MMR Is Back

June 2nd, 2006 by Ben Goldacre in bad science, mail, MMR, scare stories, telegraph, times | 67 Comments »

Ben Goldacre
3rd June 2006
The Guardian

[Mmmm uh-oh I’ve just found out the Guardian newsdesk have cut this by 200 words while I was having an afternoon snooze. I can’t bear to look. Anyway, here’s what I wrote…]

MMR is back. “US scientists back autism link to MMR” squealed the Telegraph. “Scientists fear MMR link to autism” roared the Mail. “US study supports claims of MMR link to autism” croaked The Times, a day later.

Strap me to the rocket and print my home address in the paper, I’m going after them again. So what was this frightening new data? Well it’s hard to tell, since it hasn’t been properly published anywhere yet, so you can’t actually read it and form an opinion. This is now standard operating procedure for all scare stories, because journalists have learnt that informed and informative public debate on unpublished research is basically impossible. So it turns out that these three newspaper stories are all about a poster presentation, at a conference yet to occur, on research not yet completed, by a man with a track record of announcing research that never subsequently appears in an academic journal: Dr Arthur Krigsman.

The story is that he may have found genetic material (RNA) from vaccine-strain measles virus in some gut samples from children with autism and bowel problems. Some believe that this could implicate the vaccine in causing health problems.

But let’s not forget, the Daily Mail was promoting Krigsman’s research back in 2002 as well: at that time, he was putting endoscopes into the bowels of young children with autism, and said he had found evidence of inflammation. 4 years later, looking on PubMed, the standard database for all medical papers, it seems this research still has not been published in a peer reviewed academic journal. Forgive my bluntness, but it seems a shame to go poking around up there if you’re not going to write up your findings properly.

Meanwhile the Telegraph says that Krigsman’s most recent unpublished claim is replicating similar work from 1998 by Dr Andrew Wakefield, and 2002 by Professor John O’Leary. But there is no such work from 1998 by Wakefield, at least not in PubMed (in that year he publishes his infamous, very different, and partially retracted Lancet paper on MMR, of course). Meanwhile it is well documented that other labs have tried to reproduce the 2002 O’Leary study and come out with different results, and that the protocol was likely to have problems with false positives because of the tests used: two perfect examples of the importance of research being fully written up and published, so it can be replicated and assessed. Oh, and the newspapers didn’t mention that Andrew Wakefield was also an author on the 2002 study along with O’Leary, nor that Wakefield is also very closely associated with Krigsman (they are doctors together at Thoughtful House, a private autism clinic in the USA).

I could go on, but instead, here is the news you didn’t read: this month, in the May issue of the Journal of Medical Virology, there was a very similar study, only this one has actually been published. It looked for measles RNA in children with regressive autism after MMR vaccination, much like the Krigsman story. It used tools so powerful they could detect measles RNA down to single figure copy numbers. But they found no evidence of the magic vaccine-strain measles RNA to implicate MMR, and perhaps because of that unfrightening result, the study was loudly ignored by the press.

Because it has been published in full, I can read it, and pick holes in it, and I am more than happy to do so: because science is about critiquing openly published data and methodologies, and in the real world, all studies have some flaws, to a greater or lesser extent. Often they are practical ones: here for example, the researchers couldn’t get ethics committee approval to use the tissue they ideally wanted to use (lumbar punctures and gut biopsies on children are a hard sell). And when they asked the anti-MMR lobby if they could have some of their tissue to work on, amusingly, they were ignored.

Those who campaign against MMR make huge and detailed critiques of the published studies which suggest that MMR is safe. Sometimes they are spectacularly ill-informed: excepting that, it is quite right that they should critically appraise the literature. But in the spirit of science, the least they could do is share data, and maybe tissue samples, but most importantly publish their scientific work, in full, openly, before their peers, rather than the press.


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67 Responses



  1. Fyse said,

    June 2, 2006 at 6:25 pm

    Is there anything anyone can do about the press behaving like this? Are there guidelines on science reporting? Can we all complain to the PCC? And if not, why not?!

    This sort of thing makes me SO ANGRY. It’s wildly irresponsible to run scare stories like this. Perhaps there should be official guidelines to restrict coverage to published studies, except where it’s made really clear that the results are still speculative rather than accepted. But then that restricts the ability of the press to uncover genuine problem areas. Not an easy issue, I guess.

  2. JQH said,

    June 2, 2006 at 8:46 pm

    I get the impression that most journalists writing on science, don’t actually understand scientific methodology so they can’t even tell when they’re regurgitating rubbish.

    They also have short memories so even when a fraud like Dr MRSA is exposed, they continue treating his words as gospel.

  3. Ben Goldacre said,

    June 2, 2006 at 9:15 pm

    Mmmm. I guess on top of that the emotional pay off for attacking MMR must be huge, worried parents adore you, you get to feel like a campaigning journalist, just like in Watergate, bigger than the government and the medical profession. On the other hand if you write evidence based torpedoes you get attacked by the loonies in your own paper (that’s not just my experience) and of course sued:

    bmj.bmjjournals.com/cgi/content/full/331/7525/1104-a?HITS=10&sortspec=relevance&hits=10&andorexactfulltext=and&FIRSTINDEX=0&resourcetype=HWCIT&fulltext=wakefield&searchid=1

    Andrew Wakefield, the doctor at the centre of the measles, mumps, and rubella (MMR) vaccine controversy, was criticised by a high court judge last week for trying to silence critics by warning them that he was suing for libel while at the same time failing to progress the case.

    Mr Justice Eady said that he was quite satisfied that Dr Wakefield, who now works in Austin, Texas, “wished to extract whatever advantage he could from the existence of the proceedings while not wishing to progress them or to give the defendants an opportunity of meeting the claims.”

    The judge refused Dr Wakefield’s application to stay—put on hold—the libel claim against Channel 4; 20-20 Productions; and a journalist, Brian Deer, over the November 2004 Dispatches programme “MMR: What They Didn’t Tell You.”

    Dr Wakefield’s solicitors had written to Liberal Democrat MP Evan Harris in February and the Cambridge Evening News in June this year, warning them against repeating defamatory statements made in the Dispatches programme.

    Dr Harris said, “It is ironic that Dr Wakefield should try to use such a ploy when he and his supporters allege that he has been silenced by the medical establishment.”

    Mr Justice Eady said, “It thus appears that the claimant wishes to use the existence of the libel proceedings for public relations purposes, and to deter other critics, while at the same time isolating himself from the “downside” of such litigation, in having to answer a substantial defence of justification.”

  4. afh said,

    June 3, 2006 at 4:14 am

    I am currently at the conference where Krigsman presented his poster yesterday, though I didn’t stop by to see it. But his abstract says that he collected data from 275 children, and preliminary analysis of 14 samples supports his ideas. That isn’t much data for this kind of this, really just an ancedote. And of course there are no statistics, even though stats are standard in most abstracts. So no data worth basing any conclusions on, let alone a press release.

  5. superburger said,

    June 3, 2006 at 8:44 am

    a good controversy shifts units. I enjoyed the R3 show the other night in which one of the panel (perhaps even ben?) said that the basic preimise of newspapers was to make profit by selling advetising space, and in order to do so sales must be kept hight.

    A story about the stats involved in MMR and the details of the studies performed isn’t going to excite or interest 99.99% of the paper buying population. Stories about women with large breasts are.

    However, a story about a maverick underdog scientist whose On To Something, being kept down by the Elite Medical Establishment is likely to generate enough interest to shift unit. If you throw in a sad tale of ordinary people (code for white middle class couples) whose little angel got the MMR jab at 18mnths and 6 weeks later was diagnosed autistic (see photos on p xx) is potential dynamite.

    On one level, who gives a shit. But the MMR saga is downright dangerous. Measles kills, and kids will start dying of a disease which shouldn’t exist in 2006. Perhaps people ignore the benefits of vaccination now that we don’t see the after effects of polio or smallpox etc. Or perhaps we are sliding towards a new dark age…

    Either way, science needs to recognise that in order to be heard by the public in general it needs to use the tactics of Wakefield, Mel Phillips et al and start screaming loudly like a baby whose rattle has been taken away in order to preven children dying.

  6. Wiretrip said,

    June 3, 2006 at 9:41 am

    Take a look at this, those of you with PubMed access:

    Journal of Child Psychology and Psychiatry
    Volume 46 Page 572 – June 2005
    doi:10.1111/j.1469-7610.2005.01425.x
    Volume 46 Issue 6

    No effect of MMR withdrawal on the incidence of autism: a total population study
    Hideo Honda1, Yasuo Shimizu1 and Michael Rutter2

    Of course this should have been exciting but wasn’t…

    I think that it is very sad that this whole saga has arisen in the first place. Wakefield’s research should have been treated as part of a healthy debate on immunisation practice in general (the Japanese study above is only possible because the Japanese government responded responsibly to other problems potentially linked to the combined MMR vaccine). Unfortunately, in this case, hysterical media blew the research out of all proportion and a panicky government, (admittedly trying to protect its herd immunity) responded in a fairly heavy-handed manner, effectively stamping-out any debate on the topic. Now that it has become a political, rather than scientific subject, I should think that it is extremely hard to publish work even vaguely indicating a link between MMR and Autism in most journals since it is peer review and most ‘peers’ in the herd would generally try and shy away from controversy.

  7. Weirdbeard said,

    June 3, 2006 at 10:04 am

    Bearney: I’d advise against trying to get anything published in the Daily Mail. I sent them a letter in the early 70s about some bollocks they’d printed about the inheritance of intelligence. They edited in such a way that instead of opposing what they’d written it now supported it. What they published were my words but not my sense.

  8. dbhb said,

    June 3, 2006 at 5:12 pm

    This is just intolerable.

  9. BobP said,

    June 3, 2006 at 7:10 pm

    More about the Krigsman research is pre-announced in a Wikipedia entry dated 30 May 2006 – about halfway down the page here
    en.wikipedia.org/wiki/Arthur_Krigsman
    Research apparently conducted by Dr Stephen Walker

  10. huwmanerror said,

    June 3, 2006 at 11:22 pm

    [To those who didn’t listen, sorry to make another reference to Ben on R3]

    *Obviously*, the reason the study in the Journal of Medical Virology didn’t get more newspaper coverage was because the authors hadn’t spent enough time practising explaining their findings to their mothers…

  11. JQH said,

    June 3, 2006 at 11:54 pm

    So Dr Wakefield uses the libel laws to silence critics. The Daily Mail refuses to publish postings criticising the MMR-autism link. Seems to me that the ant-MMR crowd are the oppressors not the oppressed.

  12. Ben Goldacre said,

    June 4, 2006 at 12:56 am

    the mail are really milking this, it’s in there today again…

    www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=388887&in_page_id=1770

  13. raygirvan said,

    June 4, 2006 at 12:35 pm

    BobP: More about the Krigsman research is pre-announced in a Wikipedia entry dated 30 May 2006 en.wikipedia.org/wiki/Arthur_Krigsman.

    Caution with that source: the chief editor of that article, Ombudsman, has a long history of anti-mainstream, anti-vaccination bias.

  14. mikestanton said,

    June 4, 2006 at 7:57 pm

    I am with Kev on tthis one. I blogged it as
    the Street of Shame I made one mistake. I assumed the biopsies were all taken at Thoughtful House. But Krigsman says he collected them all while at the New York University Medical Center. So why send them all down to Steve walker in North Carolina. Are there no labs at NYU?
    Like some of you i tried to post to the Mail. for the record this is what they refused to print.

    This is the same study that was reported in the Mail last Sunday and the same criticisms apply. It is impossible to judge the findings based on a press release and a poster at IMFAR. We need to read the study when it is complete and published in a peer reviewed journal. But it is possible to question how independent the study is. Dr Walker is an advisor to Thoughtful House, Dr Wakefield’s clinic in Texas. Dr Krigsman who supplied the biopsies to Dr Walker is now working at Dr Wakefield’s clinic. Dr Wakefield is listed as a consultant to the study.
    Campaigners are always quick to point to potential conflicts of interest when vaccines are exonerated by scientists with links to the drug companies Shouldn’t we apply similar standards of scepticism to this study?

  15. Teek said,

    June 5, 2006 at 7:51 am

    “his abstract says that he collected data from 275 children, and preliminary analysis of 14 samples supports his ideas. That isn’t much data for this kind of this, really just an ancedote”

    exaclty. grrrr. afh is spot on – no way should a news story get printed on the back of such flimsy ‘data.’

    i know someone on the team at the Mail (sunday i think), i’ll have a word – to be fair to him he himself has a fair understanding of science and the way peer review works, and was not responsible for this ‘story’ – will have a word tho, see if he can explain why they keep carrying such bollocks in their paper.

  16. Dr Aust said,

    June 5, 2006 at 9:52 am

    Really it just makes you cry. The Daily Mail should be ashamed of themselves (sadly we already know they have no shame), as should our old friend Melanie Phillips.

    As we all know, and Ben and others have written, the net result of all this scaremongering bollocks is that less parents will vaccinate their children, with the result that more kids will be damaged or even die from complications of measles, more women will have spontaneous abortions when they get Rubella, and more men will go sterile through getting mumps..

    Can’t all the MPs who actually know something about medicine or science get together and issue a statement, or denounce the Mail in the House? The Mail’s action will lead to more measles-damaged children, and deaths, and it needs saying out loud.

    And I hope all the people at the Royal Free who were involved in the original Wakefleid paper – including the senior people who sensed something was dodgy but went along with it in the hope of a “big splash” Lancet paper – spend a few minutes every day feeling ashamed of themselves.

    It will come as no surprise to anyone who posts here, of course, but every single person in science and medicine that I have ever discussed MMR with finds the determination of Melanie Phillips et al to see Andrew Wakefield as a “wronged crusader for the children” utterly barmy. That is as restrained as I can put it.

  17. dbhb said,

    June 5, 2006 at 12:17 pm

    One of the other comments by a David Thrower quotes numerous studies that apparently prove a link:

    “The latest research from Walker should be seen in the context of a number of other clinical studies. Studies by Horvath, by Wakefield, by Furlano, by Buie, by Krigsman, by Ashwood, by Jyonouchi, by Balzola and by Gonzalez (in each case, with co-researchers) have confirmed the gut condition first reported by the Wakefield team in 1998. Added to this, studies by Uhlmann, by Kawashima, by Singh, by Bitnun, by Bradstreet (again, with co-researchers too numerous to list) have linked the gut condition to measles virus. A very recent study by Wakefield looked at the “double-hit” syndrome, where children were immunised, then regressed, then were later immunised again, and regressed further, strongly suggesting a causal link. There is also evidence that autism has increased dramatically since the 1980s, including studies by Yeargin-Allsopp, by Gurney, by Yazbak, by Blaxill and by Newschaffer (all in the US). The Byrd study in California confirmed the increases were real, not better recognition”

    If only I had the time to check all these references. Presumably they are not valid?

  18. Ben Goldacre said,

    June 5, 2006 at 12:28 pm

    the only time krigsman-a appears on PubMed/Medline is for a paper on asthma stuff. nothing whatsoever on MMR. so that’s one name crossed off the list. likewise bitnun mmr gives nothing, uhlmann is first author on the o’leary and wakefield 2002 paper that’s been discussed already and which has many documented problems, so that’s the same paper just being repeated, bradstreet has nothing on pubmed for MMR (although he does have an article in the somewhat iffy right wing magazine medical sentinel, or “journal of the american physicians and surgeons”, or whatever it’s calling itself at the moment, on the subject), and singh is a tricky name to exclude…

  19. coracle said,

    June 5, 2006 at 2:29 pm

    Dr Aust
    Can’t all the MPs who actually know something about medicine or science get together and issue a statement, or denounce the Mail in the House? The Mail’s action will lead to more measles-damaged children, and deaths, and it needs saying out loud.

    Sadly, that will just strengthen the anti-MMR feeling, all those campainers will suddenly think “OMG – Coverup!!”

    Not that I’ve got a better idea.

  20. Dr Aust said,

    June 5, 2006 at 3:31 pm

    Hi coracle

    I suppose this is probably true… but I think the anti-vaccine nuts are already long since lost to the world of rationality. The battle is for the “hearts and minds” of general public, and stupid stories like the Mail’s just make them think “no smoke without fire”.

    I am clinging to the idea that polls usually show people do, on the whole, trust doctors and (to a lesser extent) scientists, while they don’t trust journalists and politicians nearly as much. One would like to believe that polticians who used to be doctors or scientists have some advantage over ministers or the Department of Health since parliament gives them a platform and their professional B/G gives them some credibility. But one does have the depressing feeling that in the free market of disinformation bad info drives out good, or loudly voiced scares/ conspiracy theories drive out the boring truth.

  21. tmitsss said,

    June 5, 2006 at 9:43 pm

    In the earlier thread on this someone asked the origin of the phrase “Extraordinary claims require extraordinary proof” That made me curious enough to do a little googleing.

    It seems this phase comes to us from David Hume as paraphrased and popularized by Carl Sagan. The original quote is “That no testimony is sufficient to establish a miracle, unless the testimony be of such a kind, that its falsehood would be more miraculous, than the fact, which it endeavours to establish….’ From David Hume. An Enquiry Concerning Human Understanding

  22. superburger said,

    June 6, 2006 at 7:50 am

    mdt.

    The Cochrance library study

    Demicheli V, Jefferson T, Rivetti A, Price D. Vaccines for measles, mumps and rubella in children. The Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004407. DOI: 10.1002/14651858.CD004407.pub2.

    includes a “plain language” summary

    “Measles, mumps and rubella are three very dangerous infectious diseases which cause a heavy disease, disability and death burden in the developing world. Researchers from the Cochrane Vaccines Field reviewed 139 studies conducted to assess the effects of the live attenuated combined vaccine to prevent measles, mumps and rubella (MMR) in children. MMR protects children against infections of the upper airways but very rarely may cause a benign form of bleeding under the skin and milder forms of measles, mumps and rubella. No credible evidence of an involvement of MMR with either autism or Crohn’s disease was found. No field studies of the vaccine’s effectiveness were found but the impact of mass immunisation on the elimination of the diseases has been demonstrated worldwide.”

    That’s 139 papers, all chewed up and digested, analysed and number crunched to look for shreds of evidence for a link between MMR and autism. And none was found.

    Unfortunatley mdt, it is very easy to dismiss anything which hasn’t been submitted for peer review (like the conference poster discussed earlier) or has been largley retracted (as happened in Wakefield’s original paper) and extrodinary claims (such as a link betwen MMR and autism – which is shown to be supremely unlikely based on the cochrane review) require extrodinary proof, which a press release from people with vested interests, like the Thoughtful House crowd, most certainly isn’t.

  23. dbhb said,

    June 6, 2006 at 8:45 am

    mdt: “If we haven’t read the papers (and I do not have the facilty to access them) then we shouldn’t just dismiss them with prejudice.”

    Yes, I was trying not to. Ben campaigns for people to provide references to back up their claims, and this David Thrower bloke did (kind of). So now we have one set of references that allegedly claim one thing, and another set of references that allegedly claim another. Like Ben and Gordon, I did a perfunctory search to try and establish the existence or otherwise of these papers, and I conclude that they probably do exist (although I agree that some of them appear to refer to the same paper). But, no I don’t have time to go through them and tease out what they really say or whether they are valid studies. Demicheli et al have apparently done so (were Thrower’s papers part of the set included in the metastudy?) but I can’t go through that either.

    So, like other Joe Publics, I’m left having to take peoples’ word on things. Happily I set more store by the scientific, medical and governmental consensus (and by Ben) than many Daily Mail readers do. But if somebody like Thrower posts something like that on the Daily Mail site then it will strongly reinforce their beliefs, so if there are reasons to dismiss those works then somebody somewhere needs to explain what they are.

  24. superburger said,

    June 6, 2006 at 10:54 am

    1) was retracted by 10 of the 13 authors. A retraction is a big deal for a major academic journal.

    7) As discussed in Ben’s article is not a peer reviewed piece of work, it is a conference presentation. Until results are published and peer reviewed they cannot be considered serious evidence.

    That’s ~10% discussed.

  25. mdt said,

    June 6, 2006 at 11:06 am

    Thanks Superburger

    Is there anything on the other non Wakefield papers or are all the other authors linked to him in some way. I think Wakefield is pretty discredited now

  26. superburger said,

    June 6, 2006 at 12:21 pm

    I am not 100% on clinical experiement design and am not a medical doctor so can’t comment on specifics.

    but,

    2) is a paper in which 36 children, with autism (no control group) to identify if they had any gastrointestinal complaints. Some did. The conclusion is that undiagnosed tummy trouble in non-verbal autistic kids may enhnace observed bahvioural difficulties (seems logical). No mention of any link between gut trouble and autism.

  27. pastafarian said,

    June 6, 2006 at 2:42 pm

    mdt –

    trying to work my way down your list.

    3 is a study showing that autistiuc spectrum children can have features of inflammatory bowel disease. There is NO link to MMR in this paper. It does what it says on the tin and is interesting for that point, but says nothing about MMR.

    4. likewise states that a select group of children with autism and bowel symptoms have a specific type of inflammatory bowel disease. Nothing to do with MMR

    I suspect these papers have been included in your list because they are legitimate papers, and are ok as far as they go. The antivac nuts like to think that the bowel problems are caused by MMR, but these papers provide no ev idence for that hypothesis.

    In fact, I favour the alternative hypothesis: the bowel contains a nervous system almost as rich as the brain itself. If autism is due to a problem in neuronal development, then it is likely that the enteric nervous system could also be affected by this disordered development.

  28. pastafarian said,

    June 6, 2006 at 3:13 pm

    20 is the article that Ben commented a while back. It was not published in a peer reviewed journal (despite Melanie Philip’s bleatings to the contrary) and the journal website is worth a look just for their entertaining views on immigrants, private healthcare and homosexuals!

    19 is a case report of measles encephalitis developing after vaccination. This is a known very rare side effect – not that the risk from wild type measles is WAY higher. Also vey important to note that no mention of MMR and bowel problems or autism.

    I am not going to waste my time with this any longer. Could you ask your tame nutter for some decent references? Or ask him why he thought these were relevant in the first place?

  29. superburger said,

    June 6, 2006 at 3:22 pm

    And, of course, we have, as previously mentioned, the cochrane study which investigates directly the link between MMR and autism and finds none. A rigorous study which the anti MMR fringe find so easy to dismiss…

  30. Delster said,

    June 6, 2006 at 4:59 pm

    MDT,

    the problem here is that without control groups almost any kind of study is meaning less.

    Say for instance you checked and found 85% (plucked from the air) of 200 autistic children had this type of RNA in their gut biopsies. Without checking 200 normal non autistic children the result is meaning less.

    On the other hand if you did check 200 normal children and found that around 85% of them had this RNA present as well then you could pretty much kick that link out.

    However if i had a kid i’d not be letting people take random samples for biopsy and most people would be the same, so your going to have problems getting a control groups.

  31. three tigers said,

    June 6, 2006 at 9:00 pm

    Can’t we just view this form of stupidity by “rabid anti-vaccination parents” as just a version of natural selection? Rotten for the kids I know, but they would probably only turn into Daily Mail readers too.
    Also, if I’m being VERY selfish on behalf of my genes, since both my kids have had not just one, but two MMR jabs (to improve their immunity well into their 20’s and beyond) they will not get measles (either or them), not be rendered infertile, nor loose a pregnancy to rubella (gender specific). Hopefully this will help them to pass some of my genes on in time.
    Of course sadly a number of non-fanatics will also fail to vaccinate, but I blame a total lack of basic scientific education here. Perhaps a few measles epidemics, so modern parents could see how bad these things are, would concentrate a few minds. I’m old enough to have had all 3 diseases as a child and measles especially is really not funny. I’m so pleased my kids will not need to suffer.

  32. mdt said,

    June 7, 2006 at 11:12 am

    Thanks to everyone who took the time to look through the references I passed on.
    I haven’t looked into this in detail before so its very interesting to see how this all works and I was intrigued by the sheer volume of references David Thrower could call on.

    I think I now see what is going on here. In general either the research is seriously suspect e.g. ref 1 or doesn’t relate to the actual MMR-autism link hypothesis. In fact the hypothesis seems to be more of a MMR-gut symptoms-autism link(see Dr Aust post 39). A lot of the work takes either the MMR-gut or gut-autism link as read and attempts to prove the other link (although it doesn’t seem to me that the gut symptoms examined are always the same). Therefore all the papers may me considered ‘relevant’ without actually proving anything!

    I too managed to contract all three diseases as a child and have therefore been very keen to immunise my own children. I also saw my sister suffer from whooping cough because of some problem with the vaccine for that (not sure whether it was a similar story to MMR).

  33. mdt said,

    June 7, 2006 at 11:14 am

    On a perhaps unrelated note, I’m sure i read somewhere that there is a chicken pox vaccine. This is certainly a disease we could live without so why don’t we routinely vaccinate for it?

  34. sockatume said,

    June 7, 2006 at 1:06 pm

    Presumably the risks and expense involved in mass-vaccination for chicken pox aren’t worth the result (protecting a minorty of adults who haven’t acquired immunity from getting the disease).

    That said, it’d probably be worth vaccinating anyone who hasn’t already had chicken pox once they reach adulthood.

  35. Dr Aust said,

    June 7, 2006 at 2:04 pm

    There are problems with non-vaccinating as a kind of “Darwin Award”, self-selecting nitwits out of the gene pool (if only…). True in the sense that unvaccinated kids are far more likely to get the diseases, and of course as vaccination levels drop, outbreaks become more likely (loss of “herd immunity”) so the odds that a non-vaccinated child WILL get (e.g.) measles go up steeply. This is happening in the UK now.

    The most obvious downside is that it is misguided or ill-informed or scared parents making decisions for their children, so although they (the parents) disadvantage their “genetic material” (Darwin awards!), it is hardly the childrens’ fault their parents are misguided etc etc.

    Another problem is that vaccinating only confers PARTIAL immunity, although modern vaccines are mostly pretty seriously good.. The level of immunity produced depends on the disease (e.g. may be different for mumps and measles) As I read the figures (and I am a research scientist, not a medic or a vaccinologist) one MMR shot confers immunity to measles in 95-98% of children. and after two shots, 99% are found to be immune (defined on the basis of detecting (eg) anti-measles antibodies at acceptable levels in the blood, so even the 1% “non-immune” may have some anti-measles antibodies, just not as many as one would like).

    [PS This testing is called “serology”, or often referred to on Public Health-y websites as “a laboratory test indicating immunity”. People working in healthcare typically have to have these serology tests to show they have been immunized against specific diseases. I am pretty sure that in the US you cannot work in a healthcare setting, even as a receptionist, if you don’t have immunity to measles, mumps, and so on]

    Anyway, getting back to my main point, although 99% of children who have had two MMR shots should have good levels of anti-measles antibodies, this does still mean 1 of 100 children vaccinated correctly might not have enough anti-measles antibodies to be immune. Similar arguments apply to the other diseases. So vaccinations do not usually make it absolutely 100.0 % impossible for the vaccinated person to catch the disease (a fact the anti-vaccine crazies often use against vaccination in a deliberately misleading way). They do make it far far less likely, thankfully.

    Of course, in a population with better than critical levels of vaccination cover, people without immunity (for whatever reason) are also protected by “herd immunity” – crudely put, a person who gets the disease can’t pass it on because those around them are immune, so no person-to-person spread and no outbreak.. The figure for % immunity required is different for different diseases (depending how easily transmissable they are). For measles (highly transmissable) I have heard 94-95% being needed. I guess with the anti-vaccination frenzy we are now well below that in a lot of the UK. As I have said, this is why all my GP friends hate Andrew Wakefield, the Daily Mail and Melanie Phillips so much.

    So it is just about possible that your child, even having had two MMR shots, could get measles or mumps or rubella if there are enough kids in their school/nursery who have parents who don’t vaccinate. Thankfully it is much less likely to happen. Again, in the US I believe many nurseries and even schools will require evidence of vaccination before they admit kids, although this is probably based on their fear of being sued.

    What a world, eh?

  36. tom p said,

    June 7, 2006 at 5:06 pm

    Of additional interest, the “vaccinations expert” Dr Richard Halverson the Hate Mail quoted as saying that these results were really important is the same Richard Halverson (GP) who runs Holborn Medical Services and charges scared parents £480 for all three vaccines separately.
    Surely some conflict of interests there, eh

    I posted a similar comment at the mail’s comments board, but I’ll be surprised if the publish it

  37. Aspiring Pedant said,

    June 7, 2006 at 6:56 pm

    What I’ve never been able to comprehend is the idea that MMR is suspected of causing autism or bowel disease and yet single vaccines are safe. How would you know that?

  38. Dr Aust said,

    June 7, 2006 at 10:44 pm

    Whoops… I meant thimerosal. I even did experiments with this stuff once so I can’t believe I got that wrong.

    Incidentally, MMR never had thimerosal in it, but thimerosal is still widely touted in vaccine scares. I believe the only UK vaccine that ever had it in was DipTet (Diptheria Tetanus and Whooping cough vaccine).

    But of course a good scare doesn’t worry about facts.

    “When the legend becomes fact… print the legend”

    A credo dear to health-scare-loving newspapers, methinks.

    PS Back when I wore contact lenses in the early 80s thimerosal was in lots of the contact lens solutions as a preservative, so that’s me done for. [Thimerosal was largely eliminated for this use in the mid 80s.] But hopefully instead of autism it will only give me Asperger’s, which in a scientific research setting will be completely undetectable.

  39. Jellytussle said,

    June 7, 2006 at 10:47 pm


    mdt said,

    June 7, 2006 at 11:14 am

    On a perhaps unrelated note, I’m sure i read somewhere that there is a chicken pox vaccine. This is certainly a disease we could live without so why don’t we routinely vaccinate for it?

    Yes, it does exist, and in some countries (eg Canada) it is given routinely to children. I’m not sure what the policy is in the rest of the EU. The rationale for not vaccinating against Chicken Pox in the UK is probably a combination of factors. Chicken Pox is miserable, but usually short lived, and rarely serious in otherwise healthy individuals. There is will also be a cost analysis, and any vaccination is likely to incur side effects in a few individuals.

    Probably find the vaccine is indicated for special cases eg bone marrow transplants and other chronically immunosuppressed.

  40. Ephiny said,

    June 8, 2006 at 9:49 am

    “What I’ve never been able to comprehend is the idea that MMR is suspected of causing autism or bowel disease and yet single vaccines are safe. ”

    What puzzles me is that if the vaccine is supposed to cause bowel disease, as ‘proven’ by the presence of measles RNA from the vaccine in the gut, then why would the diease itself not cause the same, or worse, problems?

    If it’s not the viral RNA but the mercury or some other ingredient that causes the problem, then as mentioned above, why would the single vaccine be any safer? In fact, presumably three separate vaccines would mean three doses of mercury rather than one?

  41. Dr Aust said,

    June 8, 2006 at 11:10 am

    Ephiny

    A large part of the underlying problem is that despite much research no-one knows what causes inflammatory bowel disorders (e.g. ulcerative colitis and Crohn’s disease). So the MMR vaccine nuts have a field day claiming it is the response to the vaccine. But your question is a good one – if it WAS something about the unusual effects of the attenuated/dead virus in the vaccine that led to the bowel symptoms in that particular person, then the “live” virus (i.e. catching the disease) might be expected to have similar effects in such a susceptible individual… Although it is much more complicated than that as other factors, including age, inherited immune system characteristics, family history, and past “what-has-been happening in your gut” also probably influence one’s likelihood of developing inflammatory bowel problems. But what you suggest would be worth studying, I would have thought. Unfortunately it is a “control” experiment of the type that are rarely (never?) included in the vaccine-nut work.

    Incidentally, simple diarrhoea is a common complication of measles, but that is not the same as the kind of colitis the papers claim to be associating with vaccination.

    The lousy non-control experimental designs, and the logical fallacies, in the vaccine-nut work are echoed all over alt medicine as well. Another well-explored example is Epstein-Barr virus (EBV, the glandular fever virus) as a purported cause of Chronic Fatigue Syndrome (CFS) / ME, and other things. “98% of CFS sufferers in our study had posittve serology for EBV” ..! Wow – 98% – sounds conclusive. Of course, what they don’t tell you is that in an adult UK population 98% of ALL people have positive serology for (have been exposed to) EBV. But since many of my 1st yr medical and bioscience students have trouble spotting the trick, it isn’t surprising that the public are often fooled.

  42. Gordon said,

    June 8, 2006 at 11:54 am

    Quote
    ” mdt said,
    June 7, 2006 at 11:12 am

    I think I now see what is going on here. In general either the research is seriously suspect e.g. ref 1 or doesn’t relate to the actual MMR-autism link hypothesis. In fact the hypothesis seems to be more of a MMR-gut symptoms-autism link(see Dr Aust post 39). A lot of the work takes either the MMR-gut or gut-autism link as read and attempts to prove the other link (although it doesn’t seem to me that the gut symptoms examined are always the same). Therefore all the papers may me considered ‘relevant’ without actually proving anything!”

    Mdt, I think that your interpretation of what is going on is slightly wrong. I agree that much of the research cited by David Thrower does not directly relate to the MMR-autism hypothesis, but I don’t think “a lot of the work takes either the MMR-gut or autism-gut link as read”. My interpretation of what David Thrower has done is link research that is related to his stance and claim that it backs up his position (MMR-autism link). But this is not the case. The individual research papers by themselves do not do this and I suspect many of the researchers behind this work would never do so for fear of looking like Andrew Wakefield, even if they did believe there was a casual MMR-autism link. I do think you are correct when you say that the papers are ‘relevant’ without proving anything, and there does appear to be a lot of interesting research ongoing, but the only paper that come close to proving anything one way or the other seems to be this review cited by Ben Goldacre (which I have not read).

    Reading this over, it occurs to me that what I’ve just written is actually what you meant anyway. If so, apologies.

  43. three tigers said,

    June 8, 2006 at 1:53 pm

    JQH post 56:
    the study has already been done (albeit by the Danish and not the Dept of Health) see Madsen et al., NEngJMed 2002, 347(19), p 1477-82. What is especially great about this study is that the vaccination records and autism diagnoses are collected separately, (so no recall bias from shocked parents looking for a scapegoat when they get the autism diagnosis). Basically, they looked at the records for about 537,000 kids from 1991 to 1998. The odds ratio for the vaccinated group (approx 440,000) compared to the unvaccinated was 0.92 (95% CI 0.68-1.24). From this result there is NO ASSOCIATION and the odds ratio is effectively 1. If you want to be really cheeky and stretch things a bit, you could almost argue that with enough samples analysed, MMR might even slightly protect against autism!! OK, sick scientist joke, but that is the direction the data from this study is pointing.
    Further, there was no association between the age at vaccination, the time since vaccination, or the date of vaccination and the development of autism.

    Direct quote from the abstract summary.
    Conclusions: This study provides strong evidence against the hypothesis that MMR vaccination causes autism. This is scientist/medic speak for “this evidence is as good as it gets folks” we are never more committal than this.

  44. DT said,

    June 8, 2006 at 2:36 pm

    mdt – more on the references.

    (8) Ashwood, Murch et al. Journal of Clinical Immunology, Vol 23 No. 6 Nov 2003 pp504-517. Wakefield is a co-author.

    The paper just detailed the type of enterocolitis they had found in ASD children, nothing more. Measles not mentioned until this section of the discussion:
    “This study did not set out to examine the aetiology of the enterocolitis in affected children. While Uhlmann et al. have reported the presence of measles virus genomic RNA in follicular dendritic cells within ileal lymphoid follicles in affected children (32), these data do not directly support a causal relationship to the mucosal findings. Further study is clearly required, particularly as Singh et al. have reported atypical humoral immune response to measles virus in children with a similar autism phenotype, that correlate with abnormal serum antibody titers to myelin basic protein (33). It will be important to determine the specificity of this lymphocytic infiltrate, to determine whether or not these cells may be responding to specific bacterial or viral peptides or whether there is potential for molecular mimicry.”

    (10) Ashwood, Anthony et al. Journal of Clinical Immunology, Vol 24, No. 6, November 2004. Wakefield is a co-author.
    A more detailed immunological study, presumably of the same cohort as above. Measles is not mentioned, but interestingly the inflammation in the bowel is likened to HIV enteropathy. In the discussion they discuss the possibility that dietary antigens can provoke a similar inflammatory response.

    (16) I cannot trace this, either in PubMed or even in the edition of the journal concerned.

    (19) This paper clearly describes a case of encephalitis which is clearly due to the vaccine strain of the measles virus. Presumably this case is quoted by antivaxers to indicate how dangerous vaccine can be. In fact, although it occurred in an apparently healthy child, after hospitalisation the boy was found to have a profound primary immunodeficieny, whcih no doubt was the underlying reason for the unusual presentation. If it were known that the child was immunodeficient, vaccine would have actually been contraindicated. He would have had to rely on herd immunity for protection against measles, and if he had then acquired natural measles, he would certainly have been in major trouble, and would probably be dead. As an argument against vaccination this doesn’t hold water, even of the homeopathic kind. In fact it is a strong argument for mass vaccination to maintain high levels of herd immunity.

    (20) Journal of American Physicians and Surgeons. A journal with an agenda.

    (21) Medical Veritas is just a mouthpiece for anti-establishment theories, antivaxers and AIDS-denialists. (www.vaccineveritas.com/pages/8/index.htm)

  45. Delster said,

    June 8, 2006 at 3:29 pm

    Gordon,

    in 57 you said “and I suspect many of the researchers behind this work would never do so for fear of looking like Andrew Wakefield”

    it’s only a partial quote i know but all i wanted to say was that any researcher worth their salt would not worry how they looked (or should not worry) provided they are sure their data is sound and the research is well designed.

    At worst i would just expect them to double check their results before release.

  46. stuart said,

    June 8, 2006 at 9:00 pm

    I note that Private Eye’s lamentable ‘In the Back’ column has joined in with the ‘told you MMR was dangerous’ rubbish too. I presume the piece was written by Heather Mills (not the ex-Lady McCartney, the journo) as it’s true to her previous form, but Eye hacks hide behind cute pseudonyms.

    Their take on it is pretty much the JABS party line, as you’d expect. Apparently this work didn’t need a control group because it replicates O’Leary’s 2002 work and that had a control, or something. I’m not a medic or even a scientist so I’ll leave the withering criticism to the more knowledgeable amongst you. What I did find extraordinary was the scorn poured on the idea that in order to be meaningful research needs to be properly performed and properly written up. I seems like their accusing the scientists of pissing about while the kids get ill. It seems like one piss-poor unpublished paper is proof of a grand conspiracy.

  47. Mike Hughes said,

    June 9, 2006 at 12:54 pm

    I do find this interesting as a parent and non-scientist who is appalled at the way both the media and scientists handle science that this debate has missed one or two crucial points from the perspective of parents.

    1) Perception is everything. Everything I read tells me that MMR is safe. I want to believe that but my perception is that it is not. Therefore my 13 month old who is lactose intolerant will not be having MMR. That turned out to be a remarkably simple decision for my wife and I to make. Why? Well, mostly because even the briefest review of the evidence and the comments on the evidence suggest that this has gone beyond science and become politicised on both sides. I do not trust the evidence re: MMR (for or against) as a consequence and I remain to be convinced by single jabs. However, given the choice, the pro MMR lobby are keen to only go as far as the “no link to autism” = “safe”. No it does not. It merely means no direct link and that not enough studies have been done that look at indirect links or even other issues.

    2) Doubtless the single jab industry is lucrative and I have little doubt that their arguments are equally lacking in adequate scrutiny. However, because politicians have bent over backwards to convince me MMR is safe when it is clear that the opinion is being expressed by the same ignorant people who refuse to properly fund scientific investigation and whose response to any problem is that it is solely one of perception so that working to change perception is an end in itself that need not involve reference to further scientific study, I could not in all conscience let my child have the MMR. In reality, this is how many parents feel.

    3) The single jab argument is even sketchier but my perception is that it feels better so that is the route we are going. In actual fact, when one reads the arguments of all sides a sane person could only conclude that neither route is safe and no immunisation suddenly rears its head as an option. It shouldn’t but it does. Hello, welcome to the real world!!!

    Of course, most parents won’t even do the research. They will rely on the media and then the political nature of this debate, which has so restricted the availability of single jabs, dictates that they will go down the route of no jabs at all. This of course is the real concern.

    Where we are presently at is that govt. has decided the MMR debate is closed. The media has not. The two are set in opposition and the result is that no real independent credible research of the key concerns can ever be concluded so the matter hangs in mid air for most parents. Govt. sees the only way forward as a campaign of politicised misinformation and restriction of single jabs as the way to alter that perception. Many here would perhaps suggest that the way to really deal with it is to fund the proper research.

    Until that is done then me and thousands like me will continue to operate on our gut (sorry!) feeling that something is not quite right with MMR and, if we have a choice at all, will choose between single jabs or nothing.

  48. wombat said,

    June 9, 2006 at 2:19 pm

    Mike I sympathise, I was there two and half years ago and back then we were still getting rubbish like the ludicrous ‘Hear the Silence’ docudrama. Actually what finally persuaded me to let my daughter have the MMR was a piece by Dr Ben in the Grauniad, but I’d been headed that way for a while. I did the reading and concluded that the ‘evidence’ for a link was so tenuous as to be barely credible.

    The reason the medical science ‘establishment’ has tended to ignore this issue is that they work by the principles of science: observe a phenomenon, propose hyphothesis, test, refine & retest or reject. Wakefield’s original Royal Free work found no evidence of a link and nothing since has provided much more than hints. The evidence in favour of a link is so scanty it is truly astonishing that this controversy has rambled on for as long as it has.

  49. Dr Aust said,

    June 9, 2006 at 4:45 pm

    Hi Mike

    Perception is key, agreed, but what shapes the perception?

    The scientific and medical evidence that MMR is safe genuinely is regarded by most doctors and scientists as totally overwhelming, way way beyond what most people regard as “acceptable levels of safety”. I work in biomedical research and have yet to meet a single scientist or doctor who believes otherwise. For us the “MMR may cause autism” line is up there with “HIV is NOT the cause of AIDS”. The studies raising safety concerns are small, poorly done, and often have an obvious antivax agenda, quite apart from the way they are endlessly misreported in the media.

    Set against that is the fear / nagging suspicion that there is no smoke without fire.

    The trouble is that this fear is terribly powerful.There are some other posts about this on the BadScience forum – see:

    badscience.net/forum/viewtopic.php?t=86

    We’re not “dismissing” perception. We are saying that the perceptions the public have about MMR are inaccurate. Public perception is shaped by the ludicrous way the media has covered MMR (equal time for anti-vaxers and the mainstream medical view, plus a new scare fanfare each time there is another study, see the Daily Mail this week). The Mail and others dust off the scare tactics even when the study’s OWN AUTHORS take care to say their work doesn’t mean MMR isn’t safe.

    I remember a poll a couple of years back that found that a sample of non-scientists believed that “scientists and doctors were divided over whether MMR was safe” – that is, they thought there were a lot of people on both sides of the argument.

    But this simply isn’t true.Almost all scientists and doctors believe that MMR is safe, based on their understanding of the evidence. A handful of people believe otherwise, many of whom now make their living via promoting the “don’t use MMR” line. So the public perception of how scientific and medical opinion was divided was dead wrong.

    When people talk about “changing public perception” on MMR, we aren’t talking about trying to brainwash you with “believe it’s safe because the Govt tells you”. We mean trying to get across the true state of scientific opinion on this (see above) and the different kinds of scientific evidence involved. The studies showing MMR is safe are huge, well-designed and well-controlled. These are the kinds of studies scientists and doctors believe. The anti-vax studies are tiny, often of only a handful of patients, lack control groups, only refer to other work taking the same slanted view, etc etc. all things that make doctors and scientist sceptical.

  50. DT said,

    June 9, 2006 at 6:19 pm

    Three Tigers,
    Your interpretation of immunity is not absolutely correct. The humoral arm of immunity is B-lymphocyte driven, and will produce both IgG and IgM (early) antibodies from plasma cells. Some plasma cells become “memory plasma cells” which can respond quickly to a new challenge of a previously encountered antigen and produce large quantities of neutralising IgG. Revaccination will certainly produce this form of IgG. This is still “humoral” immunity.
    Cellular immunity is different, and relies on the formation of memory T lymphocytes.

  51. Robert Carnegie said,

    June 10, 2006 at 11:32 am

    Mike, I hope you persuade many of your friends to not have their children vaccinated against measles, and then they all catch the disease from immigrants and die. Remember, the point of single jabs is that the measles vaccine causes autism, so single jabs really are a way to choose not to have the measles jab.

    I have a niece with multiple serious allergies who had special vaccinations and then stayed in the hospital for supervision afterwards. But I don’t see that lactose intolerance has much to do with anything. I expect you know that lactose intolerance is normal in all children and adults, after weaning and except for white Europeans, presumably because lactose exposure killed them all.

    I wouldn’t mind seeing vaccine intolerance going out the same way.

  52. DT said,

    June 12, 2006 at 11:19 am

    Three tigers,
    I see what you are getting at, namely antibody-dependent cell-mediated cytotoxicity. This relies on Natural Killer T cells which express the appropriate receptors for IgG. I am not aware that this plays much part with measles, but stand corrected if this is indeed the case.

  53. Janet W said,

    June 12, 2006 at 5:43 pm

    Mike mentions the issue of parents’ perception.

    Does this go back to the earlier point of medicine being the victim of its own success?
    Perhaps parents no longer believe that their child can be killed by an infectious disease.

    My mother was old enough to remember people in her school (pre-war) dying of infectious diseases, and being scared of dying herself. When I was a baby in the early sixties, she had me vaccinated against everything available.

    Fortunately (in so many ways) I’m not a parent and don’t have to make these decisions, but via Dr Aust I recently found this webpage, which as a layman I found helpful:
    www.cdc.gov/niP/vacsafe/concerns/autism/autism-mmr.htm#3

    (One of the arguments I’ve heard several times in the media is the anecdotal “my child developed autistic symptoms after having the vaccine” and you think “is this coincidence or not?”….. so it was interesting to read that one of the studies looked at this and concluded “the first signs or diagnoses of autism were not more likely to occur within time periods following MMR vaccination than during other time periods”)

  54. Autism Blog Web Design Blog: » Dan Olmsted and Andrew Wakefield. Rumour Mongering Ahoy! said,

    June 14, 2006 at 9:49 am

    […] Bad Science. […]

  55. Aspiring Pedant said,

    June 15, 2006 at 9:53 am

    I’ve just been into my local newsagent’s and there, on the front page of the Daily Express, I saw the headline “Measles Epidemic Sweeps Britain”. To my horror beneath that in smaller type it read “So why can’t children get single vaccine?”

    Discussing this with a colleague I discovered that she had paid for her son to have single vaccines because
    •she knows someone whose son developed autism within hours of having the jab,
    •boys are more susceptible to autism and Crohn’s disease,
    •Andrew Wakefield’s logic may have been flawed but surely he was onto something

    Naturally, I tried to explain that really there is absolutely no evidence to connect MMR with Autism, whilst at the time trying desperately to change the subject, but I hadn’t really expected that type of discussion – I anticipated a response along the lines of “yeah, isn’t the tabloid press pathetic”.

    It’s not the first time I’ve made this mistake – I just assume any reasonably educated person knows that MMR does not cause autism; Sometimes these people get quite upset when you try to point out that their beliefs may be mistaken.

    There seems to be a common theme with MMR, ES, homeopathy, audiophilia and so on, in that once certain people accept an idea no amount of evidence seems to be able to dissuade them. It seems that the oft-quoted Jonathan Swift line that “You cannot reason a person out of a position he did not reason himself into in the first place” rings true but why should this be? Why do people insist on believing the most ridiculous ideas despite all evidence to the contrary? The worst thing from my point of view is that there are all sorts of bizarre ideas that cannot be challenged for fear of offending people – witness the reaction to Ben’s articles on Brain Gym, Electro-sensitivity.

  56. Robert Carnegie said,

    June 19, 2006 at 11:43 pm

    Mike, it goes like this.

    If you believe that Dr Andrew Wakefield is a muddler and a pseudoscientific fraud, there is no reason not to go with the MMR virus.

    If you don’t believe that Dr Wakefield is a charlatan, you have to take account of his discovery of measles virus in autistic children’s bottoms, and evidently he has proved that both measles and measles vaccine cause autism, in your bottom.

    So option one is to avoid vaccination altogether. But you know that that’s wrong. Or maybe you don’t.

    Option two, if you’re middle class, is to demand separate vaccines for measles and mumps and rubella. But, remember – measles vaccine causes autism. So obviously you’re going to take the other two and skip that one.

    Are you telling me that you didn’t already think this through? That you have no qualms about your child receiving measles vaccine?

    I mean, that’s why doctors made a multiple vaccine in the first place – because patients wouldn’t turn up for all the individual vaccines at different times.

  57. Mike Hughes said,

    June 20, 2006 at 11:57 am

    Hmm, thanks Robert,

    Let me be clear here. I don’t welcome your tone in response to my original post but your point is valid.

    I do wonder though if we’re all so caught up in debating the politics v the logic v the science that we have failed to notice that this whole thing is possibly an area that just has incomplete research. Lots of, effectively, statistical surveys but nothing categorical.

    My child will be having the MMR under hospital supervision thanks to a severe reaction to cows milk and eggs. I remain unhappy with this but see little choice and that’s my point. How will you feel several years down the line if my child is autistic; research is complete and shows a demonstrable link in specific circumstances and, at the time, despite the research being incomplete, I was given no choice?

    Mike

    PS: I was unaware it was a crime to be a middle class parent!!!

  58. Aspiring Pedant said,

    June 20, 2006 at 3:03 pm

    Mike,

    see this – www.jr2.ox.ac.uk/bandolier/booth/Vaccines/noMMR.html

    & this – content.nejm.org/cgi/content/abstract/347/19/1477%20

    & this – unisci.com/stories/20011/0307013.htm

    Whatever causes autism, it is not the MMR vaccine. The research is far from incomplete – MMR does not cause autism; There is no doubt whatsoever.

    If that doesn’t convince you what research do you think could offer you categorical proof that MMR does not cause autism?

    There is a risk associated with everything we do – one of the most dangerous things people do is to travel by road but most of us are happy to accept the risk.

    What choice would you like and why would you think that alternative to be safer?

    Robert,

    I don’t think the term “middle class” is particularly helpful in this context; stupid people with money can pay for single vaccines whatever their social class.

  59. Dr Aust said,

    June 20, 2006 at 3:09 pm

    Mike

    I think the medical-scientific view is that the research IS complete, in that enormous surveys find no link between MMR vaccination and autism. As I and others have said here before, to find small effects you need big surveys (large sample numbers), so scientists and doctors find these large studies extremely convincing.

    When Wakefield and others raised the MMR-autism link, the regulators and the vaccine scientists decided to look into it. even though the evidence for any link was non-existent (as it remains). This “looking into it” is what has produced all the subsequent work which says the vaccine is safe. For instance, the Danish study, with a sample population of essentially all the children born in Denmark in almost a decade, found no evidence that there was more autism in the MMR-vaccinated population than in the non-vaccinated one. In fact, they ruled out any chance that there was more autism in the vaccinated group with an extremely high degree of certainty. The scientific/medical view would be that that is as conclusive as it is going to get.

    So there is loads of very careful, very good, very convincing evidence. It’s just that the MMR-scare anti-vaxers, and their media allies, refuse to believe it. They don’t base their view on evidence, but prefer their conspiracy theories. And despite all their efforts, they have produced NO credible scientific evidence on the other side of the argument (“autism danger from MMR”). This has been emphasised by several review panels who have gone through the evidence with a fine-tooth comb. What this means is that, as posts on this forum have indicated, the “evidence” advanced by Andrew Wakefield and his allies doesn’t stand up to any kind of scientific scrutiny.

    There MAY be some still unanswered questions, but these relate to methodology in the virus-in-the-gut hunting experiments, NOT to vaccine safety. An example of a question one could pose is “Why do some studies by some labs detect measles virus RNA sequences in some gut samples”. But in the face of at least equally good, and mostly scientifically FAR BETTER (published, properly validated by peer review, methods clearly set out) papers which do the same experiment and get the opposite answer (i.e. find that they can’t detect measles RNA, even though the methods are easily sensitive enough to find it if it were there), this is not evidence that a scientist or doctor would believe. And that’s evidence for as strictly limited a point as the virus being present at all in the gut, let alone anything else one could extrapolate from it.

    In a nutshell, the thing which keeps people thinking “knowledge incomplete” is that the media splash-report any study which says “measles virus found!” (even if it is only a conference paper) and fail to report the scientifically-sounder detailed studies which say “NB, couldn’t find any measles virus”. Hence the skewed perception. This is what Ben Goldacre was saying in the original piece at the top of the thread.

    I know these intellectual arguments are tough to weigh against a parent’s worries, and as a father I have been there, if that doesn’t sound too trite.

  60. Robert Carnegie said,

    June 20, 2006 at 8:40 pm

    Social class is a strong predictor of whether you will or will not read certain newspapers – if you find one left on a park bench, say. For my part I mostly gave them up when they were still broadsheets, and I only pick up a “Metro” for the Su-doku.

    Anyway, that’s how it bears on vaccination.

  61. Aspiring Pedant said,

    June 21, 2006 at 2:40 pm

    Robert you claim that “Social class is a strong predictor of whether you will or will not read certain newspapers – if you find one left on a park bench, say” but how do you identify the social class of someone in the first place? If I happened to be sitting on a park bench with nothing better to do I’d probably read a newspaper if I found one there – what social class does that make me?
    Is there any evidence that uptake of MMR is lower amongst the middle class than amongst the upper class or working class? The following study finds that “Population density and deprivation were both strongly correlated with low MMR uptake”
    www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16207728&query_hl=1&itool=pubmed_docsum
    However, my main objection to the term “middle-class” is that it is little more than name calling; it doesn’t mean anything. Just as an example “Su-doku is a middle class spelling of the middle class pastime Sudoku”.

  62. Dr Aust said,

    June 21, 2006 at 3:36 pm

    Interesting reference, Aspiring Pedant.

    The scoring of areas of the country for “social class” or “deprivation” in studies like this is often based on a “basket” of “indicators of deprivation” – e.g. one well-known index (the Townsend deprivation index) uses ” unemployment, overcrowding, amount of owner-occupied housing and car ownership”.

    This study uses something more complex, also looking at ethnicity, education level and other things.

    The study actually makes two points that are relevant here:

    First-off, vaccine coverage continues to be lowest in “highly deprived” (usually inner city) areas. This is probably just the vaccine version of an effect noted for all sorts of things related to health and health-care in the UK, which is that the inner-city poor get a raw deal. It is well-recognised that people in deprived areas get worse ACCESS to the health system for all sorts of reasons – less doctors, less easy to get to them, poor education and awareness, poverty stops people living a healthy lifestyle, etc etc.

    The other effect commented on in the study is that the DECLINE in vaccination rates seemed to be more marked in the LESS deprived areas. This would support the argument that we could summarize (with apologies) as “worried middle class parents stopping vaccinating”. To quote:

    “There is some evidence here that the decline in MMR coverage has been less marked in areas with more poorly qualified populations. For example, Kensington in central London with a small unqualified population has shown a much more rapid decline in MMR coverage than the East London DHA, which has a higher proportion of unqualified population. There may thus be some justification in targeting MMR health promotion materials at the more educated sectors of the population. Nonetheless, the problem of low MMR coverage remains greatest in the most deprived areas and targeting of these areas should remain a priority.”

    So better-educated “middle class” types may be vaccinating their kids less than they used to (the Daily Idiot effect?), but it is still the more deprived areas that have the lowest levels of MMR vaccination take-up, as has always been the case.

  63. Aspiring Pedant said,

    June 21, 2006 at 5:10 pm

    It’s been very much the same story in Scotland too:-

    adc.bmjjournals.com/cgi/content/full/91/6/465

    One of the conclusions of this study is that “late uptake has increased slightly and more affluent parents tend to vaccinate early or not at all, while the most deprived are more likely to experience delay”
    Interestingly, the MMR uptake figures after 2 years for all social groups follow the same trend with non-uptake increasing sharply in 1998 -99. So, the adverse publicity generated by Wakefield et al seems to have affected all social groups in a similar manner.

  64. GarySGoldman said,

    December 26, 2006 at 6:38 pm

    In response to this comment:

    21 “Medical Veritas” – a magazine dedicated to anti-vac propaganda (it says so on the website!) Does not seem to be peer reviewed and could not find on WOK or PubMed. Is is kind of funny that Wakefield is reduced to “publishing” his work these journals having previously got into Gastroenterology etc – I guess it shows how worthless his work is now. I will not bother reading the article; it is a non-article in a non-jounrnal. Next?

    Medical Veritas is a peer-reviewed medical journal published two times per year that promotes a circumspect consideration of vaccine interventions, including the deleterious effects of vaccines that are so often suppressed by other journal editors that have conflicts of interest with the pharmaceutical industry. For example, in the U.K. where a multi-billion dollar, class-action lawsuit is pending with respect to deleterious effects of the MMR vaccine–it is virutally impossible to locate a U.K. medical journal willing to publish such an article. Articles in Medical Veritas are considered to be scholarly and are methodologically sound. I would be happy to provide an electronic copy of the Wakefield article referenced and would be willing to publish a reasonable commentary addressing any areas wherein the manuscript was found to be deficient.

    To the contrary, instead of presenting non-articles in a non-journal, Medical Veritas articles have been used in expert court litigation and have contributed to both improved medical practice and policy.

    If you have further comments or questions, please e-mail me at gsgoldman@adelphia.net; also, please see website at www.medicalveritas.com)

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  66. Denouement for the MMR scare « Dr Aust’s Spleen said,

    May 24, 2010 at 3:23 am

    […] things I found myself commenting on over at Ben Goldacre’s Bad Science blog – see e.g. this thread about MMR from June 2006, where you will find me, er, holding […]

  67. MMR jab and autism - new link - Baby Club Forum (Page 2) said,

    July 31, 2011 at 9:44 am

    […] it's from 2006, here's Ben Goldacre's response: www.badscience.net/2006/06/mmr-is-back/ If you generally want to read some articles about how terriby the media have handled the reporting […]