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)

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.

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.

Anyway, that’s how it bears on vaccination.

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.

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.

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!!!

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.

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.

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”)

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.

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.

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.