It is with some trepidation and more than a little regret that I begin writing this piece. The reason for my hesitation is that, by doing so, no matter what I say I'll be inserting myself into what appears to be a disagreement among people all of whom I admire very much. I don't really want to do it, but I feel obligated, because the issues brought up in the disagreement are important, and reasonable people can disagree--sometimes strongly--about them. I also believe that someone whom I admire greatly has made a regrettable mistake.
Over the last week or so, I've been blogging a lot about the recent revelations in the BMJ by investigative journalist Brian Deer of the true depths of Andrew Wakefield's perfidy. New revelations of shady business plans to promote woo-based diagnostic tests for "autistic enterocolitis" were added to familiar revelations of massive undisclosed conflicts of interest, breaches of research ethics, and falsification of data to produce an even more disturbing picture of Wakefield's activities than ever before. Not only is he a crappy, dishonest scientist, but the evidence presented by Brian Deer is very strong that he's also a dishonest fraud as well. Over the last seven years, Deer has done amazing, yeoman work in digging into the toxic waste dump that is the Wakefield's dishonesty, fraud, and bad science, excavating the evidence, and putting it all together to produce this picture. I have nothing but the utmost admiration and respect for him.
Which is why I was more than a bit puzzled by Deer's blog post yesterday for The Guardian entitled The medical establishment shielded Andrew Wakefield from fraud claims. Emblazoned under the title is this subtitle: "Brian Deer spent years investigating Andrew Wakefield's MMR and autism research, which he now alleges was fraudulent. Here he argues that doctors closed ranks behind one of their own." Before I explain what Deer has done that, in my opinion, is a mistake, let me just point out that, actually, it would not have surprised me if this were in fact the case to some extent, given how the Royal Free Hospital and UCL aided and abetted the Wakefield publicity machine after the release of his 1998 Lancet paper, as described in Deer's BMJ article this week. Unfortunately, even though it wouldn't surprise me if it were true that parts of the medical profession actually did close rank to some extent around Wakefield, at least until the General Medical Council hearings began, the physicians chosen as examples by Deer to illustrate his point were poorly chosen and and are unconvincing. And I'm not just saying this because I greatly admire them.
First, Deer criticizes Dr. Paul Offit:
But a Philadelphia-based commentator was not impressed by the BMJ's intervention. "It doesn't matter that [Wakefield] was fraudulent," Dr Paul Offit, a vaccine inventor and author in Pennsylvania, was quoted in the Philadelphia Inquirer the next day as saying. "It only matters that he was wrong."I wasn't surprised. From his establishment vantage-point, this was the third time Dr Offit had popped up to opine on the issue. Twice previously he'd been quoted as saying that my findings were "irrelevant" (although he'd been happy enough to use them in his books). Science had spoken, his argument went. There was no link between the vaccine and autism. It was experts like him who should rule on this matter, he seemed to imply, not some oik reporter nailing the guilty men.
I will admit that, on the surface, Dr. Offit's words seem somewhat troubling in that they do appear to dismiss the importance of Deer's findings. On the other hand, having corresponded with Dr. Offit a few times over the last couple of years and read two of his books, I find it hard to believe that this is what he really meant. Personally, I'd really like to see all of what Dr. Offit said in context, because the Philadelphia Inquirer article quoted only quoted one sentence about this issue, and that was it. Moreover, later in the article Dr. Offit is also quoted as saying:
Wakefield "is not a scientist," Offit said. "He is fanatical."
This hardly sounds like any sort of bashing of Brian Deer or closing ranks around Wakefield. Rather, from my perspective, Dr. Offit's statement probably represents a fundamental--and innocent--difference between the mindset of a scientist, like Dr. Offit, and that of an investigative journalist, like Brian Deer. This difference in mindset, in my estimation, has led Deer to incorrectly view comments such as the one by Dr. Offit in the wrong light, as if they somehow represent the arrogant denigration of his years of hard work.
I can't read Dr. Offit's mind, but I just don't see such a dismissal of Brian Deer's work in his words. Indeed, I can even see where Dr. Offit is coming from, as I'll explain later. What I suspect that Dr. Offit means is that in an ideal world science should be the deciding factor in such debates, an assertion that I agree with completely. In such an ideal world, it wouldn't be necessary to worry about whether or not Wakefield committed fraud, because the science would matter far more than the scientist. (Yes, applying that word to someone like Andrew Wakefield does stick in my throat as I type this.) However, because we do not live in an ideal world, that Wakefield apparently committed research fraud matters very much indeed, not the least of which because fraud is something that lay people understand far better than long discourses on why Wakefield's science was incorrect and didn't show that the MMR vaccine causes or contributes to a syndrome of regressive autism and enterocolitis. It's far easier to convince someone saying something like this,"The MMR vaccine never caused autism or enterocolitis. Rather, Andrew Wakefield falsified data to make it seem as though MMR caused these problems, and he did it to create a market for products he had previously patented," than it is to point out the scientific flaws in Wakefield's results. More importantly, fraud undermines the scientific enterprise because, unlike errors and science that is later shown to be wrong (as in the decline effect), it produces an intentional, systematic error into the scientific enterprise.
Consider it this way. To a scientist, it really is the data that matter (or should be), not the scientist gathering the data. Science is a means to an end: to find out how nature works, to plumb its mysteries and discover rules by which it works and that we can use to make predictions. Science, to its credit, also tends to work on the honor system. We scientists tend not to consider perhaps as much as we should the possibility that an investigator is lying or falsifying data. We tend to assume honesty as the default, at least when scientists report their results. The downside of that attitude is that scientific fraud is far too easy to get away with and all too often never discovered. The other downside is that often scientists have a hard time believing it when clear evidence of fraud is presented, as it has been for Wakefield. Naively, our heads in the clouds, we tend to disdain the down and dirty business of proving fraud, assuming that science will work it all out. In other words, science and scientists tend not to deal with fraud very effectively at all.
Contrast this to an investigative journalist, like Brian Deer. A good investigative journalist has to be a crusader, and there's no doubt that Brian Deer is an excellent investigative journalist. Here's where the different purposes and world views of scientists and journalists come in. In contrast to a scientist, Deer's primary goal is not to find out how nature works but rather to use his investigative skills to develop a story and, in particular, expose wrongdoing, the better hidden and worst the wrongdoing the better the story. Just look at the history on his website, which includes not just the Wakefield story. He's taken on pharmaceutical companies galore, for instance, exposing various scams. These skills have served him well in taking on Andrew Wakefield, whose fraud goes beyond that of even many pharma scandals from the last decade.
To this end, Deer has to be every bit as tenacious as the most dedicated scientist--more so, in many cases--and there is no doubt that Brian Deer has been admirably tenacious in pursuing Andrew Wakefield. However, that tenacity is exercised in the pursuit of a good story and in exposing wrongdoing. There is also a marked contrast in that the investigative journalists that I've met, rather than assuming honesty as the default, as scientists tend to do when reading scientific reports, tend to assume dishonesty as the default because, well, they investigate a lot of dishonest people trying to hide wrongdoing from them. I can't help but wonder if this difference in world view and purpose is a large part of the reason for this misunderstanding that has led Deer to write such a misfire of a criticism.
Be that as it may, from my observations, scientists do tend to be much less concerned about exposing wrongdoing in science except insofar as when it is necessary, not because of a lack of a sense of justice, but more often due to a naive faith that science can handle anything, even conscious fraud by an investigator. Unfortunately, that is not always the case. Athough it can judge whether research is competently conducted and whether the results follow from the data presented, peer review, for example, is notoriously bad at detecting falsified data. Consequently, when Dr. Offit says that Deer's findings are "irrelevant" (I'd really like to see the context in which he said that, too) or that it "doesn't matter" that Wakefield's work was fraudulent, he is doing no more than expressing the view of a scientist looking at science at work, expressing the belief that, in the end, science will prevail and that the data matter more than the scientist collecting them. Unfortunately, Deer appears to interpret this belief as somehow denigrating his efforts:
Over the past few years, many of the MMR vaccine's medical champions have queued up to take a pop at my investigation. They've never found any fault in its accuracy or originality. But it was as if they felt that somehow it wasn't right.
What about Ben Goldacre? I don't always agree with Dr. Goldacre, but I can say, particularly after having met him in person three months ago, that without a doubt we agree about far, far more things than we disagree about. One of the things we (sort of) disagree about is one of the sore points that Deer has with him:
"Actually, I would like to speak in defence of Andrew Wakefield," said Guardian Bad Science columnist Dr Ben Goldacre in a BMJ video, long after I first skewered the man's research but before Wakefield was struck off by the GMC. "I'm not sure it was necessarily a bad piece of research."
We actually discussed this very point. First off, this quote was from a period before the GMC found Wakefield guilty of serious professional misconduct and ethical breaches. I disagreed that Wakefield's work was an acceptable case series, and told him so. Indeed, I still can't believe that The Lancet published Wakefield's report. It was, in my estimation, a mediocre little case series that, when you come right down to it, didn't show much of anything, really, even taking it at face value and even if its data hadn't been falsified and the research itself tainted by all of Wakefield's undisclosed conflicts of interest. Usually papers with such weak data don't end up in The Lancet. That's why I'm still puzzled as to why this particular case series did end up in The Lancet, given that, even knowing that none of the editors or peer reviewers was aware at the time that Wakefield's manuscript was fraudulent, it quite simply just wasn't a very good paper. Sure, if it hadn't been fraudulent it would have been perfectly acceptable to publish it, but it belonged in a lower tier journal. I also agree that the behavior of The Lancet's editors has been--shall we say?--less than admirable, probably because their decision to publish such a crappy little case series so spectacularly in their faces. If Deer is planning on including that aspect of the Wakefield case in his next article, I'll be in agreement.
Another aspect of Deer's criticism might be that Dr. Goldacre has taken a strong stance that the British press was largely to blame in this debacle, having aided and abetted Wakefield in promoting the MMR scare. He also has strongly criticized the press for focusing on the man rather than the science. Just as Dr. Offit has argued that science should matter more than the man, so has Dr. Goldacre. Both are correct, but Brian Deer is also correct in that, once the man has become an issue, his misdeeds matter, and science might not prevail without help. I agree with that as well. However, in an ideal world, science would reign supreme when it comes to settling matters such as whether the MMR causes a syndrome of regressive autism and enterocolitis, and the press would "get it" and not focus on the human conflict more than the science. In such a world, findings of fraud would be "irrelevant," at least with respect to the conclusions of science. Unfortunately, Deer appears to see this view, not for what it is, but rather as contempt for him and his methods:
So, what's my point? I think these comments reveal a striking pattern: doctors default to defending other doctors. In fact, until recently there was a GMC regulation that banned them from bad-mouthing colleagues.
But in the specifics of their stance there seemed the idea that scholarly debate, epidemiology and suchlike, should arbitrate. Truth would emerge from the "scientific method", not from "we can reveal" media muck-raking.
Such faith in science was also the apparent view of Wakefield's medical school, when in 1998 he launched the MMR scare in a five-page paper in The Lancet.
I'm afraid I'm about to risk getting in Deer's bad side right here. I don't want to do it; but I have to say this: Count me in 110% as one of those physicians who believe "that scholarly debate, epidemiology, and suchlike should arbitrate issues of science." That is the way science should work. That is how scientific questions like whether the MMR causes regressive autism associated with enterocolitis should be settled. That is what should persuade journalists and politicians, who then persuade the public.
Sadly, though, I also recognize that such is not always how science is done, how scientific questions are resolved, how the press, government, and population are persuaded. (The last case, in particular, is probably rarely how the world works.) I recognize that fraud happens and that, because science tends to assume honesty as the default, sometimes the scientist does matter. Science is a human activity that can't be divorced from the humans that do it. That's why it is sometimes necessary to focus on the scientist rather than the science. I don't like it. I don't like it at all. However, I understand that this is not an ideal world, and, because this is not an ideal world, we can't have that scientific utopia that I wish we could.
Sometimes we need pit bulls like Brian Deer to latch onto the dishonest and drag them into the light, the better to reveal their perfidy to the world.
At the same time, I must question Deer's choice of Drs. Goldacre and Offit as examples of the medical community closing ranks to protect one of its own. Indeed, even though I found Dr. Michael Fitzpatrick's characterization of the GMC hearings against Wakefield as a "witch hunt" to be clueless in the extreme, I must also question Deer's choice of him as well, because Dr. Fitzpatrick's defense of Andrew Wakefield appears to derive far more from his politics and AAPS-like distrust of authority--medical authorities included--than from a knee-jerk reaction to circle the wagons and defend a fellow physician. (Dr. Fitzpatrick has said similar things about HIV/AIDS denialists and global warming "skeptics, for example, although, if anyone comes close to deserving Deer's criticism in his article, it's Dr. Fitzpatrick.) Worse examples of such behavior than Drs. Goldacre, Offit, and Fitzpatrick I would have a hard time imagining, as all three of them have been very clear and consistent in criticizing Wakefield's "science." There is no conflict between believing that scientific questions should be settled by scientific studies, debate, and evidence whenever possible and accepting that science often doesn't deal with liars and fraud very well. Nor does expressing a desire that scientific questions be settled scientifically, as Dr. Offit does, for instance, preclude recognizing that we do not live in an ideal world and sometimes someone skilled at detecting fraud becomes necessary to overturn a false result. These are complementary, not opposite, techniques.
None of my disagreement with him alters my admiration for Brian Deer's amazing skill and dedication or the huge service he has done for the U.K. and the world by exposing Wakefield's research misdeeds at great personal cost. I will, of course, read (and very likely blog about) Deer's final installation, anticipating that it will certainly document dodgy behavior on the part of some physicians in the U.K. closing ranks behind Wakefield, in particular that of The Lancet's editors defending their decision to have published his case series in the first place. I have little doubt that the charges will, as always, be well documented and persuasive. There's plenty of blame to go around when it comes to the question of how Wakefield's fraud could have spread so far and so wide, to such horrific effect. I just wish that Brian Deer hadn't, in the lead up to the publication next week of his article describing how British physicians closed ranks around Wakefield, chosen such inappropriate examples to use to illustrate his point. Given that I know that Deer sometimes reads this blog, at least whenever vaccine stories are going around, I also hope that my words will lead him down a road that will show him that he's made a mistake.
ADDENDUM: Steve Novella has weighed in as well.
- Log in to post comments
The good part about your disagreement with Mr. Deer's approach is that he will be open and understanding, maybe even willing to change his opinion. This is so much unlike other critics of yourself and the "medical establishment" who are hell-bent on their demonizing of it. (See what I did just there?) That's the difference between someone who is rational and pretty much impartial and someone who is an ideologue.
It is odd, I agree. Of all people, Deer should know that our understanding of Wakefield's research has shifted hugely from small study to poor study to fraud study. Judging comments made in the past against what we know now is both odd and unfair.
I can only think that maybe Deer has been immersed in this so long that he's forgotten that. Maybe.
Clearly it is time to circle the wagons!
Although I don't agree with the message, our ability to have an open and honest dialogue remains a key differentiator over the anti-vax crowd.
Deer has called for an independent organisation to do random fraud checks on researchers:
http://goo.gl/PrgAE (may be behind a paywall - I'm subscriber to The Times)
"My dream is the formation of an Inspectorate of Research Integrity, with powers to examine researchersâ data and methods. They would arrive at a lab without notice, under a research integrity act. They would apologise for the trouble, but require answers to basic questions about the location and status of materials. Then they would secure the premises and return the next day with a team of legally and scientifically trained auditors."
It seems a reasonable idea but I wonder if fraud is widespread enough to make this cost effective.
When the GeWiPo (GeheimeWissenschaftsPolizei) knocks down my doors I know whom to thank. All joking aside, the whole idea that you could police science is lunacy. It might work in some rare cases of medical studies where precise protocols are to be followed in a clinical trial setting, but most science is accumulation of random facts that hopefully will make sense when you look at the whole picture, allowing you to come up with a hypothesis that you can then verify or discard.
I just spent 3 weeks writing "big bubbly sticky gooey mess" in my observations, I'd love to see the auditor dispute that.
@Paul
In the U.S., the FDA and OHRP do spot investigations of researchers. There are actually quite a few warning letters that go out every year citing violations of Federal regulations, for example, failing to maintain complete medical histories on subjects. I just read one summary of a warning letter from a couple years ago where the medical histories kept by the researcher did not match the clinical chart.
Granted, those investigations look at the research itself, not necessarily papers published as a result.
Allow me to present an argument for a somewhat contrary view.
I don't know that Deer's naming Offit, Goldacre, etc., is the best way to express this, but consider for a moment how naive, how contrary to the data, and how ineffective to defend the interests of patients, the attitude of "let the science settle it" has been demonstrated to be in this case.
I doubt you would defend the actions of doctors who kept urging a medical theory in the face of overwhelming data to the contrary. Now consider how conclusively Deer has seen it demonstrated that in the vaccine debate the science will not settle it. Think how maddening it must be for Deer to hear, from intelligent people close enough to the situation to have learned better, continued insistence that science is (or should be) adequate not only to correct itself but also to convince people that their former belief in ostensible groundbreaking scientific research was in error. (That of course is the reason for publication of what would otherwise be an unimpressive little case series - its ostensible finding of a cause for autism.)
I find myself agreeing more with Brian Deer than you do. Dr. Offit's comment, in particular. If not taken grossly out of context, that would display a rather shocking naivete. Even from the purely scientific perspective, the findings of fraud are very relevant. And the relevance is that they mean we can completely disregard the Lancet paper when weighing the evidence.
While it's true that, in this particular case, there is sufficient other evidence against Wakefield's proposition that we don't need the evidence of fraud to reject it, it is nonetheless a very important point to consider.
The investigator's biases are always relevant; that's why we have COI disclosures. In some utopian ideal that might not be the case, but in real science it is. Saying that it doesn't matter (again, unless that was badly out of context) seems to me akin to saying that seatbelts don't matter, because in an ideal world all drivers would be sufficiently careful and skilled that accidents would never happen.
I agree with you that this doesn't constitute "closing ranks" to protect Wakefield - it's just a different focus on why to REJECT Wakefield - but he has something of a point here.
On the other hand, science has actually falsified Wakefield's findings. No one not affiliated with Wakefield has been able to replicate them, despite multiple attempts and despite Wakefield's claims otherwise notwithstanding. The problem was not that scientists still thought Wakefield was on to something; they don't and the vast majority consider the question of whether MMR causes autism to have been settled with a negative answer. Science did correct itself.
The problem, really, is that this message is not the one that the public is accepting. That's when the knowledge of Wakefield's fraud becomes important, because it provides another tool that can be deployed to try to persuade non-scientists. I don't like it because it focuses on the misdeeds of a single man rather than on the body of science that validates the MMR as safe and effective, but using just the science isn't working. That's why I don't see a problem with using both the science and the findings that Wakefield is a fraud.
To build more on what you said about the scientist/journalist worldview discrepancy and how that creates the false appearance of conflict between Offit and Deer... it seems to me from the brief quote here that Offit is attempting to dismiss the emotional aspect of the story as being irrelevant to the science -- or even to the fraud charges. Whether or not Wakefield is a bad man does not alter the (un)reality of the MMR-autism link one iota.
But that's a little naive on Offit's part, and a mistake I do occasionally see in the science blogosphere. The final sentence of the previous paragraph may be strictly true... but whether or not Wakefield is a bad man sure as hell alters the public perception of the alleged MMR-autism link. And in this case, that's damn important.
By guess is that Offit is trying to say that the public should already have rejected the link based on the science, and that Deer's attempts to get the public angry about Wakefield's deception is redundant at best. And if my guess is correct, then yeah, Offit is a little wrong-headed in that regard.
(Of course, Deer's attack on him is way over the top... Offit is, at worst, being naive. "Circling the wagons" this is not.)
Well, this certainly is a touchy subject. I normally agree with you Orac, and I can see where you are coming from with your argument. However, your argument comes off in much the same way as the quote of Dr. Offit's. Scientist and doctors are the experts. Yes, in an ideal world, investigative reporters wouldn't be necessary. But, this is not the ideal world. Doctor's don't do a good job of policing their own, and scientists do have a problem detecting fraud. While the "truth" prevails and all the ugliness in the process is meaningless to the final result, it's not meaningless when people are hurt or die during the process, which is what has happened here.
The current system in which science is done allowed for the MMR scare to occur. It wasn't just the failure of Wakefield. It was a failure of the system. I would hope that Brian Deer would investigate the entire story and bring all of the problems to light, so that the public knows in full why this happened and why it took so long to correct. If that means that the good guys, like Dr. Offit take a hit for perpetuating the system that allows this kind of thing to happen, then I think that's fair game.
I don't expect that the solutions to these problems are going to be solved here at Respectful Insolence, but as a member of the general public, the message I got from reading this post was that the system is bad at exposing fraud and that's just the way it is, so don't insult us by calling us on it. It might have been a little easier to swallow if the message had been that they system is bad at exposing fraud and we'd like to fix, but it's hard and we don't know how.
Or, maybe it's time for medical journals to higher people to investigate fraud? Insurance companies do it to protect their investments, doesn't seem unreasonable for medical journals to do it to protect their reputations.
These are both triumphant and trying times for Brian Deer.
On the one hand he's gotten a lot of deserved credit and praise for his dogged and excellent investigative reporting on the Wakefield scandal; on the other he's been the target of virulent attacks from antivaxers over purported reporting ethics violations (none of which appear to be justified) and some of this blowback has even crept into mainstream reporting on the case.
So I can understand why he might take umbrage at what seem to be comments by Dr. Offit minimizing Deer's contributions. I suspect that wasn't what Dr. Offit meant to do - his point probably reflects the conviction that when all is said and done, the main thing to be concluded is that the science has spoken; MMR is not implicated in autism. Deer's emphasis is somewhat less on the overall issues of vaccine safety and poor quality science, and focused on fraud, conflicts of interest and substandard medical journal vetting of submitted articles.
Both of them have valuable perspectives. Deer sounds off-target with the "closing ranks" allegation; Offit should (if he does not already) recognize the importance of medical journals having robust fraud and conflict of interest filters and of the need for vigilant, informed media watchdogs.
Ugh, proofreading in my friend, proofreading is my friend...
Uh, I fail to see where I said otherwise.
Now I'm really puzzled where you got that message from. Did you read the same post that I wrote? For example:
Really, I'm genuinely puzzled.
I see it as Offit and others sort of -have- to take that stance in order to be sound defenders of the science. One of the biggest weapons used by denialists (anti vaxers, creationists, etc) is to create an emotional connection between the people and the issue ("Hitler was an evolutionist," "Orac's in the pocket of Big Pharma," etc) and a lot of energy and effort goes into trying to explain that good science is seperate from the people that do it.
Now the shoe is on the other foot, and we have a chance to say "Look, you anti-vaxxers are wrong because Wakefield is a fraud." But, no, that's wrong. The anti-vaxxers are wrong because they are, because the science doesn't support their assertions. Wakefield could be an angel or a demon, but that aspect of it doesn't make a difference in relation to how correct or incorrect anyone is on the subject.
For those of us in everyday, messy life, we can afford to blur the line (maybe) between the fraud and the science for political expediency, but I can see why Offit wouldn't want to blur that line and risk weakening a very strong defence against one of the anti-vaxxer's main arguments.
@Quietmarc
Excellent point. I wish I had thought of it.
Jojo writes:
Or, maybe it's time for medical journals to higher people to investigate fraud?
In a way they do, by using expert reviewers. These folks are supposed to be able to spot inconsistencies of data, the failure of conclusions to follow logically from premises (e.g., failure of purported mechanisms of action to make metabolic and biochemical sense), etc.
But look at how a study like Wakefield's blunts reviewers' ability to do these things. It wasn't big enough or designed in such a way as to raise data consistency issues. My impression (though I'm ready to be corrected if the facts are to the contrary) is that no detailed mechanism of action was proposed. As Orac says, it was a quite unremarkable paper - in everything but its implication that a cause for autism may have been found. That aspect was pushed by Wakefield outside the parameters of peer-reviewed publication, where the scientific process was ill-equipped to respond.
It isn't specific to Wakefield, vaccines, or even medicine, but Larry Moran and his readers at Sandwalk have been having some interesting discussions recently about various problems with the present-day system of dissemination of scientific information through peer-reviewed journals.
One of my concerns is how pseudo-scientists spin complex, nuanced issues that conceivably affect their supporters' behavior snd have real world consequences- the black-and-white "visionaries" at AoA, as well as Mikey et al, are probably presently concocting a distracting tale of war between Wakefield's detractors**, unable to reconcile the messy reality. When situations like this arise, I find it helpful to go back to the basic, un-elaborated facts we're considering: research, consequences, investigation, findings. We might discover that we're looking at apples and oranges here.
Actually, the entire situation vaguely reminds me of a family war that occured involving a disputed will : my father and I were placed firmly in the middle- it's not a nice place to be but is often necessary. I'm *so* glad I don't do family counselling....
** even if true, it wouldn't make Wakefield right.
I read the transcript of the Offit story.
Count me in as another voice that criticizes, unfortunately, Offit.
Orac - I know, I'm really having trouble trying to explain the feeling that Dr. Offit's quote and your post left me with. Like I said, I get your argument. I get that science is messy. I think Quietmarc above explained the dilemma that scientists have by having to stick with the science and not the emotion. Intellectually, it makes sense.
But, there is also a feeling that Dr. Offit's comment and your post evoke that is separate from the rational thought. It's like an aftertaste that I can't quite explain. I've been reading here for a long time, and I know that you care very much about people. I'm not as familiar with Dr. Offit, but I would assume that someone that refuses to give up the fight even when his family has been threatened, does it because he cares about people. But the wording of both his comment and your criticism of Brian Deer seemed a little tone deaf to the reality of Brian Deer and the public's dilemma of having to trust a system of experts that is not infallible.
I guess I sound like I'm tone trolling here, but I don't actually expect doctors and scientists to change the way they speak. I respect the fact that for the truth to work it's way to the top, you have to stick with the science and avoid the emotional arguments. However, I can also see were Brian Deer is coming from because it really makes me angry that Wakefield got away with his fraud and to me, justice matters almost as much as getting the science correct.
Without better context, it's difficult to assess just how ill considered Offit's words may or may not have been, but essentially he's right.
The findings of fraud are essentially irrelevant. Had Wakefield not committed fraud, it would still be one small, poorly designed and executed preliminary study based on an unlikely hypothesis that has have failed to be independently replicated. It's fairly settled science that nobody should give much further thought to even without the findings of fraud. The findings of fraud merely clarify that the source of the anomalous, unreplicatable data is more due to fraud than error or incompetence.
That Deer's findings are essentially irrelevant to science does not make them not valuable to society. The Wakefield story left the arena of science a long time ago, and it's unfortunate that hype and fear have largely trumped science and reason, but it has.
To over-simplify things- One group will not be particularly affected by deer's finding because the science has long been settled. One group will be unaffected because it's never been about the science, and their antivax position will never be swayed by facts. It's the third group for whom the findings of fraud may prove persuasive, and that's actually a problem. This third group (however large or small it may be) gives more credence to the finding of fraud than they have all the science and reason to date. This group has not formed their conclusions based on a rational consideration of the scientific support on the topic. They're one emotionally trumping story away from flipping their position again.
For some reason, my name gets stripped by Wordpress when I comment here these days.
-Karl Withakay
Bummer, dude. I think this whole thing isn't going down well with people; it's not having the effect the American (pharma-driven media want it to). Maybe evenBrian Deer realizes he's overstepped, twisted and been generally duped. It's a drag for your side but you really can't control the truth. It has a way of coming out.
Scientists think science is paramount.
Journalists think journalism is paramount.
It's not really surprising. I've seen the same thing among economists, biologists, physicists, lawyers, doctors, and all sorts of professionals. It's very common for each to think that their field is supreme and could police all others.
Public trust in science is nearly as important as good science. As public distrust of authority in general, including scientists, grows, it is important to demonstrate the integrity of the scientific process. The whole reason this study gained so much traction was that there was a deep mistrust of the medical establishment. And, to make progress, it has to be acknowledged that some of this mistrust is grounded, so that those of us who value the goals of science can fight against the sources of mistrust as much as the bad science.
This makes me think of my own inquiries into Poul Thorsen. To me, the greatest cause for skepticism was that Age of Autism tried to make it look like they had an actual press release about the allegations against him, where I was aware of even more serious charges (up to and including "angel of death" cases) being witheld from the public. I still have little doubt that university intentionally obfuscated and delayed in confirming that the wretched document AoA got hold of was really theirs.
I think the mentality at work is a kind of territoriality, on the lines of how the Catholic church handled molestation complaints: Reports of abuse are not necessarily met with indifference, but the first and strongest impulse is to try to settle them without letting "outsiders" get involved.
I think the major problem is that saying that Wakefield is a fraud because he was motivated financially detracts from the overall anti-quack message. Lots of quacks are true believers. That doesn't make them any less wrong. So just like Jojo feels a bad aftertaste when reading Dr. Offit, I actually feel a bad aftertaste when reading Andrew Deer. Wakefield was wrong. Why he did it is not relevant, because his message has been picked up by other people who are just as wrong, but do not necessarily profit from it.
I also think it's cute how Deer mistrusts doctors but seems to think journalists do not quote out of context.
Aww, how delusionally sweet; jen is trying to claim some sort of empty triumph because there is some disagreement as to a minor part of Mr. Deer's opinion, not the factual evidence that he has put forth mind you. "Pharma-driven media"? How hypocritical, for you are passing out silly awards when some media talking-head allows your lot to speak.
Yes jen, the truth has come out and you don't like it one bit. So much for 'open-mindedness'.
I think the major problem is that saying that Wakefield is a fraud because he was motivated financially detracts from the overall anti-quack message. Lots of quacks are true believers. That doesn't make them any less wrong. So just like Jojo feels a bad aftertaste when reading Dr. Offit, I actually feel a bad aftertaste when reading Andrew Deer. Wakefield was wrong. Why he did it is not relevant, because his message has been picked up by other people who are just as wrong, but do not necessarily profit from it.
I also think it's cute how Deer mistrusts doctors but seems to think journalists do not quote out of context.
This (quasi-)dispute really seems to be about people talking past each other, with related but distinct messages to convey.
1. Offit is mostly correct that the fraud doesn't matter to the long-term, detached evaluation of the hypothesized etiological link between MMR vaccination and enterocolitis and/or autism. Given the present data available within the field, if there had been no broad media attention associated with the '98 paper, it would have silently made its way onto the giant trash heap of small, inadequately controlled studies that failed to be validated by larger, better-controlled, independent studies. (This aspect of the so-called "Decline Effect" has been a recent topic here and in related fora.) Of course, if there had never been any media attention or vaccine scare, the follow-up studies would not have come so rapidly and thoroughly. That said, we can infer that Wakefield's hypothesis would have eventually been satisfactorily evaluated and discarded by the medical and research communities in due time. Where Offit is wrong, however, is that the egregious fraud itself now makes it reasonable, if not compulsory, to discount any published findings from Wakefield's research group and to exclude these reports from the broader analyses of scientific findings from within his fields. Rational explanatory models under development to explain the etiology of enterocolitis and/or autism do not need to take these data into account as the data likely cannot be trusted.
2. Offit is incorrect that the fraud doesn't matter in regards to the social, political, and public health outcomes over last dozen years. I honestly doubt that Offit believes this, though, and a reasonable interpretation of his statement is that he's discussing only the objective reality of the scientific question "do vaccines cause autism?" While it is within the nature of many scientists (myself included) to detach the scientific reality from its interactions with the non-science world, it's incredible naïveté to act as though such distinctions exist in any sort of real sense. Simply put, it comes off as merely a dismissive and paternalistic way to say, effectively, "the consequences of this fraudster's actions are irrelevant because the scientific community would have eventually, based on later studies, dismissed the research anyway." Again, I sincerely doubt Offit holds this opinion. However, the intent of, the implications of, and the inferences derived from a given statement can sometimes radically diverge.
3. Deer is correct that the fraud does matter. It matters a whole lot to those that have been affected by the rise in vaccine-preventable illness; it matters to those who have been wrongly convinced by Wakefieldâs actions that vaccines cause autism and that thereâs merit in the dubious, invasive treatments aimed specifically at a vaccine-associated illness; it matters to real-world public confidence in community health programs and the reputation damage for medical interventions and health organizations. The fraud matters in the consideration of the science, too, but this aspect is dwarfed by the consequences wrought upon the general public by Wakefieldâs deceit, The Lancetâs review process and editorial decisions, a willing and gullible media, and anti-vaccination misinformation groups.
4. Deer is incorrect that the statements from Offit and Goldacre support broad criticisms of scientists and scientific organizations, conflating their (likely nuanced and incompletely-presented) views into the idea that âestablishment vantage-pointâ¦expertsâ should ârule onâ revealed truth, and that such a philosophical stance is behind a perceived circling of the wagons by the medical community at large to âshieldâ Andrew Wakefield from fraud claims. There are many legitimate criticisms to make of the scientific and medical communitiesâ interactions with the general public. Here, Deer is sweeping more broadly and more deeply than he can support in his Guardian column, although he states that there is more to come regarding âhow the old boys' network of the medical establishment was mobilised to protect [Wakefield].â Deerâs self-congratulatory line, âI slayed the MMR monster,â is over-the-top enough to suggest that Deer may be taking any critique of the situation that doesnât adequately thank him for his remarkable and diligent investigations as a condemnation of his workâ¦I think he may have lost some perspective on the issue, but has always seemed open (in comments here and elsewhere) to fair criticisms. I hope he considers whether he has over-interpreted the statements heâs criticizing or has unfairly glossed over nuance and context.
Jen's little gem here gives a good idea of the anti-vax mindset. Any kind of disagreement from within is tantamount to the "whole thing not going down well". That's why they need to censor comments and why they turn on anyone who dares to disagree with the party line.
Quibbling over whether Brian Deer should or should not have taken a swipe at Dr. Offit is simply quibbling. It's not a rift, it's not a movement collapsing. It's a small debate that is making some people think about the difficulties inherent in communicating science to non-scientists. Whether I end up changing my mind on the matter or not, the debate has made me think harder about just why I felt the way I did initially. If I come to the conclusion that I was being a little too emotional in my response, I certainly will have no problem admitting to that.
And in the grand scheme of things, debating the merits of calling out Dr. Offit for his words is really, really minimal compared to what Wakefield did. Unless, of course, you still think that Wakefield's work is legitimate and that this is all just a fabrication to tarnish the poor (should that be wealthy) man's reputation.
There is one place where the scientist matters: if a scientist is shown to have made an honest mistake, the correction can be made and science goes on. If that scientist is shown to have falsified data, all their results become questionable. "Dr. X was wrong about that drug" doesn't mean Dr. X is wrong about everything; but if Dr. X faked results to make a drug look good, all their work becomes suspect, even if it's on other subjects. Conversely, if all 17 papers about a topic are by that same scientist or team, and even one of them is known to be faked, there may in fact be no good data on the subject.
I don't think that's specifically relevant here—this isn't merely one of a score of papers on autistic enterocolitis"—but it's worth remembering.
Simply put: no-data, badly-collected data, and fraudulent-data all have the same impact on scientific discourse -that is *no* impact. A disregarded paper does not somehow become negative evidence when it's proven to be a fraud, it is still disregarded.
However, when you have people like Wakefield deliberately promoting dangerous pseudoscience in the popular media, the gap between bad science and fraud is a game changer.
http://gawker.com/5732161/gawker-book-club-seth-mnookins-the-panic-virus
"Our latest iteration of the Gawker Book Club features The Panic Virus, a forensic and infuriating account of the genesis and spread of the vaccines-cause-autism meme by Vanity Fair contributor and Gawker pal Seth Mnookin."
...
"Below is an excerpt from The Panic Virus tracing Jenny McCarthy's role in peddling the fraudulent vaccine theory with an assist from Winfrey.
Give it a read and come back here at 1 p.m., when Mnookin will be taking questions from me and any other interested readers in the comments."
@Jen:
Wait, what? Big Pharma told Deer "Hey, if you do this expose on Wakefield, scientists around the world will all love you", and now Deer feels he's not being given the scientific love he's been promised? Because that's the only way I can make sense of what you said in the context of this post.
"It seems a reasonable idea but I wonder if fraud is widespread enough to make this cost effective."
Unfortunately, the lab I work in was involved in catching a series of fraudulent papers, all from the same author. The only way we caught it was because we had pulled all the author's papers (s/he was working on the same thing as us) and noticed that Photoshop was used to generate false data. It took several days of digging and analyzing the figures to realize what had been done, and there was no reasonable way to expect a reviewer to catch such deception.
It was a sad day for me, that a fraud was committed so "close" to home, in my field. :(
I knew Alison, I mean science mom would say something all dripping with venom. Thanks for not disappointing.
Is a fraudulent paper that is never reproduced the same as a flawed paper that is never reproduced? I don't think so. It depends on how common this type of fraud is. If it's rampant, there would be no way to trust the scientific method. The only reason science works is that most scientists presumably don't falsify data.
If anti-vax researchers typically falsified or massaged data, and they had sufficient resources at their disposal (which is not unreasonable to imagine -- consider the Geiers) they could very well manage to get a number of papers past peer review, they could "reproduce" some results, and so forth. This is not good for science in general. Hence, it's crucial to uncover fraud, and it's crucial to deter it.
Good editorial today in the N.Y. Times that puts the entire Wakefield debacle in perspective:
"After seven years of studying medical records and interviewing parents and doctors, (Brian) Deer concluded that the medical histories of all 12 children had been misrepresented to make the vaccine look culpable. Time lines, for example, were fudged to make it seem as though autismlike symptoms developed shortly after vaccination, while in some cases problems developed before vaccination and in others months after vaccination.
Dr. Wakefield has accused Mr. Deer of being a hit man. But the medical journal (BMJ) compared the claims with evidence compiled in the voluminous transcript of official hearings and declared that flaws in the paper were not honest mistakes but rather an âelaborate fraud.â
Some parents still consider Dr. Wakefield a hero, and others have moved on to other theories, equally unsupported by scientific evidence, as to how vaccines might cause autism.
They need to recognize that failure to vaccinate their children leaves them truly vulnerable to diseases that can cause enormous harm."
As part of her unintended irony parade, jen said:
"I think this whole thing isn't going down well with people; it's not having the effect the American (pharma-driven media want it to)."
Would that be the same "pharma-driven media" that's used Brian Deer's extensive reporting on Big Pharma malfeasance? Yesterday I did a Google search to locate information on Bactrim in connection with a case I was working up of acute liver failure possibly caused by a toxic reaction to this antibiotic. The first link that popped up was to Deer's website. Seems he's investigated problems with Bactrim.
Poor jen. It must be a real bummer when your endless twisting of facts and motivations leaves you in a hopelessly confused muddle.
I knew Jen, I mean anti-vax dumbass would say something idiotic. Thanks for not disappointing.
Offit was on WNYC's Leonard Lopate show today talking about Wakefield. You can listen here -
http://www.wnyc.org/shows/lopate/2011/jan/13/
The first link that popped up was to Deer's website. Seems he's investigated problems with Bactrim.
At least when I visited the site, Deer was saying the Bactrim info (where he exposed Big Pharma company Wellcome regarding that highly remunerative drug) remains the most popular on his site. The Wakefield stuff might challenge it, though.
In the interests of fairness, I ought to point out that The Guardian's science desk cut a paragraph from my blog item:
"And last May, when the researcher was ordered to be struck off, now-Guardian blogger Dr Evan Harris, leapt in, insisting: âIt is time to forget about Andrew Wakefield.â
So that's another doctor I hurled into the inferno. I hope that helps!
[dons tin-foil hat]
Y'see, in those cases Big Pharma knew that someone was going to uncover what they did, so they had one of their loyal minions be the first one to report it in order for that minion to accrue some anti-Pharma street-cred. That way when the minion did some pro-Pharma reporting it would look like they weren't pro-Pharma.
[removes hat]
So, how'd I do?
Offit has been crystal-clear on the distinction between evidence and [mis]conduct. His WSJ op-ed, for example, is perfectly consistent with the quote that offended Brian Deer:
Brian Deer may not share that philosophy, but he cannot argue that it is poorly thought-out.
Jen, don't try to ferret out my identity, you dolts couldn't hit the side of a barn with a bulldozer when it comes to trying to reveal bloggers' identities. Dr. Singer posts under her own name. If it helps, I'm younger, have a different field of expertise and don't have an autistic child. Now please cease your idiocy for a single day; consider it a holiday from your dumb. How's that for vitriol?
I'm reading Autisms False Prophets and I've read the parts where Offit mentions Deer's work. It never struck me as demeaning anything, on the contrary, it struck me as Offit appreciating the great work Deer has done.
But of course, that Wakefield is a fraud should be secondary to whether the hypothesis that vaccines cause autism is true or false.
Another thing I've learned:
big egos don't play well together.
Very off-topic, but an amusing rebuttal of astrology:
http://www.metafilter.com/99466/Luckily-my-sign-is-unchanged-Slippery-W…
On the flip side, if Einstein were to be proven a fraud, falsifying data for, say, special relativity, it would still be true, just because the science agrees vehemently, though it would have been a very lucky strike for him.
This is like the perennial topic of whether we should oppose torture because it's wrong or because it's useless. Not everything is a race to be first.
If Wakefield were right and honest, life is good.
If Wakefield were wrong and honest, the "wrong" would be the only issue [1]
If Wakefield were right and dishonest (it happens), the only issue would be his dishonesty.
As Wakefield is both wrong and dishonest, we have two issues:
a) What is the scientific truth -- lives depend on this
b) What is the forensic truth -- for the usual reasons when crime is committed.
Because public health is at stake, we can't ignore either of those last two. We must know the scientific truth, else we might risk lives. However, thanks to the vast media involvement this isn't some tempest in the letters column of a journal -- justice, to borrow a phrase, must not only be done but must be seen to be done.
Correcting the scientific record isn't enough because to the journalistic coverage over the past decade. Hanging Wakefield out to dry isn't enough because that leaves the medical facts in doubt and the public without sound guidance.
Brian Deer has done a great and necessary service. His work on this stands as a textbook example of journalism at its finest. But his investigation, though necessary, is not sufficient.
Paul Offit and other medical scientists [2] have done valuable and necessary work and stand as examples of how science is supposed to work. But their studies, though necessary, are not sufficient.
Together we have what should be (barring those immune to facts and reason) the final word on this tragic story. Neither prong of attack by itself would have been sufficient; without the other the public would have suffered. Let's see both get the respect they have earned, please?
[1] Timing matters, since in the meantime matters of public health would be in limbo.
[2] Not least our good host
@Sessions:
What? If he were right and dishonest, despite his dishonesty it would still mean that MMR causes persistent infection in the gut and needs to be changed.
by continuing to focus on Dr. Wakefield's indiscretions rather than on the serious studies that have proved him wrong, we only elevate his status among antivaccine groups as a countercultural hero.
I have to respectfully disagree.
(1) Can anyone imagine people/organizations such as Thoughtful House wishing to terminate their associations with Wakefield absent proof of misconduct?
(2) As others have pointed out, fudging results is something easily understood by members of the public who may have accepted Wakefield et al.'s "explanations" in part because they sounded a whole lot simpler and more conclusive than what the science-based medical community was putting out. Last week(?) I heard yet another outraged anti-vax caller spewing "Mercury is poison!" on NPR's Science Friday; Offit's response was calm to the point of dispassion, reasoned, probably over the heads of or unconvincing to many of those who heard it, and possibly giving the very unintended impression of smug contempt for the caller and those who agree with her.
There's a lot of anger out there presently directed at Big Pharma and doctors whose only "crime" is working to save kids from terrible diseases. If that anger can be turned toward the scam artist who deserves it, by simple expedients like Deer's chart showing actual characteristics of "the 12" vs those Wakefield used in his paper, then what about that is counterproductive to the eventual goal of getting these people to listen to and understand the actual science?
I'm pleased to read the resonable discussion in the comments here. I hope Mr. Deer reads them. Many researchers and clinicians have been speaking out against Wakefield for a long time, and as mentioned, Mr. Deer's extensive investigation into Wakefield's outright fraud goes a long way towards removing the undeserved influence he had in the public sphere.
The point remains that mainstream science did indeed dispose of the wrong-headed hypothesis, but the public sphere sits elsewhere and has different priorities.
(I mean, stripping the guy of his license to practice, retracting his paper, and lambasting his methods ain't 'circling the wagons,' unless you're talking about circling them to keep that guy away from kids.)
@53: I think DC was making a generalization, not trying to imply that Wakefield's specific ideas were right. Substitute "Random scientist" for Wakefield in his post. It is possible for someone to be correct, but to also be dishonest.
I'm impressed. Both by the article and the preceding comments. The comments on this blog posting are insightful, opinionated, respectful, open and an actual discussion. It's not massive walls of copy + paste of random articles found across the internet or emotional diatribe. I enjoyed reading it.
(Funny enough I just got down to Jen, anti-vaxer, and I can tell what blog's/sites she visits. Bringing down the entire discussion a notch and incapable of not spouting off dribble rather than have an actual thought.)
"In such an ideal world, it wouldn't be necessary to worry about whether or not Wakefield committed fraud, because the science would matter far more than the scientist. "
And I hate defending Deer but isnt that a bit like what went on leading to the creation of the post WWII Doctors' Trial, and revulsion at the abuses perpetrated led to the development of the Nuremberg Code of medical ethics.
@Quietmarc:
Yes, I agree on the point. What I was questioning was that DC seemed to be saying that if Wakefield was right but dishonest, that only his dishonesty would matter, and that it wouldn't matter that he was right about MMR causing persistent gut infections leading to autism. If he had been right about MMR leading to autism it would have mattered very much.
Now the shoe is on the other foot, and we have a chance to say "Look, you anti-vaxxers are wrong because Wakefield is a fraud." But, no, that's wrong. The anti-vaxxers are wrong because they are, because the science doesn't support their assertions. Wakefield could be an angel or a demon, but that aspect of it doesn't make a difference in relation to how correct or incorrect anyone is on the subject.
On the issue of science, you make a great point, but there's more to solving the problem of antivaxxers, and science denialism in general, than this.
It has been shown to be the case, especially for Americans, that the source of information is at least as important as the information content itself.
for example, see this paper published in Science a few years back:
Childhood Origins of Adult Resistance to Science
which is a review paper of the many studies showing this to be the case.
We see it again, here, with Wakefield.
Wakefield has gone into the antivaxxer community, spouting placebos and reassurances based on nothing but vapor, but the antivaxxers eat it up, and STILL will defend him, despite all evidence that he was wrong.
Part of weaning people AWAY from science denialism, is by showing them that the authorities they rely on for their information, really ARE lying to them.
IOW, they are NOT credible sources of information.
This, you might say, is the socio-political angle of this fight.
Many of us have seen this as we battle creationists. VERY rarely does won win a creationist over to reason by evidence.
Instead, what we see over and over again is that creationists who have accepted science, did so because it was shown to them that their pastor/priest/peers were lying to them.
IOW, that these authority figures were no longer credible.
So, the fraud issue here with Wakefield IS important; NOT for the sake of the science, but because it detracts from him being a credible authority figure on this issue.
It would be nice if it were the case that most people did not rely so heavily on authoritarianism, and instead were taught better critical thinking skills to begin with.
That not being the case at the moment, at least, we simply mustn't ignore the fact that Deer's work proving Wakefield's fraud DOES help to discredit him as an authority.
I hope this makes sense to people; if it doesn't, PLEASE read the paper by Bloom and Weisberg I linked to.
The science supports what I'm saying here.
A totally non-controversial situation. Science revises itself (and public health procedures) all the time.
Example: CPR. Not, I trust you'll agree, a trivial issue. CPR guidelines, in large part due to work done at the University of Arizona and field experiments done near where I live, have been changing markedly over the past few years.
In general, the number of chest compressions per rescue breath has been increasing. We're now on the scary threshold of doing away with rescue breaths in primary cardiac arrest entirely on the grounds that circulation lost during rescue breathing is not recovered; it's better to do chest compressions without breathing than to stop for breaths.
Or so the research goes. Very few in the medical community are prepared to change practice based on that yet.
Very few outside the medical science community even know that the topic is controversial.
Wakefield, had he been right (dishonest or not) would have been another chapter. Like peptic ulcers, like CPR, you name it.
But he wasn't, and he didn't confine his wrongness to the pages of journals for the medical science community to thrash until the truth emerged.
The rabbit hole just goes deeper and deeper
This debate is interesting because it shows the difference between the mindset of journalists and physicians/scientists.
Journalists have been trained by their education and experience to research and report on the human elements in addition to the science behind a small study printed in a medical journal. Physicians/scientists are (rightly )focused on the scientific data.
I don't think any journalist or physician/scientist..with the exception of reporters who practice sensational journalism and the alternative medicine practitioners...could have ever imagined the long reach of Wakefield's "study".
His "study" was debunked years ago and now Brian Deer has investigated and reports on the skewing of the data by Wakefield for personal gain. That's what journalists do.. it is in their DNA.
The "study" in question is just one of many faulty studies and theories that the anti-vax movement uses for their cause. It has also been used by those who ascribe to the physician/drug manufacturers conspiracy.
In my opinion, a small number of doctors do cover for others, by not speaking out, by not self-monitoring of their own profession and by the cumbersome process at State Medical Associations and State Health Departments for disciplining and/or revocation of medical licenses.
Offit has attempted to not add to the rhetoric, by just commenting on the validity of Wakefield's study; he has received threats by a very vocal group who still believe that immunizations cause autism. Offit and Deer are both advocates for children and I am impressed with their activities to protect children from the scourge of vaccine-preventable diseases
@56:
A thought I have had on similar lines: "One doesn't have to be innocent to be framed." Also, I believe that, as a rule, fraud rises from the researcher's sincere, prior belief in some element of a fraud. In some cases, it is to be expected that the fraudster's confidence will be justified.
sheldon, did you read the story from the Inquirer, or did you find a transcript of the entire interview with Offit? If so, got link?
Is anyone actually aware of the fact that this actually has happened especially in regards to vaccination? Of course it predates most antivaxers by decades but still this actually has happened.
Here is the BMJ editorial to which Mr. Deer refers:
http://www.bmj.com/content/340/bmj.c2829.full
I actually rather agree with Harris when he wrote in that editorial:
I remain puzzled, though. In this article, Dr. Harris seems to be arguing at least some of the same things that Mr. Deer is--and arguing them quite strongly: That the medical profession needs to get its house in order after Wakefield.
Had to share this, since it's relevant for a lot of the posts here. From the popular xkcd comic:
http://xkcd.com/836/
When I have my "scientist hat" on, I'm with Offit. I care primarily about whether Wakefield was right or wrong. That's a question that has already been answered by the science, so from the standpoint of pure science, what Deer has done is along the lines of dotting the i's and crossing the t's -- nice, but kind of irrelevant.
But from the standpoint of public health, Deer has rendered a major service. The fact is that prior to Deer's expose, Wakefield was still peddling his destructive nonsense, harming children, and getting paid for it. And the very fact that Deer is not a scientist, cannot conceivably have any vested interest in the profitability of the medical or pharmaceutical business, and has an established record of exposing impropriety within the pharmaceutical industry, gives him a level of credibility with the public and the media that no scientist, however eminent, can match. It is what makes Wakefield's attempts to use the quack's ultimate weapon, the "pharma shill" gambit, against Deer so laughable (and indeed, Anderson Cooper seemed to be having a hard time keeping a straight face when Wakefield tried it). Perhaps this rankles Dr. Offit just a bit; if so, I sympathize.
An interesting footnote; Wakefield has made a statement about Deer's and BMJ's reporting from Austin, Texas.
Also, Channel 9 Fox News in Minneapolis reported that Wakefield met with the Somali community there to discuss the high incidence of autism among Somalian children living in Minneapolis. He further stated that there is no autism in Somalia.
#70
No autism in Somalia?
Just like there's no gays in Iran, right?
Somalis are Amish?
Jen and Science Mom,
get a fucking room. Some of us could care less about your twisted affair.
Thanks in advance for your cooperation.
Orac,
I am not at all clear why a proponent of "science/evidence" based medicine, such as you claim to be, is classifying any of Deer's work as "truth" (whether that is today's post, or the real estate you've so loyally devoted this week). This entire media circus has only furthered your opposition by shining a light in the same exact spot it was last year and pushing them into places you perhaps wish they hadn't treaded. Maybe that is where your "thoughtful" position today stems? In sales they call it mirroring.... for if you are one of us, of course we believe you! For me? You'll have to try harder.
As always, feel free to file my post accordingly.
Loyal Commenters, save your snark, I could give a shit.
Sorry to go off-topic, but Orac might be interested in this:
The CBC has an upcoming episode of Marketplace entitled "Cure or Con" investigating homeopathy:
http://www.cbc.ca/marketplace/2011/cureorcon/index.html
Is anyone able to make any sense out of this? It reads like RACTER output to me.
@cynic:
Orac is criticizing Deer not out of genuine disagreement, but as an attempt to sound more credible to anti-vaxxers?
1) Deer's latest articles, far from being a blow to Wakefield and/or the anti-vax movement, have instead only strengthened public support for him and/or opposition to vaccines.
2) Orac's criticism of Deer isn't genuine, but is rather a cynical attempt to gain credibility among anti-vaxxers. Orac thinks that since anti-vaxxers hate Deer, then him criticizing Deer will make the anti-vaxxers like him more.
At least, that's what I got out of it.
@ Antaeus and Matthew, don't try and make sense of cynic, she's rather angry right now. The problem is, is that she dwells in places that don't allow for open discussions or simply gravitates to places that engage in communal reinforcement. A beehive mentality, if you will. Dissent is not expressed therefore she doesn't have the capacity to understand that sceptics are not only allowed but encouraged to have opinions or present evidence that may seem contrary to the box her ilk have placed us in. It is ignorance or misunderstanding of what scepticism should be.
Ooops, I didn't complete #2.
2-continued) Orac's fake-criticism of Deer was utterly transparent to cynic, and Orac will have to wake up a lot earlier in the morning if he hopes to pull one over on cynic.
Cynic,
'Some of us *couldn't* care less.'
'I *couldn't* give a shit.'
English: use it or lose it.
PS. For those of you who might accuse me of being a grammar nazi or some other lame epithet, your lack of respect for the English language resonates with me not one whit.
Jeff, no complaints here. It is not as thought the word could is starting to morph to mean something else. It just does not make sense to write it as "I could care less"
Travis, that is true - unless you are attempting to give the impression that you already care a great deal!
I'm fairly certain that is not the impression that Cynic is hoping to give (although it is indeed the impression that they give. The commenter known as Cynic appears to care very much).
Jeff & Travis,
Seems that 'cynic' is just a twat, and does not really bear up to the meaning his/her screen name actually means. An obvious lack of understanding of how English language works, taking that and his/her imbecilic use of the phrase 'I could care less'. No complaints here, either.
Good post. It seems we've circled back to the two cultures, where only the person from the 'right' culture can address that audience.
It's a really odd and rather sad situation; I remember first and foremost Evan Harris, Ben Goldacre and other scientists showing how crap and non-believable the science was, and then Brian Deer demonstrating what a lying shit Mr Wakefield is. These two strands really seemed to work together and complement each other. Now we are to view Brian Deer as the anti-establishment lone crusader; I guess I have to take it on the chin, as I'd argue that it's what the messenger says that is important, not the messenger himself!
Maybe compounding the problem is the different speeds that the two areas work at, with the science proceeding far slower (in years not months) than the media do, which maybe can be interpreted as 'circling the wagons'.
I think Brian's accusation is a bit "...and when did you stop beating your wife?": what ever answer you give to his accusation, you're a bastard.
Eleanor: Your memory is sort of right. An interesting thing, however, is that all the epidemiology and discussion and "science" had no impact on public attitudes. MMR uptake continued to fall, from Wakefield's first pronouncements (actually on Crohn's) right through to 2004, when they bounced sharply back following the exposure of Wakefield's involvement with lawyers.
I see at Dr Steven Novella's site the quite untrue allegation that, after science settled the matter, journalists then hypocritically changed their stance and went after him.
It is among the salutary lessons of this saga that all the opinion and assurances in the world had no discernible effect on public attitudes.
Another salutary lesson is that it took seven years of (admittedly not full-time) investigation, plus a statutory tribunal which cost UK doctors about $10m to puncture the veil of confidentiality which surrounded the original Wakefield paper. With litigation, editorial and other costs, it probably cost in excess of a million dollars a child to get to the bottom of the matter, allowing the New York Times yesterday to report "Autism Fraud" as an editorial.
What does that tell us about scientific publishing? Hence my concerns about doctors who - perhaps not themselves primarily concerned about the integrity of science in their interventions over MMR - wished to suggest that Dr Wakefield was unfairly treated and that the "scientific method" solved the riddle. It didn't.
Curiously, it was those who waxed most lyrical about how safe MMR is, and how appalling was the fall in vaccination rates, who were the interested parties least able to bring about any change in public perception.
My impressions about what Brian Deer just wrote, as a lay (non-doctor) member of the public with no special information other than following this and related stories with interest:
Hence my concerns about doctors who - perhaps not themselves primarily concerned about the integrity of science in their interventions over MMR - wished to suggest that Dr Wakefield was unfairly treated
Doctors suggesting Wakefield was unfairly treated? If you're talking about Offit, et al., my impression is that they don't particularly care how he's treated (think of the line from the Who's Tommy - "Let's forget you, better still") as long as his junk anti-vax science is well and truly known for the nonsense it is.
and that the "scientific method" solved the riddle. It didn't.
Depends which riddle you're talking about. If it's the scientific question of whether MMR causes autism, that was solved for scientists (in contrast to the general public) long ago. If it's how Wakefield got his non-replicable "results," then of course you're right, though science did lay some groundwork when other folks couldn't repeat what Wakefield claimed to have done. If it's the public's attitude regarding the safety of MMR and other childhood vaccines, then I very much agree with you that solemn, educated, expert pronouncements have played the metaphorical role of water off a duck's ass as far as changing opinions. You're going to (continue to) help save some kids' lives, Brian Deer. Good on ya.
Off topic, but on the topic of "I couldn't care less", David Mitchell did a youtube video on the subject:
http://www.youtube.com/watch?v=om7O0MFkmpw
In any event, it's an interesting conversation.
While it is true that sound scientific evidence and reassurances from experts have limits when it comes to convincing parents of vaccine safety, I'd hesitate to proclaim that the news media can pick up the slack (assuming it's doing its job properly), much less do a better job.
Steve Novella has an interesting take on the situation, in which he describes how Internet communications may have had a far greater negative effect on Britain's MMR immunization rates than the sensationalistic news media coverage of Wakefield's Lancet study.
It's well and good that major media outlets have been heavily reporting in recent days on evidence of fraud and conflict of interest on the part of Wakefield. How well that translates into improved confidence about vaccines and adequate immunization rates may ultimately depend on conversations in forums like this one.
Rather than getting into a debate about whose role was more instrumental in getting the goods on Wakefield's bad science, I'd hope that both researchers and investigative reporters recognize that their roles are complementary, and that neither element alone is sufficient to promote good science.
Well then we are fucking screwed because as I all ready said there have been scenarios specifically in regards to vaccine safety that can't solved by saying it was an act of fraud.
PS:
Your website is serving antivaccination ads.
I don't think anyone can seriously think Wakers was anything other than a charlatan at this point, based on the reporting done to date.
And I'm sure there were folks who closed ranks behind Wakefield, even those at Royal Free. It wouldn't be the first time an institution tried to make a bad situation go away quietly. It was a colossal blunder if that was their intent, but it's not like it's unprecedented.
But I do agree with Orac's main point - that at some level, the fact that Andrew Wakefield was a fraud is less important to global health policy than the fact he was wrong. Because what if Andrew Wakefield was all of the things he's been shown to be in Deer's reporting, yet for some reason his hypothesis was correct?
I meant to say Offit, not Orac, in the post above.
I guess Dr. Offitt is only concerned with the issue of whether or not vaccines cause autism and as he sees it, it doesn't matter if Wakefield were the deliberate fraud that he is or not, the only thing that matters is that Wakefield's claims were wrong and shown to be wrong many times over. So I guess in Offitt's speeches he'll just stick to saying "Wakefield is wrong" rather than "Wakefield is not only wrong, but he's a damned money-grubbing liar too". Brian Deer was a victim of Wakefield as well (after all, who would you believe - a stinkin' journalist or a doctor of medicine), so he'll probably be offended by anyone who doesn't continually point out the fact that Wakefield is a criminal. Personally, if any anti-vaccine person comes along I'd be happy to tell them about Wakefield's criminal activities and how he duped people into believing that the MMR vaccine causes autism. Wakefield's criminal actions do matter to me - if he were an honest but mistaken researcher then this would not be such an issue.
Brian, having now read read my post I feel a bit bad about the tone. But I think there were always two strands (or two riddles, if you like) to the response to the Wakefield study: scientific opinion and public opinion. It was important to prove the idea wrong scientifically, and, once that was established, highly important to counteract those claims in public.
I agree that showing it was scientifically wrong did naff all to change public opinion (which I think is terrible, and does reflect badly on some of the science and health reporting) and that the work you did and are doing which shows what crappy sham the whole study was has made massively more inroads into altering public opinion.
Where I disagree strongly is that I don't think that any of the people you named ever tried to hide Wakefield from scrutiny. I think they tried to refocus the debate towards the science, as I would do, and maybe tried to defend the scientific process. In my memory of the whole thing, I remember Evan Harris as important in bringing it into the political arena, helping publicise it.
The whole shit storm has shown huge problems in media presentation of medical results, the inability of the medical profession to deal with their own, and the huge problem the science side has with dealing with fraud. I don't think any of those parties (I include myself under the science side) can dodge blame. I think your research and reporting has directed lots of attention onto at least the last two, and I hope making it hard for the medical and scientific communities to pretend the problems aren't there. But doing down the contributions of Goldacre, Harris and Offit seems shoddy.
@Orac: I believe that the comment by #16 deserves to be an addendum to your post instead of being buried in the comments in which not everyone delves into for additional insight. I believe, without reading Dr. Offit's mind, that this would be a resonable explanation for his comments on Wakefield.
This is hilarious. Love it! Brian Deer is such a pompous *ss that now he's going to be pissing off a bunch of "doctors" (and yes, I use that term very loosely). So funny... Couldn't have scripted a better situation. :)
@Ha Ha:
So far all I see is polite discussion.
I honestly thought Cynic's comment was hilarious and apt. ( understanding that s/he could care less). I will knock it off with the taunting crap and maybe Science Mom can lose the invective. A serious question: couldn't it be the case that a) many of Dr. wakefield's colleagues don't think he did anything wrong ( unscientific, unethical) and b) they are terrified to have come forward to support him and re-canted due to fear over losing their jobs?
@Jen:
"Couldn't it be the case that there's invisible evidence which supports my side of the argument?"
This can always be the case, for any side of any argument, but such evidence is never useful because it's, well, invisible.
Ps. That's why I believe Dr. Offit said," it doesn't matter that Dr. Wakefield was fraudulent." Because he knows that really wasn't the case and that Brian Deer doesn't have a strong case, or maybe even any case of "fraud" against Wakefield.
Nervous laughter is often the response to unexpected events and to those who participate in the protected environment of AoA and other forums where dissent is purged and praise of the leader is required, polite disagreement must seem very strange and frightening indeed. Parents of autistic children should be very gentle and kind with antivaxxers who wander into this forum, and become frightened and confused, no matter what lies they tell about our children; if we are unkind, they will only retreat back into their shells.
Jen, you're misreading Dr. Offit's statement. From a stance of pure science, that he was fraudulent means nothing. From the stance of human affairs, it means everything.
I'd like to point out that Scientizzle at #31 has the most reasonable summation of the situation.
@Jen:
1) You think Offit believes Wakefield did nothing unscientific or unethical, but won't say so directly for fear of losing his position?
2) It seems pretty clear to me that Offit means "since Wakefield's science is wrong, whether or not he committed fraud is irrelevant". If that's not what he actually said, how should he have phrased himself?
Jen is actually making a really good point here.
People who are science-minded hear Dr. Offit's words as meaning one thing, and yet the general public (as Brian Deer points out) are likely to hear different connotations to those words, and people who believe in Wakefield (as Jen points out) hear an even more Wakefield-sympathetic connotation.
Science is one thing, and public health is another, and it can be hard to guess what our words sound like to members of the public. OMG I am talking like Chris Mooney, black is white, night is day, and I get myself killed at the next zebra-crossing!!!!!!!!
@Jen #101
Actually, it seems quite clear that Deer has an extremely strong case that Wakefield committed fraud. He has the documentary evidence, and it withstands scrutiny.
The reason for Offit's statement is quite clear in context (as has already been said a number of times in this thread): Wakefield could have been dishonest and committing fraud, but still could have potentially been right that MMR caused harm. As it stands, the science demonstrates that he wasn't right, either. He was, in fact, dishonest AND wrong.
I would be more than happy to.
Well, you would have to define his colleagues for he had some directly involved with the Lancet and related research and he has a different set now with his then and post-Thoughtful House activities. Given your question, I will assume that you are referring to the former, e.g. Dr.s Murch and Walker-Smith. It is possible, although unlikely (due to statements they have made) that they believe Wakefield didn't do anything wrong. At one time they may have believed that, but I don't think that's the case in the recent past. It's a tough position to be in, for by admitting Wakefield was wrong, they were too, by extension and association.
When you realise that a once-trusted colleague has not only committed an egregious sin in science and medicine, but has involved you too, it's not merely self-preservation to distance yourself from it, but a statement of intolerance and disagreement with the guilty person's actions. Wakefield has a handful of physicians and scientists that are rushing to his defence now, e.g. Richard Deth, Bob Sears and Jay Gordon and none are in jeopardy of losing their posts so I don't believe that anyone who comes to his defence is threatened.
Both Walker-Smith and Murch retracted their interpretation of the Lancet study back in 2004, yet they were both co-defendants with Wakefield in the GMC hearing. Walker-Smith was de-licensed, while Murch was not. And someone more familiar with the GMC transcripts than I may correct me if I'm wrong but Walker-Smith tried to distance himself from Wakefield so I doubt that simple support of him was enough to lose his license too; that was done because of his own actions, not Wakefield's.
Aaaand paragraphs 2 and 3 somehow got flip-flopped.
@SM: don't try and make sense of cynic, she's rather angry right now. The problem is, is that she dwells in places that don't allow for open discussions or simply gravitates to places that engage in communal reinforcement. A beehive mentality, if you will. Dissent is not expressed therefore she doesn't have the capacity to understand that sceptics are not only allowed but encouraged to have opinions or present evidence that may seem contrary to the box her ilk have placed us in. It is ignorance or misunderstanding of what scepticism should be.
Blow it out your arse lady, your conceit is suffocating. You folded that sanctimonious box around you by your own doing. Own it.
I stopped listening to your blather long ago... sad really, sometimes you have something thoughtful to say. Too bad it's overshadowed by your ego.
Your lopsided application of skepticism irritates me, it's really that simple.
@Melissa G:
Then I wonder what people like Offit should do. Pause before each statement in order to construct a verbose sentence which details exactly what you mean? Add disclaimers to each sentence you utter? Or I guess this sort of thing is just unavoidable when you communicate with others...
Matthew Cline writes:
Then I wonder what people like Offit should do.
Actually, I've been seriously thinking about this one, based on his less than optimal response to an anti-vax caller on NPR's Science Friday last week. And ISTM that someone who writes as well as Offit should be able to arm himself with general-public-friendly (but still medically accurate) talking points before going on such programs.
Of course I'm sure Offit would like to spend most of his time doing actual, y'know, medicine. So to me that would present a choice: Do the prep work necessary to make yourself easily understood and persuasive to a general audience, or cut down on public appearances before general audiences.
What I read out of Brian's latest comment here is that the scientists might have disproved Wakefield's work, but they weren't effective in convincing the public. Meanwhile, he was effective at convincing the public.
So (and here I'm reading in even more, so take it with a bigger grain of salt) he is the one who did a better job.
@Matthew re. 104, I think Offit might know/suspect that Deer's "fraud" charges are unsupportable/bogus. I don't think there is any reason for Offit to fear losing his position at all. However, Wakefield's colleagues, cohorts of that time would be an entirely different matter (of course, per Science Mom's point, not just anyone who comes to Wakefield's defense would be threatened). In interpreting Offit's words we might rely on semantics, context and maybe even sub-conscious thought processes but at the end of the day only he really knows what he meant.
-sorry about double posts. I'll blame the iPad.
I'd love to hear how manufacturing/changing/deleting data, and repeatedly straight-up lying in the paper, do NOT constitute scientific fraud.
Jen writes:
I think Offit might know/suspect that Deer's "fraud" charges are unsupportable/bogus.
It's difficult for me to believe this when sworn testimony from the hearing on Wakefield's license to practice and the Autism Omnibus, which occurred well before Deer's latest publication of more detail, completely supports the general outlines of Deer's story - for example, the testimony from Wakefield's lab assistant that he personally informed Wakefield there were no traces of measles virus in samples from any of the children.
Jen,
Given that Deer published his articles about Wakefield's fraud in the UK, which has libel laws that have been described as "plaintiff-friendly", I think that the BMJ wouldn't have published his claims unless he had rock-solid evidence backing him up. In fact, I'm convinced of it.
For the non-conspiracy theory-minded, the reasons Wakefield's co-authors disavowed the Lancet paper and have not been leaping to defend him following the latest revelations are logical and simple.
For anyone whose reputation and livelihood depend on scientific research, it is damaging to be associated with sloppy, bad science. It is worse to be linked to severe financial conflicts of interest. Being tied to outright fraud would be devastating. Add in childhood injury and deaths attributed to your actions, and it's no wonder that former Wakefield associates seem to be keeping their distance.
Of course, I am only saying this because two uniformed, jackbooted Pharma thugs are standing outside my door monitoring all my online communications. By revealing this I may already have gone too fa
@DB
Those weren't human Pharma thugs. Couple hatchlings, perhaps?
Orac, I have to disagree with this sentence of yours: "rather than assuming honesty as the default, as scientists tend to do when reading scientific reports, [journalists] tend to assume dishonesty as the default..." A good journalist (like a scientist, perhaps?) goes where the data leads, and doesn't assume either honesty or dishonesty until either the facts, or a reasonable suspicion based on prior evidence (like prior bad behavior) lead them toward one or the other.
I also disagree with Dr. Offit's statement on its face (assuming your interpretation of it is correct). It DOES matter, because the self-correcting nature of science is slow. His comment is fine as it refers to Wakefield in particular, because enough science had been done previously that Wakefield's findings were 'self-corrected' by the science fairly quickly. In other cases, like that of Jan Hendrik Schön, the limitations of science's self-correcting mechanism (and the limits of defaulting to a belief in honesty) were amply demonstrated.
I can imagine scenarios where an investigation of fraud that shows bad science could bring that bad science to light much more quickly than the scientific method itself; in certain cases, that might matter immensely.
In a similar vein, I think the public affected by the autism issue is wondering why the CDC, Aarhus University, even people like Brian Deer are not shouting fraud about the Poul Thorsen case? Why doesn't it cut both ways. I mean he has skimmed 2 million worth of a CDC grant and there is documented fraud to do with his 2002 study on autism incidence and removal of thimerosal from the Danish vaccine schedule. (full disclosure there is a post on this now that you can read at AoA). Marlene Lauritsen wrote a letter/email to Madsen (obtained through FOIA) that details her concerns with missing data. She says, "...the figures in the manuscript do not include the latest data from 2001 BUT the prevalence are still DECREASING in 2001."( bold print is her own). Madsen did respond, saying they'd get back to her and never did. It was submitted to Pediatrics 30 days later. Their study saying that thimerosal decrease had no impact( or actually helped autism )is not true and yet no one has investigated this serious fraud. Why not?
Jen, yawn.
Oh wow. One person makes one claim, with no documentation, and no indication of any genuine significance, and suddenly it's "documented fraud?" Only to the delusional.
Jen since you and your ilk continually bring this up, what was Thorson's contribution to the study such that you refer to it as "his study", despite the fact that he's neither lead nor senior author.
But JohnV, every member of that study looks bad for having knowingly disregarded the notification. Thorsen's theft on top of it all just makes it all even worse.
1) Embezzlement doesn't equal scientific fraud, nor even (necessarily) imply it.
2) As stated above, he wasn't the lead or senior author.
3) Was it even embezzlement, or was it Thorson taking a research grant with him when he left the institution the study started at?
The purported "notification" consists of nothing beyond "gee, I think that maybe I have something at the office." Means nothing at all. Was there indeed such data, or was she misremembering? Was it of sufficient quality and sufficiently similar to the rest of the data set to be included? Was it even relevant? Adding fresh data to the analysis after the study has already begun is NOT done lightly.
Simply put, an equivocal suggestion that maybe there might have been some other data has no meaning whatsoever without more context. There aren't the faintest grounds for making an accusation of "knowing disregard" when you have no knowledge of what discussions and actions ensued. And even if there were evidence that data was excluded, did it make a difference?
Is it possible that there was some impropriety there? Might it even have risen to the level of scientific fraud? It's not impossible. But there is no reason to believe it is so. Provide meaningful evidence, and we can be persuaded to disregard that particular study.
But here's the rub - even were that the case, it wouldn't change any conclusions. Removing one brick from the Great Wall of China doesn't cause it to all collapse.
Try thinking for once, instead of mindlessly parroting whatever happens to suit your preconceptions.
I just wrote a post and it didn't go through. Anyways, short version: since Orac was talking about the issue of doctors calling out other doctors/ researchers I thought of the Danish study and the fact that Keersten knew of this new info and went ahead to Pediatrics anyways. Chris, I read the original post written by Orac on this and I noticed Brian Deer's response seemed very odd (#13). You should re- read it. He seems very self-focused and personal in his attack on Kennedy's writing, never referring to the study and he conveniently just says, he has" no idea of that Thorsen guy, and he's obviously not a major player."
Meanwhile, new revelations of toxins (TOXINS!) in pregnant women, and even infant umbilical cords.
Surely the antivax crowd will leap on this study as vital evidence that these chemicals are the true cause of autism. They're TOXINS!
I mean, this toxin stuff cuts both ways, right jen?
By the way, I've seen no version of this story yet that finds it necessary to discuss what amounts of these substances are present in human tissues, and what dosage might make them "toxins".
Those statements are not evidence of fraud, Jen. But your question is nonsense. Brian Deer investigated Wakefield's fraud not because he was urged to do so by someone. It's something he did out of his own initiative. Don't anti-vaxers have "journalists"? I thought you did. Why don't they do their job for once, and investigate this alleged "fraud"? We'll see how far they get.
From the article:
From Brian Deer:
Jen, you really need to work on your reading comprehension. You are using Thorsen as a diversionary ploy, and continuing so by noting that Deer commented on Kennedy's writing.
Point number 1: Thorsen was not the primary player in that paper. For some reason you keep skipping that little detail.
Point number 2: It was just one of several papers that showed that Wakefield was wrong, wrong, wrongety wrong. Even if Wakefield did not commit fraud and was just the most incompetent researcher in the world, the twelve case studies proved nothing in regards to the MMR vaccine.
Point number 3: Kennedy is also wrong, and probably suffered intellectually while doing the self-medicating which forced a ruling that he do community service. That community service is the only reason he got into Riverkeepers. This is the same guy whose Salon/Rolling Stone article required numerous corrections.
@Jen:
So since scientists are calling out other scientists on scientific fraud, they should be equally vociferous on calling out embezzlement too?
Matthew Cline writes (#110):
Then I wonder what people like Offit should do.
Beats me, man. Seems like people in the public sphere are damned no matter what they say. Fwiw, I think Offit's straight-from-the-hip science talk is awesome. But then, I am often tone-deaf myself when it comes to communication, and I have no answers.
I'm also on the autism spectrum and am feeling a bit bitter about humanity in general today.
O.k. O.k. I totally get that Thorsen was not the head researcher, he's just a part of the team ( Danish study) and he *seems* to have got away with 2 million. Put that aside. Forget about Poul's possible embezzlement.
In plain English, it still doesn't seem right that Madsen ( not Thorsen) didn't act *if* she knew ( or any of them knew) that the data was false or premature before submitting it to Pediatrics.
Chris, as to your point that it was just one paper, I still think it matters. Fraud is fraud.
To your point three about Kennedy, well it just may be that this Brian Deer is not so balanced, either. I mean he does seem to be very ego-driven, which could lead one to do some strange things. I don't know, but time will tell.
Yes, Joseph, we vaccine-safety types have journalists and I'm sure they are working on it.
Jen, work on your reading comprehension. Kennedy wrote an illiterate and innumerate piece years ago, and an even worse one recently. He burned too many brain cells.
Now what about Hviid? Hornig? Mrozek-Budzyn? Baird? Uchiyama? Honda? Klein? Smeeth? Makela? Taylor? Davis? Kaye? Nielsen? Afzal? What evidence that they have committed fraud? Is it in the same place that Wakefield's science actually matters?
Jen:
I ran the thorsen story into the ground months ago. Poul Thorsen has never been formally charged with a crime in the matter, and probably never will be. Aarhus never disclosed what evidence they had for implicating him in forgery. As I opined early on, whomever forged the grants could also have forged evidence to incriminate Thorsen, and Thorsen could also have been genuinely culpable, without actually being the forger. Also, Aarhus never claimed or confirmed that they actually PAID the full 2M the grants were for, or that they suspected any amount had been spent for purposes other than research.
As I already pointed out here, the Thorsen incident illustrates the degree to which institutions may try to avoid disclosing evidence of misconduct, which in this case included waiting almost two months to confirm that a key document was authentic.
ORAC
You published here January 10, 2011 2:36 PM Mr Deer's formal looking statement which included this:
Unfortunately, Mr Deer's statement misses out the crucial family doctor [ie. General Practitioner or GP] National Health Service records. These were not provided to the Royal Free Hospital, were not part of the hospital records and are the key documents upon which all his allegations are based regarding The Royal Free team's 1998 Lancet paper ["early report"].
And what is the relevance? This cuts across the entire credibility of everything Mr Deer has ever published about Wakefield.
An answer to the question about the GP records is fundamental. Can Mr Deer therefore please clarify his statement.
Unlike the USA, UK medical records do not travel with the patient. And they belong to the UK National Health Service not the patient.
Mr Deer claims to have gone behind the paper - but he has not. It is clear now from his publication in the British Medical Journal that he compared the Lancet paper's findings with the GP records. That is comparing apples with concrete.
The 1998 Lancet paper was written by Wakefield based on the data and results provided to him by the other 12 Royal Free team of interdisciplinary specialists. They had the initial referral letter from the GP, the "Red Book" of developmental progress [held by the parents], fresh parental histories taken by Professor Walker-Smith [not Wakefield], their test and clinical examination results and any further information in any ensuing correspondence with GPs.
The Royal Free Team did their own examinations, took fresh histories and made their own specialist diagnoses afresh.
They did not rely on shaky family doctor [ie. non specialist] records. This is standard practice in British NHS hospitals.
If Mr Deer wanted to "go behind" the paper then he needed to have the data and results the Royal Free team provided to Wakefield and compare them with the contents of the Lancet paper.
Mr Deer did not do that, but in his statement he claims to have used just the hospital records "read under legal supervision".
The hospital records did not include the GP records. The GP records were not available to, did not form part of the hospital records at The Royal Free and were not used by the treating specialists at the Royal Free.
GP records are made by non specialists [General Practitioners], taken over years, by more than one person, omit information provided by parents and contain other information unknown to parents.
It is also clear from the transcripts at the GMC that the GP records are riven with fundamental errors like incorrect dates of vaccinations [eg. Child 8 - 7th January instead of 27th January - "I think" said the GP in evidence] and incorrect types of vaccinations being recorded [eg. Child 4 - was it measles vaccine or was it MMR - the records say MMR - the GP said in evidence it was measles].
And there are significant inconsistencies in the account Mr Deer has now published in detail in The British Medical Journal. We will be happy to point these out in a later post. Child 1, 8 and 11 are easy examples and there are many more.
Furthermore, the GP records which Mr Deer cites extensively and in detail but regrettably inaccurately in the British Medical Journal are sealed under Court order. They are not available from the General Medical Council - only extracts read out in the GMC proceedings from the transcripts are available.
Mr Deer does not take shorthand notes but managed to publish in February 2009 allegations that Wakefield "fixed the data" based on the GP records. He has now published in the same general vein more extensively and in greater detail "fraud" allegations when fraud by Wakefield was impossible. If he had committed fraud then that would have been noticed by the other 12 authors of the 1998 Lancet paper long before now and before it was ever published.
As 'childhealthsafety' (Clifford Miller) moves around the site making the same points, I have copied something from another Orac thread, hoping that Mr Miller can explain himself.
From another website, I learn that Clifford Miller is child health safety (I am not sure what the ethical position of being a malevolent troll pretending to be a body for the protection of children, but we will leave that).
He evidently has neither read Mr Deer's report, nor indeed Dr Wakefield's, which says under 'methods': 'Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records.'
Under 'patients and methods' it explains:
'Developmental histories included a review of prospective developmental records from parents, health visitors, and general practitioners.'
This is quoted verbatim in Mr Deer's report.
So, if Clifford Miller is correct, and Dr Wakefield did not have access to these records, his study is fraudulent in this respect also.
Perhaps 'childhealthsafety', as he wishes to be known, would like to explain the position.
Posted by: Norman42 | January 15, 2011 9:44 AM
@ChildHealthSafety:
So, in otherwords, Wakefield was merely incompetent for basing his research on incomplete information, rather than being a fraud?
As 'childhealthsafety' (Clifford Miller) moves around the site making the same points, I have copied something from another Orac thread, hoping that Mr Miller can explain himself.
From another website, I learn that Clifford Miller is child health safety (I am not sure what the ethical position of being a malevolent troll pretending to be a body for the protection of children, but we will leave that).
He evidently has neither read Mr Deer's report, nor indeed Dr Wakefield's, which says under 'methods': 'Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records.'
Under 'patients and methods' it explains:
'Developmental histories included a review of prospective developmental records from parents, health visitors, and general practitioners.'
This is quoted verbatim in Mr Deer's report.
So, if Clifford Miller is correct, and Dr Wakefield did not have access to these records, his study is fraudulent in this respect also.
Perhaps 'childhealthsafety', as he wishes to be known, would like to explain the position.
Posted by: Norman42 | January 15, 2011 9:44 AM
Norman42
In UK medical practice it would be unusual if not unprecendent for General Practitioner notes to be sent on to consultants. However, there is a booklet in red plastic covers which circulates between parents, GPs and health visitors in which standardised developmental histories are kept, and this is what is signified.
@John Stone
But we're not talking about routine medical practice. We're talking about clinical research. Now, maybe things are vastly different in the U.K., but in the U.S., at least, it is not uncommon for researchers to access subject medical records to look for medical information that may be pertinent to the research, like, say, a diagnosis of autism, vaccination dates, etc.
Mr Stone: Of course, your theory would not account for Dr Wakefield's assertion that the records of health visitors and GPs were reviewed. Nor the details in the referral letters, including clear warnings to Dr Wakefield that children were not normal before their MMR, nor the Royal Free records which cannot be matched with the paper.
However, to enlighten us further, perhaps you could draw to our attention where in the 200-day GMC hearing the 'booklet in red plastic covers' is mentioned, or where Dr Wakefield has perhaps raised this claim in the two years since Mr Deer first reported on the fraud.
Or would this just be something of your own that you have made up?
@Todd W.:
Nice denier tactic right there: say something technically true (about routine medical practice) which isn't about the situation at hand (medical research).
@Norman42:
Ummm, umm... Aha! Wakefield never said that! More lies by the Pharma controlled media!!
"prospective developmental records from parents, health visitors, and general practitioners.'
So, what is a prospective record? It is each individual child's developmental record marked out on charts against the normal parameters, which can be kept by parents and shown to health visitors and doctors - and will include all routine deveolpmental checks. It would also include vaccination record. You would certainly take it along to your appointment with Prof Walker-Smith or Prof Murch, or any other child consultant. The information is recorded irrespective of health, and is different from GP notes which would come about if by any chance your child needed special attention. It is a prospective record because it begins at birth irrespective of health events: that is what prospective means (as anyone who know anything about medical/scientific terminology would know). It is quite a complicated little book (you probably have an equivalent in the US) but it is not the GP notes. And for scientific purposes it is the "prospective developmental record" rather than the "red book" (since apart from anything not all red books are "prospective developmental records" including the little Red Book of Chairman Mao, which as I recall also had a red plastic cover).
Have you chaps got it now?
Mr Stone.
Can you identify where in the 200 day GMC hearing there was any reference to a parent bringing any chart to their appointments at the Royal Free?
@John Stone:
So then the GP records aren't updated for routine medical checkups, and if a child has only received routine checkups then their GP record will be empty, but it being empty doesn't mean they have no health problems, just that all health problems were found via regular checkups. Further, Brian Deer only looked at the GP records, not the GP records plus everything else, so he missed all the data gathered at regular checkups.
Is that what you're saying?
Mr Stone.
Can you identify where in the 200 day GMC hearing there was any reference to a parent bringing any chart to their appointments at the Royal Free?
In the light of this mini-kerfuffle over who gets the credit for bringing down Wakefield and putting the antivax movement in further disrepute, it might be instructive to look back at myths that have grown up about the Watergate affair.
This article discusses popular perceptions that Woodward and Bernstein's Washington Post reporting was responsible for bringing down the Nixon Administration, and covers the important roles played by others that tend to get forgotten by those whose familiarity with Watergate is derived chiefly from "All The President's Men".
Coverage of the antivax movement and the harm it's done has come not just from Brian Deer, but from many other traditional and online media sources. Good reporting and editorializing has been featured in newspapers like the Chicago Tribune, New York Times and Sydney Daily Telegraph.
Antivaxers are hoping to distract attention from Wakefield misdeeds by attacking the reporter who's done key reporting on the case. During the Watergate affair, reporters were targets too.
"The Nixon administration variously investigated, wiretapped and audited the income tax returns of numerous reporters. In all, more than 50 journalists appeared on a special White House "enemies list." Nixon's otherwise pro-business Justice Department filed antitrust charges against all three broadcast networks. As Woodward reported a year after Nixon's resignation, Nixon himself allegedly ordered an aide to falsely smear syndicated columnist Jack Anderson as a homosexual, and two White House aides held a clandestine meeting to plot ways to poison the troublesome journalist. In many respects, reporters who investigated Nixon were less hunters than prey."
The harassment of Deer, while not in this case engineered by vengeful government officials, follows a familiar pattern of blaming the bearer of bad news.
'Can you identify where in the 200 day GMC hearing there was any reference to a parent bringing any chart to their appointments at the Royal Free?'
It is so utterly routine it may never have even been mentioned. Can anyone explain to me how the children could have had prospective records unless it was routine to compile them?
@John Stone:
Was my interpretation of your statement about GP notes/records correct or incorrect? If it was incorrect, please explain further.
Mr Stone,
All of the "utterly routine" records were read during the hearing. Admissions and discharge documents, referral letters, GP notes, Walker-Smith's clinic notes, letter to Wakefield, indivisual blood measurements. Everything pertinent to the clinical status and history of those children.
You have just exposed yourself to be a dissembling idiot, who knows nothing of the things you speak of, and who simply makes it up, wasting everybody's time and your own life.
You have nothing on Mr Deer.
In order to simplify things for Stone's and Miller's clear lack of comprehension, Deer has what Wakefield and Royal Free had for medical histories of the children. It doesn't match with what Wakefield et al. reported in the Lancet.
End of story (at least for the rest of us not trying to cling desperately to a dead horse).
@Science Mom:
So, if there's anything at all to what Stone and Miller have said, Wakefield had no access to the GP records, while Deer had access to Wakefield's data plus the GP records. Assuming that to be the case, then at best Wakefield is innocent of (further) fraud but guilty of sloppy research, unless GP records are so error prone that medical researchers ignore them as a matter of course.
Matthew Cline
If major health concerns turned up at routine checks then perhaps they could have entered the GP notes, but otherwise this routine data (collected in the Red Book) would stay with the parents. The Royal Free however would have seen the routine data but not the GP notes. The GP would communicate his concerns in a letter. As for Brian Deer, I am not perhaps the best person to consult about what he has seen.
You see their technique? They just keep saying the same thing, often dressed up with some obtuse new verbage. Nothing goes in to their brains, or if it does, nothing comes out that is not mendacious.
Here we go again. The Lancet paper 1998:
'Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records...Developmental histories included a review of prospective developmental records from parents, health visitors, and general practitioners.'
What you will see now is them saying the same thing. Blah, blah, blah.
Whatever documents Mr Deer has access to his allegations focus on alleged discrepancies not between the paper and what the Royal Free team told Wakefield, but between the paper and the GP notes which none of them ever saw.
John Stone and Cliff "childhealthsafety" (yeah, real safety oriented. I wouldn't let you anywhere NEAR my children, nor would I follow your advice from your site) are repetitious trolls.
Neither will hear anything they don't want to hear, and somehow "know" what people think. What they obviously don't know or understand is how medical referrals work. When a physician (GP) refers a patient to a specialist, he/she generally sends along either a copy of the pertinent office records or a referral in which is given the pertinent history of the patient. (And, if those words are too big, John and Cliff, I'm sorry but I DO speak medicalese; it's my second language.)
For example, if I was to go see a GI specialist, my GP would send along a letter with the documentation from his records as to when the problem began as reported to him (i.e. "CC* - Pt states she has been having problems with constipation and diarrhea for 2 weeks prior to today). He will also include any treatments/tests/bloodwork he has recommended or done so that the specialist won't have to repeat everything.
In the case of a child, of course, the CC* would be "Parent states that child has..."
So, I am quite sure that the records Brian Deer saw probably HAD the relevant information in the referrals. Not the "Red Book" referred to above, and not the physician's original records, but the referral information, which is also what Wakers and his team supposedly used.
*CC: Current Complaint. In medical records, it is almost always a direct quote of the patient (or parent)'s words. It may be expanded upon by the physician's questions, but should always contain the patient's words as to why they are in the office that day.
I have a hard time grasping John Stone's point (emphasis added):
When I say "perhaps they could have", I mean that it could happen but more than likely it would not. Is it really true that major health concerns with a child would likely be entered nowhere except in a document that was in the hands of the parents, so that if they moved a few times and lost the documents, there would be no records anywhere?
I'm not even sure how this is supposed to prove or disprove anything about Wakefield, but it surely doesn't seem likely to me, whatever the intended point.
@John Stone:
Like I said, at best this would mean that Wakefield is merely guilty of sloppy research, and that his Lancet paper lends no credence to the idea that MMR contributes to autism (or gastrointestinal problems).
So then, if someone is doing medical research, the standard way of doing things is like this?
1) The researcher starts out without the GP notes
2) The GP notices that research is being done on a patient for which s/he has some notes. (And how in the world would the GP know if another doctor is doing normal clinical treatment vs research?)
3) The GP sends the notes to the researcher.
4) The researcher thinks "D'oh, I should have thought to get their full medical records from the start!"
Even assuming that Wakefield was just doing ordinary treatment at the start, and only decided to turn it into research after the treatment finished, he should still have gotten their full medical records. (This is an assumption I'd have a hard time swallowing, given that Wakefield tried to look for measles viruses in their intestines)
Further assuming that the Lancet paper wasn't a research paper, but merely a collection of 12 case studies, he should still have gotten their full medical histories and integrated it into the case studies.
So, any way you slice it, Wakefield not looking at the GP notes before publishing his paper was sloppy.
Here are some of many examples of discrepancies in Mr Deer's work.
This is what the 1998 Royal Free Lancet paper said about all the Lancet 12 children:-
That was a main issue The 1998 Royal Free Lancet paper was reporting on scientifically and medically. It also states clearly it was an âearly reportâ and called for further investigation.
For Child 8 specifically the Lancet paper stated:-
THERE IS NO FRAUD
COMPARE â the General Medical Council hearing transcripts.
CHILD 8
These show what the specialist developmental pediatrician said on 23 December 1994 taken from the prior clinical records just over one month before Child 8 had her MMR vaccination on 27th January 1995.
This specialist was not any part of the Royal Free team and was part of the normal UK NHS health service.
CHILD 8â²s Timeline [added 17:15 13 Jan 2011]
May 1994 age 10.5 months:
17 months of age:
23 December 1994 (approx 18 months) â developmental pediatrician wrote:
27 January, 1995: MMR vaccination
17 February 1995: The developmental pediatrician writes three weeks after MMR:
CHILD 11
There are no notes for Child 11. Child 11 was not included although briefly mentioned.
Everything is based on Brian Deerâs personal word and there are no documents or other substantiation.
This is bizarre.
CHILD 1
Brian Deer implies in his recent publication in the British Medical Journal that Child 1 may have had symptoms of an autistic condition aged 9 months â well before the MMR vaccination:
But what Deer fails to disclose is that review of the additional GP records (not available to the Royal Free team at the time of writing The Lancet paper) shows that Deer failed to mention the entry documenting his motherâs concerns about Child 1âs hearing, her additional concern was about a discharge from Child 1âs left ear. This concern is not suggestive of an incipient developmental disorder but of an ear infection. But âProfessorâ Deer decides in his inuendoed non expert opinion it did. But this would have been sufficient reason for his mother to express possible concerns about Child 1âs hearing. Here we have an example of Deerâs selective reporting of results that were not available to the authors of The Lancet paper at the material time. Throughout his reporting, Deer appears to rely selectively on such âfactsâ that support his premise that Wakefield perpetrated a fraud.
Jen @ 122:
It bristles me that you would deign to speak for the autism community. Why should anyone be shouting fraud when we simply don't have the adequate evidence to do so? Isn't the responsible and ethical thing to do is to wait until an investigation has been conducted?
Would any wrongdoing on the part of Thorsen somehow exonerate Wakefield? They are two separate matters all together. The same standards would apply to Thorsen and he would be rather unfavourably reported about should he been proved to have committed embezzlement.
No, we don't know that to be the case and AoA has certainly not made that case. It is wholesale dishonesty to assert that Dr. Thorsen has committed embezzlement when the results of an investigation have not even been released. Do you disagree?
Jen, do you even know the provenance of these alleged emails? Sure they claim it was obtained from an FOIA request, but where is the paper trail for the FOIA? Where are the email headers or screen shots of the emails? If I should report on my blog some text of an email exchange between Wakefield and I in which he said that he knowingly and wilfully faked his data for monetary and personal gain, would you accept that as well-supported evidence?
Disclaimer: I have never had any contact with Wakefield, nor do I possess any such email exchange.
I believe it is our moral imperative to ascertain actual evidence before raising the spectre of wrongdoing. What AoA is doing is wrong, damaging and continues to fracture the autism community. Not just with their feeble, vapid responses to Mr. Deer's investigations, but also with their 'hit pieces' against those who oppose them but also with their rookie reporting on autism aetiologies. Just the fact that you come here, and now seem to be eager to engage in productive dialogue, indicates to me that you may be piqued by the possibility that there is more than what 'they' report to you.
@163:
AoA based their whole story on i) a leaked document that AoA mispresented as an actual Aarhus press release and ii) a HOAX by an Austrian "journalist" whose mental competence was challenged in court a few months later. AoA was so lazy that they didn't even correct elements of the hoax that were contradicted by the document, and threatened litigation when I disputed the document itself as a hoax rather than conduct any kind of investigation themselves.
They also kicked out a conspiracy theory based on a dogend of Kennedy's nonsense, and some emails. I did an analysis on the data from the email, and found it was actually consistent with an "autism epidemic" as early as 1980-85, and also showed a DROP in diagnoses after a vaccine was introduced. See here:
http://www.examiner.com/special-education-in-mesa/autism-epidemic-or-s-…
Just to save many of you some trouble, Cliff Miller has been peddling his same dishonest shtick on LB/RB: http://leftbrainrightbrain.co.uk/2011/01/7246/
Note the convenient omission of relevant information about child 8.
John Stone is an idiot.
It's quite late, or maybe early, here in the UK and I don't want to type it all out again, but I explained the red book, and its lack of use by GPs (and many parents) as anything more than a vaccination record on another thread this issue was brought up in. The only routine developmental check performed by the GP, rather than a health visitor running a baby clinic, is that done at two months and for both of my children I actually saw the GP enter information into his notes at that time.
John Stone is right the the NHS owns the medical records, including GP notes, and that the patient (excluding maternity patients) does not generally have access to his or her own notes. In fact, legally portions of the notes can be kept hidden from the patient even if he or she asks to see them or redacted before giving the patient a copy. None of that has anything at all to do with whether Wakefield et al saw the GP notes.
For what it's worth, I have a red book beside me issued in N London in the 1990s. It has a growth chart (weight, height, head circumference), vaccination records, questionnaires about development, places to write concerns. 7-9 month review, 18-24 month review.
John Stone, I have two slightly more recent red books here. They contain all that you say. The difference between your statements and mine is in how they are used. They are not replacements for GP notes on development. GPs are required to keep their own notes on every visit and do not do the regular developmental checks. Those are routinely done by health visitors. As a parent, I could write anything I choose in my child's red book. It is not a requirement that anything beyond the birth details and the first assessment of needs of the family ever be entered. It is a record of contacts with the health visitor and of vaccines at best. It is not a record of GP visits, even routine developmental checks, and it is not a record of all parental concerns unless a particular parent chooses to make it one. I could easily write in there that my daughter learned to walk at 3 months and was talking at 6 days if I chose. It is not a part of my children's medical records. It is owned and held by me, not the NHS, and is not intended to be a full record of the child's health or development.
@Wren
So, the Red Book is akin to the maintenance checklist that I keep in the glove box of my car? The actual diagnostics and such that my mechanic performs, the results, etc., don't appear in there, unless I actually write it down. My mechanic's notes would be much more detailed.
I'm awed at how organized other people's parents are. Is this the norm? My parents had no record of our growth, any developmental milestones, or even vaccination.
Wren
I did not say that the Red Book was replacement for GP notes, I was saying this was what was meant by prospective records, which every UK parent will have. I see that Brian Deer seems now to have confirmed that he didn't realise, and obviously his materials were less complete than he thought. Also, it remains the case that while the GP would make the specialist aware of what he/she believed to be all relevant information, the GP's patient notes do not travel to the hospital.
@John Stone
Your interpretation of Deer's response is beyond idiosyncratic; it's delusional.
If Wakefield had relevant data which exonerated him from the charges of altering medical records, he had three years to produce that evidence in front of the GMC. He didn't. And it appears that Deer has managed to pin down the types of medical records which the study claimed that it was based on, and whose existence could be verified, and this has now withstood scrutiny by a large number of people.
You are seeing something that you want desperately to believe, and which you can only support through a desperately twisted interpretation of the statements made. No objective observer could possibly come up with the interpretation you have. Sadly, this isn't surprising; you seem to make a habit of that in numerous arenas.
LW, it's much easier to be organised when they give you a book, emphasise you shouldn't lose it and ask for it every time you take your child for a vaccination or to see the health visitor.
John Stone, why did they never refer to the red book by its proper title, instead making up the new one of prospective development record? I am fully aware that GP's patient notes fo not ordinarily travel to the hospital, however, this was not an ordinary hospital consultation but a research project. Why do you insist that the ordinary rules apply for a special circumstance? The red book does not ordinarily accompany a patient to hospital either, yet you see no problem with that having occurred.
To believe your view, the red book was used in a manner inconsistent with the usual use, including GP notes on development in it and being brought to the hospital. The GPs also failed to make notes in the patient records for these developmental concerns and failed to convey this to the hospital when referring the children. No note of this unusual practice was made in the paper itself and no mention of the red book was made by anyone but Wakefield or excerpts from them were read during the GMC hearing, but that should be ignored in favour of your unsupported theory.
Correction to my earlier post: I do not own my children's red books. Technically, they are owned by the primary care trust we lived in when my children were born, but I am requested to "keep it carefully for at least 8 years after my child leaves school".
Todd, in general, your analogy is correct. The vaccination record and a few other pages are filled out by medical professionals have copies which are sent to the appropriate authorities (Immunisation Section, the health visitor and Community Services).
Luna_the_cat | January 16, 2011 10:51 AM
No one was accused of altering medical records in the GMC. It was not an issue in the proceedings.
Brian Deer never included that one because he knew he could not prove it and waited until after the hearing was over to level it.
Now he has done he has completely exposed himself thankfully.
Also of course it is completely improper to do what Brian Deer has done. If he had a case of fraud it should have been included but he waited until he got a verdict and then made this new accusation.
The GMC panel decision seems to have been shabbily executed. The panel Chairman Kumar it now appears believes in compulsory MMR vaccination - a position described as "Stalinist" and of dubious ethics by BMA Chairman Hamish Meldrum - and which would have debarred Kumar from sitting on the GMC hearing panel. The failure to disclose is a breach of the UK's Nolan Principles on such appointments.
The previous proposed chairman Prof Denis McDevitt was going to hear the case until it was revealed he was on the panel which approved a dangerous MMR vaccine which caused deaths and very serious health problems and had to be withdrawn.
That is how shabby the UK's General Medical Council is.
Luna the Cat
Sorry, if what I have just said is delusional you need to show where rather than attacking me personally, or going on about the GMC decision - ever so deftly moving the subject on.
Therein lies the problem Stone. You and Cliff have been shown, repeatedly. You simply refuse to accept it. If your case is so strong, then play it out in the UK courts, very plaintiff-friendly and deep-pocketed potential defendants. Instead, here you are, whimpering on the interwebz. Your case is closed, move on.
@John Stone:
1) Are you saying that the red books contained information that the wasn't present in any of the rest of the documentation? (Since parents can write anything they want in the red books this could technically be true, but you know what I mean)
2) Just because red books are prospective records doesn't mean all prospective records are red books. What indication is there that the prospective records mentioned in the GMC hearings were the red books?
I know that I keep pounding on this, but: if he didn't get their complete medical records while doing medical research, that research is sloppy.
@Luna_the_cat:
Note that nobody is accusing Wakefield of having altered records, but rather that he lied about their contents.
Jen:
Oh, Jen, lookie here: Correcting our record, We've removed an explosive 2005 report by Robert F. Kennedy Jr. about autism and vaccines. Here's why.
@Matthew Cline -- yes, you're right -- to be accurate, I should have said "misreported", not altered, since the medical records were not altered. It was in my mind as "altered" in that he had deliberately changed what was actually in the records to the very different information that he'd reported in the paper, if you follow. But I phrased it badly.
"1) Are you saying that the red books contained information that the wasn't present in any of the rest of the documentation? (Since parents can write anything they want in the red books this could technically be true, but you know what I mean)"
It certainly would do. There is no way GP notes would have data assembled in that systematic way about a child. Anyway, Wakefield and the Royal Free team didn't have the GP notes.
"2) Just because red books are prospective records doesn't mean all prospective records are red books. What indication is there that the prospective records mentioned in the GMC hearings were the red books?"
There would not be any other standard format for prospective recording of individual patient data, unless a child was part of some project. I see for some US posters, at least, prospective recording seems like a novel idea anyway.
@John Stone:
"Data assembled in a systematic way" doesn't imply "data that is found nowhere else". Now it could well be that having data assembled in a systematic method in one place makes certain things obvious that aren't at all clear if the exact same data is scattered across a bunch of different documents, and that while Deer had access to the same totality of data as Wakefield, since Deer's data wasn't well organized he missed things that were obvious to Wakefield. However, that doesn't seem to be what you're saying.
Now if the red books, beyond containing data organized in a systematic fashion, contained data found nowhere else, well, give an example of the sort of data to only be found in a red book. (Beyond notes added by the parents)
Wait, what? "There is no way GP notes would have data assembled in that systematic way about a child."? Excuse me, but isn't the entire purpose of GP notes to have data assembled in a systematic way about the patient? Sure, the GP notes would have different data than the hospital notes, but given that both were available to be examined this is just a silly objection.
John, you are flailing.
@John Stone:
Also, why would a medical professional record something only in the red book and fail to record it anywhere else? Besides laziness or incompetence?
It has proved quite interesting that though there were a number of letters to BMJ congratulating on them publication of the first part of Brian Deer's "research" from doctors and scientists outside the UK there have been none that I have noticed to date from any inside - I doubt whether this is because Andy Wakefield is hugely popular within the profession at the moment but more because British doctors would be sufficietly familiar with procedures to have doubts about what they were being shown. And while I don't agree with Paul Offit about much I suspect he has taken wise counsel on this: it's not going to stick. Of course, people can be as rude as they like about me, but it won't change anything.
To Science Mom | January 15, 2011 7:39 PM
If the discrepancies in Mr Deer's paper are easy to dismiss, Mr Deer can do that. He has not done it. He has not done it here. He has not done in on LeftBrainRightBrain and he has even not done it on his own blog on the UK newspaper The Guardian.
The BMJ is not answering questions either.
'nuff said.
You can answer all you like and make arguments - but the only answers that count are Mr Deer's.
Since I know that you are reading my responses on LB/RB, this is rather tedious to have to repeat myself. Cliff, they (Deer and BMJ) have laid out their case; you don't like it, nor accept it. Mr. Deer has made numerous comments on the subject here and on LB/RB and perhaps elsewhere so it is very disingenuous of you to claim that he hasn't. Just because he doesn't directly acknowledge your paltry, dishonest questions, doesn't mean he isn't supplementing his BMJ features.
They don't have to. Now you and certainly Wakers know what remedy you have if he has been wronged. Get to it.
I second Science Mom's motion.
The official legal disclosures surrounding all the payments Wakefield received for his *research* will just be the icing on the cake.
Science Mom | January 16, 2011 9:22 PM
They do. They lay claim to being a science journal. The work published does not withstand scrutiny. The BMJ's response is "Mr Deer's article is peer reviewed and if you don't like it sue us".
It is unacceptable for any science journal to block scientific peer review [This is aside from the fact no reasonable learned journal invites litigation.]
The purpose of publishing in science is to make a researcherâs work available for public scrutiny and review. Additionally, the BMJâs âpeer reviewâ is not scientific peer review but refereeing of manuscripts by peers.
Scientific peer review is the process which takes place following publication. A work is exposed to the scrutiny of scientific peers for replication or falsification. It is fundamental to scientific method. The BMJ is actively blocking that process when it comes to Mr Deer.
Ms Groves intervention on Mr Deerâs Guardian blog shows that the BMJ is not prepared to accept any sound enquiry of Mr Deerâs paper or of the data behind it. That is because they cannot answer.
Mr Deer has not answered either. Still silence from him.
Won't answer - can't answer.
And here is what "blows" the "irony meter". Mr Deer claims that he went âbehindâ a paper for the first time and exposed what he claims are discrepancies. Now he calls for surprise audits of researchersâ work in his Sunday Times commentary last Sunday. And on his blog he claims that the medical establishment acted to prevent him exposing fraud in a Lancet paper published in 1998.
And what is the BMJ pre-publication review of manuscripts worth? BMJ Editor Dr Godlee's predecessor former BMJ Editor Dr Richard Smith has said when interviewed in the BMJ just last year [âRichard Smith: Scrap peer review and beware of âtop journalsâ 22 Mar, 10]:-
Smith himself wrote little over a year ago:
So "Science Mom" maybe you need to change your name to just "Mom".
ChildHealthSafety is a lawyer alright.
Argumentation by assertion is not working here. How is BMJ blocking scientific scrutiny?
Maybe they know you are in no position to start a litigation.
Most posters here are scientists, or familiar with the process of scientific publication. Yet you dare to tell us what is peer review, and what's its limitations. We know about it, thank you. Orac even posted a few thoughts on the topic, in the past.
Actually, the limitations of peer review apply to the Lancet article as well. So, if we cannot trust Deer's article because peer review is not that good, why should we trust Wakefield's article instead? After 10 years, it has not been independently replicated. No, it really hasn't.
And speaking about someone who doesn't answer questions about his published articles, what was Wakefield defense again? Ah yes, "buy my book". I daresay let's have him first provide some meaningful answers, then we will worry about having Mr Deer answering whatever question you have.
Arguing about Deer's article is moot. At the end of the day, we still end up with a very suspicious Lancet's article.
Scientifics should go with documented evidence. And the documented evidence is not on your side, sir. That is, once we realize you are quote-mining. I followed your discussion last week-end with Sullivan on Left Brain Right Brain, it was very instructive.
I wouldn't go there if I were you Cliffy. You don't even have a clue of what BMJ can or cannot do, you inflate your importance by expecting answers to your repetitive, vapid questions and then claiming that the (non) silence vindicates you. Mr. Deer has provided his sources of information that are also available to you if you would get off your fat, drunk arse and put in a request for them. See, I can do that too and even better.
Insults, abuse, disparagement. Not a good substitute.
Still no answers from Mr Deer.
How drôle.
How exactly does CHS propose that scientific peers would engage in replication or falsification of Brian Deer's work? The only reasonable way would be to use the publicly available documentation that he used. Craig Willoughby did, after all, and recognized that Deer was correct. How is BMJ blocking that process, if a private citizen was able to get the documentation and review it himself?
Of course, there have been repeated attempts to replicate Wakefield's work, which have all failed unless they were conducted by him or his close allies. I assume CHS therefore agrees that Wakefield's work is not scientifically sound.
ChildHealthSafety is very confused. Peer review is not the process that occurs after publication.
Other than suing BMJ for libel, what you could do is publish a rebuttal in another journal. Then BMJ might take you seriously, if indeed you have any arguments worth considering (which I doubt.)
Why would BMJ publish the material they published (with editorial and all) in possibly the worst jurisdiction when it comes to libel, unless they know they have a rock solid case?
ChildHealthSafety said:
Oh, my apologies. I didn't realize that, by asking you to back up your assertions, I was insulting and disparaging you.
On the other hand, as Orac say, a statement of fact cannot be insolent, so I don't feel that bad.
So again, could you enlighten me on how the BMJ is blocking scientific peer review?
Could you tell me why the BMJ, or Mr Deer, should be writting to you personally?
Could you tell me why, if the peer review is so bad and we cannot trust Mr Deer's article, we should trust Wakefield's articles? Articles which have not been replicated in a satisfying way in 10 years?
Apparently you missed Mr Deer's posts on another thread , in answer to another poster, just a few hours after your Monday's post.
His second post was a lengthy discussion about child #1. His first post was like this:
Not exactly a man hidding and not answering questions.
I note that these questions placed by 'The Parent' to journalist Brian Morgan on Brian Deer's Guardian science blog have been disappeared (the NUJ is the National Union of Journalists):-
"perhaps as a journalist you can answer how and why Brian Deer displayed childrens medical records on his website?
would the NUJ support this ?
would you use your first name and middle name to conceal you identity?
again would the NUJ have an issue with this?
would you report on and receive payment from a journal and a major news paper on a case where you laid the initial complaint?
would the NUJ be happy with this ?
"and maybe you could enlighten us as to how much a freelance gets paid per article in the Sunday times and a series in the BMJ not forgetting a bit of blogging for the Guardian.?"
Meanwhile, Deer has failed to return to his own blog after a week to address any of the festering issues. Can't answer, won't answer...
This was my response to "The Parent" and LukeTunyich:
"brianmorgan
19 January 2011 12:03AM
to - theparent
Identify yourself - maybe contact me off list? Ask the people who did what you claim. But don't ask me questions anonymously. There really is no point. My concerns are solely to do with unethical research. Just tell us all how the research in question was ethical and devoid of any financial conflicts of interest, without asking questions which do not relate.
to - LukeTunyich
What's your explanation for the difference in media interest then?
Oh and by the way, I am not getting paid for commenting here, I'm doing it in my spare time, and if anyone thinks I might have a conflict of interest please do say what they think it is. Notes and Theories does not provide a standard form and if it did I doubt if there would be as many anonymous contributors as there are."
All of those correspondents everywhere who speak on behalf of Dr Andrew Wakefield - presumably they all have good contact with him - please tell us what stage the appeal to the High Court has reached against the GMC rulings. That does really seem to me to be the next most significant stage in this matter.
According to the General Medical Council, yesterday 19th Jan 2011, Dr Andrew Wakefield's erasure is now effective. He may no longer act as a medical doctor. As yet I do not know how far his appeal progressed nor why it was unsuccessful.
Do his supporters know? Or are they completely outside his information loop?
Furthermore, the firm of publicist Max Clifford no longer represents Dr Wakefield (confirmed by the firm on January 17th 2011). Max Clifford did represent Dr Wakefield in April 2010, they told me then.
I apologise if the information is already common knowledge. I have been out of the loop for over 24 hours because of attending the Royal Courts of Justice with my own application heard today in front of the Family Court President as a directions hearing, asking for an expert in a controversial child protection case to be named.
The president LJ Wall decided my application will be given a full one-day hearing on a date to be arranged.
My estimation of Offit - increases a notch.
This is not a matter that can be "won" by public debate.
The only thing public debate can win is the science that is so desperately needed.
But that anyone can say how wonderful Deer is [when they say he out and out lied (I've always said extremely mis-represented the truth] it's laughable.
Thousands of man hours have gone into proving one little case study is a fraud, making any sane person think - who would want to do research in such a field?
Any questions that nobody wants to hear and you get tied up in every court there is...
So the research does not get done. And that is further proof of lies? And fraud. Studies get disbanded or declared fraudulent and most indicting of all BMJ even dismantled all the comments on Deer's accusations. There was good scientific and medical refutation of Deer's hypothesis. I was sending people there - so they could see the information pro and con and decide for themselves.
So much for open scientific debate. What a sham.