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Quoth Mark “not a doctor, not a scientist” Blaxill: “Help, help, Andy Wakefield’s being repressed!”

Help! Help! I’m being repressed.

Somehow, that is the image I have gotten in the three weeks since the very last shred of Andrew Wakefield’s facade of scientific respectability tumbled. As you may recall, at the end of January, the British General Medical Council found Andrew Wakefield, the man whose trial lawyer-funded, breathtakingly incompetent, and quite possibly fraudulent study in 1998 launched the most recent iteration of the anti-vaccine movement, not to mention a thousand (actually, many more) autism quacks, guilty of gross research misconduct, characterizing him as “irresponsible and dishonest.” Soon after that, the tainted first fruit of Wakefield’s “research,” his infamous 1998 Lancet paper, was retracted by the Lancet‘s editors. The anti-vaccine movement reacted, predictably enough, with paranoid conspiracy theories that surpass even those promulgated by Alex Jones of Prison Planet or Jeff Rense. In particular, the conspiracy theories pushed by Jenny McCarthy and Jim Carrey (not to mention J.B. Handley) were particularly entertaining in their sheer paranoid nuttiness.

Basically, the conspiracy theory went like this: It’s all a conspiracy to suppress Andrew Wakefield’s latest “research,” which, if you believe them, demonstrate once and for all that vaccines are The One True Cause of autism. I’m referring, oof course, to Andrew Wakefield’s “monkey study,” which I blogged about in 2008 and again in 2009. Prometheus and Science Mom have also eviscerated the study, which, as you may also recall, had somehow managed to slither its slimy way past some haplessly clueless peer reviewers and editors in order to ensconce itself in the actual real scientific literature. Make no mistake, the anti-vaccine movement took full advantage of it, as cranks always do whenever editors and reviewers for peer-reviewed journals slip up and let pseudoscience into their pages. Of course, this must have been a doozy of a conspiracy theory, though. Not only did it get the GMC to bring him down but it even went beyond that. It somehow managed, if you believe the antivaccine movement, to pressure the editor of NeuroToxicology, which had accepted Wakefield’s latest manuscript reporting on his monkey study for publication. Indeed, it worked so well that pharmaceutical company heiress and benefactor of Andrew Wakefield’s Thoughtful House had had enough. With Wakefield’s last hope for scientific vindication gone, she forced Wakefield to resign. Since then, we’ve been wondering where Wakefield would finally show up. Indeed, Free Speaker has started a blog WakefieldWatch, that specifically asks, Where in the world is Andrew Wakefield?

Now it looks like it’s Mark “not a doctor, not a scientist” Blaxill’s turn. The one anti-vaccine loon who can match or even exceed Orac’s logorrhea, Blaxill’s shown up after a suitable pause, entitled Joan Cranmer’s Fateful Decisions and the Suppression of Autism Science. He asks:

How can a scientific study simply vanish? This paper had cleared every hurdle for entry into the public scientific record: it had passed peer review at a prestigious journal, received the editor’s approval for publication, been disseminated in electronic publication format (a common practice to ensure timely dissemination of new scientific information), and received the designation “in press” as it stood in line awaiting future publication in a print version of the journal. Now, and inexplicably, it has been erased from the official record. For practical scientific purposes it no longer exists.

Correct. Consider it a mistake being erased. It’s not unlike the case of anesthesiologist Scott Reuben, who was caught in massive scientific fraud and, as a result, many of his manuscripts in press were retracted. True, it’s might not be fair to other authors who may not have known about the scientific fraud. Also true, Wakefield wasn’t accused of scientific fraud on the monkey paper manuscript itself, but it is not unreasonable in light of the ruling of the GMC to consider all of Wakefield’s work to be suspect. Indeed, there’s abundant evidence of utterly incompetent science and possibly even scientific fraud on the part of Andrew Wakefield. It is not “censorship” or “suppression of science” to acknowledge that. Rather, in the case of the monkey study, it is simply acknowledging that the peer review system screwed up big time. Not that that stops Mark “not a doctor, not a scientist” Blaxill from claiming otherwise:

The answer, of course, is that this is no ordinary scientific study. Age of Autism reported previously on its importance HERE , where we noted that “one likely tactic of critics of the study will include attempts to nullify the evidence based on the alleged bias of those involved.” The obvious risk, of course, was that a co-investigator on the paper, Dr. Andrew Wakefield, might make the study a target, especially in light of the hearings then underway at the U.K.’s General Medical Council (GMC). In the wake of last month’s GMC findings of misconduct, we also reported on the calls by Generation Rescue to recognize the even greater importance of Dr. Wakefield’s work on this primate project, an analysis of the health outcomes of vaccinated and unvaccinated macaque monkeys (see HERE and HERE). Sadly, true to our prediction, and despite the quality of the work and the importance of the findings, it appears that the “attempts to nullify the evidence” have been successful.

No, it is because of the quality of the work, as in the lack of quality of the work and its highly unethical nature, that the study should never been done, much less accepted for publication, much less published. Of course, it is a measure of just how critical to the anti-vaccine movement Wakefield’s monkey study was to providing a false appearance of scientific respectability to his work.

My speculation regarding this paper, of course, was that the peer reviewers probably had no clue about the stench of dishonesty and incompetence that hang on Andy Wakefield’s “scientific” career like a shroud. Those of us who pay close attention to the anti-vaccine movement often forget that we are oddballs in a way. The vast majority of people, even scientists who study this stuff, are either unaware or only vaguely aware of Andrew Wakefield and the anti-vaccine movement. Many of them are vaguely aware of the anti-vaccine movement but correctly view them as dangerous cranks who could cause them trouble and therefore stay as far away from them as they possibly can. My guess is that neither Cramner nor the peer reviewers knew the depths of Wakefield’s scientific perfidy. If they did, they never would have accepted the paper for publication. On the other hand, Blaxill does provide a revelation at the end that shows that NeuroToxicology had some connections that I didn’t know about with the anti-vaccine movement, specifically the revelation that the anti-vaccine group SafeMinds had sponsored past NeuroToxicology conferences.

Be that as it may, the editors clearly made a huge mistake as well, given that apparently the huge problems with the study that I described in detail didn’t stop them from accepting the manuscript for publication. Leave it to Not a Doctor Not a Scientist to paint the acceptance of Wakefield’s paper as a brave act, rather than the profound failure of the peer review process:

When Joan Cranmer accepted the primate paper in Neurotoxicology, her decision could not have been an easy one. The study subject and one of the study authors, Andrew Wakefield, were known to be highly controversial. All of the information about the GMC proceedings and the accusations against Wakefield were well known to the editors and peer reviewers. Despite that knowledge and the risks involved, Cranmer and her editorial team judged the science to be sound and decided to go ahead. We complimented them at the time, noting that “the journal editors at Neurotoxicology have taken a courageous stand in publishing what is sure to be unwelcome evidence in some circles.” It appears, however, that Cranmer’s superiors within Elsevier did not share those views.

Uh-oh. The Brave Maverick Scientist appeared to have triumphed, thanks to Brave Maverick Actions by a Brave Maverick Editor, to the acclaim of Brave Maverick Anti-vaccine Cranks everywhere, especially Andrew Wakefield sycophants, toadies, and lackeys. But all is not well in woo-ville. Dark and evil forces were gathering to thwart Brave, Brave Sir Andy, much as the Nazgûl gathered to thwart Frodo and Sam. Can you guess what those forces might be? Of course, one of them is the evil Elsevier publishing. Now, don’t get me wrong. I’m not a big fan of Elsevier. Indeed, I’ve ragged on Elsevier myself on more than one occasion for its dubious activities, not the least of which is its publishing that bastion of pseudoscience Medical Hypotheses, as well as a number of really bad “alternative” medicine journals. Speaking of Medical Hypotheses, I note that HIV/AIDS denialists reacted pretty much the same to the retraction of a Peter Duesberg article from Medical Hypotheses as Not a Doctor Not a Scientist is reacting to the withdrawal of Wakefield’s monkey studies. I guess Wakefield can take solace in the fact that at least he hasn’t sunk so low as to have a manusript withdrawn from Medical Hypotheses. Yet. It’s hard to go lower than that. It’ll probably happen soon, though, because crank journals like Medical Hypotheses or JPANDS are probably the only journals that will even look at a Wakefield manuscript from here on out.

But I digress.

I’m sure you can guess where Not a Doctor Not a Scientist is going with this, can’t you? It’s not as though he’s been telegraphing his intent from early in his article, and it’s not as though he hasn’t been posting on the anti-vaccine crank propaganda blog Age of Autism. If there’s a conspiracy to “suppress” science there, it’s got to come from one place and one place only. That’s right.

Big pharma:

Suspicions over the editorial independence of Reed Elsevier on the question of vaccine safety draw support from evidence of board level conflicts of interest involving Reed Elsevier’s CEO, Sir Crispin Davis. Davis, who retired in 2009 as CEO of Reed Elsevier, has served since July 2003 on the board of directors of GlaxoSmithKline (GSK) a major vaccine manufacturer (also recently appointed to the board of GSK is James Murdoch, publisher of News Corp., which owns The Times of London, the newspaper which launched the media attack on Wakefield). In 2008, vaccines accounted for 12.5% of GSK’s worldwide revenues. And although Reed Elsevier has no known vaccine liability risk, GSK has been directly exposed to two of the most prominent autism/vaccine controversies. GSK manufactured Pluserix, a version of the MMR vaccine introduced in the UK in 1989 and withdrawn in 1992 due to safety concerns. GSK also produced a thimerosal containing vaccine similar to the one examined in the primate paper (which was a Merck product) named Engerix B, for hepatitis B. GSK lists its financial exposure to thimerosal litigation in the U.S. under the “legal proceedings” section in its 2008 Annual Report.

Of course! It had to be! Damn those vaccine manufacturers! Is there nothing they can’t control? Clearly, they saw Wakefield’s monkey study as a grave threat to their profits, even a grave existential threat to their very existence. Such is the power of Andrew Wakefield and his Brave Mavericky-ness™. Cower, thou vaccine-injecting evildoers! None can stand!

The reason, according to Not a Doctor Not a Scientist, is because Andrew Wakefield is just like Herbert Needleman, the man who carried out groundbreaking studies demonstrating the neurodevelopmental effects of lead exposure in children starting back in the 1970s. Amazingly, Not a Doctor Not a Scientist actually has the audacity to make this comparison:

Seen from this perspective, what if the next-generation incarnation of Herbert Needleman is Andrew Wakefield, but in today’s version of the story, the balance of power has shifted in critical ways? In Wakefield’s case the product is neither gasoline nor paint, but vaccines, one of the most privileged product categories ever invented, products that are produced and promoted by the medical industry with missionary zeal. In contrast to the limited scientific influence of the oil and gas industry, the medical industry Wakefield faces is far more powerful, pursues its interests with greater skill, controls the flow of scientific information and effectively dictates media coverage. It appears now that the medical industry is so powerful that it can rewrite scientific history when it wants and even erase important scientific publications in a reputable journal.

Yes, when I think of Herbert Needleman and his successful crusade to reduce childhood exposure to lead, the first man I think of as the heir to Needleman’s legacy is, of course, Andrew Wakefield. (For any anti-vaccine loons who might be reading this, that’s sarcasm.)

I wonder what Herbert Needleman would think of this comparison. After all, he dedicated his life to protecting children and their health by trying to decrease their exposure to lead as much as possible. He also did it through sound epidemiology and science, not litigation-driven, incompetent, and quite possibly scientifically fraudulent research. My guess is that, if he’s aware of the full extent of Andrew Wakefield’s anti-vaccine pseudoscience, Dr. Needleman would likely take a very dim view indeed of being compared to such an incompetent, unethical, and dishonest “scientist.” I wonder if he knows that Mark “not a doctor, not a scientist” Blaxill is talking smack about him and comparing him to a pseudoscientist whose activities have greatly contributed to the resurgence of measles in the U.K. and continue to frighten parents about vaccination, endangering children. At least when Blaxill compares Wakefield to Galileo (perhaps the most hilariously inapt bit of hyperbole ever to come out of the anti-vaccine movement), Galileo is hundreds of years in the grave, leaving as his only option what’s left of his bones spinning at thousands of RPM in his grave to protest the news. Dr. Needleman is still alive, and I’d love to see what his reaction to such a comparison would be.

In the end, Cramner’s action to purge her journal of the taint of Wakefield’s bad science surprised me. I didn’t think that she’d do it, but she did. Whatever Elsevier’s other faults or previous misdeeds, in this case, for once, an Elsevier journal did the right thing.

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]

207 replies on “Quoth Mark “not a doctor, not a scientist” Blaxill: “Help, help, Andy Wakefield’s being repressed!””

Loons, all of them. At least the Lancet people and others were grown-up enough to admit the mistake. Anti-vaccine groups keep pushing and pushing their agenda even after being proven wrong time and again. That’s the kind of faith that would make a Catholic blush.
Of course, anti-vaccine groups have NO MONETARY INTERESTS WHATSOEVER, right? Right?
I’m off to buy some all-natural vitamins and chelating agents from companies who are not at all interested in profit, only the health of the little children.

Logorrhea, eh? It’s nice you can be introspective. I actually agree with most of the points you make in your blog, but why does it require such verbosity? It reminds of talk radio. You make a point, then proceed to make the same point, over and over again. I wonder how many people you convince after reading the upteenth paragraph who were not convinced after the second paragraph.

I continuously laugh at the demonizing of BIG PHARMA based on the vaccine issue. It’s such a pathetic argument, particularly when, as the poster who already commented said, there are huge profits being made by these sham companies off of the ignorant and gullible.

And yes, none of the numerous case-control studies which have been published refuting a link between autism and vaccines are valid literature, but a dubious study performed on non-humans written by a discredited scientist who takes money from trial lawyers is iron clad proof. Aren’t some of these anti-vaccine nutjobs the same people who don’t believe in evolution and thus believes monkeys are not at all related to us?

Baxill and the other stooges at AoA need to whip up the frenzy and keep it whipped in order to keep the clicks and donations up. Silsby and the other profit centers won’t pay if the traffic sags.

“Indeed, I’ve ragged on Elsevier myself on more than one occasion for its dubious activities, not the least of which is its publishing that bastion of pseudoscience Medical Hypotheses, as well as a number of really bad “alternative” medicine journals.”

I’m still hopeful that the welcome, if a little tardy, decision to withdraw the Hewitson/Whakefield study is an indication that the just criticizm that you and others have been directing towards Elsevier is beginning to have an effect.

I’d forgotten all about the Duesberg paper being rejected by Medical Hypothesis…that must have took some doing…thanks fot brightening up my day!

What’s very lucky about the Neurotoxicology withdrawal is that the paper was still “in press”. That fact makes it easy to completely purge this flawed paper from the scientific literature. That isn’t so easy when a paper has already appeared in print. You can’t go back and tear it out of a bound volume, no matter how deserving of that treatment it is. And make no mistake, most, if not all of Wakefield’s scientific work should be retracted. His irresponsible and dishonest conduct puts all of his work under deep suspicion.

The first paper that should be carefully examined by the publishing journal is “Detection and sequencing of measles virus from peripheral mononuclear cells from patients with inflammatory bowel disease and autism”, Digestive Diseases and Sciences, Volume 45, Issue 4, 2000, Pages 723-729. DOI: 10.1023/A:1005443726670
PubMed ID: 10759242

This paper was subject to testimony at the autism omnibus hearing, summarized here

http://autismdiva.blogspot.com/2007/06/omnibus-hearing-chadwick-and-brent.html

So, we have sworn testimony that Wakefield knew the results were garbage, but went ahead and published anyway. Moreover, it certainly looks like the autistic subjects were the same as in the withdrawn Lancet paper:

Nine children with autistic
enterocolitis—proven by ileocolonoscopy and histology—
were all UK cases (3–10 years of age). These children have
been reported on elsewhere. All had ileal lymphoid nodular
hyperplasia and nonspecific colitis [neither Crohn’s disease
nor ulcerative colitis (3)].

reference (3) is the Lancet paper.

Anyone want to contact the editor?

I actually agree with most of the points you make in your blog, but why does it require such verbosity?

Because that’s how Orac rolls, take it or leave it, baby.

Orac, I love you so much for that video.

Can I cry repression for the way that Blaxil and others make scientists out to be.

You know, this just occurred to me. Since the evil spectre of BIG PHARMA is so fond of rigorous, double-blind studies to, y’know, actually prove stuff, maybe they’re doing that here and they don’t even know they’re part of a massive conspiracy because they’re blinded to it!

Think about it. It would be just like BIG PHARMA (it’s important to put it in all caps) to have proper controls and parameters even in their attempts at global conspiracies. Also, they shot 9/11 while faking the moon landing with AIDS.

Is this man seriously trying to convince us that the oil industry is not influential? What color is the sky on his planet? Bluer from lack of hydrocarbon pollution, possibly?

The actions rebuking Wakefield(GMC,1998 article retraction, Thoughtful House “dismissal”,monkey article)and those concerning HIV/AIDS denialists Duesberg and Ruggiero(retraction of their separate articles)occurred in a relatively short period of time:this leads me to wonder how those of a conspiratorial bent(the “correlation=causation” crowd)will interpret these events.It’s grist for their mills:not only were “brave mavericks” slapped down in *two different areas of inquiry* but it involved *more than one country*,(UK,US;Ruggiero is from Italy)making it *global*!I can hear it now:”BigPharma stretching its greedy tentacles across continents…feeding vampirishly on dollars and euros…hell-bent on World Domination through psycho-active drugs!!!!” It’s only a matter of time before one of their “sharper tools” puts it all together..which is what makes brave maverick “truth tellers” so *dangerous*…

“Because that’s how Orac rolls, take it or leave it, baby.”

Best response to a troll ever.

“The [wakefield] paper always was and still remains a perfectly good small case series report, but it was systematically misrepresented as being more than that, by media that are incapable of interpreting and reporting scientific data.” – Ben Goldacre

Gee, I can hardly wait till DSM-V is released, and Aspergers, PDD-NOS, and Rett Syndrome are all deleted from diagnosis under ASD. See, e.g., DSM V and Rett Syndrome http://leftbrainrightbrain.co.uk/2010/03/dsm-v-and-rett-syndrome/ As this will reverse the expansion of ASD as a category that occurred, the number of new ASD diagnoses will likely drop, and, AoA and Green Our Vaccine apologists will claim that their heroic work turned the tide of the “autism epidemic.”

Would it be unethical to send ALF after Wakefield for this monkey study?

Well, off to participate in a farcical aquatic ceremony…

Is this man seriously trying to convince us that the oil industry is not influential?

To be fair, he said that the oil industry has little influence over science. As to what metric he’s using to compare the scientific influence of Big Oil vs Big Pharma, I haven’t a clue.

I’m with Free Speaker. Where is Andy? Sounds like he should be wearing a red and white striped shirt and a knit cap

http://www.findwaldo.com/

Blaxill isn’t quoting Wakefield at all. Why? It isn’t as though Blaxill doesn’t have Wakefield’s email address (even if his thoughtful house email address may not longer work) or phone number.

I’ll use Hanlon’s Razor here, and assume that this is alt-med unfamiliarity with the “big pharma” concept of recalling possibly-faulty or possibly-adulterated product in the interests of public safety.

— Steve

Matthew,

The “metric” used by Mr. Blaxill seems to be that, while “BIG OIL” couldn’t stop Dr. Needleman, “BIG PHARMA” – in Mr. Blaxill’s version of reality – has managed to stop Dr. Wakefield.

There are – as you might guess – several hidden (and erroneous) assumptions in this line of……logic.

[1] The most glaring false assumption is the premise that since Dr. Needleman triumphed over “BIG OIL” and Dr. Wakefield is being plowed under by “BIG PHARMA” (again, in the universe according to Blaxill), that “BIG PHARMA” is therefore more powerful than “BIG OIL”.

This is akin to saying that since the German Army was crushed by the Red Army and the Italian Army triumphed over the Ethiopian Army, that the Italian Army was more powerful than the German Army.

Apples and orangutans. “BIG OIL” actually was trying to suppress Dr. Needleman’s findings. “BIG PHARMA” isn’t threatened by Dr. Wakefield’s inept bumblings in the slightest.

[2] The second false assumption is that Dr. Wakefield’s research is as sound as Dr. Needleman’s. That, I think, comes perilously close to libel. If Dr. Needleman had not been meticulous and rigorous in his work, he would have been dismantled by the forces arrayed against him. Dr. Wakefield’s work, on the other hand, pretty much self-destructed.

If “BIG PHARMA” was interested in destroying Dr. Wakefield’s reputation, they couldn’t have done half as thorough a job as Dr. Wakefield has done.

Of course, if Mr. Blaxill knew anything about how science is done, he would have seen that. Unfortunately for Mr. Blaxill, his area of expertise is business, not science.

Perhaps if he stuck to what he knows, he would do better.

Prometheus

wfjag: Asperger’s, PDD-NOS, CDD and Autistic Disorder are all being folded together into a single diagnosis, Autism Spectrum Disorder. People who were previously diagnosable with AS or PDD-NOS will still be diagnosable under the new category; it’s not as if they’re declaring everything but Autistic Disorder to be non-pathological.

Rett is being removed apparently on the grounds that it shouldn’t be considered a specifically psychiatric disorder; presumably it’s well-enough characterized that it shouldn’t be in the same differential as anything listed in the DSM (remember that some diagnoses in the DSM are there purely for rule-out purposes, like the much-ridiculed “caffeine intoxication” which is there simply because caffeine intoxication can mimic the symptoms of much more serious conditions and because you need a proper diagnosis to justify giving a benzo to someone suffering from caffeine intoxication).

Because that’s how Orac rolls, take it or leave it, baby.

I have never heard your voice but for some reason I have now created a very cool one in my head to go along with that wonderful reply.

Speaking of lead: when the GMC panel pulled the medical records of the autistic children in the 1998 Wakefield Lancet paper (retracted), two of the 12 showed dangerously high lead levels in their blood, probably indicating that they were eating paintwork at home.

What did the noble, caring Dr Wakefield do about this?

You bet.

“The [wakefield] paper always was and still remains a perfectly good small case series report, but it was systematically misrepresented as being more than that, by media that are incapable of interpreting and reporting scientific data.”

John @14, Dr. Goldacre wrote that back in 2005 when little was known about the scientific misconduct of Wakefield save one journalist and just getting the attention of a handful of bloggers. Let’s see what Dr. Goldacre has said since:
http://www.badscience.net/2008/08/the-medias-mmr-hoax/
http://www.guardian.co.uk/science/2010/jan/28/mmr-vaccine-ben-goldacre

A proper sceptic doesn’t become so wedded to an idea that he can’t review new evidence and adjust his beliefs accordingly.

“The [wakefield] paper always was and still remains a perfectly good small case series report, but it was systematically misrepresented as being more than that, by media that are incapable of interpreting and reporting scientific data.” – Ben Goldacre

It’s worth noting that Goldacre made that comment several years before it was discovered that Wakefield had manipulated the data.

@23: Actually, I’d expect quite a few people currently diagnosed with PDD-NOS would not qualify under the proposed criteria. At present, PDD-NOS:

This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder or Avoidant Personality Disorder. For example, this category includes “atypical autism”— presentations that do not meet the criteria for Autistic Disorder because of late age at onset, atypical symptomatology, or subthreshold symptomatology, or all of these.

For example, technically speaking, a child with only a delay in verbal and non-verbal communication skills could receive a PDD-NOS diagnosis. I don’t think such a child would receive a diagnosis under the proposed ASD criteria.

“Because that’s how Orac rolls, take it or leave it, baby.”

nice….

Brian Deer–

say what?!? Wrong on so many levels.

I expect the reply to be, “but none of the parents complained”.

@Dan

Logorrhea, eh? It’s nice you can be introspective. I actually agree with most of the points you make in your blog, but why does it require such verbosity?

I, for one enjoy Orac’s “verbosity”. Keep rolling Orac ;D.

@Jen

yes! Let the damage continue!!

Were you referring to the damage Andy is doing to his reputation? Or continuing to damage your own credibility by supporting his “research”?

@ebohlman:
I was not implying that persons meeting DSM-V’s criteria for ASD will not be diagnosed as ASD. Rather, it appears that DSM-V will reverse the broadening of criteria that occurred with DSM-IIIR and DSM-IV. Rett should be removed, as it appears that a genetic basis has been identified, and so, even if included in DSM-V, it should not be in ASD, which is a broad diagnosis (IMO, overly broad). Hopefully, people now diagnosed as Asperger’s will largely be outside the new ASD criteria. (IMO, we find enough ways to label kids. If you can function in society on your own, then you have the right to be left alone. Being smarter than everyone else, or approaching problem solving differently, should not be considered as pathology).

My point was (and is) that DSM-V appears to be narrowing the diagnostic criteria for ASD, somewhat. That likely will result in fewer new ASD diagnoses. As the criteria were broadened under DSM-IIIR and DSM-IV, among other results was a diagnostic shift from MR to ASD (the r-squared on that was over .9999, something generally unheard of in social science subjects). The increasing ASD diagnoses rates led to claims of an “autism epidemic” (and, has largely fueled the hysteria accompanying much of the antivax movement, and been a major basis for funding drives). Narrower diagnostic criteria will lead to fewer new ASD diagnoses — but, you can bet that antivaxers will claim credit and dismiss the notion that a change in diagnostic criteria had any effect.

Once a movement is established (especially one that involves a lot of money being gathered by its leaders and proponents), there is strong motivation by its leaders, proponents, and beneficiaries for it to continue (even if its reason for existance ceases to exist). If, under DSM-V, there are fewer diagnoses, the easiest claim that AoA, Green Our Vaccines, etc., to make is that their heroic efforts turned the tide (and, with more funding, they can “save” everyone).

I believe that you were focusing on the science. I wasn’t.

Umm…I wouldn’t mind some comment on how the monkey studies got through the peer review process in the first place. From what I have read, they were seriously flawed in design and implementation, and should have been rejected on that basis by any competent reviewer. Now this guy hangs his entire conspiracy theory on the fact that they made it through the peer review therefore it is ‘legitimate’ science that is being suppressed (conveniently ignoring all those peer reviewed studies that don’t support his contention).

While I don’t expect science to be perfect and I know it is self-correcting (this being an example), it does raise the question in my mind about whether there is a problem in the publication process, and if so, how could it be fixed? Given that these studies involved animals, is there also a problem there that needs addressing?

Umm…I wouldn’t mind some comment on how the monkey studies got through the peer review process in the first place.

This is one question the editors of Neurotoxicology need to address. Did they give this paper any special treatment in the first place?

Where’s Wally? err… I mean Where’s Wakey?

He looks as though he will resurface for the upcoming Autism One conference in the guise of a primate neurologist (is there no end to this man’s talents?), when he will expound on his new concept that mercury and toxins absorbed through the vaccine-measles damaged guts of children circulate to the brain stem where they damage the “dorsal vagal complex”, causing autism.

This new hypothesis appears to be based upon findings from his 12 munkeyz study.

Autism and the vagrant in the brainstem

This talk examines the possibility that brainstem injury plays a central role in autism. In light of recent observations of brainstem injury in a primate model of vaccine-associated effects on early neurodevelopment, and an analysis of the scientific literature, it is proposed that, as an epicentric event, damage to the dorsal vagal complex (DVC) of the brainstem may be necessary and sufficient to initiate the central and systemic features of autism, including the many that fall outside the behavioral definition of this condition. Mechanisms by which primary systemic inflammation can cause brainstem damage are presented with reference to the published literature. The talk discusses the anatomical predeliction of the DVC for injury resulting form a variety of mechanisms including disruption to the blood supply in the developing brain, environmental toxicity and, via retrograde vagal pathways, intestinal inflammation. Ways of examining this theory are discussed.

http://conference.autismone.org/abstracts.cfm?a1year=2010#wakefield1

Ummm, I am not a neurologist, but brainstem functions are pretty primitive in the grand scheme of things (like breathing). Social interactions and the developmental delays seen in ASD are higher brain function issues, like what is thought to lie in the frontal cortex and higher areas of the brain. Thus, this new theory really shouts bogus to me.

As for peer-review, a peer review process is only as good as the peers who are doing the review.

I’m surprized Andy didn’t somehow manage to cram “Mitochondrial Disease” into that description(@36).

Andy’s Amazing Hypothesis references: “…the anatomical predeliction of the DVC for injury resulting form a variety of mechanisms including disruption to the blood supply in the developing brain, environmental toxicity and, via retrograde vagal pathways, intestinal inflammation. Ways of examining this theory are discussed.”

Presumably Andy is guessing that MMR vaccination (or vaccination for other diseases) causes inflammation in the gut that zooms up the vagus nerve and does nasties in the brainstem, thus causing autism. If one accepts this impressively Rube Goldbergish theory, what’s to stop all manner of infectious diseases themselves from causing this sort of postulated inflammation? Will Andy be mentioning this in his “talk”, or just continuing an obsessive focus on vaccines and their “toxins”? Maybe his own gotta-be-safer-than-the-MMR proposed vaccine will be shown to have an amazing theoretical non-predilection for causing the evil inflammation.

Hope there’ll be a video of his presentation, or at least someone with a tape recorder to preserve it for posterity.

Dan- “It’s because they mistake their self-righteousness for happiness.” <---- best line EVER when describing these fundamentalists! (who I also often agree with but my God could their delusional egos be any more out of control?) t-minus 9 minutes until Dangerous Bacon surfaces...

Curse you, dt!

I could have been happy *not* knowing about the upcoming AutismOne conference with its execrable pile of “presentations”. I could have been happy *not* clicking your oh-so-helpful link to the conference’s planned proceedings. I could have done without the increase in my blood pressure while reading some of the authors’ names and presentation titles.

It burns me to think that dangerous quacks pushing unproven ideas/treatments, under the misleading guise of a “scientific conference”, might influence even just one individual parent of an autistic child.

However, one presentation title did make me chuckle … “Not so Black and White: The Many Faces of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)”. Get it? Black and white? Pandas are…

Never mind. Given the humourlessness of anti-vaxxers (and their supporters), I’m thinking the joke might have been unintentional.

“Shut up! I order you to be quiet. Long live autism!!”
I did enjoy the video, though.

Hey Orac

If you can roll doesn’t that make you a Zeroid from Terrahawks?

Brian Deer —

Oh. My. God. He ignored cases of lead poisoning in one-sixth of his test subjects?!?!

No wonder the antivaxers worship chelation therapy — one wonders how many of them live in homes with lead paint. (Of course, if there’s no actual contamination, chelation does the kid no good and can likely do harm, but what the hey.)

Quoth Orac (OK, I’m just partially quothing him): “…the very last shred of Andrew Wakefield’s facade of scientific respectability tumbled.”

Tumbled? That’s bein’ right charitable, that is! I’d say the shred of the facade burned down, fell over and then sank into the swamp!

(With apologies to Monty Python)

Dan @ 2: your Concern is noted.

Orac : well done.
The other reason to re-visit a point was once stated by Sir Winston Churchill, who said “If you have an important point to make, don’t try to be subtle or clever. Use the pile driver. Hit the point once. Then come back and hit it again. Then hit it a third time; a tremendous whack.”

Sorry Kayleigh.
Looking at the content of the conference is interesting. There are numerous hypotheses for autism etiology being put forward (which is good scientifically) but I would say the evidence base for many of them seems very speculative, and many of the supposed “causes” are mutually inconsistent/contradictory.

There is even a chiropractor saying that autism is the result of birth trauma causing misalignment (ie “subluxations”) in the neck which affects the brain.
Most of the theories that get attention wil be the ones that finger vaccines in some way, no doubt.

It’s hard to know how seriously any of this gets treated by the scientific community. It just seems a forum for proponents to rehash their own ideas and present these to an adulating and totally uncritical audience.

“Speaking of lead: when the GMC panel pulled the medical records of the autistic children in the 1998 Wakefield Lancet paper (retracted), two of the 12 showed dangerously high lead levels in their blood, probably indicating that they were eating paintwork at home.”

Did the panel get the medical records from you, Brian?

Did the panel get the medical records from you, Brian?

@50 I don’t mean to speak for Brian but the GMC had access to the medical records, not Mr. Deer until the proceedings began. I’m sure he will correct me if need be. But in any event, so what if he did have access and presented those? It certainly would be relevant and doesn’t say much about Wakefield and how he ‘cares only for the children’.

Well, I’m trying to understand how the patients’ medical records came to be entered into evidence. Who entered them?

This is from the “MMR doctor fixed data” story:

“However, our investigation, confirmed by evidence presented to the General Medical Council (GMC), reveals that: In most of the 12 cases, the children’s ailments as described in The Lancet were different from their hospital and GP records.”

It sounds as though Brian had already concluded from the medical records that Wakefield had fiddled the data; the GMC then agreed.

So did Brian submit them himself?

Brian Deer has a pretty complete record of the years he spent investigating Wakefield. I read it maybe half a year ago and do not recall seeing any references to patient records but I could have missed or forgotten that. Google his saga. It’s good reading and shows the best results of the sadly dying art of investigative journalism.

The one anti-vaccine loon who can match or even exceed Orac’s logorrhea

A comic strip that describes Orac. 😉

Did the panel get the medical records from you, Brian?

Is that the beginning of a new conspiracy theory? I guess Wakefield must have forgot to point out during the hearings that the medical records supposedly submitted by Brian Deer were not the real medical records.

“I guess Wakefield must have forgot to point out during the hearings that the medical records supposedly submitted by Brian Deer were not the real medical records.”

…How did the patients’ medical records come to be submitted to the GMC panel?

Have you any idea, Joseph? Was patient approval obtained beforehand?

“Speaking of lead: when the GMC panel pulled the medical records of the autistic children in the 1998 Wakefield Lancet paper (retracted), two of the 12 showed dangerously high lead levels in their blood, probably indicating that they were eating paintwork at home.

What did the noble, caring Dr Wakefield do about this?

You bet”.

——————————————————————–

More reason to believe that children with autism may have difficulties in tolerating/handling toxic assaults on their system. Thanks Brian… for showing evidence which supports OUR beliefs (that’s the loony anti-vax crowd to you). Of course, instead of believing that this could be an individual issue with the child who has difficulty tolerating toxic substances… Dopey Brian has to assume that the crazy parents just sit around while their babies are gulping down lead paint pieces… Brian, you’ve really outdone yourself. Congrats.

Awesome–

The claim isn’t that lead poisoning meant the parents were “crazy” or “just sitting around.” It’s that lead poisoning is a specific problem, with real neurological consequences. It should not be ignored. I don’t know whether there’s any correlation between lead poisoning and autism, much less which direction any causality goes in, but autistic or neurotypical, a kid with lead poisoning has a problem that should be addressed.

Lead paint is not necessarily, or usually, a sign of parental carelessness or neglect. Often, it’s a sign of poverty: the landlord doesn’t repaint, or not often enough, and old lead paint is exposed. Or it could be buying a toy that was painted with lead or made with lead alloys. (They aren’t labeled as such, of course.) Nor is it neglect not to be literally watching your child every second: the kid is sitting quietly with a picture book or a set of blocks, and you’re listening as you cook dinner or read a bit yourself. So the kid tastes her blocks. That’s completely normal behavior–but if that nice bright paint contains lead, it’s also dangerous.

Without blame, if a pediatrician detects lead poisoning in a patient, he should not ignore it. If he detects it in two out of twelve patients, he either has an epidemic in his practice, or those patients are atypical. (With n=12, all sorts of random variations can occur, of course–if five of them were left-handed or blond, that would prove nothing.)

…How did the patients’ medical records come to be submitted to the GMC panel?

Have you any idea, Joseph? Was patient approval obtained beforehand?

@56 The parents didn’t complain so all’s well right? 😉

@57 Leave it to an anti-vaxer to pull that one out of her bum and completely ignore the dire implication. That wasn’t evidence supporting your BELIEF and yes, that is belief as in leap-of-faith, unsupported fabrication. Don’t blame the messenger for the failings of your precious St. Andy.

But… how can you just look through a patients’ medical records then report them in a national newspaper, paint or no?

“The claim isn’t that lead poisoning meant the parents were “crazy” or “just sitting around.” It’s that lead poisoning is a specific problem, with real neurological consequences”.

The point is… if a child has issues with lead, it is not a huge jump to be concerned about other toxic assaults, correct? Thimerosal, anyone? This isn’t tough people…

@Awesome

The simple fact that they had high levels of lead doesn’t say much other than that they have high levels of lead. It does not say when they got to those levels (before or after their diagnosis?) It says nothing about how much lead was actually ingested.

PICA is a very common thing among kids with autism. If these two kids had PICA, they very well could have been going around eating little bits of paint or other lead-containing tidbits.

And why are you bringing up thimerosal? It’s already been shown to have no correlation with autism. Sheesh!

To my knowledge, Deer was given access to anonymised copies of the relevant sections of the childrens records during the failed court action against him by Wakefield.

I believe that at least two mothers and one father have volunteered information to Deer.

@Todd W.

“And why are you bringing up thimerosal? It’s already been shown to have no correlation with autism. Sheesh!”

LOL! No it hasn’t… Sheesh!

If, in fact, a child has a problem with lead… (for whatever reason)… you darn well better be concerned about any and all toxic assaults on the system. This is NOT brain surgery. It’s simple common sense. I get it though… Lead = possible lead poisoning = possible autism diagnosis… but Mercury = totally safe = no chance of autism. Got it….

(Not) Awesome…
For possibly the millionth time, Thimerosal was studied and NOT linked to autism.

If the child has issues with lead, I’d say that dwarfs any other concerns and getting the lead out a primary focus.

Was there an actual point to your rant?

Awesome… leads me to believe that Tom Smykowski’s infamous “Jump to Conclusions Mat” may actually be a marketable idea.

if a child has issues with lead, it is not a huge jump to be concerned about other toxic assaults, correct?

As a matter of fact, yes, it is a gargantuan leap. Since there are no actual connections between them.

“you darn well better be concerned about any and all toxic assaults on the system.”

Why? Not all toxins have the same biochemical profile and don’t all have the same pathway for elimination.

The difference in chemical properties alone will mean that some toxins will bind to, or otherwise be transported by, transporter molecules with different properties.

This is clearly evidenced in the use of different chelators for different heavy metals.

@ (not) awesome

What do you mean by “issues” with lead? Any kid who’s exposed to enough lead is going to have problems.

Awesome, I don’t understand how you can assume that if a child is found to have high levels of lead, one should assume they have high levels of some other heavy metal, absent any evidence of the same. If someone stubs their toe, do you assume they have probably also been smacked upside the head?

(Note, however, that Wakefield wasn’t studying thimerosal. He was studying what he called “autistic enterocolitis” caused by measles virus acquired from the MMR vaccine. The MMR vaccine, notably, has never contained thimerosal. It can’t; thimerosal would render the rubella portion ineffective. So if you want to find a researcher to pin your hopes for the thimerosal connection on, it ain’t Wakefield. I simply do not understand why the “mercury militia” likes Wakefield, given that his research, if true, would contradict their thesis. It wasn’t even anti-vaccination research; his aim at the time was to clear the way for his own monovalent measles vaccine. That’s right — just like Paul Offit, Wakefield is a vaccine developer. It would also contradict his later work, but I’m not sure we should expect consistency from him.)

@ LK PhD

“What do you mean by “issues” with lead? Any kid who’s exposed to enough lead is going to have problems.”

Yup. Totally agree…. How about those kids who are/were exposed to too much mercury? That’s totally safe, right? Around and around we go….

@Awesome

Who said lead can result in a possible autism diagnosis? If you go back and read what I said, I stated that kids with autism have a higher risk of PICA, an eating disorder where they ingest non-edible objects. If that is the case with these two kids, they may well have eaten leaded paint or other lead-containing things because they have PICA.

Also, please show where anyone has said that “Mercury” is totally safe. Again, we have said that thimerosal has been studied and the results of those studies show that thimerosal is not a toxic agent in the doses that used to be found in vaccines.

Oh, and regarding the GMC pulling medical records….

I don’t know what the rules are in Britain, but I believe in most US states (maybe even all), medical boards are permitted access to patient records in the course of their duties. I know the GMC isn’t entirely analogous, but it seems to fulfill a similar role and so I would expect it would be allowed the same access. How else are they to investigate claims of malpractice or fraud? In general, the details would have to be redacted before allowing the general public to see, and perhaps even the patient names would be redacted before allowing the agents of the medical board to see the records. (After all, they don’t need to know who the patient is. Just how the doctor treated them so they can judge whether or not it was appropriate.) Doctors can even be reprimanded purely for failing to keep adequate records (partly because that can conceal fraud, but also because if you don’t keep good records, you can’t be sure you’re remembering their history accurately and you certainly can’t hand them over to another doctor reliably should it become necessary to do so).

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