Get the Shots Already

Of course the really scary thing is that Wakefield never demonstrated an association of autism with the MMR in the first place – he just claimed there was one. But that statement has now lead to this whole brouhaha, and a generation of parents convinced of an association through some kind of cultural osmosis.

The mistake of the scientific and medical establishment was to underestimate the grip this meme had on the general populace – they just couldn’t understand why people would accept a claim without any basis and reject all the evidence to the contrary.

I’m gonna have to do a front page post about this some time soon. Studies like this can’t, possibly, prove that MMR doesn’t cause autism in the small number of cases where live measles is found in the gut. This is because these cases are too rare to be picked up by any reasonable epidemiological studies. (For example, if I went mad and decided to bump off every 1000th CT reader, I could probably get away with it if the only means of investigation you had was to look at statistical measures of association).

What this study is picking up is that any vaccine effect is swamped by the trend; but we could have guessed that anyway from the fact that Wakefield was only able to trick up a dozen or so cases. It’s similar to the sample size issues that we covered ad nauseam in the Lancet/Iraq debate.

What appears to me to have happened is that peoples’ bullshit-detectors gave off a false positive. Looked at objectively, the scramble of the scientific establishment to crush Wakefield was outright disgusting behaviour (and this behaviour cannot at all be vindicated by Wakefield’s own later sins). Furthermore, we were treated for years to the sight of medical/government spokesmen turning up on television claiming that epidemiological evidence had “conclusively proved” things that epidemiology could not possibly have conclusively proved, because of the nature of the beast (think how long it took to prove that cigarettes cause lung cancer!). When a man is saying something he knows to be untrue (even if he is saying it in service of a larger but more complicated truth), he tends to look shifty, and it is my opinion as a professional judge of character that it was this nonverbal communication that the public reacted to.

However, because the incidence of measles in gut plus autism is very rare, while the incidence of rubella and measles is only rare, the risk ratios favour vaccination. I swear that if we had had a commonsensical debate about risk ratios, rather than trying to pretend that science had conclusively established that the ratio was zero to one and shouting down anyone who argued for a higher number, this whole fiasco need not have happened.

My personal assessment of the underlying science is that this is not a fear made up out of nothing; there are a (practically rather than statistically) significant number of autistic kids who have live measles in their gut and nobody appears to have a sensible explanation of how it got there. That is the sort of thing that medical science ought to be taking a look at; anyone who says that it shouldn’t “to avoid sending out the wrong message” has stopped being a scientist and become a politician.

On the other hand, Wakefield has disappeared up his own arse several years ago, and persists in making statements about vaccination which go miles beyond his evidence, and which often say things which don’t make sense to me given the risk ratios. I’m getting my kid done next week.

(Some may find it interesting that I was vaccinated against measles the old-fashioned way; I was sent round to play with a kid who had caught it so as to “get it out of the way” and not take the risk of catching it at the same time as another illness. This was pretty common practice when I was growing up, and probably also makes sense on a risk ratio basis given the very small likelihood of very nasty outcomes).

Even the original reports which suggested there might be a link between MMR and autism did not advocate missing out on the jabs altogether, simply having them seperately rather than combined. personally i think that’s probably a sensible idea anyway when you think about whats in those jabs anyway. the government of course has reacted by introducing a 5-in-1 jab now to replace the 3-in-1. certainly no-one should fail to immunise their kids though. cru

Didn’t you read Silent Spring?

Dsquared, I also can’t prove that invisible pink elephants didn’t force you to type your comment. Science doesn’t work by proving negatives. The fact is, there was never credible evidence of the autism link, and subsequent examination of Wakefield’s data (his own unscientific demeanor not helpful either, as you admit) has only decreased their credibility. (Also there are any number of irrelevant “associations” between this and that that can, given the right set of calculations, be shown as “statistically significant”, something I feel 100% sure you’re very well aware of.) If the valid criticism of Wakefield (again, greatly strengthened by his own idiocy) is your idea of “crushing” someone, I shudder to think of the state of intellectual hygiene in your own field. But the difference is that in public health, bogus claims like the vaccine / autism link _cost lives_, in this case by discouraging critical vaccinations. I hope you haven’t lost sight of that.

I have to admit, as a parent of an autistic daughter, that the first time I read this suggestion of a MMR/autism connection, I was outraged and horrified.

Those feelings remained, for different reasons, when I read the scientific responses to this claim. It burns me that not only are people refusing important vaccinations (FYI both my children had the MMR jab as well as all other recommended inoculations) but that this type of media-grandstanding is diverting resources from more worthy studies.

Autism is inexplicably on the rise — we need to know why, but it seems as if the answer is going to be much more complex than proposed. Already there’s the credible argument that part of this rise is the increased recognition of the problem. But I’m not even so involved in this debate anymore. I prefer to devote my time to assisting my daughter to become as “high functioning” as she can.

Dsquared, you are right that the epidemiology can’t prove that a very small subset of autism is due to the MMR, but it does suggest that Wakefield’s original advice to avoid the jab was flawed. It also counters the widely made claim by anti-MMR campaigners that the rise in autism is due to MMR. Additionally, while you can’t prove a negative, Wakefield’s original paper did not provide evidence that MMR caused autism, it was simply an aggregation of case reports, 12 subjects with autism associated with inflammation of the bowel.

“there are a (practically rather than statistically) significant number of autistic kids who have live measles in their gut and nobody appears to have a sensible explanation of how it got there”

I’m not sure where that comes from, I thought they were mostly studying autism plus bowel disorder patients and finding that. I could posit that children with a pervasive developmental disorder like autism might be more susceptible to MMR induced bowel disorder. I have no evidence, but then you have no evidence that MMR causes autism with bowel disorders.

On the other hand, it does seem like autism + bowel disorders is a real phenomenon, and that Wakefield helped to bring the attention of the medical community to it.

I agree with Tim – the desperation of parents of autistic children is a major influence on the MMR story. But there is also a larger undercurrent of distrust of scientific “authority,” which has been growing over the last few decades. It just doesn’t work anymore to say “experts say there is no evidence of a connection between MMR and autism.” It’s a real problem. More on this here (along with further debunkings of Wakefield’s claims). Meanwhile, thanks to Wakefield, apparently measles is on the verge of becoming an endemic disease in Britain once again.

A few points:

Steve: turn the heat down please. We are all aware that people die of measles. However, the population at risk is orders of magnitude smaller than the casualties of the Iraq War or a medium sized World Bank famine, so it’s not as if there is a special or uniquely urgent public policy imperative here. It is important that medicines be safe, and it is also important that scientists feel that they are able to make controversial statements about big medical programs without getting the treatment that Wakefield received.

It’s only important if it suggests some broader problem with the MMR vaccine, and that’s the hypothesis that has been conclusively debunked.

No it hasn’t. On the balance of evidence, it currently looks as if MMR is not the cause of the trend in autism, but that is not the same as saying that the proposition that there is something up with the MMR vaccine has been “conclusively debunked”. The authors of (for example) the Danish study of 500,000 children do not make this claim and occasionally complain when it is made on their behalf.

To take any interest whatsoever in the possibility that in a miniscule fraction of cases live measles in the gut is implicated is at this point a kind of weird diversionary response to the overall question.

Not necessarily. It’s a direction for research. Remember yer Kuhn; one of the ways in which science proceeds is by piling up anomalies, and live measles virus in children who have not been exposed to measles, is an anomaly. A connection between autism and gut disorders, if it exists, would also be an anomaly.

In general, I’d say that it is arrogant and unscientific to regard “the decline in public trust of science” as something like the weather or women’s fashions, that just happens of its own accord. People distrust scientists, and specifically government scientists, because of the behaviour of scientists on a number of issues in the past.

The treatment of Wakefield wasn’t “valid criticism”. He partly brought it on himself, but it went well beyond anything that you might call valid scientific debate; he was even dragged up on a trumped-up conflict of interest charge two years later. The standards by which Wakefield’s case study were judged were ludicrously more rigorous than anyone would ever think of applying to their own work and owed more to the sort of thing Steven Milloy does than to any normal criteria. As I say, nothing that Wakefield has done since justifies that behaviour.

It wasn’t quite as scandalous as the case of Arpad Pusztai, who had his career ruined by “devastating critiques” of a piece of perfectly decent work on genetically modified potatoes, but it was bad.

Of course the analogy fails because a causal relation between deckchairs and finger lopping can be established.

People also distrust scientists because demagogues who either don’t understand science, or do understand but are dishonest, keep stridently demanding that science do impossible things such as prove that X, Y or Z has precisely zero risk, whatever that could even mean, and then smearing scientists as being contemptuous of the public good when they try to explain why they can’t comply. I learned a lot about this process when, as a graduate student, I observed this kind of crap going on in the campaign against recombinant DNA technology.

“However, there is a risk there, and a deckchair manufacturer who came out shouting “there is no way that a deckchair can cut your finger off, that has been comprehensively disproved, it’s simply loony to say anything of the sort”, would look like quite a shifty character.”

I don’t know what the vaccine manufacturers had to say about the MMR link, but the government scientists were initially not saying that it was loony to suggest a link, only that there was no proven link (because there wasn’t, as a quick perusal of the Lancet paper will show). Later, epidemiological studies confirmed that the MMR was not associated with increased risk of autism, so therefore, again, there is no evidence that MMR causes autism, and evidence that overall it doesn’t increase the risk of autism. I just read a quote from deputy chief medical officer from around 1999 saying that while you can’t prove a negative, evidence suggests that MMR doesn’t cause autism – a perfectly reasonable position given the evidence.

Steve is right, we’re in invisible pink elephant territory here, your only claim against the government scientists is that they argue that autism isn’t caused by the MMR, while you are clinging to the theoretical possibility that the MMR could cause a small and epidemiologically undetectable subset of autism. You’re splitting hairs.

Sorry; I completely misread this reference. The figure of 100 deaths in a bad year is right, but it wasn’t 1968.

Similarly, some people might think it’s legitimate scientific criticism to try and push a man out of his job, but it isn’t. This isn’t a matter of “invisible pink elephants”; the point I’m repeatedly trying to make is that neither the absence of an epidemiological link nor Wakefield’s behaviour since leaving the Royal Free Hospital can possibly justify the way in which UK scientists behaved in 1998-9.

I wonder how many of the people who were prepared to defend Larry Summers’ right to “raise questions” are prepared to say the same about Wakefield?

rs writes:

What was the bad behaviour of UK scientists ‘98-‘99 exactly, could you give some examples where it is anything other than pointing out that a) the study didn’t show a link between MMR and autism, b) there is no known link between MMR and autism therefore you should give your child the MMR?

dsquared will surely speak for himself, but I’m pretty certain his point (or part of his point) is that your statement (b) is not correct, or at least not complete.

It is almost certainly correct that as we sit here today, children should get MMR vaccinations because the risks of those infectious diseases are serious and well-established, and would outweigh any foreseeable increased autism risk from MMR (whether or not there really is any increased autism risk from MMR). It is not the case that because we have not identified any link that giving a child MMR must be OK.

To explain a bit, it is clearly not the case that across the entire population, giving any child MMR puts that child at very high risk of autism. It is possible that we could find out someday that giving the MMR to children with some unusual characteristic — say, genetic mutation X — puts them at very high risk of autism. In that case, we might say that we ought to make a different decision for such children. However, because we don’t know that today, we have to make a decision based on what we do know, which is that the infectious diseases addressed by MMR are widely prevalent and very serious, and that we don’t have reason to think in the case of any given child that MMR would seriously increase autism risk.

To sum up: the absence of statistically significant data does not mean that our decision is automatic. We still have to weigh risks, even if we don’t know everything we’d like to know.

People distrust scientists

They do? Where? Certainly not in Canada, and not terribly much in Britain either.

“To sum up: the absence of statistically significant data does not mean that our decision is automatic. We still have to weigh risks, even if we don’t know everything we’d like to know.”

I’m afraid that, given that -there is no evidence that MMR is linked to autism-, and that there is evidence that it isn’t, we are back in invisible pink elephant territory if you assign the MMR any risk greater than zero.

=
fwiw – the CDC has guidelines on when vaccination is contraindicated.

They’re not ‘all vaccines all the time’

There is no proof that reading Crooked Timber doesn’t increase the risk of dementia. Be afraid, be very afraid. ;)

A relative risk of 1.000001 is to all practical intents and purposes equivalent to a relative risk of 1, no amount of Bayesian obfuscation can change that.

And actually, there is -no- evidence that MMR causes autism, which is my whole argument – what do you think the evidence is that MMR causes autism?

Steve, give over:

Ah, I see, as long as the number of deaths (by the way, failure to vaccinate a cohort in one year has conseqences which potentially extend for quite a few years thereafter so mortality in one year is an underestimate) is less than the magic number of 10,000, that’s all right then. Whatever. Tell it so somebody whose kid dies of measles because they were misled by the irresponsible campaign against the vaccine. I’m sure they’ll sympathize with your argument.

First, I only raised the number 10K because you had claimed that the “casualties” of the MMR scare could be greater than those of the Iraq war and they couldn’t. When you’ve misestimated a number by a factor of one hundred, the gentlemanly thing to do is put your hands up and apologise, not to immediately move the goalposts and start saying “even if it’s one, that’s too much”.

Second, if we’re now restricting ourselves to talking about the small number of children who die of measles, then it’s no longer on to regard the small number of children with measles-gut-autism symptoms as statistically insignificant. It is quite possible that there is a connection in that small number of cases.

This is exactly what I was talking about upthread. I do not disagree with you about the risk ratios, or about the epidemiological evidence. I do disagree with you about the issue of telling the truth about the epidemiology; saying that the balance of evidence suggests that the risks of non-vaccination are much greater than those of vaccination. You appear to be in favour of not telling the truth about the epidemiology and claiming that we have conclusively proved that there is zero risk, and you appear to have admitted that your reason for saying this is not because you believe it, but because you want other people to believe it.

Telling people things which you know to be untrue because you want to influence their behaviour, no matter how noble the motives, is what I call “acting as a politician rather than a scientist”. I’d also submit that the evidence of BSE, GM foods and MMR suggests that this policy is practically as well as ethically bankrupt.

we will never prove that there is precisely zero association there, but that doesn’t mean there is any good reason to believe it. There isn’t, and there never was.

As I understand the science, this ain’t so.

There is some reason to believe that there is some as yet not understood association between gut disorders and some autistic symptoms.

It is known that measles virus can cause gut inflammation.

Wakefield thought he had found live measles virus in the gut of autistic children, with not much explanation of how it got there other than from vaccination.

This isn’t strong evidence at all, but it is not nothing. The first two propositions are (these days; their general awareness is an achievement of the Royal Free team) uncontroversial. A causal link between the two is not uncontroversial, but can certainly be argued for. The second causal link (that the measles in the gut of the children with the particular set of symptoms displayed by Wakefield’s patients) is in my view without evidence, but it is not exactly prima facie ridiculous either.

This argument could have been ended before it began if the government had simply pointed out that out of the entire vaccinated population of England, Wakefield had only found twelve cases, not all of whom had the full set of symptoms. Everyone would then have got a sensible idea of the relative risks involved and we would all have got on with our lives (as we eventually did with respect to beef). Instead, they had to start making the dogmatic claim, just as they did at the start of the BSE panic, and they set everyone’s alarm bells off, just as they did with the BSE panic.

Firstly, I’d like to point out that Wakefield and the anti-MMR campaigners have only relatively recently made the retreat into the subgroup MMR-autism association position. Originally they claimed that MMR caused autism to a significant extent – this has now been refuted as all agree. with regards to the subgroup hypothesis:

“There is some reason to believe that there is some as yet not understood association between gut disorders and some autistic symptoms.”

I believe that the association is between a certain atypical presentation of a gut disorder with autism.

“It is known that measles virus can cause gut inflammation.”

Not so sure about this, I know Wakefield was involved in attempts to associate Crohn’s with measles, but that proved not to be the case.

“Wakefield thought he had found live measles virus in the gut of autistic children, with not much explanation of how it got there other than from vaccination.”

Did he? I thought that some studies had managed to find a disproportionate amount of PCRed up measles in autistic-bowel disorder cases versus others.

Now the Wakefield paper proposed the first point (but it was only properly studied later), the second was believed by Wakefield but controversial, the third had not been done. So what we had was a group of highly selected cases that -may- suggest a new syndrome (autism-bowel disorder association) with some pretty weak evidence for a bowel disorder-measles association. How can that be sufficient evidence to advocate the precaution of stopping MMR jabs (to avoid vaccine overload apparently)?!

Careful readers will have noticed that my first post on this thread contained such phrases as “Wakefield has disappeared up his own arse”, “I’m going to get my kid done next week” and “the risk ratios massively favour vaccination”. I’m not, to be honest, all that interested in discussing this with people who either can’t be bothered to read things properly or who would rather berate the straw scaremongers in their head than discuss the science.

Because measles has not been eradicated, immunized individuals are still exposed to wild type virus and will present measles DNA as part of their subclinical case of measles. Very normal. No link to autism. In rare cases, long term sequella result from exposure to wild type virus. There are some viruses that mutate and some persons respond unusually to the wild type virus. Again, no link to autism. There is no evidence that the attenuated virus used in the vaccine persists or is involved in any of these sequella.

Word-wide there are about 800,000 people who die of measles every year. Numbers are similarly high for other childhood infectious diseases. It is no small matter to erode the public trust in vaccines.

Steve, come on. Would you like to reread this thread and compare your comments to mine? I have consistently stuck to saying things about the facts and the science. You have consistently made unsupported and unsupportable claims about people’s motivation. Could you give me one single reason why I should take you seriously?

Do you actually imagine that I search my conscience each day, asking myself “can Daniel Davies take me seriously today”? That’s a pretty serious case of self-importance you’ve got there, poor fellow.

Why don’t we carry on this debate on the “Steve Labonne Website”?

Oh yeh, it’s because I don’t read it and never post there.

Interesting thread. Several observations, comments.

1) I’ve not read ALL the thread. If covered elsewhere herein, your patience, please.

2) Vaccination has always had a risk (of getting the disease; of having side-effects as bad or worse than the disease; of having NO effect at all) and these risks needed to be assessed by an informed populace.

3) But the information was witheld by a well-meaning medical profession, acting as a priesthood, ostensibly on behalf of We, the People.

4) We, the People, became much better informed over the last 40 years; and the Internet (and THIS site) allowed and encouraged significantly more and qualitatively better research into our experiential records with autism, whether anecdotal-personal or research-personal.

5) My anecdotal-personal experience, as one holding a doctorate in the health professions, is that there IS a relationship to bowel-function and autism; diet and autism; and we’re still researching several promising avenues, BUT

6) But now there are entrenched orthodoxies who, like the astronomers who obstructed Harrison in his monumental efforts to create a trustworthy, practical chronometer, obstruct today efforts to investigate several proven productive approaches to autism; at least in part because they DON’T REQUIRE MEDICINE to achieve good results.

This thread has noted the widespread rejection of ‘authority’ born of increased awareness. This should not, however, be allowed to cloud one who speaks truly authoritatively on any subject.

Dr. Kerry Dean Hooper
Bangkok, Thailand