Orac is the nom de blog of a (not so) humble pseudonymous surgeon/scientist with an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his miscellaneous verbal meanderings, but just barely small enough to admit to himself that few will. (Continued 
If I am wrong I will be a bad person because I will have raised this spectre.
The martyrdom of brave maverick Saint Andy continues apace, it would appear.
As you recall, last week, after an interminable proceeding that stretched out over two and a half years, the General Medical Council in the U.K. finally ruled on the question of whether Andrew Wakefield, the man whose incompetently performed, trial lawyer-backed study published in the Lancet in 1998, acted unethically. The answer, not surprisingly, was a resounding yes, or, as Mark Slackmeyer would put it, "Guilty! Guilty! Guilty! Guilty!" True, not all the counts against Wakefield were ruled as proven, but most damning of them were, including misuse of public funds, performing invasive procedures on children for research purposes without proper ethics panel approval, and, worst of all from my perspective, acting not in the best interests of the children under the care of his research team. That last one, quite frankly, is unforgivable--every bit as unforgivable as wrong site surgery or mistakenly giving overdoses of radiation. Its manifestation was the performance of medically unnecessary invasive procedures, such as colonoscopies and lumbar punctures, on autistic children.
I won't lie. When I heard of the ruling last week, it brought a smile to my face, even though it was announced on the very day before my grant deadline, the very day I was in the midst of pulling an all nighter to get the grant done, the very day I was in a pretty lousy mood--tired and even more cranky and cantankerous than usual. Hearing that the man whose bad science launched a thousand quackeries had finally been declared unethical and dishonest and was on the verge of having his U.K. medical license yanked (or, to use that wonderfully British turn of phrase, struck off) brought joy to my heart, the joy that comes with seeing justice done. True, it was justice delayed--by several years, given that evidence of Wakefield's dishonesty and conflicts of interest had been published by Brian Deer back in 2004--but it was justice nonetheless.
Yesterday, there was a bit more justice laid down upon poor, poor, pitiful Saint Andy. Yesterday, what minuscule bit of seeming scientific credibility Wakefield had left was taken away from him. Yesterday, The Lancet decided to retract Wakefield's 1998 paper, the paper that started the whole MMR scare nearly 12 years ago. For, yesterday, published online on The Lancet's website was this brief message from its editors:
Following the judgment of the UK General Medical Council's Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al1 are incorrect, contrary to the findings of an earlier investigation.2 In particular, the claims in the original paper that children were "consecutively referred" and that investigations were "approved" by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.
Let me repeat that again:
We fully retract this paper from the published record.
Quite frankly, this is utterly astonishing. I can't recall every having seen editors of a scientific or medical journal retract a paper in this manner before. Usually when papers are retracted, it's the authors who do the retracting, most commonly as a result of either the reports by other groups that they cannot replicate the results in the paper or allegations of scientific fraud. True, authors may not do it quite so willingly. Usually they are in a position where they have little choice but to retract if they want to try to salvage some honor. One common example is when scientific fraud is alleged, particularly when it's not the senior author but rather one of the trainee authors who committed the fraud and the senior author didn't catch it. In that case, the senior author will usually ask that the relevant paper(s) be retracted. Rarely, however, do the editors decide to retract a paper that they have previously accepted. Even more rarely do editors retract a paper whose publication they defended so vociferously six years earlier, even as they admitted that it was a mistake to have published it.
That's right. Six years ago, when Brian Deer's allegations first came to light, so serious were they that The Lancet's editors addressed them in an editorial, basically refusing to retract the paper while admitting that most of the criticisms leveled against it were true. Indeed, this 2004 editorial was a masterpiece of weasel words and equivocation. For example, this is what Richard Horton, the editor of The Lancet, wrote:
In the light of the public controversy surrounding this work and the allegations made to us, one could argue that more explanation could and should have been provided in the original paper. Although, with hindsight, this seems a reasonable criticism, all research papers published by all journals are inevitably concise accounts of often complicated research protocols. We do not judge that there was any intention to conceal information or deceive editors, reviewers, or readers about the ethical justification for this work and the nature of patient referral. We are pleased to have had the opportunity to clarify the scientific record over the matters raised by these serious allegations.
Of course, it's understandable that the editors of the Lancet would be reluctant to admit their error in having accepted Wakefield's publication. After all, there were multiple red flags in Wakefield's study that should have set skeptical antennae a' twitchin' among both editors and reviewers, not the least of which was the small sample size of only 12 patients. For a finding as provocative as Wakefield's, namely that MMR vaccination was associated with autistic regression and bowel complaints, 12 patients are nowhere near enough to conclude anything with confidence. The reason is simple. Small sample sizes are prone to spurious, seemingly "statistically significant" correlations. Small sample size wasn't the only problem, though. The study stated that these children who experienced autistic regression had shown no signs of autism before being vaccinated. However, this claim was not based on clinical records in many cases; it was based on parents' memories, which are particularly prone to confirmation bias. Indeed, approximately a year ago Brian Deer demonstrated that many of these children had actually showed signs of autism that had been documented in their general practitioner's records before their having been vaccinated with the MMR vaccine. Granted, that revelation came a decade after Wakefield's paper was published, but if you read the paper itself (courtesy of--heh--J.B. Handley and his execrable 14 Studies website), you can see that its methodological flaws are numerous. The Lancet is a high impact journal. It should have better standards. Even though the editors and reviewers couldn't have known that the "consecutive patients" in the study were anything but consecutive, several having been cherry picked from patients whose parents believed that vaccines had caused their children's autism and wanted to sue vaccine manufacturers, there were enough other red flags that should have led them to nix Wakefield's manuscript.
Maybe the Lancet editors are embarrassed. They should be. After all, back in 2004, ten of the original thirteen authors retracted their support for the article and its findings. Andrew Wakefield and Peter Harvey refused to to retract. From my perspective, if the the editors had had any balls back then, they would have retracted the paper then. it would have been the right thing to do. After all, the editors all but admitted that Wakefield had violated The Lancet's rules on disclosure of conflicts of interest. Come to think of it, if Andrew Wakefield and Peter Harvey had had one iota of honor, they would have retracted the paper themselves, as honorable scientists do when such flaws are brought to light. Not surprisingly, Wakefield did no such thing, because he is not an honorable man.
Showing us once again what is the wrong thing to do is David Kirby, who has leapt to Wakefield's defense. Yes, that's exactly what Kirby does in--where else?--that repository of antivaccine pseudosience and quackery, The Huffington Post, in a post entitled The Lancet Retraction Changes Nothing. Kirby is actually correct about this, but not in the way that he thinks he is. The Lancet retraction doesn't change the fact that Wakefield's study was incompetently performed, riddled with undisclosed conflicts of interest, and missing critical information that would have cast doubt upon its findings. No, the retraction doesn't change the fact that Wakefield's work is a steaming, stinking load of fetid dingo's kidneys. It wasn't a case series; it was a fishing expedition to create "science" to support a legal case against MMR manufacturers, and Wakefield played it for all it was worth in the press.
But Kirby sure do write real pretty trying to convince you otherwise.
He starts with the usual complaint about our poor brave martyred St. Andy:
I believe that the public lynching and shaming of Dr. Wakefield is unwarranted and overwrought, and that history will ultimately judge who was right and who was wrong about proposing a possible association between vaccination and regressive autistic spectrum disorder (ASD).Wakefield's critics can condemn, retract, decry and de-license all they want, but that does nothing to stop or alter the march of science, which has come a long way over the past 12 years, and especially in the last year or two. The evidence that autism is increasing at alarming rates, and that some thing (or things) in our environment is wreaking havoc on a vulnerable one-percent of all US children is now so irrefutable that, finally, the federal government is climbing aboard the environmental research bandwagon - way late, but better than never.
Actually, I agree that history will ultimately judge who was right and who was wrong about proposing an association between vaccination and autism. In fact, it is already in the process of doing that, with study after study failing to find such an association. In any case, once again, there is almost no such thing the "autism epidemic." The apparent increase in autism prevalence is almsot certainly a result of several factors, including widening of the diagnostic criteria back in the mid 1990s, increased awareness, and diagnostic substitution. I've discussed this time and time again on this blog; so I won't belabor the point.
Next up are David Kirby's favorite hobby horses:
There was the case of Hannah Poling, in federal vaccine court, in which the government conceded that Hannah's autism was caused by vaccine-induced fever and overstimulation of the immune system that aggravated an asymptomatic and previously undetected dysfunction of her mitochondria. Hannah received nine vaccines in one day, including MMR.Then there was the Bailey Banks case, in which the court ruled that Petitioners had proven that MMR had directly caused a brain inflammation illness called "acute disseminated encephalomyelitis" (ADEM) which, in turn, had caused PDD-NOS, an autism spectrum disorder, in Bailey.
Poor David. He never learns. As I've discussed extensively before, the way the anti-vaccine movement--and David Kirby in particular--jumped all over the Hannah Poling case was truly shameful. It is, as I have pointed out, nothing more than a rebranding of autism as a mitochondrial disease, and the Bailey Banks case does not prove that vaccines cause autism. Indeed, it's hard not to note that somehow the anti-vaccine movement didn't mention Banks for a long time; it only resurrected the case in the wake of the Autism Omnibus hearing that went against them. Truly, it was stupid cubed when David Kirby and his brother in antivaccine pseudoscience Robert F. Kennedy, Jr. teamed up with Generation Rescue to try to spin the Banks case to support the view that vaccines cause autism. My saying so resulted, predictably enough, in another broadside of ad hominem attacks and other invective against me by our old friend J.B. Handley.
Kirby also returns to deceptive rhetoric that he's used many times before. Basically, he cherry picks studies in a desperate attempt to make you believe that the link between vaccines and autism is plausible. For example, he references this PLoS ONE study regarding mitochondrial disorders. It's a series of 25 patients with autism and later determined to have mitochondrial defects. The point of the article is that there may be a subset of children with autism with mitochondrial disorders and that they have different clinical features. It's a small study, and it does not provide evidence that vaccines cause autism. There was one child who regressed after vaccines, but, as we all know, correlation does not equal causation, and even the authors pointed out that fact.
Kirby also decides to try to spin yet another study:
And last September, a chart review of children with autism and mitochondrial disease, published in the Journal of Child Neurology, looked at 28 children with ASD and mitochondrial disease and found that 17 of them (60.7%) had gone through autistic regression, and 12 of the regressive cases had followed a fever. Among the 12 children who regressed after fever, a third (4) had fever associated with vaccination, just like Hannah Poling.
Kirby appears to be referring to this study. Again, this is a small study, and, if anything, it simply shows what we've known since the Hannah Poling case came to light, namely that fever can be associated with autistic regression in children diagnosed with autism and mitochondrial disorders. It says little or nothing about whether fever can cause autistic regression in a child with mitochondrial disorders and no evidence of neurological dysfunction or whether vaccines can induce autistic regression in such children. What it does say is that fever is a problem for children with mitochondrial disorders, and who is likely to get more fevers due to febrile illness, children who are vaccinated or children who are unvaccinated? In fact, the recommendation is that children with mitochondrial disorders should be vaccinated.
But let's for a moment accept Kirby's argument as valid--for the sake of argument, nothing more. As I've pointed out time and time again, Kirby's desperate argument is in effect an admission that the anti-vaccine movement has lost, that it's utterly failed, and that it's original claims have been soundly refuted by science. It is an admission of defeat. After all, remember what antivaxers originally claimed a few years ago. It wasn't that vaccines might trigger autism in a small number of genetically predisposed children. Oh, no. That wasn't nearly grandiose enough a claim. Rather what antivaxers used to claim was that vaccines are responsible for the "autism epidemic." Not a few children, an epidemic of autism. Indeed, the whole premise of Kirby's book Evidence of Harm was that the thimerosal additive in childhood vaccines was fueling an "epidemic of autism, ADD, speech delay and other disorders in America's children," not a rare reaction in the odd child or two with an rare mitochondrial disorder. An epidemic. The same is true of the MMR, vaccine, which, in the years following Wakefield's study, has also been blamed for an epidemic of autism. Bernard Rimland, for instance, has written:
I was the first to announce the "autism epidemic", in 1995, and I pointed out in that article that excessive vaccines were a plausible cause of the epidemic. As you know, an enormous amount of clinical laboratory research (as opposed to epidemiological research), has been accumulated since that time, supporting my position. (I did not know then that the vaccines contained mercury, although I had been collecting data since 1967 from the mothers of autistic children, on any dental work they may have had during their pregnancy.) The evidence is now overwhelming, despite the misinformation from the Centers for Disease Control and Prevention, the American Academy of Pediatrics and the Institute of Medicine.
Blaming vaccines for the surging numbers of autism diagnoses since the mid-1990s was, of course, a classic case of confusing correlation with causation. Time and time again, we've seen the antivaccine movement claiming that the increase in the vaccine schedule in the early 1990s is responsible for the skyrocketing autism prevalence that was (and sometimes still is) painted in near apocalyptic terms at times. Yet now Kirby and the anti-vaccine movement are in effect arguing that if a child with a rare genetic disorder (say, mitochondrial disorders leading to symptoms) gets a certain combination of vaccines at the right time (when the moon if full perhaps?), that child might have a reaction that might lead to regressive autism. Even if this were true, the end result would be a vanishingly small number of children who would be effected, and there's no good evidence that it is true. All Kirby has is his uninformed extrapolation based on a few carefully selected studies.
So much for the vaccines causing an "autism epidemic." Even David Kirby seemingly admits that it is impossible, given how he's grasping at straws yet again. I must admit, though, he's very clever at it. He might almost have you believing that the vaccine-autism hypothesis isn't pining for the fjords, as he swears, like a mad scientist in a B movie that he'll "show them all":
Another fact that gets little attention in this never-ending debate is that more than 1,300 cases of vaccine injuries have been paid out in vaccine court, in which the court ruled that childhood immunizations caused encephalopathy (brain disease), encephalitis (brain swelling) and/or seizure disorders. Encephalopathy/encephalitis is found in most if not all ASD cases, and seizure disorders in about a third of them.If we know that vaccines can cause these injuries, is it not reasonable to ask if they can cause similar injuries that lead to autism? (Stay tuned as those 1,300 cases come under closer scrutiny).
Of course, no reputable scientist denies that rare vaccine reactions result in encephalopathy. After all, if there weren't rare adverse reactions to vaccines, the vaccine court wouldn't exist. It wouldn't need to. Implying that scientists believe that vaccines never cause harm is nothing more than a strawman so large that its like is rarely seen outside of the Burning Man Festival, and Kirby's just the guy to set the torch to it, to the oohs and ahhs of the assembled crowd of his antivaccine fans. I'd also like to know where he got the idea that encephalopathy and encephalitis are associated with "most, if not all" ASD cases. That sounds like the classic misuse of a study, as so well described by Trine Tsouderos, to me. Sadly, Andrew Wakefield and his defender David Kirby remind me more and more of the Black Knight in Monty Python and The Holy Grail taking on science:
Yep, the GMC ruling and the Lancet retraction are just "flesh wounds."
Ironically, though, as I pointed out earlier, Kirby is right about one thing. The Wakefield retraction doesn't change anything at all in terms of the manufactroversy regarding vaccines and autism. It's good that the GMC ruling gave the Lancet's editors the opening they appeared to have been looking for to retract Wakefield's paper and save some bit of face, but it is unforgivable that they waited six years longer than they should have. In that, they've been cowardly, weasely, and utterly failed in their responsibility as the stewards of a high impact journal and the medical science contained therein. I guess it's better that they finally did the right thing late rather than never, but their delay has besmirched the reputation of the Lancet for a long time to come.
Medicine & Health
Comments
At the urging of a former coworker, I rewrote a song for St. Wakefield.
Chorus:
Give me those old time diseases
Give me those old time diseases
Give me those old time diseases
They're good enough for me
Make me infect everybody
Make me infect everybody
Make me infect everybody
That's good enough for me
(chorus)
They are good for Third World children
They are good for Third World children
They are good for Third World children
And they're good enough for me
(chorus)
It's Darwin at his finest
It's Darwin at his finest
It's Darwin at his finest
That's good enough for me
(chorus)
They will shorten my lifespan
They will shorten my lifespan
They will shorten my lifespan
That's good enough for me
(chorus)
Sing praises to Saint Wakefield
Sing praises to Saint Wakefield
Sing praises to Saint Wakefield
He's good enough for me
(chorus)
Posted by: C. Corax | February 3, 2010 8:58 AM
"especially in the last year or two" surely a typo, shouldn't in be "especially in the last year of woo"...
Posted by: Charlie | February 3, 2010 9:00 AM
"Once again, there is almost no such thing the "autism epidemic." The apparent increase in autism prevalence is almsot certainly a result of several factors, including widening of the diagnostic criteria back in the mid 1990s, increased awareness, and diagnostic substitution."
My husband was not diagnosed with Asperger's as a child because his parents didn't want to label him. When he was in third grade the teacher called and told his mom that she thought his social development was slightly off. But his mother thought that he would 'grow out of it' and didn't want to give him an excuse to not try.
I don't know if he would have been diagnosed back then if she had him evaluated or not (early 80's), but the signs were there. I know he can't be the only high-functioning adult that fell through the cracks as a child.
Posted by: Kristen | February 3, 2010 9:29 AM
BTW, my blockquotes didn't work. Is HTML not working?
Posted by: Kristen | February 3, 2010 9:33 AM
I'd think the anti-vaxxers would give up on and try to wash their hands of Wakefield and his vaccine-autism thing. I mean, it's not like they have any credibility anyway, but you'd think they'd at least try to put on the appearance of sensibility here.
Posted by: Party Cactus | February 3, 2010 9:51 AM
"I believe that the public lynching and shaming of Dr. Wakefield is unwarranted and overwrought"
Actually, given that spreading FUD about vaccines --> sick kids --> dead kids, the public shaming and spanking of Dr (for how much longer?) Wakefield is fully deserved. One could even say that the punishment is not very harsh...
Posted by: Christophe Thill | February 3, 2010 9:52 AM
I know he can't be the only high-functioning adult that fell through the cracks as a child.
Geeze, do I have a hard time with this. I was labeled "genius IQ, low social functioning," "bright but immature," and "having read every book in the house but can't deal with the real world" as a young girl and teenager. I asked my mom about ten years ago if she thought the Asperger's definition fit me, and she said no, but she could see where someone might think so.
I am now a corporate trainer in the IT department of an international energy company. My classes are extremely well-received by the 99 percent of my class participants who are engineers and IT support staff. I frequently get comments like, "I really enjoy your classes. You know just how to explain things."
A young engineer came up to me at the end of my last class, and asked me if I knew what Asperger's was. I told her that I did, and asked her why she brought it up. She said she had been diagnosed with it, and that she thought I might have been too. I just said I didn't know, and I kind of laughed. If I am, which I mostly doubt, I'm hard put to say how I'm impaired by it now.
Posted by: badgersdaughter
| February 3, 2010 9:57 AM
After the vile baby-eating post on AoA, why would you expect the plague rats to care enough about their image to appear 'sensible'? They've hopped down the rabbit hole of cultish pseudoscience and they have too much ego invested to admit they're wrong and move on. All they can do is attack; it's all that can distract them from the horrible reality of their position.
Posted by: Bob | February 3, 2010 10:03 AM
This would require them to consider the situation at least semi-rationally to recognize Wankerfield as a liability. But if they were at all inclined to rationality, they wouldn't be anti-vax.
Irrational gullible loons acting like irrational gullible loons is not really surprising.
Posted by: Scott | February 3, 2010 10:28 AM
Orac, great post, but you'll want to go back and clean up the typos. You must still be in a post-grant daze.
Once again, there is almost no such thing the "autism epidemic." The apparent increase in autism prevalence is almsot certainly a result of several factors, including widening of the diagnostic criteria back in the mid 1990s, increased awareness, and diagnostic substitution.
The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education
Posted by: Anonymouse | February 3, 2010 10:29 AM
Anybody want to set up a betting pool for when the website ThirteenStudies gets produced?
Posted by: t_p_hamilton | February 3, 2010 10:31 AM
In many cases a diagnosis should open doors to treatment options but the anti-vax idiots want it to be a label of shame. A label which could identify areas where extra care is needed is being used as a millstone around the kid's and parent's necks.
Twelve years wasted. Huge sums of money wasted. Rising numbers of vaccine preventable disease outbreaks. All because ijit andy lied. And is still lying.
Posted by: MikeMa | February 3, 2010 10:36 AM
True, the *Lancet*'s retraction will change *nothing* for those most invested in Wakefield: those who blog antivax, sell products or treatments related to his hypothesis,those with an axe to grind against the medical establishment or whose hackles were raised by pharmaceuticals' rising profits,those who owe their fleeting fame to their association with the movement....Hopefully, people *influenced* by this inner circle will re-consider in light of this new information- remember, Wakefield's project was originally given prestige by being published in the *Lancet*.((concerning Wakefield,Kirby, Loe Fisher,McCarthy, and other "insiders"- here is a parallel- although most sane people today are HIV/AIDS realists,a small coterie of denialists remain: the perpetrators (Duesberg, the Perth group, and other "scientists"), the publicizers-(including bloggers, writers, and woo-meisters like Crowe,Null,and Adams), and unfortunate followeres - including the late Christine Maggiore))
Posted by: Denice Walter | February 3, 2010 10:40 AM
True, the *Lancet*'s retraction will change *nothing* for those most invested in Wakefield: those who blog antivax, sell products or treatments related to his hypothesis,those with an axe to grind against the medical establishment or whose hackles were raised by pharmaceuticals' rising profits,those who owe their fleeting fame to their association with the movement....Hopefully, people *influenced* by this inner circle will re-consider in light of this new information- remember, Wakefield's project was originally given prestige by being published in the *Lancet*.((concerning Wakefield,Kirby, Loe Fisher,McCarthy, and other "insiders"- here is a parallel- although most sane people today are HIV/AIDS realists,a small coterie of denialists remain: the perpetrators (Duesberg, the Perth group, and other "scientists"), the publicizers-(including bloggers, writers, and woo-meisters like Crowe,Null,and Adams), and unfortunate followeres - including the late Christine Maggiore))
Posted by: Denice Walter | February 3, 2010 10:40 AM
Sorry- I don't know how that happened!
Posted by: Denice Walter | February 3, 2010 10:43 AM
Who is David Kirby, and what gives him the right to tell lies about reality?
What a mockery of journalism he engages in.
Posted by: Free Lunch
| February 3, 2010 10:45 AM
@BadgersDaughter You have to remember that things like autism and asperger's are spectrums: everyone's on them somewhere.
Posted by: Sam Cook | February 3, 2010 10:48 AM
The Lancet Retracts! [from AMA Member Communications]
Lancet formally retracts paper linking vaccine to autism.
ABC World News (2/2, story 7, 0:30, Sawyer) reported that "one of the world's most respected medical journals," The Lancet, is "formally retracting an article that...sparked a fierce debate." The "1998 study...linked the vaccine for mumps, measles and rubella to autism," which "led to a drop in vaccinations and a jump in measles cases," the CBS Evening News (2/2, story 9, 0:30, Couric) reported. But, "25 studies in all have found no link between the vaccine and autism."
The move "is part of a reassessment that has lasted for years of the scientific methods and financial conflicts of Dr. Andrew Wakefield," whose "research showed that the...vaccine may be unsafe," the New York Times (2/3, Harris) reports. Last week, "a British medical panel concluded...that Dr. Wakefield has been dishonest, violated basic research ethics rules, and showed a 'callous disregard' for the suffering of children involved in his research." A spokesman for the CDC said the retraction "builds on the overwhelming body of research...that concludes there is no link between MMR vaccine and autism."
The Washington Post (2/3, Kelland) reports, "The Lancet said that after the" panel's "ruling, it was clear that parts of Wakefield's paper were wrong." The journal "highlighted, for example, assertions that investigations of children for the study were 'approved' by the local ethics committee." Richard Horton, editor in chief of The Lancet, said the journal was especially concerned that Wakefield's study specifically chose certain children to participate rather than testing those who arrived at the hospital as described in the study, the Wall Street Journal (2/3, Wang) reports.
The AP (2/3) reports, "The retraction...comes a day after a competing medical journal, BMJ, issued an embargoed commentary calling for The Lancet to formally retract the study." The BMJ "said once the study" was published, "the arguments were considered by many to be proven and the ghastly social drama of the demon vaccine took on a life of its own."
"Despite multiple subsequent studies that have refuted the link, vaccination rates have remained lower than they were before" Wakefield's study, the Los Angeles Times (2/2, Maugh) reported. BMJ editor Dr. Fiona Goodless said the retraction "will help restore faith in" the vaccine "and in the integrity of the scientific literature."
Bloomberg News (2/3, Cortez), Reuters (2/2), WebMD (2/2, DeNoon), HealthDay (2/2, Gardner), CNN (2/3, Park), and MedPage Today (2/2, Gever) also covered the story.
WSJournal criticizes Lancet over vaccine-autism link article. In an editorial, the Wall Street Journal (2/3) criticizes British medical journal The Lancet for apologizing for a study published in 1998 that linked the measles-mumps-rubella vaccine to autism. The Journal says the article gave credence to vaccine skeptic Dr. Andrew Wakefield, and resulted in a reduction of vaccinations despite evidence to the contrary.
Posted by: rz german | February 3, 2010 10:52 AM
Luckily, that's not an issue for Wakefield.
Posted by: James Sweet | February 3, 2010 11:00 AM
I have a friend who, although never clinically diagnosed, almost certainly would have been diagnosed with Asperberger's up until his mid-20s. This wasn't just ordinary nerd-grade poor-social-skills... he was a totally functioning adult, but he was unable to pick up on any implicit social cue in a conversation whatsoever. None at all.
He worked really hard on it and has it pretty much completely under control now. He's still a bit nerdy (aren't we all!) and for those who knew him then you can still spot signs of it here and there... but I think he's aware enough of it to keep it under control.
And just like you say, it's hard to argue that he's really "impaired" in any way.
This is the mild end of the autism spectrum though... heh...
Posted by: James Sweet | February 3, 2010 11:04 AM
A story about the Lancet retraction was on our local news last night. My brother the plumber said "Wow. Retracted the paper. That's really, really bad, right?" Yes. Yes, it is.
Posted by: Angel | February 3, 2010 11:06 AM
Aw, where's Sid Offit? I could sure use some of his trenchant analysis right about now...Sid? Siiiiid...!!!
Posted by: howdini | February 3, 2010 11:21 AM
@ James Sweet,badgersdaughter, & for the morbidly curious:Cambridge's Simon Baron Cohen** has a self-test(AQ) that you can easily find on line to see what issues are involved- (although don't stake your life or make any bets based on an online test)...**(yes,he's "Borat"'s cousin)
Posted by: Denice Walter | February 3, 2010 11:23 AM
I had fetid dingo kidneys for breakfast this morning. Good with a little tabasco on them...
Posted by: AZSketpic | February 3, 2010 11:43 AM
What I want to know is how did someone paint a picture of my prelim exam 540 years before I took it.
Posted by: JohnV | February 3, 2010 11:59 AM
I'm certainly not srguing that autism is an epidemic and I believe the current evidence is correct in pointing to better diagnostic tools, increased awareness, and diagnostic substitution as the most pertinent factors in the increased prevalence. Most of the papers that support these variables note that a true increase in prevalence can't be ruled out. That's partly because we would be comparing apples and oranges (though there was the recent UK study suggesting that 1% of the adult population in the UK has an ASD). What should be kept in mind, however, is the fact that there are many more people with ASDs than were thought to be there. Given this, there should be recognition that there is a greater need for funding of educational, clinical, vocational, etc. services.
Posted by: BA | February 3, 2010 12:10 PM
I always thought the term "epidemic" was only ever used in regards to communicable diseases, in which case the phrase "autism epidemic" would be demonstrably laughable. Is this not the case?
Posted by: Dan | February 3, 2010 12:21 PM
@26:
Well said! That is a point which sometimes seems to get lost in the arguments over vaccines. It's appalling that so much money and attention has to be diverted to beating a dead horse when it could instead be spent on the worthy needs you list instead.
Posted by: Scott | February 3, 2010 12:21 PM
This solution (called 'passing' in the autistic community) probably works well for his friends and relatives - in terms of outward appearance - but (from experience) I bet it doesn't work too well for him personally.
Posted by: Joseph | February 3, 2010 12:38 PM
Good article in the NYT by Lisa Belkin.
Posted by: MikeMa | February 3, 2010 12:40 PM
Yes, that argument has been made. For example, see this statement by Jim Sinclair.
The incidence of Down Syndrome seems to be increasing. It would be incorrect to define this as an epidemic, would it not?
Posted by: Joseph | February 3, 2010 12:44 PM
@howdini
Aw, where's Sid Offit? I could sure use some of his trenchant analysis right about now...Sid? Siiiiid...!!!
----------------------
Just got here. Remember I'm on west coast time. I was never took a position on Wakefield so I really don't have much to say on that issue, but I'm sure I'll find something in the thread about which to post. Thanks for thinking of me.
Posted by: Sid Offit | February 3, 2010 12:47 PM
Just posted the following in response to a comment on Kirby's article at AoA, cross-posting here in case I get censored:
Posted by: Todd W. | February 3, 2010 1:19 PM
Ah, David Burd... He wrote a post in October or so saying that Australia had no H1N1 vaccine (they did) and wasn't suffering flu fatalities (fifty new deaths were reported in one week). I had an amusing time roasting him. I'm surprised even AoA let him come back.
Posted by: David N. Brown | February 3, 2010 1:52 PM
Heh. On their sliding scale, that qualifies as a cogent argument.
You have to work really hard to get kicked out of the AoA community.
Posted by: a-non | February 3, 2010 2:08 PM
I find this to be true. I don't think autistic people need to learn to fit in so much as find a place where they are accepted. My husband works in IT and he does very well as long as he doesn't have to deal with people too often. He does have to do presentations from time to time, but he always comes home and asks me what people mean when the say this or that. This is just how he is, and I certainly don't think he needs to change.
This works well for him, but it might not for someone else. Grown people with Asperger's are not disabled, they just don't fit in with societies version of normal.
Posted by: Kristen | February 3, 2010 2:40 PM
@Mikema (#30): Great article you linked to. And, for at least the first 2 pages of comments, there are NORMAL people commenting, and, for the few who are anti-MMR/vaccine, the others are pointing out their errors. It's so nice to see that the majority of people don't believe in the "MMR/vaccines/too many too soon/whatever cause autism" crap.
Posted by: triskelethecat
| February 3, 2010 2:49 PM
Just to add my two cents: the NIH did a study and found that rates of ASDs in adult populations were the same as those in child populutions:
http://www.physorg.com/news172845617.html
I'm surprised that no-one's picked up on this finding. Was there something wrong with the study? I'm a layman and found the study reasonable, but maybe I missed something. However, this seems to jive with my own, admittedly anecdotal, experience: there are way more of us adult Aspies and Auties walking around than people realize.
OT: I hope US authorities will look into Wakefield and yank his licenses to practice here in the States. What he has done was done so with callous disregard for the consequences. I'm surprised it has taken so long.
Posted by: Rjaye | February 3, 2010 3:06 PM
Actually, Wakefield doesn't have a license to practice in Texas, which is where Thoughtful House is located. He's listed as "research staff." Of course, he does appear to have a lot of input into treating the children there; one wonders if a case could be made that he is practicing medicine without a license.
Posted by: Orac | February 3, 2010 3:08 PM
I'd guess that if you made the pilgrimage to Thoughtful House, you'd be irked if you didn't get to see the great and powerful
ozandrew. I wonder if he's got a Dr Wakefield nameplate/badge/directory listing there?I also guess you'd be hard pressed to make a case that he's practicing without a license if he's got real (albeit crappy) doctors on staff.
Posted by: MikeMa | February 3, 2010 3:44 PM
@38 & 39
If he isn't licensed to practice in Texas, or, indeed anywhere in the US, isn't he already practicing without a license regardless of whether he's been 'struck off' in the UK? It's not like he could have any sort of courtesy appointment, right? I guess i would think that someone would have pursued the 'practicing without a license' charge already if it was going to happen at all, but admittedly I know very little about medical licensing and the privileges they confer.
Posted by: Jennifer B. Phillips | February 3, 2010 3:46 PM
That was actually the NHS from the UK, which is kind of like the NIH in the US.
I don't think anything was wrong with it, but its methodology was novel. Essentially, they came up with a case-finding method that can work with unreliable screening tools. In fact, they made up a screening tool, the AQ-20, based on the well-known AQ test (which has 50 questions, as opposed to 20.) Even so, it took several person-years to do stage 1. This just comes to show how expensive and difficult it is to do an adult study. In a child study, the fact that children attend school helps.
Of course, since the screening tool was expected to fail much of the time, they had to project prevalence, and this is the part of the study that is most often criticized. The calculations they made are probabilistically sound, though.
There's a prior study that is not very well known: Kadesjö et al (1999). The "children" from this study were born in 1985, so they've been adults for a while now. The prevalence was 1.2%.
Posted by: Joseph | February 3, 2010 4:37 PM
Arthur Caplan has weighed in, and he pulls no punches going after St. Andy:
How A Zealot's Word Led Us Astray on Autism
http://www.msnbc.msn.com/id/35218819/ns/health-health_care/
Posted by: Michelle | February 3, 2010 4:37 PM
The irony of being diagnosed with an autism spectrum disorder by a woman who by her own admission has no gift for reading social cues suddenly struck me just now.
Posted by: badgersdaughter | February 3, 2010 4:43 PM
Arthur Caplan is great. I interviewed him once for a magazine article and he knows how to explain science simply but not simplistically.
Posted by: Anonymouse | February 3, 2010 7:49 PM
Joseph, thank you for the answer. I was wondering but I hope there will be follow up studies of some kind.
As for Wakefield operating in the States, doesn't he have to have some kind of "credentials" to act as any kind of medical consultant? Doesn't he need some kind of paper in order to oversee any "qualified" doctors on his staff, especially if he is operating under his direction?
If he can operate without any accountability in the US due to some loophole, it would be terrible...and make my head hurt.
The Caplan article was right on.
Posted by: Rjaye | February 3, 2010 10:09 PM
I should think that two big handicaps of Asperger's would be in finding a mate and avoiding arguments. The subtle indications of interest would slide right by with no return, and so would rising tensions as tempers fray.
Posted by: monado
| February 3, 2010 11:12 PM
Orac, I am not an anti-vaxxer but can you be more precise about the following:
"Of course, no reputable scientist denies that rare vaccine reactions result in encephalopathy. After all, if there weren't rare adverse reactions to vaccines, the vaccine court wouldn't exist."
Specifically, how "rare" are these reactions and which vaccines cause them?
Posted by: Alex | February 4, 2010 12:50 AM
Monado, on the other hand people with AS are easy pickings when someone comes along who is willing to skip the subtle indications of interest - my father never had a girlfriend before he met Mum. Mum says that she decided when she first met him that here was a man she wouldn't get bored with, and her only problem was that both her flatmates thought the same thing.
Posted by: Tracy W | February 4, 2010 4:24 AM
Actually, as a person surrounded by engineers and IT nerds, I have a theory that all men are autistic to a degree. Some techy women as well, including me. Otherwise we couldn't manage that fierce uncompromising concentration for days at a time.
It is probably a prerequisite for being good at science.
Posted by: OurSally | February 4, 2010 4:48 AM
@Alex (#48): To briefly answer your question: ALL vaccines can cause reactions. All vaccines have the risk of causing adverse reactions. (All things can cause reactions in some one...think of peanut allergies. I love peanuts. A friend of mine is deathly - almost literally, although it didn't happen thanks to modern medicine - allergic to them).
If you want to know how rare a reaction is, a good place to start is Todd W's website (click on his name at comment #33). He compiles a lot of really good, factual information there.
You can also search for specific vaccines and read the package inserts from the drug companies; they usually give known reactions and the frequency.
The first hit I get with googling vaccines and side effects is: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm. They also give the frequency of all known side effects (those actually linked with the vaccine, not those made up by the antivax legions.)
Posted by: triskelethecat
| February 4, 2010 7:02 AM
@triskelethecat: What scared me a bit in the passage I quoted from Orac's post is the word "encephalopathy". I understand that side effects are mostly minor like fever and that kind of thing, but encephalopathy is pretty serious.
Posted by: Alex | February 4, 2010 11:25 AM
@Alex
Another good resource is the CDC's Some Common Misconceptions page. They list a couple common vaccines and compare the risks from vaccine injury to the risks from the diseases they prevent. For example, encephalitis from measles is about 1 per 1,000. Contrast this with encephalitis from the vaccine's risk of 1 per 1,000,000 (note that this figure also includes severe allergic reaction).
Posted by: Todd W. | February 4, 2010 12:22 PM
Cross-posting the following comment that I left on AoA's article "The Lancet Retraction", responding to a commenter there:
Posted by: Todd W. | February 4, 2010 12:35 PM
@Alex: yes, encephalopathy can be scary. It can be caused by many things. Bacterial infections, viral infections can also cause it. And, as Todd points out, the risk of measles encephalopathy is far greater from the illness itself than it is from the vaccine. (In case you aren't medically educated, you may not be aware of the nomenclature... "-itis" simply is the suffix that means inflammation, -"pathy" refers to the disease state itself).
Posted by: triskelethecat (MI Dawn) | February 4, 2010 1:24 PM
Orac notes that Andrew Wakefield stated, back in 1998:
This gives some insight into Andrew Wakefield's continued denial of wrongdoing (or even error). He is convinced that to be wrong would make him a "bad person". What he seems incapable of admitting (even to himself, I suspect) is that he is only a "bad person" if he persists in error despite being shown where he was wrong.
Nobody in the scientific community (or the medical community, I imagine) expects their members to be 100% correct 100% of the time. What is expected is to own up to mistakes and do what is needed to correct them.
If, at some time in the past 12 years, Andrew Wakefield had publicly admitted that his research was tainted by undisclosed conflicts-of-interest and that he had ignored data showing that his conclusions were wrong, then he might have been able to salvage some portion of his reputation (meagre though it was) as a researcher.
To persist in claiming that he (Dr. Wakefield) is right and that all the researchers who disproved his findings are not only wrong but persecuting him....well, that's not the mark of a healthy psyche. Even if a miracle occured and Wakefield's findings were correct, he would still need to explain why so many other researchers can't find the same things he did and why his reported findings - in at least one of his published studies - don't agree with the data his study team collected.
Given that Dr. Wakefield has declined to address these substantive concerns (and has, instead, attacked the people questioning him on his methods, his ethics and his data), I am left to conclude that he doesn't have any satisfactory answers.
Claims by his "fans" that there is a "conspiracy" to damage Dr. Wakefield's reputation don't answer the questions raised about his research. If anything, these claims raise additional questions - about the sanity of his supporters.
Prometheus
Posted by: Prometheus | February 4, 2010 1:52 PM
my fear from reading the detailed GMC report - is that the GMC will not find his unethical, callous, lying behaviours severe enough for him to be struck off.
Posted by: wotnoquack | February 4, 2010 3:08 PM
He isn't. I didn't receive an ASD diagnosis until I was 22, and had learned to cope well enough on my own that my psychiatrist got cold feet about actually applying the "Asperger's" label specifically, despite the fact that my issues as a child almost categorically matched the disorder's description. Unfortunately, every clinician I saw as a minor had to be dragged kicking and screaming away from the idea that I was "just a brat" and I wound up with a cyclothymia misdiagnosis stuck to me for most of my adolescence. My parents raised the Asperger's possibility with some of those psychiatrists and they summarily refused to consider it.
Posted by: Azkyroth | February 4, 2010 7:26 PM
@Todd W.: Thanks for the info (especially the statistics). What I don't understand is how the vaccine can still give emcephalithis (or pathy -- no, I'm not in Med lol). I mean there's only a very small ammount of the virus in there and it's mostly dead or attenuated. 1/1,000,000 is low but considering how much lower the rate should be, it's a bit weird.
@triskelethecat (MI Dawn): Yeah I got the shot. My issue wasn't whether or not the vaxx was better than the disease. What actually is scaring me is whether or not it was effective and whether or not I am now immune. Encephalithis is pretty scary and I don't know if there's a cure.
Posted by: Alex | February 5, 2010 10:50 AM
@Alex
I'm not certain as to the specific cause of encephalitis from the vaccine. 1 per 1,000,000 is getting into the realm of chance occurrence. With that kind of rarity, it's really hard to pinpoint with certainty the actual cause. Where the vaccine is concerned, it is most likely largely based on temporal correlation combined with a lack of other known causal factors.
As to efficacy, once the series is completed, I believe the MMR is around 95%-99% effective. I'm going on memory, so I might be wrong, but more likely than not, you're going to be protected. So, if you get the vaccine, the likelihood that you would get encephalitis from the disease is vanishingly small. You would be more likely to be severely injured in an auto accident.
If you have any other concerns about either the vaccine or the disease, I would recommend talking with your doctor or getting in touch with some of the docs over at Science-Based Medicine, like Dr. Mark Crislip, who is an infectious disease specialist.
Posted by: Todd W. | February 5, 2010 11:15 AM
@Todd W.:Yeah I got it already and was just having some questions about it. Thanks a lot for the info and the sources of info.
Posted by: Alex | February 5, 2010 1:37 PM