Ben Goldacre
3rd June 2006
The Guardian
[Mmmm uh-oh I’ve just found out the Guardian newsdesk have cut this by 200 words while I was having an afternoon snooze. I can’t bear to look. Anyway, here’s what I wrote…]
MMR is back. “US scientists back autism link to MMR” squealed the Telegraph. “Scientists fear MMR link to autism” roared the Mail. “US study supports claims of MMR link to autism” croaked The Times, a day later.
Strap me to the rocket and print my home address in the paper, I’m going after them again. So what was this frightening new data? Well it’s hard to tell, since it hasn’t been properly published anywhere yet, so you can’t actually read it and form an opinion. This is now standard operating procedure for all scare stories, because journalists have learnt that informed and informative public debate on unpublished research is basically impossible. So it turns out that these three newspaper stories are all about a poster presentation, at a conference yet to occur, on research not yet completed, by a man with a track record of announcing research that never subsequently appears in an academic journal: Dr Arthur Krigsman.
The story is that he may have found genetic material (RNA) from vaccine-strain measles virus in some gut samples from children with autism and bowel problems. Some believe that this could implicate the vaccine in causing health problems.
But let’s not forget, the Daily Mail was promoting Krigsman’s research back in 2002 as well: at that time, he was putting endoscopes into the bowels of young children with autism, and said he had found evidence of inflammation. 4 years later, looking on PubMed, the standard database for all medical papers, it seems this research still has not been published in a peer reviewed academic journal. Forgive my bluntness, but it seems a shame to go poking around up there if you’re not going to write up your findings properly.
Meanwhile the Telegraph says that Krigsman’s most recent unpublished claim is replicating similar work from 1998 by Dr Andrew Wakefield, and 2002 by Professor John O’Leary. But there is no such work from 1998 by Wakefield, at least not in PubMed (in that year he publishes his infamous, very different, and partially retracted Lancet paper on MMR, of course). Meanwhile it is well documented that other labs have tried to reproduce the 2002 O’Leary study and come out with different results, and that the protocol was likely to have problems with false positives because of the tests used: two perfect examples of the importance of research being fully written up and published, so it can be replicated and assessed. Oh, and the newspapers didn’t mention that Andrew Wakefield was also an author on the 2002 study along with O’Leary, nor that Wakefield is also very closely associated with Krigsman (they are doctors together at Thoughtful House, a private autism clinic in the USA).
I could go on, but instead, here is the news you didn’t read: this month, in the May issue of the Journal of Medical Virology, there was a very similar study, only this one has actually been published. It looked for measles RNA in children with regressive autism after MMR vaccination, much like the Krigsman story. It used tools so powerful they could detect measles RNA down to single figure copy numbers. But they found no evidence of the magic vaccine-strain measles RNA to implicate MMR, and perhaps because of that unfrightening result, the study was loudly ignored by the press.
Because it has been published in full, I can read it, and pick holes in it, and I am more than happy to do so: because science is about critiquing openly published data and methodologies, and in the real world, all studies have some flaws, to a greater or lesser extent. Often they are practical ones: here for example, the researchers couldn’t get ethics committee approval to use the tissue they ideally wanted to use (lumbar punctures and gut biopsies on children are a hard sell). And when they asked the anti-MMR lobby if they could have some of their tissue to work on, amusingly, they were ignored.
Those who campaign against MMR make huge and detailed critiques of the published studies which suggest that MMR is safe. Sometimes they are spectacularly ill-informed: excepting that, it is quite right that they should critically appraise the literature. But in the spirit of science, the least they could do is share data, and maybe tissue samples, but most importantly publish their scientific work, in full, openly, before their peers, rather than the press.
Robert Carnegie said,
June 10, 2006 at 11:32 am
Mike, I hope you persuade many of your friends to not have their children vaccinated against measles, and then they all catch the disease from immigrants and die. Remember, the point of single jabs is that the measles vaccine causes autism, so single jabs really are a way to choose not to have the measles jab.
I have a niece with multiple serious allergies who had special vaccinations and then stayed in the hospital for supervision afterwards. But I don’t see that lactose intolerance has much to do with anything. I expect you know that lactose intolerance is normal in all children and adults, after weaning and except for white Europeans, presumably because lactose exposure killed them all.
I wouldn’t mind seeing vaccine intolerance going out the same way.
DT said,
June 12, 2006 at 11:19 am
Three tigers,
I see what you are getting at, namely antibody-dependent cell-mediated cytotoxicity. This relies on Natural Killer T cells which express the appropriate receptors for IgG. I am not aware that this plays much part with measles, but stand corrected if this is indeed the case.
Janet W said,
June 12, 2006 at 5:43 pm
Mike mentions the issue of parents’ perception.
Does this go back to the earlier point of medicine being the victim of its own success?
Perhaps parents no longer believe that their child can be killed by an infectious disease.
My mother was old enough to remember people in her school (pre-war) dying of infectious diseases, and being scared of dying herself. When I was a baby in the early sixties, she had me vaccinated against everything available.
Fortunately (in so many ways) I’m not a parent and don’t have to make these decisions, but via Dr Aust I recently found this webpage, which as a layman I found helpful:
www.cdc.gov/niP/vacsafe/concerns/autism/autism-mmr.htm#3
(One of the arguments I’ve heard several times in the media is the anecdotal “my child developed autistic symptoms after having the vaccine” and you think “is this coincidence or not?”….. so it was interesting to read that one of the studies looked at this and concluded “the first signs or diagnoses of autism were not more likely to occur within time periods following MMR vaccination than during other time periods”)
Autism Blog Web Design Blog: » Dan Olmsted and Andrew Wakefield. Rumour Mongering Ahoy! said,
June 14, 2006 at 9:49 am
[…] Bad Science. […]
Aspiring Pedant said,
June 15, 2006 at 9:53 am
I’ve just been into my local newsagent’s and there, on the front page of the Daily Express, I saw the headline “Measles Epidemic Sweeps Britainâ€. To my horror beneath that in smaller type it read “So why can’t children get single vaccine?â€
Discussing this with a colleague I discovered that she had paid for her son to have single vaccines because
•she knows someone whose son developed autism within hours of having the jab,
•boys are more susceptible to autism and Crohn’s disease,
•Andrew Wakefield’s logic may have been flawed but surely he was onto something
Naturally, I tried to explain that really there is absolutely no evidence to connect MMR with Autism, whilst at the time trying desperately to change the subject, but I hadn’t really expected that type of discussion – I anticipated a response along the lines of “yeah, isn’t the tabloid press patheticâ€.
It’s not the first time I’ve made this mistake – I just assume any reasonably educated person knows that MMR does not cause autism; Sometimes these people get quite upset when you try to point out that their beliefs may be mistaken.
There seems to be a common theme with MMR, ES, homeopathy, audiophilia and so on, in that once certain people accept an idea no amount of evidence seems to be able to dissuade them. It seems that the oft-quoted Jonathan Swift line that “You cannot reason a person out of a position he did not reason himself into in the first place†rings true but why should this be? Why do people insist on believing the most ridiculous ideas despite all evidence to the contrary? The worst thing from my point of view is that there are all sorts of bizarre ideas that cannot be challenged for fear of offending people – witness the reaction to Ben’s articles on Brain Gym, Electro-sensitivity.
Robert Carnegie said,
June 19, 2006 at 11:43 pm
Mike, it goes like this.
If you believe that Dr Andrew Wakefield is a muddler and a pseudoscientific fraud, there is no reason not to go with the MMR virus.
If you don’t believe that Dr Wakefield is a charlatan, you have to take account of his discovery of measles virus in autistic children’s bottoms, and evidently he has proved that both measles and measles vaccine cause autism, in your bottom.
So option one is to avoid vaccination altogether. But you know that that’s wrong. Or maybe you don’t.
Option two, if you’re middle class, is to demand separate vaccines for measles and mumps and rubella. But, remember – measles vaccine causes autism. So obviously you’re going to take the other two and skip that one.
Are you telling me that you didn’t already think this through? That you have no qualms about your child receiving measles vaccine?
I mean, that’s why doctors made a multiple vaccine in the first place – because patients wouldn’t turn up for all the individual vaccines at different times.
Mike Hughes said,
June 20, 2006 at 11:57 am
Hmm, thanks Robert,
Let me be clear here. I don’t welcome your tone in response to my original post but your point is valid.
I do wonder though if we’re all so caught up in debating the politics v the logic v the science that we have failed to notice that this whole thing is possibly an area that just has incomplete research. Lots of, effectively, statistical surveys but nothing categorical.
My child will be having the MMR under hospital supervision thanks to a severe reaction to cows milk and eggs. I remain unhappy with this but see little choice and that’s my point. How will you feel several years down the line if my child is autistic; research is complete and shows a demonstrable link in specific circumstances and, at the time, despite the research being incomplete, I was given no choice?
Mike
PS: I was unaware it was a crime to be a middle class parent!!!
Aspiring Pedant said,
June 20, 2006 at 3:03 pm
Mike,
see this – www.jr2.ox.ac.uk/bandolier/booth/Vaccines/noMMR.html
& this – content.nejm.org/cgi/content/abstract/347/19/1477%20
& this – unisci.com/stories/20011/0307013.htm
Whatever causes autism, it is not the MMR vaccine. The research is far from incomplete – MMR does not cause autism; There is no doubt whatsoever.
If that doesn’t convince you what research do you think could offer you categorical proof that MMR does not cause autism?
There is a risk associated with everything we do – one of the most dangerous things people do is to travel by road but most of us are happy to accept the risk.
What choice would you like and why would you think that alternative to be safer?
Robert,
I don’t think the term “middle class†is particularly helpful in this context; stupid people with money can pay for single vaccines whatever their social class.
Dr Aust said,
June 20, 2006 at 3:09 pm
Mike
I think the medical-scientific view is that the research IS complete, in that enormous surveys find no link between MMR vaccination and autism. As I and others have said here before, to find small effects you need big surveys (large sample numbers), so scientists and doctors find these large studies extremely convincing.
When Wakefield and others raised the MMR-autism link, the regulators and the vaccine scientists decided to look into it. even though the evidence for any link was non-existent (as it remains). This “looking into it” is what has produced all the subsequent work which says the vaccine is safe. For instance, the Danish study, with a sample population of essentially all the children born in Denmark in almost a decade, found no evidence that there was more autism in the MMR-vaccinated population than in the non-vaccinated one. In fact, they ruled out any chance that there was more autism in the vaccinated group with an extremely high degree of certainty. The scientific/medical view would be that that is as conclusive as it is going to get.
So there is loads of very careful, very good, very convincing evidence. It’s just that the MMR-scare anti-vaxers, and their media allies, refuse to believe it. They don’t base their view on evidence, but prefer their conspiracy theories. And despite all their efforts, they have produced NO credible scientific evidence on the other side of the argument (“autism danger from MMR”). This has been emphasised by several review panels who have gone through the evidence with a fine-tooth comb. What this means is that, as posts on this forum have indicated, the “evidence” advanced by Andrew Wakefield and his allies doesn’t stand up to any kind of scientific scrutiny.
There MAY be some still unanswered questions, but these relate to methodology in the virus-in-the-gut hunting experiments, NOT to vaccine safety. An example of a question one could pose is “Why do some studies by some labs detect measles virus RNA sequences in some gut samples”. But in the face of at least equally good, and mostly scientifically FAR BETTER (published, properly validated by peer review, methods clearly set out) papers which do the same experiment and get the opposite answer (i.e. find that they can’t detect measles RNA, even though the methods are easily sensitive enough to find it if it were there), this is not evidence that a scientist or doctor would believe. And that’s evidence for as strictly limited a point as the virus being present at all in the gut, let alone anything else one could extrapolate from it.
In a nutshell, the thing which keeps people thinking “knowledge incomplete” is that the media splash-report any study which says “measles virus found!” (even if it is only a conference paper) and fail to report the scientifically-sounder detailed studies which say “NB, couldn’t find any measles virus”. Hence the skewed perception. This is what Ben Goldacre was saying in the original piece at the top of the thread.
I know these intellectual arguments are tough to weigh against a parent’s worries, and as a father I have been there, if that doesn’t sound too trite.
Robert Carnegie said,
June 20, 2006 at 8:40 pm
Social class is a strong predictor of whether you will or will not read certain newspapers – if you find one left on a park bench, say. For my part I mostly gave them up when they were still broadsheets, and I only pick up a “Metro” for the Su-doku.
Anyway, that’s how it bears on vaccination.
Aspiring Pedant said,
June 21, 2006 at 2:40 pm
Robert you claim that “Social class is a strong predictor of whether you will or will not read certain newspapers – if you find one left on a park bench, say†but how do you identify the social class of someone in the first place? If I happened to be sitting on a park bench with nothing better to do I’d probably read a newspaper if I found one there – what social class does that make me?
Is there any evidence that uptake of MMR is lower amongst the middle class than amongst the upper class or working class? The following study finds that “Population density and deprivation were both strongly correlated with low MMR uptakeâ€
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16207728&query_hl=1&itool=pubmed_docsum
However, my main objection to the term “middle-class†is that it is little more than name calling; it doesn’t mean anything. Just as an example “Su-doku is a middle class spelling of the middle class pastime Sudokuâ€.
Dr Aust said,
June 21, 2006 at 3:36 pm
Interesting reference, Aspiring Pedant.
The scoring of areas of the country for “social class” or “deprivation” in studies like this is often based on a “basket” of “indicators of deprivation” – e.g. one well-known index (the Townsend deprivation index) uses ” unemployment, overcrowding, amount of owner-occupied housing and car ownership”.
This study uses something more complex, also looking at ethnicity, education level and other things.
The study actually makes two points that are relevant here:
First-off, vaccine coverage continues to be lowest in “highly deprived” (usually inner city) areas. This is probably just the vaccine version of an effect noted for all sorts of things related to health and health-care in the UK, which is that the inner-city poor get a raw deal. It is well-recognised that people in deprived areas get worse ACCESS to the health system for all sorts of reasons – less doctors, less easy to get to them, poor education and awareness, poverty stops people living a healthy lifestyle, etc etc.
The other effect commented on in the study is that the DECLINE in vaccination rates seemed to be more marked in the LESS deprived areas. This would support the argument that we could summarize (with apologies) as “worried middle class parents stopping vaccinating”. To quote:
“There is some evidence here that the decline in MMR coverage has been less marked in areas with more poorly qualified populations. For example, Kensington in central London with a small unqualified population has shown a much more rapid decline in MMR coverage than the East London DHA, which has a higher proportion of unqualified population. There may thus be some justification in targeting MMR health promotion materials at the more educated sectors of the population. Nonetheless, the problem of low MMR coverage remains greatest in the most deprived areas and targeting of these areas should remain a priority.”
So better-educated “middle class” types may be vaccinating their kids less than they used to (the Daily Idiot effect?), but it is still the more deprived areas that have the lowest levels of MMR vaccination take-up, as has always been the case.
Aspiring Pedant said,
June 21, 2006 at 5:10 pm
It’s been very much the same story in Scotland too:-
adc.bmjjournals.com/cgi/content/full/91/6/465
One of the conclusions of this study is that “late uptake has increased slightly and more affluent parents tend to vaccinate early or not at all, while the most deprived are more likely to experience delayâ€
Interestingly, the MMR uptake figures after 2 years for all social groups follow the same trend with non-uptake increasing sharply in 1998 -99. So, the adverse publicity generated by Wakefield et al seems to have affected all social groups in a similar manner.
GarySGoldman said,
December 26, 2006 at 6:38 pm
In response to this comment:
21 “Medical Veritas†– a magazine dedicated to anti-vac propaganda (it says so on the website!) Does not seem to be peer reviewed and could not find on WOK or PubMed. Is is kind of funny that Wakefield is reduced to “publishing†his work these journals having previously got into Gastroenterology etc – I guess it shows how worthless his work is now. I will not bother reading the article; it is a non-article in a non-jounrnal. Next?
Medical Veritas is a peer-reviewed medical journal published two times per year that promotes a circumspect consideration of vaccine interventions, including the deleterious effects of vaccines that are so often suppressed by other journal editors that have conflicts of interest with the pharmaceutical industry. For example, in the U.K. where a multi-billion dollar, class-action lawsuit is pending with respect to deleterious effects of the MMR vaccine–it is virutally impossible to locate a U.K. medical journal willing to publish such an article. Articles in Medical Veritas are considered to be scholarly and are methodologically sound. I would be happy to provide an electronic copy of the Wakefield article referenced and would be willing to publish a reasonable commentary addressing any areas wherein the manuscript was found to be deficient.
To the contrary, instead of presenting non-articles in a non-journal, Medical Veritas articles have been used in expert court litigation and have contributed to both improved medical practice and policy.
If you have further comments or questions, please e-mail me at gsgoldman@adelphia.net; also, please see website at www.medicalveritas.com)
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Denouement for the MMR scare « Dr Aust’s Spleen said,
May 24, 2010 at 3:23 am
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MMR jab and autism - new link - Baby Club Forum (Page 2) said,
July 31, 2011 at 9:44 am
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