tell the tale of a man who is "open-minded" and "just wants to make sure." If that were true, he wouldn't have ignored the concerns of researchers working for him about false-positive PCR tests for measles in the gut.
On the other hand, for all the cesspit of misinformation he laid down in this steaming, stinking turd of a post, Dr. Bob is sort of correct about a few things. Sort of. For example, there are indeed dozens of studies failing to find a link between vaccines and autism--at minimum, many dozens. Also, virtually the entire public health establishment, including doctors, scientists, the government, vaccine manufacturers, and public health officials, does accept that vaccines are safe and effective--based on those many "dozens" of studies, natch! Finally, such a large prospective, randomized, double-blind, placebo-controlled study as described by Dr. Bob is indeed "years" away--as in never. Unless we as a nation have a radical "reimagining" of our current ethical concepts that govern human subjects research--and not for the better or more stringent, I might add--such a study will never be approved by any IRB or board responsible for human subjects protection. Nor should it ever be.
Dr. Bob is wrong about one thing, though. While he is correct that there are parents who don't believe that vaccines don't cause autism, where he is incorrect is in his charmingly naive belief that even a large prospective, randomized, double-blind, placebo-controlled study of vaccinated versus unvaccinated children were done and its results definitively showed that vaccines do not cause autism. The mountains of existing evidence haven't convinced these parents already; more evidence, no matter how high quality from a scientific standpoint (albeit of incredibly dubious clinical trial ethics) is highly unlikely to convince them. Just look to the example of Sallie Bernard of SafeMinds. In a misguided effort to be "inclusive," investigators consulted her in the design a very large epidemiological study looking for a link between thimerosal-containing vaccines and adverse neurodevelopmental outcomes. When the study was resoundingly negative, not at all what Bernard wanted, she didn't believe it and started attacking it.
It is in order to assuage the fears of these parents whose fears cannot be assuaged by reason and science that Dr. Bob goes on to repeat his evidence-free advocacy of a "slower," "alternate" vaccine schedule. If you have a child with autism, Dr. Bob suggests that any further children you might have shouldn't get the MMR vaccine, saying:
Although the science is overwhelmingly in favor of no link between MMR and autism, until a large-scale study is done in the manner I suggest above to really prove there is no link (or as close to "proof" as we can come), parents with autism in their family already should be cautious. But what about the other 99% of families without a child with autism? If your child has any of the risk factors associated with autism, such as severe food allergies, chronic diarrhea, any form of early developmental delay, or a strong family history of autoimmune disease (as revealed this month in Pediatrics), the MMR should be at least postponed until these problems resolve. Again, no science, just a precaution.
Oh, well, at least Dr. "Bob" Sears admits that the science is overwhelmingly in favor of no link between the MMR and autism. He even admits there's no science behind his recommendations, but he makes them anyway! After all, he don't need no steeenkin' science. He's Dr. Bob, Brave Maverick Doctor, who really and truly cares so very, very deeply about your child! Unfortunately, so eager is Dr. Bob to be seen as the "brave maverick doctor" by parents who think there is a link that he makes evidence- and science-free recommendations to delay or even skip important vaccines--just until a study that can never ethically be done is done, that is.
If that isn't anti-vaccine, I don't know what is.
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Perhaps someone should send Dr. Bob a copy of the Declaration of Helsinki. Seems he could use some remedial education.
Here's a link for those who are interested: http://www.wma.net/e/policy/b3.htm
Will Dr. Bob do a very large, double-blind study to show that his "alternate schedule" is safe?
Heck, he could at least show that it is safer than the currently recommended schedule.
Or does the burden of RCTs only apply to non-anti-vaxxers?
Pretty nice, eh? "You can only know for sure if you use very large RCTs" coupled with "I got nothing, but do it anyway"
I started reading the comments at Dr. Bob's HuffPo article. Yikes! That really is a cesspool of stupidity.
The mountains of existing evidence haven't convinced these parents already; more evidence, no matter how high quality from a scientific standpoint (albeit of incredibly dubious clinical trial ethics) is highly unlikely to convince them
That is exactly right. They didn't get there by reviewing scientific reasoning, they won't leave that way either. The only thing that will get these parents to change their minds are if the people current profiting from this conspiracy theory decide to find integrity and say "I was wrong".
I'm not waiting around for that to happen.
I stopped reading the comments when I got to "millions of parents can't be wrong".
Because yes, millions of people's opinion=truth. That's why, one day all of a sudden the earth transformed from a flat plain to a sphere, because "millions of [people] can't be wrong".
I actually thought that this could make a good study, since the anti-vaxxers are crying for a study of children who are vaccinated versus not vaccinated, and that is clearly unethical.
Instead, we could have a study where a group of children are tested periodically from birth for specific signs of autism. This would rule out the bias of anti-vaxxers ignoring their kid's problem. Then children could follow either a standard schedule or a delayed schedule. It would be pretty straightforward to compare not only the rates of autism, but the timing. It's hard to claim that something caused autism if the autism came first (although I'm sure they'd try).
It would be difficult to make the study double-blind because parents and doctors know when children are vaccinated. The only way to control for this is to give all children some inert injections in addition to their vaccines. Of course, even if those injections were pure water, the anti-vax crowd would find some way to blame them.
There are only 2 problems that I can think of with this type of study.
First, it's somewhat unethical to leave some children at risk for a longer period of time, but certainly not as bad as leaving them completely vaccinated. You could just study children whose parents voluntarily chose the alternate schedule, but that would remove the blindness factor and introduce some obvious bias, even if the participants underwent routine autism screenings throughout the study.
The second problem is the biggest one. If this study showed no autism link to vaccines, just like every other study has done, it would not change any minds in the anti-vax crowd anyway. We already have plenty of evidence, and another really good study won't make a difference to people who already don't care about evidence.
Check for signs of illness before injection. Use sterile needles and syringes, latex gloves and alcohol swabs.
Next?
If no difference was found, they would conclude that even the modified vaccination schedule causes autism, leading parents who might otherwise have chosen the modified schedule (which is probably inferior, but still better than nothing) to avoid vaccination entirely.
@trrll
Or, they would claim that the researchers involved were part of the conspiracy and getting payoffs from Big PharmaTM.
Ooh, the Huffington Post, that is a bad one. Yeah, he is beyond redemption. Not that it matters. No amount of studies will convince them of anything. All that is left to do is to educate the masses.
Well, one of the parroting points I hear from the anti-vax crowd is that their kid's autism was diagnosed soon after a certain vaccine, and I think that's also the main motivation for Sears's alternate schedule. The study I proposed would have periodic screenings for autism symptoms, and it would show that timing of onset has no correlation with vaccination. Also, I expect that it would show plenty of autism showing up before vaccination even occurs. Of course, they'd probably justify that by saying that the kid developed autism just knowing that they would be vaccinated in the future.
The most likely possibility is that they would cry conspiracy or fraud, like Todd W. suggested.
There is, of course, the elephant in the room here - vaccine preventable disease. It is on the rise in many places around the world, thanks in my opinion to AoA, Jenny, & Wakefield et al. As the "opinion of millions" sways more and more fence-sitting parents, the real danger will take root and do real damage. Polio, mumps, measles and the devastation they leave in their wake may eventually drown the vast majority of anti-vax noise. I can see nothing else, not the immoral study Sears advocates, not any amount of evidence, swaying the idiots.
I suspect a resurgence of vaccine preventable disease is the only thing that might convince any large number of parents to return to vaccination.
Many of them would attribute it to exposure to other children who had been vaccinated. TEH TOXINZ are contagious, you know.
As dumb as this sounds, I have seen such noise (ok, on sMothering.com, so take that for what it's worth). There was the mom who said she knew someone who's child was autistic but not vaccinated, and said she never realized that non-vaccinated children could get autism (now, who in the world would give her that idea?). Others jumped in and started blaming the toxins all over, even resorting to mercury contamination of the breastmilk from the mother's fillings.
Run and hide from the toxins!!! They're everywhere! They're everywhere!
No, 16 years of quote-mining and outright incomprehension of the scientific literature does not constitute research.
Again with the appeal to authority; if Dr. Healy is so speshul, then why has she been relegated to "Health Editor and Columnist" for U.S. News and World Report? She turned her back on science a long time ago in lieu of failed political aspirations. Why she is afforded any voice on this subject is beyond me.
This offends my sensibilities beyond description. How can someone who claims "sixteen years of vaccine research" write this with a straight face? I suggested to him that he consult with a statistician the next time he makes a foray into risk calculations, although I suspect it has fallen upon deaf ears. And to think, people actually believe this twaddle.
Wow, that's all he learned about vaccines? He didn't learn all about immunology at med school? About herd immunity etc (oh yeah, I forgot, he wants everyone of his million+ followers to hide in the herd)?
I am facing the prospect of my daughter being diagnosed with an ASD. She's fully vaccinated. If I have another child, they will be fully vaccinated. My brother has an ASD, shocker my daughter may have one too... Oh I forgot, Generation Rescue is saying it isn't genetic...
Sigh.... I am really saddened to see this kind of anti-vaccine propaganda over and over again.
i found myself wondering why dr. bob would write that article. then i got to this sentence:
"I also offer another schedule in my book..."
what a scam.
@Science Mom:
"This offends my sensibilities beyond description. How can someone who claims "sixteen years of vaccine research" write this with a straight face?"
Apparently he can write it, but not say it. As far as I can tell, Dr. Bob has never testified in any court, or even been tendered, as an expert (in any field, much less one that involves vaccination). Best selling author with a nice smile and friendly demeanor (sorta like Prof. Gilroy in the Harry Potter book), you'd expect that some lawyer would hire him to look at the jury and intone "When I've been writing and lecturing trying to make your kids safe . . ." But, apparently, the result is a Nada. Even Mark Geier has managed to get to testify a few times. But, apparently Dr. Bob hasn't. ('course, that might'n have to do with that statistics thingy you mentioned, along with other thingies others have mentioned. The world's a little different when someone can ask you pointed questions you have to answer). If anyone knows of him testifying as an expert, please provide a case cite.
Note, I'm not implying that everyone who is allowed to testify as an expert witness in fact knows what he/she is talking about. But, if he can't even get past a layman (judge) and be allowed to testify, I wonder why anyone would take him seriously -- much less let their kid's health depend on his opinions.
The only thing lamer than appeal to authority is appeal to an authority who is...er..not one.
Healy has no expertise or training in any relevant field: autism, immunology, or public health.
Yeah, I learned a new concept: "clinical equipoise". I can imagine how to design an ethical trial for the most part, but I didn't know there was a special term for it.
This is slightly OT, but I thought it was worth mentioning as a heads-up. The next salvo in the autism wars may come not from the anti-vaxers, but from the anti-dairy crowd. An article showed up on Alternet on Monday, claiming that a particular type of milk may be a trigger for diabetes, heart disease, autism, and schizophrenia.
The supposed culprit is the A1 beta casein variant, which is said to be very nasty, unlike the A2 variant. This hypothesis has been around for a while, and, naturally, we now have a professor (from New Zealand in this case) who has written a book detailing the horrors of A1.
I've just done a little digging about this one on PubMed, and the theory looks to be bogus. Early studies seemed ominous, but later, larger studies didn't find any statistical relationship. Well, at least for heart disease. This is starting to remind me of that article on Mercola's site that claimed pasteurized milk was to blame for autism, actually. But I've got a feeling the "toxins" crowd will eagerly seize on this new book and use it as a fallback when ever more "no, it's not thimerosal, and it's not vaccines either" evidence emerges.
You heard it here first.
"...excreting a turd of logical fallacies and pseudoscience entitled Vaccines And Autism: What Can Parents Do During This Controversy? The stupid in there is so concentrated, under such high pressure, that it's going to turn into diamonds of ignorance..."
Orac, you silver-tongued devil.
You are the Master of the Metaphor
....the Ayatollah of Imagery
.......the Bard of the Blogosphere.
Keep up the good work!
ORAC writes: " . . . science can never absolutely prove a negative, only demonstrate an extremely low likelihood that there is a link, which is what it has already done."
In that phrasing, I agree with ORAC. And yet, many people continue to claim that it's been proven that there's no link between vaccines and autism.
Can you really have it both ways? And, if so, could you refer me to the literature which says you can.
The stupid there burns, too.
Best,
Jay
You must be done with that article you mentioned before, Jay. Otherwise, I don't see why you're tilting at strawmen, and/or bringing up a point that no one is discussing.
Jay G @23
How about "the research shows a near certain conclusion that vaccines do not cause autism".
This is in the tradition of science where we make a conclusion and continue to test it. With each supporting result (there are hundreds) we feel more confident in our conclusion. Good science is always checking but not preventing a conclusion based on a non-certainty. Strawman indeed.
Straw man.
When you answer questions with clichés and repeatedly point out that an argument is a "straw man" I'm starting to think that you really don't have an answer at all.
None. You can't prove that vaccines have no connection to autism. The IRBs would never allow the studies required and I agree with you and the IRBs. And . . . I agree that the connection is tenuous, unproven, and controversial; But to say that there's no connection is scientifically unsound. Kind of like a Tin Man with no heart to the argument. (I like that one.)
Jay
This is the proper terminology, but something which anti-vaxers use to try and justify yet more studies because they don't understand how science works.
What are the 'many people' and what does that have to do with Orac's correct phrasing?
My issue with this whole vaccines causes autism debate and this incessant need for anti-vaxxers to "reinvent" the wheel so to speak by doing more and more studies on the connection (which many many many studies have said there isn't a link) is that it is detracting from further research and money to look into other therapies or resources and help for kids and adults (they exist) who are on the autistic spectrum (some resources would say to help autistic/AS adults find meaningful employment).
I have a brother pushing grocery carts with an IQ of over 150 since he lacks the critical social and communication skills needed to present himself well in job interviews.
I will most likely be looking for therapies (don't worry, I am not putting a penny towards any biomed stuff) for my daughter to help her learn to converse properly and learn critical social skills.
With this constant barrage of articles and pressure this media attention garners to do more studies on this autism/vaccine link (though again there has been a plethora of studies done on it) takes valuable resources away to help many people be able to function in a world that unfortunately doesn't always accept or accommodate the neurodiverse.
Dr. Jay, Jay, Jay, Jay.
You've clearly learned nothing at all. Either I'm not a good enough teacher over the last four years or you're unteachable. Not sure which is the case.
All of medical science is like that. You can never absolutely prove a negative. However, when large enough studies are done with sufficient power, you can in essence show that there is such an incredibly small likelihood that there is a link that for all intents and purposes in the real world there is no link, which is where we are with vaccines and autism, and, in fact, we say there is no link as short hand because it's easier than saying that the null hypothesis hasn't been falsified, with all the qualifications about statistical power and the probability of alpha and beta errors.
Let me put it this way. You can never absolutely, positively prove that there is not a celestial teapot circling the sun between Mars and the Earth, either. Are you going to assume that there is one?
Shall we try to teach you science and statistics again? Obviously all the previous lessons over the last four years haven't stuck.
Jay sez: "When you answer questions with clichés and repeatedly point out that an argument is a "straw man" I'm starting to think that you really don't have an answer at all."
Please do not project your failures and confusions onto me. If you insist on making fallacious arguments, then it will never be "cliche" to reply by pointing out why you are wrong.
That's to say nothing of the fact that you didn't ask a question! What would you like me to respond to? If you would like me to agree with you, here you go: yes, if someone claims to have PROVEN that there is ABSOLUTELY NO link between vaccination and autism, then they are wrong.
But, as you pointed out yourself, no one here is saying that. Did you have a point, Jay? Oh, and how is that article coming?
Orac how do I love thee? Let me count the ways ... or at least the first few that come immediately to mind: your clarity; your insolence; and definitely not least your absolutely wonderful turns of phrase, that often serve to keep me from sinking too far into the mire of despair when reading of the stupid you battle for us. ;-)
... celestial teapot ... lolz ^_^
There's no definitive proof that reading Jay Gordon's blog posts does not cause irrepairable liver damage.
The connection is tenuous, unproven and controversial, but we can't say there's NO connection because that would be scientifically unsound.
So will Jay stop writing posts on the remote possibility that this might be true? It's what he demands we do with vaccines.....
MikeMa - I wrote the same thing last time we had this Dr. Bob discussion. The true believers wouldn't even believe the unethical study suggested by Dr. Bob--they are like the "birthers", "deathers" and so on, committed to their "belief" and unable to process anything else.
Also, everyone, there is a very annoying ad off that keeps flashing off to the left and says: "JOIN THE FIGHT AGAINST GOVERNMENT TAKEOVER OF HEALTH CARE". How does that turn up here?????
@Orac
Tough choice for tomorrow's show: Andrew Weil on Larry King vs. Kirby/autism/vaccines on Huff Po. Can't wait.
Actually, if we get all nit-picky about the metaphors of black hole physics (one of my all time favorite theoretical subjects), wouldn't that be a powerful gamma ray burst of neuron disintegrating stupid?
Other than the random, nerdy technicality from me, great job as always!
Tsuken, I too love Orac for his insolence and articulate turns of phrase.
However the "celestial teapot" gambit is not an Orac original, but a well described one from Bertrand Russell.
http://en.wikipedia.org/wiki/Russell's_teapot
You gotta feel for Dr. Jay.
His role as the go-to celebrity maverick antivax pediatrician is being threatened by the emergence of Dr. Bob Sears. Pretty soon, when Tila Tequila falls out of the news and Larry King needs another hit of antivaxery to flog the ratings, he could well go to Sears as his "expert".
Poor Dr. Jay will be left steaming, much like a celestial teapot. :(
via Mark Probert misc.health.alternative
Alternative Informed Consent:
By signing below, I acknowledge that I have been informed that
vaccinating my child is a risk-filled endeavor that may lead to
autism, ADHD, skepticism and even death*. I acknowledge that I have
been informed that the current risk of acquiring a vaccine-preventable
disease in the US may be less than the risk of the vaccine**. I
further acknowledge that I have been advised to let my neighbours bear
the risk of vaccinating of THEIR children and let my children slide by
on the slipstream of the "herd immunity" they provide***.
Having decided, against well-meaning and heartfelt advise, to
vaccinate my children, I choose to follow the vaccination schedule
checked below (initial in the box next to your choice):
[ ] I choose the current CDC recommended vaccination schedule against
all recomendation and with full knowledge that it might turn my child
into a soul-less autistic monster or give them "hummingbird-on-meth"-
style ADHD. By making this choice, I release "Dr. Bob" Inc. from any
and all liability and financial, professional or moral responsibility
for what may subsequently happen to my child. May God have mercy on my
soul.
[ ] I choose to make the smart choice and "spread out" my child's
vaccinations according to the current "Dr. Bob" (TM) vaccine schedule
(subject to change without notice or reason). I acknowledge that this
vaccination schedule is supported only by "Dr. Bob's clinical
experience" (pat. pending) and may not protect my children from
vaccine-preventable diseases to the extent that the CDC recommended
schedule does. I hereby release "Dr. Bob" Inc. from any and all
liability and financial, professional or moral responsibility for any
infectious diseases my child may acquire and/or spread to others as a
result of this vaccination schedule. I further acknowledge being
warned against taking my children out of the country or into areas of
the country where vaccine-preventable diseases have become endemic.
Signed ____________
Relationship to child ____________
First of all, I don't think many scientifically minded people actually use the exact phrasing above: "it's been proven that there's no link..." It probably happens from time to time, but it's simply a short-cut for what we all know: that studies have simply failed to rule out the null hypothesis again and again. One study in particular, Thompson et al. (2007), is shockingly consistent with the null hypothesis in a statistical sense, but even this doesn't prove the null hypothesis.
Now, if science is not supposed to rule out hypotheses once they have failed to produce results, then effort should be spent researching, say, the refrigerator mother hypothesis of autism, or secretin as a treatment option. For that matter, it hasn't been proven that bloodletting doesn't work.
Two black holes coalescing are expected to produce a major gravity wave. So the combination of the black hole of stupid that is Bob (no way I'm going to dignify him with an honorific when he spends his days trying to kill children) with that which is HuffPoo would indeed produce a gravitational wave of stupid.
Anthro @33
Sadly, the point made about vaccine preventable disease on the rise as the one possible way to convince the Dr Jay/Dr Bob/Jenny/AoA masses they may have made a little error, is a common one here but it bears repeating I think.
As for the ads, I use firefox with noscript and adblock. I see only what I wish to see and no more. Very pleasant browsing experience.
When I gave birth in 2002 to my first child, many people recommended Dr.Bob to me. I read his book, and just about threw it across the room. I have despised him ever since.
Not only is he vehemently anti-vaccine no matter what he says, he is also extremely sexist and anti-working mother. Of course breastfeeding is good for a baby, and I did it, but you are not giving your child dreaded toxins if you use formula.
In a section designed to "help" women decide whether or not to go back to work, he asks you to consider ALL financial options available (including asking grandparents to chip in) and tells you to ask yourself "who can better mother your child than you?"
Uh, maybe the same child care provider that can father better while my husband is at work as well!
I usually look to frequent Rolling Stone contributor Matt Taibbi's works for the likes of the paragraph quoted below - combining outrage with mastery of the English language to the end of enlightening the audience with truth in a context of threatening nonsense. Bless you. My weekend will be that much better now.
"Which is exactly what Dr. Bob did yesterday, excreting a turd of logical fallacies and pseudoscience entitled Vaccines And Autism: What Can Parents Do During This Controversy? The stupid in there is so concentrated, under such high pressure, that it's going to turn into diamonds of ignorance, which is undoubtedly why Age of Autism is promoting it."
No, Orac, never doubt your ability to teach. Dr. Jay is a cement head.
Unfortunately, Heidi, this attitude is still very prevelant in all of society. Double unfortunately, it is due a lot to men's own actions. Their willingness to fulfill the traditional role leaves mothers stuck with the role of "nurturing parent."
I have been trying for the last year to fight this attitude as much as I can, but it's difficult. I do things like volunteer for Dad's Boot Camp in baby classes, and hang out at WhatToExpect.com to interact with other moms and dads, but it is certainly fighting a tough battle. When dads come in and ask, "How much time should I take off from work after the baby is born? Is a week long enough?" I can only roll my eyes (the answer, of course, is "as much as you can afford to take"). Moms are expected to take at least 6 weeks, why should dads be any different?
Of course, too many moms are also content with it, as well. Look at the social groups that are formed (either in person or on-line). They are always "Moms with Multiples" or "Mommy and Me" or "Religious Moms" etc. Clearly, dads are not considered to be part of them.
As a dad, I was not allowed to participate in the local mom's meeting (my wife was working) because there were women who breastfed and they wouldn't be comfortable with guys around (I didn't care). While that might have some basis, it doesn't make sense to exclude guys from on-line groups at all. I have fought for this at WhatToExpect.com with no avail. Why do the groups have to be "Moms in College" etc? Is it really so hard to call it "Parents in College"?
Why mothering.com and not parenting.com? Oh that's easy...because sParenting.com doesn't work.
"Dr. Jay" opines:
True, there is no study - not even one that involved every human on the planet - that could "prove" that vaccines never cause autism. There would always be the possibility that someone in the control group or someone now dead or someone not yet born could develop autism from a vaccine.
However, in real science, we have already seen that the risk of autism from vaccines is indistinguishable from zero.
If "Dr. Jay" could point to some study that showed an increased prevalence of autism in vaccinated vs. unvaccinated children, he would have a point. As it is, he has zero data to support his conjecture and so his "point" has died before it ever lived.
Prometheus
Oh Doctor Jay,
You insist there's a connection, yet there's no scientific proof of that connection. You expect everyone else to prove your claims false, yet your proof that vaccines cause autism is...where?
since you CAN prove a positive, it should be trivial for y'all to do that. Oh, and no, the addle-pated ramblings of a silicone princess and her rubber-faced idiot boyfriend do not in fact constitute scientific proof.
Dr. Jay, you ignorant attention slut.
You've apparently forgotten the original claim of the vaccine etiology of autism believers - that vaccines cause autism.
The logical position (I don't expect you to understand) is not that they don't, but that the claim that they do is baseless.
Yep, it's often shortened to, "no, they don't," or "the original claim is false," but the logical essence is that the original claim is baseless.
If you're going to suggest otherwise, bring some evidence. There is burden on no one to prove to you that you are not incorrect. You need to prove that you are correct. So, in short, why don't you knock of the idiotic ranting if you got nothing to back it up? It just adds to the weight of evidence proving you're an idiot (and no, we can't prove beyond a shadow of a doubt that you're not a complete idiot).
@45, Pablo
Don't you know that the only way to truly bond with your baby is through breastfeeding? Dads can't do that so they're SOL. Your child will never be close to you, so sorry. Keep working those 60 hours work-weeks and do what little you can to be useful. Dads also don't have any other "superpowers" like growing a human or the always-right mommy instinct.
:huge eye roll:
BTW your comment about sParenting.com cracked me up!
Yeah, this one pisses me off to no end. Moms are constantly bombarded with the message, "Use your instincts, they are usually right." Unfortunately, too often it is taken to mean, "That means everyone else (including dad) is wrong," which isn't true (actually, there is truth in the saying, "you are usually right," but that's because the issues that are being talked about are so trivial that it doesn't matter what you do, it's not wrong. Of course, that applies to everyone else's opinion, too - they aren't wrong, either)
When I talk to dads, I emphasize the concept of "team parenting," which means both parents contribute. "Team parenting" does not mean "dad does everything mom tells him to do." Too many moms and dads let it become like this.
"The goal of parenting is not to think alike, but to think together."
That works. But by themselves, gravitational waves are nothing to worry about. They're just distortions of time and space we wouldn't really notice. Now the gamma rays... that would be devastating.
@"Dr." Jay...
And you absolutely can't prove that this comment wasn't written by a Sasquatch who broke into a house and used someone's computer. However unless you're absolutely brain dead, you could say that the odds against it are overwhelming and probably wouldn't start looking for the comment-leaving Sasquatch and demanding that the entire scientific establishment helps you.
The same goes for vaccines.
But of course, you need to make money by selling false hope with a hefty dollop of bullshit to scared parents which is why you're neglecting the basic common sense you should've learned in med school.
Don't tell us you want studies because that's such an obvious load of fertilizer in progress. You don't. It would put your quack business in peril.
The numbers just don't work. Vaccine-preventable diseases are not "on the rise" in a statistically significant way and you all know it.
The "studies have proven no connection between vaccines and autism" phrasing is used over and over and you know that too.
And, you continue to try to have it both ways.
Modulate your rhetoric to promote reasonable discourse rather than calling me--or anyone else--a "cement head" or a "slut." Yes, I appreciate the SNL allusion.
My experience is more valuable than your 14 slanted poorly-executed studies. There, I said it.
Best,
Jay
P.S. If Larry King chooses Bob Sears over me, I'll be thrilled. :-)
J
Dr. Jay:
Um, ever hear of a town in Southern California called "San Diego"? How about the following countries: the United Kingdom, New Zealand, Switzerland and Japan? They have all experienced increases in measles since 1998. In Japan there are enough mumps cases to show that mumps actually causes deafness in one in a thousand cases... or don't you read the medical literature: An office-based prospective study of deafness in mumps.
Oh dear, looks like 'someone' really really hasn't been paying much attention again.
Time to grab some popcorn and enjoy the regular ass-kicking.
Since Dr. Jay evidently has some kind of block when it comes to understanding the scientific method and comprehending the association between vaccination rates and infectious disease outbreaks, here's some concise information listing recent measles outbreaks (with accompanying severe pediatric complications and deaths), and the association between the drop in MMR coverage (due to antivax scaremongering) and jump in measles cases:
http://jdc325.wordpress.com/2009/02/27/measles/
There are simple graphs with colored lines and bars to help Dr. Jay understand what's at stake here.
So on the one side we have solid evidence of the value of vaccination and the harm caused by encouraging parents not to vaccinate their kids - and on the other side we have Dr. Jay's personal biases.
What should be most important to Dr. Jay is protecting his vulnerable patients. Somewhere along the line he got horribly off track. The fact that he feels the need to keep defending himself in this forum is the only flicker of hope we have that on some level, he feels the need for acceptance by his professional colleagues and might actually at some point allow himself to recognize the mistakes he has made.
Dr. Jay, perhaps you would like to discuss why you think those studies are so 'slanted and poorly-executed' and offer those that support your claims. I have also read the so-called 'fourteen studies' critiques on AoA and have not been done by anyone that has the ability to objectively parse scientific studies so I would appreciate if you do not simply direct me to that site.
Aren't there far more than fourteen studies that have been done over the past ten years that conclude that there is ? What evidence does Dr. Jay present other than his experience with a very limited demographic?
Bullshit, Dr. Jay.
There, I said it.
In any case, there have been far more than fourteen studies that fail to find a link between vaccines and autism. Perhaps you can explain to us how your "personal experience," chock full of your confirmation bias, confusing correlation with causation, personal bias leading to selective memory, and a patient population that, as your fame as a "vaccine skeptic" has grown has undoubtedly become more self-selected as people who believe that vaccines caused their children's autism and tell you so, outweigh the huge weight of basic scientific and epidemiological evidence that have thus far failed to find an association between vaccines and autism that is distinguishable from zero?
I've tried to get you to explain this to me time and time again over the last four years, and time and time again you have failed, in the process admitting that science doesn't support your views and showing that you do not understand how science is done.
But, hey, perhaps even at this late date you can still prove me wrong. Tell me how those fourteen studies are "slanted" and "poorly executed." Try doing it without reference to Generation Rescue's absolutely execrable "Fourteen Studies" website. Or, if you must refer to that website, please read the following by some of my "friends" before you do:
Welcome back, my friends, to the show that never ends, part II: Generation Rescue, the anti-vaccine propaganda machine, and âFourteen Studiesâ
More On Fourteen Studies
14 Studies Later*
Dr. Jay, you seem like a nice guy, but if there's anyone who demonstrates the arrogance of ignorance on par with Jenny McCarthy and J.B. Handley, it's you. I'm sorry if you perceive that as "mean" or if it hurts your feelings, but it's the inescapable conclusion to which your behavior and arguments lead me.
Now you can do one of two things. You can either slink off whining about how mean and uncivil I am, or you can actually argue specifics and science to try to convince me. Which is it going to be?
Indeed, there are more than 14 studies that have looked at the issue, and that's not including any non-english language ones, or the incalculable number of studies that weren't looking expressly, but could have indicated a connection, if it were actually present.
"What evidence does Dr. Jay present other than his experience with a very limited demographic?"
None, and yet it's a requirement of maintaining registration that he must engage in life-long learning. I doubt the AAP would be happy to learn that he is dismissing the hierarchy of evidence in favour of his own opinion.
At this point it must be pointed out that internet postings may be used as evidence in FTP and complaints hearings.
Oops, didn't finish my sentence: there are more than fourteen studies that all conclude that vaccines have very little correlation with autism,plus several that show they are safer than the disease, and few more that show that vaccines save money (preventative medicine usually does).
I am curious as to why Dr. Jay would take the analysis of the studies done by those who no medical nor scientific training over the several dozens of specialists around the world.
Heidi, are you sure you're not conflating Dr. Bob with his father? I don't think Dr. Bob was writing in 2002. The Baby Book was out then, and it is very sexist in parts. I don't remember Bill Sears being anti-vaccine, though.
Alexis - I remember reading in it only a brief part about vaccines, where he said "Vaccines have a high benefit to risk ratio" and mentioned thimerosal had been removed. Nothing specifically anti-vax that I recall
I like your site and have laughed my a off on some of your articles! (especially the john edwards thing). I do however want to say that I do think that my little man's autism 'could have possibly' been linked with the vaccines and I will explain how. When he was 1 1/2 he had a series of shots, he was not ill at the time and did not seem to have any other disorders at the time other than the regular adhd that his older brother and I myself have, hyperactivity runs rampent in my family lol, but Ive never beleived in medication (another story), so anyway he was given the shots and developed a high fever of 106 degrees! I rushed him to the ER and they played it off like it was nothing, just a reaction from the shots, happens all the time thing, well he had a fevral convulsion and ever since he seemed to lack normal eye contact, did not seem to listen and just seemed all around different. As a mother you know your child. I knew my child was somehow changed. Then after I waited over five months (that was how long it took to get a doctors appt.) he was finally diagnosed with PDD which is a milder autism. Obviously I cannot say with certainty that the shots caused the autism but I have heard very similar stories about the seizures associated with the vaccines. So I think indirectly there may be a link. Your thoughts?
@"Dr." Jay,
Right... this is why the UK, New Zealand, Australia and some cities in the U.S. are facing formally declared outbreaks of mumps and measles which were formerly prevented by vaccines. But hey, health agency certified outbreaks can't possible be statistically significant right? And in light of your overwhelming evidence consisting of an indignant "you know it," we should all start blaming vaccines for all the evils of the world, right?
Seriously, idiots like you in the healthcare profession are a worse public hazard than any disease.
I'm even going to go one step farther.
You should have your license to practice medicine revoked for being a quack and your negligence towards actual medicine.
For a doctor to make such an assertion bespeaks not merely ignorance of science, but abysmal ignorance of the history of his own profession. The history of medicine is chock-full of examples of patients being subjected to worthless or even harmful treatments inflicted by doctors who were certain that they could judge from experience whether or not a therapy was effective without the need for statistics and controls. Like Dr. Jay, Dr. Gonzalez believed in his experience over scientific plausibility. He knew (and like Dr. Jay, probably still believes in spite of scientific evidence to the contrary) from experience that his cockamamie treatments (which made about as much biological sense as Dr. Jay's previous belief that formaldehyde in vaccines could pose a danger to patients) were saving lives--when in reality they were shortening patient's lives and increasing their pain.
Modulate your rhetoric to promote reasonable discourse...My experience is more valuable than your 14 slanted poorly-executed studies. There, I said it.
Your arrogance disgusts me, Jay Gordon.
What "reasonable discourse" have you even provided to this discussion. You've admitted that the science clearly does not support your professed stances; often the data stands in direct opposition to your . You've admitted that you have made choices as a physician, and/or as a spokesperson, without sufficient knowledge or care to back up your assertions (e.g., formaldehyde). You bluntly claim that your "experience" outweighs the evidence provided by a substantial number of independent research groups using multiple sets of data (with no apparent explanation as to why each of them is apparently "slanted" or "poorly-executed").
Tell me where the reason part of the "reasonable discourse" is even met? If I didn't think you were a public health nuisance, I'd laugh at your farcical attempts to demand reason while clearly and brashly eschewing it.
This is why I consider Jay Gordon to be a waste of time. I really don't know why I ever respond to him, but I do.
He's made it clear time and time again that he doesn't care about science. Scientific studies mean nothing to him. We can talk all we want about educating Jay about the science, but it's a waste of time. He doesn't care.
That's all we need to know about Jay Gordon. He does not practice science based medicine. He has no interest in science based medicine. So it's a waste of time to talk science with him.
Oh I disagree; he cares very much about the "science" that supports his conclusions and impotently tries to trash the science that doesn't. He is an exercise in confirmation bias. I am still, however, very much interested in his assessments of the fourteen studies. Perhaps he will grace us with a mention of that.
Don't hold your breath. He doesn't know and doesn't care anything about those 14 studies. All he knows is that they don't agree with his experience, and therefore they must be wrong.
And it's not confirmation bias in any way. Confirmation bias means that you use those things that agree with your view for assessment, i.e. you are right because those things support your view. His position is that they are correct because they agree with him.
I stand by my statement. Jay Gordon does not care what the science says. Oh sure, he may use it when it agrees with him, but that has no effect on his beliefs in any way.
He is anti-science. Do not be fooled.
Easy Pablo, I was being facetious; I'm painfully aware of Dr. Jay's inability to parse real or even pseudo-scientific studies.
Confirmation bias and Dr. Jay has a healthy (or not) dose of it.
"Dr. Jay" can put his fingers in his ears and scream, "La la la la la! I can't hear you!" as loudly and often as he likes, but it won't change the reality of the data failing to show a "connection" between autism and vaccines.
Not only is there a growing body of data that fail to show a connection, there is no data (zero, nada, nicht, none) showing that there is a connection.
Seriously, his "experience" is "more valuable" than data? That one sentence sums up all of what is wrong-headed about "Dr. Jay" and others of his ilk. In the face of overwhelming data refuting their "experience", they reject reality in favor of their own belief system.
What do you call it when somebody rejects reality in favor of their own internally-generated beliefs?
Delusion (or religion). It's not science - or even close to it.
Personally, I think that "Dr. Jay" is uneducable on the topic of autism and vaccines. The only point to rebutting his inane comments is to show the people who still might see him as a reliable source of information how inpoverished his reasoning has become.
And if "Dr. Jay" thinks that there are only "fourteen studies" showing that he is wrong, then he simply hasn't been paying attention.
Or he's in deep denial. Take your pick.
[Note: I expect "Dr. Jay" to soon use the "There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy." gambit to say that there is more to medicine than science. This is true enough, but when the "art" of medicine collides with reality, reality wins.]
Prometheus
I am wondering, what is Jay's response these days to parents who consider using chelation therapy?
After getting his ignorant ass hauled to the woodshed and soundly beaten, I am willing to bet that he still has never advised anyone against using it.
Actually, given Jay's demonstrated incompetence and the fact that so much of his practice is actually MALpractice, I'm astounded he still has a license.
How many babies do you have to try to kill before somebody takes action?
It's all about you, isn't it?
You indeed did say it, Jay. You're right and everybody else is wrong. We may need to "modulate our rhetoric," but you need to modulate your brain. A little more science, a little less arrogance ought to help ...
Jay has made it clear he doesn't care about science.
Sorry to be so slow in responding to the above posts. Had a really nice family weekend at a wedding and didn't put in enough time at the keyboard.
As a result of my not posting and not counseling vaccine ambivalence for three straight days, the CDC estimates that forty-six children's lives have been saved. They have the data and science to support this claim but I still say that my experience trumps their science.
I have gathered a list of excerpts from your comments and will try to answer this evening.
Welcome back to my life, all of you. Sorry to have missed the weekend with you.
Best,
Jay
P.S. ORAC, potty-mouth, sir. Potty mouth. I call a foul on you.
J
P.P.S. Chris, go back and reread Horowitz. You have cheated and should be banned from this forum for a week. "Hearing loss" is not "deafness."
http://www.ncbi.nlm.nih.gov/pubmed/19209100
J
Please tell me this is a spoof comment.
The paper is titled "An office-based prospective study of deafness in mumps." Does "hearing loss" make it much less severe? By the way, I know you don't take health insurance, but most American health insurance companies don't cover hearing aids for children (I have a bit of experience with deaf and hard of hearing children, obviously more than you).
Dude! Len Horowitz is a serious whacka-loon! Are you ought of your mind?
Also, read this comment again:
@Jay Gordon
The abstract does not define what level of hearing loss, so we're not able to tell from there, but given the title of the paper, as Chris already pointed out, the focus is deafness, which is a type of hearing loss.
From the American Heritage Science Dictionary:
Though, like dedicated lurker, I also have to wonder if that is really Jay Gordon or someone spoofing him.
VERY busy day here. It takes more time than you can imagine to commit malpractice and practice unscientific pediatrics ten hours/day. (Your stupid burns here, too.)
But I have to expand on the last comment I made. Chris' post about Horowitz "mumps-hearing loss" study was given a pass by all of you. If I had distorted a medical article that way, no less than twenty of you would have jumped down my throat. Stop yelling at me until you get your own unscientific house in order. Orac, Prometheus, and the other pillars of this community, you catch me--correctly I might add--when I pretend that I have science, and not just experience, to support certain of my ideas and impressions. How can you not call others when they come in here--on "your" side--with dishonesty?
And by the way, San Diego?? Are you kidding me, Chris? And then, help the "big boys" redefine "pandemic" please.
Jay
Dr. Jay, the lead author's name is "Hashimoto"... I think it is an interesting slip that you use the name of an anti-vax loon instead.
That's unbelievably arrogant, Dr. Jay. How are you any different to a very experienced doctor from the 19th century?
I'm not aware of any other ways of knowing that trump science.
"Dr. Jay" comments:
Don't hurry. We have already heard all of your answers and they all boil down to one thing:
If that's all you have to say, don't bother - I've already said it for you.
In a "post script", he comments:
The author's name is Hashimoto, not "Horowitz". And, as has been noted above, the title of the article was "An office-based prospective study of deafness in mumps." Not "hearing loss", but "deafness".
As for the possibility that this might be a "spoof" of "Dr. Jay", I allow that this is a distinct possibility, since "Dr. Jay" is so "over the top" that a spoof of him would necessarily be nearly identical to the "geniune article". As a Literature professor once told me, "It's nearly impossible to satire a farce."
Prometheus
Hashimoto, for goodness sake. Hashimoto. Too busy here.
Still, no one wants to call Chris on his distortion? OK, I'll do my best later.
Must return to my rheostats to modulate the amount of woo I'm administering to all these helpless children.
Prometheus, I was taught that "It's nearly impossible to force a satire." Different prof.
You want an interesting concept to contemplate? Don't say something on line that you wouldn't say to someone's face. Insults being the first thing that comes to mind.
Jay
Dr Jay, don't worry. I'd say "That's got to be a spoof." anytime in person. But there isn't much I wouldn't say in person. I'm blunt.
The hearing loss was unilateral, yet severe.
So losing hearing in one ear is okay dokay?
Is it because it is one ear? Or because they are Japanese? How about the mumps outbreak in the Midwest a few years back? Update: Multistate Outbreak of Mumps --- United States, January 1--May 2, 2006:
Let us see, about 2600 cases of mumps and four cases of deafness. That comes out to more than one in a thousand.
Why are you so upset over this information? Did I just distort the CDC data? I actually rounded the number of mumps cases up. Was that bad?
(I suspect the reason that in the 1960s that it was thought that mumps only caused deafness in 1 in 10000 cases in the 1960s was that many more kids were getting deafness from measles, rubella, Hib and other infections. Since the incidence of those diseases have been drastically reduced, a more accurate number of the effect of mumps is being realized... especially in Japan where they do not vaccinate for mumps.)
Here is what I read in the abstract, if anyone wants read it and call me out how I distorted, go ahead:
An office-based prospective study of deafness in mumps.
Hashimoto H, Fujioka M, Kinumaki H; Kinki Ambulatory Pediatrics Study Group.
Collaborators (38)
Fujita T, Harima Y, Hino T, Katayama K, Kumagai N, Matsumoto H, Matsuura S, Noma O, Okafuji T, Okafuji T, Sakuragi K, Maruyama S, Watanabe R, Funaki H, Hanayasu H, Kodo N, Nakanoin H, Shimizu T, Okamoto K, Katagiri S, Fukunaga Y, Nishida N, Nishigaki M, Nishimura T, Yamaue F, Kakuta O, Kidowaki T, Ono K, Saito N, Takahashi Y, Kashii K, Kawarano S, Sato Y, Negoro H, Otani K, Yamairi T, Kaya S, Tanimura S.
Hashimoto Pediatric Clinic, Osaka, Japan. hiromi@reasoning.org
BACKGROUND: Deafness is a rare but important complication of mumps virus infection. Its incidence has been estimated at 0.5 to 5.0 per 100,000 cases of mumps, but recent reports from Japan, where mumps is endemic, suggest that the incidence might be higher. OBJECTIVE: Prospective office-based study to determine the incidence of hearing loss in children with mumps. METHODS: Forty pediatric practices participated in this survey. The study population consisted of patients < or =20 years old with mumps seen between January 2004 and December 2006. Clinical diagnosis of mumps was made by experienced pediatricians. Among those from whom written consent was obtained, parents were asked to conduct hearing screening tests by rubbing fingers near the ears twice daily for 2 weeks. Patients suspected with hearing loss were further examined by an otolaryngologist. RESULTS: Among 7400 children who underwent hearing ability assessment after clinical onset of mumps, 7 had confirmed hearing loss; none had been previously vaccinated against mumps. In all cases, hearing loss was unilateral but severe and did not improve over time. CONCLUSIONS: The incidence of hearing loss in children due to mumps was 7/7400 (approximately 1/1000 cases), which is higher than previously suggested. Prevention of deafness is another important reason for assuring universal immunization against mumps.
RE: Mumps & Deafness
From the results section Hashimoto et al Pediatr Infect Dis J. 2009 Mar;28(3):173-5.
The incidence of deafness among subjects with clinical mumps was 7/7400 cases, or 0.1% (95% confidence intervals 0.03%â0.18%).Of the 7 subjects with deafness, all had confirmed mumps infection by positive serologic tests for mumps-specific IgM antibodies (EIA), and none had received mumps vaccination. Deafness among the 7 subjects was severe and remains unresolved compared with those of the other 17 subjects whose apparent deafness had resolved completely within the study period.
[emphasis mine]
7/7400 mumps cases in a prospective study exhibited unilateral deafness that manifested after the disease. Deafness developed within 5 days after parotitis in 5/7 subjects, with prior normal hearing confirmed in most cases and no evidence to suggest congenital or other hearing loss in the 5. The other two cases were also described, with different circumstances that delayed diagnosis.
"Hearing loss" and "deafness" were used interchangably in the article; "total deafness" was used to indicate complete loss of hearing.
The article also discussed its limitations: e.g., no control comparison group, which prevents comparison of mumps-associated deafness with deafness in the overall child population. This is justified with the following: We can only assume that that baseline incidence of acquired sensorineural deafness is quite rare.
All this is to say, Chris was pretty much right...
Satire (n): A literary work in which human vice or folly is attacked through irony, derision, or wit.
Farce (n): A ludicrous, empty show; a mockery.
Prometheus
Dr J. Gordon, There are a lot of us out here who appreciate your hard work. Sorry you have to deal with such delusional people. All the science in the world is not going to save a person if there isnt someone there with medical experience to back it up. Medicine is subjective and objective. I have never seen an illness that decided to go perfectly along with some study. Especially when some studies will never exist. THANK YOU!
Orac said: "Tell me how those fourteen studies are "slanted" and "poorly executed."...Now you can do one of two things. You can either slink off whining about how mean and uncivil I am, or you can actually argue specifics and science to try to convince me. Which is it going to be?"
Dr. Jay's response: " ORAC, potty-mouth, sir. Potty mouth. I call a foul on you."
And there's Dr. Jay's answer. To give him discredit, he did throw in a badly aimed tu quoque and yet another reference to his overwhelming professional responsibilities that somehow don't limit his fact-free sniggering in this forum.
Your posts are lacking in intelligence or insight. Just repeated nastiness and now racist sarcasm. That stinks. I'd say that to your face.
"The article also discussed its limitations: e.g., no control comparison group, which prevents comparison of mumps-associated deafness with deafness in the overall child population."
No causation should have been implied either by Dr. Hashimoto or by us here. Don't accuse me of lacking science or implying causation when I should suggest correlation instead, and then hinge your argument on a study flawed beyond usefulness.
BACON posts: "The fact that he feels the need to keep defending himself in this forum is the only flicker of hope we have that on some level, he feels the need for acceptance by his professional colleagues and might actually at some point allow himself to recognize the mistakes he has made."
No, Bacon, I'm not here to defend myself; I'm here to attack your lack of real science (which must include observation in it's much-touted "hierarchy") understanding, compassion and civility.
Jay
Dr. Jay:
But it is okay to imply causation by vaccines for autism on even less data?
"Dr. Jay" complains:
Huh? Clearly, I missed something in the comments. Maybe "Dr. Jay" could enlighten me when he can spare a moment from his busy practice. Or, just "maybe", "Dr. Jay" should abstain from commenting until he has time to read for comprehension.
BTW, "Dr. Jay", I would be happy to repeat any and all of the disparaging and insulting comments to your face. If you feel that would be helpful or enlightening for you, I could look you up the next time I am in Southern California. If you tire of being called a fool, stop acting like one.
Prometheus
Perhaps he protests my guess that he dislikes the study because it came from Japan.
Though he has not brought up the 2006 outbreak of 2600 mumps cases in the USA that caused, along with other injuries, four cases of deafness.
Note that he denies that there are outbreaks of diseases like measles, even though it has been pointed out that measles has returned to several countries where vaccination has declined. I also used the paper from Japan to point out that mumps has returned enough that this office study could be done. Japan does not include mumps in its vaccine program.
Call all the fouls you like. It doesn't change the fact that you're doing exactly what I expected: Using the "meanness" or "potty mouth" gambit as a means of avoiding providing any scientific evidence to back up your claims. Exactly as I predicted:
It was a rhetorical question, by the way. I knew which course you would choose. Sadly, you didn't prove me wrong.
Dr. Jay, you just fried my irony meter. There's nothing left but a sizzling, smoking heap of molten metal, plastic, and wires.
In response to Dr. Jay @ 92 who said: No causation should have been implied either by Dr. Hashimoto or by us here.
Correlation does not equal causation; we know this. However, there is very good prior plausibility to suggest that mumps infection can cause unilateral deafness. The virus commonly infects CNS tissues and causes meningitis and/or encephalitis in ~10% of patients. To quote from a 2008 Lancet review, "Sensorineural hearing loss is a well known complication of mumps" (PMID 18342688).
What Hashimoto et al reported was a tight correlation of unilateral hearing loss with the onset of diagnosable mumps. As I wrote above, "Deafness developed within 5 days after parotitis in 5/7 subjects, with prior normal hearing confirmed in most cases and no evidence to suggest congenital or other hearing loss in the 5."
Unilateral deafness is known to be a complication of mumps infection (previously reported to occur at a lower rate than in the present study). There is a plausible causation suggested by this correlation. A matched control group would certainly strengthen an argument of causation. However, in practical terms, I'm inclined agree that spontaneously acquired unilateral deafness is likely to be very rare. How about you, Dr. Experience? How often have you seen spontaneously acquired unilateral deafness?
Follow-up studies will certainly be necessary. Among the questions I'd like to see explored, off the top of my head: 1) Some of those in the study were partially vaccinated--does incomplete vaccination offer any protection regarding infection severity and the likelihood of deafness as a complication? 2) What, if any, treatments were taken during the infection that could have contributed to or been protective of the development of mumps-associated deafness?
Don't accuse me of lacking science or implying causation when I should suggest correlation instead, and then hinge your argument on a study flawed beyond usefulness.
I don't see how this study was "flawed beyond usefulness"...care to enlighten? Inclusion of a matched control group would certainly strengthen the study conclusions, but it seems pretty well established in the field that the correlation of deafness with mumps infection exists precisely because there is causation. Correlation does not equal causation; however, a well-controlled correlation can be strong evidence in favor of a causative relationship.
If you're trying to argue any equivalence between correlation/causation of mumps and deafness to, say, correlation/causation of vaccination and autism, you're making a very poor argument. A a well-controlled correlation does not exist between vaccination and autism.
In the end, Chris was 99% correct: the study only shows a correlation between mumps infection and deafness, however that correlation has been established to be the result of a causative relationship. He could have been more precise. Ultimately, though, he wasn't far off.
If you, Dr. Jay, were to make an error of this magnitude, I wouldn't feel any compulsion to call you on it...unfortunately, your errors tend to be vastly greater than Chris's imprecision.
Now this is ironic. You criticize another physician for relying upon his clinical experience to judge that sudden hearing loss within a week or so after acquiring mumps--a disease that is already established to sometimes cause hearing loss--is likely the result of the disease.
Yet you argue, based upon your own clinical experience, that development of autistic symptoms after vaccination (which is not established to cause autism) is indicative of causality--even if it is at an age when autistic symptoms typically emerge even in the absence of vaccination.
But perhaps you can cite some evidence, or even "experience" that deafness typically appears somewhere around age 5 even in kids who don't have mumps?
I accept that I was less than 100% accurate in my assessment. But I went back to my original posting of the study and noticed that I used it as an example of a disease that has returned. Dr. Jay was claiming that the outbreaks of disease were not statistically significant when he said "The numbers just don't work. Vaccine-preventable diseases are not "on the rise" in a statistically significant way and you all know it."
So I noted several places were there are or have been measles, and that (quoting myself): "In Japan there are enough mumps cases to show that mumps actually causes deafness in one in a thousand cases."
He is focusing on my lack of precise language to get away from the fact that diseases have been returning, and in a very statistically significant way where vaccination has declined.
You know, I think that "Dr. Jay" isn't used to the sort of open, honest and - frankly - emotionally charged debate that goes on in real scientific circles.
I suspect that he's comparing this 'blog to one of those "CME" medical conferences, where nobody questions the speakers because they don't know enough. Either that, or he's comparing it to a "DAN!" conference, where adoring parents hang on his every word and the other speakers don't dare call "bullshit" on anyone else lest their bullshit be similarly exposed.
"Dr. Jay" should try going to real scientific or medical research conferences where contentious issues are discussed and the people in the audience are also researchers. Even when both "sides" have fairly equal amounts and quality of data, the discourse can be acrimonious. And in those situations when one "side" is clearly outmatched in data but refuses to yield, I've seen it turn really ugly.
I suggest that "Dr. Jay" should go the next NFID Annual Conference on Vaccine Research. He doesn't have to present a paper - he could just ask a question (or, in his case, make a statement) from the audience. I'll bet his reception there would be all that he wishes this 'blog would be.
I, for one, have lost patience with his whining. He has been asked innumerable times to "show his work" and he invariably comes out with one of two pat responses:
[1] My vast clinical experience is better than dozens of studies. (I'm right because I know I'm right.)
or
[2] You are all so mean and uncivil! (You can't be right because you aren't nice to me.)
Clue to the clueless - it's not all about you, "Dr. Jay".
Prometheus
Dr. Jay: "No, Bacon, I'm not here to defend myself; I'm here to attack your lack of real science (which must include observation in it's much-touted "hierarchy") understanding, compassion and civility."
I've said this here once before, but it bears repeating: the plural of "anecdote" is not "compassion".
Your compassion towards your patients is badly diluted by your lack of knowledge about vaccines.
They deserve better.
Thank you all for your comments.
Certainly neither of us will convince the other about this issue.
I'm still surprised that no one else found the Hashimoto article flawed enough to merit comment.
I understand your feelings about my vaccine ambivalence but when you cast aspersions on how I practice medicine you really don't know what you're talking about. Bacon, I think there are gaps in your knowledge base. Where those exist in mine, I attempt to fill them. You just talk louder and louder.
Ladies and gentlemen, this is "your" place and I don't want to be a constant irritant or unwelcome commentator on the proceedings. Please vote me off the island if you'd like me to stop posting here. I will respect your decision.
Best,
Jay
Still you missed the point... the use of the Hashimoto article was to show you that mumps has come back to Japan in large numbers. Are you going to now deny that vaccine preventable diseases have not returned in places where vaccination for those diseases have declined.
Are you also going to deny that measles is endemic in the UK and other countries?
Certainly neither of us will convince the other about this issue.
Here's where you're wrong...at least about me. If some new studies of respectable quality came out this year that support a causitive link between vaccines & autism, I would change my stance based on the preponderance of the evidence. I respect the scientific method's capacity to zero-in on objective reality, in imperfect fits, as data sets are increased and methodologies strengthened.
I am willing to be convinced. I, however, demand evidence in proportion to the claims leveled. As has been stated by me and others here several times, anecdotal evidence is useful, but it is necessarily low-quality due to man's natural cognitive biases. Thus, I expect that a suite of important claims regarding the cost/benefit analysis of vaccination be based on the highest-available quality of evidence.
You have stated that you can't be convinced. I appreciate your honesty; I'm dismayed at what that means. For better or worse, you have the ear of at least a portion of the public. That science is devalued in what you tell your audience I fear does more harm than good.
"I'm still surprised that no one else found the Hashimoto article flawed enough to merit comment"
Nonsense, the supposed flaws were discussed several times, including what they meant for the overall idea expressed by Chris.
"I understand your feelings about my vaccine ambivalence but when you cast aspersions on how I practice medicine you really don't know what you're talking about."
Nonsense, you have openly stated that you consider experiential learning to be significantly superior to evidence based medince. You have belittled the entire structue of evidence and professionally impugned several teams of relvantly qualified experts, all on the basis of "Dr Jay knows".
This casts serious doubts on whether you are engaging in life-long learning, which is something that you are expected to do to maintain registration.
"I will respect your decision."
But you won't. You have been directly asked specific questions time and time again, yet you have attempted to ride rough shod over the commentators, implicitly declaring yourself the start and end of what constitutes good science.
You have never had respect for any of the poeple here. You have not respected direct questioning and direct responses, as demonstrated by your ignoring of the direct responses to your blithe dismissal of Hashimoto.
There's no way will you respect direct requests to leave.
Now for a question Dr. Jay will not answer:
How many American children need to get measles before you think that there is a problem with the disease?
Obviously the over 130 in 2008 is too small, and from an earlier blog comment he did not seem concerned about the between 10000 to almost 30000 per year between 1989 and 1991 (with over 120 deaths). So it must be something like over 10000... so is 20000 enough?
At those numbers at least a dozen people get to die. Obviously the experience with measles deaths in the UK ("only" two), and Japan (several dozen) does not bother Dr. Jay. Will he think there is a problem with measles when over a hundred Americans die from measles per year?
What about the much more milder disease of mumps?
Now look more closely at the Hashimoto paper... they surveyed forty pediatric practices and found 7400 cases of mumps. This is just a sampling of offices in the country, there must be many more pediatric practices, and therefore cases of mumps in Japan. How many cases in the USA (which has a much larger population than Japan) would Dr. Jay consider statistically significant? Would it be up into the hundreds of thousands?
How about pertussis? In 2006 there were over 15000 cases of pertussis and at least a dozen deaths in the USA. Now this does not seem to bother Dr. Jay. How many cases of pertussis are needed to be statistically significant? A hundred thousand? How many deaths? A few hundred? A thousand?
What does "statistically significant" mean to Dr. Jay?
Actually, you're half right. You will never be convinced that you are wrong in your belief (and that's all it is, a belief unsupported by evidence) that vaccines cause autism. However, you could convince me I'm wrong. All it would take is convincing scientific evidence, which you are sadly unable to provide. Really, it's true. Show me good, high quality evidence, from well-done clinical trials or epidemiology, and I'd start to rethink my position.
That's the difference between us. That's the difference between someone who thinks his personal clinical experience trumps science and a real scientist.
Having a sudden moment of undrstanding here, it almost qualifies as a revelation. Many anti-vaxers rant on and on about how arrogant and pateranalistic medical professionals are, and than never made sense to me as it massivly conflicted with my own experience. But if you consider the fact that they mostly listen to arrogant pricks like Jay Gordon it suddenly makes a lot of sense, I finaly understand where their skewed view of reality comes from!
I think we may have reached the point where it's time to put down the tools of rational debate and just laugh at the idiot.
Chris asked
The answer:
When a death or serious complication occurs to one of his patients. Until that happens any increase incidence, no matter how large, will not be "statistically significant" to Jay G because he won't "experience" it.
Your supposed practice of medicine is factually wrong and demonstrably dangerous. These points are not debatable - they are, rather, incontestable facts.
Let's draw an analogy. Suppose that a doctor were to conclude that blindness is caused by insufficient fat in the body, and he therefore recommended that all of his patients force-feed themselves to the point of morbid obesity. Should that doctor be stripped of his license for endangering patients?
Now, consider the fact that said doctor's belief is actually more credible than Jay's (since there isn't data specifically refuting it) and may well be less dangerous.
How's that article coming, Jay? (If it's even you anymore. I hope it is, because the last time someone spoofed you, you used it as an excuse to attack Orac rather than defend your actual claims.)
Since that has not been Jay's experience, of course it is wrong. Shoot, that doctor is probably a pharma shill. Jay will give him the benefit of the doubt, however, and just call him a deluded fool whose experience doesn't trump Jay's 14 years.
Dr Jay: "Bacon, I think there are gaps in your knowledge base. Where those exist in mine, I attempt to fill them."
With what?
I work to stay abreast of the literature on communicable infectious diseases and vaccination. I welcome evidence-based rebuttals of my positions. I and others have presented information to you time and time again here, more than sufficient to provoke a thoughtful discussion. In response from you we only get insinuations that we're in league with Big Pharma, unexplained dismissals of all the evidence you don't like as "slanted" and claims that your "experience" trumps science.
How exactly does that help fill in your knowledge gaps?
I suggest you take the time you waste here slapping back at critics, and use it productively to learn about infectious disease and vaccination. Start with Arthur Allen's Vaccine. You could probalby read a chapter in the time it takes you to think up an allegedly witty and contentless reply to a detractor.
I loved the comments about Sears, then everything spiraled downhill with the Jay thread. Maybe we should change the subject back because right now ALL the posters sound nonsensical and irrational. I'm sorry, it's just that skeptical and intelligent are much preferred.
Don't you know? "Making shit up" is perfectly accetable when knowledge is lacking.
Of course, it is not clear what Jay means by knowledge "gaps." That he is ignorant of the information does not mean the knowledge does not exist. Of course, that doesn't stop him from making shit up anyway.
I fill my knowledge gaps by reading what you've written and integrating the science I'm missing into my knowledge base. I spend hours on PubMed and other sites because it's difficult to practice pediatrics full time and read as much as I need to continue these discussions on your level. I'm trying, though.
I sincerely believe that if the work ORAC mentions were produced it might help, but only a little.
ORAC writes:
" All it would take is convincing scientific evidence, which you are sadly unable to provide. Really, it's true. Show me good, high quality evidence, from well-done clinical trials or epidemiology, and I'd start to rethink my position."
I think you could correctly state that the many other studies showing "no connection" stand in stark opposition to the few new "yes" studies which have yet to stand the test of time.
I know that my attitude and perceived disrespect for your science annoys many of you but I really don't make stuff up and I really will continue to keep an open mind. No matter where one places observation and experience on the hierarchy, it's still impossible for me to discard it completely. Your comments have helped me gain a better perspective on it's place in my evaluation of this crucial set of issues. Thank you for that.
Best,
Jay
And, to further my education, please define "science" as you mean the word when you use it here.
And, why is repeated observation of connected, correlated events not a contribution to science? Yes, a contribution mandating further hypothesis testing, but a contribution--a piece of the puzzle--nonetheless.
Best,
Jay
@Jay Gordon
Citations, please.
That's because the few "yes" studies are of such low quality and power that it's not even a comparison. The "no" evidence overwhelms the "yes" evidence; it's not even close.
I don't give a rodent's posterior if you "disrespect" science; what irritates all of us is that you reject science. You do this every time you tout your "decades of clinical experience" as trumping the epidemiology and science that cannot find a correlation between vaccines and autism distinguishable from zero.
And, why is repeated observation of connected, correlated events not a contribution to science?
The problem with your observation is that you have not established either connection or correlation with anything related to vaccines. The increases in ASD diagnosis don't correlate to any changes in the vaccine schedule or the vaccines themselves. The observed correlation in "regression" with vaccine administrations is only observed if you stretch out the time window by a rather excessive amount. Additionally, you have failed to demonstrate that the correlation exceeds that which would be expected by pure chance if the "regression" typically appeared at a given age. Basically, you have yet to establish that any significant correlation exists at all!. Right now you are sitting at a level of correlation equivalent to "An alarming number of murderers ate carrots when they were children!"
You can't prove that vaccines have no connection to autism.
You forgot the "absolutely" part, Jay. Science cannot absolutely prove that vaccines do not cause autism, just as it can never absolutely prove that there isn't a spectral clown who follows you everywhere you go and jumps just out of your sight if you turn your head to try to look at him and turns invisible if you try to look at him in a mirror or take a photograph.
Science can never absolutely disprove any hypothesis. What it can do is establish that a hypothesis is just rubbish unsupported by any evidence and that's what it has done with the "vaccines cause autism" hypothesis. If you were a scientist, you'd realize this when entities such as "the mercury from the cremations of Chinese people with dental amalgams" started being pulled into the discussion as a means to rescue the hypothesis.
This is all a set-up by Dr Jay.
Aside from the ridiculous assertion that he both disregards higher order evidence in favour of personal experience yet also tours pubmed (a place full of exactly the higher order evidence he disregards), he's also setting us all up.
By refusing to address direct challenges but instead making this all about how mean we are to him and how he cannot disregard observation completely (which he is not being asked to! It's called a hierachy for a reason Dr Jay! Doh!) he can convince himself in all honesty that we chased him out because we're 'dogmatic vax believers', rather than the truth, which is that we're tired of the sort of dodging the issue style posts, as evidenced above.
Don't let him trick you, and most importantly don't let him trick himself.
And, why is repeated observation of connected, correlated events not a contribution to science? Yes, a contribution mandating further hypothesis testing, but a contribution--a piece of the puzzle--nonetheless.
Jay, I observed that my son made a HUGE developmental leap within days after his second MMR (given at 2.5 years). His whole disposition turned from "angry terrible twos" to entirely happy, he switched from constant whines to 5 word sentences and soon after got interested in potty training. I have just heard from somebody else's daughter, similar age, varicella vaccine who went through the same. A temporal order does not imply causation...
Catherina @ 124
If only Jay Gordon would do the same.
Dr. Jay: "No, Bacon, I'm not here to defend myself; I'm here to attack your lack of real science (which must include observation in it's much-touted "hierarchy") understanding, compassion and civility."
Your personal observations of your patients might be of value if you keep contemporanous written records and are careful to control for confounds such as selective recall, confirmation bias, etc. They might be published as case reports. Others could review the patient records and perhaps confirm the facts with the patients or other collaterals.
Human memory is pretty terrible. I often have cases referred to me where someone says that patient x went downhill after being taken off med Z. Then when I comb through the records I find that patient x went downhill first and later was taken off med z.
The memory problem means that we need contemporanous records of events.
Why not submit your evidence for peer review, Dr. Jay? Select perhaps five cases where a child's development seemed to go off course post-vaccination. Write up a proposal describing the plan to review these case critically, explaining how reviewers will be fellow MDs who won't disclose identifying data with others. Someone around here will know the best way to establish a human rights committee to approve the proposal and insure patients give informed consent. We can get some MDs to volunteer their time to examine .pdf scans of the charts.
Best to pick cases where the parents aren't true believers on a mission to convince the world that vaccines cause autism, for obvious reasons.
I doubt such a case series will establish a vaccine-autism link. There's too much published evidence out there contradicting that hypothesis. But it may uncover some alternative hypotheses not yet considered.
As we learn more about the neural substrates involved in the theory of mind problem, my guess is we'll link autism to anomalies in fetal neuron migration and connection in those areas. That's just a guess. Seems to fit what I see better than a toxin-type injury, which I'd expect to follow a dose-response curve.
Above, I was using Orac's comment about his needing those "yes" studies to change his mind.
The studies have not been done yet but will be rejected by you if they're ever done because you'll refer to the greater amount of "no" studies. Your minds will not be changed by real science because you know what you know.
You are using your experience with the older possibly biased research to trump the possibility that future science might show harm from certain medical interventions, for example, vaccines. Ignoring the possibility that future research might mandate caution in the present endangers our patients. If you are truly scientists and understand statistics, you realize that the furor over last year's extra 72 measles cases among three hundred million American was little more than media hype. Anyone can figure out that completely discarding our vaccination programs would lead to an increase in disease. I have never proposed that option. That does not mean that we should discard caution when using new medicines.
Best
Jay
Dr. Jay:
There were more than 72 cases of measles even before summer was over! And the main issue was that it was several outbreaks that were clustered in areas with low vaccine coverage (like the schooling group in Illinois). The only thing that kept measles from spreading was the high vaccine rate among the general population (helped by public school requirements).
I know I am going to be called a big ol' meany for this, but where do you get your information?
Above, I was using Orac's comment about his needing those "yes" studies to change his mind.
The studies have not been done yet but will be rejected by you if they're ever done because you'll refer to the greater amount of "no" studies. Your minds will not be changed by real science because you know what you know.
Again, I can only speak for myself, but this is not true. It is true that a single study linking vaccination and autism may not shift me to your current position, Dr. Jay, but it will be entirely dependent upon the state of the enire field of research in the future. To overturn established research, the newer research needs to address that which it would refute with sufficiently better design and power. There is a qualitative element to the evaluation of a field of research, but its not as simple as counting up yes and no votes from PubMed.
I'm serious when I say this: publish some case reports, Dr. Gordon. Make a contribution to the research. It is possible that vaccines contribute to the etiology of ASDs, but it's unlikely to be MMR or thiomersal based on the publiushed research, and the evidence in favor of an association is currently of low quality.
If you are truly scientists and understand statistics, you realize that the furor over last year's extra 72 measles cases among three hundred million American was little more than media hype.
Sure, was some media hype. However, we've witnessed a dramatic increase in measles cases in the UK that corresponds directly to the reduced uptake of MMR--there's suggestive evidence that an uptick in measles cases may be the beginning of a wider spread. The vast majority of the cases were un-immunized individuals from locales with low uptake.
This reduced uptake and higher rate of measles does not appear to have had any advantages, either, as MMR has been practically ruled out from the etiology of autism. Thus, we've seen a rise in measles cases that may be a harbinger for further increases in measles, which is the result of previous media hype surrounding claims of MMR dangers that have been discredited...
Ignoring the possibility that future research might mandate caution in the present endangers our patients.
Basing current clinical practice on the possibilities of future research results that might overturn current research is...um...a bit crazy. Actually it's a lot crazy. What if future resarch were to actually show something supporting the currently-discredited refrigerator mother hypothesis? Or that Gerber strained peas were unusually correlated? Should Orac not perform tumor resections because future data might show that leaving the tumor in is a better option?
This...this is one of the dumbest things I've seen written. What the hell good is scientific research if we can't make treatment recommendations based on current knowledge because "future research might mandate caution"? Surely you don't actually mean this?
And who said caution should be discarded when using new medicines? You're full of crap, Dr. Jay.
@Jay Gordon
Since you're clamoring so loudly for the "right" studies to be done, why don't you do them? Or present them to colleagues who have the skills to design and perform them? Certainly, that would be a lot better than just whining here, no?
"Dr. Jay" sees into the dim mists of the future:
For those not yet familiar with this sort of personality, this is "Dr. Jay's" attempt to justify his lack of data by miraculously prognosticating our future rejection of a hypothetical study showing a connection between autism and vaccines. In other words, "Why should anyone bother collecting data; you'll just reject it out of hand!"
He further whines:
Project much, "Dr. Jay"?
Fortunately, I disconnected my irony meter before reading "Dr. Jay's" comment, thereby sparing myself the expense and bother of replacing it after such a thermonuclear blast of irony.
I am perfectly willing to not only accept but embrace any results that come from well-designed, well-executed studies, no matter what the results may be. To date, only poorly-designed and poorly-executed studies - and only a scant few of those - have shown any connection between autism and vaccines.
Like many others, I would truly like to have "Dr. Jay" educate me about the data that has so firmly convinced him that he is willing to ignore the growing mountain of data that find the association between autism and vaccines to be indistinguishable from zero.
However, having waited years for the good doctor to "show his work", I have gradually become convinced that he doesn't have any data and that his firm convictions are based on nothing more than his own "gut feelings". While that may be "good enough" for "Dr. Jay", I have higher standards.
Prometheus
The problem with Dr. Jay is not simply that he thinks his ad-hoc observations are superior to published science. Clearly, Dr. Jay is dead wrong about that. But in addition to this, we have no way to verify if his observations actually are what he thinks/claims they are. We have no access to his records, and it's unclear if Dr. Jay himself has reviewed his own records. I bet he hasn't.
Catherina: Incredibly interesting post. The old time docs all used to talk about the same kind of developmental spurts after kids got the measles.
Chris: There 72 extra cases of measles beyond the usual 62. Sorry you misunderstood me.
Bob: Article's coming along a lot slower than I had hoped.
Joseph: No, you can't have access to my records. And, I get called a poopoohead by the four-year-olds during my office day and I'm comfortable with your epithets. New vaccines are medicines and should be used cautiously.
Prometheus: As I've mentioned before, my data is anecdotal only and I've never claimed otherwise. Your mountain of data is biased, poorly accumulated and most often funded by the herd of people who are funded by the makers of the drugs themselves. Pharma shills I believe you've called them. Oh, sorry, there's no such thing as a real pharma shill?
Best,
Jay
Dr. Jay,
Observation of cases that seem to support the notion of a vaccine-autism link does not necessarily burden you with the duty to share your case reports with colleagues. However, promotion of the idea of a vaccine-autism link to the public does burden you with this duty.
"Dr. Jay" opines:
All of it? Care to give us a study-by-study run-down?
Besides, even if we accepted your......eccentric opinion about the data, your data showing that there is a connection is - by your own admission - non-existent.
So, on the one hand we have a large number of studies done by a large number of different researchers, from a large number of different research institutions, funded by a wide variety of different sources - which you collectively dismiss as "biased", "poorly accumulated" and apparently corrupt.
On the other hand, we have the "clinical" experience - supported by no review of records or objective analysis - of a mere handful of doctors, which is contradicted by the "clinical experience" of thousands of physicians (who, by "Dr. Jay" standards, must also be "biased" and corrupt).
Which would you believe?
It must be a wonderful thing, "Dr. Jay", to believe that you are incapable of error - my mind doesn't work that way.
Prometheus
Dr. Jay has had no qualms about sharing anecdotes with us. For example, I recall one of an 8 month old baby who became autistic, implausible as that is.
Yet, I don't recall Dr. Jay ever citing stats or numbers derived from his work; e.g. X% of my patients are autistic, etc. That's why I don't believe he's ever even analyzed his own records in order to arrive at his beliefs. They are entirely based on "gut feeling" and biased recollection.
Looks like Dr. Jay has left the building.
He's probably busy writing up those case reports for independent review.