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Yet another bad day for the anti-vaccine movement

ResearchBlogging.orgArguably, the genesis of the most recent iteration of the anti-vaccine movement dates back to 1998, when a remarkably incompetent researcher named Andrew Wakefield published a trial lawyer-funded “study” in the Lancet that purported to find a link between “autistic enterocolitis” and measles vaccination with the measles-mumps-rubella (MMR) trivalent vaccine. In the wake of that publication was born a scare over the MMR that persists to this day, 11 years later. Although peer reviewers forced the actual contents of the paper to be more circumspect, in the press Wakefield promoted the idea that the MMR vaccine either predisposes, causes, or triggers autistic regressions. Even though over the next several years, investigations by investigative journalist Brian Deer revealed that not only was Wakefield’s research funded by trial lawyers looking to sue vaccine manufacturers for “vaccine injury” when he did his research (for which he is now being charged by the U.K.’s General Medical Council with scientific misconduct), but during the Autism Omnibus trial testimony by a world-renowed expert in PCR technology showed that he was incompetent. Even worse for Wakefield, in February 2009 Brian Deer published a news expose based on strong evidence that Wakefield may very well have falsified data for his Lancet paper.

None of this mattered. Andrew Wakefield still enjoys a cult of personality among the anti-vaccine crowd that no revelation seems able to dislodge, even the revelation that at the time he was both in the pay of trial lawyers and working on his study, Andrew Wakefield was also applying for a patent for a rival measles vaccine. Indeed, the anti-vaccine propaganda blog Age of Autism bestowed upon him last year its “Galileo Award” as the “persecuted” scientist supposedly fighting for truth, justice, and anti-vaccinationism against the pharma-funded or brainwashed minions of the “Church of the Immaculate Vaccination.” In the meantime, MMR uptake rates in the U.K. have plummeted over the last decade, far below the level needed for herd immunity, to the point where, last year the Health Protection Agency declared measles to be once again endemic in the U.K., 14 years after the local transmission of measles had been halted.

Since Wakefield’s study was released, a number of studies have shown that there is no epidemiologically detectable link between vaccination with MMR and autism, including one by a researcher who once appeared to be a believer in the idea that vaccines are somehow linked with autism, Mady Hornig. Hornig actually tried very hard to replicate Wakefield’s 1998 Lancet study, only this time with more children, and she found no link between MMR and autism using methodology similar to Wakefield’s. None of this has had any effect on the anti-vaccine movement, except to motivate them to circle the wagons even more, as J.B. Handley of Generation Rescue did when he launched a website called Fourteen Studies, whose sole purpose is to launch fallacious and pseudoscientific attacks on studies failing to find a link between vaccines and autism and to promote the lousy science that gives the appearance of supporting the hypothesis that there is a link between the MMR vaccine and autism and then sliming anyone who points out how deceptive their attacks were.

Last week, yet another study was released investigating whether there is a link between MMR vaccination and autism. Last week, yet another study failed to find a link between MMR vaccination and autism. This week, yet another study is all set to be attacked by Generation Rescue and the anti-vaccine movement. The sad and sordid history of reactions of the anti-vaccine movement to studies that do not support its belief in the unsinkable rubber duck of a myth that vaccines cause autism. This study was published online in The Pediatric Infectious Disease Journal by a group from Department of Epidemiology and Preventive Medicine, Jagiellonian University, Collegium Medicum, Krakow, Poland (a Polish group, my people!) and entitled Lack of Association Between Measles-Mumps-Rubella Vaccination and Autism in Children: A Case-Control Study. It’s yet another nail in the coffin of the myth that the MMR causes or contributes to autism. Indeed, this study not only shows that MMR vaccination is not associated with autism but that it may even be protective against autism. True, for reasons I will discuss shortly, I doubt that that latter interpretation is true, but there’s no doubt that this study is powerful evidence against the view that there is an association between MMR and autism. Unfortunately, I fear that all the nails in my local Home Depot would not be enough to keep the zombie of this pseudoscience from rising from its grave yet again.

Here’s the abstract of the paper:

OBJECTIVE: The first objective of the study was to determine whether there is a relationship between the measles-mumps-rubella (MMR) vaccination and autism in children. The second objective was to examine whether the risk of autism differs between use of MMR and the single measles vaccine.

DESIGN: Case-control study.

STUDY POPULATION: The 96 cases with childhood or atypical autism, aged 2 to 15, were included into the study group. Controls consisted of 192 children individually matched to cases by year of birth, sex, and general practitioners.

METHODS: Data on autism diagnosis and vaccination history were from physicians. Data on the other probable autism risk factors were collected from mothers. Logistic conditional regression was used to assess the risk of autism resulting from vaccination. Assessment was made for children vaccinated (1) Before diagnosis of autism, and (2) Before first symptoms of autism onset. Odds ratios were adjusted to mother’s age, medication during pregnancy, gestation time, perinatal injury and Apgar score.

RESULTS: For children vaccinated before diagnosis, autism risk was lower in children vaccinated with MMR than in the nonvaccinated (OR: 0.17, 95% CI: 0.06-0.52) as well as to vaccinated with single measles vaccine (OR: 0.44, 95% CI: 0.22-0.91). The risk for vaccinated versus nonvaccinated (independent of vaccine type) was 0.28 (95% CI: 0.10-0.76). The risk connected with being vaccinated before onset of first symptoms was significantly lower only for MMR versus single vaccine (OR: 0.47, 95% CI: 0.22-0.99).

CONCLUSIONS: The study provides evidence against the association of autism with either MMR or a single measles vaccine.

Indeed it does. It’s worth talking a bit about the methodology of the study. First of all, this is a case control study, which means that it’s retrospective and therefore not randomized. On the other hand, it was a case control study by Sir Richard Doll that was the first outside of Nazi Germany (whose scientists, oddly enough, had found evidence linking smoking to lung cancer more than two decades before the Surgeon General issued his report in 1964) to find an association between tobacco smoking and lung cancer, a finding that was subsequently followed up in cohort studies and found to be valid. Be that as it may, case control studies, instead of prospectively following a population over time, study a population of patients who already have a disease or condition and then try to identify factors associated with the development of that condition. Basically, this involves picking a control population that is equivalent to the study population, and this is how the investigators did it:

Subjects were identified using general practitioner records in the Lesser Poland (Małopolska) Voivodeship in Poland. The sample population of this study included children aged 2 to 15 years diagnosed with childhood or atypical autism, classified according to ICD 10-criteria as F84.0 or F84.1, respectively. Every diagnosis of autism was made by child psychiatrist. Dates of these diagnoses were recorded in general practitioners files. Cases with uncertain diagnosis of autism, secondary to disease state or trauma, were excluded. Two controls were selected for each affected child, individually matched by year of birth, gender, and physician’s practice. The first 2 children visited the physician after the time of the autistic child visit who met entry criteria served as controls.

This is a reasonable strategy to use to pick the control group, as it means that the children would be coming from the same pediatric practices as the autistic children and would be about as comparable as it is possible to make them in this sort of trial design. Another strength of this study is that it used physician reporting for vaccination history and the age at which each autistic child was first diagnosed, rather than relying on parents’ reporting, which is prone to serious confirmation bias. True, the parents were also asked when they first suspected their child’s symptoms might be related to autism, and their knowledge and beliefs regarding the cause of autism, but vaccination was not mentioned in order to avoid biasing the parents’ answers. Cases of autism were then analyzed and considered to have been vaccinated if they received the MMR prior to the onset of autistic symptoms. Controls were considered vaccinated if they had received the MMR before the age of onset of their matched case controls. Finally, the authors corrected for other potential risk factors for autism, including mother’s age, education, gestation time, medications during pregnancy perinatal injury, and the APGAR score of the child at birth. Those that appeared significant in univariate analyses were then subjected to multivariate analysis.

The money table is Table 4, which represents the multivariate analysis:

i-9c78c91ce6aeedd429ff252c55f80df7-Table-4.jpg

What’s surprising about these results is that the multivariate analysis found a relative risk (RR) of autism for children vaccinated with any vaccine before the onset of autistic symptoms of 0.65 and 0.28 for children vaccinated before their “official” diagnosis of autism. When looking at the single vaccine for measles or the trivalent MMR vaccine, both appeared to be protective against autism, but the MMR appeared to be considerably more protective than the single shot measles vaccine. (This comparison could be made because the Polish national health service only covered the single dose measles vaccine and not the MMR until 2004, meaning that before 2004 parents who wanted the MMR vaccine had to pay extra.) Indeed, this study even found that for children vaccinated with MMR before their diagnosis of autism the RR = 0.17, suggesting a six-fold decreased risk of autism in children vaccinated with MMR!

Is this really true? Is MMR vaccination really that protective against autism? Probably not. An effect of that magnitude would very likely been picked up in one or more of the large population-based studies that failed to find a correlation between vaccines and autism. There is also one shortcoming in this study is that it only looked at autistism and not other pervasive developmental disorders; however there is ample other evidence that MMR is not associated with PDDs other than autism, and the original claim of the anti-vaccine movement was that MMR causes autism. So how to explain such a result? One possibility is simply random chance, given that the sample size, although reasonable, is not that large. Another possibility is that there is a confounder that wasn’t adequately controlled for. Whatever the case, here’s one thing to remember about retrospective studies in general. They often find associations that later turn out not to hold up under study using prospective studies or randomized trials or, alternatively, turn out to be much weaker than the retrospective study showed. They do not so often find a result that is exactly the opposite of hypothesis tested for. In other words, when such a study is used to look for a positive association between a factor and a specific condition or disease, it is quite uncommon to find a negative association, particularly one this strong. One possible reason for this seeming protective effect observed was discussed by the authors:

The decreased risk of autism among vaccinated children may be due to some other confounding factors in their health status. For example, healthcare workers or parents may have noticed signs of developmental delay or disease before the actual autism diagnosis and for this reason have avoided vaccination.

I have speculated before that a study of “vaccinated” versus “unvaccinated” children could be similarly confounded by parents who have one autistic child, become convinced that vaccines caused it, and therefore don’t vaccinated subsequent children that they might have. The main point to remember is that, even though this study is not compelling evidence that MMR is protective against autism, at the very least, the Polish study is strong evidence against a positive correlation between vaccination with MMR or single vaccination against measles and the development of autism. It is yet another pebble in the mountain of evidence that vaccination with MMR is not associated with autism or “autistic enterocolitis.”

It’ll be fun to see how long it is before Handley adds this study to his “Fourteen Studies” website and renames it “Fifteen Studies.” Of course, at the rate studies failing to support Generation Rescue’s cultish clinging to the unsinkable rubber duck of a belief that vaccines cause autism, Handley will have to rename his site every few months at least, and I or other skeptical bloggers will have to slap down yet another scientifically ignorant attempt at discrediting each new study. So far, the silence has been deafening, even though it’s been over a week since the study was published. I figured that by now they could have trotted out Mark Blaxill or one of its other “scientific” luminaries to slime the study. Heck, even J.B. Handley could have given it a hand. I’m sure the results would have been as hilariously off base as they always are whenever J.B. Handley tries his hand at analyzing science.

On and on it goes. Meanwhile, autistic children pay the price for quackery related to anti-vaccine beliefs, and normal children face the resurgence of vaccine-preventable diseases, thanks to the efforts of anti-vaccine cranks like J.B. Handley, Jenny McCarthy, Jim Carrey, Barbara Loe Fisher, and the rest of the vaccine denialists. Meanwhile, millions of dollars are wasted to do study after study that show the same thing over and over again, diverting money in a zero-sum game from other potentially promising avenues of research.

REFERENCE:

Mrożek-Budzyn D, Kiełtyka A, & Majewska R (2009). Lack of Association Between Measles-Mumps-Rubella Vaccination and Autism in Children: A Case-Control Study. The Pediatric infectious disease journal PMID: 19952979

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

119 replies on “Yet another bad day for the anti-vaccine movement”

Nice writeup Orac. I believe the GMC decision on Wakefield is due out on the 19th, just in time for the holidays.

I fear you are correct in stating that there are not enough nails to keep the zombie from rising but it is nice to see the zombie get a few hits.

As for Wakefield receiving the Galileo award, it should have been the Nero award celebrating the tragic loss by others now that measles is endemic again, the reason for which lies solely at his feet. He planned to make money from the crap study and gave not a thought to the damage he has wrought.

I’m so confused. Having heavy deja vu. Please tell me you posted this elsewhere under your real name. In which case, BTW, you might want to note that on the post somewhere to avoid confusion like mine.

As I posted on that friend’s commentary to the article, I would consider the MMR an anti-autism vaccine. Congenital rubella is associated with an increased probability of autism.

For example:

J Pediatr. 1978 Oct;93(4):699-703.

Behavioral consequences of congenital rubella.
Chess S, Fernandez P, Korn S.

Psychiatric and behavioral consequences of congenital rubella are reported for 243 children studies during the preschool period, and for 205 of these who were re-examined at ages 8 to 9. At preschool 37% were retarded, with the skew toward severe and profound; 15% had reactive behavior disorder and 7% had autism. At school age retardation diminished to 25%, but neurotic problems and behavioral pathology due to neurologic damage both increased. There were two remissions and three new instances of autism.

PMID: 702254 [PubMed – indexed for MEDLINE]

Off topic: Orac, there was a lovely bit of woo at the latest ASH meeting. They really are infiltrating everywhere…

The educational session entitled “Integrating complementary medicine into hematology care.” Description here. I must admit I didn’t actually see the session-it conflicted with a session more useful for me-but the description in the program book was…disturbing. On the plus side, at least one of the authors seems to have discussed the fact that any “alternative medicine” treatment with an effect will also have side effects and to review specific cautions concerning patients’ use of alternative medicines. On the minus side, Volker Diehl, previously a well respected researcher in lymphoma, going on about Reiki and Tai-Qi.

I’m not sure anyone approached the basic problem of “alternative medicine” though: that any CAM that works becomes part of “standard medicine”-and is usually given in a safer and more effective manner than it was when it was “alternative”.

Unfortunately, I am going to tell you all now that the anti-vax people won’t take this paper seriously. Of course, we all know that they wouldn’t do it on principle, but the data showing MMR to prevent autism is going to impeach the study without any further consideration. I’m telling you, if I’m reading your blog as an anti-vaxxer, my response would be,

“Jeez, you admit that there are potential confounders that haven’t been considered. Why do you only invoke them in trying to explain away the idiotic conclusion that vaccines prevent autism? Why do you assume that the confounders stop at the point of no effect? If there really are factors you have missed, given the size of their apparent effect (come on, a factor of 6 difference? 600% is a huge difference), why isn’t it enough to mask an effect in the other direction? Why is a 6 fold effect believable, but not a 12 fold effect (which would mean that vaccinated kids are 6 times more likely to have autism)?”

Then again, I am not an anti-vaxxer, and know enough to know that selective rationalization is a bad approach. If you conclude that “The data showing that MMR decreases autism is suspect because none of the previous studies show it, but the conclusion that MMR does not cause autism is not suspect because it agrees with the previous studies” then this study hasn’t taught us anything. I’d try to find some better explanation than, “There are possible confounders that we missed,” because that just boils down to special pleading. You really have to find them.

BA has a start to this. For one thing, it’s easily testable (how many of each group has had rubella? If few of the autism group had rubella, then it would not account for the difference.

That all being said, the offspring goes in tomorrow for his 1 year shots, including the first round of MMR. It’s getting complicated, though, because he still needs his seasonal flu shot, and his H1N1 booster. That is a lot of jabs with a needle. I haven’t decided whether it is going to be better to just get them all over with in one sitting, or devise a strategy to allow the soreness to subside before adding more. Then again, chronic soreness from needle jabs won’t be fun, either.

“They often find associations that later turn out not to hold up under study using prospective studies or randomized trials or, alternatively, turn out to be much weaker than the retrospective study showed. They do not so often find a result that is exactly the opposite of hypothesis tested for.”

I appreciate the fact that you pointed out the failings of this type of retrospective study. It is exactly this kind of rationality the anti-vaccine groups lack. But, if they were rational I guess this post would be unnecessary because the study(ies) would speak for itself.

@ Pablo: I don’t know if *any* research would convince the most adamant anti-vaxxers- if you created a “Volk Register”-type study(from Denmark or elsewhere) that showed a clearly familial pattern of autism(similar to that of SMI),*totally* unrelated to vaccination,it would probably be dismissed as well.If people are irrational,arguing *reasonably* will not be effective(there *are* other ways to affect their beliefs/behavior but that’s more in the realm of therapy).We can only reach those who are (mostly) rational but ill-informed or deliberately mis-guided by others.

I am autistic. I did not get the MMR as a toddler, but I did have rubella as a neonate.

The antivax propaganda is so heavily reliant on anecdotes that I am strongly tempted to step forward as a counter-anecdote,xcept that step would be irrevocable, and invite attention into my life from a whole lot of unsavory people, and like most autistics, I do not enjoy attention even under the best of circumstances.
Still, I might do it. We’ll see.

Temporarily Anonymous
Tough call for you but I applaud you even considering it. Unsavory characters indeed but there is a lot of support here and elsewhere if it is needed.

Am I mistaken or did my comment regarding this article on Science-Based Medicine disappear? If it did, what did I do wrong for you to remove it? Or is there a general antipathy regarding my person?

The scientists who “persecute” Wakefield are like a church? Really? And I suppose the antivaxxers don’t behave like a church… No, not at all.
I bet that if God Himself appeared out of the sky and told them that, no, vaccines are not a bad thing, antivaxxers would say that God has a hidden agenda and wants to punish people with Autism.
Seriously, I’d put good money on it.

It doesn’t matter how many times this type of article is published, where it clearly states that there is no link, people believe what they want to believe. There will be appeals to conspiracy. There will be strawman arguments. The debate will continue.

Maybe a good science education will help. Probably not.

@12
Just wanted to thank you for your input. My husband has Asperger Syndrome, so I can see very clearly that there is a strong genetic link for our son’s autism.

As I am learning in these threads, there is just no convincing some people of what they don’t want to believe.

I agree with Rene Najera: “I bet that if God Himself appeared out of the sky and told them that, no, vaccines are not a bad thing, antivaxxers would say that God has a hidden agenda and wants to punish people with Autism.”

Indeed, I would put money on it too.

Tsutsugamushi @ 14: depending on what you wrote, it’s possible that your article was flagged and is being held up in the moderation queue until Orac can pass on it. He rarely censors unless you’re a complete loon and a persistent one.

Tsutsugamushi — did you include links? If so, it may be held up in moderation. That’s to catch the twerps who use blogs to increase a particular site’s search engine ranking.

Pablo — regarding doing the jabs all at once or spread out, I personally find it better to do it all at once. Gets it over with. Especially since the nurses are generally very experienced and can get them all done pretty quickly. Plus, if you spread them out, the kid will start to get the idea that ALL doctor’s visits involve shots, and that can make it worse.

My 6-year-old got her first 2009 H1N1 shot yesterday. Her seasonal flu vaccine last month was fairly traumatic for her (she tensed up pretty hard, and wound up with a good-sized bruise) so this time I tried to prepare her by explaining that morning that flu shots don’t have to hurt, and this is what you do to keep them from hurting — you relax your muscles, so the needle can slip in and out without hurting you. We practiced tensing and relaxing our muscles. When the time came, she was a little apprehensive, starting to get scared when the nurse did the alcohol swab, but I used a soothing tone of voice and reminded her to relax her muscles. When she realized it hadn’t hurt (although she had felt it), she gave the most beautiful, amazed smile. 😉

Not all vaccines are as painless, alas, but hopefully this will make the next one easier.

For children vaccinated before diagnosis, autism risk was lower in children vaccinated with MMR than in the nonvaccinated
———————-
I’ve only seen the abstract but this doesn’t seem to make sense. The authors say the nonvaccinated were vaccinated before their diagnosis. How is nonvaccinated defined?

It might be clearer rearranged as

Autism risk was lower in children vaccinated with MMR before diagnosis than in the nonvaccinated

That is, they’re dealing with the subset of the vaccinated-before-diagnosis for whom that vaccination included MMR, and comparing that to the nonvaccinated.

@Scott

In addition to Gabe’s Mom’s comment, he also has a tendency to cherry pick quotes, as he’s done, yet again, in order to misrepresent the information. The full sentence makes it clear that they are comparing the risk of autism in the nonvaccinated children to the risk of vaccinated children who got the MMR and the vaccinated children who got the single measles vaccine.

Thanks for the response.:-) I linked to an article on the Science-Based Medicine site, it appears identical to this one, as others noted before. Just wondered about that.

Funny, I’ve never seen this David Gorski and Orac in the same place at the same time

I’m sure the antivaxxers will just spin it as a study showing a correlation between autism and the MMR vaccine. (Negative, shmegative — it’s a correlation!)

Denice Walter:

If people are irrational,arguing *reasonably* will not be effective

Oh I agree, Denice, and as I noted, an anti-vaxxer would not accept the results of this on principle. However, I’m not talking about the irrational, I am talking about the rational. I am contending that selective rationalization of the results, like Orac is doing here, is enough to make even someone rational question it’s worth. As I said, resorting to “unknown confounders” to account for data you don’t believe but unquestionably accepting data you do believe is special pleading.

I’m quite well aware of Sid’s history, but when he actually asks a logical question that the average reader might well have, in a perfectly reasonable tone, he deserves a civil answer.

Non sequitur personal attacks and unsupported foolishness, not so much.

Pablo — regarding doing the jabs all at once or spread out, I personally find it better to do it all at once. Gets it over with. Especially since the nurses are generally very experienced and can get them all done pretty quickly. Plus, if you spread them out, the kid will start to get the idea that ALL doctor’s visits involve shots, and that can make it worse.

Unfortunately, it will only be me with him at the appointment, as mom has to work. Therefore, there will be fewer comforting hands available or to provide distraction, and I will have to assist with restraint.

Scott,
I humbly stand corrected and apologize to Sid for my offensive tone.
I assumed he was trying to provoke an argument. This is the only blog I have ever posted to, please forgive my novice trespasses.

@Tsutsugamushi: Orac is the author of both articles. He posts under his real name on SBM but prefers to use his ‘nym on Respectful Insolence. His regular readers all know, when he refers to an article written by his “friend”, to whom he refers. He rarely (if ever…can’t recall an instance, but don’t want to say never) links to his own articles on the other site (gotta give the trolls some work to do).

I don’t know why Orac refers to his “friend” with “friend” in quotation marks. It’s almost like he’s saying it’s not really his friend. Are they not getting along or something? Therapy can help with that, I’m told.

Gabe’s Mom

I do admit to provoking arguments when I believe I have evidence to support them. But I’m also quite willing to listen to, and learn from, the other points of view expressed on this site.

I don’t think there is a therapy developed as yet that could bridge this gap between man and machine.

I don’t think there is a therapy developed as yet that could bridge this gap between man and machine.

The Terminator?

wow that’s some kind of news. It comes late after many years of uncertainty as well. These studies are very important to re=establish the faith vaccine all over the world. Here in the UK some people do refuse to vaccine their children because of hear say or fear and that is just plain wrong.

FWIW, I don’t like giving more than four shots in a single visit. That’s what I’m doing with my son and that’s what I do for my patients (except for one whom I loaded up with either 6 or 7 shots all at once… she’s 14 yo, wicked behind on her immunizations, and definitely needs them).

That said, I’m just waiting for the response from AoA to see how they’re going to complain about this one. I agree that no study is ever going to make them change their mind.

There is only one part of this article I would disagree with, i.e. the title. 2008 was a fairly bad year for the anti-vacs. 2009 was a terrible year for them. Not only did they lose the Omnibus, and have studies refute their claims, they seem to have lost readership at the AoA Collective. This is but one more shovel of dirt in their hole. Here’s to 2010, which should be another banner year.

Pablo @30 – when I was a kid I got allergy shots weekly (or so it seemed). The nurse who gave the shots suggested that, on the morning of the day I got the shot, I draw a circle on my arm where the needle would go and stare at the circle periodically during the day before getting the injection. It seemed to reduce the pain of the injection. I think it was some sort of Yoga thing. Never underestimate the power of suggestion

It doesn’t matter how many times this type of article is published, where it clearly states that there is no link, people believe what they want to believe. There will be appeals to conspiracy. There will be strawman arguments. The debate will continue.

Maybe a good science education will help. Probably not.
********
For years, I have been baffled as to why critical thinking and logic are not taught more in middle school and high school. My husband teaches those classes at a university, but the students who sign-up for his classes are taking them as an elective. It should be a mandatory in middle school, high school, and college.

My child will go to kindergarten next year. Is it true that children are allowed to go to school without being vaccinated? I thought parents are required to provide a shot record in order to enroll them.

shmedelle:

My child will go to kindergarten next year. Is it true that children are allowed to go to school without being vaccinated? I thought parents are required to provide a shot record in order to enroll them.

In the USA it depends on the state. Some states are more permissive than others. Two states, West Virginia and Mississippi, do not allow non-medical exceptions. See Nonmedical Exemptions to School Immunization Requirements – Secular Trends and Association of State Policies With Pertussis Incidence

Chris:
Thanks for the link.
A little off topic. A few weeks ago, I had a meeting with my daughter’s preschool for an I.E.P. (She recently had neurosurgery for epilepsy. She is seizure free thanks to science, and the wonderful Dr.’s) I actually asked the teacher if un-vaccinated children were in the school. She sort of rolled her eyes, and said yes. I mentioned that there is no connection between vaccines and autism. She said some people just want something to blame. I gathered that she and the principal were not to happy about the situation, because now, she said, for the first time in her 25 years of teaching, they are seeing whooping cough. That pisses me off.

Pablo @30 – when I was a kid I got allergy shots weekly (or so it seemed). The nurse who gave the shots suggested that, on the morning of the day I got the shot, I draw a circle on my arm where the needle would go and stare at the circle periodically during the day before getting the injection. It seemed to reduce the pain of the injection. I think it was some sort of Yoga thing. Never underestimate the power of suggestion

I can try, but I am not too optimistic that it will be too effective with my 12 mo old. Although he might find it interesting if I draw a circle on his thigh, it will be difficult for him to stare at it.

shmedelle:

Thanks for the link.
A little off topic. A few weeks ago, I had a meeting with my daughter’s preschool for an I.E.P. ..snip…I gathered that she and the principal were not to happy about the situation, because now, she said, for the first time in her 25 years of teaching, they are seeing whooping cough. That pisses me off.

The same for me! My son had a seizure disorder and required herd immunity for pertussis. Back when he was a baby they only gave the DT to kids with a history of seizures. He finally got his first pertussis vaccine by getting the Tdap at the age of 19.

Back before there was a chicken pox vaccine it swept through the school he was attending. Not only did this school have a large special ed. pop (his, plus a hearing impaired program), it is also one of the schools that kids who are living in the local Ronald McDonald House attend (which is less than five blocks from my house!). Most of the kids are siblings, but several are the ones going through active treatment.

There were a couple of families that the nurse was not happy with. She sent home letters home saying that no child with a fever or breakout should be sent to school… yet she had at least one idiot send a child to the school with a fever and a bottle of Tylenol!

It doesn’t matter how many times this type of article is published, where it clearly states that there is no link,

Actually, the data clearly shows an anti-correlation, with vaccination correlating with less autism.

But as I pointed out above, Orac doesn’t seem to have any problem discounting that part. Given that, I don’t think I could blame anti-vaxxers for discounting the rest of the paper, too. They can just say, “don’t look at us! Orac is the one who says the data are unreliable. He admits there could be missing confounders.”

You folks know I am as anti-antivax as they come, but I think Orac’s post highlights a massive problem with this study. Until there is an identified explanation for the apparent “vaccine prevents autism” data, which contradicts what has been found previously in the epidemiological studies, then either the results of this paper must be taken with a grain of salt (and that means ALL of the results, including the ones we like), or the previous epidemiological studies must be considered flawed. Because the same “hidden factors” that could be masking no effect could just as easily be masking a positive effect in the other direction.

Orac, maybe you can explain why an educated, experienced, socially responsible physician would play down the impact of Wakefield’s deceit.

Why do doctors make excuses for each other despite repeated accounts of abuse? Why would a layperson, working in the field, have more insight into an offending doctor’s character than a medical professional would? Is it an “old boys” thing, or is it some secret code of conduct?

The person in question is female. I have managed to sway her greatly with Brian Deer’s stuff, but she still hesitates to come right out and condemn other doctors (not just Wakefield, but some who have butchered and scarred her own patients).

Non confrontational, or just defending the tribe? I have experienced this time and time again with various physicians.

The person in question is female. I have managed to sway her greatly with Brian Deer’s stuff, but she still hesitates to come right out and condemn other doctors

Would it be worthwhile pointing out that acceptance of Wakefield’s crap is an implicit condemnation of others who have found contradictory results, such as Mady Hornig?

One of these two has to be wrong, either through incompetence or deceit. Since we have evidence for Wakefield’s deceit, it shouldn’t be hard to figure out where the problem might be.

But as I pointed out above, Orac doesn’t seem to have any problem discounting that part. Given that, I don’t think I could blame anti-vaxxers for discounting the rest of the paper, too. They can just say, “don’t look at us! Orac is the one who says the data are unreliable. He admits there could be missing confounders.”< ?blockquote>

No, no, no, no, no.

The data are pretty reliable. Here’s the problem. If there’s an inverse correlation that appears statistically significant, while it’s easy to find reasons why that negative correlation probably doesn’t imply that MMR protects against autism (although, come to think of it, it might), it’s pretty hard to think of a way to slice and dice the data or find confounders that would turn that correlation around and make it a positive correlation between vaccines and autism that could imply that MMR causes autism. In other words, it’s a lot farther to go from a negative correlation to a positive correlation controlling for confounders than it is to go from no correlation to a positive correlation.

I’m still confused as to the framework for a case-controlled study… I get the general idea, inasmuch as looking at the population against a matched control, but I can’t for the life of me figure out how you get RRs out of it.

An interesting study, and certainly another nail in the “Vaccines cause autism” hypothesis. It wasn’t a good hypothesis to begin with, having no plausible mechanism of operation, but it had to be investigated.

“but I think Orac’s post highlights a massive problem with this study. Until there is an identified explanation”

Orac’s post does not highlight a ‘massive problem’ with the study, in fact, he lays out in great detail why this study suggests the “vaccine prevents autism” association may be unreliable; if you go back to the paragraph beginning “Is this really true?” you can read all about it!

“then either the results of this paper must be taken with a grain of salt (and that means ALL of the results, including the ones we like), or the previous epidemiological studies must be considered flawed.”

If A is flawed, then B and C must also be flawed. Right. I think you ought to retract this last bit or put up evidence telling us why you think these ‘previous’ studies are flawed.

c

“An interesting study, and certainly another nail in the “Vaccines cause autism” hypothesis.”

My reaction is “Get off the hypothesis, we need the nails.”

Until there is an identified explanation for the apparent “vaccine prevents autism” data, which contradicts what has been found previously in the epidemiological studies, then either the results of this paper must be taken with a grain of salt (and that means ALL of the results, including the ones we like), or the previous epidemiological studies must be considered flawed.

The authors admit there’s a possible confound, and that’s a sign the authors know what they are doing.

Epidemiological studies where they look at autism and MMR time series (like the Japanese ones) are different, methodologically. The same confounds would not apply.

I believe there are prior MMR/autism case-control studies. A good question is why they would produce different results. It’s possible there’s more rejection of MMR in families of autistic people, or in children with some developmental delays, than there was in the past.

So if there are possible confounders that make some of the data unreliable, then why don’t those possible confounders make the rest of the data unreliable?

“Possible confounders” don’t just apply to data you don’t like, they are also possible for the stuff you agree with. If your only basis for whether to believe it or not is whether it agrees with other studies, then this provides nothing new.

Re: question of whether it is more stressful for child to receive multiple immunizations at one visit versus single immunizations, in addition to the responses above and the obvious effect that parents can have on how a child experiences something, there two studies I have seen of cortisol concentration and behavioral responses of infants to vaccination comparing infants who receive 2 injections at one visit compared with infants who received one injection – their responses were similar, suggesting that a second injection does not increase stress. Ramsey DS et al “Developmental change in infant cortisol and behavioral response to inoculation. Child Dev 65;1491-1502, 1994. Also: Lewis et al. Validating current immunization practice with young infants. Pediatrics 90;771-773, 1992. (Cited in Vaccines (ed by Plotkin, Orenstein,Offit – I have the 2008 edition, p.94)

Amy – would that apply 4 vs 5 shots?

In the end, he got 4, and we have deferred one of his last boosters to his 15 mo appointment. He did great. He actually cried more when the doctor tried to look in his mouth.

If vaccination anecdotes mean anything, right after getting his MMR shot, he fell asleep in the car on the way home and is still taking his nap. Then again, it is his normal naptime…

I stopped for ice cream afterward, but we will get that for lunch.

Oh, I forgot to mention. The offspring played with his ball in the doctor’s office for about 10 minutes after getting his shot while I was getting ready to leave. I think it is clear: the MMR shot causes kids to play with balls.

Really pathetic at AoA today – now they’re going after Tony Fauci, one of the most respected figures in immunology in the U.S. Guess why? He agrees with those of us with brains that this issue has pretty much been decided! Still no specific comment on the particular study cited above. However, J.B. and Kim’s love child Craig has his own “anti-Orac” blog now, and he has a rant about the MMR study and Orac’s analysis of it. It’s a typical hate-filled fact-free piece.

What incentives are there for the anti vaccine movement to keep propagating the idea that MMR causes autism in the face of considerable evidence that it doesn’t? Is it that their reputations are at stake? Or does someone’s livelihood depend on this?

Hi Folks,

Since I see that my friend Andrew Wakefield is up for discussion, I thought I might ask a favour of any lurking, time-heavy anoraks, or better-still, newbies to it all.

I’ve just posted the shortest possible summary I can muster of my MMR investigation to date. But I wonder if, in my desire to compress (the long version is 10 times the length), it’s still as clear as the crystal pool to which I aspire.

If anybody spots anything they think is wrong or unclear, it would be doing me a great favour to let me know. I can’t make it much longer, as this would defeat the object, but anything else is possible.

http://briandeer.com/mmr/lancet-summary.htm

Lurker:

your question assumes the GOV movement are even aware of the evidence against them.

I’ve had, and witnessed, discussions with GOV members who were unaware of the primary sources of their own arguements, unaware of basic terminology and unaware of the disjoin between their evidence and their potrayal of it, sometimes even presenting evidence to support arguement the original source has expressly said thier evidence does not support.

This wasn’t with rank and file members, but with members who are or are going to be published authours on this subject.

But to answer your questions.

Yes, too many to feasably list here.
and, yes, to the tune of millions of dollars.

“What incentives are there for the anti vaccine movement to keep propagating the idea that MMR causes autism in the face of considerable evidence that it doesn’t? Is it that their reputations are at stake? Or does someone’s livelihood depend on this?”

http://www.grc.nia.nih.gov/branches/rrb/dna/pubs/Becker%20and%20Schultz%202009.pdf

It’s worth mentioning that several members of the Johnson and Johnson family have invested several hundred thousand dollars (I believe 1 million was donated by them to start up Thoughtful House) in Wakefield’s work at Thoughtful House. You know, the same family that has made billions from the sales of Tylenol?

Of course, it’s entirely possible that Becker and Schultz are dead wrong and Tylenol has absolutely nothing to do with autism, and that they are funding his work out of a deep concern for autistic children.

However, since it’s well-known within the biomed community that Tylenol is a huge no-no for autistic kids, it seems odd that they would think that Tylenol and autism have no connection whatsoever.

Brian Deer @64
Nice summary. Points are all outlined coherently. The only confusion for me is in section 2:

But Deer discovered they had been recruited and selected through MMR campaign groups, and that, at the time of their admission, most of their, anonymous, parents were clients and contacts of the lawyer: Richard Barr, a High Street solicitor of King’s Lynn, Norfolk.

The anonymous seems out of place or incomplete.

Great work.

@Brian Deer

Overall, a good summary. A couple suggestions, though:

1) It reads a bit self-aggrandizing. Tone it down some.

2) In point 9, include links to original sources of Wakefield’s published reports and claims that undermined the MMR. In fact, linking to original sources throughout the summary would be a good idea, rather than only linking to articles on your site.

3) If there is any other reporter who has corroborated your findings, it might be wise to include a link to their work, as well.

Jen:

So Jane Johnson is one of the Johnson and Johnson Johnsons?

Do have more on that? Like where she fits into the family etc? Or better still, a document or source which shows the connection, or how much money she might have?

Dr Wakefield was funded in the past by Big Pharma – especially Merck and GSK, the big vaccine makers – and I’ve sometimes wondered if he wasn’t a stooge, put up by them and supported by them because they knew that any lawsuit based on his measles virus claims was bound (after a good few years of wasted effort) to fail. They must love him.

I’m sure we’d all be interested in a J&J connection.

@61
“I think it is clear: the MMR shot causes kids to play with balls.”

Did you know killing turkeys is also a direct cause of winter?

Which is exactly the point; correlation /=causation. Alas, I wish that was common knowledge. (Is that how you do doesn’t equal?)

Kristen
There are many ways to do “not equal” but many computer languages use != for the construction. Being understood is more important than being letter or symbol perfect.

“For years, I have been baffled as to why critical thinking and logic are not taught more in middle school and high school. My husband teaches those classes at a university, but the students who sign-up for his classes are taking them as an elective. It should be a mandatory in middle school, high school, and college.”

I could not agree more with this statement. Critical thinking should not be a “service pack” or “hotfix” for an existing, broken mindset; it should be part of the OS from the git-go.

Sorry about the belabored extended metaphor, but I stump endlessly for this sort of thing whenever I can. We’ve spent a century or more teaching people basic skills like reading and math, but we haven’t complemented it with the skills that allow them to really *use* their minds; we assume they’ll just pick that stuff up on their own. The end result is a lot of people who are just too easily fooled.

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