Go to any medical educational meeting, and you’ll usually find individuals giving Powerpoint presentations that, when you boil down to it, sell the merits of a drug or device. Such presentations are usually delivered by doctors who are sometimes known as ‘key opinion leaders’ or ‘KOLs’. Being doctors, one might imagine that these doctors give their objective, independent view of the drug or device of which they speak. In reality, though, key opinion leaders are usually paid by pharmaceutical or medical device companies, and might just be viewed as ‘drug reps’ according to one industry insider.
The issue of Key opinion leaders and their payment came to light in this week’s British Medical Journal [1]. Attention to the practice of using key opinion leaders was drawn by Kimberly Elliott who had been a drug company sales rep for almost 20 years. Ms Elliott describes how doctors are initially approached by drug companies and ‘interviewed’ to gauge their opinion and attitude to relevant medical matters and their treatment. Those whose views match the drug company’s own objective are then ‘groomed’ by the company.
This process entails the drug company providing speaking opportunities for these doctors that helps raise their profile and help morph them into key opinion leaders and ‘product champions’. The drug company will often provide the very slides that are used for the basis of the presentations. And doctors tend to be well paid for their efforts too. Ms Elliott, for instance, paid doctors $2500 (�£1280) for a single lecture, and delivering more than one lecture in a day could allow doctors to earn several thousand dollars in a single day.
According to Elliott: These people are paid a lot of money to say what they say. I’m not saying they are bad, but they are salespeople just like the sales representatives are.�
The money paid to key opinion leaders is not for nothing though: the performance of these hired helps is monitored, and if their efforts do not lead to cost-effective increases in sales, they are dropped.
In the BMJ piece Richard Tiner of the Association of the British Pharmaceutical Industry is asked how doctors in the pay of drug companies can retain their independence. His reply referred to the fact that these doctors are free to speak about other drugs and that their presentations are often quite balanced.� His suggested cure for the malady of the sometimes cosy professional and financial relationship between doctors and drug companies is transparency: Doctors should be declaring their potential conflicts of interest whenever they speak.
The articles also cites Harvard University researcher David Blumenthal who has a special interest in the area and whose opinion is that the payment of doctors by drug companies to promote a particular message or product might not be in the best interests of the public, including the patients served by these doctors. He and others have called for the scaling back of influence that drug companies have over doctors and their education.
In the meantime, what are doctors to do? Ms Elliott advises doctors who attend KOL presentations to take them with a grain of salt and go back and do your own research.� However, it’s important to bear in mind that the messages propagated through key opinion leaders gets out into the mainstream too. This means that not just doctors but members of the public too may need to do their own research. My opinion is that the internet now allows unparalleled opportunity for this, and for the uncovering of information that isn’t the usual party line on a some drug or treatment.
References:
1. Moynihan R. Key opinion leaders: Independent expert of drug representatives in disguise? BMJ 2008;336:1402-1403
“I am against what has been termed the “Nirvana fallacy” – the concept that if one cannot do something that is proven to be 100% safe, then it is better to do nothing. Many antivaccine campaigners apply this irrational principle to the issue of vaccination. Vaccination may not be completely risk free, but the alternative of no vaccination is far more likely to lead to death, disability or other harm.”
This does not represent the situation at all. Most “anti-vaccine” campaigners are vaccine safety campaigners, who accepted the proposition of the lesser risk when they vaccinated. The trouble is that it is difficult to see what the basis of the risk-benefit equation is, when their cases are subject to aggressive dismissal, non-investigation, professional persecution of anyone who shows concern for the problem – all of which are (a) sources of bias (b) means that if it does go wrong, so far from being supported you will be subject to huge amounts of personal unpleasantness if you speak out of turn.
One thing I deduce from the weak evidence base for MMR safety, is that most studies were desperately evading detecting a likely effect. In the case of the Madsen and Honda studies the problems have been mentioned, and the aggressive dismissal does not suggest that Ross, David & co really mind what happens providing a negative relation is found. That is bias.
The most bizarre case was when Prof Fombonne (involved in so many of these studies) produced a study in which the PDD rate in a district of Montreal was comparen not with the MMR vaccination rate for the province of Quebec in which Montreal is situated, but with the vaccination rate in Quebec City 265km away. All Ross and David will do is pretend I am weird for pointing it out.
http://www.vaproject.org/yazbak/tale-of-two-cities-20070307.htm
That is how much they care for the conduct of science in reality.
No, you are not weird for pointing out Yazbak’s criticisms. But it’s worth considering evaluating the criticism as well as the study:
“When he was in France, Dr. Fombonne was a well known psychiatrist who published articles on psychiatric topics. He was still a psychiatrist when he moved to England …until Andrew Wakefield suggested that the link between MMR vaccination and autism should be further investigated and suddenly… Dr. Fombonne became a “psychiatrist / epidemiologist” and a consultant to the UK medical authorities on MMR vaccination and autism.”
THe following studies were done pre Wakefield (1998):
Fombonne, E. (1996). Is the prevalence of autism increasing? Journal of Autism and Developmental Disorders
Fombonne, E. (1997). The prevalence of autism and other pervasive developmental disorders in the UK. Autism, 1,
For what it’s worth, there’s a good summary of the shortcomings of the study and the critique here:
http://leftbrainrightbrain.co.uk/?p=515
I don’t have those early Fombonne studies to hand but the prevalence rates in them for autism were much lower (going on memory) than latterly.
Also, by the mid-90s the rising trend in autism was already becoming a bureaucratic embarrassment.
Yazbak’s error is not comparable with the deliberate manipulation and apparent mis-representation of data.
I would just add that my personal doubts about Fombonne go back to before my acquaintance with many of the people in this debate, to when I was sent a copy of his latest article by the DH: ‘Is there an epidemic of autism?’ (February 2001):
http://pediatrics.aappublications.org/cgi/content/full/107/2/411
The fallacy of his position, as it struck me at the time, was that while you might conclude that there were still insufficient controls on the California data to prove that autism was rising, there was certainly no grounds for assuming that it was not. If this was his view, then it denoted bias.
Also, it was quite clear with my dealing with DH at the time, that while I was only raising the issue of the more than apparent increase in autism they seemed to be backed into a corner over MMR, which I had not brought up. But the projects of denying autism increase and denying vaccine damage always seemed to go hand in hand.
PS Yes, I do recall reading the comments of Jonathan Semetko and Kevin Leitch at the time of Ed Yazbak’s publication. They were certainly forced to concede much more than usual.
David said,
“For the record, I maintain that it is feasible that a small subset of vulnerable children might be disposed towards ASD from external triggers (which could include vaccines although the evidence to suggest a plausible causal mechanism is currently lacking).”
You’ve conceded that a subset, albeit tiny, of children, could be vulnerable to ASDs through vaccination. Considering the devastating nature of ASDs, do you not think this matter merits serious investigation? As a scientist, are you not a tiny bit curious? Is playing Russian-roulette any longer acceptable?
Mr Stone – no you are not weird for pointing it out. What is weird is your baseless prediction that I would label your comment as weird and that this would enable you to jump to the nonsensical conclusion that I do not care about the realities of science. I care very much about the scientific method and how science operates, thank you. Are we to conduct this debate on the basis of speculative accusations of others regarding their possible theoretical future actions?
The phrase I used when talking about the Nirvana fallacy was that many antivaccine campaigners use it. I don’t see how you can disagree with the statement that “many” antivaccine campaigners, who are by definition against vaccines, would fulfil this definition. I could have said “all” and still been technically correct. It is true that there are those who campaign for safer vaccines or an altered vaccination schedule, and I agree these individuals would not necessarily argue against all vaccination. There are in fact some vaccines that even I think should not be routine (but that is another story). However, those who campaign against all vaccines have sneakily jumped onto the bandwagon of vaccine “safety”. One only needs to look at the “Green our vaccines” movement in the States to appreciate this. Supposedly, the concept is that they only want safer vaccines. This is such a reasonable plea that no-one could disagree with it. But in fact, if you look at what the campaigners actually say, it is clear that nothing less than a total removal of all vaccines form the routine childhood schedule is their underlying aim.
Regarding the Fombonne data, the basic underlying fact remains that PDD rates increased at a time when MMR rates were not correspondingly increasing. In Quebec MMR rates have always been high, so even if you dismiss Fombonne’s use of MMR rates from elsewhere in Quebec province than montreal to use in his analysis there is a problem for you. Let us hypothetically assume MMR rates actually increased from 96% to 100% in the period under study – a 4% rise. In the same period, PDD rates rose from 45 to 107 – a 240% rise.
Can you provide a rational explanation for this? What is it about MMR that when administered to 96% of children it produces autism only in a certain percent, but that is so strange that when given to an extra 4% of children it suddenly makes the autism rate more than double? If the base MMR vaccination rate was, say 40%, and an increase to 90% correlated to a more than doubling of autism rates then you might have a point.
The conclusions of Fombonne appear quite logical – MMR and autism do not appear to be linked. Pointing out some methodological or selection bias problems in studies like his does not negate the underlying findings which remain consistent. The inescapable conclusion is that virtually all cases of autism must be due to something other than MMR, and even if there are any cases where MMR could trigger autism, these cases must make up a tiny fraction of the overall numbers.
David
I do not accept you reading of the vaccine safety movement. Almost everyone had their children vaccinated – it does not have naturopath ideology though this would not in itself be dishonourable. This is the kind of propaganda we have to deal with – an article by Lorde Taverne, Chairman of Sense About Science:
“The first was a claim against manufacturers of the MMR (measles, mumps, and rubella) vaccine. As long ago as 1994 legal aid was granted to a group of parents who were opposed to immunisation (and who were strong believers in homoeopathy), for an action claiming that MMR causes brain damage, epilepsy, arthritis, and autoimmune disease.”
http://www.bmj.com/cgi/content/full/329/7459/239
You have to ask what Taverne could possibly have known about the beliefs of the litigants except that they all had their children vaccinated. I bet there were many nuanced opinions on the ‘Green our Vaccines’ rally, but I am sure the basic message was people wanted the authorities to be a great deal more careful.
The other point is that you are using the usual straw argument. No one is saying that MMR is the sole cause of autism, or even that vaccines are, but the vaccine schedule certainly represents a cumulative challenge and even if people had not witnessed the immediate adverse events with their children – sometimes very scary particularly with an indifferent GP telling you everything is alright – there should still be great concern. And every time you add another vaccine with other adjuvants or excipients you are adding further confounders which make the problem harder to investigate.
It really also will not do to announce that the conclusions of a study were fine despite the mis-matching of data. I note that Fombonne also participated in the data analysis not only of the heavily criticised study with Chakrabarti, but also Smeeth. A lot of routes lead to Eric.
In response to Ross on July 9, 2008 @ 11:16 pm.
Ross is regrettably trolling. S/he thinks that by providing any form or aggressive response is an adequate answer to the other person.
The statement “No credible evidence of an involvement of MMR with either autism or Crohn’s disease was found” appears nowhere in the discussion or conclusions in the Cochrane MMR review.
So Ross can produce as many “plain language” summaries as he likes. They are not the authors’ paper nor are they the data or results which are all that count. Conclusions or discussions of authors or papers are opinion and irrelevant. Here Ross refers to a statement which is no part of the body of the paper or the discussiion or conclusions. Even if Ross claim this is a statement in an abstract, that is also not the body of the paper and is to be disregarded.
Ross again is trolling here when s/he says asks for the showingn that tThe Cochrane MMR review itself has been associated, in the very words of one of its own authors, with fraudulent research practices. Ross and everyone else can read about it here in:-
“Questions on the Independence and Reliability of Cochrane Reviews, with a Focus on Measles-Mumps-Rubella Vaccine”
http://www.jpands.org/vol11no4/millerc.pdf
As to the question “Can MMR cause autism”, that question is beginning to be answered in the affirmative in the USA. I have put some details on my website here:-
Explaining Vaccines Autism & Mitochondrial Disorder
http://homepage.ntlworld.com/clifford.g.miller/Mitochondrial.html
CM, I note that you haven’t addressed any of the questions I put to you but have accused me of ‘trolling’, providing an ‘aggressive’ response and repeated that:
“The statement ‘No credible evidence of an involvement of MMR with either autism or Crohn’s disease was found’ appears nowhere in the discussion or conclusions in the Cochrane MMR review.”
So I will repeat that I know. It’s in the plain language summary here:
http://www.cochrane.org/reviews/en/ab004407.html
“So Ross can produce as many “plain language” summaries as he likes.”
I think one is suffiecient.
“They are not the authors’ paper nor are they the data or results which are all that count.”
Presumably the plain language summary was written by the authors and they are happy that it reflects their findings. Do you have any evidence to the contrary?
Do you know of any other studies where the conclusions and plain language summaries were not written by the authors and do not reflect their findings?
“Conclusions or discussions of authors or papers are opinion and irrelevant. Here Ross refers to a statement which is no part of the body of the paper or the discussiion or conclusions. Even if Ross claim this is a statement in an abstract, that is also not the body of the paper and is to be disregarded.”
CM, can you please explain why the conclusions the authors draw and the plain language summary they provide are to be ignored?
I’d also like you to address these points:
“The statement appears to have been added after the event to the abstract for the puirposes of inclusion in worldwide press releases.”
a) Your evidence?
b) Even if it was, what’s your point?
c) Presumably the authors are happy that it’s a fair reflection of their findings since they wrote it, why do you disagree and are you going to take up this issue with them or have you done so?
David, you say:
>>>“ Let us hypothetically assume MMR rates actually increased from 96% to 100% in the period under study – a 4% rise. In the same period, PDD rates rose from 45 to 107 – a 240% rise.
Can you provide a rational explanation for this? What is it about MMR that when administered to 96% of children it produces autism only in a certain percent, but that is so strange that when given to an extra 4% of children it suddenly makes the autism rate more than double? If the base MMR vaccination rate was, say 40%, and an increase to 90% correlated to a more than doubling of autism rates then you might have a point.”<<<
So the rate in the 40% of children vaccinated was X percent.
You are assuming that the rate of autism in the 50% increase (40 + 50 = 90%) to be inherently identical to the first 40%. Why?
When a parent has a really robustly healthy child, they don’t consider that anything could go wrong. After all their babies are “strong enough to take what comes their way”. Though illogically, this doesn’t extend to a belief that their ultra healthy babies might survive disease, but medical conditioning is an interesting subject of study. But it is notable to me that parents of healthy children give little thought to the possible consequences of vaccines. They just want to avail themselves of any opportunity to keep their children healthy.
But what say that the second 50%, were parents who were initially reluctant to vaccinate their babies? What say these reluctant parents didn’t vaccinate because their children were low birth weight. Maybe some had initial failure to thrive. Perhaps some had repeated urinary tract infections, or ear infections, or whatever circumstance, which made the parents hesitate to stick needles into them.
When your children don’t look as tough as an ox, you think twice about vaccines.
Then along comes the doctor to push you and say, “But can’t you see, that because your child is not a strong child, they are much more likely to have complications to the disease, or die? (Implant fear here) Can’t you see that the safer of two options is to vaccinate?”
And so you vaccinate.
But here’s where the logic stops. When your “not so strong child” suddenly keels over after the vaccine, the doctor says their complaint is coincidental: “the vaccinee effect”, because we all know that the these things happen in those not given the MMR (which isn’t what the studies say, but never mind).
And we all know where the original vaccinee effect “fallacy” theory comes from too, don’t we David? That unscientific study (PMID 2871241) done with the placebo that wasn’t, but which is then extrapolated by you doctors to mean illnesses which happen to everyone out there in the community who hasn’t had a needle of any sort stuck in them for years!
The reason why there might be a higher rate in the 50% of children vaccinated after the first 40%, just might come under the heading of “vaccinomics”, and might be because there are a much larger percentage of fragile children in that 50%.
AND I venture to suggest that if Canada made sure the FINAL 10% of “errant parents” had their babies vaccinated regardless of their state of health, and studied them they might find an even higher percentage of resultant developmental disorders in them as well.
That wouldn’t mean that the vaccine had nothing to do with it David. It just might be that the first 40% were “self selected” because they were children whose parents thought them to be ultra healthy and therefore never considered the effect of any vaccine to be an issue.
It just might be an unstudied confounder, which you’ve not taken into account. It could well be argued that the 240% increase could reflected a real increase in the percentage of fragile children whose should have vaccines, and, whose parents (if you knew who that “small subgroup” was) would be advised to skip vaccine altogether.
It does not mean, as you allege, that vaccines have nothing to do with the developmental disorders these children have.
That second to last paragraph should read:
It could well be argued that the 240% increase could reflected a real increase in the percentage of fragile children whose should NOT have vaccines, and, whose parents (if you knew who that “small subgroup” was) would be advised to skip vaccine altogether.
Reply to Ross July 12, 2008 @ 12:22 am.
I see Ross has no answer to the evidence showing a causal mechanism between vaccines and autism some of which I put on my website here:-
Explaining Vaccines Autism & Mitochondrial Disorder
http://homepage.ntlworld.com/clifford.g.miller/Mitochondrial.html.
Ross demands evidence of the obvious is trolling behaviour. The statement ‘No credible evidence of an involvement of MMR with either autism or Crohn’s disease was found’ was obviously written after the event. It and nothing like it is in the paper itself, and as Ross describes it a summary, it must have been written after the event. Not too smart eh, Ross?
And as the papers the Cochrane MMR review commented on were themselves were so poor, they were not credible evidence. So we can all agree with Ross’ “plain language” summary on that.
Ross also tries to supplant an entire formally published paper with what Ross calls a “Plain language” summary. Only data and results of formally published papers are relevant. Either you cite the formal literature or you do not. Ross does not.
The “no credible evidence” claim is an interesting statement in itself for authors who are meant to be so expert.
Epidemiology deals with “associations”, not “involvements” so it is strange for them to use the word “involvement”. “Involvement” means MMR is the cause or part of it. Epidemiology does not prove cause or lack of it but only whether there might be an association.
Non epidemiological evidence is required to assess causation, and the standard guide is the Bradford Hill criteria. So the statement is completely irrelevant.
If the authors claimed in their paper (but did not) to have found no evidence of “involvement”, that would be unsurprising, if reviewing epidemiology. If the statement said “no credible evidence of an involvement of MMR in icecream consumption was found” it would be equally valuable. The papers being studied were not looking for that either. So all in all, Ross’ point again suggests trolling.
Ergo, Ross is a troll, Ross employs common troll tactics like demanding others answer irrelevant questions and raising spurious points as if important. Responding by demanding evidence for irrelevancies when Ross has no other answer to sound points is typical troll behaviour.
Thanks Ross for the opportunity to clarify these points.
This message is posted at approx 0620 BST 12 July.
In reply to David July 11, 2008 @ 4:54
pm
David says “the basic underlying fact remains that PDD rates increased at a time when MMR rates were not correspondingly increasing.
Fombonne showed that autism Englsh incidence in 8 years during the 1990s was a steady uniform rate [1]. And we know that during that time MMR vaccination uptake was a steady uniform rate too.
Fombonne’s study found that autism prevalence had increased in the 15 years since 1990.
That is evidence the increase in autism is a new phenomenon affecting the child population.
It is also evidence of a temporal association with the introduction of tthe 1988 MMR and 1990 accelerated DTP vaccination programmes.
Where incidence is uniform over many years, that is evidence there is no “better diagnosis” or “greater awareness”. The rates were uniform as Fombonne showed.
[1] Chakrabarti S, Fombonne E. Pervasive Developmental Disorders in Preschool Children:Confirmation of High Prevalence. Am J Psychiatry 2005;162:1133”1141
Hilary
Several very interesting points.
Mind you, I think David gave the game away when he congratulated Fombonne for coming up with the right result, even though he had compared and matched data from different locations to get it.
“I see Ross has no answer to the evidence showing a causal mechanism between vaccines and autism some of which I put on my website here”
I haven’t read it yet. But I read your paper:
http://www.jpands.org/vol11no4/millerc.pdf
Please point out the part where one of the authors of the Cochrane MMR review states, in his or her own words, that the “review itself has been associated…with fraudulent research practices”
“Ross demands evidence of the obvious is trolling behaviour.”
If the evidence were obvious then there would be no need to ask you to clarify it. And on the contrary, I think that making statements without the evidence to back them up is a more obvious behaviour trait of a troll.
“The statement ‘No credible evidence of an involvement of MMR with either autism or Crohn’s disease was found’ was obviously written after the event. It and nothing like it is in the paper itself, and as Ross describes it a summary, it must have been written after the event. Not too smart eh, Ross?”
Hmmm, well I wouldn’t have expected them to write the summary before the research was concluded. But you said “That statement appears to have been added after the event to the abstract for the puirposes of inclusion in worldwide press releases.”
Appears to? For the purposes of inclusion in worldwide press releases? Where’s your evidence for this? Even if it was, what’s your point? Presumably the authors are happy that it’s a fair reflection of their findings since they wrote it, why do you disagree and are you going to take up this issue with them or have you done so?
“Ross also tries to supplant an entire formally published paper with what Ross calls a “Plain language” summary.”
I point to the what the authors call a “Plain Language Summary”. It was written by the review authors and can be found here:
http://www.cochrane.org/reviews/en/ab004407.html
“Only data and results of formally published papers are relevant. Either you cite the formal literature or you do not. Ross does not.”
I cite: V Demicheli, T Jefferson, A Rivetti, D Price, Vaccines for measles, mumps and rubella in children, Cochrane Database of Systematic Reviews 2008 Issue 2
I also cite the ‘Main Results’ where it states that “Exposure to MMR was unlikely to be associated with Crohn’s disease, ulcerative colitis, autism or aseptic meningitis (mumps) (Jeryl-Lynn strain-containing MMR).”
“The “no credible evidence” claim is an interesting statement in itself for authors who are meant to be so expert.”
Perhaps you could point to the ‘data and results of formally published papers’ to demonstrate the credible evidence? After all, you have stated that only this is relevant.
“Conclusions or discussions of authors or papers are opinion and irrelevant.”
Please explain why.
“Even if Ross claim this is a statement in an abstract, that is also not the body of the paper and is to be disregarded.”
So the statement “The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate” from the ‘Authors’ conclusions’ section of the abstract can be disregarded as an argument for supposedly demonstrating t that the other review findings in the same study have been undermined?
Are you using this statement as evidence for your argument that “as the papers the Cochrane MMR review commented on were themselves were so poor, they were not credible evidence” or do you have more substantial criticisms of the science?
In any event, I think it makes more sense to read that statement in the context of the main body of the report:
Authors’ conclusions
Implications for practice
Existing evidence on the safety and effectiveness of MMR vaccine supports current policies of mass immunisation aimed at global measles eradication in order to reduce morbidity and mortality associated with mumps and rubella.
Implications for research
The design and reporting of safety outcomes in MMR vaccine studies, both pre and postmarketing, need to be improved and standardised definitions of adverse events should be adopted.
CM, can you please provide a good explanation as to why the conclusions the authors draw and the plain language summary they provide are to be ignored?
(Can’t we try and keep this civil? If I’m quoting from the published review and you call me a troll for doing so then we’ll never get anywhere. Likewise stating that ‘I see Ross has no answer for…’ if I haven’t given an immediate response is playground behaviour and no way to conduct a reasoned debate.)
Mr Miller, I think your slip is showing:
So, let’s get this straight. You feel it is fine to ignore conclusions and summaries that authors have written concerning their own data (simply because you disagree with them), and now you think it is fine to use data from studies (Fombonne’s) to derive your own ridiculous conclusions (which we are meant to believe merely because you say so).
Sorry, but I’d rather believe the opinions and conclusions of international experts in pediatrics and child health, infectious diseases, epidemiology, public health, immunology and vaccination than I would a lawyer who has a vested interest in vaccine damage cases.
PS: There is also a “temporal association” between autism trends and the sale of McDonald’s hamburgers. Want to make something of it?
David
“There is also a “temporal association” between autism trends and the sale of McDonald’s hamburgers. Want to make something of it?”
This is an honest question: do you have any evidence which shows that McDonald’s hamburgers don’t/can’t cause autism?
“This is an honest question: do you have any evidence which shows that McDonald’s hamburgers don’t/can’t cause autism?”
I thought we had got past this?
You said “My interpretation of this is that there is currently no evidence of a link between MMR and autism, though one may exist (in, say, a small subset of a population). Public concerns about this need to taken seriously. There is also what appears to be call for future research (i.e. this matter is not necessarily a closed book).
These seem like a generally reasonable set of conclusions to me.”
So presumably you would agree with the first part of my assertion which was “there does not seem to be any good evidence to show a causal link between MMR and autism”?
And given that you believe that the Wilson review offers a ‘generally reasonable set of conclusions’ (including as it does the statement ‘Our review finds no evidence of the emergence of an epidemic of ASD related to the MMR vaccine’) you would also agree with the second part of my assertion which was “…there is a lot of good evidence that shows no correlation between MMR and autism”?
Or at the very least that there is some good evidence that shows no correlation between MMR and autism?
Oh and CM, well done for getting published in such a prestigious journal as JPANDS (formerly the Medical Sentinel). Was that your first choice or did you submit elsewhere? Perhaps to a journal that is listed on MEDLINE/PubMed? Or one that hasn’t been described as the “house magazine of a right-wing American fringe group [AAPS]” and “is barely credible as an independent forum.”
There’s a nice summary of the kind of journal it is here:
http://en.wikipedia.org/wiki/Association_of_American_Physicians_and_Surgeons
They’ve published some interesting papers haven’t they? Amongst the AIDS denialist ones there’s a peach of a paper arguing that
that “humanists” have conspired to replace the “creation religion of Jehovah” with evolution. (Conspiracy — Part III, by Curtis W. Caine, MD. Published in Medical Sentinel, 1999;4(6):224)
All good scientific stuff no doubt, so presumably you would disagree with the Quackwatch assessment of JPANDS as ‘fundamentally flawed’ and its listing here as a “Non-recommended Periodical”:
http://www.quackwatch.org/04ConsumerEducation/nonrecperiodicals.html
David
One of the most nauseating aspects of this matter is that we are all expected to kowtow to experts even when they are caught with their trousers down. I have already pointed to your ludicrous and pompous endorsement of Fombonne over the Montreal data – never mind the data you say, just look at the conclusions. And we also have the way that British health officials recorded a more than doubling of the autism rate in N London temporally associated with the introduction of the accelerated DPT in their MMR studies but failed to note it as confounder. I don’t see why we should trust or defer to people who do that, particularly as they were investigating their own policies.
Frankly, it is the biggest try-on in history, and all this rank-pulling is just bluff.
In response to Ross July 12, 2008 @ 1:24
pm
Ross is trolling.
Ross – deal with the important point – do you agree or disagree that there are plausible biological mechanisms for how vaccines cause autism. I see Ross still has no answer to the evidence showing a causal mechanism between vaccines and autism some of which I put on my website here:-
Explaining
Vaccines Autism & Mitochondrial Disorder
That is key to the discussion here. Ross instead ignores that and goes off on a tangential troll regarding the fraud issue relating to Cochrane.
As Ross has read my paper Questions on the Independence and Reliability of Cochrane Reviews, with a Focus on Measles-Mumps-Rubella Vaccine
s/he can see the matter is fully and clearly set out in the paper and anyone else reading this can see for themselves the Cochrane MMR review itself has been associated, in the very words of one of its own authors, with fraudulent research practices. Ross chooses to disagree.
Ross makes many claims without evidence. What Ross calls a “plain language summary” is not part of the body of the paper. Ross now has difficulty contesting the plain language summary was quite obviously written after the event.
The particular sentence Ross claims to rely on is not supported by the data and the results of the paper. It was given prominence in the worldwide publicity someone paid to obtain for this paper and was specifically included in the press release but does not appear in the body of the paper itself.
I cannot help Ross when Ross seeks to contest that discussion and conlusions of the authors of papers are to be ignored as opinion and interpretation and the data and results preferred. That is well known and accepted. Obviously not by Ross, but then, Ross is a troll, so Ross will not accept anything if Ross can keep on arguing about anything. That is what trolls do.
ross re comment 119
Who said anything about MMR and autism (in my comment 118)?
As I said, it was an honest question (no need to be quite so defensive…)
OK Clifford, just started to read your webpage for “the evidence showing a causal mechanism between vaccines and autism” bearing in mind that “only data and results of formally published papers are relevant. Either you cite the formal literature or you do not.”
http://homepage.ntlworld.com/clifford.g.miller/Mitochondrial.html
I got as a far as the 2nd paragraph when I came across:
“The clinical “vaccines-to-autism” case of Hannah Poling appears to be just one example of what is shown by the recent research to be caused by a biological mechanism.”
Now apart from the fact that the statement is unclear and ungrammatical, please cite the evidence that the Poling case was ‘vaccine to autism’. I think you should define what you mean by ‘a biological mechanism’. Inheritance of genetic traits is a biological mechanism but I don’t think that is what you mean.
Paragraph 2 then goes on to say:
“That mechanism is indicated by current research to account for 20% of cases of autistic spectrum disorders (ASDs) and be triggered by vaccines. ”
The study you reference is here:
http://adventuresinautism.com/images/VivaPortugal.pdf
It states quite clearly that:
“The global prevalence of ASD per 10 000 was 9.2 in
mainland, and 15.6 in the Azores, with intriguing regional
differences. A diversity of associated medical conditions was
documented in 20%, with an unexpectedly high rate of
mitochondrial respiratory chain disorders.”
You even underlined the last sentence!
What led you to conclude that the ‘biological mechanism’ you refer to could “account for 20% of cases of autistic spectrum disorders (ASDs) and be triggered by vaccines.”?
Dr B, not defensive, guess I was just a little bit eager for an answer to the following:
You said “My interpretation of this is that there is currently no evidence of a link between MMR and autism, though one may exist (in, say, a small subset of a population). Public concerns about this need to taken seriously. There is also what appears to be call for future research (i.e. this matter is not necessarily a closed book).
These seem like a generally reasonable set of conclusions to me.”
So presumably you would agree with the first part of my assertion which was “there does not seem to be any good evidence to show a causal link between MMR and autism”?
And given that you believe that the Wilson review offers a ‘generally reasonable set of conclusions’ (including as it does the statement ‘Our review finds no evidence of the emergence of an epidemic of ASD related to the MMR vaccine’) you would also agree with the second part of my assertion which was “…there is a lot of good evidence that shows no correlation between MMR and autism”?
Or at the very least that there is some good evidence that shows no correlation between MMR and autism?
CM “Ross – deal with the important point – do you agree or disagree that there are plausible biological mechanisms for how vaccines cause autism.”
I haven’t seen any good evidence but I’m willing to be persuaded. Show me some evidence.
CM – “I see Ross still has no answer to the evidence showing a causal mechanism between vaccines and autism some of which I put on my website ”
I’ve got as far as para 2, see above.
CM “That is key to the discussion here. Ross instead ignores that and goes off on a tangential troll regarding the fraud issue relating to Cochrane.”
We’ve been discussing the Cochrane MMR review for most of this post. It’s very much part of the discussion. You raised the fraud issue, not me, I just asked you to provide evidence to back up yor claim. I will do so once again:
Please provide a quote of one of the authors of the Cochrane MMR review stating, in his or her own words, that the “review itself has been associated…with fraudulent research practices”.
That was your original claim (“The Cochrane MMR review itself has been associated, in the very words of one of its own authors, with fraudulent research practices”) so please provide the quote, not a reference to the paper.
“What Ross calls a “plain language summary” is not part of the body of the paper. ”
Again, I’ll point out that the authors call it a ‘plain language summary’,
“Ross now has difficulty contesting the plain language summary was quite obviously written after the event.”
I don’t. I said “Hmmm, well I wouldn’t have expected them to write the summary before the research was concluded.”
But you said: “That statement appears to have been added after the event to the abstract for the puirposes of inclusion in worldwide press releases.”
Appears to? For the purposes of inclusion in worldwide press releases? Where’s your evidence for this? Even if it was, what’s your point? Presumably the authors are happy that it’s a fair reflection of their findings since they wrote it, why do you disagree and are you going to take up this issue with them or have you done so?
“The particular sentence Ross claims to rely on is not supported by the data and the results of the paper. ”
I don’t claim to rely on that particular sentence. And please explain why the review summary is not supported by the data and the results of the paper and why the review authors have made an error in their summary.
ross said,
“Oh and CM, well done for getting published in such a prestigious journal as JPANDS (formerly the Medical Sentinel). Was that your first choice or did you submit elsewhere? Perhaps to a journal that is listed on MEDLINE/PubMed? Or one that hasn’t been described as the “house magazine of a right-wing American fringe group [AAPS]” and “is barely credible as an independent forum.””
In some of my more pointless travels into the outer reaches of the blogosphere, I recall a cranky creature with an obsessive antipathy to JPANDS. The alien blogoterritory onto which I inadvertently alighted (!) was occupied by a certain Anthony R Cox PhD, an evil pharmacovigilant insurgencyshill from the far-out planet MHRA.
http://www.blacktriangle.org/blog/?p=1798
(Home territory is currently a very arid and bleak place to land)
Dr Cox, blacktriangulist, said,
“The anti-vaccine movement feeds off a steady stream of poor quality research that either appears in posters at conferences not subjected to sufficient scientific scrutiny, in gray literature, or in dubious journals. The Journal of American Physicians and Surgeons (JPANDS) is the house journal of The Association of American Physicians and Surgeons (AAPS). The AAPS are a right wing fringe medical organisation in the US described by the New York Times as “ultra-right-wing… political-economic rather than medical” group. Their journal carries material denying that HIV is linked AIDS, that gay lifestyles shorten life by 20 years, and is pro-creationist.”
We know that ‘ross’ has never worked full time as a ‘Senior Shill for Evil Pharma Ltd’, so any similarity with the views of Anthony R Cox must surely be entirely coincidental.
In reply to David July 12, 2008 @ 2:43
pm
You really must tell us who you are and what you do. You are demonstrating a comprehensive lack of knowledge. It is impossible to have a reasoned debate with those unencumbered by the facts.
It is essential to ignore the conclusions and summaries authors have written concerning their own data and to assess the data and results independently.
That is a fundamental and a given. David is unaware of this.
If the conclusions of authors of a paper diverge from their own data and results, it is not a question of whether anyone disagrees but a question of what the data and results show rather than what the authors claim and opine or would like them to show as stated in their discussions and conclusions, influenced by author bias.
If David wants to think the data lead to “ridiculous conclusions” he is welcome to do so. It is a free world. And he really does not have to believe “merely because” I “say so” but by assessing the data and results, if he is able, which regrettably appears not to be the case.
David’s difficulty is that he is wrong and cannot admit it and because, like his double act with Ross, he appears to be trolling.
You said “do you agree or disagree that there are plausible biological mechanisms for how vaccines cause autism.”
Then you said “What you need to do is to answer the question, either “yes” or “no”.”
No I don’t. I need to answer the question. Which I did.
Then you say “Ross cites Wikipedia as a peer reviewed authority. Wikipedia is not a reliable source.”
I didn’t ‘cite Wikipedia as a peer reviewed authority’. If you think I did then please quote my actual words.
Instead of making strawman arguments like the ones above, perhaps you’d like to deal with the substance of the questions I’ve asked.
Clifford
I have noted above that trolling or not, the strategy of certain posters in this blog and related ones has been to hide behind the “plain language summary” of Cochrane, and accuse others who go to the main text of such crimes as “quote mining”. This was the case, for instance, when I collected Cochrane’s remarks on all six autism studies:
http://www.drbriffa.com/blog/2008/06/13/fda-acknowledges-that-the-jury-is-still-out-on-whether-mercury-amalgam-fillings-can-be-hazardous-to-health/#comment-97631
Quoting the main text of Cochrane is evidently a great heresy, it is the “plain language summary” in which official truth lies. It should be said once and for all that the “plain language summary” is not – in plain language – a summary at all: it has the character of an official statement for popular consumption tacked on to the main text, and is deliberately misleading – this is true, whoever authored it.
I think it is fascinating to watch these apparently seasoned professionals like Ross and David, who really want to tell you that anything which lies below the public front “of the plain language summary” and the press release are mere details.
CM, – are you happy to be published in a ‘scientific’ journal that sees fit to publish ‘scientific’ studies such as “Conspiracy ” Part III, by Curtis W. Caine, MD. 1999;4(6):224″ that concludes that “‘humanists’ have conspired to replace the “creation religion of Jehovah” with evolution”? Was this your first choice? Second? Third?
CM, you said “Ross – deal with the important point – do you agree or disagree that there are plausible biological mechanisms for how vaccines cause autism.”
I said “I haven’t seen any good evidence but I’m willing to be persuaded. Show me some evidence.”
Could you please explain why this isn’t an acceptable answer and why only:
“I agree that there are plausible biological mechanisms for how vaccines cause autism”
or
“I disagree that there are plausible biological mechanisms for how vaccines cause autism”
would suffice. Please bear in mind that we are working in the shadow of the wisdom of the famous “Briffa Blue Ball/Red Ball Thought Experiment (TM):
http://www.drbriffa.com/blog/2008/06/02/i-was-going-to-write-about-beta-carotene-and-sunburn-but/
In response to “Ross” July 12, 2008 @ 5:04
pm
The question for you is whether you agree or disagree that there are plausible biological mechanisms for how vaccines cause autism.
What you need to do is to answer the question, either “yes” or “no”. If it is “no” then you need to tell us all who you are and what you believe your credentials are for forming a view.
Ross cites Wikipedia as a peer reviewed authority. Wikipedia is not a reliable source. It is edited by nine year olds, anonymous people some of whom pretend to have advanced academic qualifications they sadly lack and others some of whom sadly appear to spend their lives on in a zealotic zeal to ensure only what they agree with is published.
The Journal of American Physicians and Surgeons and the 4000+ members of the Association of American Physicians and Surgeons, the journal takes no drug company advertising. It is very unpopular with those who are fond of the drug companies and who take all the freebies. It is very common for people like Ross and Anthony Cox to attack it in very personal terms, as well as the wikipedia zealots. However, it continues to challenge and its mission statement is “publishing scholarly articles related to the practice of medicine and to promoting open debate and scientific integrity.”
But before you deal with the myriad questions I’ve asked of you so far (that you haven’t taken the trouble to answer as of yet) could could you please explain how you got from:
“The global prevalence of ASD per 10 000 was 9.2 in mainland, and 15.6 in the Azores, with intriguing regional differences. A diversity of associated medical conditions was documented in 20%, with an unexpectedly high rate of mitochondrial respiratory chain disorders.”
to:
how the ‘biological mechanism’ you refer to could “account for 20% of cases of autistic spectrum disorders (ASDs) and be triggered by vaccines.”?
In reply to Ross July 12, 2008 @ 11:04
pm
All you have to do Ross is say whether or not you agree there are plausible biological mechanisms for vaccines causing autism. Is it “yes” or is it “no” or are you saying “maybe”? If it is “maybe” then surely that is “yes” because the question is asking for “plausible” mechanisms. I will not require that you provide proof. I will be happy to provide proof once you have pinned your colours to the mast and you also need to tell us who you are and what background you have to debate these matters. As previously noted, it is difficult to engage in a meaningful dialogue with those unencumbered by the facts.
Is that OK, Ross?
Ross
Could you be specific about which facts in Clifford Miller’s JPandS article about Cochrane you are disputing?
“All you have to do Ross is say whether or not you agree there are plausible biological mechanisms for vaccines causing autism. Is it “yes” or is it “no” or are you saying “maybe”? If it is “maybe” then surely that is “yes” because the question is asking for “plausible” mechanisms.”
There may be plausible biological mechanisms for vaccines causing autism but I haven’t seen any good evidence that there are. Which was my original answer. Do you have any good evidence?
“Could you be specific about which facts in Clifford Miller’s JPandS article about Cochrane you are disputing?”
JS – where have I disputed anything? CM said:
“The Cochrane MMR review itself has been associated, in the very words of one of its own authors, with fraudulent research practices”
I merely asked him to provide a quote of one of the authors of the Cochrane MMR review stating, in his or her own words, that the “review itself has been associated…with fraudulent research practices”.
So CM, I’ve answered your question. Are you going to answer any of mine? Apart from asking you to provide the quote, they are as follows:
Presumably the plain language summary was written by the authors and they are happy that it reflects their findings. Do you have any evidence to the contrary?
Do you know of any other studies where the conclusions and plain language summaries were not written by the authors and do not reflect their findings?
Can you please provide a good explanation as to why the conclusions the authors draw and the plain language summary they provide are to be ignored?
“That statement appears to have been added after the event to the abstract for the puirposes of inclusion in worldwide press releases.” Appears to? For the purposes of inclusion in worldwide press releases? Where’s your evidence for this? Even if it was, what’s your point? Presumably the authors are happy that it’s a fair reflection of their findings since they wrote it, why do you disagree and are you going to take up this issue with them or have you done so?
“The “no credible evidence” claim is an interesting statement in itself for authors who are meant to be so expert.” Perhaps you could point to the ‘data and results of formally published papers’ to demonstrate the credible evidence? After all, you have stated that only this is relevant.
“Conclusions or discussions of authors or papers are opinion and irrelevant.” Please explain why.
“Even if Ross claim this is a statement in an abstract, that is also not the body of the paper and is to be disregarded.” So the statement “The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate” from the ‘Authors’ conclusions’ section of the abstract can be disregarded as an argument for supposedly demonstrating that the other review findings in the same study have been undermined? Are you using this statement as evidence for your argument that “as the papers the Cochrane MMR review commented on were themselves were so poor, they were not credible evidence” or do you have more substantial criticisms of the science?
“The clinical “vaccines-to-autism” case of Hannah Poling appears to be just one example of what is shown by the recent research to be caused by a biological mechanism.”
Now apart from the fact that the statement is unclear and ungrammatical, please cite the evidence that the Poling case was ‘vaccine to autism’.
“That mechanism is indicated by current research to account for 20% of cases of autistic spectrum disorders (ASDs) and be triggered by vaccines. ” The study you reference(…)states quite clearly that: “The global prevalence of ASD per 10 000 was 9.2 in mainland, and 15.6 in the Azores, with intriguing regional differences. A diversity of associated medical conditions was documented in 20%, with an unexpectedly high rate of
mitochondrial respiratory chain disorders.” What led you to conclude that the ‘biological mechanism’ you refer to could “account for 20% of cases of autistic spectrum disorders (ASDs) and be triggered by vaccines.”?
Are you happy to be published in a ‘scientific’ journal that sees fit to publish ‘scientific’ studies such as “Conspiracy ” Part III, by Curtis W. Caine, MD. 1999;4(6):224″ that concludes that “‘humanists’ have conspired to replace the “creation religion of Jehovah” with evolution”? Was this your first choice? Second?
I appreciate that there’s some crossover between these questions but perhaps if you take them one by one from the beginning you can just point out the duplicates.
(It would be good as well if you could avoid the strawman ‘Ross cites Wikipedia as a peer reviewed authority’ type of argument, the ignoring my previous answer‘Ross has difficulty contesting the summary was written after the event’ type of argument, the ad hom‘Ross is a troll’ type of argument, the ascribing somebody else’s words to me ‘What Ross calls a “plain language summary” ‘ type of argument and, my personal favourite, the ask a question and assume because you don’t get an immediate answer then the respondent has been won over by the force of your ‘evidence’ “I see Ross still has no answer to the evidence” type of argument).
In response to Ross July 13, 2008 @ 7:57
pm
Ross says There may be plausible biological mechanisms for vaccines causing autism but I haven’t seen any good evidence that there are.
Is that a “yes” or a “no”, Ross? What is your position? Are you here to contest that vaccines cause autism or what? At the moment it looks like you are here to waste people’s time or to quote you “the myriad questions I’ve asked of you so far” look very much to me like trolling.
Pin your colours to the mast. What are you here for? And you really must tell us who you are and what background you have to debate these matters. As previously noted, it is difficult to engage in a meaningful dialogue with those who appear to be unencumbered by the facts.
“Wikipedia is not a reliable source. It is edited by nine year olds, anonymous people some of whom pretend to have advanced academic qualifications they sadly lack and others some of whom sadly appear to spend their lives on in a zealotic zeal to ensure only what they agree with is published.”
CM, one more for the pile. You obviously don’t have a high opinion of Wikipedia (I’m also wary of those who refuse to accept other points of view and revel in ‘zealotic zeal’) but are there any inaccuracies in this article?
http://en.wikipedia.org/wiki/Association_of_American_Physicians_and_Surgeons
In response to Ross
July 13, 2008 @ 10:45
pm
As all can see, instead of coming clean, Ross has gone off on a troll to Wikipedialand, ducking and diving as trolls do. So endeth these exchanges – what has become a troll’s version of the tennis-elbow-foot game.
Mr Miller, I can agree with you in some things.
I see from your website that you are trying to find papers that might support a link to autism and vaccination and which explore possible biological mechanisms. That is commendable, but you must remain objective, and examine all the evidence, not just cherry-picking papers that can be used in anyway possible to confirm your preconceptions. That is not how science works.
Secondly I can agree that it is the data which are important. You are vitriolic in your criticism of ross and myself for considering what the authors conclude about their own studies. OK, let’s play the game by your rules. Where, in the peer-reviewed publication of the case of Hannah Poling is there any evidence or data to indicate vaccination triggered her “autism”? There is none, of course. It is others who have subsequently drawn this conclusion. And we all know how much you dislike people drawing “conclusions”. Even statements from Hannah’s father do not count, as these are clearly “made after the event with an eye to promoting a certain viewpoint for public consumption” – a form of “plain language summary”, as it were. (And don’t forget that there is the added conflict of interest in seeking compensation for vaccine damage to be considered). This being the case, by your own criteria, all these statements about vaccines, mito dysfunction and autism can be immediately disregarded. Delightful irony, don’t you agree?
So what about mitochondrial dysfunction? Is it a plausible mechanism for triggering autism? Well, possibly, and I look forward to more studies. But remember that according to the biological hypothesis put forward, virtually anything could “trigger” the metabolic cascade, including fevers and infections. This is important, as children suffer from dozens of mainly viral infections in their infancy, many of which may be inapparent. An attack of genuine natural measles, for instance, would certainly be a potential trigger since it causes several days of febrile illness with high spikes of fever. As I have mentioned in other blogs, there may be justification in vaccinating children to expressly prevent this possible outcome.
You have mentioned on your website that:
As ross has pointed out, this refers to the Portuguese study
http://adventuresinautism.com/images/VivaPortugal.pdf
Now I believe you did a science degree at University. Can you explain how you derive from the data in this paper, the conclusion that 20% of autism cases can be triggered by vaccination in someone with underlying mitochondrial dysfunction?
You are quite right to warn us about people drawing incorrect “conclusions” from data – that is precisely what you have done here, since the data show nothing of the sort. The study showed several things (one of which was that autism rates are 1:1000 in Portugal – some way off the 1:50 or whatever it is that you guys are claiming this week.)
They looked for possible medical explanation for autism. Having identified a group to analyse (120 cases) they immediately dismissed 15% which had obvious causal genetic disorders. In the remaining 102 cases, they did further studies. In 69, they checked for lab markers that might indicate mitochondrial disorders. The initial screening test for this was a serum lactate level – found to be abnormal in 14 (20%) of the 69 cases (Is this where your “20%” figure comes from?). Of these 14 cases, 11 had muscle biopsies, and mitochondrial dysfunction was definitively confirmed in 6 of them.
By my own calculations, the only conclusions that can be drawn from this are that 8.7% (6 of 69) cases of unexplained autism in those where genetic disorders have already been excluded have underlying mitochondrial disorder. The authors (Figure 1.) put mitochondrial dysfunction at 4% of the total. It takes some bizarre mental gymnastics to conclude, as you do, that 20% of cases of autism have mitochondrial dysfunction triggered by vaccination.
Now Mito dysfunction might be a problem, but do you know how prevalent it is in children without autism? In children with autism who have been vaccinated versus those who haven’t?
I see why you are so fixated about “looking at the data” and ignoring conclusions. It is so you can cherrypick your own data from papers, use a bit of smoke and mirrors, and hey presto! – You can now present your own interpretation and conclusions – ones that conform to your preformed, biased opinion.
David
Talking of potentially “preformed, biased” opionions, would you mind answering my question to you (comment 118) about the evidence (which may or may not exist) which shows that McDonald’s hamburgers don’t/can’t cause autism?
Let’s see – First what is the evidence there may be a link? Plenty of anecdotal evidence where mothers recall visiting a McDonald’s within 3 months of their child being diagnosed as autistic. Plenty of “temporally associated” evidence – just look at the autism rates rising as the numbers of McDonalds outlets rise. Open and shut case I would have thought, wearing my “vaccine-autism hat”.
So, evidence they are not closely linked? Studies showing that 90% of mothers already ate at McDonalds outlets even before the autism rates began to double. Evidence that when outlets have closed, autism rates still continue to rise. Scanty scientific evidence for a biologically plausible mechanism to relate the two events causally. Studies showing autism is also correlated to mothers eating at M&S. Studies examining children of mothers who ate at McDonalds and who did not develop autism at a rate higher than background. Evidence that the supposed indicator of autism in these children (PCR burger positivity) were all false positives. Population based studies showing no increase in autism rates with the opening of new McDonalds outlets. etc.
However, despite all this “evidence” one could not reject the null hypothesis and conclude McDonalds never causes autism, because one can never prove a negative.
Grateful for David’s acknowledgement that “autism rates began to double”. At least we have stopped pretending they are flat. Perhaps David could communicate his sensible view to Prof Baron-Cohen, Ben Goldacre (IoP), Prof Sir Michael Rutter, Prof Eric Fombonne etc.
“As all can see, instead of coming clean, Ross has gone off on a troll to Wikipedialand, ducking and diving as trolls do. So endeth these exchanges – what has become a troll’s version of the tennis-elbow-foot game.”
I answered your question Clifford. Are you going to answer any of mine?
Dr B, do you agree with my assertion that “there does not seem to be any good evidence to show a causal link between MMR and autism”?
Given that you believe that the Wilson review offers a ‘generally reasonable set of conclusions’ (including as it does the statement ‘Our review finds no evidence of the emergence of an epidemic of ASD related to the MMR vaccine’) do you also agree that “…there is a lot of good evidence that shows no correlation between MMR and autism” or, at the very least, that there is “some good evidence that shows no correlation between MMR and autism”?
I should also have mentioned Prof Brent Taylor, Prof Elizabeth Miller, Prof Gillberg….
You might call them the “flat-earthists” of the autism epidemic.
David
You cite no actual evidence. Can you provide it please? Because if can’t, then what this looks like is an example of someone confidently predicting the outcome of an experiment before the experiment has even been done: Not exactly what you’d call ‘scientific’.
This suggests a certain sort of mindset, I think. ‘Bias’ would be one way of describing it.
ross
“do you also agree that “…there is a lot of good evidence that shows no correlation between MMR and autism” or, at the very least, that there is “some good evidence that shows no correlation between MMR and autism”?”
I agree with the Cochrane review authors when they state (in their own words) that ““The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.”