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Antivaccine nonsense Autism Medicine

Brian Deer strikes again: More evidence of the worthlessness of Andrew Wakefield’s “research”

I had been wondering why the anti-vaccine crank blog Age of Autism had been gearing up the slime machine against Brian Deer lately. For example, former UPI reporter turned vaccine/autism cran Dan Olmsted has been attacking the BMJ. As you recall, the BMGpublished Brian Deer’s latest revelations earlier this year when he quite pithily and correctly referred to the now infamous (not to mention fraudulent and consequently retracted) 1998 Lancet case series published by vaccine/autism quack and crank Andrew Wakefield “Piltdown medicine.” Particularly curious are the more recent articles, which try to cast doubt on Deer’s reporting about Child 11, in essence calling Brian Deer a liar when he reported that Child 11’s symptoms of autism developed before he got the MMR vaccine, hitting that theme a week ago and then again earlier this week. I had been curious why Olmsted had resurrected his putrid yellow journalism directed at Brian Deer, after not having added to the series (An Elaborate Fraud) since part 6 in August.

Now I know. It’s a preemptive strike.

Just yesterday, the BMJ published another followup article by Deer entitled Pathology reports solve “new bowel disease” riddle that further elaborate on the the real “elaborate fraud,” namely Andrew Wakefield’s fraudulent research that ignited a scare about the MMR vaccine as a cause of regressive autism. It is a scare that has not yet abated, even nearly 14 years after the publication. It was a scare based on the claim by Wakefield that he had identified a new syndrome, which he later dubbed “autistic enterocolitis” in a followup paper in the American Journal of Gastroenterology. This syndrome, Wakefield suggested, was associated with vaccination with the MMR vaccine, and The Lancet paper, which linked autism and “autistic enterocolitis” with the MMR served as the basis of Wakefield’s later claims that the MMR vaccine was a cause of regressive autism. Thirteen years and multiple studies later, no investigator not somehow associated with either Wakefield and/or the anti-vaccine movement has been able to replicate his work. Indeed, an explicit attempt to replicate Wakefield’s work failed utterly. After all that time, there remains no persuasive evidence that such a syndrome as “autistic enterocolitis” even exists. Indeed, Deer found in his investigation that the vast majority of specimens that the gut was normal but only after a re-review by Wakefield’s team were they described as abnormal.

In any case, this alleged new syndrome depended on the finding of “colitis” in ileal biopsy specimens from autistic children in Wakefield’s original case series. In his book Callous Disregard, Wakefield claimed that he “played no part in the diagnostic process at all” and:

It was decided that, in order to standardize the analysis of the biopsies, the senior pathologist with the most experience in intestinal disease, Dr. Paul Dhillon, should review all biopsies from autistic children. In turn, Dhillon decided that pathology should be graded on a reporting form designed by him to document the presence and severity of microscopic damage. Thereafter, a regular review of biopsies took place involving Drs. Dhillon and Anthony, a trainee pathologist. I was also in attendance. Dhillon’s diagnosis formed the basis for what was reported in The Lancet.

Unfortunately, as Sullivan notes, these statements have been difficult to verify, and the original pathology slides made from biopsy samples taken from the original children studied in Wakefield’s case series are missing, which obviously makes it impossible to go back and look at the specimens and see whether expert pathologists agree with Wakefield’s team or not. This does make me wonder what happened to the original pathology blocks used to make the slides. If those still existed, it would be possible to cut and stain more sections. In fact, it makes me wonder how all of these specimens, slides, blocks, and all, could go missing. Be that as it may, it’s also interesting that Dr. Dhillon’s original scoring sheets were also missing.

Until now.

Deer got ahold of the original scoring sheets, as he describes here:

Between 1988 and 2001, Wakefield was an academic researcher at the Royal Free medical school in Hampstead, north London, from which his five page paper was published. “Researchers at the Royal Free Hospital School of Medicine may have discovered a new syndrome in children involving a new inflammatory bowel disease and autism,” the school announced to promote the paper, which the Lancet retracted last year.

But the data–passed to us by David Lewis, a self employed American environmental microbiologist working with Wakefield–tell a different story, kept hidden for nearly 14 years.

The funny thing is that Lewis forwarded these reports to the BMJ because he thought they exonerated Wakefield, probably leading Wakefield now to wonder, “With friends like these, who needs enemies?”

What Deer got ahold of where Dhillon’s histology scoring sheets for 62 intestinal biopsy specimens from 11 of 12 of the Lancet children, and it turns out that Dhillon’s reports actually showed nothing particularly unusual. Deer reproduces some of the grading sheets in his article and on his website. For example, here’s the scoring sheet for Child #1 and for Child #2. It turns out that Dhillon did not find frank enterocolitis in any of the children, and in fact, quite the contrary to what was reported in The Lancet paper, what is recorded in these reports is far more consistent with normal intestinal mucosal than with any significant enterocolitis:

But Dhillon’s reports produced results that pathologists, gastroenterologists, and a gastrointestinal immunologist to whom we have shown them say are overwhelmingly normal and might be found in almost anybody’s gut.

“Most of this stuff is so close to normal that you’ve really got to question whether there is really anything there,” said Henry Appelman, professor of surgical pathology at the University of Michigan and a specialist in gastrointestinal disease. “These are the kind of things that we in our practise here would ignore completely.”

By way of background, remember that these specimens were nearly all read as normal by consultant histopathologist Susan Davies, who also challenged claims of “colitis” in a draft of the original Lancet paper withdrew her objections in favor of Dhillon’s analysis. However, as Deer reports:

But it now emerges that, although expressed as scores rather than narratives, Dhillon’s findings were largely consistent with Davies’s. “Everyone thinks I am crazy even asking them,” said King’s gastroenterologist Bjarnason, after discussing the scorings with other specialists. “All but one of the children is normal in their eyes. There is no enteritis and no colitis, simple as that.”

There was at least one other major problem, and that’s what was left out of the reports that might have put even the mild changes noted in the intestinal biopsies. What was left out was a history of severe constipation. For example, one of the patients endured failure to pass the endoscope because there was still fecal matter in the cecum, even after a full bowel prep. This is very important because pathologists, if they knew about this, would think less of even the mild changes observed, mild inflammation and lymphoid follicles, are common in biopsies of patients with severe constipation.

In a second article in the same issue of BMJ entitled MMR fraud needs parliamentary inquiry, says BMJ, as new information puts spotlight on Wakefield’s co-authors, BMJ editor-in-chief Dr Fiona Godlee goes one further than Brian Deer in that she asserts that at least six other papers by Wakefield besides the Lancet paper require “independent investigation.” She sent a letter to Andrew Miller MP arguing that Parliament must investigate University College of London, where the research was carried out, unless UCL immediately starts an independent inquiry:

“If UCL does not immediately initiate an externally-led review of its role in the vaccine scare, we believe that parliament should do it,” concludes Godlee. “After the effort and time it has taken to crack the secrets of the MMR scare, and the enormous harm it has caused to public health, it would compound the scandal not to heed the warnings from this catastrophic example of wrongdoing.”

Amusingly, Lewis, stung that his attempt to exonerate Wakefield by supplying the pathology scoring sheets to the BMJ has backfired so spectacularly and actually made the Wakefield team look even worse, is mounting a counterattack by writing a letter to the BMJ. Basically, his argument boils down to trying to claim that Wakefield was just “reporting what he was told” and had nothing to do with shaping the analysis of the bowel samples. In other words, Lewis is arguing that Dhillon and Wakefield were incompetent, although that’s not what he calls it. However, that’s not what the General Medical Council found after two years to investigate the matter. It concluded that there was fraud involved.

Hilariously, Lewis discusses learning of Deer’s stories earlier this year while at a “vaccine safety conference” with Wakefield. It’s hard not to note that if you say you’re at a “vaccine safety conference” with Wakefield, it was in actuality an anti-vaccine conference, and the conference to which Lewis refers is the infamous conference in Jamaica held earlier this year. There, Wakefield shared the bill with other anti-vaccine cranks such as Dr. Russell Blaylock (who is an all purpose medical crank and, like many all purpose medical cranks, anti-vaccine), Dr. Shiv Chopra (who is anti-vaccine to the core), and Dr. Richard Deth, Raymond Obamsawin, among others. Here’s a hint: While trying to defend and anti-vaccine crank like Wakefield, don’t bring attention to the fact that he’s an anti-vaccine crank by mentioning his having attended an anti-vaccine conference. Come to think of it, don’t mention your having attended the conference as well.

In the end, Deer’s latest findings are evolutionary, not revolutionary. It’s not clear why Lewis so wanted to exonerate Wakefield and clear his name that he was willing to persuade Wakefield to let him provide Dhillon’s scoring sheets to the BMJ, but I’m grateful that he was so clueless that he did so. In the absence of the original pathology specimens and the ability to get other pathologists to evaluate them, Lewis inadvertently provided the next best thing to help confirm once again the utter incompetence and fraud that is Wakefield.

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]

248 replies on “Brian Deer strikes again: More evidence of the worthlessness of Andrew Wakefield’s “research””

I wonder if Wakefield is now liable for criminal prosecution – I know the laws in the UK are significantly different, but in this case, it is like someone who shouted “fire” in a crowded movie theater, resulting in people getting injured or perhaps killed in the stampede to the exits, without even a hint of fire, much less smoke.

Obviously, the analogy applies to raising the alarm on the vaccine-autism link, without even a shred of evidence (and in face, showing that any presented evidence was not only false, but made up out of whole cloth).

Always happy to hsee people offer their own diagnosis of the Lancet 12 children and what the underlying clinical diagnosis relating to GI symptoms was.

Please try to include all the relevant findings including that found by the three paeditaric gastroenterologists.

I’m sure there’ll be some interesting theories.

Diarrhea or constipation …

You see not only do you have to deconstruct an argument you also have to problem solve a solution that fits the requisite evidence.

An apparent big vacuum in the skeptik schema.

I wonder if the pathologist was aware of the gross misrepresentation of his results?

Off-topic, but relevant to a post a few days ago, The Onion has picked up on the chicken-pox lollipop story with one of their man-on-the-street features:

http://www.theonion.com/articles/chicken-pox-lollipops-ineffective,26588/

The best response:

Additionally, kissing a broken arm is not adequate treatment for such an injury. You have to rub it with a half-eaten Big Mac from someone else who has a broken arm.

You see not only do you have to deconstruct an argument you also have to problem solve a solution that fits the requisite evidence.

… did Th1Th2bot get loose and start posting under a new pseudonym?

You see not only do you have to deconstruct an argument you also have to problem solve a solution that fits the requisite evidence.

Leaving aside the fact that this statement is patently false – it’s not necessary to prove what’s right in order to conclusively demonstrate that Wakefield was wrong – there IS an obvious conclusion that perfectly fits the evidence. Namely, that Wakefield engaged in comprehensive and deliberate fraud for personal monetary profit.

If this David Lewis was truly forced out of the EPA as a GS-15, then he would have either had to do something unethical or abusive in order to have been let go. The protections given to govt employees are extraordinary. The @aol.com email address he used for his contact information listed on a pubmed citation was everything I needed to know about his credibility. /snark

So his holiness Wakefield speaks on nigh through disciples now huh? It still boggles my mind the grip that this utterly, ethically-bankrupt buffoon has over some people and the lengths they will go to defend him.

I imagine that “shock and awe” will follow promptly…

Andy is not only the cherished darling of the anti-vaxx set but ranks highly amongst the pantheon of heroes dearly beloved by alt med mavens of all stripes: they characterise him as a scientific revolutionary who has unmasked the “fraud” of SBM’s infatuation with vaccines and has, almost single-handedly, bravely undermined the public’s confidence in these “scandalous” inventions. Thus, pushback has already begun as I’ve reported previously. More will follow.

A few years ago I inadvertently invoked the wrath of a person who had “problems with impulse control” ( amongst other issues): a friend succinctly queried, “How’s the security at *your* building?”

When you “kick the hornet’s nest” you should expect stings as the enraged swarm descends upon you. And anyone else in its path within striking distance- i.e supporters of SBM. I venture though that the “security in our building” is very good indeed.

I find it hilariously satisfying that Wakefield was undone by the very means by which he sought exoneration. As though the universe itself had been conspiring to complete his entire and devastating ruination.( Not that I believe in stuff like that- it’s metaphorical and anthropomorphic but poetic- what can I say, I like it).

Because Orac is known unto the furthest reaches of cyberspace as a supporter of SBM and vaccination, I suspect that much of the buzzing hive of chaotic thinking should land here. Makes you proud to be a target.

If this David Lewis was truly forced out of the EPA as a GS-15, then he would have either had to do something unethical or abusive in order to have been let go.

Not necessarily and this is why whistle-blower protection laws have been implemented. However, it doesn’t sound as though this Dr. Lewis even has a whistle-blower case so he is left to kicking stones and shilling for Wakefield (who is NOT a whistle-blower by any stretch of the imagination).

Didn’t one of his lackeys threaten a reporter with bodily harm if they weren’t nice to him?

Did Dr. Dhillon’s scoring system for purported pediatric enterocolitis get validated in any published research (prior to the Wakefield “study”, or subsequently) as a legitimate means of evaluating disease, or was it conceived solely for the purpose of evaluating Wakefield’s small sample set?

And just what did happen to the tissue blocks and slides? You’d think that if the findings of enterocolitis were legitimate, the actual tissue would hold evidence in support of Wakefield for reviewing pathologists to find.

It’s hard to escape the conclusion that someone has been very careless or naughty.

@ D6782:
“someone has been very careless or naughty”

It’s either a “someone” or a vast baroque imbroglio of a matrix of nested conspiracies immaculately maintained by the trans-Atlantic-pharma-medico-governmental-media cartel.
“Someone” gets my vote.

Wakefield wrote in Callous Disregard: “a regular review of biopsies took place involving Drs. Dhillon and Anthony, a trainee pathologist. I was also in attendance.

Yet Wakefield earlier wrote in the Lancet aricle: “All tissues were assessed by three other clinical and
experimental pathologists (APD, AA, AJW).”

I suppose the fellow with the initials AJW who “assessed” the tissues wasn’t Wakefield. Perhaps that’s just a weird coincidence that explains why one of those statements from Wakefield would otherwise seem to be false; that should have been obvious, as Andrew J. Wakefield, who trained as surgeon, could never had credibly described himself as a “pathologist.”

BTW, it’s also amusing to see how Wakefield’s boosters coordinated their efforts, as when John Stone inadvertently included in his post to Nature, according to an intersting post on the biology files:

“Here is information to post on Nature” and this other oopsie in what was otherwise supposed to be a third-person reference: “editors at Annals of Internal Medicine rated me in the top 10% of its reviewers in 2010.15.” (Nature has since deleted the comment, which violated their “no self promotion” comment rules). In other words, Stone was serving as poster boy for David Lewis.

http://biologyfiles.fieldofscience.com/2011/11/oh-what-tangled-web-we-weave.html

And just what did happen to the tissue blocks and slides? You’d think that if the findings of enterocolitis were legitimate, the actual tissue would hold evidence in support of Wakefield for reviewing pathologists to find.

It’s hard to escape the conclusion that someone has been very careless or naughty.

Exactly. When you perform a set of experiments that has the potential to blow the roof off of a convention (and even when you don’t), you make damn sure you keep your samples safe. I have tissue samples that I collected over a decade ago safely locked away in a freezer should they be needed. If I recall correctly, Dr. Afzal requested samples from Wakefield years ago and he refused. This rather important detail of “where are the samples” escapes his acolytes, conveniently.

Brian, John Stone resubmitted that comment without the initial bit, but he did not edit the sentence that used both “He” and “me.”

MESSAGE BEGINS ————————

Minion Walters,

Like you don’t know who “someone” is. Slick. Very slick.

Lord Draconis Zeneca, VC, iH7L

Forward Mavoon of the Great Fleet, Suzerain of V’tar Pharmaca Magna of Terra, Chief Someone of the Orion Arm


PharmaCOM Orbital HQ
0010101101001


—————————————— MESSAGE ENDS

BTW, I think Orac skipped over one of the important points, which is that despite finding nothing unusual in the specimens, Dhillon signed on to the paper as a co-author — evidently in full knowledge that its fundamental claim was completely false. He’s now a senior professor at UCL, as I understand it, which refuses to investigate or do anything about the situation.

Nice dig Brian Deer!

Won’t shake the faithful but it does give the sane more reason to point and laugh at Wakers & Co.

Very nice work, Brian! I wish only that all other fraudsters receive the same amount of exposing!

Christmas has come early here in the U.S. as well.

David L. Lewis, I’ll pay for courier service to hand deliver Wakefield’s papers to Brian Deer.

(I’m reminded of Nixon’s trusted White House Aide Alexander Butterfield, who first revealed during an interview with the Senate Watergate Investigation Committee, the presence of multiple recording devices in the Oval Office.)

@Lawrence #1:

I wonder if Wakefield is now liable for criminal prosecution – I know the laws in the UK are significantly different, but in this case, it is like someone who shouted “fire” in a crowded movie theater, resulting in people getting injured or perhaps killed in the stampede to the exits, without even a hint of fire, much less smoke.

IANAL, but I imagine the difficulty would lie in demonstrating the damage which Wakefield might have foreseen from his choice of action. He might just have thought that his initial ‘revelation’ would have benefited his paymasters and gone little further, rather than it becoming an intercontinental decade-plus cause celebre by which ignoramuses could advocate the early death, maiming and/or suffering of little children. But how would you go about proving that in court? To what degree are the ignoramuses to blame, as opposed to the instigator?

Please, no-one flame me for suggesting that Wakefield could not be prosecuted. I would sincerely like to see him lose more than his licence to practise, pour encourager les autres.

@RW23 #24: He did fan the flames and profit substantially, financially and otherwise. I wonder if that would have any bearing…

IASUNAL.

Always happy to hsee people offer their own diagnosis of the Lancet 12 children and what the underlying clinical diagnosis relating to GI symptoms was.

“Diagnosis”? That implies a gut disease to be diagnosed. What part of “overwhelmingly normal” do you not understand?

@Roadstergal #24:

True, but the justice system tends to go for specific events. If he’s got away with it this long, the odds of a prosecution being brought are low. Then again, in the UK we have seen over the last few decades more civil prosecutions allowed where criminal prosecutions have failed or where the Crown Prosecution Service has failed to make them. There may be an opening there. Unfortunately civil prosecutions don’t result in jail terms, to the best of my knowledge, nor in fines or recompense against monies held outside the EU (although once again I must say IANAL).

@ Brian Deer:

Well.. actually I was thinking of something like “Let the Punishment Fit the Crime”…
At any rate, I bow gracefully in your general direction, sir.
DW

Antaeus Feldspar:

… did Th1Th2bot get loose and start posting under a new pseudonym?

No.

herr doktor bimler:

What part of “overwhelmingly normal” do you not understand?

He has a habit of deliberately ignoring actual facts, and substituting his own interpretations. Something that is very apparent as he demonstrates in the aptly named “The fixed mindset of the anti-vaccine activist” article. It seems he also lives on Htrae.

So I propose the following two nicknames:

Th1Th2 = Thingy

blackheart = ThingyJr

And let us not forget the ever morphing nasty person who keep claiming there are vast quantities of vaccine damaged children, but can’t be bothered to post any evidence. And she really hates several researchers like Madsen, Forbonne, etc. She is Common Sue (even if this person is a guy), if for nothing else in “dishonor” of Sue M. who had a similar posting style (and who first morph was as “Common Sense”).

MESSAGE BEGINS———————-

Dear Minion Deer,

Word of your brilliant work has reached the homeworld and come to the attention of Her Imperial Highness, Clopidogra Invicta XXIII (may She live for all time). H.I.H. has instructed me through representatives of The Great Egg Mother of The Mist at Sandringham to proclaim you a Class VIII Shill with all that entails. You have also been awarded the coveted Glaxxon Order of the Platinum Hypodermic Cross which you may pick up at Bulgari at your convenience (176-177 Sloane Street, Knightsbridge
London, SW1X 9QL). Make sure to use the correct Glaxxon PharmaCOM password of the day to receive your medal. You will also receive a year’s supply of Blaxill™ (moronoviramix hyperchlorate 5ml) Glaxxon PharmaCOM’s new intelligence suppressant for those nights when you just want to “get stupid” as you monkeys so quaintly put it.

But wait, there’s more (I’ve always wanted to say that)! Your new status entitles you to free drinks at all Corpus holiday parties and, of course, the mink interior trim upgrade on your next private jet. Looking forward to meeting you in person at the PharmaCOM Phuntime Jamboree next summer.

A raised battleclaw salute for your service to The Corpus! Now back to work! We have a planet to subjugate . . .

Lord Draconis Zeneca, VC, iH7L

Forward Mavoon of the Great Fleet, Suzerain of V’tar and Pharmaca Magna of Terra, Smooth Operator

PharmaCOM Orbital HQ
0010101101001
—————————————— MESSAGE ENDS

@Roadstergal #30:

Or now that I’ve spotted the unhappy smiley, was my last comment crass and inconsiderate. If so, I apologise.

[Shoots MWH self in head]

[Shoots MWH self in head]

Don’t. Just….don’t, please. Those of us who have lost people to suicide also get the flinches.

@Luna_the_cat #33:

I am so sorry. It was a bad physics joke. I’ve lost friends and family too, and it’s just my twisted way of coping.

BTW, I think Orac skipped over one of the important points, which is that despite finding nothing unusual in the specimens, Dhillon signed on to the paper as a co-author — evidently in full knowledge that its fundamental claim was completely false.

@ cervantes, I agree and have also raised the spectre of Susan Davies’ apparent recantation of her results (also normal) after the Lancet pre-submission meeting with Wakefield et al. More than Wakefield have some explaining to do and hope that a proper inquiry is launched.

Well, rw23’s joke (bad or not) does raise an interesting question. If you kill a different version of yourself from another universe, does that constitute suicide, or murder?

(I am presuming MWH stands for Multiple Worlds Hypothesis.)

Nah, I was just 🙁 in the sense that I cannot contribute substantively to the discussion. No All The Myriad Ways-ing required.

@beamup #36:

Your presumption is correct, although I don’t believe your subsequent question follows entirely. My silly joke (in bad taste to some, I agree) supposes that in one or more related worlds out of 10^500 (or whatever the latest estimate might be) I felt enough shame for my incomplete response to Roadstergal that it would cause me (or at least one of me in those alternate worlds) to commit suicide in an attempt to exonerate the shame of potentially upsetting another person. Understandably (and here I also fell down, as Luna_the_cat rightly pointed out) such a light-hearted reference could also be upsetting to many people.

I wish I hadn’t started this. However it has been an eye-opener into other people’s lives, regarding what they have to deal with and the way they manage. I apologise for any offence. I much prefer to live and learn.

@Roadstergal #37:

Contribute substantively to the discussion? You made a very reasonable point. As far as UK law goes, I am desperately drawing upon O-Level Economics And Public Affairs lessons I tried to learn in school thirty years ago, buttressed by attempting to stay up with Parliament (in all its shenanigens) since, and by reading decent newspapers and Private Eye whenever affordable.

Apparently we are all personally responsible if we break the law, even if no-one has ever told us it what it actually says.

Sorry, too. I try not to be oversensitive to it, especially because suicide is unfortunately still a meme or a gag in a lot of places. It’s just that sometimes I run across it in a place and a way that I don’t expect, and it gets an “urgh” reaction.

It has been kind of a bad year.

@Luna_the_cat #41:

I can sympathise with that. I think that suicide (or cancer deaths, my current bugbear) is at risk of being minimalised through a throwaway culture which does its best to avoid the topic of death or hope we can all get away with joking about it. However we do it, we deal with our losses and we do our best to get on with our lives.

Anyway, enough of this depressing shit. Rainbows, autumn leaves, roast chicken! Baby cuttlefish!

@palindrom #43:

Another day, another dollar.

It’s not like they care that sick people might get sicker, because in their eyes regression to the mean equals cure.

Out of the dozen or so practices in my adopted home town there are two which employ homeopaths (MDs who willingly advertise their HomPath ‘qualifications’). As a matter of principle I avoid those places, even though one practice is the largest and most convenient for those of us living in the centre of town without personal transport.

Oops, I forgot to add ‘bleurghh!’ to the direction of my previous comment.

Though I’d like to think it goes without saying.

I suspect that Wakefield, who seems to be a charismatic and persuasive chap, led Davies, Dhillon, Walker-Smith et al (and possibly himself) into an error that has fooled many intelligent and learned people; that of seeing patterns in noise. If you stare at any noisy data for long enough you can start to see imaginary patterns in it, especially when someone tells what pattern you are looking for. Minor inflammatory changes in the biopsy samples of children with constipation and/or irritable bowel syndrome (or “toddler diarrhoea” as Walker-Smith called it) are ideal noisy data for this.

I can understand people making this error, but refusing to acknowledge this when it is pointed out to them (I am thinking of Wakefield and Walker-Smith here) is something else.

Damn you Palindrom, I went over there and read the article and got sucked into the vortex of stoopid! Ullman is riffing away in the comments. He actually used the argumentum ad populum fallacy with fashion models as his exemplars of the efficacy of arnica montana. Well, I say, what about hannah montana?

@ Krebiozen:

I truly wonder how fellows like Andy could ever believe that they’d get away with it? Personally I know that I’m rather bright but still wouldn’t *dream* that I could possibly fool *everyone*- including experts worldwide: many people are at least *as* bright or, more importantly may see the material in an entirely different light than I do which would render my fraud transparent.

I think that there is much more than narcisscism here- there must be an inability to “read” and understand others’ capacities and reactions. I wouldn’t be surprised if self-deception was involved as well. Not a pretty picture.

This orac, whatever that is ,is some piece of work. No one can better twist information into a pure slant to one side. Once orac is done, theres no recognizing the issue at all. There is simply no other side in these ficticious reports.
Pure dishonesty at its finest. Say hi to your friends in the Pharmafia for me.

Blackheart (#2):

“You see not only do you have to deconstruct an argument you also have to problem solve a solution that fits the requisite evidence.”

Wrong – to invalidate an argument (such as Dr. Wakefield’s “autistic enterocolitis” claim), all you have to do is show that it is incorrect. There is no requirement to have a “better” explanation.

This is a common line of fallacious reasoning among “alt-med” supporters and other fantasy-based philosophies. Again, showing that an argument or claim is incorrect is sufficient – there is no need to provide an alternate explanation.

As this pertains to Dr. Wakefield, we now have evidence showing that his “study” [a] enrolled “subjects” referred by lawyers rather than sequentially, as was stated in their paper; [b] some of the autistic children regressed before receiving the MMR vaccine and some regressed over six months after receiving the vaccine; and now we have [c] even the “specialised” pathologist examining the biopsy slides interpreted them as “normal”.

What’s left? Are we going to find out that some of the subject weren’t children?

Prometheus

Denice,
I don’t think we will ever know how much of Wakefield’s behavior was down to self-deception, and how much was a callous quest for glory and financial reward. I suppose it’s possible that he was, and still is, simply certain he was right and this justified, in his mind, what he did. However, the way he set everything up ready to profit from MMR being discredited suggests a lot of premeditation. The fact that he rejected the opportunity to conduct further research at the Royal Free to replicate his results suggests he knew that this would fail. His refusal to defend himself at the GMC hearing is difficult to understand if he believed he had done no wrong. His behavior since his fall from grace, throwing in his lot with some very unsavory people doesn’t show him in a good light. I like to give people the benefit of the doubt, but it’s very hard to do this in regard to Wakefield’s behavior.

For example, former UPI reporter turned vaccine/autism cran Dan Olmsted has been attacking the BMJ.
……..
Now I know. It’s a preemptive strike.

BMJ editor-in-chief Dr Fiona Godlee goes one further than Brian Deer in that she asserts that at least six other papers by Wakefield besides the Lancet paper require “independent investigation.” She sent a letter to Andrew Miller MP arguing that Parliament must investigate University College of London, where the research was carried out, unless UCL immediately starts an independent inquiry

But…But I don’t understand…(:p)

The constant mantra of the antivaxx congregation has been that Wakefield’s “finding” was genuine and so he is innocent of all charges. So if the antivaxx managers really believe this, shouldn’t they be very loudly celebrating an independent inquiry into all of Wakefields papers?

*Listens out for the sound of Black Helicopters over at AoA*

Oh I just can’t resist…

*in my best attempt at antivaxxer tone*
What is it that Dan Olmsted is so afraid of?

The phrase “hoist by his own petar[d]” comes immediately to mind. Or how about “I love it when a plan comes together?”

@Sauceress:

So if the antivaxx managers really believe this, shouldn’t they be very loudly celebrating an independent inquiry into all of Wakefields papers?

Ah, but an inquiry done by the government won’t be independent, but instead will be controlled by Them, who will twist and fabricate evidence to make it look like Saint Andy did something wrong.

I’ve been “slumming” again at AoA and they are actually stating that this latest revelation about the pathology reports is “proof positive” that Brian Deer is part of the conspiracy against St. Andy.

They have even linked the “Nature” and “Scientific American” websites, so that their devotees can post comments about Deer’s vendetta against Andy. Ann Dachel and John Stone have both posted a number of comments which are “classics”.

I love AoA for their conspiracy theories and their quality of scientific journalism.

Herr Doktor

“Diagnosis”? That implies a gut disease to be diagnosed. What part of “overwhelmingly normal” do you not understand?

Are you implying that three of the world’s leading gastroenterologists do not know what a paediatric gastro disease pathology looks like ?

You do know that a paeditric disease differs remarkably in physiology to an adult disease didn’t you ?

You did know that both severe and acute constipation and diarrhea are both implicated in colitis.

They did see the pathology slides , the patients and the actual colonoscopies.

This is what science rationalism looks like is it ? Very interesting.

Prometheus

Wrong – to invalidate an argument (such as Dr. Wakefield’s “autistic enterocolitis” claim), all you have to do is show that it is incorrect. There is no requirement to have a “better” explanation.

Wrong – In the real world of medicine diagnosis rather than your prejudicial construct of science, it is incumbent on the physician to diagnose and treat the patient. Thus come up with a solution. These are not artificial constructs (You see the factor that gets in the way … humanity).

[a] enrolled “subjects” referred by lawyers rather than sequentially, as was stated in their paper

Wrong – Lawyers are unable to ‘refer’ anyone to a medical specialist. The normal pathway is through a registered medical practitioner.

some of the autistic children regressed before receiving the MMR vaccine and some regressed over six months after receiving the vaccine

Did they ? I’m supposed to be surprised by that. Do you know nothing of the pathology of diseases and neurodevelopmental disorders and their aetiology. Do all conditions follow the same functional aetiology and timeline.

One supposes your talking about the child with Otitis Media.

even the “specialised” pathologist examining the biopsy slides interpreted them as “normal”.

Wrong – Go and read the actual pathology sheets again.

—————————————————-

Guess what I’m going to take the word of one of the world’s leading paeditaric gastroenterologists when he says he saw evidence of …

“this mucosal abnormality has been apparent in 47/50 children within the autistic spectrum, whether or not there is any perceived link with immunisation. Thus the lymphoid hyperplasia/ microscopic colitis changes were found in over 90% of the autistic children studied. Even if there is no immunodeficiency, the lymphoid hyperplasia in many cases is remarkable, with germinal centres showing higher numbers of proliferating (Ki67 positive) cells than we have detected in any immunodeficient controls with lymphoid hyperplasia. We are very familiar with the detection of lymphoid hyperplasia in children with minor immunodeficiency, as are Lindley and Milla, and have published several reports on this topic. We were thus ideally placed to detect the exaggerated lesion found in many of these children. The colitis itself is variable, but may feature crypt abscesses, increased macrophage infiltration and unregulated class II major histocompatibility complex expression.

—————————————————–

What’s left? Are we going to find out that some of the subject weren’t children?

Well they are not statistics or play things for epidemiologists or journalists with an axe to grind.

How many times can you be wrong Prometheus.

Pareidolius @47 — Sorry, but you were a consenting adult. I can’t be responsible for your lack of self-discipline. [I kid, I kid.]

That said, you did leave excellent comments from experience of how ineffectual this stuff is.

I left one comment which was simply: “6.02 x 10^23”.

So far, no one’s goat appears to have been gotten by that.

“But Dhillon’s reports produced results that pathologists, gastroenterologists, and a gastrointestinal immunologist to whom we have shown them say are overwhelmingly normal and might be found in almost anybody’s gut.

“Most of this stuff is so close to normal that you’ve really got to question whether there is really anything there,” said Henry Appelman, professor of surgical pathology at the University of Michigan and a specialist in gastrointestinal disease. “These are the kind of things that we in our practise here would ignore completely.”

Dr. Appelman (a distinguished G.I. pathologist with whose work I am familiar) refers to a common situation in pathology – avoiding misinterpretation of biopsies in which the tissue by its very nature contains lots of inflammatory cells. Everyone posting here (gasp!) has a gut jammed full of lymphocytes, plasma cells, histiocytes, eosinophils, lymphoid aggregates and other inflammatory cells, all busily processing antigens that arrive via our diet, drugs and supplements we take, normal gut flora (and not-so-normal flora) etc. The challenge as a pathologist (I am a general surgical pathologist who sees lots of G.I. biopsies in daily practice) is interpreting abnormal patterns in conjunction with architectural changes, and not being too enthusiastic about assigning pathology to minor changes that can be induced by something as simple as the bowel prep (laxatives) used prior to colonoscopy. Otherwise you wind up diagnosing dubious entities like “mild chronic colitis” and getting people worked up for imaginary inflammatory bowel disease and other conditions.

If Dhillon’s descriptions of what he saw under the microscope are unconvincing to a highly respected expert in the field like Dr. Appelman, I’d take it as strong evidence that there was nothing of significance to be reported.

So, just where are those tissue blocks and slides? (the Wakefield debacle and its persistent apologists are sounding more and more like a bad remake of The Fugitive).

“So far, no one’s goat appears to have been gotten by that.”

I just left a bit of snark at Ho-Po…if it gets through, I am sure the good doctor will be responding.

“So, just where are those tissue blocks and slides? (the Wakefield debacle and its persistent apologists are sounding more and more like a bad remake of The Fugitive).”

Good question Dangerous Bacon. I don’t know how Wakefield might have “misplaced” these particular slides, but wouldn’t the fixed-in-paraffin specimens be easily transported out of his laboratory in “someone’s” briefcase? It is my understanding that paraffin blocks are not “regulated medical waste”.

Perhaps Lord Draconis has a colleague he can consult about such nefarious activities.

parliament UK not interested in Godlee’s request = More evidence of the worthlessness of the witch hunt against Dr. Andrew Wakefield’s research.

@65: No it isn’t. Wakefield’s research is still invalid, and he’s still no longer a doctor.

Funny how Common Sue (SS) is so enamored with a case series of just twelve kids, but rejects the several large epidemiological studies done on several countries on three continents that covered hundreds and thousand of children.

She never did have much common sense.

@Dangerous Bacon

How long would you, a surgical pathologist, expect the slides and embedded biopsy materials to be maintained from a research effort that produced undoubtedly controversial results that might be expected to have both a profound impact on public health and obvious legal implications?

I suppose that even if those important materials had been misplaced early on, Wakefield would have been able to replicate them, given that the Royal Free offered him financial and staff support to conduct a study of 150 children. Pity he didn’t do it . . .

My habit has been to save everything that might be important. Perhaps things were different at the Royal Free.

Wrong – to invalidate an argument (such as Dr. Wakefield’s “autistic enterocolitis” claim), all you have to do is show that it is incorrect. There is no requirement to have a “better” explanation.

Wrong – In the real world of medicine diagnosis rather than your prejudicial construct of science, it is incumbent on the physician to diagnose and treat the patient. Thus come up with a solution. These are not artificial constructs (You see the factor that gets in the way … humanity).

So if a physician has no actual answers to give to a parent, the “real”, “human” thing to do is to lie through one’s teeth to the parents and pretend one has the answers? Sorry, but even if we were talking specifically about “what should a physician in Wakefield’s position have told the parents about the cause of their child’s condition” rather than “what would have been the scientific truth of what’s known about the cause of the child’s condition” the answer is still the same, and it isn’t “make up some unproven bullshit called autistic enterocolitis and parlay it into fortune and fame.”

[a] enrolled “subjects” referred by lawyers rather than sequentially, as was stated in their paper

Wrong – Lawyers are unable to ‘refer’ anyone to a medical specialist. The normal pathway is through a registered medical practitioner.

Blackheart is only pointing out how badly Wakefield and his business associates in fact behaved. The fact is that the children went to be examined by Wakefield, not because a registered medical practitioner thought that was an appropriate step for the children’s medical care, but because the lawyers thought that it was a productive step for the lawsuit.

some of the autistic children regressed before receiving the MMR vaccine and some regressed over six months after receiving the vaccine

Did they ? I’m supposed to be surprised by that. Do you know nothing of the pathology of diseases and neurodevelopmental disorders and their aetiology. Do all conditions follow the same functional aetiology and timeline.

In this universe, effects come after causes, not six months before. This applies to all diseases, and in fact to everything except maybe some funky sub-atomic particle stuff. So yeah, if you encounter a claim that a child regressed into autism as a result of something that wouldn’t even happen until half a year later, the honest thing to do would be to be surprised and dubious of the claim.

The legal minimum requirement in the U.S. for retention of laboratory materials (under the federal Clinical Laboratory Improvement Amendments (CLIA)) is for retention of glass slides and test reports for at least 10 years, and for paraffin tissue blocks to be retained for at least two years (the College of American Pathologists requirement for CAP-accredited labs is to hold onto tissue blocks for at least 10 years). Many labs retain such materials far longer.

Remember that we’re talking about day-to-day surgical pathology materials for which storage can get expensive and inconvenient in high-volume practices.

I don’t know what requirements there may be as regards research material in the U.K., but I wouldn’t expect there to be much of a storage problem, and also that as part of good research practice you’d want to hold onto slides and blocks for lengthy periods for possible additional testing (special stains, molecular studies and so on). I don’t see the need to discard them so expeditiously. And yes, since Wakefield’s research was reported to be so groundbreaking and momentous, that’s all the more reason to retain the slides and blocks indefinitely.

@Sicksauce:

parliament UK not interested in Godlee’s request = More evidence of the worthlessness of the witch hunt against Dr. Andrew Wakefield’s research parliament short of money and doesn’t think it worthwhile to investigate years after the fact.

FTFY.

Sorry, I’ll try that again.

parliament UK not interested in Godlee’s request = More evidence of the worthlessness of the witch hunt against Dr. Andrew Wakefield’s research Parliament short of money and doesn’t think it worthwhile to investigate years after the fact.

parliament UK not interested in Godlee’s request = Why waste money to find even more evidence that Wakefield is a crook when the current evidence would convince anyone who is not profiting from Wakefield’s crimes?

Are you implying that three of the world’s leading gastroenterologists do not know what a paediatric gastro disease pathology looks like ?

I see no such implication in my comment. Are you implying that “three of the world’s leading gastroenterologists” did find a “paediatric gastro disease pathology”? These being?

The gist of the post is that one of the people who examined the samples described them in terms that were “overwhelmingly normal”:

Dhillon did not find frank enterocolitis in any of the children.

They were also examined by “consultant histopathologist Susan Davies”, for whom “these specimens were nearly all read as normal”, and who challenged the colitis description; and by a trainee pathologist, Dr Anthony.

Wakefield describes his own role as “in attendance”, ruling out any personal part in the diagnostic process.

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