Another swing for the fences and a miss by the anti-vaccine movement

Knowing what you are destined to blog about on a given night three days beforehand is a two-edged sword. On the plus side, I don’t have to worry about writer’s block or lack of suitable material to use as fodder for my Insolence, Respectful and not-so-Respectful, and that’s usually a good thing. On the other hand, by the time the evening rolls around, my attention can easily stray to other things, and I might not be as enthusiastic about deconstructing the latest example of, for example, anti-vaccine idiocy as I was when I first learned of its impending arrival. Yet not blogging about it after I said I would seems like breaking a promise to my readers.

So it is, now that I’ve sat down to write about the “study” or “report” (or whatever you want to call it) that was touted late last week as “proof” that the government has compensated vaccine-injured children based on their having autism. Maybe the buildup was just too much. After all, the anti-vaccine flacks at Age of Autism have been flogging this report relentlessly since the press release was first announced. So have other anti-vaccine groups. A little known fact is that I’m on the mailing list for a number of anti-vaccine groups. I do it for you, to keep my finger on the pulse of the anti-vaccine loons and as an early warning system to let me know when they’re up to various chicanery. Between being plugged in to anti-vaccine blogs and various mailing lists, I can report that the entire anti-vaccine crankosphere was abuzz with excitement over the release of this report, so much so that I was starting to wonder if there would be anything there that might be be worth paying attention to. Heck, even FOX News took the bait:

I needn’t have worried. Now that the report, written by anti-vaccine stalwarts Mary Holland, Louis Conte, anti-vaccine lawyer Robert Krakow, and Lisa Colin and entitled Unanswered Questions from the Vaccine Injury Compensation Program: A Review of Compensated Cases of Vaccine-Induced Brain Injury, has been published, I sort of wish I hadn’t promised to blog about it, because now that I’ve actually read the damned thing I can’t believe it. It’s just that bad.

The things I do for you! One thing that I didn’t do for you, I will admit, is to watch the press conference announcing the report. After all, why bother with the spin when I can look at the report itself, which has plenty of spin, all wrapped up in legalese and logical fallacies commonly used and abused by lawyers?

If there’s one thing that cranks routinely do when they can’t win on science is to shift to other venues to try to win their case and to convince people that they are not, in fact, cranks. After all, if they stuck to arguing facts, science, and evidence, they wouldn’t be cranks. They also wouldn’t have a prayer of obtaining influence because the science is so much against them. So, failing at science yet again, what the anti-vaccine movement has done is to move over to law, in essence claiming that legal decisions mean that there is a scientific case to be made in favor of the hypothesis that vaccines cause autism. This is a fallacious argument at its core, because findings of law all too often have very little to do with findings of science. Examples abound, but my favorite one is the scare over silicone breast implants during the 1990s. The science supporting the claims that silicone from these implants was causing systemic diseases, such as cancer, autoimmune diseases, and a panoply of other conditions, was weak to nonexistent; later, as more studies were carried out, it was found that there was no correlation between silicone implants and the conditions attributed to them. It wasn’t until 2006 that the FDA approved these implants again for cosmetic use. None of that stopped flood of lawsuits that bankrupted Dow-Corning in 1995.

No, law is not science. In law, for example, the object is to win your case, not to find out how nature works and develop models (i.e., theories) that accurately describe it and predict its behavior. In law, there are no truly objective right or wrong answers about issues of science. There is only the law and how it has been interpreted by courts. Advocacy for one’s position, using every tool at one’s disposal and denigrating or ignoring evidence that conflicts with that position, is not just acceptable, but mandatory. And that’s what Holland et al do, with little exception. In fact, they go so far as to use the common legal tactic of making like Humpty Dumpty in this passage from Lewis Carroll’s Through the Looking Glass:

‘When I use a word,’ Humpty Dumpty said, in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

‘The question is,’ said Alice, ‘whether you can make words mean so many different things.’

‘The question is,’ said Humpty Dumpty, ‘which is to be master — that’s all.’

Alice was too much puzzled to say anything; so after a minute Humpty Dumpty began again. ‘They’ve a temper, some of them — particularly verbs: they’re the proudest — adjectives you can do anything with, but not verbs — however, I can manage the whole lot of them! Impenetrability! That’s what I say!’

And that’s what Holland et al also appear to say, as well. Impenetrability based on legal jargon is their shield and their sword. They also fall back on the famous “just asking questions” ploy, so beloved of cranks and commonly known as JAQing off, which they do blatantly here:

This assessment of compensated cases showing an association between vaccines and autism is not, and does not purport to be, science. In no way does it explain scientific causation or even necessarily undermine the reasoning of the decisions in the Omnibus Autism Proceeding based on the scientific theories and medical evidence before the VICP. Nor does this article have anything to say about state childhood immunization mandates in general.

What this article does point to are unanswered questions about vaccines and autism, a thorny issue that affects approximately one in one hundred and ten children.10 On this point, this study strongly suggests the need for further Congressional and scientific investigation to explore the association between vaccine-­induced brain injury and autism and the integrity of this federally-­administered compensation program.

If you admit that what you are peddling is not science (and it most definitely is not), and you can’t show convincing evidence of an association between vaccines and autism, then why even bother?

The core of the argument in Holland et al appears to boil down to three claims. First, they claim to have found 83 cases of autism associated with vaccine-induced brain injury, which, they claim, makes autism three times more prevalent in children compensated by the Vaccine Injury Compensation Program (VICP). Second, because they base this estimate primarily on children for whom there are reports of “autistic-like” symptoms or who ultimately developed autism. Finally, they claim that this means that autism is three times more prevalent in VICP-compensated children than in the general population. Let’s look at these one at a time.

Looking at the second claim first, only a non-physician could make such an utterly brain-dead argument as this:

Because autistic disorder is defined only by an aggregation of symptoms, there is no meaningful distinction between the terms “autism” and “autism-­like symptoms.” This article makes the distinction only to accurately reflect the terms that the Court of Federal Claims, caregivers, and others use. It is not a distinction to which the authors attach significance.

It is not as uncommon as we would like in medicine for conditions and diseases to be defined primarily (or even only) by aggregations of symptoms. Irritable bowel syndrome is an example. Ditto tension headache. Moreover, it is often the context within which those symptoms arise that distinguish one diagnosis from another. In any case, the DSM-IV provides fairly clear diagnostic criteria for autism. If the child doesn’t have enough of these criteria to be diagnosed as autistic, that child could have “autism symptoms” but not autism. This is not a difficult concept, except apparently for Holland et al, who seem to be arguing that any child with autism-like symptoms must have autism. This is akin to arguing that anyone who has a belly ache or diarrhea must have irritable bowel syndrome or that someone who experiences a headache must have migraines.

Regarding the first claim, if we take at face value the claim that there are 83 children compensated by the VICP, it is first essential to compare this number to the number of children compensated by the VICP. This the authors try to do but utterly miss the point in doing it:

This discussion must start with the caveat that we are able only to interpret the subgroup of eighty-­three compensated cases that we have located. Out of a total number of approximately two thousand five hundred compensated vaccine injury claims,137 we recognize that this is a small subset. It is our hope that this preliminary study will lead to more complete study of all cases of compensated vaccine injury. Such a study might provide a far more comprehensive understanding of vaccine injury.

83/2500 results in an estimated prevalence rate of approximately 3.3%. On the surface, this seems to support the claim that the prevalence of autism is three-fold higher in VICP-compensated children than it is in the general population. Of course, there’s at least one problem, and that’s that the authors admit that, of these 83 children, they could only find documentation of autistic symptoms for only 39. This results in an estimated prevalence of autism of around 1.6%. This is rapidly falling into the range of what we would expect in the general population. Given that the VICP population is a skewed sample, many of whom have developmental disabilities, I’d be shocked if the prevalence of autism in this group wasn’t at least slightly higher than it is in the general population. Of course, this “study” is not good evidence that it is. Taking into account the skewed population and the noise inherent in looking at a small population over 20 years, the prevalence of autism in VICP-compensated children does not appear to be detectably different than it is in the general population. That’s even accounting for very loose criteria used by the authors to define who might be autistic. As Prometheus put it:

If the prevalance is higher among people compensated by the VICP, there is a basis for further investigation. It still wouldn’t “prove” that vaccines cause autism – it would simply be an indication for further study.

If, on the other hand, the prevalence of autism among people compensated by the VICP is the same as the general population (or less – see below), the argument that “vaccines cause autism” receives yet another (totally redundant) nail in its coffin.

The problem is that the autism prevalence numbers for the general population – even the educational numbers – use much tighter criteria than used by the authors of this study.

According to a Generation Rescue telephone survey (in other words, a “study” by the anti-vaccine movement iteself), the prevalence of autism is even higher than what Holland et al found in the VICP-compensated group of children.

It’s even worse than that. In fact, the timing of this study’s release is very, very bad indeed. In an ironic twist of fate that leads me to think that there might justice in the universe after all, shortly before the anti-vaccine movement tried to make hay out of this poorly argued, scientifically nonsensical report, a real scientific study, was released out of South Korea that found the prevalence of autism to be considerably higher than previously believed. Basically, in this study, researchers administered a screening test for autism spectrum disorders in a population and then did more detailed tests on children who screened positive. Their results were stunning. The study estimated that the prevalence of autism spectrum disorders was 2.64% in the population studied and that 2/3 of those cases were undiagnosed. True, this study will need to be replicated, but it adds more support for the hypothesis that autism spectrum disorders are more common than previously thought and that a significant proportion of them are subclinical and thus undiagnosed. The timing of this study, of course, couldn’t be worse for Holland et al, because it simply reemphasizes that the prevalence of autism that they think they measured in the VICP population is almost certainly not higher than the prevalence in the general population.

In other words, they did all that work and wrote all those words in order to add yet more evidence to support what we already know from copious evidence from a large and robust existing body of studies: That vaccines do not cause autism. They just refuse to realize or admit that that’s what they’ve done.

That realization provided sufficient motivation for me to power through this turgid mess of a “study.”