Why the MMR-autism ‘war’ is far from over
This blog is about the safety of MMR and the science and politics surrounding this issue. I didn’t have any intention of writing about this until very recently. Let me say up front I have no special interest in this area, other than having met a significant number of people who believe their children have been damaged by vaccines. I mentioned the possibility of vaccine damage in my blog of last Friday which can you read here. This remark came in a post that was mainly about the limited value of the concept of ‘statistical significance’ in the real world.
In summary, my point was that what is deemed ‘statistically significant’ is determined by arbitrary cut-offs known as ‘P-values’. I mentioned MMR vaccination because statistical significance is often invoked when we are being ‘persuaded’ that MMR is safe. But, as I was at pains to point out, just because there is no ‘statistically significant’ link between MMR and some adverse effect, doesn’t prove that MMR doesn’t cause that adverse effect. To provide a graphic example of this I used an analogy: crossing the road may not be linked with a statistically significant increased risk of getting run over, but that doesn’t mean you can’t get run over crossing the road. Accidents can happen, after all.
One of the reasons I chose to focus on MMR last Friday is because it’s an issue where I think some have attempted to use ‘science’ to silence anyone who expresses an opinion that they do not like or disagree with and would like labeled as a ‘dissenter’. Sometimes I have been aghast at the bullying, aggressive, uncaring tone of those who would have us see those who believe their children may have been damaged by vaccination as stupid, or hysterical, or simply looking for someone or something to blame for their child’s illness.
So, I perhaps should have been too surprised when someone took me to task over the merest mention of the concept that MMR vaccination might not be a safe as we are repeatedly told it is. ‘Jdc’ in his comment (number 18) seems keen to show me what he believes are the errors of my ways, and then draws our attention to the UK Government’s dedicated MMR site. Have a look here for the soothing reassurances it offers regarding the safety of MMR.
You can read my reaction to the largely misleading, irrelevant, nonsense written there in my comment number 20 here. It seems clear to me that some will bend over backwards to insist that MMR is safe, even if that means taking people for complete dummies.
Thinking about this yesterday reminded me of how the whole MMR/autism debacle got underway. And anyone who knows anything about this subject at all will be familiar with the name Dr Andrew Wakefield. For he is the doctor often ‘blamed’ for any mistrust in MMR as a result of his study, published a decade ago, which suggested that their might be link between vaccination (the measles component of the MMR vaccine) and bowel disease/autism.
Some of you may know that on and off now for about the last year Andrew Wakefield has been answering charges put to him by the General Medical Council in the UK (this is the body that regulates medical practice in the UK, and it has the power to strike individuals off the medical register). Dr Wakefield stands accused of a variety of charges including conflict of interest (it is alleged he received money from legal sources that he did not declare when he published his paper). He also is accused of subjecting children in his research to unnecessary tests, and not having ethical approval for the research in the first place.
Now, most of us will be aware of the big brouhaha regarding Wakefield’s research, but the reporting on his case with the GMC has been scant to say the least. There are no restrictions on the reporting of this case, so why the near ‘radio silence’? In a quiet and undisturbed couple of hours yesterday I thought I’d find out what I could about the Wakefield case, and report it here.
Looking at press reports, I did find a flurry of activity in April when it emerged that Dr Wakefield had admitted on questioning, that he didn’t know that much about the medical ethics of paediatrics cases. The ‘shock horror’ way this was reported was somewhat surprising to me. Because it seems to me that whether the research was ethical or not was not Dr Wakefield’s call. That was the call of the ethical committee. So, the real issue is whether the research he undertook had ethical approval or not (more on that later). This story was, to all intents and purposes, a non-story.
Since then, from what I can make out, we’ve had no stories in the mainstream press regarding how the case is going. I did find this radio broadcast/podcast though on a site dedicated to autism issues (http://www.autismone.org). It features the accounts of the Dr Wakefield/GMC trial from Dr Carol Stott (a psychologist and friend of Andrew Wakefield) and Jim Moody (a lawyer with a special interest in the area). This piece is hosted by someone called Polly Tommey. The first quarter or so of the piece focuses on the alleged misdemeanours of the journalist Brian Deer, who had investigated Dr Wakefield for the Sunday Times and Channel 4 in the UK, and who some believe instigated the GMC case against Dr Wakefield. This section of the recording is all a bit melodramatic and cloak and dagger for my liking, and its true relevance to the case is somewhat tenuous, I believe. However, I reckon it’s worth sitting through, though, if only to get to the interviews with Dr Carol Stott and Jim Moody.
It appears from their accounts that Dr Andrew Wakefield has put up a very robust defense with regard to all the allegations he faces. From what I could glean here, there really is no case to answer. If you listen to Jim Moody’s interview, he suggests that the prosecution team have made deliberately false allegations concerning Dr Wakefield, or at the very least did not do their due diligence with regard to the case or were just extremely careless.
Other revelations even more significant revelations followed. Dr Wakefield’s research was published in the Lancet medical journal, edited by Dr Richard Horton. Ever since the MMR/autism storm started Dr Horton has been trying doing his level best to distance himself from Wakefield’s research (although, it should be pointed out that the Lancet organised a press conference to trumpet Wakefield’s findings).
Perhaps as part of this effort, Dr Horton has said that if he knew about Dr Wakefield’s alleged financial conflict of interest prior to publication, he would not have sanctioned its publication. Dr Horton testified to this effect in front of the GMC last year. However, listening to the autismone podcast I discovered that evidence has come to light which appears to prove that Dr Horton was aware of the alleged conflict of interest well before the study was published. In other words, it appears Richard Horton is lying (or has a very bad memory indeed). Jim Moody suggests there’s a case for Richard Horton himself to be up in front of the GMC, on a charge of giving false testimony.
To me, this really is news, and of an order of magnitude far, far greater than the fact the Andrew Wakefield has no specific expertise in paediatric ethics. Hands up now, how many of you out there knew about the fact that the editor of the Lancet medical journal (one of the most ‘respected’ medical journals in the World) appears to have committed perjury? I’d be surprised if many of you do, because I can’t find a single reference about this in the mainstream press. Remember, there are no restrictions on the reporting of this trial.
So, while this week I had no intention to write about MMR, I now feel compelled to do so as a result of what I found when I looked: It seems to me that some distinctly shoddy science and no small amount of bullying has been used in an attempt to ‘silence’ those who dare suggest there is a link between MMR vaccination and autism, including countless parents who believe they witnessed the regression into autism of their children after MMR vaccination before their very eyes. And of course someone’s head had to roll, and Dr Wakefield’s was the obvious one to lop off. Yet, it seems that there really was never any case to answer. And now we find it looks as though the editor of the medical journal who published Dr Wakefield’s research is prepared to lie through his teeth to save his skin and ensure that any fingers of accusation point elsewhere. And the press, for some reason, is keen to have Dr Wakefield the pariah, and is not interested in reporting honestly and openly about the case brought against him by the GMC.
But getting back to the safety issue, it is my contention that the science used to ‘prove’ MMR does not cause autism is simply inadequate. And I’m not the only person who thinks so: In my research yesterday I came across this video interview where you can see and hear Dr Bernadine Healy, former director of the National Institutes of Health in the USA, express her concern about the way in which a link between vaccination and autism has been so readily dismissed. She accuses the US Government health officials of deliberately not doing the scientific which would show, once and for all, whether vaccines can cause autism, and if so, what the extent of the risk is (so that parents can make an truly informed choice about whether to have their child vaccinated or not). And Dr Healy also suggests that the reason for why the US Government has not done the definitive scientific work is because it is afraid of what it might find when it looks. The interview concludes by Dr Healy stating that the question about whether vaccination can cause autism has still not been answered.
In the interview, Dr Healy refers to research in primates which has been dismissed. Even this month, research has come to light which finds that subjecting infant primates to a ‘human’ vaccine schedule led them to exhibit autistic symptoms. And on top of this, the US Government recently conceded (out of court) that a child’s (Hannah Poling) autistic state had been significantly contributed to by vaccines she had as a toddler.
The issue of MMR’s safety has not been a debate, more a war. And a brutal one at that. Some, it seems, have attempted to misuse science to bludgeon dissenters into silence. But they have not gone away, and neither should they. And now some dirty great cracks are starting to show in the defense of the pro-vaccine lobby. I might be wrong, but I think the MMR vaccine/autism war is far from over. In fact, I reckon it’s only just begun. And while the reason that the debate rages on is usually put down to the likes of Dr Wakefield and the parents who believe their children were damaged by MMR, the real guilty parties here have been our Governments whose intransigence regarding proper, definitive research in the area has inevitably left a huge question-mark hanging over MMR.
Now, I’ve got a sneaking suspicion that those of the pro-vaccine lobby will want to claim that this blog is scaremongering by making out that MMR vaccination causes autism. So, just to be clear, I’m not saying that at all. What I am saying though is that there’s a huge pile of anecdotal evidence and some experimental evidence too which supports the idea that MMR vaccination might cause autism. The evidence used to persuade us of the safety with regard to autism is simply inadequate. The fact is, I don’t know whether MMR causes autism or not. But then again, it seems neither do those who insist it is safe.
Published May 30, 2008 . Filed under: Brain and Behaviour, Children's Health, Food and Medical Politics
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It’s a sad fact of life that few scientists conduct truly rigorous scientific experiments nowadays - few of them have even heard of the ‘null hypothesis’ never mind devise their studies to (dis)prove it. When it comes to medical studies, epidemiology is frequently used with statistical models that may have little bearing on the issue other than to be manipulated to ’statistically prove’ the probably biased expectations of those conducting or funding the work. Even they ought to be able to acknowledge that a highly significant p value of 0.001 (***) has a 1 in a thousand chance that their conclusions are disproven i.e. WRONG.
So let’s suppose that there could be an association between autism and vaccination. Why not look very carefully at the health of such children shortly before vaccination? I hypothesise that those subsequently affected are not in fact 100% healthy but have lung, skin or especially gut problems - in Chinese medicine showing a ‘Metal’ picture. Whereas I remain to be convinced of the efficacy of homeopathy, Samuel Hahnemann (the so-called father of homeopathy) appeared to have made some logical and sound observations that disease (thinking not of a specific condition but of the state of health) can be driven deeper and higher into the body by unhelpful interventions (e.g. vaccination or perhaps antibiotics) thus moving from a comparatively superficial level up into the head. If things move the other way then healing is occurring.
It is not outwith the bounds of possibility that the child’s state of hydration might also influence the outcome of vaccination.
It might thereby be possible to link certain conditions or states to a increased risk of the possibility of developing problems (such as autism) post-vaccination and to avoid vaccination in those circumstances.
May 30, 2008 @ 1:12 pm
Thank you for this thoughtful, well-researched piece.
Over the past 25 years we have seen an exponential rise in the number of children affected by autism. Please see http://www.fightingautism.org/idea/index.php?s=CA&z=m for 15 years of U.S. data.
The pro-MMR lobby says there is no demonstrable link between the vaccine and autism.
But the much more important issue to be tackled is why the 16,000 diagnosed cases in the US in 1992 had grown to 260,000 US children with the condition in 2006.
And if MMR is not responsible, then what is?
Also, what course of action would Dr Briffa recommend to a parent reluctant to put their child through MMR?
May 30, 2008 @ 1:41 pm
There’s another issue to look at when deciding whether or not to vaccinate with the MMR or any other vaccination…I’m pregnant with my first child and i live in South Africa, which is essentially a third world country. I probably have to take the decision based on the chance that my child will be better off vaccinated than not, living where i do.
May 30, 2008 @ 3:45 pm
Yes Belinda, and I think it’s a shame I think that some appear to have resisted doing the scientific studies that would give you a clearer picture of the risk/benefits of MMR, so that you can make a truly informed choice.
May 30, 2008 @ 3:49 pm
Many years ago I began reading up, by coincidence initially (happened on the topic, is all) on the ‘alleged’ link between vaccinations and autism.
What I found was report after report of parents with perfectly NORMAL children who, after a vaccination, regressed into autism very promptly. There is no doubt about this, I mean parents live with children every day their whole life, it’s not like a kid who is normal up to getting a shot and autistic a week later leaves some QUESTION about the actual cause of this, especially when it happens time after time after time.
There are a variety of rules and regulations about ‘reporting’ which may be different now, but as one mother told me back then, you have to ‘report’ it within like 4 hours for it to be considered potentially related, except of course you’re told kids will be flu-ish for 24+ hours as a norm when they get the shots, plus the evidence is not always obvious merely within hours. There’s other info, like that some families know they’re at genetic risk and every child vaccinated ends up autistic afterwards and still some states don’t want to allow exemption.
Basically it’s like that big marketing campaign where a cute little boy and a dog were shown and we’re all supposed to agree that to save that cute little boy, we gotta do research on the dog. Except now, your kid is the dog.
The horror of having my beautiful child put at risk for that because drug companies don’t want to lose money was so disgusting that when choosing where to move, I chose a state (Oklahoma) that allowed both religious and philosophical exemption from vaccinations.
It’s not like this is just a few people. This is a HUGE subject. There is a near-total media blackout on the subject… follow the money to why. Getting anybody to take it seriously — or if they do, getting them to care more than a hand-waving, “Sorry your kid’s the collateral damage, too bad” — is not easy.
May 30, 2008 @ 5:42 pm
Dr Briffa,
I have read that many other European countries offer a choice of either 3 separate injections or the combined MMR to avoid a drop in numbers of people immunising their children.
Do you think that 3 (well-spaced, mercury-free) injections might be a suitable alternative for those parents who are concerned about the MMR, but still believe in vaccination for their child?
Is it an option here in the UK?
May 30, 2008 @ 6:21 pm
The thing is, though, that there’s absolutely no vaguely credible evidence that MMR is even remotely connected to autism. There really isn’t any at all. We have one discredited study and a lot of ranting parents — and I can find you any number of ranting parents you like to support the idea that humanity was created in a week from dust by a magical wizard who lives in the sky.
With that in mind, a key reason nobody’s done a prospective trial looking at MMR and autism (or “some appear to have resisted doing the scientific studies that would give you a clearer picture of the risk/benefits of MMR” as you put it) is that it would be unethical to do so: if the study group was large enough to show the effect (which even anti-MMR types claim is very rare, even when they’re demanding that all three of their children were hit by it) then you’re deliberately avoiding giving a potentially life-saving vaccination to at least hundreds of children, on the basis that a few ill-informed, untrained, tabloid-reading morons think there might be a risk. There’s no way that would ever get past an ethics committee.
This research would also be hugely expensive. Certainly most governments could easily afford to do such a trial (in terms of money — the political backlash for letting all those kids get measles would probably be huge), but you’d get nothing for the investment. You’d never convince all the anti-MMR people they were wrong, and if you did, they’d just say “oh, well it must be wifi”, and then you have to do another big expensive study to disprove that (which you can’t anyway because science doesn’t work that way). Then they’ll say it’s phone masts, then videogames, then fast food, then sweets, then preservatives, then nitrogen, then TV, then the Internet, then immigrants, then gypsies, the McCanns, then the KGB, then aliens… You’d end up with an entire government department whose sole purpose would be to assuage the fears of the ignorant. That’s no way to run a country.
You have to be a little bit detached and just accept that the so-called link between MMR and autism is, in fact, just made up. That doesn’t prove it’s false, but it puts it’s odds at much the same level as other made-up hypotheses, such as “cider causes shortness” or “MRI scans cause blindness”. (I just pulled those out of thin air.) Doing huge studies to attempt to disprove things you’ve made up would be a tremendous waste of time, and that doesn’t change just because they were made up a long time ago by someone else and then relentlessly repeated by bad journalists and angry but unqualified mothers.
May 30, 2008 @ 6:51 pm
Andrew
By your own admission, the definitive work which proves MMR does not cause autism has not been done. I think you’re right: a study like the one you suggest is unlikely to get ethical approval. But how about study, maybe, where a large group of ‘apparently’ vaccine-damaged children (a few hundred maybe, they won’t be difficult to find) are taken, and assessed in a way that is designed to establish whether or not MMR vaccination can cause autism.
Now, the US Government recently looked at such evidence relating to just one girl (Hannah Poling) and concluded that vaccination had contributed significantly to her autism. What would be so difficult about repeating maybe this sort assessment on a much larger scale? Nothing, really, though it seems many are reluctant to do the work. Why? I don’t know, but as is suggested above, it’s possibly because some are scared of what they might find when they look.
Another important point, I think, is that, as you have admitted, there is no definitive evidence in the area. So, it follows that there is NO DEFINITIVE EVIDENCE THAT MMR DOES NOT CAUSE AUTISM. And how are we going to discover the truth if the proper research is not done? Basically, we’re guessing. And we’re gambling – with people’s lives.
Now, against this let’s put your assertion that all we have is one discredited study and a ‘lot of ranting parents’. Do you think in the absence of evidence to the contrary, that it is caring and responsible and ‘scientific’ even to dismiss the experiences of countless parents who claim to have witnessed their children regress into autism quite soon after receiving MMR vaccination? Do you not think, at all, that we owe it to these people, their children and everyone wishing to make a truly informed decision about the vaccination of their child to do the relevant research?
In your preceding post you end with the words “…in a debate where people are actually dying of preventable diseases because they’ve been lied to and told that the prevention causes autism.”
Can you tell me how you think this ‘think of the kids!’ cry squares with your opinion that parents who believe their children may have been damaged by vaccines are the sort of people who ‘support the idea that humanity was created in a week from dust by a magical wizard who lives in the sky.’
And imagine now for a moment, that you were not a PhD student in 2D and 3D image analysis (as you tell us here: http://www.apathysketchpad.com/blog/about-me ), but are perhaps a paediatrician with a special interest in autism. Think what it might be like to be regularly consulted by parents who tell, usually very credibly, a very consistent story about how their children appeared to be developing normally, but then spiked a fever shortly after receiving their MMR vaccination, and subsequently went on to regress into autism.
Imagine, if you can, these parents telling you of how their talkative, happy child, transformed into one that cried a lot, stopped making eye contact, and perhaps stopped talking as well in a matter or a few weeks.
In the light of no good evidence to prove that MMR does not cause autism, do you really think you could look these parents in the eye, and tell them, hand on heart, that in your opinion, they were simply ‘ranting’?
May 30, 2008 @ 8:05 pm
[...] nutritionism is a crowded field, but John Briffa has managed to carve out a niche for himself. And Briffa’s take on vaccines stands out, even among media nutritionists. JDC takes a broader look at Briffa’s take on [...]
May 30, 2008 @ 10:45 pm
Dr. Briffa,
Wondered when you would get to this issue and again thank you for your courage. I had my three children vaccinated when I was ignorant. My granddaughter has not and will not be unless the government forcibly subjects her to it. I have done extensive reading on the subject and was shocked to learn how much evidence points to autism and also sudden infant death syndrome. The rate of autism has grown as the number of vaccines has increased. Some children are not able to release the mercury from their systems and I don’t think anyone denies the toxicity of mercury. Here in the U.S. the mercury is still in some of the vaccines and does anyone know what else is part of what is being injected into the child? I did read accounts of some vaccine in which the monkey component of the vaccine was carrying a disease that later cropped up in the vaccine recipients. I know from my own experience over trivial matters in which the MDs would not listen that most certainly would not acknowledge any adverse affects from a vaccine. It is always the same story with parents, and I have personally met two, the child was perfect then within a week the child’s behavior changed dramatically. One lady represented an organization of several hundred families. She had lost her home from the drugs prescribed which did nothing, and was at a meeting fighting to save alternative therapies which were showing some promise for her son. I can imagine the emotional pain, anger, and frustration to have such a tragic thing happen to your child and then be treated as if you are a parent with impaired judgment. These parents and children deserve our concern and not a cover-up!
May 31, 2008 @ 2:31 am
Until a genuine scientific inquiry into the subject, and not just pharmaceutical company sponsored denial and media repression, happens, I have no objective way to measure the likelihood of my kid getting measles vs. my kid getting autism. So “withholding a lifesaving vaccination” seems like hyperbole given that (a) measles are very rare, and (b) people do survive the measles.
It is possible that the vaccinations happening later when the child has a more mature immune system could help but since nobody will look at the issue with science we may never know.
May 31, 2008 @ 10:40 pm
I have to take Dr Briffa’s comments seriously. I went to my doctors 3 months ago and was told statins were safe. Is this ignorance or just the health profession listing to the propoganda put out by the drug companies.
In the case of autism and MMR, I wonder if the reality is the science has not been done because the vaccine manufacturers would not like to know the results. The anecdotal evidence is there but like most drug interactions it has not been reported to the proper channels.
Also epidemiology is a science where cause and affect are rarely provable but only the posiblility of a link between cause and effect can be sumised.
June 1, 2008 @ 3:31 pm
Toddlers do not require rubella vacc, prevents blindness in the foetus, mumps is generally amild disease, both of my children went to school with mumps- only realised when I saw the school photos and thought they both had fat cheeks !!! what a twit, they must’ve given it to the whole class, but nobody died!!!
Measles can be nasty, my brother’s eye lashes fell out, but he was sixty last year complete with eyelashes.
I was one of four we all had measle around the same time, other kids came in from the village and caught it, nobody died with complications.
We were poor with no bathroom and had free school dinners,
would be considered on the poverty line now but we all recovered.
If the government is so concerned about children dying from measles why not bring back the single measle vacc which we used to have.
ell done Dr Briffa for listening to these parents god Bless you and Dr Wakefield.
By the Way Poll;y Tommey wrrites THE AUTISM FILE with her husband and they have an autistic son.
Wendy Satterthwaite.
June 1, 2008 @ 6:13 pm
I don’t have a dog in this fight, but I find what Emma has to say about autism and vaccines interesting:
http://blog.plantpoisonsandrottenstuff.info/
She has a special interest in Asperger’s Syndrome and autism, and takes a keen interest in all the issues.
June 2, 2008 @ 4:14 pm
Dear Dr Briffa
I, like you have been following the case with some interest and scepticism about the government’s claim that the MMR is safe.
My son, who is now 10, was diagnosed with ASD at the age of 5. My husband (who is the world’s greatest sceptic) is of the opinion that ‘the lights’ went out at the age of 2. Most ’scientists’ and ‘behaviourists’ will claim that 2 is the average age most children start exhibiting ’symptoms’.
That fact aside, they will also claim that Autism is genetic.
We have searched back 4 generations in both families and have not found any history of ‘ autism’.
What I have found is a family history of autoimmune disorder and epilepsy.
From various tests I have established two main factors. These were 1)severe bacterial and yeast dysbiosis and 2) gut inflammation. These may well have been present at the time of vaccination or a result of vaccination.
According to my research there is sufficient data available to identify ‘at risk groups’. A responsible government should take cogniscance of this ’subgroup’ of children and provide an alternative. Failure to take this course of action places untold stress on families trying to cope with our children, an education system that cannot teach our children and a society that does not understand or acknowledge these children.
According to research this ‘irresponsible’ approach by the government costs £2.4 million per child over his/her lifetime.
Hello, is anybody out there in the land of reason?
June 2, 2008 @ 8:20 pm
Dr Briffa.
1. Much is written about Dr Wakefield and his so called failings but if any other papers published in the Lancet - or indeed in any other journals - were examined with the same degree of forensic journalism I suspect that there would be few, if any articles without weaknesses , surely this is the point of peer review? The Sunday Times has continually peddled a viewpoint which is so sympathetic to the government that they ( the government ) could almost have written it themselves?
2. The whole crisis of herd immunity and the collapse of the vaccination programme could have been avoided had the parents concerned about possible risks with MMR vaccines simply been offered the option of single vaccines within the NHS. Instead many parents with the means have made the choice to travel often great distances to clinics and paid substantial amounts to ensure that their children were protected. Those without the means were forced to choose either to vaccinate with MMR or not to vaccinate at all. This is the stark choice inflicted upon us by the government, not by Andrew Wakefield.
Incidentally I have no idea whether Andrew Wakefield is correct or not but I was and remain wary of the huge programme of vaccination being forced upon our children. My own daughter was a premature 1.32 Kg baby suffering from failure to thrive, I took her to London for Measles innocculation then again to Exeter when the London clinic was found to have stored the product incorrectly. I have no regrets. I doubt however that the published statistics count her as one of the children innocculated when the government is highlighting the percentage of children without protection against measles and therefore a risk to the general population. They do not have a record of privately treated children so again their statistics are not valid.
June 2, 2008 @ 8:34 pm
This is not an argument, just a request for more information. A couple of posts seem to be saying ‘I had measles and it never did me any harm’ or ‘measles aint that bad’ and I realised I personally know nothing about measles. After a quick google I found this sobering information:
http://www.unicef.org/immunization/23244_measles.html
But does that imply that measles isn’t really a threat to otherwise healthy kids with good access to first-world healthcare? (or in perhaps populations were most are vaccinated). I would love to see any info on measles especially incidence and mortality in this or first world countries. Does anybody have such info?
May be interesting to weigh up the comparative risks
June 3, 2008 @ 9:25 am
On my blog I wrote this of your post on statistical significance: “If his readers don’t fully understand or appreciate the arbitrary nature of p-values then perhaps they won’t fully understand or appreciate p-values themselves. If Dr Briffa is going to educate his readership perhaps it would be better to do a more thorough job and explain what p-values are before he tells people that they are arbitrary (which, apparently, therefore means scientific findings are arbitrary).”
Given Claire’s misconception about p-values, I think my point was an appropriate (perhaps even prescient) one to make. Perhaps you would care to clarify the meaning of p-values, for the benefit of Claire and your other readers. I’m sure Claire’s misconception is a common one and other readers are likely labouring under the same misapprehension.
June 3, 2008 @ 1:43 pm
I’ve also been observing the non-coverage of the Wakefield case over the past few months. The lack of crowing by the blog crew seems to indicate that they don’t have much to crow about. Reticence isn’t their strong suit.
Thanks for providing me with lots of amusement over the last few days!
June 3, 2008 @ 9:20 pm
Cynic, some measles info for Europe can be found in Eurosurveillance.
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18837
They cover the recent epidemics in central Europe - eg Germany, Switzerland (all driven via unvaccinated cases). In 2005/6 in Germany there were 3 deaths out of about 3000 notified cases (there will be some under-reporting;- the true numer of cases will be greater than this, and in Western countries the measles case fatality is more like 1 in 6000).
In Romania there were 14 deaths in the same period (though the medical facilities may have been less “first world” here).
Still, the mortality is sobering - for each death there will be dozens of children with serious disability from encephalitis etc. And remember - if no-one vaccinated against measles, every child would get it.
Antivaccine campaigners maintain that measles is a trivial illness in the first world. Reliance on personal experience is a very poor indicator of problems. The “I-had-measles-and-it-didn’t-do-me-any-harm” brigade are dangerously deluded individuals with no concept of the impact of disease within populations. I also had measles and survived unscathed. That means nothing. I also fell off my bike as a child and didn’t get brain damage. But that’s not an argument to say its OK for my kids to avoid wearing cycle helmets (and worse, for me to persuade other kids to do likewise).
June 4, 2008 @ 4:41 pm
Here is an analysis of the measles numbers from the CDC. Oddly they give one set of numbers on the parent’s pages (very scary) and a different set of numbers for the medical professionals in the Pink Book.
http://insidevaccines.com/wordpress/?p=65
The short answer is that measles can be dangerous to children living in developed countries, but vaccination has, in some ways, increased the hazards of the disease.
June 4, 2008 @ 5:39 pm
Minority, at least you admit measles can be dangerous even in developed countries. However, your throwaway comment that that “vaccination, in some ways, increased the hazards of the disease” is totally misleading.
I presume you refer to the rare instance where someone who was vaccinated may get, through waning immunity, an attack of measles as an adult, which may occasionally be a more severe illness. Adult measles is exceedingly rare, as indicated by the near total absence of adults in the cases of measles seen in outbreaks - take this one in Germany for example:
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=615
(Look at the age-specific incidence in the chart, and also consider the fact that 95% of cases are in unvaccinated people).
Also consider the fact that if high levels of vaccination are achieved, then herd immunity will protect all those who for medical reasons have not been able to be immunised, and also anyone whose immunity may have waned.
Vaccination has reduced the risks of the disease many-fold, and only a complete fool would try and promote the view that it is undesireable in the way you are implying.
June 5, 2008 @ 12:21 pm
Minority, I’ve just been looking at your website and article on measles. I think you are suggesting that in the prevaccine era in the USA, the CDC report measles caused 450 deaths per year, 28,000 hospitalizations, and 1,000 children with chronic disabilities from measles encephalitis. I guess there is no wiggle room over these figures.
You have calculated that prevaccine, only 0.007% of measles cases were hospitalised. You are wrong, having made an error in your calculation by a couple of orders of magnitude. You ask the CDC guys to “keep their stories straight”, and you may have a point, but you are unable to calculate percentages yourself?
You used the numbers of 28000 hospitalisations out of 4 million measles cases annually. This is in fact 0.625%. Elsewhere you readily accept the lower limit of the annual measles estimate for your calculations (3 million cases a year), which gives a hospitalisation rate of 0.93%. Some way from your 0.007% claim, isn’t it?
True, it is still some way from what you have dug out of a CDC “information for parents” leaflet which says “up to 20% may need to be hospitalised”, but then this leaflet is not from one of their scientific publications, and is likely to be laid on heavy just to help persuade parents to consider vaccination. Not a great tactic, true, but I wouldn’t quote this figure as hard fact, since it is clearly not. For a start it is an upper estimate, in the same way my ISP promises me “up to 16Mb” for my broadband speed. I’d be lucky to achieve a tenth of that.
The children likely to get measles today are a selected population subgroup, many are unable to be vaccinated because of underlying medical illess, for example, and their risk of complications is greater than is the case for the whole population. Better herd immunity through vaccination would solve this problem.
June 5, 2008 @ 1:25 pm
David thanks for the measles info.
June 6, 2008 @ 1:41 pm
David thanks very much for correcting my arithmetic error.
You did overlook the hazards of measles to infants, who used to be protected by maternal immunity, now gone with the wind. There was an outbreak of measles in Boston, not terribly long ago, all adults.
I do find the scaremongering by the CDC problematic. Any parent who digs a bit and discovers that the numbers, not just on measles, but on all the diseases, are fudged to make them scarier, is going to lose trust. Further, on one of the parent’s pages the CDC warns parents to distrust data unsupported by references. Then this same organization proceeds to present page after page of data…unsupported by references. Not only that, but data which cannot be supported by references, because it is, simply, untrue. Not arithmetic errors, like mine, but, conscious, deliberate, on purpose lies.
Read some of the CDC parent’s pages for yourself. Try to confirm the numbers being presented. You do recognize that 600,000 hospitalizations (20%) is a long way from 28,000 hospitalizations, right? Could this be an honest mistake? An arithmetic error?
June 7, 2008 @ 12:58 am
If I can save one family from going through what we have done since 1989 then please listen to our story. Our son will never be able to live alone without support, his brother’s life will be severely compromised and as for the the lives of my husband and I, well I don’t know how we get through each day. We believe this was all due to MMR. We saw our son change before our eyes. If I knew then what I know now I’d have taken a chance on all these illnesses. Girls should get immunised against rubella in their early teens like they used to and that would prevent the damage done to unborn babies. Lives are being ruined and you are just left to get on with it. It has cost us our careers, home and any chance of a normal life. Thank God for Andrew Wakefield. He should be given an honour not be persecuted like this.
July 28, 2008 @ 4:25 pm