Recently I watched a clip of Andrew Wakefield being interviewed on Good Morning America, and it gave me the chills.
Andrew Wakefield, if you haven't heard of him, is the guy who pretty much singlehandedly scared thousands of parents away from the MMR vaccine with a study he published in the Lancet linking the vaccine with autism. The study has since been retracted by Lancet, something journals almost never do, after it was discovered that data in it was falsified. Not only that, Wakefield lost his medical license.
But is he backing down? No way. On the contrary: he is suing the BMJ for defamation. And he is still defending his findings.
It was stunning to watch. George Stephanopoulos, who was interviewing him, pointed out that his colleagues who worked with him had backed away from the study. Wakefield said they hadn't. Stephanopoulos pointed out that no scientist had been able to replicate the study; Wakefield said it wasn't true, that his study had been replicated. He sat there and said none of it was true.
How do you fight someone who feels free to ignore facts?
Not that I want to fight him. For me, this isn't about fighting. I'm not on a pro-vaccine crusade. My only crusade as a pediatrician is to keep my patients healthy -- and vaccines are part of what I use to do just that.
That's what gets me angriest about the anti-vaccine rhetoric: those of us doctors who think vaccines are a good idea, if we aren't portrayed as out to hurt children, are portrayed as brainwashed by pharmaceutical companies or the government. As if being anti-vaccine was somehow more free or enlightened.
In medical school, we are taught to make decisions based on evidence, on solid science. We are taught to be aware of the risks of anything we do (primum non nocere, first do no harm), and weigh those risks against the benefits. Well, the science abundantly shows that immunizations are both effective and safe. Yes, side effects are possible and sometimes vaccines don't work -- that's true of any medical treatment. That's why we have a whole system for collecting information about any problems with vaccines -- it was that system that caught problems with the first rotavirus vaccine, and we stopped giving it and made a better one. We take immunizations as seriously as we take any other medical treatment, and work diligently to be sure we are doing the right thing, always.
We stick to the facts. But people like Andrew Wakefield don't, and as Seth Mnookin writes about in his book Panic Virus, it doesn't take much to scare parents. Some guy like Wakefield gets up and says authoritatively, as he did in the interview I watched, that the vaccine system in the U.S. isn't safe, and what responsible parent wouldn't be at least a little worried? And somehow, people like Wakefield and Jenny McCarthy keep getting airtime and headlines (I guess I'm contributing to that myself now), while the thoughtful people like Paul Offit get drowned out.
I have been at this doctoring stuff for more than 20 years, long enough to have seen kids with meningitis and epiglottitis from haemophilus influenzae -- we don't see that anymore. I've seen kids die of pneumococcal disease and chickenpox -- we immunize against both now. I'm not quite old enough to have seen polio -- but isn't that amazing enough for people, that in the U.S. we have wiped out a disease that could paralyze you forever? It's really clear that vaccines save lives.
As for the argument that getting the illness gives you stronger immunity -- this comes up a lot with chickenpox -- that may be true, but the illnesses we immunize against have real risks. Kids with chickenpox might have a mild case and be fine, but they could also end up with infected blisters (some of those infections are very serious), dehydration, pneumonia, or a brain infection. Is that a chance you'd really want to take with your child?
At the end of the interview, Wakefield encouraged parents to get educated, and to read about immunizations. He even suggested the CDC website. He said, emphatically, that there are two sides to the story.
I couldn't agree more. But just one of them is grounded in facts.
*In its original form, this post incorrectly stated where Andrew Wakefield's study had been published. It was in fact the Lancet.
Follow Claire McCarthy, M.D. on Twitter: www.twitter.com/@drClaire
http://www.telegraph.co.uk/health/children_shealth/9128147/MMR-doctor-wins-battle-against-being-struck-off.html
At last. Sanity and Justice have today prevailed in the High Courts of the UK.
Prof John Waker Smith´s reputation was torn to shreds over a case which has lasted 10 years, by a certain "award winning" so called journalist with his own odious agenda, whose accusations of corruption and fraud and "illegal professional practices", have now been proved to be completely false. Need I remind others that this journalist was the only complainant. It was his and only his, interpretation of certain facts, encouraged and backed by the Murdoch owned Sunday Times, which brought the case to the attention of the GMC. And their handling of the case was pitiful. They have recently established a new Medical Tribunal in ackowledgment of their inadequacies.
What now? What of Brian Deer´s culpability, I ask? A case which should never have been brought ot court. Does he still have the right to boast of his Award winning articles?
The Senior Clinical investigator has had all charges dropped by the GMC and guilt erased by the High Court.
The BMJ suddenly start throwing up legal walls to prevent the public having access to their case and the relationships between various parties.
Interesting times ...
Dravet syndrome: patients with co-morbid SCN1A gene mutations and mitochondrial electron transport chain defects.
RESULTS:
Two children were found to have pathological mutations in the SCN1A gene and defects in mitochondrial electron transport chain complex activity. Both developed early febrile and medically intractable afebrile seizures with resulting neurocognitive decline. In the first patient, a muscle biopsy demonstrated complex IV dysfunction and in the second patient, complex III dysfunction. Patient 1 had more difficult to control seizures, and had features consistent with severe autism. Patient 2, who had earlier control and less severe seizures, did not have features of autism. Patient 1 had SCN1A missense mutation, c. 3734 G>A and patient 2 had a mutation, c. 3733 C>T, which produces a truncation mutation.
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Epilepsy Behav. 2011 Jul;21(3):291-5. Epub 2011 May 26.
Autism in Dravet syndrome: prevalence, features, and relationship to the clinical characteristics of epilepsy and mental retardation.
Autism in Dravet syndrome, however, has rarely been studied. In this study, the prevalence and features of autism in patients with Dravet syndrome, their potential association with mental retardation, and the clinical characteristics of epilepsy were investigated.
Clinical data of 37 patients with Dravet syndrome were collected
Nine patients (24.3%) met the criteria for autism. All patients with autism showed speech delay, no emotional reciprocity, and narrow interests, whereas 89.3, 46.4, and 39.9% of patients without autism had speech delay, short temper, andnarrow interests, respectively.
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Autism science always interesting
Vaccines for measles, mumps and rubella in children.
A significant risk of association with febrile seizures and MMR exposure during the two previous weeks (RR 1.10; 95% CI 1.05 to 1.15) was assessed in one large person-time cohort study involving 537,171 children aged between three months and five year of age. Increased risk of febrile seizure has also been observed in children aged between 12 to 23 months (relative incidence (RI) 4.09; 95% CI 3.1 to 5.33) and children aged 12 to 35 months (RI 5.68; 95% CI 2.31 to 13.97) within six to 11 days after exposure to MMR vaccine.
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J Child Neurol. 2012 Jan
Risk Factors for Autistic Regression: Results of an Ambispective Cohort Study.
Zhang Y, Xu Q, Liu J, Li SC, Xu X.
To better characterize autistic regression and investigate the association between autistic regression and potential influencing factors in Chinese autistic children, conducted an ambispective study with a cohort of 170 autistic subjects. Analyses by multiple logistic regression showed significant correlations between autistic regression and febrile seizures (OR = 3.53, 95% CI = 1.17-10.65, P = .025), as well as with a family history of neuropsychiatric disorders (OR = 3.62, 95% CI = 1.35-9.71, P = .011). This study suggests that febrile seizures and family history of neuropsychiatric disordersare
correlated with autistic regression.
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Autism science is always interesting.....
Isaksen J, Diseth TH, Schjølberg S, Skjeldal OH.
Source
Department of Habilitation, Innlandet Hospital Trust, Maihaugveien 4, 2609 Lillehammer, Norway
Multiple search strategies were applied to identify children at risk of ASD or diagnosed with ASD. Hospital registers were searched and a mapping tool was used in all local schools.
RESULTS:
The total number of patients with ASD found in the population was 158. This gives a prevalence of 51 per 10 000
CONCLUSION:
Compared with the previously reported prevalence of ASD in Norway, there has been almost a fourfold increase in the occurrence of childhood autism and a tenfold increase in the occurrence of all ASD groups. These findings have significant implications for designing and dimensioning appropriate intervention programmes for children with ASD and their families.
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A 2006 study of nearly 57,000 British nine- and ten-year-olds reported a prevalence of 3.89 per 1,000 for autism and 11.61 per 1,000 for ASD; these higher figures could be associated with broadening diagnostic criteria.
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Autism science is always interesting.
http://onlinelibrary.wiley.com/doi/10.1002/aur.237/abstract
Research undertaken by Vanderbilt University and Keck School of Medicine, University of Southern California
* Parents in all three groups completed questionnaires about their child's behavior and GI symptoms, and a dietary journal.
*Functional constipation was the most common type of GID in children with ASD (85.0%).
*Parental report of any GID was highly concordant with a clinical diagnosis of any GID (92.1%).
*Presence of GID in children with ASD was not associated with distinct dietary habits or medication status.
*Odds of constipation were associated with younger age, increased social impairment, and lack of expressive language (adjusted odds ratio in nonverbal children: 11.98, 95% confidence interval 2.54–56.57).
*This study validates parental concerns for GID in children with ASD, as parents were sensitive to the existence, although not necessarily the nature, of GID.
*The strong association between constipation and language impairment highlights the need for vigilance by health-care providers to detect and treat GID in children with ASD.
* Medications and diet, commonly thought to contribute to GID in ASD, were not associated with GID status. These findings are consistent with a hypothesis that GID in ASD represents pleiotropic expression of genetic risk factors.
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I distinctly remember a team of paediatric gatroenterologists looking at this type of disease pathology in 1998.
Judge in High Court Appeal worried by GMC case. Even after "inadequate reasons" counsel for the GMC says final decision was fair, not wrong..
Look at the1988 "inadequate reasons" by the UK to disregard the fact that Canada had stopped using the MMR vaccine with the URABE strain of mumps virus for reasons of safety. And look the "inadequate reasons" to segregate the distribution of two different MMR strains (URABE and Jeryl-Lyn) within the UK population of children "to obtain comparative data."
“IN-CONFIDENCE, JCVI [Joint Committee on Vaccination and Immunisation] WORKING PARTY ON THE INTRODUCTION OF HEASLES, HUHPS AND RUBELLA VACCINE, February 11, 1988…The Chairman reminded those present that the proceedings of the Working Party were confidential…Members read a report of cases of mumps encephalitis which had been associated with MMR vaccine containing the URABE strain of the mumps virus. The Canadian authorities had suspended the licences of MMR vaccines containing the URABE strain, but Dr Salisbury considered that the data on which the decision had been based was slender. It was agreed that North Hertfordshire would use the Jeryl-Lyn vaccine, if it was available from MSD, to obtain comparative data. A statement would be prepared in anticipation of any adverse publicity which might arise.”
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_095328.pdf
“IN-CONFIDENCE, JCVI [Joint Committee on Vaccination and Immunisation] WORKING PARTY ON THE INTRODUCTION OF MEASLES, MUMPS AND RUBELLA VACCINE, February 11, 1988…
The A.J. Wakefield et al (1998) case series paper looked at a possible pattern in children’s medical conditions for the purpose of suggesting a possible hypothesis regarding a connection in those medical conditions to investigate further.
“We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder…We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described…We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.”
Unfortunately this document, which simply suggested a hypothesis to be further examined, followed the heels of a scandal in the UK involving use of the Urabe strain of MMR vaccine after it had been already discontinued in Canada.
“MMR Vaccination In Canada
Members read a report of cases of mumps encephalitis which had been associated with MMR vaccine containing the URABE strain of the mumps virus. The Canadian authorities has suspended the licences of MMR vaccines containing the URABE strain but Dr Salisbury considered that the data on which the decision had been based was slender..."
See http://www.ageofautism.com/2012/01/jackie-fletcher-of-uk-vaccine-safety-group-jabs-writes-to-bmj-about-wakefield-libel-suit.html
"Miller said it had been important that the disciplinary panel “separate out research from the clinical medicine – but that was a task that appeared to be beyond them”.
The judge asked Miller whether the alleged link between MMR and the vaccine “has now been utterly disproved” in the opinion of “respectable medical opinion”.
Miller said that was “exactly” the position."
"Miller said it had been important that the disciplinary panel “separate out research from the clinical medicine – but that was a task that appeared to be beyond them”.
1. Children with severe bowel pathology need to be clinically investigated ?
2. Parental concerns in regards to their child's severe bowel pathology and subsequent behavioural and intellectual regression needs to be investigated ?
3. There was no bowel pathology ?
Now using a disinfection theory for a crude model of destruction of neurons over time from the Chick Watson law (1908), per Gallagher et al (2004)--Reference No. 1 at http://www.usbr.gov/gp/dkao/biota_transfer/app11.pdf , then the equation for viability is:
Percent Viability = 100 x N/No = 100*e^-[t * (ln (1/0.7)/3)]
where t is time (days) and 100 x N/No is viability (percent).
So at 3 days this equation yields 70 percent viability, which is the Fujimura et al result.
And extrapolating, using the Chick Watson law of disinfection to provide a crude estimate of neuron viability for in vitro rat neurons with an exposure of 20 parts per billion inorganic mercury for 120 days, then this equation for the Chick Watson Law yields 0.000062846 percent viability.
A We had a strange situation at the Royal Free. We had two professors, a professor of community child health (Professor Taylor) and a professor of paediatric gastroenterology (Professor Walker-Smith) and two relative small academic teams. Low and behold, they seemed to be trying to prove one another wrong rather than coming together and working on a joint project. They were submitting conflicting arguments, with good reason, to the scientific press. I, for a number of different reasons was in conversation with everybody except, perhaps Dr Wakefield, at that stage. I always listen sympathetically to Professor Taylor and his concerns, because I was in some ways…. I listened to his concerns and I went around – and I am going from memory now – in effect I was trying to say to senior people like the dean, “Did you think, with hindsight that the ethical application was misleading? Were you hoodwinked?” And no.
There was considerable discomfort in the hospital and the medical school about aspects of this business, but not about the ethical approval. People seemed to think it was not an inappropriate way to work in 1996/1997. As I said earlier today, people with much larger research output than me, and very distinguished people, still take that view: that this was not by any stretch of the imagination the most worrying or disappointing aspect of this whole episode.
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What strange times - " internecine " rivalry at the medical school.
.
Thousands and thousands of pages.
Come watch JRS posting random pointless extracts.
Or you can skip to the concluding bits, in which Andrew Wakefield was found guilty by the General Medical Council of numerous ethical breaches, unprofessional conduct, callous disregard for vulnerable children, and dishonesty.
He was stripped of his medical registration in the UK, and the evidence against him was so damning he never even bothered to appeal.
Draw your own conclusions from the evidence, or alternately you could be silly enough to swallow the "narrative" that JRS is trying to sell, consisting of historical revisionism and negationism that would have made Stalin envious.
Trying to sell a 'narrative' What narrative may that be Dyson ?
Possibly because it is that "simple" view on science that is an anathema to more complex understanding of human physiology.
such as:
"The Panel made findings of transgressions in many aspects of Dr Wakefield’s research. It made findings of dishonesty in regard to his writing of a scientific paper that had major implications for public health, and with regard to his subsequent representations to a scientific body and to colleagues. He was dishonest in respect of the LAB funds secured for research as well as being misleading. Furthermore he was in breach of his duty to manage finances as well as to account for funds that he did not need to the donor of those funds. In causing blood samples to be taken from children at a birthday party, he callously disregarded the pain and distress young children might suffer and behaved in a way which brought the profession into disrepute."
and
"Dr Wakefield’s continued lack of insight as to his misconduct serve only to satisfy the Panel that suspension is not sufficient and that his actions are incompatible with his continued registration as a medical practitioner."
to make just two quotes.
A Yes, but also to deal sometimes with the direct consequences of long-term illness and the treatment thereof. Coming to terms is important but sometimes there were psychiatric consequences of either the underlying illness or the treatment.
For example, a field of study which Dr Murch and I would have pursued if he had stayed was the relationship between inflammation and mood.
Our clinical impression is that inflammation causes depression. I would be asked: “This boy seems depressed, can you try to work out whether he has an autonomous depression or whether this is, as it were, a sort of biochemical response to all the inflammatory products circulating around his body?” If it was the latter, then the best thing is to try to reduce the inflammation, but if it was the former, you have to follow a different course.
Child psychiatry is like liaison work because it is very variable, keeps you on your toes and you are always learning different things every day and one has to be flexible.
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Paul Patterson - CalTech
http://mitpress.mit.edu/catalog/item/default.asp?ttype=2&tid=12756
I love the way skeptiks like to stomp all over the science with hob nail boots ...
Q That will shorten the questioning I hope. We see, just to turn it up, the personal letter you received from Professor Hull. Again, we have seen it a number of times in this hearing already. You passed it on to Professor Walker-Smith to assist you with a reply to him. You were not looking other than to know how to respond authoritatively to Professor Hull.
A Absolutely. My practice throughout as the Dean of the Medical School was where necessary to seek the advice of my senior colleagues. As I stated earlier, I found the letter from Professor Hull extremely disturbing and I was not going to reply in haste to this without getting the information and the advice of my senior colleagues who were involved. I was entirely satisfied with the response which I had from Professor Walker-Smith. Furthermore, Professor Walker-Smith obviously took this extremely seriously because he, as soon as he received the letter, flew into my office to discuss this. As I said earlier, we had a very meaningful, fruitful, helpful, useful discussion. I was left completely satisfied that the children were investigated by clinical need. That, as far as I was concerned, was perfectly satisfactory.
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Professor Arie Zuckerman made that statement in full knowledge of the varying factors involved including his clear knowledge of the Legal Aid Investigation.
Q There is one other matter on that letter I wanted to ask you about. At the very last paragraph Professor Hull puts forward an offer that the Ethics Committee of the Royal College of Paediatrics and Child Health might give an independent review of the ethical position. Did you take that offer up at all?
A I consulted the professor of Community Paediatrics, Professor Brent Taylor, who felt that we should do that. If you study Professor Brent Taylor’s response, and in the light of the events at that time, it was far too late to seek yet another independent opinion. Had I not been satisfied with the response that I received from the clinicians, namely Professor Walker-Smith and Dr Simon Murch, had I not been satisfied, I certainly would have taken it further to the Ethics Committee of the College of Paediatrics. It really appeared a little churlish to continue further when both the hospital Ethics Committee, the chief executive, the medical director and others were satisfied that, in fact, Professor Walker-Smith and Dr Simon Murch were operating under full ethical approval.
John Walker-Smith testimony (Miller QC)
Q This is a letter from Dr Wakefield, following a conversation which he had had with the Chief Executive.
A Yes.
Q It is 3 July 1997.
“I am writing to confirm that there is no conflict of interest in relation to the Legal Aid funding for our clinical study of children with autism and intestinal inflammation.”
A Yes.
Q
“This study, which has been sponsored by the Legal Aid Board, is similar to a study they have sponsored as an investigation into Gulf War Syndrome. There are no pre-conditions to our grant. Furthermore, there is no intention whatsoever on behalf of the Legal Aid Board or its agents to take action against the National Health Service: it is against the manufacturers of vaccine that any future actions will be taken if and when our studies indicate that is a valid strategy.
Please find enclosed a copy of our first paper submitted to The Lancet concerning the children under investigation. This has been an extremely successful study and has clearly demonstrated a new pathology in these children and put the Royal Free Hospital as the world leader in this field.
We are aware of 300 children who merit investigation under this protocol, most of these as ECRs (or commissioned referrals for the future).
Thank you very much for your help in this matter. If you have any further questions, please do not hesitate to get in contact with me.”
I think anyone with a knowledge of the justice system realise that defendants have the right to have their testimony given weight....not here apparently.
What that letter clearly shows is that the university executive understood what exactly was taking place , how this applied to ethics and clinical need and the eventual publication of the Lancet article and the media conference.
No lone wolf here ...