The Wakefield MMR verdict

January 28th, 2010 by Ben Goldacre in bad science, MMR | 135 Comments »

Here’s a very brief piece I bashed out for the Guardian newsdesk today on the Wakefield finding, the further reading below will be more helpful if you’re interested in the story.

Ben Goldacre, The Guardian, Thursday 28 January 2009

In medicine, “untoward incident inquiries” tend to look for systems failures, rather than one individual to blame.

It’s certainly clear that Andrew Wakefield and his co-defendants failed to meet the high standards required of doctors in research. The GMC have found he was “misleading” “dishonest” and “irresponsible” in the way he described where the children in the 1998 paper came from, by implying that they were routine clinic referrals. As the GMC have also found, these children were subjected to a programme of unpleasant and invasive tests which were not performed in their own clinical interest, but rather for research purposes, and these tests were conducted without ethics committee approval.

These tests were hardly trivial: they included colonoscopy, where the child is sedated, and a long tube with a camera and a light passed through the anus and deep into the bowell; lumbar puncture, where a needle is placed into the spine to get cerebrospinal fluid; barium meals and more. It’s plainly undesirable for doctors to go around conducting tests like these on children for their own research interests without very careful external scrutiny.

But there is the wider context: Wakefield was at the centre of a media storm about the MMR vaccine, and is now being blamed by journalists as if he were the only one at fault. In reality, the media are equally guilty.

Even if it had been immaculately well conducted – and it certainly wasn’t – Wakefield’s “case series report” of 12 children’s clinical anecdotes would never have justified the conclusion that MMR causes autism, despite what journalists claimed: it simply didn’t have big enough numbers to do so. But the media repeatedly reported the concerns of this one man, generally without giving methodological details of the research, either because they found it too complicated, inexplicably, or because to do so would have undermined their story.

As the years passed by, media coverage deteriorated further. Claims by researchers who never published scientific papers to back up their claims were reported in the newspapers as important new scientific breakthroughs, while at the very same time, evidence showing no link between MMR and autism, fully published in peer reviewed academic journals, was simply ignored. This was cynical, and unforgivable. Then, after Tony Blair refused to say if his son had received the vaccine, the commentators rolled in. Experts from Carol Vorderman to Fiona Philips from GMTV have all shared their concerns about MMR with the nation. Less than a third of all broadsheet reports on MMR in 2002 mentioned that the overwhelming evidence showed no link between MMR and autism.

The MMR scare has now petered out. It would be nice if we could say this was because the media had learnt their lessons, and recognised the importance of scientific evidence, rather than one bloke’s hunch. Instead it has terminated because of the behaviour of one man, Andrew Wakefield, which undermined the emotional narrative of their story. The media have developed no insight into their own role, and for this reason, there will be another MMR.

More:

I talk about this stuff at much greater length in the last chapter of the book:

www.amazon.co.uk/Bad-Science-Ben-Goldacre/dp/000728487X/?tag=bs0b-21

And more importantly, because it’s free, here:

www.badscience.net/2008/08/the-medias-mmr-hoax/

The Cardiff ESRC report is good (and I don’t want to incite copyright theft or anything, but for god’s sake, someone put it on Scribd, this is good publicly funded research, but Cardiff and ESRC change their web address for it every five minutes, I don’t think they really understand how the internet works):

www.esrc.ac.uk/ESRCInfoCentre/Images/Mapdocfinal_tcm6-5505.pdf

Lastly, I recommend reading the GMC’s findings for yourself, if you’re interested in this stuff, as the details of what they got up to, the ethics committee dodginess, and the mis-statements around who the children were, is pretty bad. The document annoyingly hasn’t appeared on the GMC website – even though this is a massive news story today – but someone has resourcefully uploaded it for free public access here:


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135 Responses



  1. drmikie said,

    January 28, 2010 at 8:57 pm

    First time commenting on your thought provoking articles. Being a fairminded person I thought I would read the Mails article on this, and please forgive me if I am wrong but it still make Dr Wakefield out as a Hero.

    “Today’s ruling will fuel fears that Dr Wakefield has been the victim of a sustained witch-hunt.”

    www.dailymail.co.uk/news/article-1246775/Doctor-centre-MMR-row-Andrew-Wakefield-faces-struck-GMC-ruling.html

    I do not think we have heard the last of this and the uptake of the vaccine will drop again simply because of this kind of reporting in the media

  2. isitmedicine said,

    January 28, 2010 at 9:22 pm

    It’s the ultimate dream story for the papers, though. Underdog discovers medical conspiracy, could save children from condition that’s been featured in a Hollywood movie, changes hearts and minds of the public… but the twist is, he was evil all along!

    Shame the truth is much more interesting and a lesson to society. It would be nice if it motivated the public to not believe everything they read, but I fear not.

    BTW: completely off-topic but:
    www.huffingtonpost.com/robert-j-elisberg/super-cali-fragilistic-ex_b_440054.html

  3. reprehensible said,

    January 28, 2010 at 11:42 pm

    Deconstructing media coverage of trastuzumab (Herceptin): an analysis of national newspaper coverage

  4. reprehensible said,

    January 28, 2010 at 11:56 pm

    Another example i came across recently, if anyone’s interested…

    jrsm.rsmjournals.com/cgi/content/abstract/101/3/125

    Deconstructing media coverage of trastuzumab (Herceptin): an analysis of national newspaper coverage. J R Soc Med 2008;101:125-132

  5. mike stanton said,

    January 28, 2010 at 11:58 pm

    Your link to scribd does not work for me but www.neurodiversity.com/weblog/article/199 works fine. It links to the full ruling and contains edited highlights. Kathleen Seidel rocks (as usual)

  6. FelixO said,

    January 29, 2010 at 1:21 am

    It seems that someone has put the “Cardiff ESRC report” you mention on Scribd:

    www.scribd.com/doc/26008088

  7. FelixO said,

    January 29, 2010 at 1:25 am

    @Mike Stanton:

    the scribd link to the GMC findings works for me
    www.scribd.com/doc/25983372/

  8. the rim groper said,

    January 29, 2010 at 4:06 am

    Yes, the media have played a role in keeping the story alive for far longer than may have appeared to be reasonable…

    “But the media repeatedly reported the concerns of this one man.”

    … the manipulation of the media is a double-edged sword. Hardly a week slips by without some new ‘research’ making the headlines and it is usually leaked with a cynical (almost mandatory) disregard for how it will be viewed by the public.

    If the situation were reversed and the “concerns of this one man” were whistle-blowing about some foul NHS practice which we would all rather see stopped, would your position be any different, with respect to demonising the media?

    In truth, this is an ancient story… where should free speech be stopped? Nothing to see here – move along now.

  9. the rim groper said,

    January 29, 2010 at 4:07 am

    Yes, the media have played a part in keeping the story alive for far longer than may have appeared to be reasonable…

    “But the media repeatedly reported the concerns of this one man.”

    … but we know that the manipulation of the media is a double-edged sword. Hardly a week slips by without some new ‘research’ making the headlines and it is usually leaked with a cynical (almost mandatory) disregard for how it will be viewed by the public.

    If the situation were reversed and the “concerns of this one man” were whistle-blowing about some foul NHS practice which we would all rather see stopped, would your position be any different, with respect to demonising the media?

    In truth, this is an ancient story… where should free speech be stopped? Nothing to see here – move along now.

  10. jodyaberdein said,

    January 29, 2010 at 7:44 am

    Re: ‘where should free speech be stopped?’

    It would seem currently that it should be stopped if you speak in such a way as to offend somebody’s religious sensibilities, but not if you speak in such a way as to induce somebody to risk their child getting a potentially serious entirely preventable disease. Does that about describe where we are at?

  11. mikewhit said,

    January 29, 2010 at 9:37 am

    “Experts from Carol Vorderman to Fiona Philips” not to mention actor Juliet Stephenson … even outside her role in a TV drama – www.guardian.co.uk/media/2003/dec/16/broadcasting.tvandradio

  12. mikewhit said,

    January 29, 2010 at 9:40 am

    Oops, should have been ‘Juliet Stevenson’ and www.guardian.co.uk/society/2003/dec/14/research.broadcasting

  13. the rim groper said,

    January 29, 2010 at 10:46 am

    @ jodyaberdein

    I guess not everyone is as sensible as you are and neither can they be trusted to always do the right thing. My problem with your viewpoint is this… freedom to speak is only ok so long as you personally approve of the viewpoint.

    You may to reflect on the following words which were ascribed to Einstein…

    “If we knew what it was we were doing, it would not be called research, would it?”

  14. simongates said,

    January 29, 2010 at 1:02 pm

    One small correction

    “Wakefield’s “case series report” of 12 children’s clinical anecdotes would never have justified the conclusion that MMR causes autism, despite what journalists claimed: it simply didn’t have big enough numbers to do so.”

    This is correct but for the wrong reason: a case series could never conclude an association no matter how big it was, because it lacks a control group. It would need to be a different sort of study (cohort or case-control) to start investigating whether there was an association between MMR and autism.

  15. Colonel_Mad said,

    January 29, 2010 at 2:26 pm

    I had to read the Daily Mail in the work canteen today, due to all the good papers having already been taken. They devote several pages and an Editors comment to this story. The upshot of it all is that they feel sorry for Dr Wakefield. They can barely bring themselves to mention that there is no link between MMR and autism. They even go as far as to provide 3 cases (over the best part of a whole page) of families who say their children started exhibiting autistic behaviour soon after having the MMR. In other words, every reputable scientist and doctor in the western World can see there is no link, however several dowdy Tory housewives from middle England still think there could be something in it so we’re not going to write it off as a possibility just yet.

  16. masterofreality said,

    January 29, 2010 at 7:43 pm

    @simongates

    “This is correct but for the wrong reason: a case series could never conclude an association no matter how big it was, because it lacks a control group. It would need to be a different sort of study (cohort or case-control) to start investigating whether there was an association between MMR and autism.”

    Not (strictly) so. Modern vaccination studies often don’t use classical (case-control or cohort) designs. Comparisons between populations perform poorly in studies of routine vaccination effects because almost all children are vaccinated. Only very large (often pan-continental) studies are able to provide the statistical power necessary to detect moderate or small risk increases, and even then the results are often questionable as those who go unvaccinated tend to have immune illnesses or to be from minority groups, which can introduce all manner of biases or confounding.

    One way around this problem is to use a population consisting only of those who received the vaccine and who had the outcome of interest, and to statistically examine the temporal relationship between the two events.

    See Pubmed PMID:18562396 for more.

  17. quasilobachevski said,

    January 29, 2010 at 10:34 pm

    tgr,

    You seem to have completely missed Ben’s point. This isn’t a freedom of speech issue. It’s a critique of the media’s reporting of a particular scientific issue of importance to the public.

    The media certainly tried to impose a ‘whistle-blower’ narrative on Wakefield. The concern is that they consistently failed to report on subsequent developments in the science.

  18. themightyrambo said,

    January 30, 2010 at 9:00 am

    There’s a bizarre piece in the Mirror about our friend Mr Wakefield, who is apparently “only guilty of caring”, and not of all the bad stuff we previously thought

    www.mirror.co.uk/news/top-stories/2010/01/30/mmr-doc-s-just-guilty-of-caring-115875-22005783/

  19. md1364 said,

    January 30, 2010 at 11:51 am

    Can anyone please provide an answer to a question that occurs to me regarding the vaccination business. If the MMR and other vaccines are so reliable and safe then what is the problem with parents individually making a decision to have them or not? I have heard it argued that if the uptake is low then it puts others at risk, how can this be, if the vaccine prevents contraction of the diseases then if one child in a class has had it and one has not how can the un-vaccinated child pass it on to the one who has had the vaccine. Also I have seen the graphs that show the disease incidence dropping off radically even before the introduction of the individual vaccines, then dropping off even more after the introduction of the single vaccines and again after the triple MMR, who is to say that the natural life of that disease wasn’t waning already naturally and it was coincidental with the vaccine? I remember many years ago seeing similar graphs about the incidence of many diseases that were on a wax and wane cycle (can’t remember where, sorry) and it did appear that the trend for vaccination was in synch with thaqt cycle.
    This is a genuine question and I honestly do not understand, my parents chose not to vaccinate me against anything and I am very rarely sick with any of the illnesses that go around, I did have measles and mumps when I was young as did all (or certainly most) of my classmates and friends and to my knowledge no one died.

  20. mikewhit said,

    January 30, 2010 at 12:09 pm

    Website bug ? – I have two postings (11,12) but they do not show up unless I log in !

    I suspected some kind of site moderation, but then how does Mr Findrxonline get all his postings to show up ?

  21. natsils24 said,

    January 30, 2010 at 1:09 pm

    @ md1364

    The whole point with vaccinations is that it protects the individual child but vaccination levels in a population need to be high enough to cause herd immunity. Herd immunity is when large amounts of the population are immune to a disease because of vaccination this can stop or slow the spread of disease to other people (usually the figures are that 85% or above of the population needs to be vaccinated but it depends on the disease to some extent).

    This herd immunity is critical as there are people in the population who cannot be vaccinated, for example children who have deficient immune systems (i.e. treatment for cancer) or who have an extreme allergic reaction to vaccinations. Having herd immunity protects these children from contracting a disease.

    Lots of people have had measles, mumps and rubella with no serious effects. However measles can be extremely serious with neurological damage and the death rate in under 2 year olds is about 1:7000. Mumps can lead to infertility in some men who contract it and other serious disease. Rubella is usually mild, however if a pregnant mother contracts it in the first trimester of pregnancy it can cause alot of congenital abnormalities and can be devastating.

    The other diseases we vaccinate for can also be extremely serious. Having been out in Africa and see children die from measles, whooping cough and tetanus we should count ourselves lucky that we have the means to protect our children from these diseases.

  22. Squander Two said,

    January 30, 2010 at 1:24 pm

    The other issue with herd immunity is that diseases have a greater chance of mutating into more dangerous strains if they infect a larger population. This is why, for instance, it is a bad idea for two HIV+ men to have unprotected sex with each other: there are strains of HIV resistant to drug A and other strains resistant to drug B, and the last thing we want is for those two strains to get together in the same host and create a new strain resistant to both. How badly measles affects you if you catch it is in fact related to how many other people in your population have it.

    I’m sure someone more medical than me can give a more technical and less vague explanation than that.

  23. Squander Two said,

    January 30, 2010 at 1:26 pm

    Sorry, should have added:

    This is why the popular libertarian belief that it’s simply a personal decision whether to vaccinate or not is wrong. Vaccinations are a genuine example of a public good. When you decide not to vaccinate yourself (or your kids), you put everyone else at greater risk.

  24. md1364 said,

    January 30, 2010 at 1:36 pm

    @natsils24
    So what about diseases that mutate to get around this herd immunity? Strains of bacteria that get stronger and nastier because of stronger varieties of antibiotics? I have to say I am not convinced and although it may well be demonstrated that MMR is not linked to autism, there seems to be an underlying awareness that there is something quite counter intuitive about innoculation generally. I know Ben Goldacre uses some arguments in his Bad Science book to demonstrate the unreliability of intuition vs empirical science and it makes for a good trick of logic but I didn’t find that it follows in all cases. I don’t think he has any children and may not have had to face the quandary of do or don’t vaccinate and all the implications involved. I believe that it wouldn’t have been so easy to whip up a scare if it didn’t touch a collective nerve, maybe people were feeling a little bullied into this herd immunity thing, I know I feel that way when I am told I can’t send my child to certain schools unless she is immunised.
    Also how about addressing the part of my question that concerns the evidence that incidence rates were dropping anyway before the triple vaccine was introduced and that different ways of life had contributed to this rate dropping already?

  25. natsils24 said,

    January 30, 2010 at 2:08 pm

    @md1364

    Yes, there are strains of bacteria that have mutated because of antibiotics and do now show resistance to them, a huge problem in clinical practice. I admit, I am no expert in immunology or virology, if you have read any research then you can enlighten me. However I still strongly believe in vaccination, partly because it does protect individual children but as I stated, what about those children who cannot be vaccinated? They don’t have a choice in this and herd immunity does, to a certain extent, protect them.

    I am interested to know why you feel innoculations are counter intuitive. I think parents can feel extremely concerned when it comes to their children being vaccinated, partly because of all the negative stories in the press. However I strongly support the vaccination programme, not just because of herd immunity (although this is vital) but because of the risk to the individual child.

    When standards of living rise of course the burden of communicable diseases drops as well, due to fewer people living in small areas coming into direct contact each day. One of the major places that sees outbreaks of disease are university halls, when I was doing my first degree there was a huge outbreak of mumps in unvaccinated people who all lived in very close proximity. However, even with improved living standards people still contract diseases which can be vaccinated against.

  26. quasilobachevski said,

    January 30, 2010 at 4:45 pm

    md1364,

    So what about diseases that mutate to get around this herd immunity? Strains of bacteria that get stronger and nastier because of stronger varieties of antibiotics?

    I don’t think the comparison works because antibiotics and vaccines are so different. Vaccines, I believe, ‘teach’ your body to deal with (a particular) pathogen, whereas antibiotics target a pathogen in your body directly. Sometimes, the mutation rate is so slow that vaccines can be used to eradicate a disease completely – smallpox is the most famous example.

    Regarding your point about ‘natural cycles’.

    Also I have seen the graphs that show the disease incidence dropping off radically even before the introduction of the individual vaccines, then dropping off even more after the introduction of the single vaccines and again after the triple MMR, who is to say that the natural life of that disease wasn’t waning already naturally and it was coincidental with the vaccine?

    Phrased this vaguely, I think it’s impossible to disprove your theory that the disease was ‘waning already’. (Who is to say that there isn’t a teapot in orbit between Earth and Mars?) But to back this up, you would need to propose some sort of mechanism or explanation.

    On the other hand, the graphs you quote do seem to back up the ‘theory’ that: hygiene and better nutrition help to protect against disease; a vaccine also helps; and that uptake of MMR was higher than it was for the individual vaccines.

  27. Arthur Dent said,

    January 30, 2010 at 5:41 pm

    MD1364, smallpox has been irradicated, do you think this was caused by vaccination or did it just dissappear naturally?

  28. skyesteve said,

    January 30, 2010 at 5:56 pm

    @md1364 – can only back up what natsils24 says – vaccination programmes saves lives and when vaccination rates fall for a particular disease the incidence of that disease rises – measles being the most recent example if Dept of Health figures are to be believed.
    For example, prior to the introduction of diptheria vaccination in 1941 there were 2400 deaths from diptheria in the UK in 1940; by 1957 this had fallen to only 6 deaths. Endemic diptheria in the UK is now effectively non-existent. The collapse of the diptheria vaccination programme in Russia after the fall of the Soviet Union led to a resurgence of deaths form diptheria there, running into the thousands.
    Prior to the introduction of tetanus vaccination in the UK there were regularly 200 deaths per annum; now endemic cases in the UK are seldom more than one or two per annum (and remember tetanus is widely regarded as one of the most unpleasant and painful ways to die). Yet worldwide, because of poor immunsation programmes elsewhere, up to 1 million people die from tetanus each year.
    Perhaps the most well-known story of the impact of effective immunisation is smallpox. In the 18th century in Britain it was responsible for 10% of all deaths. In 1967 it killed 2 million people worldwide. But then WHO introduced an immunisation programme and within 10 years the death rate from smallpox had fallen to zero and remained that way such that is was declared “extinct” in 1980.
    Please don’t listen to the scaremongers. Diseases such as smallpox, measles, diptheria, whooping cough, tetanus, and polio killed millions of all our forebearers in Britain and now they don’t – and immunisation is the reason why.

  29. md1364 said,

    January 30, 2010 at 7:47 pm

    @Arthur Dent
    Can’t answer your question, in case you hadn’t noticed I was asking questions myself, but I do know how to spell eradicated and disappear

  30. md1364 said,

    January 30, 2010 at 8:06 pm

    @natsils24
    The counter intuitive part I was referring to is the injecting strains of a disease grown on a culture from a dead foetus into a very young baby who may or may not suffer an adverse reaction to it, that is the part that most anti vaccination people I have spoken to feel can’t be justified.
    You must have realised by now that I am certainly not an expert on immunology or virology either and I like to believe I am open minded about the proof on this subject. I have a baby daughter who was born with a congenital condition and my wife and I have had a lot to do with the ‘medical establishment’ over the past 18 months. We have been lied to and bullied by ‘experts’ and it has undermined our ability to consider the caring side to what doctors do. When in a crisis and honesty is required to make a decision of life or death over a tiny new-born and it is discovered that you were lied to by the only people who can help so that they can reinforce their agenda it makes you see the profession in a totally different light altogether. There is no question that they lied and eventually it was admitted but there has been no explanation or apology, it makes me feel that I need to read and analyse data myself to come to an informed decision.
    There are probably many people like me who feel that some doctors won’t let the truth get in the way of their chosen treatment path, this is what I meant when I said that the Wakefield business touched a nerve and many found it so easy to believe that the powers-that-be could be lying to them.
    Oh yes, as for my last post it was just me being petty and I apologise

  31. mikewhit said,

    January 30, 2010 at 8:47 pm

    “there seems to be an underlying awareness that there is something quite counter intuitive about inoculation generally”

    Anything more specific ? Surely the point is, if your immune system is primed to tackle an infection that is usually serious in those exposed for the first time, it helps to avoid most of the ill-effects that would arise.

    That’s the way the immune system works, so nothing really counter-intuitive there.

  32. mikewhit said,

    January 30, 2010 at 8:56 pm

    “some doctors won’t let the truth get in the way of their chosen treatment path” – if that is the case then those doctors are guilty of professional misconduct and I suggest you make a formal complaint with the General Medical Council (GMC)

    www.gmc-uk.org/concerns/making_a_complaint/faqs.asp

  33. banshee said,

    January 30, 2010 at 10:51 pm

    Couple of comments aimed at the recent comments:

    Firstly, I’ve never been vaccinated against smallpox despite being born in the UK some years prior to 1967. I’m therefore very grateful for herd immunity and the international eradication programme.

    Secondly resistance to antibiotics arises when organisms are exposed to these medicines and organisms capable of resisting antimicrobials survive and multiply. I’m unaware of any similar mechanism with regard to vaccination although the means of microbial organisms to resist or subvert the human immune response has existed for…..well, a lot longer than vaccinations!

  34. md1364 said,

    January 30, 2010 at 11:18 pm

    @mikewhit
    That is not really the way the immune system works it is the way we have adapted it. The way it works is by developing resistance to naturally contracted illnesses and if it proves to be not strong enough then the person dies. I know it is tragic when someone dies, I have had family members and friends die and funerals are very depressing but life goes on. The way that humans have tampered with the balance of life and death has caused so many problems that we all face possible extinction if the worst case scenario claims are to be credited. In medieval times there was a plague that wiped out two thirds of the population, there was no effective cure or even any clue as to how to stop it and then it just stopped. It took several hundred years for the population numbers to get back to the pre plague levels. This is nature and the assumption that we can beat it is incorrect, somehow nature will reassert itself and balance will be restored.
    There was a great programme in the Horizon time slot last week about the pharmaceutical industry, some waffling crap but some good stuff too, like the drug researcher saying that the only real way to test drugs is to prescribe them then wait and see what happens, that made me feel really fortunate to have not taken so much as a headache tablet for the past 8 years.

  35. natsils24 said,

    January 31, 2010 at 1:07 am

    @md1364

    I am not sure if I understand the link between how the vaccinations are produced and how this might cause a reaction? Of course some people will have an adverse effect from having a vaccination for reasons which we don’t fully understand, just as people will do to a drug (penicillin being a common example) or to another product, for example an allergic reaction from having a blood transfusion (if carried out properly this is rare). But years of experience of using vaccinations shows that they are safe but of course I have to admit, we don’t know everything.

    What I do know is the effects the diseases we vaccinate against can have, having studied them and seen them first hand. It was devastating to watch a child die of tetanus during my time in Tanzania knowing that in the UK we are lucky enough to have a vaccine that can stop this. The smallpox vaccination programme eradicated this devastating disease, I happen to think this is one of medicine’s greatest achievements and can only hope the WHO polio campaign can also be eventually as successful.

    I am sorry you had such an awful experience and of course this is going to lead you to mistrust the medical profession (or at least some members of it). What galls me about the Wakefield case is the staggering conclusions he drew from his research, the unethical things he did as part of it (which does bring the medical profession into disrepute) and the effect it had on the vaccination campaign.

  36. md1364 said,

    January 31, 2010 at 9:40 am

    @natsils24
    I agree totally that seeing the effects of disease can be horrific, my wife is from Cambodia and I have spent some time there, many of her friends are polio survivors and coming from a country where the disease has not been around for a while I found it to be a little difficult to deal with.
    Also I agree that what Wakefield did has not helped with trust issues between doctors and public. My experience recently has shown me that although there are doctors who care deeply and deal openly with the public there seems to be an arrogance among some that we (the public) need to be protected from the truth because we can’t be trusted to make the ‘right’ decision. It seems to me that this is the same arrogance that Andrew Wakefield suffered from, manufacturing the tests and manipulating the results in order to show what he wanted to prove as we can’t be trusted with the truth, two sides of the same coin. I appreciate that there are people around who will tell the truth and who campaign for transparency in testing and publishing of results, but it seems to me that there is still a long way to go.
    The situation with my daughter was that the NHS has the their way of dealing with her condition and they will always do that, even though it is just the trend at the moment and it was different several years ago and seems to be changing again now as doctors argue about what is ‘the right way’, but they didnt inform us that they were comitted to this course of treatment before they injected her with a drug that precipitated the need for their treatment. We were told the drug was for a ‘routine test’ but that was not the truth, it actually triggered the symptoms that required the drugs that they wanted to prescribe. The drugs themselves are dangerous and carry many side effects but we were told that there were no known side effects with the way that they were being used in this case. The published side effects make for some scary reading and when I questioned this I was told that we had been lied to but that the drugs were necessary anyway. I am not the only person to have been treated this way and it appears to be part of the system that has bred Andrew Wakefield and the mistrust of the medical profession that sends people to the ‘alternative’ practitioners that are so ridiculed in this column. Making a stick for their own backs. I know of an ‘alternative’ practitioner who has medical training and can read and understand studies and reports and once we get past his agenda I find it very helpful in balancing what doctors tell me. I don’t feel it appropriate for me to accept at ace value what medicos say or accept wholesale what the alternatives say either, I find the same biased agenda with both camps.
    And finally… it’s not so much the way that vaccinations are produced that may cause a reaction it’s the reaction I got when I found that they are grown from cells from a dead foetus that makes me really wonder if there may not be a better way.
    Thanks for your time in answering these posts, if you are a doctor you probably get quite sick of it all.

  37. Squander Two said,

    January 31, 2010 at 12:20 pm

    A lot of medicine is counterintuitive. Eating the bark of a willow tree to prevent pulmonory embolisms isn’t intuitive, is it? But so what? That’s why we have science, really: to find out things that are counterintuitive yet true.

    md1364,

    > That is not really the way the immune system works it is the way we have adapted it. The way it works is by developing resistance to naturally contracted illnesses and if it proves to be not strong enough then the person dies.

    No, your immune system has no idea whether a disease was contracted naturally or unnaturally. It will heal a cut just as well whether the cut was caused by natural rose thorns or unnatural steel knives. And we have not adapted it. We have simply exploited our knowledge of how it works.

    The evidence that vaccination works is overwhelming. I personally think that anyone who wants to opt out of all vaccination programs should be welcome to as long as they also opt out of living in vaccinated populations.

    > We have been lied to and bullied by ‘experts’ and it has undermined our ability to consider the caring side to what doctors do. When in a crisis and honesty is required to make a decision of life or death over a tiny new-born and it is discovered that you were lied to by the only people who can help so that they can reinforce their agenda it makes you see the profession in a totally different light altogether.

    I could not agree more. As I’m always saying, evidence-based medicine sounds like a great idea, and I’ll be first in the queue if doctors ever start offering it. In the meantime, if you’re unlucky enough to find yourself in hospital, proceed on the assumption that they’re a bunch of egotistical self-absorbed bastards who are more interested in wielding power, increasing their prestige, and clocking off early to play golf on a Friday than they ever will be in your wellbeing, and you’ll generally be better off. Not all of them are like that, I hasten to add — I’ve dealt with some great ones — but you only get to tell the difference between the good and the bad ones in retrospect, and the bad ones are ubiquitous, so you’re a lot safer assuming they’re all useless until you’re healthy again.

    Mike Whit,

    If you think the GMC would actually give a damn, you are naively misunderestimating how widespread the problem is. What md1364 is discussing there is just plain old business as usual.

    That being said, Isaac Newton was by all accounts an obnoxious bastard, but he was still right. In the case of vaccination, our obnoxious medical profession are right too.

  38. natsils24 said,

    January 31, 2010 at 1:57 pm

    @ Squander Two

    Although you follow it with the caveat that you don’t think all members of the medical profession are in your words “egotistical self absorbed bastards” I have to take offence at this and assuming we are all useless until you are healthy again doesn’t really help the situation. Surely this undermines the very point about vaccinations that you clearly make, in order for people to have faith in the process they must have some sort of working relationship with the doctor who is carrying out the programme. Else people will never trust what we say and won’t engage with vital things like the vaccination programme.

    To get back to the topic of conversation, this is exactly what Andrew Wakefield did. By drawing such staggering and unfounded conclusions from his work he eroded the faith parts of the public had in vaccinations and caused mistrust.

    I don’t want this thread to turn into an argument about the medical profession but I felt I had to object to what you are saying.

  39. andyfromembsay said,

    January 31, 2010 at 2:09 pm

    I see Peter Hitchens has waded in again in the Mail on Sunday – the MMR scare wasn’t Wakefield’s fault, it CERTAINLY wasn’t the media’s fault – it was that evil “Anthony Blair” because he wouldn’t say whether his child had been vaccinated. And he does take the opportunity to drop in that those of us doubting a link might like to spend some time with a mother and her autistic son because he’s been “damaged”.

  40. skyesteve said,

    January 31, 2010 at 3:09 pm

    @squander two – I’m sorry but I have to agree with natsils 24 re your generalisation of the medical profession. I would be the first to say that the medical profession is not perfect and there are probably a few around who shouldn’t be let near a patient but in my 26 years of experience the overwhelming majority are exactly what you claim they are not – caring, selfless individuals who put the needs of their patients ahead of all other professional concerns and who are extremely distressed when things go wrong or they are not able to cure a problem.
    As for the GMC, again they are not perfect and you may think that they look after the interests of doctors before patients but I can assure you the vast majority of doctors have exactly the opposite view of the GMC which, in my book, means they are probably pretty close to striking the right balance between pursuing genuine malpractice but avoiding doctors lives being ruined (as they sometimes are) by vexacious complaints.
    As for evidence-based medicine, I cannot comment on secondary care as I don’t work there anymore but her in primary care, in Scotland at least, we practice a high level of EBM as recognised in the recent Nuffield Trust report.

  41. Squander Two said,

    January 31, 2010 at 9:05 pm

    My wife & I used to presume that medical incompetence was occasional bad luck on our part. But this bad luck was so ridiculously consistent, across different health issues, different health trusts, and about ten years, that we eventually came to the inescapable conclusion — about the same time as gross incompetence by hospital staff damn near killed her, funnily enough — that it was the norm. Approaching medical staff with the assumption that they are incompetent and vindictive has led to far better results for us. Relying on them is bloody dangerous.

    > As for evidence-based medicine, I cannot comment on secondary care as I don’t work there anymore but her in primary care, in Scotland at least, we practice a high level of EBM as recognised in the recent Nuffield Trust report.

    Really? That’s quite astonishing, since, when we lived in Glasgow, my wife was told that her knee injury was “wear and tear” (despite her being able to tell them when and how it happened) and that she’d just have to get used to being less mobile and less good at climbing stairs in her “old age”. She was thirty. She has of course since been told that her knee would have been fine if only she’d got it treated at the time it happened. Ha. Been eight years now, and we’re still waiting for a diagnosis.

    But look, I’m not even wanting to get into an argument about what proportion of medical staff are shite, becase it doesn’t matter. The real issue is how likely patients are to become the victims of one of the bad staff. Because that, as md1364 ably demonstrates, is a big factor in the MMR scare and others like it. For far too many people, the choice is: believe the medical profession, who went to court to fight to withdraw food and water from my baby daughter who they claimed could only survive another couple of months but who is now fifteen and doing fine, or who took my baby’s dead body and hundreds of others to do experiments on them without their parents’ permission, or who advised my mother to take thelidomide, or who got those women jailed for being unlucky enough to have more than one child die of SIDS; or believe the anti-vaxers, who have never directly harmed me, don’t talk down to me, don’t regularly write on the Web about how much they hate bloody stupid patients who’ve researched their own medical conditions and think they know what they’re talking about, and whose claim that doctors don’t have my best interests at heart strikes one hell of a chord.

    Look at what has just been uncovered in Canada, for instance. Interesting that it was widespread for many years and, in all that time, out of the hundreds of medical students to pass through Canadian teaching hospitals, one had enough moral qualms to raise the alarm. In the vaccine debate, doctors are convinced that the important issue is who has the best evidence on their side. It isn’t. The important thing is who is trusted. What do you think is about to happen to vaccine uptake rates amongst Canadian women who have been under anaestetic in the last ten years? And not just vaccine uptake, either: they’ll start avoiding doctors, and will probably suffer increased incidences of all sorts of different health problems as a result.

    Ben is right to blame the media for the MMR scare. But he’s missing the other elephant in the room.

  42. Squander Two said,

    January 31, 2010 at 9:09 pm

    Oops, sorry…

    > What do you think is about to happen to vaccine uptake rates amongst Canadian women who have been under anaestetic in the last ten years?

    Sod all, obviously. But what do you think is going to happen to their children’s vaccine uptake rates?

  43. natsils24 said,

    January 31, 2010 at 9:38 pm

    @ Squander Two

    The medical profession is far from perfect, we are after all human beings as well as doctors and things do go wrong. Things have gone horribly wrong in the past, and you may not think that we have learnt from our mistakes. Thalidomide, for example, was an horrific thing to happen and I am never going to state that medicine hasn’t had some very very dark days. But whether or not you believe it things do change and things are put in place to improve the standards of care.

    As for patients’ researching things on the web, I am all for it. www.patient.co.uk is a brilliant resource that I am always recommending. But try typing in most conditions to google and see what you come up with. Some of the misinformation out there on the web is down right frightening and it can take alot of time to unravel these untruths when you see a patient who has read some of this stuff on the internet.

    But there are good doctors out there, I work with them everyday and I am proud of my profession and what I do. I do this because I love it and because I do feel like I get a chance to make a difference. Not for the money (I certainly could be earning alot more with my qualifications in the private sector) or for the time off to play golf on a Friday (having just finished nights all I want to do is get some sleep!) but because I am so lucky to be able to practice medicine and I hope I do make an impact on peoples lives for good.

    MMR has only eroded the public’s faith in doctors and the whole of medicine even further but I hope that my patients will always trust me and I certainly work hard to earn that trust. Vaccinations can be a matter of life and death and can prevent some very serious illnesses. I can only hope that this story coming back into the limelight does not have an adverse effect on vaccination rates yet again.

    As for the Canada story, if true that is horrific. During my obs and gynae rotation as a student we had to approach each patient and gain their written consent in order to carry out such an examination and I know this has been the practice at my medical school for many years. I cannot speak for all but students do raise their concerns as we do have a moral compass too.

  44. Squander Two said,

    February 1, 2010 at 12:56 am

    > Things have gone horribly wrong in the past, and you may not think that we have learnt from our mistakes.

    You’ve completely missed my point. It doesn’t matter whether I think the profession has learnt from its mistakes or whether the profession actually has learnt from its mistakes. What matters is trust, across large populations. Trust is more of a visceral thing, and it’s a hell of a lot easier to damage than to build. I think most people start from a default position of trusting doctors because they’re doctors — doctors are, among other things, a cultural archetype, and we feel deep down in our bones from childhood onwards that they are to be trusted. This is necessary, as it enables doctors to persuade us to swallow things that taste awful and submit to procedures that hurt like hell. That profound trust seems to be very difficult to break, but, when it does, it smashes good and proper. If you’re a scientist, you know that whether you’re right depends on evidence, but you have a tendency therefore to think that whether the public will believe you depends on evidence. But for most people, it doesn’t; it depends on trust. When something like Alder Hey or this latest Canadian thing happens, when not just one rogue doctor misbehaves but the appalling behaviour turns out to be standard practice across large swathes of the profession, you lose people. Some of them will go on seeing doctors, but suspiciously; others will turn to homeopaths and crystal healers and will eagerly believe every bad thing they hear about doctors abusing patients, as such news will tally so closely with their own first-hand experience.

    Here’s a question. If Wakefield hadn’t publicised his results, do you think he would have been pulled up by the GMC for his methods by now? Personally, I doubt it.

  45. md1364 said,

    February 1, 2010 at 9:17 am

    @natsils24 & Squander Two,

    Very good points and really interesting reading. I feel I should commment that although I did experience some unbelievable arrogance amongst certain branches of the medical profession in the case of my daughters condition, there were also a couple of doctors, younger interns, who spent time with us long after their shift had finished simply because they cared so deeply about what they were doing, so I have witnessed both sides of this argument at first hand.

    What I have read above enforces my growing belief that it is all very personal and subjective, each persons experience of the medical profession is their own and as such brings with it the issues that they are familiar with in their life. This flows through into the debate on immunisation, the trust issue may just be an excuse that has become more handy to use. My mother refused to have me immunised and it was not mistrust of doctors generally that motivated her, my older brother and sisters were immunised but for me she decided it wasn’t going to happen.

    There is still no reasonable explanation for her actions but I think it reflects how if this system is relying on herd immunity then it just won’t work because without enforcement you won’t get everyone (or even 85%) to sign up, and if you go down the compulsory route it starts to look like totalitarian style government. To say it is for our own good doesn’t wash when we are being forced to do something.

    I can see how BG et al, with their deeply held beliefs that science is all and nothing else exists if it doesn’t hold true for a high enough percentage of test subjects, would despair at the perceived stupidity and short sightedness of parents who refuse to bow before the altar of mighty science because they don’t believe as he does. It is perhaps similar to the beliefs held on any number of other subjects that differ, we hold them because we do and we are all individual people. Ths is possibly the biggest bugbear of politicians etc. who want to herd us all in the same direction to make society as easy to manage as possible for their purposes.

    I have had some very difficult decsions to make in regard to my daughters life, decisions that I don’t envy anyone else having to make, at the moment she relies on dangerously toxic drugs with long term side effects that are possibly worse than dying in order to stay alive, she is my world and so loved, but I wonder if it is the right thing to do to maintain life just for the sake of it if the organism can’t maintain life without intervention. Other parents in the same position find nothing difficult in this decision.

    We are all individuals and the decision not to do what scientists are convinced is right does not make us stupid, I have read all the evidence and heard the arguments and I still believe that it is counter intuitive to inject disease into a little baby when we are in a position of trust to protect them from the illness. I understand all that has been said and that Andrew Wakefield manipulated conditions in his study to the point of dishonesty, and I STILL feel that sometimes we have to get ill and sometimes that means some of us will die, it is just a different point of view and one with which many will vehemently disagree.

    One final point. In the course of my work I have been required to be in many care homes for the elderly and to see so many people being kept alive for the purposes of revenue and because of relatives emotional needs is heartbreaking. Before anyone comes back with the obvious response, I am not espousing euthenasia, but possibly a little lower level of intervention to reflect the fact that we are all going to die sometime, and there are worse thinigs than death, like living in a vegetative state simply to provide a revenue stream.

  46. pv said,

    February 1, 2010 at 10:28 am

    I’m curious as to why anyone would want to be a real medical doctor. So many patients apparently regard them as ignorant, arrogant bastards. These would be patients with no training, knowledge or ability to do anything except type stuff into Google in search of information to confirm their prejudices.

  47. natsils24 said,

    February 1, 2010 at 10:47 am

    @ pv

    Your comment actually made me laugh out loud! I am all for people doing their own research, I just always direct my patients to good resources rather than asking them to just google their condition!

    @ Squander Two

    I have no idea if the GMC would have investigated Wakefield had he not published his research, maybe I am naive but I hope they would have. But it would have taken someone to come forward and complain that what he was doing was unethical, if not then his methods may have never come to light. But I do love the fact that so many hold him in such esteem when some of the things he did (unnecessary procedures, taking blood samples at at children’s party) are things I consider completely abhorent.

    @ md1364

    I would never condone anyone being forced into a treatment they did not want to have, I fully support the right to choose. I understand it is incredibly difficult to make health decisions when it comes to children. But vaccinations have been shown time and time again to be safe and have an extremely large body of evidence to show their efficacy. The example that by vaccination we have eradicated smallpox is a fantastic achievement.

    I understand people’s concerns and I always try my best to give my patient’s high quality information so they can make an informed decision. In the case of MMR what people read in the media was exactly the opposite and this is what I am concerned about and the point Ben makes far more eloquently in his article.

  48. skyesteve said,

    February 1, 2010 at 4:57 pm

    @md1364 – I genuinely feel for and understand the position you find yourself in as I have been there myself (though with an adult, not with a child). Do you do something just to prolong a life, no matter the quality fo that life, or do you allow “nature” to take it’s course? In the end of the day it’s not a decision that can be made easier by guidance. You just have to make whatever call you believe is the right call to make and accept that’s what you have done, as long as the intention is good.
    You wonder about immunisation being compulsory. I may be wrong here but I seem to think that in the US they get around this with a kind of Catch 22 situation – vaccination is not compulsory but school is and you can’t get into school without being vaccinated! As I said I may have got that wrong.
    Anyway, to again back up what natsils24 says my job as a doctor is first and foremost to listen to my patients and, in doing so, show them care, concern and compassion. I hope that’s what I do. I will then ask them why they think what they think and if I feel that their thinking is wrong or misplaced I will tell them so – they have, afterall, come for an opinion! Then we will either agree to disagree (in which case they are, of course, free to seek a second opinion) or we’ll come to some kind of agreement as to how best to proceed.
    In that way they will be in a position to make an informed choice. It’s informed choices that should be the bedrock of any medical doctor’s practice in the 21st century in my view.

  49. Squander Two said,

    February 1, 2010 at 5:43 pm

    pv,

    > I’m curious as to why anyone would want to be a real medical doctor. So many patients apparently regard them as ignorant, arrogant bastards. These would be patients with no training, knowledge or ability to do anything except type stuff into Google in search of information to confirm their prejudices.

    It says a lot that, when faced with patients who are angry at the medical profession because so many doctors have harmed them, you conclude not that it must be awful to be the victim of malpractice but that it must be awful to be a doctor.

    In case you missed the reference earlier, my opinion of the medical profession is based on years of experience, culminating with the bit where they damn near killed my wife. I didn’t Google it, though I did blog it, so other people can. If they do Google it, that doesn’t make it any less true.

    Course, it’s anecdotal. So how about a stat? In Northern Ireland, two diabetics are killed every year by hospital staff giving them the wrong insulin dose. These are not patients with no training, knowledge, or ability; they are patients who have been managing their own insulin dose four times a day for years. But the NHS have an arbitrary “no self medicating in hospital” policy, so these experienced knowledgeable diabetics are forced to hand over their insulin and trust staff who aren’t diabetic specialists and have very little knowledge of their medical history to medicate them instead. And some of them are then killed. We are lucky enough that my wife’s diabetic consultant, who is brilliant, overrules our hospital and insists that his patients be allowed to keep their own insulin pens. If we had a different postcode, she’d have a different diabetic consultant, and she’d just have to run that gauntlet.

    I’ve seen this idiocy in action first-hand, though we were lucky enough that it led to my wife’s blood sugar merely being screwed up to the extent that she had to miss her surgery slot, which in turn led to extreme pain — the worst she says she’s ever experienced — as the painful drugs which were supposed to kick in while she was under anaesthetic instead took effect while she was awake. But at least she didn’t end up in a diabetic coma. I’ve also seen a midwife utterly screw up my wife’s insulin dose, but because, as I explained, we keep an eye on what’s going on rather than blindly trusting the staff, we were able to point out the error and have it fixed. If we’d trusted the staff to do everything right, I’d be a childless widower.

    I’m perfectly happy to concede that doctors are human and some mistakes are inevitable and normal and forgivable. But the above couple of examples hardly scratch the surface of our experiences. We kept forgiving the odd mistake, and it just became clearer and clearer that they weren’t one-offs; fuck-ups are standard practice.

    As for the charge of arrogance, have we been caught in pissing matches between different hospital departments throwing their egos around? Yes, of course we have.

    natsils24,

    > I do love the fact that so many hold him in such esteem when some of the things he did (unnecessary procedures, taking blood samples at at children’s party) are things I consider completely abhorent.

    Absolutely, yes. I just see him as yet another example a doctor who treats patients as disposable props. And, just like all the others who get caught doing stuff like this, it doesn’t even occur to him that he’s done anything wrong. Typical.

  50. Squander Two said,

    February 1, 2010 at 5:46 pm

    Skysteve,

    Schooling is compulsory in the US, but school isn’t.

  51. mikewhit said,

    February 1, 2010 at 6:01 pm

    “a kind of Catch 22 situation” – I thought in Catch-22, both situations were mutually exclusive …

    In your case that would be that “you had to be in school to get vaccinated” !

  52. natsils24 said,

    February 1, 2010 at 8:00 pm

    @Squander Two

    I have to ask, do you think all doctors are as bad at their jobs as your posts suggest? I have never, and will never, treat a patient like a disposable prop. This is going to be my last post on the matter as I don’t want to hijack this thread but I do my best for my patients and I always will do. I stay behind to treat them when my shifts should have finished hours before, I take great care and pride in what I do. I, like Skysteve and the overwhelming majority of doctors I have met, as a patient as well as a member of the profession, have been fantastic role models for me and are people I utterly respect for what they do, a hard job under very challenging circumstances. The best part of what I do is when I make a difference to a patient and I love my job and consider myself very very lucky.

  53. jweirmccall said,

    February 1, 2010 at 8:10 pm

    Wow, pv, I thought vitriol and hyperbole in this thread had peaked, but youve really outstriped him, and in turn embarrassed those of us who are scientists and/or doctors by dismissing every complaint against the medical profession as mere whining.

    Engagement is the key to ensuring patients have access to balanced useful information on their conditions to avoid google misinformation, it is also the key to identifying that ever elusive hidden agenda. Anger should instead be directed at websites that provide misleading or inaccurate information, patient groups sponsored by drug companies are an especially virulent group of misinformation (again, not the patients fault for grasping a false holy grail, but the pharmaceutical company for offering it to them in the first place)

  54. jweirmccall said,

    February 1, 2010 at 8:25 pm

    *them, not him, rubbish autocorrect going on

  55. second hand fumes said,

    February 1, 2010 at 11:35 pm

    GMC’s findings also posted at www.gmc-uk.org/static/documents/content/Wakefield__Smith_Murch.pdf

  56. Squander Two said,

    February 1, 2010 at 11:57 pm

    natsils24,

    > do you think all doctors are as bad at their jobs as your posts suggest?

    You may have misread my posts. My point, as I made clear right at the start, is not that they’re all awful — I’ve said a couple of times that some of them are brilliant — but that it is safer to assume that they’re awful until they prove otherwise. If you wrongly assume a doctor or nurse is bad, the worst-case scenario is… well, not much, really. If you wrongly assume a doctor or nurse is good, they can kill you.

    I also said this:

    > I’m not even wanting to get into an argument about what proportion of medical staff are shite, becase it doesn’t matter. The real issue is how likely patients are to become the victims of one of the bad staff.

    If you stay in hospital for a couple of weeks and are treated by a dozen excellent staff and one bad one who makes a serious mistake that damages your health, it’s that one that will decide how you rate your treatment. That may be unjust from the good doctors’ point of view, but it’s perfectly reasonable from the patient’s. Which is why the problem is structural. What any medical organisation, like a hospital or the whole NHS, needs to do to increase trust is to do everything it can to identify the bad apples, get them the hell away from every single patient, and thoroughly disassociate itself from them. So striking doctors off and doing it publicly is a Good Thing. For me, what the vaccination scares demonstrate is that public mistrust of the medical profession is so widespread that not enough disassociation measures are being taken.

    Look, here’s an example. Mao Tse Tung successfully eradicated TB in China by having everyone go to their doctor for a test and then shooting everyone who tested positive. The Chinese government, to this day, are faced with a population that refuse to go near doctors. One of the measures they’ve been taking to address this is recruiting American doctors to set up clinics in China with conspicuous signs of Americanness: Stars & Stripes on the wall, that sort of thing. What they want is for their people to go to the doctor, and they know that most Chinese people won’t go near a doctor if they suspect it has anything to do with the state. Encouraging doctors to look like representatives of one of the state’s enemies is a good move. It’s a very interesting example of how to repair damaged trust. You may note that it’s all about perception and politics, not evidence.

    As an aside, something we noticed a while ago is that junior doctors are more reliable than consultants. Junior doctors know they don’t know, so they do tests and find out. Consultants are far more likely not to bother with tests because they just know because they’re so clever, so it’s less likely to get spotted when they’re wrong. As they regularly are. The worst mistakes tend to spring from medical staff’s desire to look knowledgeable by never admitting they don’t know something, so they just wing it instead. And that happens a hell of a lot.

  57. md1364 said,

    February 2, 2010 at 5:10 pm

    Just saw that The Lancet are backpedalling desperately following the verdict from the GMC, distancing themselves from Andrew Wakefield and the whole MMR business.
    He seems to be doing ok for himself despite the attention he has received. Perhaps that’s because no one is really interested in the evidence as such, all they really want is something to confirm what they already think.
    Maybe it just shows how unpopular the vaccines really are (for whatever reason) and how the scientific evidence only means something to people who believe in scientific evidence.
    The ridicule that is heaped on homeopaths and others who deal in something other than something that works for ‘everyone’ maybe serves to distance these people even further from the scientific stance.
    Reflecting on the fact that the entire basis for our society is the miraculous and unsubstantiatable (I think I just invented another word) ie christianity could reveal why science has trouble making headway against intuition and superstition.

  58. jodyaberdein said,

    February 2, 2010 at 6:10 pm

    Re 56: ‘junior doctors are more reliable than consultants’

    This is an interesting area. To which data are you referring? I saw some observational small scale stuff that suggested the Reg was most likely to do antibiotic prescribing the best. Surely it’s a bit more complicated than you suggest though. If medicine were just a matter of ordering a test to know what is going on you wouldn’t need doctors at all.

  59. pv said,

    February 2, 2010 at 9:47 pm

    jweirmccall said,

    Wow, pv, I thought vitriol and hyperbole in this thread had peaked, but youve really outstriped him, and in turn embarrassed those of us who are scientists and/or doctors by dismissing every complaint against the medical profession as mere whining.
    Wow yourself. Who has dismissed anything? And what vitriol or hyperbole? Have you by any chance had a humour bypass operation? Are you drunk? Talk about up your own bottom!

    We are all human and imperfect, including Doctors nurses and patients – and you – and no-one as far as I know is above criticism. No-one is suggesting otherwise as far as I can see. So, if you feel embarrassed you might look first to yourself and then lighten up.

    The medical profession is under constant fire whether justified or not and, if it helps you understand my rhetorical comment, it is a particular first-line strategy of woos and quacks to undermine the medical profession at every opportunity. It’s not exactly a secret.

    On a personal note I am having quite a lot of dealings (daily in fact) with various members of that profession at the moment. And, honestly, I have a lot of admiration for most of them doing what is much of the time a shitty, stressful job not made any less shitty or stressful by criticism and advice from experts whose PhD was earned at the University of Google.

    Quite what any of this has to do with Wakefield though is beyond me – but I am very thick.

  60. skyesteve said,

    February 2, 2010 at 10:04 pm

    @md1364 – the truth is the Lancet should not have published this paper in the first place – as they were told in no uncertain terms after the event I seem to recall.

    According to the BBC website “Dr Wakefield has since worked for the International Child Development Resource Center. The centre, based in Florida, is associated with the Good News Doctor Foundation, a Christian ministry.
    He has also continued to see patients at the Thoughtful House, a centre for autistic children in Texas, where he is currently the executive director.
    Dr Wakefield remains adamant that the scientific results of his 1998 study are still valid.
    In a statement, he said: “The clinical and pathological findings in these children stand as reported.””

    He also seems to have rejected the GMC’s verdict yesterday and so seems unrepentent – it will be interesting to see what sanctions the GMC impose in due course (but given that he now works in the States it may not matter). It will also be interesting to see what the Royal College of Pathologists say as they allegedly gave him a Fellowship for his research (again according to the BBC).

    Vaccinations are not that unpopular if current figures from Scotland are to be believed:

    “In Scotland as a whole, quarterly uptake rates by 24 months of age for primary courses of diphtheria, tetanus, pertussis, polio, Hib, MenC and PCV remain high and stable at around 96% to 98%.
    Quarterly uptake of one dose of MMR by 24 months is 93.8%. This is an increase of 0.5 percentage points on the previous quarterly figure. Quarterly uptake by 5 years of age is 96.2%, the same as the previous quarterly figure.
    Quarterly uptake of the Hib/MenC booster vaccination by 24 months rose to 94.3% this quarter (94.1% in previous quarter). Quarterly uptake of the PCV booster by 24 months is 94.8%, an increase of 1.0 percentage points on the previous quarterly figure. These vaccines were introduced to the childhood immunisation schedule in September 2006 along with the other substantial changes to the programme mentioned above.” (from Information Services Division of Scottish Government, Dec 15th 2009)

    After MMR was introduced in 1988 rates of measles fell by between 80 and 90% (from between 50,000 and 100,000 er annum to only 10,000) and average annual death rates fell from 13 to 4.

    But in the end of the day, as I said before, parents have to make the final call and do what they think is right. It is also realistic, however, to expect them to accept the potential consequences of those decisions. Rights = responsibilities and all that.

  61. Squander Two said,

    February 2, 2010 at 11:15 pm

    jodyaberdein,

    > To which data are you referring?

    I think it was pretty clear from the context that I was talking about our own experiences.

    > Surely it’s a bit more complicated than you suggest though. If medicine were just a matter of ordering a test to know what is going on you wouldn’t need doctors at all.

    I didn’t suggest that.

  62. Alasdair.Kay said,

    February 3, 2010 at 10:24 am

    I’m not defending the means by which the Wakefield study was conducted which was deplorable and has huge effects on the public perception of science…however…

    I had a child of MMR age at the time so read pretty thoroughly through this study and there was, as always, many discrepancies between what was reported in the press and what actually happened, both positive and negative. For example, my resounding impression of the conclusions wasn’t that there was a DIRECT link between MMR and austism, but that the process was mediated by gatrointestinal complications (i.e. MMR caused the gastrointestinal problems, gastrointestinal problems were linked to autism). Furthermore, the reasoning behind this was a possible link between the high levels of mercury in the triple jab, and whilst the single jabs offered similar or increased levels the requirement to wait between jabs gave the body time to clear the mercury from the system. If you read the scientific journals there is still regular publications linking high mercury levels in injections with gastrointestinal complications, and other research linking GI disorders with autism. So the “science” Wakefield used was disastous, but I’m not sure whether the theory should have been equally tarred.

    Then there’s the fact that at this point when parents were rejecting MMR, what was there options? All they could do was to personally pay for individual jobs, which ironically the Government refused to support and even, I seem to recall, halted the import of additional stocks. This raised serious questions about Government motivations – surely if what they wanted was reduced spread of these diseases then they would have wanted vaccinated kids, regardless of MMR or single jabs. Every parent I knew who opted not to have MMR would have happily used single jabs, but they just weren’t available. Coupled with Blair’s refusal to comment on his own parental decision, this cause huge public paranoia about the reasoning behind all this. In the wake of watching an MP feed potentially BSE infected beef to their child to prove it was safe (hey – we’re about to see the heterozygous form second wave of vCJD erupt in this country so that worked out well!) people just didn’t trust anyone – Wakefield, the media or the Government. The whole MMR issue could have been aborted, and PROPERLY investigated, if parents had been given real options instead of forced down a single route. Science was responsible for single jabs as much as triple jabs, so why reject that option? I know the argument at the time was the delayed timescale – but this in itself raised two questions… Isn’t three jabs over three years better than no jabs? Why is it necessary to wait a year between individual jabs whilst all three can be given simultaneously in MMR?
    What was lacking in all this scandel was any REAL answers. We heard the hype, we heard the faults, but where was the research that told the true story? Surely that is what science is about – finding definitive answers – not solely pointing out where it hasn’t done that and smugly leaving it be…?

  63. skyesteve said,

    February 3, 2010 at 12:49 pm

    @Alasdair.Kay – part of the problem is that, as a society, we seem to be increasingly throwing rationalism out the window and going with hype and hyperbole. Perhaps it’s just another symptom of the increasing Americanisation of our society – that country where people are so scared about hot coffee in a burger bar it’s impossible to get a decent hot coffee much of the time but it’s okay to conceal and walk around with a device that’s sole design purpose is to injure or kill someone or something else. Is that what we want for ourselves?
    I’ve been to America often and I like it but I have to say that the media there is driven by “scares” which are seldom based on the facts or in-depth analysis. Decent, objective, intellectual, rational discussion on the telly or in the press is quite hard to come by.
    Our media is going the same way. Hyping the scare; printing lies that it actually knows are lies (but seeming to think that it’s ok to live by the old adage of “why let the truth get in the way of a good story?”).
    With the exception of the BBC, the media is not there to be informative or give honest, balanced opinion – it’s there to make a profit – first, last, always – and in order to do that it will do what it can to hype stories to increase sales (whether it’s newspapaer or TV).
    Not that the BBC can be exempted – I’ve seen loads of documentaries purporting things as fact which are just crap.
    In my view if you print/broadcast untruths and get caught out there should be a legal obligation that the withdrawal receives the same amount of column inches and page prominence or the same amount of air time as the original story. That seems fair to me.
    The medical profession is under fire at the moment and we have to accept some of the responsibility for that. The recent scandals that have hit the headlines are unforgiveable and we do have to work hard to regain trust.
    But the story is bigger than that. Science and rationalism is increasingly under attack across the world as people seem to be increasingly drawn back to an age of superstition. If we lose that argument then we will all be worse off.
    Can I presume to recommend a read? “Scared To Death” by Booker and North. Not a perfect book by any means but does give a good outline of how the media likes to pull the pin out of the “scare” hand grenade then run away…

  64. pv said,

    February 3, 2010 at 1:43 pm

    Surely that is what science is about – finding definitive answers…”

    Well, actually it isn’t. All answers are provisional and depend on the evidence available at any particular time – hence scientific study progresses human knowledge with the acquisition of evidence. And so the obsession with and overriding importance of evidence and the quality of it.

    The job of providing definitive answers belongs to religion and other superstitions – and, of course, the news media.

  65. pv said,

    February 3, 2010 at 1:44 pm

    Surely that is what science is about – finding definitive answers…

    Well, actually it isn’t. All answers are provisional and depend on the evidence available at any particular time – hence scientific study progresses human knowledge with the acquisition of evidence. And so the obsession with and overriding importance of evidence and the quality of it.

    The job of providing definitive answers belongs to religion and other superstitions – and, of course, the news media.

  66. Alasdair.Kay said,

    February 3, 2010 at 2:46 pm

    @pv
    Please allow me to rephrase.
    “Surely that is what science is about – trying to find definitive answers…”

    “Science” comes from scientia, the Latin for “knowledge”, and refers to the attempt to progress human knowledge through the systematic formation and testing of hypotheses, by applying scientific methods and making empirically testable observations. I agree with what you say, but that’s just half the story. The whole point of “quality of evidence” is so that you can define a fundamental truth, even if that truth is dependent upon variables. The variability in your results is due to a variability in conditions, exactly replicate the conditions and you should exactly replicate the results – that’s what you are defining with your definitive answer. If you don’t get the same results, it’s because something is different. Even a chaos mathematician defines random events as predictable if you know all the variables. Define precisely what has changed and you have increased your knowledge of the system being examined, define how to control the variables and you have an answer. Most scientists I know wouldn’t say they apply themselves in an on-going quest for provisional answers that are impossible to explain, they are seeking fundamental answers. They may never find them, but it’s still the goal. Just like football is about working as a team to score goals – just because a team doesn’t score it doesn’t change the objective of the game.

    It all depends on the question. For example, gravity is a scientific theory but the definitive answer to the question “If I stood up now and dropped a rock, if nothing else intervenes will it go downwards?” is “yes”. And the terminal velocity of that stone (with completely defined variables such as temperature, height, air pressure etc) is also a definitive answer. Science is about evolution of knowledge towards an end-point, whether or not that will ever be reached. Science isn’t just about how the most complex, unpredicatable systems work. It was science that suggested the theory that the Earth wasn’t flat, and then empirical evidence and observation gave the definitive answer that it isn’t flat.

    On the flip-side, religion is about non-definitive answers that are held without or against actual testing, precise definition of those answers is . Faith not fact.

    I’m not really sure how your comment contributes to the discussion about MMR though.

  67. Alasdair.Kay said,

    February 3, 2010 at 2:52 pm

    @Skysteve

    I couldn’t agree with you more and think that’s an excellent description of the dangers of this combined bad science and media interference. The worst situation is indeed when the science can’t give a proper answer to the hysterical media. As far as I can see, the only way to stop the hysteria is to provide an actual answer (or, pv, a tested hypothesis with a statistically significant result) that says whether or not the media line is correct. Whether or not the answer is complete, you can still allay the hysteria by stating actual tested facts.

    Thanks for the reading recommendation too – I will check it out.

  68. Alasdair.Kay said,

    February 3, 2010 at 3:02 pm

    Sorry – I meant to put skyesteve with the ‘e’

  69. estskept said,

    February 3, 2010 at 3:10 pm

    @Alasdair.Kay
    There is no mercury (and has never been) in MMR.

  70. Alasdair.Kay said,

    February 3, 2010 at 3:26 pm

    @estskept

    Precisely! Yet The Times reported the story using MMR classed in with a group of vaccines, some of which did contain mercury and some that didn’t, and then the BBC reported that the Times had reported that MMR had mercury, then the other networks reported that the BBC said MMR had mercury….

    The basic fact wasn’t made clear soon enough that MMR didn’t contain mercury, and yet in the US they withdrew all (I believe) vaccines with mercury in based on the findings of a study that was badly done and didn’t even look at a thiomersal containing vaccine!

  71. pv said,

    February 3, 2010 at 11:14 pm

    #
    Alasdair.Kay said,
    February 3, 2010 at 2:46 pm
    @pv… I’m not really sure how your comment contributes to the discussion about MMR though.

    Likewise. I was responding to your comment (I presume that’s not against the rules). And I still disagree with you.

  72. dw said,

    February 4, 2010 at 6:34 am

    @skyesteve

    I may be wrong here but I seem to think that in the US they get around this with a kind of Catch 22 situation – vaccination is not compulsory but school is and you can’t get into school without being vaccinated!

    Not exactly. These laws only ever apply to publicly funded schools, and the situation varies by state. In two states, Missipppi and West Virginia, your description is accurate. 26 other states offer religious exemptions to vaccination, and the other 22 offer “personal belief” exemptions — basically exemption for any reason at all. However, many people don’t know about the exemptions, and the school authorities usually aren’t eager to tell them. Private schools can do whatever they want.

    www.vaccinesafety.edu/cc-exem.htm

  73. Nasimf said,

    February 4, 2010 at 4:43 pm

    My view is that, regardless of the scientifically bogus nature of the Lancet paper, this whole fiasco makes the General Medical Council look like the bunch of tossers that they are, and really lets the science off the hook. the GMC couldn’t care less about science, and instead apply their rules randomly in a vindictive and politically self serving way.

    Of course everyone knows that many others have committed crimes far worse than Wakefield in terms of abusing individual patients in trials.

    It would have been better if the thing had concentrated on the science (and its faking if there was such faking), instead of having this protracted frippery carried out by an essentially corrupt regulator.

    The GMC really was not the body for this job.

  74. skyesteve said,

    February 4, 2010 at 5:32 pm

    @dw – many thanks for clarification.
    @nasimf – don’t know if libel laws apply to organisations (though the current action against Simon Singh and the British Chiropractic folk suggests that it does)but perhaps you might wish to amend your views of the GMC as they may not like being called “tossers”, “vindictive”, “self-serving”, or “corrupt”.

  75. pv said,

    February 4, 2010 at 11:07 pm

    Nasimf, I hardly think puncturing a child’s bowel during an unnecessary endoscopic procedure is trivial. None of the other examples of Wakefield’s medical abuse of children is trivial either.
    As for the GMC being corrupt, vindictive or self-serving then I think you should present your evidence for it. Otherwise the resemblance to a tosser will be yours.

  76. Piccolo said,

    February 5, 2010 at 10:13 am

    www.dailymail.co.uk/sport/article-468413/At-admit-jab-CAN-harm-child.html

  77. skyesteve said,

    February 5, 2010 at 1:14 pm

    @Piccolo – and your point is? This piece of non-evidence based, subjective haranguing was published in July 2007!
    Common vaccine-induced side effects include: pain/redness/swelling at the injection site; systemic effects such as fever, malaise, sore muscles, headache, loss of appetite. None of these are regarded as contra-indications to future vaccination.
    More worrying is anaphylaxis – a severe allergic reaction – which can ,of course, happen with first time exposure to any drug, food substance, insect sting, etc. The risk of anaphylaxis with vaccines is about 1 per million and according to the last recorded statistics I could find, between 1997 and 2003 none of these cases of vaccine-induced anaphylaxis was fatal.
    Also there are some children who shouldn’t get some vaccines (or in whom vaccination should be delayed) but that is for very specifc medical reasons, not because of any concerns about the safety of vaccines per se.

  78. Piccolo said,

    February 5, 2010 at 1:41 pm

    Calm down mate, I was putting it on in line with the other links to utter nonsense put out in the media. I agree it does make one angry reading it, but it was Hitchins what did it, not me Guv.

  79. skyesteve said,

    February 5, 2010 at 2:09 pm

    @Piccolo – mea culpa and sorry – but one of the essences of this site is clarity. Just putting up a link without explanation, especially a 2 years out-of-date rant like that…

  80. Alasdair.Kay said,

    February 5, 2010 at 2:27 pm

    I would have liked it if, instead of retracting the paper, The Lancet had got Wakefield to re-write it properly for the record. The new one should have then replaced the original with the original as an appendix.

    The new one would have full declarations of financial interests and the conflicts; proper descriptions of where the subjects came from and why they were “chosen”; and full and accurate descriptions of what was actually done and how that led to their conclusions.

  81. Piccolo said,

    February 5, 2010 at 2:40 pm

    Sorry it wasn’t clear that I didn’t believe the drivel. But you have got me to bite now, exactly why is it out of date? The MMR story kicked off at the turn of this century, I was merely showing one of the articles over this time. One that has the benefit of being able to evaluate a full range of studies. Now I am aware that this thread often turns into people spoiling for a bit of verbals but I probably hold the same views as you about MMR and Hitchins. I am eternally sorry for not saying “look at this nonsense” before or after my link, but it’s the weekend, chill and have some beers or however else you toast Friday evening.

  82. skyesteve said,

    February 5, 2010 at 3:30 pm

    :-)

  83. milli said,

    February 6, 2010 at 12:27 am

    The first thing I was taught in college and the only thing I remember is that all research is biased. The MMR debate highlights this from the lancet who published crap study, to dr. wakefield who compromised research ethics for money prestige whatever, to the media who brought it to the attention of the public, to the government who support big business, GSK profits increased by 66% this last 1/4, why, the H1N1 vaccine, to the GMC who have a thread of corruption, by means of their connection with GSK thro’ their CEO Dickson and the policiticans, liberal democrats who are affiliated with the GMC-all have their agenda’s.
    The only folks who have the most unbiased interest in interpreting vaccine related science are parents who have to inject the stuff into their babies.
    I know the risks outweight the benefits for vaccines,but to believe that parents must accept that vaccine research/science is more pristine than other pharma research just because the government/media says so,is just criminal.

  84. pv said,

    February 6, 2010 at 1:07 am

    The first thing I was taught in college and the only thing I remember…
    You don’t say whether you stuck around after the first ten minutes.

    It’s just criminal that one is required to trust anyone at all, isn’t it. As for knowledge, it’s highly overrated. Give me gut feelings and ignorance any day.

  85. milli said,

    February 6, 2010 at 3:40 am

    PV.. actually I did hang around for more than 10 mins. I
    thanks for reading my post or the first line :)
    I am not good at typing, an overrated knowledge, so I mean’t the benefits outweigh the risks.

    I take ignorance and gut feelings over corruption any day.

  86. mikewhit said,

    February 6, 2010 at 10:41 am

    “and then the BBC reported that the Times had reported that MMR had mercury, then the other networks reported that the BBC said MMR had mercury….”

    My basic instinct is to always ‘drill down’ to the original evidence, rather than reporting ‘hearsay’.
    Why can’t so-called journalists do that ?

    Does make me a bit pedantic (sorry about the Catch-22) but at least I would be commenting on the real data rather than someone else’s possible misconception.

  87. skyesteve said,

    February 6, 2010 at 11:02 am

    @milli – “I know the risks outweight the benefits for vaccines” – did you mean this or did you mean it the other way round?

  88. pv said,

    February 6, 2010 at 11:52 am

    milli said,
    February 6, 2010 at 3:40 am

    I take ignorance and gut feelings over corruption any day.
    Personally I prefer neither – they are equally as pernicious.
    But you make blanket accusations of corruption, mostly about people you don’t know, without bothering to provide blanket evidence. Yet you presume others are to accept your own qualification to make the accusation, together probably with your own implicit lack of corruption, without question. Because you say so.

  89. skyesteve said,

    February 6, 2010 at 4:00 pm

    My own view is that an opinion is only valid and worthwhile when you understand what you are talking about and take a view when there is a view to be taken – in otherwords, when there is something controversial that allows you to take one view or the other.
    When it comes to the standard vaccination protocol in the UK there is no controversy. It’s safe and effective and its benefits outweigh any risks if one looks at the overall picture. As a society we have the responsibility to do that which benefits society as a whole.
    There’s an old expression that says “ignorance is bliss” but it’s not. Ignorance is just that – ignorance.

  90. milli said,

    February 6, 2010 at 7:25 pm

    I believe that the MMR vaccine is safe to use, although I do think that if parents have concerns they should be addressed not ignored and labelled. however vaccines seem to be the next gold rush. with regards to my corruption thing, I was surprised by the cleverly crafted tabloidy type decision handed down by the GMC.. the media ran with it of course. the timing of the decision? not a coincidence that thalidomide is back in the news, not good for the pharmaceutical/government image. I don’t need any qualifications to know that pharmaceuticals underwrite patient groups, continuing doctors education, the list goes on and on. why not the GMC? it would be naive of me not to think this way. i think the GMC have a whiff of corruption about them, that is my opinion.
    anyways enough said,about this topic.

  91. pv said,

    February 6, 2010 at 10:57 pm

    milli, you have more than a whiff of the conspiracy theorist about you.
    Your association of the GMC announcement and thalidomide is preposterous. You don’t appear to understand the function of the GMC. You ascribe unsupported claims of ulterior motive regarding the timing of the GMC announcement and the news media’s reporting of it… as if the GMC has some magical control over what the press put out. (Incidentally, has not the overwhelming output of the media in the last few years been in support of Wakefield? Or is that just faulty memory?)

    In other words, if you can think it then it must be an established fact.

    It’s interesting to see that your previous incontrovertible claims about the GMC have been modified to become “a whiff”, in your informed opinion.

  92. Mr Ashy said,

    February 7, 2010 at 1:24 pm

    The comments on the anti-vacine sites are astonishing “the real issue is whether he was right’ is frequent.
    It isn’t, the real issue was whether he acted unethically, experimented on children without permission and misrepresented their case histories

  93. md1364 said,

    February 7, 2010 at 1:40 pm

    Interesting point raised about GSK profits re H1N1. Given the widespread issuing of Tamiflu, with no more than a phone consultation with medically untrained staff, to anyone who called describing symptoms they had been told to quote as a result of media hype about something that wasn’t real (nothing new there then), fancying a few days off work or in case they really did develop something in the future, and then the prescription figures being released as accurately describing the spread of the illness in a reliable way when it was all contrived in the first place…… and still conspiracy theorists feel they need to make things up!
    Was it just total mismanagement or something more sinister, who was it who said that in order to find the culprit you just need to follow the trail of money?

  94. skyesteve said,

    February 7, 2010 at 3:06 pm

    @md1364 – as ever, I can’t comment on what happened south of the border but here in Scotland things weren’t quite how you describe.
    Tamiflu was reserved for those deemed to be at high risk and, in my experience, even among those people, when told what the pros and cons of Tamiflu were, the majority that I dealt with chose not to have it. In fact, during this flu outbreak I have literally written only one or two prescriptions for Tamiflu.
    Likewise, vaccination was only offered to high risk groups (including children under 5 and pregnant women) and, again, many opted not to have it.
    There’s definitely grounds for discussing whether Tamiflu was over-hyped and over-rated and there’s a fair amount of evidence that it was.
    Likewise there are grounds for saying that the vaccination programme was a bit chaotic and disorganised at times because it was!
    And it’s also possible to gripe about how much money the Government spent stock-piling both Tamiflu and vaccine.
    The supposed over-hyping of the outbreak is easy to say in retrospect but imagine the public reaction if the Government and public health folk said everything was fine and there was nothing to worry about but then people started dropping like flies. There would have been hell to pay so I think they were really in a no-win situation, even if it does mean that in future people don’t take public health warnings seriously enough.
    The prescription figures were NOT used to assess the level of flu activity. Instead public health used so-called “spotter practices” who kept a note of all patient contacts resembling flu and phone in the results every week. How do I know? Because we were one of them!
    The flu outreak was not “contrived” – over-hyped maybe (thanks in no small part to our friends in the media again) but not contrived. There is no conspiracy though it might be possible to have a go at the Government for over-hyping the situation as it gave them the chance to appear in control when the economic crisis had shown them to be so obviously out of control.

  95. DrJG said,

    February 7, 2010 at 8:04 pm

    @skyesteve – sadly, my commonest experience (in England) was this: Patients phoned the advice line as they had been told to, and were told to have tamiflu. I certainly cannot remember seeing anyone who came to me worried that they had been refused it. Many then came to see me, asking whether or not they should take it. Many of these patently did not have flu of any type, and gave no indication of having lad it on thick on the advice line. Others who may have had flu (contrary to popular belief, without testing I had no way of telling swine flu from any other variety of flu) often, as you comment, chose not to take it after discussing the pros and cons with myself. Of course, there were more who were pretty ill, took their tamiflu appropriately, and sat it out without the need to consult me, so my experieence was not comprehensive.

    Cut down heavily, as far as I can tell the benefits of Tamiflu are a slight reduction in the average duration of the illness, and a reduction in the risk of developing complications. Much the same could be said for conventional antibiotics and respiratory tract infections, yet we have spent years trying to discourage their use. The only difference is that the decision with tamiflu has to be taken early or the window of opportunity is lost, whereas, if anything, antibiotics may be more likely to benefit those not recovering spontaneously after a reasonable period of time.

    Agree about the chaotic vaccination campaign, though.

  96. nevajism said,

    February 8, 2010 at 12:56 am

    Ive read that none of the parents of any of the children involved in the study have made a complaint about wakefield (in fact as far as I can see they are quite supportive of him and have written two books detailing their story called “Silenced Witnesses” vol. 1 and 2) and the hearings are because of compliant by the journalist Brian Deer- do people agree with that?

    I would like to declare that I have no vested interest other than having two small children who are in very good health and hense I have spent alot of time reading about the vaccine issue from all perspectives – I am quite capable of reading and understanding scientific papers having written many myself. For anyone interested, this paper (often referred to as “the danish study”) is a model of bad statistical analysis for anyone who is prepared to look beyond the misleading abstract:

    Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J,
    Melbye M. A population-based study of measles, mumps, and rubella vaccination and
    autism. N Engl J Med. 2002;347(19):1477-82.

    anyone want to point out the fatal flaw??

  97. colinj said,

    February 8, 2010 at 11:28 am

    AoA has a little go at BG:-

    www.ageofautism.com/2010/02/the-conflicting-views-of-dr-ben-goldacre-and-the-wakefield-affair.html

  98. pv said,

    February 8, 2010 at 7:12 pm

    nevajism said,
    February 8, 2010 at 12:56 am

    Ive read that none of the parents of any of the children involved in the study have made a complaint about wakefield (in fact as far as I can see they are quite supportive of him and have written two books detailing their story called “Silenced Witnesses” vol. 1 and 2) and the hearings are because of compliant by the journalist Brian Deer- do people agree with that?

    Reality doesn’t agree with you. On the last part you are wrong. Brian Deer was not the complainant, and there doesn’t have to be a complainant in order for the GMC to take action. They are not the Press Complaints Commission, thank goodness. But don’t let the facts spoil your view.

    From the GMC themselves:
    I can confirm that, in response to widespread public interest in the MMR issue, we instructed our solicitors to investigate further,” a GMC official explained in a May 2009 freedom of information response to NHS investigator Dr Rita Pal, stating that, since 1993, 575 inquiries had been opened in reaction to press reports. “This in turn led to action under our fitness to practise procedures. It has always been the case that the GMC has been able to act on information that raises a fitness to practise issue. This has not been restricted to the receipt of a complaint from an individual.”

    I hope your spelling in your scientific papers is better than here! :-)

  99. pv said,

    February 8, 2010 at 7:33 pm

    Just to add, nevajism, that the books to which you refer were written by one Martin Walker – a professional liar, scum bag and fraud. Read about him here:
    briandeer.com/mmr/mli-information.htm

    On that score alone I doubt you’ve ever written a scientific paper, even less had one published in a reputable journal. I’d say it rather puts your entire comment above into an interesting light.

  100. quasilobachevski said,

    February 9, 2010 at 1:02 am

    nevajism,

    I for one would be really interested if you could point out the ‘fatal flaw’ in the Danish study. As you know, that study is a key component in the case that there is no link between MMR and autism. My statistics could do with a refresher course, and I’m sure many other readers are in the same boat, so please don’t leave us in tenterhooks!

  101. quasilobachevski said,

    February 9, 2010 at 1:11 am

    Gah. I meant ‘on tenterhooks’, of course.

  102. Alasdair.Kay said,

    February 9, 2010 at 3:20 pm

    @nevajism

    At a brief skim it looks to me like their control group of “unvaccinated” is the same kids as the test “vaccinated” kids only in the ~15 months prior to their vaccination – which given that the mean age of onset is >4 years would present a problem. They don’t really explain how they do the “age adjustment” to account for this.

    They don’t appear to have any kids over ~15 months old who are not vaccinated (98.5% vaccinated before the age of 3).

    Could be wrong though, I was just skimming it and couldn’t see any description of the unvaccinated group aside from “The children were assigned to the nonvaccinated group until they received the MMR vaccine. From that date, they were followed in the vaccinated group.”

    I assume that since Poisson regression requires occurrence of “events” to be independent that the fact that both groups are the same people would negate that even if you ignore that there isn’t an actual control group.

  103. Alasdair.Kay said,

    February 9, 2010 at 3:43 pm

    Actually, I see they hint the vaccine uptake to be about 85% so there would be about 15% of children who are unvaccinated. Their numbers could still be skewed, and lack independence, by including the transition from one group to the other on vaccination though.

  104. skyesteve said,

    February 9, 2010 at 5:30 pm

    I maybe be wrong here – I don’t have the Wakefield and Co paper in front of me – but if memory serves me well that paper carried with it a statement along the lines of “We did not prove an association between measles, mumps and rubella vaccine and the syndrome described”.
    Was it not afterwards that Dr Wakefield suggested more strongly there was a link and urged a switch to single vaccines whilst his fellow authors said “We emphatically endorse current vaccination policy until further data are available.”
    As I said, I could be wrong and I’m happy to stand corrected…

  105. pv said,

    February 9, 2010 at 6:39 pm

    Whatever other studies might or might show, how does any of this validate Wakefield’s falsified nonsense as anything other than falsified nonsense. There is still no evidence to link MMR with autism, and Wakefield has still been found guilty of gross misconduct and dishonesty.

  106. pv said,

    February 9, 2010 at 6:40 pm

    “… might or might not show…” obviously!

  107. quasilobachevski said,

    February 9, 2010 at 10:59 pm

    pv,

    Whatever other studies might or might show, how does any of this validate Wakefield’s falsified nonsense as anything other than falsified nonsense. There is still no evidence to link MMR with autism, and Wakefield has still been found guilty of gross misconduct and dishonesty.

    To make a scientific (rather than, say, ad hominem) argument that there’s no link between the MMR vaccine and autism, it’s not enough to discredit Wakefield or his methods. From reading Ben’s book and this blog, the Danish study seems to be one of the most definitive and often-cited pieces of evidence in this direction. So any suggestion that it’s flawed seems interesting.

    Alasdair.Kay,

    I don’t think your criticism of the Danish study holds up. The authors do more than ‘hint’ at the numbers involved. In the results section of the abstract, so in the first column of the first page, they say:

    Of the 537,303 children in the cohort … 440,655 (82.0 percent) had received the MMR vaccine.

    So it seems pretty clear that they had a decent-sized control group (about 18%).

    nevajism,

    I’m still on tenterhooks!

  108. nevajism said,

    February 10, 2010 at 3:59 am

    Sorry- I was busy with a few things- ok the paper im going to analyse is actually this one

    “Thimerosal and the Occurrence of Autism: Negative Ecological Evidence From Danish Population-Based Data”
    Kreesten M. Madsen, MD* et al
    PEDIATRICS Vol. 112 No. 3 September 2003, pp. 604-606

    which I think is pretty much the same study and can be found here:

    pediatrics.aa…/full/112/3/604

    ok so reading the title and abstract all seems to be well, there is an increase in autism despite the removal of thimerasol from vaccines in 1992 so no link, QED you might think, but lets look at this a bit closer

    in the methods they say “since 1995 outpatient activities were registered as well”

    and

    “The proportion of outpatient to inpatient activities was about 4 to 6 times as many outpatients as inpatients”

    ok so thay have increased the patient base from 1995 onwards by adding 4 to 6 times more patients, fine proving they have normalised for it, and it does look like they have by looking at the graph (incedence are given in cases per 10,000)
    but look how they calculated that:

    “For each year and age band, we calculated the incidence as the number of people who at that age band and year was diagnosed with autism for the first time divided by the total number of people alive and living in Denmark at that age band and year.”

    so they have effectively given a measure which has NOT been normalised for the change in size of patient base- this is a fatal flaw and yet you wouldnt know it if you just read the abstract and title (which most people do)

    This is equivalent to saying we looked at a disease in bromley in 1995 and there were 100 cases, we then looked in the whole of london in 1997 and there were 200 cases- hence there is more of the disease

  109. skyesteve said,

    February 10, 2010 at 7:27 am

    Wasn’t the basis of the Danish conclusions, however, that they had 440,000 children who had had MMR and about 100,000 who hadn’t and the incidence of ASD was not significantly different?
    If the incidence of ASD has risen is this a genuine rise in actual “disease” or is it a rise due to increased awareness and increased likelihood of a diagnosis of ASD being made? Whilst I know it has no scientific basis I’m sure we’re all aware of folk from our childhood who nowadays would be readily diagnosed as ASD but weren’t then.
    Moreover, if MMR is the cause of any rise in ASD (real or perceived) should there not have been a dramatic rise in ASD within a year of it’s widespread introduction? Perhaps I’m wrong but I’m not aware that that’s what happened. Indeed, I have seen some stuff which suggests the rise in ASD diagnosis preceded the introduction of MMR.
    Perhaps there is a genuine rise in the incidence of ASD but by focusing so much on MMR maybe we have let the real culprit slip through our hands. I don’t know – just sepculating (which I know I shouldn’t do here but I still think it’s a valid question).

  110. Alasdair.Kay said,

    February 10, 2010 at 9:48 am

    @quasilobachevski

    Apologies – I did say I just skimmed it, but correct me if I’m wrong, it does say that the “nonvaccinated” group includes all the people who were later vaccinated up until the point where they were given the injection? I wouldn’t have thought that you could include members in the control group as “untreated” if they then became “treated”, unless that was consistent for all subjects or unless they had 3 groups, treated, untreated and transfers.

    For example, assuming they developed autism after the injection, how would you ever know that it wasn’t something they would have got anyway had they remained in the non-vaccinated group – at that stage they would be counting as a “nonvaccinated, no autism” and also as a “vaccinated, autism” statistic. I wasn’t sure if when they said “from that date, they were followed in the vaccinated group” meant that their data was removed from the “nonvaccinated”. I’d have thought that since it was a retrospective study they should have just assigned the people to one group or other. I didn’t see any explanation of their age adjustment either. But as I say, just skimmed it…

  111. Alasdair.Kay said,

    February 10, 2010 at 9:53 am

    @skyesteve

    I think you make a very valid point there – all the fuss over MMR may well have taken the attention off any one of a number of other possibles factors. It’s so difficult to know what the historical incidence was, when accurate techniques for scoring and recognition is such a recent thing. Whilst the questions hang over MMR there will be less opportunity for researchers to get funding to investigate other possible causal factors.

  112. pv said,

    February 10, 2010 at 11:38 am

    quasilobachevski
    To make a scientific (rather than, say, ad hominem) argument that there’s no link between the MMR vaccine and autism, it’s not enough to discredit Wakefield or his methods.

    I actually wrote:
    “There is still no evidence to link MMR with autism…”, which I think at this point in history is true. I did not say there is no link.

    And I hardly think it is ad hominem to write:
    “Wakefield has still been found guilty of gross misconduct and dishonesty”, because it too is true.

    The only point I was making is that Wakefield didn’t find any link in the first place so, even if anyone can find fault with the Danish study, it in no way makes a case for Wakefield’s “claims”.

  113. nevajism said,

    February 10, 2010 at 11:12 pm

    sorry got the link wrong on that paper its here:

    pediatrics.aappublications.org/cgi/reprint/112/3/604

    if that doesnt get it just do a search on the title, the pdf is freely available

  114. quasilobachevski said,

    February 11, 2010 at 2:16 am

    nevajism,

    The authors of the Pediatrics paper address your criticism on the nose. Specifically, they say the following at the end of the first column on page 605.

    In additional analyses we examined data using inpatients only. This was done to elucidate the contribution of the outpatient registration to the change in incidence. The same trend with an increase in the incidence rates from 1990 until the end of the study period was seen (data not shown).

    Alisdair.Kay,

    In the NEJM paper they do two different analyses. One measures persons, and the other person-years. I think you’re referring to the second analysis. The difference is explained in the first footnote to Table 2, which documents the results of the second analysis. It says

    The distribution of cases of autistic disorder or other autistic-spectrum disorders according to vaccination status differs from that in Table 1 [the first analysis] because, in this analysis, children who were vaccinated after the disorder had been diagnosed were classified according to their vaccination status at the time of the diagnosis (i.e., as unvaccinated).

    From this I infer that, in the first analysis, children who were diagnosed with autism were counted as vaccinated or unvaccinated in the obvious way.

    (The statistical analysis section doesn’t say this exactly, and seems really confusing.)

    pv,

    Very sorry to have misrepresented you. Of course you’re right that Wakefield never established a link.

  115. Martin said,

    February 11, 2010 at 4:34 am

    If there were a link between MMR and autism, would the reduction in MMR vacinations in the UK during the previous decade lead to a reduction in cases of diagnosed autism? Or am I being overly simplistic?

  116. Alasdair.Kay said,

    February 11, 2010 at 9:14 am

    @Martin

    Good question – unfortunately not because accurate diagnosis of autism and ASD is still a developing process. Autism diagnosis rates may have increased over the last 20 years – but the prevalence of autism or ASD may not have.

    More cases of autism are being diagnosed, but this could just be that we are able to recognise ASD now where before it went undiagnosed. It’s hard to get a precise prevalence rate because ASD varies so much – Asperger’s Syndome or high functioning autism may never get diagnosed if the person is able to live a relatively normal life and the ASD isn’t accompanied with any learning difficulties. More accurate ability to diagnose autism really improved from the 90′s, whilst widespread use of MMR was introduced in 1988 (so the effects would theoretically be seen early 90′s). It’s like which came first, the chicken or the egg (and is it even a chicken’s egg anyway)?

  117. nevajism said,

    February 16, 2010 at 12:00 am

    quasilobachevski
    Back to the piediatrics paper-
    you have to admit that if this is the hard evidence for anything it is pretty unclear- first they show a graph of data which they admit has not been normalised for patient population size, then as a throw away comment thay say that they looked in-patients only and it shows the “same trend”- but we dont know what the trend is because the data has been presented in a statistically flawed manner and they dont present the in-patients only data at all which we realy want to see- how did this make it through any kind of peer review? – and how can this be the hard evidence that organic mercury in vaccines dosent cause autism — anyone who wants to see the other side of the story should look at this talk from David Ayoub, M.D:

    video.google.co.uk/videoplay?docid=6890106663412840646&ei=w995S9TtNdOM-AaBpvjEBw&q=mercury+vaccines&hl=en#

  118. nevajism said,

    February 16, 2010 at 3:02 pm

    Guess Im now banned from the other thread after ben sent that stream of insults he then blocked my reply (nice one ben!)

    On the subject of systematic reviews and MMR’s (nicely combining the two subjects in one) here is a paper outlining some of the problems with the Cochrane review on MMR:

    C.G. Miller (2006) Questions on the Independence and Reliability of Cochrane Reviews, with a Focus on Measles-Mumps-Rubella Vaccine, Journal of American Physicians and Surgeons 11(4) pp111-115.

    www.jpands.org/vol11no4/millerc.pdf

  119. Ben Goldacre said,

    February 16, 2010 at 3:12 pm

    you mean here where you prevented people from having an interesting discussion about systematic reviews?

    www.badscience.net/2010/02/moments-of-genius/

    nothing has been censored, i can find no evidence of you posting anything to that thread anywhere in my email or the web interface of this website.

    you’re an idiot, and a waste of time, pure and simple. and now you’re quoting JPANDS. beautiful that you’ve found each other, they’ll probably print an academic article from you if you send them something, give it a go.

  120. nevajism said,

    February 16, 2010 at 3:45 pm

    why all the insults Ben? have I touched a raw nerve?
    I tend to look at what something says rather than where it comes from – authoritory does not always mean truth. I once spent quite a bit of lab time showing that a paper in PNAS was wrong, but the rebutal only merited a paper in biophysical J.

  121. nevajism said,

    February 16, 2010 at 3:47 pm

    is it anoying for you to find another science nerd who does not agree with you ben?

  122. pv said,

    February 16, 2010 at 4:00 pm

    nevajism, you refer to a book called Silenced Witnesses (Vols 1 & 2) and you described Brian Deer and a complainant (which you can’t spell). That puts you in a deep hole of idiocy to start with. Everything else you write only makes it deeper. You just keep on digging…

  123. nevajism said,

    February 16, 2010 at 4:07 pm

    just because you and Ben call me an idiot doesn’t make it so – I assume you have heard of the term ad hominem?

    (sorry about the spelling – I’ll run things through a spell checker in future if it makes you happy)

  124. Ben Goldacre said,

    February 16, 2010 at 4:32 pm

    hi nevajism

    i guess if we were at a party i’d just ignore you. if you were being as annoying as u have been in my house (which u kind of are) i guess i might think about asking you to leave

    now, on this thread, i’m happy to leave you being dumb about vaccines, because we expect fools on those threads. what i found objectionable was when you drifted and started to be tedious on another thread. that was like jumping on a table and shouting at a party, and demanding that everyone looked at you and attended to you and your thoughts, instead of having their own chats. that’s why i think you’re unpleasant. you’re very free to continue being a fool here. we have no obligation to like you.

  125. pv said,

    February 17, 2010 at 9:51 am

    nevajism said,
    February 16, 2010 at 4:07 pm

    <i<just because you and Ben call me an idiot doesn’t make it so – I assume you have heard of the term ad hominem?

    You also need to brush up on your reading and comprehension skills. It’s not because anyone says says you are an idiot, it’s because you make it so evidently obvious. And you seem to be wearing your pointy “big D” hat with more than a modicum of pride.
    You cite books written by a known fantasist and fraudster as if they have some merit. You make claims about Brian Deer and the GMC which are patently false (and have been refuted by both Deer and the GMC), presumably because they fit in with your prejudices. So far you haven’t acknowledged the error of your claims. And you expect to be taken seriously.

    I’d say you’ve dug yourself an escape-proof hole there. Keep digging!

  126. quasilobachevski said,

    February 19, 2010 at 3:20 am

    nevajism,

    I agree that it would be preferable if they had given the figures. But let me just summarise how the debate so far has gone.

    1. You said there was a problem with the NEJM paper.

    2. You changed your mind and said the problem was with the Pediatrics paper.

    3. I pointed out that the authors address your complaint.

    4. You blustered and moved on to something else.

    Have you ever heard Ben talk about the rhetoric of denialism? You’re a classic example. When one of your arguments gets knocked down, you move on to the next with no sign of self-criticism or apology for wasting everyone’s time.

    Funnily enough, I can’t be bothered to watch your video. I have better things to do.

    Oh, and one other thing. Ayn Rand? Ron Paul!? Ahahahahahahahaha! Ahahahahahahahhahaha! Thanks, I needed a laugh.

  127. jweirmccall said,

    February 19, 2010 at 8:55 pm

    nevajism:

    “I once spent quite a bit of lab time showing that a paper in PNAS was wrong”

    The lady doth protest too much, methinks. I love how your evidence against vaccines come from people who stated the following regarding evidence:

    ‘Physicians must beware of accepting the concept of a standard of care that is itself evidence-based, threatening the autonomy of physicians and subjugating the patient’s interest to that of the collective.”

    They also share your love for Ayn Rand quoting them in their editorials. You are very apt bedfellows indeed.

    Ps. Having problems posting at the moment, so sorry if this has appeared before

  128. nevajism said,

    February 28, 2010 at 2:32 pm

    Guys,

    I thought I’d wait a while before replying just to see if you could muster a good argument- sadly I was disappointed.

    “The lady doth protest too much, methinks”
    Funny that I was thinking the same thing – I seem to have triggered a lot of protestations from Ben and his acolytes

    quasilobachevski – I thought I addressed your points pretty directly- are you SERIOUSLY telling me that you think this is a valid piece of work?

    pv – so a person who has made accusations against Brian deer and the GMC is wrong because they (the accused) have said he is a mentally deranged fantasist? – Well they would say that wouldn’t they. What did you expect them to say? Rather than take sides in that way I suggest you read what all parties have said and then use your own logical powers of reasoning.

    On the subject of Wakefield- may I suggest that the sudden resurgence of interest in his case was in a desperate attempt to try to block this paper:

    fourteenstudies.org/pdf/primates_hep_b.pdf

    which had passed the peer review process but now seems to have been withdrawn at the request of the editor- the results are pretty damning wouldn’t you say? Does anyone want to point out a specific problem with this paper? I cant see why it would be withdrawn other than for political reasons, even if you say there weren’t enough monkeys in the experiment, the least that should happen is that this work should trigger a larger scale study to confirm or refute its findings, this is how good science works, is it not?

    - I wait for further accusations of being a dunce, madman, idiot – please use your imaginations and see what other words you can come up with to try and refute me with personal insults- its always the best standby when you haven’t got a real argument to fall back on.

  129. nevajism said,

    February 28, 2010 at 2:59 pm

    should mention the title of that NeuroToxicology paper, just in case you dont follow the link:

    Delayed acquisition of neonatal reflexes in newborn primates receiving a thimerosal-containing Hepatitis B vaccine: Influence of gestational age and birth weight
    by
    Laura Hewitson Lisa A. Houser, Carol Stott, Gene Sackett, Jaime L. Tomko a, David Atwood, Lisa Blue, E. Railey White and Andrew J. Wakefield

  130. nevajism said,

    July 12, 2010 at 12:39 pm

    this is a very interesting recent lecture from wakefield outlining the above study:

    www.youtube.com/watch?v=Rm1CTxaw3AY

    the other 9 sections are also on youtube

  131. edwardm said,

    January 1, 2011 at 6:25 pm

    nevajism – Get a grip. You’re just posting random papers now which test for possible links between thimerosal-containing vaccines and autism. Are you that stupid that you think this is evidence that MMR causes autism when the MMR vaccine has never had thimerosal as an ingredient.

  132. oakwoodbank said,

    January 8, 2011 at 10:24 am

    It can reasonably be assumed that some vaccines do cause damage to children or we would not have the Vaccine Damage Payments Act 1979. [1] The list of diseases to which this act applies includes measles and rubella as well as diphtheria, tetanus and whooping cough.

    There does not appear to have been a consolidated paper that attempts to show how vaccines might cause brain damage by a review of the scientific literature except for the one that I have published on various web sites including scribd. [2] It has been published for open access. This paper looks at the causative factors mainly from the effects of the whooping cough vaccine (pertussis).

    However, the U.S. Department of Health & Human Services, Centers for Disease Control and Prevention, National Immunization Program, promulgates that the risks from MMR vaccine can be permanent brain damage. [3]

    Epidemiologists will probably say, and quite rightly, that the benefits of vaccination outweigh the occasional damage that is caused by some of them. The number of payments for vaccine damage in the UK is in excess of 1,000 and compared with the number of children who have benefitted, that number is miniscule bit not unimportant.

    Over a thousand children will be living diminished lives as a result and their parents will be anguished that they were, in part, responsible for their child’s disability.

    For this lifetime of inequality and the loss of; normal education, a job and a life that contains the expectancies that most of us have envisaged and possibly achieved, the maximum award is, If you are severely disabled as a result of a vaccination, a one-off tax-free payment of GBP120,000.

    It is this shameful situation that ought to cause concern rather than a continuing denouncement of Wakefield. He may have got his understanding of the relationship between MMR and Autism wrong but that does not prove that there isn’t one.

    1 www.legislation.gov.uk/ukpga/1979/17/section/1

    2 Challoner A. Brain Damage Caused by Vaccination. www.scribd.com/doc/19408267/Brain-Damage-Caused-by-Vaccination 2009.

    3 www.cdc.gov/nip/publications/VIS/vis-mmr.pdf

  133. trombone said,

    November 19, 2011 at 12:30 am

    Probably history now, but from memory Wakefield et al’s research didn’t actually say they had found a causal link, indeed I think it pointed up that the results were inconclusive and that more research needed to be done.

    If my recollection above is correct, then all of his co-author colleagues who later renounced the study, were in effect renouncing their own conclusion that the study was inconclusive!!! Exactly what the establishment were trying to claim!

    This is important when you recall that the press/establishment repeatedly claimed the research (and Wakefield himself) were claiming to have found a link. Bad interpretation on the part of the press? If true, it also implies that those who renounced their own work might have been concerned about their own personal situations.

    Can somebody correct me please? – I don’t like to be wrong!

    Btw, While I accept he may have made mistakes(I am not a medic etc) I was under the impression good science was about asking the sort of questions that Wakefield did, and that all research was good in some way -ie a “no causal link” answer can be just as informative as a positive link. Further, while scientists, journalists etc should try to undertake the best possible work they can, sometimes even the bad science tells us something about say, the peer review process, how to better reduce errors, Accreditation flaws etc, and by identifying those flaws we can address them. Provided it’s not hectoring, criticism is always constructive.

    Of course a corollary of the above para is that the atmosphere between Wakefield, the press and the establishment could have warped the direction of research and hence the wider picture

  134. Alex said,

    August 21, 2013 at 11:22 pm

    Not sure if you picked up on this recent article Ben, any comment? I’m still unsure as to which ‘side’ is trying to pull the most wool!

    www.whydontyoutrythis.com/2013/08/courts-quietly-confirm-mmr-vaccine-causes-autism.html?m=1

  135. Alex said,

    August 21, 2013 at 11:32 pm

    Sorry, That link should have been www.whiteoutpress.com/timeless/courts-quietly-confirm-mmr-vaccine-causes-autism/

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