I had a bit of a bone to pick with Randi about his recent comment about this controversy in SWIFT, so I emailed him and he replied quite promptly, to point out I said he said something he didn't say. Point taken. But, I thought I would start a thread so I can get some feedback from the Forum.
I was quite taken aback by his celebration of Wyeth Pharmaceuticals' recent court victory in vaccine/autism case as a victory for scientific skepticism. I have not read the decision so I don't have any other details beyond Randi's comments, but I'll look into it.
But since when is a court decision proof of anything other than a jury's willingness to agree with a lawyer?
I don't think this proves anything at all. Let me explain what I mean.
I am a little bit puzzled by the level of animosity towards this line of inquiry (whether vaccines can cause autism). It seems to me to be a quite reasonable one.
Whenever a population has a sudden and continuing increase in the incidence rate of a disease, whether or not people may have a genetic susceptibility to that disease, to ignore the possibility, and indeed, the likelihood, of an environmental factor would not be good science at all. This has been borne out time and again, with many different diseases.
A good example is the endometrial cancer epidemic in the early 1970s, which was proven to everyone's satisfaction to be caused by estrogen containing birth-control pills, which became massively popular in the mid-1960s. The sudden spike in incidence rates in California caught the attention of public health researchers.
They knew that the likelihood of a toxicological (carcinogenic) insult to the organ in question was high, in the past that has explained many such spikes in incidence rates. In other words, an environmental factor. An obvious culprit here, for a cancer of a female sex organ, was the female hormone estrogen. They (by they I mean Donald Austin et al) proposed a study, and requested, and got, health records from Kaiser California, but when he went to the manufacturer of the birth control pills to obtain prescription data of these drugs, they refused to give him the data. Coincidentally (or not, you decide) the manufacturer was Wyeth.
Anyway, they got the data eventually despite Wyeth's reluctance, did the study, and the association was so strong as to be incontrovertible. Several other studies done around the same time supported his findings.
The whole thing was founded on an educated guess, but no one today questions the causal association.
Now, endometrial cancer certainly has a genetic component. People are at increased risk if they have a family history, which is a good marker for genetic susceptibility. Deliver to that population a known carcinogen via a drug, and the genetically susceptible people are going to contract the disease at a higher rate.
So, of course some women who never took estrogen got endometrial cancer, and many who took estrogen did not. This does not change the fact of the causal association.
To say the case is "genetic" is only partly true, and, when used to imply that there is no other cause, somewhat intellectually dishonest, in my opinion.
Ditto for lung cancer and smoking. As I recall, "it's genetic" was one defense the tobacco companies used.
To me, the vaccine/autism question does not seem like hysterical hand-wringing of distraught parents, or ambulance chasing by lawyers, it seems like a very reasonable avenue of inquiry.
The fact is, we do not have adequate data, and we still don't know if vaccines might play a role in the onset of autistic spectrum disorder.
This is a very muddy question, since the time of diagnosis and the vaccine schedule are contemporaneous. But, that is precisely why it seems to me like a good place to start looking. The only way to tell is to do a well-designed case-control study, using the medical records of the kids. That has not happened.
What has happened, is that the IOM, and the California Dept. of Health and Human Services, issued reports that basically said "We did not see a decrease in the rate of autism diagnosis following the date when Wyeth told us it stopped putting mercury in the vaccine."
Well, this is a step in the right direction, but hardly definitive.
And then we have the Verstraaten paper, which, though peer-reviewed, has been widely criticized for it's methodological short-comings. That's it.
(Please forgive me for not citing this stuff properly, it's the weekend, I am supposed to be relaxing.)
Many researchers around the country have proposed well-designed case-control studies to get more information about this possible link. Not surprisingly (to me anyway), they were denied access to the vaccination records.
This is not hysterical hand-wringing, I repeat. It is sound reasoning.
We have a sudden, continuing increase in neurodevelopmental disorders.
Genetic susceptibility being well-considered, there is a very strong likelihood of an environmental factor, due to the sharp and steady increase in recent years. What that may be, I don't know, but investigating a known neurotoxin, mercury, present in the environment, at the time of the onset, seems like a good place to start.
What exactly is illogical about investigating that more thoroughly? How is that woo in any way? I submit to you that it is not. I also submit, that a retrospective measurement of incidence rates, without a control group or medical records, is almost utterly meaningless. Perhaps vaccine link theory of causation would be borne out by further study, perhaps not.
The point is, we need to do several well-designed case-control studies before we start saying we know it's not this or that.
This might also be a situation where we might not want to dismiss out of hand the parents' anecdotal evidence. By itself, it is scientifically worthless, but collected in a controlled fashion and weighed in the context of other evidence, this kind of data can be helpful in disease control.
For example consider the cholera outbreak in London, the advent of modern epidemiology. How did doctors determine who drank from which well? They simply asked. No one had to prove which well they drank from, it was not necessary. That is no different from asking a parent when they first noticed a difference in their child's behavior.
All I mean is, in context, if you have thousands of parents swearing that their child was fine until they got these shots, I don't think you can entirely dismiss that. It is another piece of the puzzle, no more and no less.
At any rate, these questions of public health are never very nicely cut and dried. Of course, Wyeth does not want to be on the hook for billions of dollars in compensation. The CDC will want to proceed VERY slowly, to avoid any disruption in the current mandated vaccine program.
If everyone suddenly stopped vaccinating their kids, the adverse public health impact might far outweigh anything currently being experienced by these unfortunate families.
These would be horrible choices to make, weighing the public good against an individual's harm, and I am glad I do not have to make them.
But please, extend a little skepticism to the claim currently being offered by Wyeth and the CDC, that the current absence of evidence is conclusive proof of no harm. That is ridiculous. I am not suggesting anyone here would think that, but I'm constantly surprised by the tone of people's reaction to this controversial issue.
As I said, I do not know the details of this recent court decision mentioned by Randi, but I posted in my comment the recent concession by the Dept. of Justice in a similar case in U.S. Court of Claims. Wyeth is not a defendant, it is the vaccine injury compensation program. Still, if we're matching court decisions, I've got one too.
I should add, regarding my example of the endometrial cancer epidemic, that the incidence rates DID fall after the doctors stopped prescribing the drug. This was the definitive proof the researchers needed to declare a causal association.
But remember, this was borne out by rigorous scrutiny, with all of the information; medical records and prescription data. That has not yet been done for thimerosal and autism, and now it is looking like it will never be done, since the CDC considers the case closed based on the current state of knowledge. I don't think that is scientifically sound, albeit from a layperson's perspective.
Anyway, that's all I wanted to say. Thanks for reading.
Lots of fodder for the nit-pickers. Bring on the pain, I can take it!
I was quite taken aback by his celebration of Wyeth Pharmaceuticals' recent court victory in vaccine/autism case as a victory for scientific skepticism. I have not read the decision so I don't have any other details beyond Randi's comments, but I'll look into it.
But since when is a court decision proof of anything other than a jury's willingness to agree with a lawyer?
I don't think this proves anything at all. Let me explain what I mean.
I am a little bit puzzled by the level of animosity towards this line of inquiry (whether vaccines can cause autism). It seems to me to be a quite reasonable one.
Whenever a population has a sudden and continuing increase in the incidence rate of a disease, whether or not people may have a genetic susceptibility to that disease, to ignore the possibility, and indeed, the likelihood, of an environmental factor would not be good science at all. This has been borne out time and again, with many different diseases.
A good example is the endometrial cancer epidemic in the early 1970s, which was proven to everyone's satisfaction to be caused by estrogen containing birth-control pills, which became massively popular in the mid-1960s. The sudden spike in incidence rates in California caught the attention of public health researchers.
They knew that the likelihood of a toxicological (carcinogenic) insult to the organ in question was high, in the past that has explained many such spikes in incidence rates. In other words, an environmental factor. An obvious culprit here, for a cancer of a female sex organ, was the female hormone estrogen. They (by they I mean Donald Austin et al) proposed a study, and requested, and got, health records from Kaiser California, but when he went to the manufacturer of the birth control pills to obtain prescription data of these drugs, they refused to give him the data. Coincidentally (or not, you decide) the manufacturer was Wyeth.
Anyway, they got the data eventually despite Wyeth's reluctance, did the study, and the association was so strong as to be incontrovertible. Several other studies done around the same time supported his findings.
The whole thing was founded on an educated guess, but no one today questions the causal association.
Now, endometrial cancer certainly has a genetic component. People are at increased risk if they have a family history, which is a good marker for genetic susceptibility. Deliver to that population a known carcinogen via a drug, and the genetically susceptible people are going to contract the disease at a higher rate.
So, of course some women who never took estrogen got endometrial cancer, and many who took estrogen did not. This does not change the fact of the causal association.
To say the case is "genetic" is only partly true, and, when used to imply that there is no other cause, somewhat intellectually dishonest, in my opinion.
Ditto for lung cancer and smoking. As I recall, "it's genetic" was one defense the tobacco companies used.
To me, the vaccine/autism question does not seem like hysterical hand-wringing of distraught parents, or ambulance chasing by lawyers, it seems like a very reasonable avenue of inquiry.
The fact is, we do not have adequate data, and we still don't know if vaccines might play a role in the onset of autistic spectrum disorder.
This is a very muddy question, since the time of diagnosis and the vaccine schedule are contemporaneous. But, that is precisely why it seems to me like a good place to start looking. The only way to tell is to do a well-designed case-control study, using the medical records of the kids. That has not happened.
What has happened, is that the IOM, and the California Dept. of Health and Human Services, issued reports that basically said "We did not see a decrease in the rate of autism diagnosis following the date when Wyeth told us it stopped putting mercury in the vaccine."
Well, this is a step in the right direction, but hardly definitive.
And then we have the Verstraaten paper, which, though peer-reviewed, has been widely criticized for it's methodological short-comings. That's it.
(Please forgive me for not citing this stuff properly, it's the weekend, I am supposed to be relaxing.)
Many researchers around the country have proposed well-designed case-control studies to get more information about this possible link. Not surprisingly (to me anyway), they were denied access to the vaccination records.
This is not hysterical hand-wringing, I repeat. It is sound reasoning.
We have a sudden, continuing increase in neurodevelopmental disorders.
Genetic susceptibility being well-considered, there is a very strong likelihood of an environmental factor, due to the sharp and steady increase in recent years. What that may be, I don't know, but investigating a known neurotoxin, mercury, present in the environment, at the time of the onset, seems like a good place to start.
What exactly is illogical about investigating that more thoroughly? How is that woo in any way? I submit to you that it is not. I also submit, that a retrospective measurement of incidence rates, without a control group or medical records, is almost utterly meaningless. Perhaps vaccine link theory of causation would be borne out by further study, perhaps not.
The point is, we need to do several well-designed case-control studies before we start saying we know it's not this or that.
This might also be a situation where we might not want to dismiss out of hand the parents' anecdotal evidence. By itself, it is scientifically worthless, but collected in a controlled fashion and weighed in the context of other evidence, this kind of data can be helpful in disease control.
For example consider the cholera outbreak in London, the advent of modern epidemiology. How did doctors determine who drank from which well? They simply asked. No one had to prove which well they drank from, it was not necessary. That is no different from asking a parent when they first noticed a difference in their child's behavior.
All I mean is, in context, if you have thousands of parents swearing that their child was fine until they got these shots, I don't think you can entirely dismiss that. It is another piece of the puzzle, no more and no less.
At any rate, these questions of public health are never very nicely cut and dried. Of course, Wyeth does not want to be on the hook for billions of dollars in compensation. The CDC will want to proceed VERY slowly, to avoid any disruption in the current mandated vaccine program.
If everyone suddenly stopped vaccinating their kids, the adverse public health impact might far outweigh anything currently being experienced by these unfortunate families.
These would be horrible choices to make, weighing the public good against an individual's harm, and I am glad I do not have to make them.
But please, extend a little skepticism to the claim currently being offered by Wyeth and the CDC, that the current absence of evidence is conclusive proof of no harm. That is ridiculous. I am not suggesting anyone here would think that, but I'm constantly surprised by the tone of people's reaction to this controversial issue.
As I said, I do not know the details of this recent court decision mentioned by Randi, but I posted in my comment the recent concession by the Dept. of Justice in a similar case in U.S. Court of Claims. Wyeth is not a defendant, it is the vaccine injury compensation program. Still, if we're matching court decisions, I've got one too.
I should add, regarding my example of the endometrial cancer epidemic, that the incidence rates DID fall after the doctors stopped prescribing the drug. This was the definitive proof the researchers needed to declare a causal association.
But remember, this was borne out by rigorous scrutiny, with all of the information; medical records and prescription data. That has not yet been done for thimerosal and autism, and now it is looking like it will never be done, since the CDC considers the case closed based on the current state of knowledge. I don't think that is scientifically sound, albeit from a layperson's perspective.
Anyway, that's all I wanted to say. Thanks for reading.
Lots of fodder for the nit-pickers. Bring on the pain, I can take it!
