And now for something completely different. I read the original paper that supposedly linked autism to the measles/mumps/rubella (MMR) vaccine (link). I know that this can get to be a heated topic, but for the moment I'm going to try to focus on the paper itself. (Of course I'm going to be biased, but I'll try not to be!)
The paper suggests that a new disorder has been discovered. Characteristic of this disorder is a combination of inflammatory bowel disease (IBF)-like symptoms, combined with autism-like symptoms. The most notable feature of this disorder is that sufferers consistently presented with it between 24 hours and 18 months of receiving the MMR vaccine. Most sufferers presented with symptoms within two weeks. Such a disorder would be quite interesting, as the gastrointestinal tract and brain are two very different areas. The author's original data in support of this disorder was a case study of 12 people. Shortly after the paper was published with the original 12, an additional 40 patients were observed, of whom 39 were found to have this new syndrome.
Those are the facts, as presented by the authors. Without going beyond the paper, this is not very convincing data of a new disorder. Within the paper itself, there is only complete data presented for the original 12. Of these 12, there is still considerable variability between patients. Additionally, there is no control group; these 12 were hand picked by the authors. The authors openly acknowledge this. This was published as an "Early Report", and was more or less intended to be a springboard from which further research could be conducted. To directly quote the paper, "We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described." Though the evidence suggests an association, there is simply not enough data to be able to make a scientifically valid determination. Even if there is sufficient data to back an association, then one must determine if the relationship is causative or merely correlation. (For example, when hot cocoa drinking is up, the crime rate goes down. The reason is that it's typically cold when people drink hot cocoa, and the crime rate is known to drop in cold weather.) Medical case studies need hundreds if not thousands of patients to be able to draw any hard and fast conclusions, and 12 patients is not enough to make such a claim.
Now I'll go beyond the paper. For one, the main author (Dr. Wakefield) was covertly being paid by a law firm that was intending to sue the MMR vaccine manufacturers. This is a conflict of interest. Generally, conflicts of interest are rare in published research. If they exist at all, they should be openly acknowledged. (Here is a link to a paper with an open acknowledgment of a conflict of interest.) This is a red flag. Science is supposed to be as objective as possible, but with a conflict of interest it can be disadvantageous to be objective.
The more troubling problem is that most of the data itself is just plain not true. Although 10/12 patients were listed as having something classifiable as autism (9/12 if you ignore data with question marks next to it), it was revealed that 3 of them never had a formal diagnosis. Only a professional can make such a diagnosis. Many of the symptoms of autism appear in other disorders, and only someone skilled in seeing all these disorders can actually make this judgment. (I'm sorry, you cannot diagnose yourself as having a complex disorder just by reading a few pages on Wikipedia.) As such, this is fraud.
Another point is that earlier drafts of the paper used lengthier values for the time between exposure to MMR and first signs of symptoms. As it came closer to the final draft, these time intervals shrank dramatically.
A third point is that much of the data was acquired not directly by doctors at the time of visit, but rather by parents at other times. In the case of one of the children, such data was not acquired until 2 1/2 years until after symptoms first appeared. For something as complex as autism, nonspecific data acquisition is not sufficient. There are particular things that professionals look for, preferably directly as opposed to through a medical file.
I could go on and on about the different kinds of fraud and deception that occur in this paper. A complete description of all these things can be found in here. Note that this is from BMJ, which is a peer-reviewed source of legitimate medical information. This is not some random website that some anonymous person made. I must make that point clear, as there is a lot of misinformation on the Internet regarding this situation.
There have been a substantial number of follow-up peer-reviewed publications that have shown no link between autism and vaccinations, including this one. However, the damage has already been done. Many members of the general public think that there is a link because of this paper. It has left a bad taste in people's mouths, with big bad science coming along to give our children autism. This blog post is just going to be part of the fodder in this battle, which will likely continue without merit for years to come.
People who still think there is a link will likely associate me with some evil corporate machine, and dismiss me. Fine. It would not be the first time someone has written me off that easily. Let's assume there is a link, that this paper was correct, that it should never have been retracted, and this is all part of some conspiracy to cover the truth. So if that's all true, then why does no one relate vaccinations to inflammatory bowel disease? The bulk of the data of the paper is in support of IBF, not autism. Dr. Wakefield is neither a psychologist nor a pediatrician, though he does specialize in the gastrointestinal tract. The paper is not suggesting a link between autism and MMR - it is suggesting a link between autism, MMR and IBF. It brands the combination of these three under a new disorder. Removing one element means something else entirely, something the authors were not discussing. In other words, if one believes what this paper is claiming, then it is self-contradictory to say that there is a link between autism and MMR without IBF involved. As to how it happened to be autism and not IBF that was picked up by the media I'll never know.
No comments:
Post a Comment