Late last month one of my posts focused on the eating of fish during pregnancy. On the one hand this may be a good idea on the basis that the omega-3 fats certain fish can supply may have benefits for the developing foetus. On the other hand, fish (particularly tuna, marlin and swordfish) can be contaminated with mercury which has the potential to have toxic effects on the nervous system.
Fish is not the only source of mercury. It can also be found in ‘silver’ fillings we may even have in our teeth. In fact, about half of the weight of dental amalgam comes from mercury. I remember some years ago talking to a dentist friend of mine about mercury. He told me that dentists are instructed to treat this substance with extreme caution, especially if there were any ‘spillage’. Just to remind you, this is the same stuff that can end up getting put into our teeth. To my mind, and the minds of some other people too, there’s always been a bit of a ‘disconnect’ here.
Another dentist friend I used to know decided to take some time alongside his professional career to study the health effects of dental amalgam in depth. I remember him telling me that while mercury amalgam was indeed a good material for filling teeth, his view was that it did have the potential to harm health. He didn’t see this as a problem for most individuals with amalgam fillings, though. However, even if only a relatively small percentage of people had problems as a result of their fillings, then the fact that fillings are very common, means that the number of people affected can be considerable.
By way of example, let’s imagine that of the 60 million odd people in the UK, half have at least one mercury amalgam filling. Now, imagine just 1 per cent of these people has a health problem as a result of their filling(s). That equates to 300,000 people (that’s a lot of people).
The reason that I’m writing about this is because for a long time there’s been general resistance from the dental fraternity that mercury fillings may pose a hazard to health. However, there seems to be some reversal in thinking on this as the Food and Drug Administration (FDA) in the USA has very recently published a statement on its website here which raises the issue of the potential for mercury fillings to cause health problems, including neurological problems, in children and foetuses.
This statement includes a link (see here) to a summary of the findings of a panel that looked at this issue in September 2006. After two days of hearings, the panel were asked if the information presented objectively and clearly presented the current state of knowledge about the exposure and health effects related to dental amalgam�? The panel voted ‘no’ to this. The summary states that: Some of the reasons cited by the majority were that the paper was limited and scope and had knowledge gaps particularly regarding exposure limits.�
The panel also concluded that: no conclusion could be drawn regarding the health effects of mercury amalgams because the evidence was often contradictory and that conclusions based on a limited search should not be made.�
Personally, I think it is reassuring that the FDA is taking this issue seriously, and is inviting information and comment that will help it make a proper assessment regarding the impact that mercury fillings may have on health. How refreshing that it recognises that research in the area was inadequate to come to a decision.
As a result, the FDA has re-opened the file, so to speak, and is now engaging in further consultation on this issue. The comment period ends on 28th July 2008, after which the FDA will pronounce again on this issue.
I can’t help notice some parallels here with the potential link between MMR and autism. In particular, while the UK Government and most scientists assert that MMR has been vindicated with regard to autism, research into a potential link (as well as a link between MMR and developmental regression) is still alive in the US. It seems that in the US this issue is not the ‘closed book’ some in the UK believe it to be.
I went to the dentist when I was 17 and received 17 fillings in one visit. I was never the same. But it wasn’t until I was over 50 that I looked back in my diaries for something unrelated and saw that many visits to the dentist were followed by being “sick”. It was strange because noone else in the family ever caught what I had. The worst instance was a month long migraine, stiff neck, sore shoulders, and an inability to think straight. I have had my fillings removed, taking chelators, and now feel much better.
As a boy I had many fillings given to me by the doctor. I actually had no idea they contained mercury. How anyone can say they are safe is an idoit in my book. Mercury is a poison no matter what forms it’s in – in a compound or in a metal. it’s all the same – it’s poisonous. I had to pay many thousands to have my fillings removed and replaced with ivory – not a cheap process i can assure you. but now i feel much better.
John Briffa said,
“I can’t help notice some parallels here with the potential link between MMR and autism.”
Of course, any potential link between MMR and autism cannot directly link with mercury. The vociferous “no evidence that MMR isn’t safe” brigade will soon be squawking that MMR contains no mercury and never has done.
Is it possible that a link may be found between young brains primed with mercurial neurotoxins from infant vaccinations and an MMR mediated mechanism that triggers developmental regression in a small subset of genetically vulnerable children? There’s got to be a Nobel Prize awaiting the brave soul who makes it to the end of the rainbow on this one.
Hi CT, nice to see you engaging in some debate instead of just commenting on it in your own, erm, idiosyncratic way:
http://www.jabs.org.uk/forum/topic.asp?TOPIC_ID=1902&whichpage=4
So what led you to hypothesise that (if I am interpreting this correctly) mercurial neurotoxins in infant vaccinations prime developing brains so that ASD is triggered by a mechanism found in MMR. It’s certainly possible but I could hypothesise 500 different causes of ASD, any of which would sound superficially plausible but none would not have a shred evidence to recommend them.
What makes yours a good hypothesis? For example, what are the ‘mercurial’ neurotoxins? In which vaccinations are they found? What is the MMR mediated mechanism you suspect?
Ross said,
“It’s certainly possible but I could hypothesise 500 different causes of ASD, any of which would sound superficially plausible but none would not have a shred evidence to recommend them.”
If you want to find the ‘evidence’, then you’ll have to look for it – and I don’t think anybody is really looking, least of all you.
It seems highly likely that Andrew Wakefield and his professorial colleagues will be acquitted of all charges at the GMC. Nevertheless, the persecutors, the antiscience rabble, will live with that outcome but be more than happy with the extent of the damage done. No one in this country will have the courage to hunt down the evidence of a link between mercurials, non-mercury containing vaccines and regressive autism. It’ll be a very brave scientist who successfully tests my hypothesis, retrieves the evidence and eventually wins the Nobel Prize … it’s possible he’ll be a Briton but he certainly won’t be a British resident.
PS. The scientist will be a double Nobel laureate, winning the peace prize as well as that for medicine. Personally, I think Armageddon will come sooner.
“No one in this country will have the courage to hunt down the evidence of a link between mercurials, non-mercury containing vaccines and regressive autism.”
But the epidemiology shows no evidecce of link. What makes you so sure that there is a link?
“It’ll be a very brave scientist who successfully tests my hypothesis, retrieves the evidence and eventually wins the Nobel Prize … it’s possible he’ll be a Briton but he certainly won’t be a British resident”
But why would anyone want to test your hypothesis? Why is it a good hypothesis and better than my 500?
Unless, of course, the hypothesis that you have regarding mercury /MMR/autism/etc/etc turns out to be false….
If you accept that link/links are just an as yet unproven hypothesis, can you describe the experiments that need to be done in order to
a) confirm the hypothesis
b) reject the hypothesis
don’t think it requires a 100 page research proposal, just a rough idea of the experiments that you’d like to see (and their results)
superburger said,
“Unless, of course, the hypothesis that you have regarding mercury /MMR/autism/etc/etc turns out to be false….”
Let’s test it first – honestly and rigorously – and cross that bridge if we get to it. However, I believe that bridge over to the ‘evidence of a link between mercurials, MMR and autism’ has already been sabotaged.
“If you accept that link/links are just an as yet unproven hypothesis, can you describe the experiments that need to be done … “
I’m not a clever scientist, simply a jobbing GP who trys to listen to his patients, some of whom are mad, some of them bad, a different one every ten minutes or less.
what has any on this got to do with fillings??
“I’m not a clever scientist, simply a jobbing GP who trys to listen to his patients, some of whom are mad, some of them bad, a different one every ten minutes or less.”
But you managed to come up with a fairly detailed hypothesis, surely you have some idea how to test it?
Ross said,
“But the epidemiology shows no evidecce of link. What makes you so sure that there is a link? “
I am not sure. I don’t know whether there is a link but then you don’t know that there isn’t – and the epidemiological ‘evidence’ does not disprove the possibility – as John Briffa has already taught you (you seem a slow learner).
“But why would anyone want to test your hypothesis? Why is it a good hypothesis and better than my 500?”
I think my hypothesis may be a good one because of the parental witness statements I have read.
May I recommend the book ‘Silenced Witnesses: The Parents Story’ published by Cryshame with Slingshot publications. Carol Stott, an epidemiologist, co-wrote the introduction to the book. She devised an interview schedule to collect information from over 100 sets of parents of children who had apparently regressed in to autism after exposure to the MMR vaccine. What she found startling was the consistency with which the parents told their story.
“A normally developing child, often with a history of repeated infections, allergies and/or food intolerance had been taken along, readily, by their parents for routine inoculation against measles, mumps and rubella and nothing had been the same since.”
This is powerful stuff. I believe this powerful evidence should now be properly tested. And I strongly believe in the principle of innocence until guilt is proved. Vaccines, whether containing mercury or not, should be prosecuted in a proper scientific arena to determine their guilt – or possible innocence – of grievous crimes against humanity. Ignorance is not a good defence.
If anyone cares to click on my name here they will be connected to my three part investigation, originally published in the Canadian on-line journal Red Flags, ‘Mercury and Autism in the United Kingdom’, and the follow article ‘How PEDIATRICS validated erroneous British mercury data’. It documents among many other things how health officials deliberately ignored the doubling of the autism rate in NE London which coincided with the introduction of the accelerated DPT (including 25 micrograms per shot mercury) schedule in 1990. I believe the most telling piece of evidence is that the authors of the PEDIATRICS study on thimerosal had published this data in a separate study, and did not remark on this matter.
This is, of course, not scientific evidence but it is evidence of a bureaucratic cover up.
‘Let’s test it first – honestly and rigorously – and cross that bridge if we get to it. However, I believe that bridge over to the ‘evidence of a link between mercurials, MMR and autism’ has already been sabotaged.’
Hmm. If you are going/proposing to perform a test/experiment then there will surely be a positive and negative result.
So, you’d *like* a test /tests to be performed. what form should it take?
What result will confirm that there is no link?
What result will confirm there *is* a link?
surely, given you obvious interest in the topic, you can suppose an experiment to test your hypothesis. Like i said, no need for 100 page grant proposal, just a rough outline.
“I don’t know whether there is a link but then you don’t know that there isn’t – and the epidemiological ‘evidence’ does not disprove the possibility – as John Briffa has already taught you”
Correct (apart from the ‘Briffa taught you’ thing). Although you do seem to think that a link is likely because you have hypothesised what that link might be.
But there is no good evidence in support of the MMR hypothesis and there is lots against it. So the possibility of a link is very, very small indeed. So your hypothesis needs to have something to recommend it.
“(you seem a slow learner).”
I don’t do silly insults and don’t expect them either.
“I think my hypothesis may be a good one because of the parental witness statements I have read.”
So the timing is the issue then? OK, that’s a starting point for some science then.
“May I recommend the book ‘Silenced Witnesses: The Parents Story’ published by Cryshame with Slingshot publications. ”
Oh, a book.
“Carol Stott, an epidemiologist, co-wrote the introduction to the book. She devised an interview schedule to collect information from over 100 sets of parents of children who had apparently regressed in to autism after exposure to the MMR vaccine”
You mean this Carol Stott?
http://briandeer.com/mmr/carol-stott.htm
CT, I’m sorry but I’m going to have to point out that this is a collection of anecdotes. They may be emotive anecdotes. They may be powerful anecdotes. The may even be compelling and persuasive anecdotes. But they are still anecdotes.
The problem I have with this is that it does not serve the interests of those affected in the slightest. She had the opportunity to do some science, to do some academic research, to do something that would add to the body of evidence to help prove or disprove the hypothesis.
But she decided on a polemic instead of a paper. She’s an epidemiologist who does not do epidemiology in her own sphere of interest where all the other epidemiology counters her belief that MMR causes autism. Why? What does she expect to achieve with this?
When in doubt you can always mention Dr Stott’s indiscretion. But there is a basic problem that a body of epidemiology which may not support a link between MMR and autism also provides no evidence against it, while we have also seen that the data in studies like Honda, and Madsen may actually support a connection. What Cochrane did not say about the flaws it detected in Madsen was that this would have led to an underestimate of autism in the vaccinated group.
A fundamental problem which Cochrane ducks is why – if MMR is so safe – are there so few good studies demonstrating it. Cochrane sifts 5000 studies and reviews 31. Even the 31 are subject to extremely negative comments.
so, what *can* one do to try and establish a link between MMR and autism?
And if one plans to perform an experiment what result(s) would prove a link, and which ones would disprove a link?
You (and a to a certain extent Dr Briffa) avoid answering this question – something i take to be quite revealing.
ross says,
“But there is no good evidence in support of the MMR hypothesis and there is lots against it. So the possibility of a link is very, very small indeed. So your hypothesis needs to have something to recommend it.”
Curious. I think it may have something to do with that learning disabilty thing.
“CT, I’m sorry but I’m going to have to point out that this is a collection of anecdotes. They may be emotive anecdotes. They may be powerful anecdotes. The may even be compelling and persuasive anecdotes.”
And epidemiologist Carol Stott found the anecdotes startlingly consistent. As a pharmaco-vigilant scientist, aren’t you just a little bit curious?
“The problem I have with this is that it does not serve the interests of those affected in the slightest.”
Curiouser and curiouser. You, me, we, don’t know that in the slightest. If we don’t know the cause, we don’t logically know the remedy for the malady ” though some anecdotal evidence suggests that mercury chelation may lift some autistic symptoms. Of course, that says little about the potential guilt of the MMR vaccine, which, as you know, contains no mercury and never did.
Now I expect you’ll tell me that curiosity killed the cat.
JS, it’s almost as if you don’t know what a Cochrane review is…
CT. I explain my position and you respond with “Curious. I think it may have something to do with that learning disabilty thing.”
I was hoping you’d leave the silly insults alone and debate the evidence, but you seem to have lapsed back into your JABS persona. Let’s try and have a reasoned discussion instead.
“And epidemiologist Carol Stott found the anecdotes startlingly consistent. As a pharmaco-vigilant scientist, aren’t you just a little bit curious?”
I’m not a ‘pharmaco-vigilant scientist’, but yes, I am curious. I’m curious why Stott, a scientist, was content to present anecdotes instead of doing some research.
I said that writing a polemic wouldn’t serve the interests of those affected because it would not advance the science. But you said:
“Curiouser and curiouser. You, me, we, don’t know that in the slightest. If we don’t know the cause, we don’t logically know the remedy for the malady ” though some anecdotal evidence suggests that mercury chelation may lift some autistic symptoms.”
That doesn’t address my point. Is Stott’s book good or bad evidence for the ‘MMR causes autism’ hypothesis?
Can you give a reference for the chelation therapy? Also, as a GP,
do you think that the benefits of MMR (and the flu vaccine) outweigh the risks? What advice do you personally give to patients re. these vaccinations?
ross says,
“I’m not a ‘pharmaco-vigilant scientist’, but …”
… you appear to display the shifty, anxious vigilance of a pharmaceutical scientist teetering on the edge of a pool of quicksilver …
“I’m curious why Stott, a scientist, was content to present anecdotes instead of doing some research. I said that writing a polemic wouldn’t serve the interests of those affected because it would not advance the science.”
Carol Stott did not write the book, the parents did. How do you know it’s a polemic if you haven’t read it? She co-wrote the introduction to the book with Martin Walker. It is clear that she very carefully researched the experience of over 100 parents who thought their children may have been damaged by the MMR. And collecting this experience and the information about each child’s developmental history took over a year. Carol Stott’s work is not polemic and it is NOT mere anecdote. And the evidence from the parents proved to be highly consistent.
“Is Stott’s book good or bad evidence for the ‘MMR causes autism’ hypothesis?”
To my mind, the book, ‘The Parents Story’ very definitely points to the need for further research on that possible link between MMR and autism in some children. And I think mercury is very probably an accessory to the felony and that there is now enough circumstantial evidence to bring a prosecution.
Ross
“JS, it’s almost as if you don’t know what a Cochrane review is…”
Just to note (admittedly not for the first time) what Cochrane said about the three studies it reviewed which were cited evidentially by Ben Goldacre in his GSK award winning article “Never mind the facts” (and he didn’t):
“The study demonstrates the difficulties of drawing inferences in the absence of a non-exposed population or a clearly defined causal hypothesis”. (Re: Taylor 1999)
“The number and possible impact of biases in this study was so high that interpretation of the results is impossible”. (Re: Fombonne 2001)
“The interpretation of the study by Madsen was made difficult by the unequal length of follow up for younger cohort members as well as the use of the date of diagnosis rather than onset of symptoms of autism”. (Re: Madsen 2002)
Try as I might I cannot read these as mild criticisms.
so, how *should* one test the hypothesis that mmr/Hg/autism are in some way linked.
What results would demonstrate the presence of a link?
What results would demonstrate the absence of a link?
It’s the one question you will never answer, I suspect.
Again JS, it’s almost as if you don’t know what a Cochrane review is.
CT – ignoring again your insults (it’s getting a bit tedious now) you say that “Carol Stott’s work is not polemic and it is NOT mere anecdote”. Even though it is a collection of anecdotes.
“It is clear that she very carefully researched the experience of over 100 parents who thought their children may have been damaged by the MMR.” Did she do any analysis of the anecdotes? Did she also collect anecdotes from parents whose children did not develop ASD after MMR? Or those whose ASD became apparent prior to MMR? Or those whose children developed ASD despite not having MMR? Do you see what I’m getting at here? Could you point me to the science please. Is there an abstract?
Can you give a reference for the chelation therapy? Also, as a GP, do you think that the benefits of MMR (and the flu vaccine) outweigh the risks? What advice do you personally give to patients re. these vaccinations?
Ross
Instead of making an ad hominem remark against me, why don’t you address the problem that the studies were completely deficient.
First study – an example of inadequate design, no control group, no expanation of the driving forces behind the rise.
Second study – too many confounders to draw any conclusions
Third study – results biased by unequal follow up for younger cohort members (ie the vaccinated group).
ross says,
“Again JS, it’s almost as if you don’t know what a Cochrane review is.”
How does the tedious repetition of this absurdly enigmatic statement advance the science?
superburger said,
“so, how *should* one test the hypothesis that mmr/Hg/autism are in some way linked.”
I agree: the hypothesis *should* be tested, but …
… it used to be that sexual indiscretion with a patient was the short cut to an appearance at the GMC and a peremptory striking off. Now, the practical testing of such an hypothesis is the short cut to a prolonged (and expensive) GMC inquisition and the abrupt end to any possible research in this country that might link mmr/Hg/autism. Do you not agree?
ross says … again,
“Also, as a GP, do you think that the benefits of MMR (and the flu vaccine) outweigh the risks? What advice do you personally give to patients re. these vaccinations?”
What have my interests, conflicts and benefits got to do with the price of fish … and my hapless hypotheses. However, I would say that the pharmaco-vigilant pharmaceutical operative is likely to be much more conflicted. What do you say?
nope, don’t agree in the slightest.
But, *irrespective* of anything else, you claim that a hypothesis should be tested, because inter alia previous experiments have failed to completely confirm or deny a link.
OK, without any further deviation, or sidetracking, get to the point.
What experiments do you think need to be done to test this hypothesis?
What results would prove (in the scientific sense) a link between MMR and autism (Hg mediated or otherwise)?
What result would disprove a link between MMR and autism?
Is cherry picking quotes and placing them out of context the best you can do John? Have you read the entire review?
Maybe you missed the bit where it is clearly stated:
“No credible evidence of an involvement of MMR with either autism or Crohn’s disease was found”
If you have evidence the MMR contributes to PDDs or ASD’s please post.
colmcq
Certainly, I have read the entire review (you seem to have read only a single sentence) and the assurance is slippery bearing in mind that none of the individual studies has a favourable review, and Wakefield had proposed a novel condition rather than Crohn’s disease. Madsen’s data would support a link with autism if the errors Cochrane reports had not occured. Honda’s data (too late for Cochrane) would support a a link – the authors having failed to heed Wakefield’s point that it was not specifically MMR but mealses vaccine in close temporal combination with other vaccines.
http://homepage.ntlworld.com/clifford.g.miller/hondarutter.html
You cannot absolutely prove things with statistics, but in these cases the health officials disregarded the information staring them in the face. On an institutional footing it looks self-delusional (to put it charitably).
colmcq says:
“If you have evidence the MMR contributes to PDDs or ASD’s please post.”
Highly significant evidence is accumulating that ‘ross’ is not the only one with an all pervasive learning disorder.
JS, you said: “Instead of making an ad hominem remark against me, why don’t you address the problem that the studies were completely deficient. ”
I wasn’t making ad hominem remarks. I just don’t think you understand the purpose of a Cochrane review, viz your statement: “A fundamental problem which Cochrane ducks is why – if MMR is so safe – are there so few good studies demonstrating it. Cochrane sifts 5000 studies and reviews 31. Even the 31 are subject to extremely negative comments.”
If you do understand then you are misrepresenting the purpose of the review to make a point, which you then back up by quotemining.
CT, “What have my interests, conflicts and benefits got to do with the price of fish … and my hapless hypotheses.”
It’s called debate. I’m interested in how you view the evidence and how you apply your opinions as a healthcare professional. Why so coy? They’re simple questions. Do you think that the benefits of MMR (and the flu vaccine) outweigh the risks? What advice do you personally give to patients re. these vaccinations
“However, I would say that the pharmaco-vigilant pharmaceutical operative is likely to be much more conflicted. What do you say?”
You’ve lost me a bit with the JABS-speak, I don’t know what a ‘pharmacetical operative’ is. If you could rephrase the question I’ll happily respond.
Ross
The issue is the difference between the public face of Cochrane which gave MMR a clean bill of health, and its detailed assessment of the studies which showed how ropey the evidence base for safety actually was (“largely inadequate” was the encompassing phrase). Also, I note that the three dodgiest studies were used by your pal Goldacre.
I can assure you I have read the entire review and find it rather alarming that the conclusions you draw are so radically different from practically the whole scientific community! The only possible explanation is that you misunderstand the scientific method or you do understand the scientific method but have some serious congnitive dissonace about the reviews outcomes.
Clifford ‘lawyer’ Miller’s analyses have been comprehensively eviscerated by numerous commentators. They are rather desperate if you ask me.
ross says,
“It’s called debate.”
The current debate is about the evidence for the safety (or lack of it) of MMR and the evidence (or lack of it) for links between Hg, MMR (Hgless) and autism.
“Why so coy?”
I think you may be being a little disingenuous here. I have to toe the party line and toe it I do. I do it because we live in a land of the neo-Stasi, a land that has acquiesced in the absurd (and expensive) trials of Sally Clark, Andrew Wakefield, Lisa Blakemore-Brown, David Pugh and Jayne Donovan ” and many, many others who have somehow failed to toe the line on governing vaccinatory policy. And, of course, there are pharmaceutical operatives, goons like you around, to watch over me, like the great moronic shepherd that you are. What did you expect me to say?
PS. In truth, I’m rather pro-vaccination but strongly believe there is a Nobel Prize to be won in the unravelling of the tapestry that is autism. I don’t think you will win it ” but then neither will I.
“Highly significant evidence is accumulating that ‘ross’ is not the only one with an all pervasive learning disorder.”
To be honest CT, I think colmcq and myself are more interested in get straight answers to the questions we have posed rather than behaving like children. So, do you think that the benefits of MMR (and the flu vaccine) outweigh the risks? What advice do you personally give to patients re. these vaccinations?
Colmcq
This, extensively, is what Cochrane on MMR had to say about autism:
“The study demonstrates the difficulties of drawing inferences in the absence of a non-exposed population or a clearly defined causal hypothesis”. (Re: Taylor 1999)
“The number and possible impact of biases in this study was so high that interpretation of the results is impossible”. (Re: Fombonne 2001)
“The interpretation of the study by Madsen was made difficult by the unequal length of follow up for younger cohort members as well as the use of the date of diagnosis rather than onset of symptoms of autism”. (Re: Madsen 2002)
“The conclusion, however, implied bias in the enrollment of cases which may not be representative of the rest of the autistic population of the city of Atlanta, USA where the study was set.” (Re DeStefano 2004)
“In the GPRD – based studies (Black 2003; Smeeth 2004) the precise nature of controlled unexposed to MMR and their generalisability was impossible to determine…The study (Smeeth 2004) appeared carefully conducted and well reported, however, GPRD-based MMR studies had no unexposed (to MMR)representative controls. In this study the approximately 4% to 13% seemed to be unexposed controls regarded by the authors as representative. Such a small number may indicate some bias in the selection of controls.” (Re: Smeeth 2004)
“The retrospective person-time cohort study by Makela assessed the association between exposure toMMR and encephalitis (EN),aseptic meningitis (AM) and autism (AU) in a cohort of 535,544 Finnish children (95% of the surveillance cohort); the children were aged one to seven years at the time of vaccination.The authors compared the incidence of outcomes in the first threemonths aftervaccination with the incidence in the following months and years.They concluded that there was no evidence of association. The study was weakened by the loss of 14% of the original birth cohortand the effects of the rather long time frame of follow up. What the impact of either of these factors was in terms of confoundersis open to debate, however the long follow up for autism was dueto the lack of a properly constructed causal hypothesis …” (Re: Makela 2002)
Cochrane also mentions separately that Makela and DeStefano have moderate risks of bias, and Fombonne a high rik of bias. Cochrane does not mention that every single one of these studies carries huge conflicts of interest. This is not an evidence base.
well john, if we take the position that conclusive (scientific)proof that there isn’t a link between MMR/autism (however mediated) it would be good if you could decribe how you think experiments could prove such a link.
And of course, in doing so, you would have to suggest results that would disprove a link.
Colmcq
PS It is no use claiming that other people have “eviscerated” Clifford Miller’s evidence. They haven’t. If you think he is wrong please state where. Otherwise you are just making vague claims as usual.
I do agree that he is a lawyer, but I am not sure what that has to do with it.
Ross
I gather you like straight questions. You are very critical of people who identify themselves, so who are you?
Cybertiger rather misleadingly said,
“PS. In truth, I’m rather pro-vaccination …”
Well, goodness, who can you trust to tell the truth these days?
Of course, there are huge caveats attached my rather misleading statement. I’m happy that congenital rubella is rarely seen and that diphtheria and neonatal whooping cough are rare. I haven’t seen a soul with proper measles for 20 years which may have saved me the trouble of a few home visits. However, I believe the flu vaccine is useless and a monstrous scam. And I predict the upcoming HPV vaccine program will be a complete disaster masquerading as an expensive success. And I could go on …
John
If the biases and confounders in the studies were so high as to be meaningless, as you suggest, they would not have been included for review.
Why do you think they were?
Colmq
Why should people produce dud studies? Perhaps you ought to ask Prof Fombonne that, not me. It is certainly my contention that that the UK GPRD is too poor in that kind of data to support autism studies though there are several, some co-authored by Prof Fombonne:
http://www.vaproject.org/stone/mercury-autism-in-uk-part-3-200602.htm
http://www.vaproject.org/yazbak/tale-of-two-cities-20070307.htm
http://www.ageofautism.com/2008/06/heckenlively–1.html#more
http://homepage.ntlworld.com/clifford.g.miller/pandemic.htm#Discounting_Fombonne
I agree that Cochrane does not answer the problem why the studies are so poor, and I am not sure where its institutional faith in the safety of MMR stems from, because it is not the science.
colmcq
An earlier answer seem to have got stuck in the blogger. This is a supplementary one.
It was not me in the first place that was suggesting it, it was them. I think they were the best politically acceptable studies they had.
To ross, John Stone says,
“I gather you like straight questions. You are very critical of people who identify themselves, so who are you?”
In my opinion, the evidence points, beyond any reasonable doubt, to the good gentleman being a pharmaceutical operative, probably a shill.
Cybertiger
I wouldn’t be too surprised. But let’s see what he has to say for himself.
John,
even if everyone involved in the MMR/autism/Hg saga is tainted in some way by whatever or whoever
*it is still possible for you to explain what experiments you think need to be done to confirm the link between MMR and autism*
Crucially, you would also be able to describe the results that would disprove a link.
These results are *totally* independent of whatever conspiracies may or may not exist.
So, describe what it would take to prove/disprove a link! Then one can enjoy the debate about whether these experiments are possible or likely to be performed.
“In my opinion, the evidence points, beyond any reasonable doubt, to the good gentleman being a pharmaceutical operative, probably a shill.”
CT – then that just shows the problems you have drawing conclusions from the evidence. I’m not a healthcare professional or involved in the pharmaceutical industry in any way. But that’s not really important, it’s perfectly possible to discuss the evidence anonymously.
Feel free to point out something I’ve said that the demonstrates that I’m a pharma shill.
“You are very critical of people who identify themselves, so who are you?”
BTW – I’m not critical of people, I’m critical of people’s ideas, opinions and arguments. As I expect other people to be critical of my ideas, opinions and arguments. Which is why I don’t think identities are important in a forum like this.
Ross
Just the slippery sort of answer I would expect.
… on June 19, 2008 @ 9:22 pm, ross says,
“BTW – I’m not critical of people, I’m critical of people’s ideas, opinions and arguments. As I expect other people to be critical of my ideas, opinions and arguments. Which is why I don’t think identities are important in a forum like this.
… and on June 18, 2008 @ 1:55 pm , ross said to Cybertiger,
“I’m interested in how you view the evidence and how you apply your opinions as a healthcare professional. It’s called debate.”
Now, we really do need some proper debate on how opinions are applied to the evidence. I realise that there are wicked identity thieves let loose on the blogospere, but ross, I don’t think you need to be so coy about your own identity, even though we now know you’re not a pharmaceuticals operative.
joh, i think you’ve been rather ‘slippery’ in avoiding any meaningful attempt to answer my questions!
ross said,
“It’s called debate. I’m interested in how you view the evidence and how you apply your opinions as a healthcare professional. Why so coy? They’re simple questions. Do you think that the benefits of MMR (and the flu vaccine) outweigh the risks?”
Obviously, in the interests of debate, such a simple question deserves a simple answer.
Might I draw a parallel with Saddam and the war on Iraq?
In early 2003, it was alleged that Saddam posed a threat to the US and UK and that such a real and imminent threat justified the ‘shock and awe’ attack on Iraq. Clearly, the commanders-in- chief of coalition forces felt that the extent of the threat justified the collateral damage to life and limb by the high-tech precision bombing of Baghdad and beyond. For the coalition, the cost of eliminating Saddam (including collateral costs) was a price they were only too willing to pay … to protect the future safety of the herd (flock) back home. What is your opinion, ross – as a non-healthcaring professional?
superberger
No, because it is obvious that you only want to play logical games in which no standard of proof would be good enough, and it would be a waste of time.
We start off with the bad faith that parents report events which are expediently ignored and denied by the medical profession and the government rather than monitored and investigated. Normally with adverse drug reactions they gets to be part of literature simply on the basis of being witnessed and reported, but with vaccine the boot is on the other foot: unless you can prove every link in the scientific chain it is all anecdote – but if you do try and investigate it you will likely meet with the experience of Andrew Wakefield – who was subject to abuse and personal denigration from the outset.
But also the problem with the epidemiology is that it is precisely so poor as analysed by Cochrane in order to disguise statistical association with MMR and autism – that would not be proof, of course, but it is evidence.
I was just amused by this from Aubrey Blumsohn’s ScientificMisconduct website:
http://scientific-misconduct.blogspot.com/2008/06/how-new-paradigm-is-created.html
“No, because it is obvious that you only want to play logical games in which no standard of proof would be good enough, and it would be a waste of time.”
pot. kettle. black.
colmcq
No, I was making a point about superburger’s obvious strategy. I don’t actually see that there is a tremendous problem with designing studies, but argued at a logical extreme you could always argue that no study definitively shows anything. However, with the vaccine autism issue studies which are actually really weak that don’t show an association regularly pass peer review journals, as Cochrane has demonstrated. Studies showing the opposite will be subject to nit picking criticisms and never get through: there are different standards.
‘CDC: Vaccine Study Design “Uninformative and Potentially Misleading”‘
“CDC Director Dr. Julie Gerberding has delivered a potentially explosive report to the powerful House Appropriations Committee, in which she admits to a startling string of errors in the design and methods used in the CDC’s landmark 2003 study that found no link between mercury in vaccines and autism, ADHD, speech delay or tics.”
http://www.huffingtonpost.com/david-kirby/cdc-vaccine-study-design_b_108398.html
How valid is this damning assessment of the CDC study by the NIEHS? Is it still safe to assert: “But the epidemiology shows no evidecce of link.”
john,
My conclusion is that there does not exist an experimental result that would disprove the hypothesis that mmr is in some fashion linked to MMR.
I’ve asked for *your* opinion. And you cannot, or will not, describe experiments that would disprove your hypothesis, to standards acceptable to *you*.
it seems you’d rather stay on the sidelines, popping up all over the internet putting your point of view across. Nothing wrong with that, per se, but it is curious that when offered free reign to try and actually propose a solution the question that occupies so much of your time, you can’t contribute anything.
it is true that almost every experiment is flawed in some aspect, and methodological criticisms are always possible.
but that shouldn’t stop you trying to at least indicate what experiments you would like to see done, and the results which would show/disprove a link between MMR and autism to standards acceptable to you.
superberger
Yes you are playing logical games. For you MMR causing autism is in the same unconfirmable realm as religious beliefs. But I don’t think it is like that. If someone sees their child become ill and lose faculties after vaccination (a link which is instantly denied by the senior medical profession and the government) and then is further hit by the second vaccination, as many parents have seen, then this both evidence and some thing that ought to be investigated at the clinical level, which is what Wakefield attempted to do. So, actually we are looking at the situation where actually all the normal medical rules have been suspended, and instead of accepting (a) that this very bad thing has happened and (b) that it deserves proper medical attention, everyone hides behind bogus statistics and denigrating the characters of the witnesses.
In my experience doctors (not all of them) and health officials instantly deny vaccine damage and that is the basis of a supersticious belief.
superburger cryptically said,
“My conclusion is that there does not exist an experimental result that would disprove the hypothesis that mmr is in some fashion linked to MMR. I’ve asked for *your* opinion.”
It is *my* opinion, for what it’s worth, that mmr *is* linked in some fashion to MMR. It is also *your* opinion, based on published experimental results, that a neurotoxin may *not* in some fashion be linked to neurotoxicity. *My* hypothesis, yet to be disproved, is that (mmr) MMR, containing no known neurotoxin, may be the fabled missing link.
PS. To finally settle the evidential score, it is clear that we are sadly missing the non-ad-hom debating skills of *ross*.
The tapestry of scientific deceit is rapidly unravelling.
MinorityReport has reported that Julie Gerberding MD, Director of CDC no less, has found the ‘no evidence’ link between vaccinatory mercury and autism … to be less than compelling. It seems that the ‘evidence’ was not fit for purpose … for disproving the link between mercury and autistic spectrum disorders.
But MMR doesn’t contain mercury and never did. MMR is safe and the ‘evidence’ is thoroughly compelling. How can MMR possibly be linked to autism? Over to you, ross, superburger, and colmcq – let the debate begin … again.
John
You may not rate the cochrane review as perfect science, but the rest of the scientific community laud it. The component reviews may have individual flaws, but when taken in broader context of the meta-analysis, lend great support to the argument that MMR has nothing to do with autism.
“Studies showing the opposite will be subject to nit picking criticisms and never get through: there are different standards.”
A fair point – could you offer some references?
colmq
“You may not rate the cochrane review as perfect science, but the rest of the scientific community laud it.”
Is that a scientific analysis? The fact is that Cochrane is misleading and contradictory. You have not explained where I am wrong.
” The component reviews may have individual flaws, but when taken in broader context of the meta-analysis, lend great support to the argument that MMR has nothing to do with autism.”
Do you mean “component studies”? OK. We have three studies that Cochrane reasonably clearly says are of no value, one of which would have shown a correlation between MMR vaccination and autism if it had not been for the reported flaws. We have two others which Cochrane states rather generously have “a moderate risk of bias” and one where it clearly identifies a risk of bias, and uses a database frankly unfit for purpose. To meta-anlyse that as a robust evidence base would be insane. It is not clear that Cochrane did this: they said the safety studies were “largely inadequate” which certainly covers the situation with six autism studies, and that they provided no evidence of a link which was almost true (not quite true in the case of Madsen), but very misleading.
“Studies showing the opposite will be subject to nit picking criticisms and never get through: there are different standards.”
“A fair point – could you offer some references?”
Obviously you hear talk, but if they are not published they are not published.
john,
i think you miss my point. All I ask is whether you can describe the experiments you would like to see done to confirm your hypothesis, and in doing so, reflect upon what result would disprove your hypothesis. You can’t or won’t. Tells me enough.
CT. Not sure i follow your posts! sorry….
superburger
My hypothesis is that 99.9% of the time the medical profession walk away from vaccine damage, and pretend nothing has happened – it is a clinical issue like any other but the profession is in denial. The immediate answer is give them some paracetamol, and as to the sequelae, God help us!
The most direct and appalling adverse consequences of vaccination are routinely denied. This is the problem. I have no difficulties with the reponse to Andrew Wakefield’s response to the sub-group he was trying to treat. If you are going to pretend that Wakefield can be refuted through epidemiology, that is very foolish. I note that historically vaccine damage cases have been awarded on a one-off basis: epidemiology does not come into it.
I have friends whose children have fallen into a coma directly after vaccination and damage is still denied. This is what is going on.
john,
that is not the answer to the question i asked. You can’t or wont answer it.
Surely, you must have had some thoughts about what you would like to see done to test the relationship between mmr and autism and how one might prove or disprove a link?
Like i’ve said, your unwillingness or inability to answer simple questions tells me all i need to know.
cheers anyway.
“Is that a scientific analysis? The fact is that Cochrane is misleading and contradictory. You have not explained where I am wrong.”
My intending to draw your attention to the fact that your opinions are grossly at odds with most of the scientific community. Perhaps I was not clear. I must add it’s hard to say where your ‘scientific analysis’ went wrong because it’s not actually anything I could call ‘scietific’, unless you include speculation and quote mining as acceptable methods for review.
“Cochrane sifts 5000 studies and reviews 31. Even the 31 are subject to extremely negative comments.”
and on balance were deemed of sufficiently *high* quality to be included for review.
“My intending”
I was //
superburger said,
“CT. Not sure i follow your posts! sorry….”
The measly threat posed by Saddam, your enigmatic typo, or the vanishing evidence for MMR’s safety with regard to mercury: what bit did you find difficult?
colmcq: “your opinions are grossly at odds with most of the scientific community”
So much the worse for a community repeatedly shown up to be unwilling or unable to cope with exceptions, variations, individual susceptibilities, anything that undermines its one-size-fits-all mentality. The use of epidemiology to deny clear temporal relations at the individual level was always plain stupid, and looks increasingly desperate as well.
colmcq
I was not trying to be popular, I was just pointing out that Cochrane was contradictory and misleading. How can the studies be good enough and “largely inadequate” at the same time?
“Quote mining” is an interesting new thought crime – I was actually producing the evidence in some detail from within Cochrane that the studies were “largely inadequate” (as it said). You will actually find no autism studies in the review which according to review are remotely robust. You select your quotations too, but you fail to acknowledge that they are completely undermined by the detail, and even by some of the general comments (which, however, were not part of the press release and the plain language summary).
The only reasonable conclusion is that a chasm lies between the ideology and the hard science (also, incidentally, in relation to effectiveness as well).
You assert that I am guilty of “speculation” but you provide no examples.
Cochrane on MMR rides two horses, it trashes the evidence base and then proclaims that everything in the garden is lovely.
“You will actually find no autism studies in the review which according to review are remotely robust.”
This is simply not true – all the studies included in the review were deemed of sufficiently high quality to meet the authors selection criteria.
colmcq
Well it obviously is true – that the evidence as discussed contradicts their inclusion criteria, or certainly the spirit of the inclusion criteria. What they say about some of these studies may be low key but it also borders on the contemptuous (notably Taylor and Fombonne studies). They say in a veiled way that Madsen is wrong:
“The interpretation of the study by Madsen was made difficult by the unequal length of follow up for younger cohort members as well as the use of the date of diagnosis rather than onset of symptoms of autism”.
If they had explained that the “younger cohort members” were the vaccinated group (which was the case), it might have begun to expose the whole charade.
But the point that you completely fail to engage with is that while you are correct that only studies of a certain quality should have been included (which would possibly resulted in no studies at all), they are being inconsistent and this can be demonstrated from the text.
Ok. We’re not going to agree on the quality of the studies, that’s pretty clear. Leaving this aside it is still true that if there was a link between MMR and autism it would show in the data by virtue of the huge numbers cummulatively invloved; there is no way you can argue that the epidemiological data is so corrupted as to be completely useless.
colmcq (aka Colm Quinn, known homeophobe) said,
“there is no way you can argue that the epidemiological data is so corrupted as to be completely useless.”
Oh dear, oh dear, all the evidence suggests that you are the one who is completely useless and corrupt. And you seem so keen to go on juggling a load of balls. Do you not remember the parable of those balls, red and blue?
http://www.drbriffa.com/blog/2008/06/02/i-was-going-to-write-about-beta-carotene-and-sunburn-but/
colmcq
Here we go round the mulberry bush!
It is not just you and me – Cochrane does not agree with itself, and that is a problem.
No, 5000 dodgy studies do not make a single good study – and a study is as strong as its weakest link. In the case of the very large Madsen study the autism problem would have shown in the data if it had been properly conducted.
Another question is why would it be with so many studies that virtually all of them suffer from design and execution defects? Circumstantially, I would be inclined to suspect that if the job was ever done properly that an association between MMR and autism and possibly other conditions would become manifest. So, I cannot see the basis of Cochrane’s confidence given what they have said about the science. It is both contradictory and anti-intuitive.
“Another question is why would it be with so many studies that virtually all of them suffer from design and execution defects?”
not virtually all, but *all studies*. Every experiment, in every field, is subject to error – all any competent investigator can do is try and minimise sources of error and discuss them when drawing conclusions.
Absolute proof is the realm of the mathematician and the philosopher.
I guess when you answer my question (e.g. post 76) you will take that into account.
“In the case of the very large Madsen study the autism problem would have shown in the data if it had been properly conducted. ”
Are you levelling that charge at all the included studies?
Superberger
I don’t have any problem with that point – in fact, oddly, I said something very similar in reply to you above. However, in the case of Cochrane it says some rather contradictory things, and the negative things – which are very negative – were not part of its public front. Quite apart the specifically flawed studies the overall view that the safety studies were “largely inadequate” when the political pressures were certainly great to say something else, must be regarded as troubling.
Colmcq
No, it is a specific charge against Madsen, where a great deal is known about the data – and the point is even obliquely made by Cochrane.
Ok, well, do you accept that there is then a body of data in the review that would show a relationship between MMR and autism if there was a link?
superburger said,
“Absolute proof is the realm of the mathematician and the philosopher.”
On Monday this week, Dr Miriam Stoppard, in The Mirror said,
“It’s now been proven beyond doubt that the MMR (measles, mumps, rubella) vaccination does NOT cause autism.”
http://www.mirror.co.uk/lifestyle/yourlife/drmiriam/2008/06/23/health-why-families-with-autism-sufferers-need-a-better-deal-89520-20618194/
Doctor, scientist, mathematician and philosopher, Miriam Stoppard clearly lives in a rarefied realm of her own. Do you agree with the proof of this pudding?
“proving beyond (reasonable) doubt” (e.g.force is proportional to mass.accelaration)
is very different from absolute proof (e.g. the square root of two is irrational)
you know that though CT, you big tease!
I wonder, CT (and john) if you’d like to consider colmq’s excellent point (82).
Cybertiger
You forgot her other accomplishment – wife of former GSK chairman Sir Christopher Hogg.
Struthers
Why are you posting such irrelevant and distracting nonsense?
colmcq
“Ok, well, do you accept that there is then a body of data in the review that would show a relationship between MMR and autism if there was a link?”
I have already said there is a body of data in the Madsen study that does suggest an association. I don’t think you can tell much from the other studies. For obvious reasons I know the ground quite well in Taylor. The trend in Taylor could easily include such an association. Taylor ignored such factors as the catch up for older children affecting pre-1987 cohort rates, and the introduction of accelerated DPT in 1990, and HiB in 1992 (just to mention other vaccination events).
From everything I have been able to ascertain about the GPRD used in the Smeeth study, trying to study the autism rate from that would be like trying to navigate a journey from a map which was nine-tenths missing – most cases never got onto the database at all and those that did were inconsistently recorded – they couldn’t even tell which cases were regressive. A completely perverse exercise. But Smeeth was the least criticised study of the six. I don’t understand why you would use the GPRD for this problem if you wanted to find useful answers.
PS I thought that Cybertiger’s intervention was witty and relevant.
re smeeth – could you provide a figure for the number of autism cases missing from the database.
Yes – from ‘Mercury and Autism in the UK’ part III:
“The U.K. General Practitioners’ Research Database used in the PHLS study (8) is an inadequate tool, both quantitatively and qualitatively, to research neurodevelopmental disorders. The authors of the PHLS study, amid their opaque and unverifiable data, include only 104 cases of autism among term infants, and two among pre-term infants, representing an incidence of barely more than 0.1 percent. By comparison, a survey from the Office of National Statistics offers a much more plausible one percent incidence of autistic spectrum disorders (ASD) among children born between 1988 and 1999. (6) The question further arises with the PHLS figure as to how much of it is interpretation. The study of Hershel Jick and James Kaye came up with much lower figures still, albeit rising dramatically from 1.6 boys in 10,000 in 1993 to 9.5 boys in 10,000 in 1999. Supposing four ASD boys to one ASD girl, this would amount to 1 in 10,000 in 1993 to 6 in 10,000 in 1999, so that in 1993, the median year of the PHLS study, they perhaps were only picking up one-tenth as many cases as the PHLS total using the same database. (7) This is a wide and unacceptable margin of error.”
(The PHLS study is the Andrews, Miller, Taylor thiomersal study in PEDIATRICS.)
I suspect this was because GPs tended not to be involved in the business of diagnosing autism. I think concerns got routed via health visitors to the child development centres. And the information if it did get onto the GPRD tended to be patchy. The situation was described in another Smeeth/Fombonne study based on the GPRD:
“Medical notes for 318 subjects were obtained. They varied in quality and exhaustiveness. For some children, GP records included several consultant reports, speech and language assessments, and educational psychology reports. For other children, the information available was scanty, with sometimes the only available data consisting of one, or a few, letters between the GPs and consultants. A high proportion of records had missing data on parental age, socio-economic status, and detailed psychometric assessment of the child and, therefore, the frequencies of these variables are not described here. Of the 318 children whose medical forms were obtained, the raters confirmed a diagnosis of PDD (pervasive developmental disorders) in 294 children (92.5 percent).”
http://www.vaproject.org/stone/mercury-autism-in-uk-part-3-200602.htm
Note also that in relation to the thimerosal issue, Thomas Verstraeten – who would have had access to the GPRD – doubted the quality even of its vaccine records:
“The quality of the comparison group is maybe even more important if you consider all the criticism we have received of comparing high T exposure to no or low T exposure. I am not sure if the GPRD is that reliable that you can be sure that low exposure is really low exposure and not underascertainment in the database.”
http://www.vaproject.org/stone/mercury-autism-in-uk-part-2-200602.htm
The thing is John, your assertions are nothing more than well… assertions. Without some hard facts backing them up, ideally written up, in full, with methods, results and conclusion, in quality peer reviewed journals, I feel very uneasy and sceptical about your position.
re smeeth (to paraphrase Adam Jacobs):
“the controls were randomly selected from the population, so there is no reason to think the prevalence of ASDs in the control group would be higher than in the population. In fact, it would be expected to be less, as anyone with a recorded diagnosis of an ASD would be ineligible for the control group”
Do you have evidence to the contrary?
Colmcq
Incorrect: you assert; my claims are fully documented. Can you say which bits I made up?
I have to admit I find the Adam Jacobs quote unintelligible. How could the control group be representative if it excluded ASDs?
In regard to Jacobs these links may be of assistance:
http://www.bmj.com/cgi/eletters/329/7472/0-g
http://www.bmj.com/cgi/eletters/330/7484/163
http://www.bmj.com/cgi/eletters/334/7586/208
On 23. June 2008, Dr Miriam Stoppard, a key opinion leader (KOL) said,
“It’s now been proven beyond doubt that the MMR (measles, mumps, rubella) vaccination does NOT cause autism.”
In 1947, Bertrand Russell, mathematician and philosopher said,
“Not to be absolutely certain is, I think, one of the essential things in rationality.”
And he also said,
“The whole problem with the world is that fools and fanatics are always so certain of themselves, but wiser people so full of doubts.”
I wonder where this leaves some of the KOLs of this world.
“Incorrect: you assert; my claims are fully documented. Can you say which bits I made up?”
You’re twisting my words John. Please don’t. My question was very straightforward – you claim the GPRD is an innapropriate tool, despite peer reviewed evidence to the contrary. You still haven’t cited any peer-reviewed evidence that corroborates your position.
Re Adam Jacobs
??
Colmcq
You seem to think that one most show deference to peer review articles by virtue of the fact that they are peer reviewed. Actually, not technically correct – the peer review is the discussion which takes place after the publication of the paper. But we are now dealing with the obscene position in which government departments refer to publications in peer review journals as revealed truth by virtue of their publication, and never need to be reviewed or looked at with a sceptical eye again. But to rigidify science like this is to destroy it. It is saying that no discussion should ever take place: it has all been decided by our elders and betters, who – my experience – generally get things wrong.
There is in fact a lot of information which derives from the studies themselves which tells us that there was huge under-ascertainment of autism and PDD on the GPRD, inconsistent recording even where mentioned, and very unreliable information concerning vaccine status – so it looks like it was a perverse place to go to research these issues. At best you could only find weak traces of the problem you had theoretically set out to research – that is if you ever wanted to find anything. As the parent of a profoundly damaged autistic son, I find this approach whimsical and bordering on insult.
If you are saying the GPRD is suitable by virtue of the fact that there are many published studies in peer review journals using it – that is your uncritical opinion. You have simply got there by touching your forlock to the system. This is a foolish position – not because my criticisms are necessarily right, but it is childish or cynical take things on trust like that.
The first sentence of my preceding post should have read:-
“You seem to think that one must show deference to peer review articles by virtue of the fact that they are peer reviewed. “