Too Little, Too Late
The Lancet has finally withdrawn the paper on MMR and autism that it published 12 years ago. The study: “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children” consisted of a series of 12 children all of whom had been referred in to a paediatric gastroenterology unit with a triad of autism-like symptoms, abdominal pain and diarrhoea. Note that this study is little more than a series of linked case studies with a very strong pre-selection bias towards gastroenterology (they were referred in to the gastroenterology unit).
While the Lancet's response to a poorly written article was "too little, too late", the vaccination program could well be characterised as "too much, too soon".
”The study was seized upon by the anti-vaccination groups, despite its deep inadequacies, and used to promote unreasonable fear of the vaccination process. Long-time readers of this blog will know that I am not a fan of the drive to indiscriminately vaccinate children against every known disease. It seems to me that this is likely to be a counterproductive policy in the long run because each addition to the armamentarium of needle-weilding nurses meets with more and more parental resistance. After all, it is a traumatic experience having your child vaccinated. At some point (which we may have already reached) parents are just going to say “forget it” and ignore vaccination entirely. Of course articles like the above study simply reinforce this tendency.
I can’t see that the belated withdrawal of the study is really going to make any difference to this situation. At this stage, the withdrawal merely intensifies the suspicions of parents (look, they’re suppressing the truth) who increasingly tend to see the myriad of vaccines as just a ploy of vaccine manufacturers to make money. Given the combination of trauma and fear-driven conspiracy theory, it is a wonder that any parent has their child vaccinated!
I see a fair number of parents who opt out of the vaccination program. I usually try to (gently) persuade them to have the DTP, Polio and HiB courses. All of these diseases (Diphtheria, Tetanus, Pertussis, Polio and Haemophilus Influenza B) have appreciable mortality and are worthwhile having your child protected against. Thereafter, the benefit of vaccines compared to their cost becomes more and more dubious. Judging by the almost hysterical reaction of the public health department, one would have thought the recent measles “epidemic” – that did not actually happen – was an outbreak of ebola virus. Families who had not vaccinated their kids were being treated like some sort of plague factory. Measles is very unpleasant but not really a great deal more dangerous than seasonal flu, so some sense of proportion would have been helpful.
While the Lancet’s response to a poorly written article was “too little, too late”, the vaccination program could well be characterised as “too much, too soon”.
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Feb 4 10 12:21 pm
It’s an odd situation really. A medical study from 1998 should really be considered outdated by now, and yet the media has seized on it.
I disagree that a disease like tetanus would have appreciable mortality. In a developed country like ours- the risk is very negligible indeed. I was told as much by an ED doctor who stitched up my thumb that I had cut on a can lid.
After I refused the tentanus vax for fear of a reaction, he recounted for me the grisly symptoms of catching tetanus including total paralysis. I responded by asking how likely I was to catch tetanus in NZ, for which he was forced to concede that the chances were negligible. Naturally his attempt at emotional blackmail tended to further convince me that the vax was not the way to go- the opposite of what he intended. After all that he did a great job stitching the thumb!
Feb 5 10 12:15 am
I was talking about mortality, not risk, when discussing tetanus. Risk is a different equation. Currently it is quite small for tetanus, but then the risk of side effects are smaller still.
Feb 4 10 10:42 pm
Glad you posted on this MacDoc. I was aware the study due to searches I had made on Autism/Aspbergers following possible diagnosis of that condition in a grandchild. As a result of this reading I have some idea of the background to this issue. Some think Andrew Wakefield has had a raw deal. I understand that includes the parents of the children involved in the original study. A post dated January 28 2010 on http://www.ageofautism.com is headed – ‘ Wakefield’s Science Proven Valid Again In New Study That Replicates Findings’. The post has associated links to the Abstract and the full text.
Abstract is at http://www.la-press.com/article.php?article_id=1816
There is also link to full text below abstract.
What is your view of this new study MacDoc?
Feb 4 10 11:34 pm
Personally, I don’t think Wakefield is guilty of anything more than producing a poor paper. The Lancet editors at the time are the ones who should be censured for publishing it in the first place. On the other hand, the Lancet has a long-standing reputation for publishing trendy, controversial, poorly-constructed papers. Give me the BMJ any day.
The other study you cite is somewhat better than Wakefield’s and does not attempt to spuriously link MMR vaccination to the syndrome couplet of Autism and bowel inflammation. Had Wakefield not attempted to link these two things and had not been receiving funding from an anti-vaccine lobby at the time, I think there would have been no controversy and medical science would have been better served. There is probably a genuine link between inflamed bowel and Autism that should have been properly looked at, rather than diverted into an anti-vaccination side show.
Feb 5 10 12:05 am
There is absolutely no problem with being funded by an anti-vax lobby when it is considered that drug-companies can fund studies on their own products, and the results of these studies is widely considered free of conflict of interest within the medical fraternity.
This requires a twisted definition of the concept. Sorry, but if you fund a study, run in part by your own employees, in which you have a financial interest in the result, you have a conflict of interest that cannot be resolved unless you pull out of the study- there is no acceptable measure that can be put in place to mitigate this.
As such Lancet was in no position to judge whether Dr Wakefield had a conflict of interest until the medical fraternity addresses this long-standing ethical blind-spot.
Feb 5 10 12:18 am
I have a similarly dim view about the conflict of interest in much research funded by big pharma. I am an ecumenical sceptic in this regard.
Feb 4 10 11:38 pm
A NZ anti-vax campaigner has also weighed in here
On another note I understand that legal cases against the US government for adverse reactions due to the MMR vaccine will always fail for trying to link autism to the vaccine, but a number of recent cases (2 or 3) have succeeded by linking symptoms of cerebral encephalopathy (brain damage, of which autism is one part of this general type of damage) to the vaccine. Maybe a new trend worldwide for these cases.
Feb 6 10 12:06 am
“Personally, I don’t think Wakefield is guilty of anything more than producing a poor paper. ”
He falsified the data. He made it appear symptoms of autism appeared after the vaccines when most of the children had symptoms before. He did non-clinically indicated invasive tests. One child ended up with a bowel perforation. That’s not a poor paper that is sheer fraud and one that has hurt many children.
This wasn’t funded by the anti-vaccination lobby, it was funded by the UK taxpayer. The anti-vaccination groups and lawyers were working hand in hand to get fraudulent litigation-based research published that was tailor made to “prove” their case and they found a willing accomplice in Wakefield. This was dumped back in 2003 for lack of evidence. If they could prove a spurious link there was a lot of money involved, and Wakefield took home more than 400,000 pounds out of it.
That this went on so long and was ably assisted by the media is an crime. Parents and children need the truth and this isn’t it and we don’t need the repetition of anti-vaccination talking points either. They get shoved down our throats enough these days. Give some evidence instead. It’s not really that traumatic to have vaccines, I got a tetanus booster when my daughter was having her vaccinations because it was since I was a child that I’d had one. I didn’t fall into a screaming heap of whatever they claim these reactions are and neither did my daughter.
Feb 7 10 7:26 am
Personally, I don’t think Wakefield is guilty of anything more than producing a poor paper.
Then pleaase read more about him.
The General Medical Council does not agree with you.
The man did terrible damage.
Link.
.-= Cedric Katesby´s last blog ..RECEIVED FROM A THAI CORRESPONDENT =-.
Feb 7 10 12:49 pm
Thanks for the link, Cedric. I thought the GMC had not yet made it’s ruling, but it turns out they have not yet decided on a punishment. Have now read the ruling (thank heavens for speed reading) and have revised my opinion of him. There is no doubt the man is an unethical toad. I await the GMC disciplinary measures with interest.
It does not really change my observation that this was a crap paper that the Lancet should never have published in the first place. The damage to the MMR vaccine reputation was enormous and the Lancet board share a big chunk of the blame.
Feb 7 10 7:18 pm
Maybe you needed to look at the reading a bit more closely MacDoc. The linked post failed to address the key argument the Age of Autism blog put forward,
“Let’s put in perspective the actions at issue here. No children were harmed and no parent or guardian has complained about the care these three men provided. In fact, the procedures involved were routine, the resulting treatments standard and the careful attention to gastrointestinal illness in autistic children has recently been endorsed by a consensus statement published in the journal Pediatrics (no friend of the autism community)”.
So what part of the ruling or the linked post led you to believe that he is in fact an unethical toad? Was it the taking of bloods from those kids? Not exactly the most dangerous medical procedure I have heard of, and no charge of lack of parental consent was proven at all!
Feb 7 10 7:25 pm
Perhaps you ought to read the actual GMC judgement. It is not my assessment that he was unethical. It is theirs.
Feb 7 10 10:16 pm
(Hmm, couldn’t get through. I’ll try again. Apologies if this is a double-post)
Thanks for the link, Cedric.
Gald you found it useful.
Respectful Insolence is one of my favourite medical blogs. Orac is one of the most industrious, funny and biting medical writers around.
The anti-vacc nutters loath him.
Another favourite is Dr Ben Goldacre.
He runs Bad Science. Always worth a look.
In case you are not familiar with his style, here’s a quick video….
Link.
It makes me so very angry that this sort of dangerous nonsense has established itself in my own backyard.
Criminal stupidity.
.-= Cedric Katesby´s last blog ..RECEIVED FROM A THAI CORRESPONDENT =-.