Over the last ten days, two articles by the investigative reporter Brian Deer, published in the British Medical Journal, have shown that the research purported to connect vaccination of children with development of autism was not only incorrectly done, but fraudulent in its conclusions. Are you thinking that True Believers will not be convinced by this information, but will go on believing that vaccination causes autism? Yes, you’re perfectly right.
According to the New York Daily News of Jan. 12, Jenny McCarthy, the Joan of Arc of the anti-vax forces, stated that “this hoopla made us a little stronger, and even more determined to fight for the truth”, by which she meant a connection between vaccination and autism, not Brian Deer’s investigation. (And by the way, thanks to Jane Sarwin of Gateway Maternal Child Health for passing this on to me!)
Why does Jenny say this? How can it be that she’s MORE convinced than ever when she receives information that says Wakefield was wrong? In fact, this is exactly what often happens when the facts contradict strongly-held beliefs. The first real demonstration of this phenomenon was described in a 1956 book, When Prophecy Fails, by the social psychologists Leon Festinger, Henry Riecken, and Stanley Schachter. Festinger and his co-authors studied a cult of UFO believers who were convinced that a flood would destroy the world and they alone would be rescued by a ship from another planet. The psychologists had to infiltrate the group, whose members were secretly preparing for their rescue by giving away their property. Of course, the predicted time arrived, and the world did not end. Most of us would have guessed that the cult members would go home in disgust, after telling the leaders in no uncertain terms what they thought of them and feeling thoroughly embarrassed at having been fooled this way. But no, the opposite was true. The believers became more thoroughly committed than ever and began to publicize their beliefs, to seek converts, and to provide flattering explanations for the failure of the prophecy. Similarly, we can expect Jenny McCarthy and her followers to become more active than ever in their support of Andrew Wakefield’s claims.
Sometimes, thank goodness, people do change their minds when new information shows they have been mistaken. Intensified belief seems to occur only under particular circumstances--- and those circumstances are present for Jenny McCarthy and other Wakefield supporters
The first necessary circumstance is that the belief is deeply held and that it is associated with some real-world behavior; the believer acts in ways dictated by the belief. (This is certainly true of the beliefs about vaccination and autism. Like most beliefs about our children, they involve serious commitment. This belief also dictates not only decisions about vaccination, but spoken and written opinions expressed in public ways.)
Second, the believer must have committed himself by an action that would be difficult to undo. (Public statements of support for the anti-vax cause, leadership in the cause, the collection or donation of money to support that cause-- all these are commitments that are so public and well-known that they can hardly be recanted. At least one person in this group even made death threats against the noted vaccine researcher Paul Offit. )
Third, the belief must be specific and related to real world events, so it’s possible for those events clearly to contradict the believer’s expectations. (This condition is present in the vaccination-autism case, but not in such a clear form as occurred for the UFO group. Understanding the evidence for cause and effect in the present case requires more sophisticated thought than simply noticing whether the earth has been destroyed by a flood.)
Contradictory evidence must occur and be noticed by the believer. (Publicity about Brian Deer’s investigation must be making it almost impossible for anti-vax believers to be unaware of the report.)
Finally, the believer must have the social support of other believers-- if social support is missing, an isolated believer is more likely to yield to the evidence. (Organizations and groups of committed individuals have provided social support to anti-vax believers for a decade and a half.)
As we see, then, the circumstances are nearly perfect for an intensification of anti-vax belief on the part of Jenny McCarthy and others who believe that vaccination causes autism. Paradoxically, the overwhelming case put together by Brian Deer makes McCarthy’s group more strongly biased against vaccination at the same time that it convinces those of us who were neutral or opposed to Wakefield’s claims.
If this seems hard to understand, consider what it would mean to Wakefield believers, what they would need to accept about themselves, if they were to accept the investigative report -- that they have essentially made fools of themselves in public, and that they must therefore be foolish people as well as mistaken; that they have been defrauded by someone they sincerely admired and trusted, and that therefore their judgment is poor; that they have risked their children’s health by mistaken choices and are therefore bad parents. Adopting the belief that the report is a tissue of lies or a fraud perpetrated by the pharmaceutical companies is a far more attractive position for believers to take, and it appears to be the position that Jenny McCarthy will espouse.
Showing posts with label Wakefield. Show all posts
Showing posts with label Wakefield. Show all posts
Friday, January 14, 2011
Thursday, January 13, 2011
Autism, Vaccines, and the Wakefield Study: II. The Apparent Motives
In my last post, I described some important reasons for the rejection of Andrew Wakefield’s 1998 paper that claimed a causal link between the MMR vaccine, the development of autism in young children, and gastrointestinal disease. Information about those reasons came from a remarkable investigation by the British reporter Brian Deer and was published on Jan. 5, 2011, in the British Medical Journal.
Deer also looked into the motives that seem to have been behind Wakefield’s publication of distorted data, and published a discussion of these in the British Medical Journal on Jan 12 (“How the vaccine crisis was meant to make money”). I’ll summarize some of the points Deer described, but this is a long story, and I would strongly recommend that interested readers read the BMJ article for all the disturbing details.
Before the study even began, Wakefield had patented a test for measles virus in bowel tissue and products. Claiming that certain bowel diseases could be diagnosed by detection of measles virus, Wakefield proposed starting a company that would manufacture testing materials and calculated that such materials would bring in over 70 million pounds a year from Britain and America. This income would depend in part on government health administrations and on governmental legal aid funds for patients suffering from bowel diseases. This business proposal was followed by a patent for a single measles vaccine (rather than the usual combination of measles, mumps,and rubella) and the suggestion that there was a connection between measles vaccine, bowel disease, and autism-- a posited syndrome Wakefield called “autistic enterocolitis”. Among the participants in the ensuing business plan were Wakefield, a venture capitalist, and the father of one of the children in the 1998 Lancet study. Also involved was an entity called Freemedic, the commercial section of the merged Royal Free Hospital and the University College (London) Medical School, which later resisted strongly Brian Deer’s attempts to untangle these matters.
Wakefield’s plan thus appears to have been that he and a few others would reap enormous financial benefits from his patented tests and vaccines, and that much of their income would be derived from litigation by parents of sick children. This did not happen, and in fact neither the test nor the measles vaccine had their efficacy demonstrated by later research. (Although Wakefield was directed by his superior to do a controlled study to replicate his research claims, he did not do so.)
What did happen, instead, was that parents became frightened of vaccination and began to resist conventional medical advice about protection from contagious disease. Immunization rates in Britain and other countries dropped and there was an increase in the occurrence of diseases like measles, mumps, rubella, and pertussis, which had been almost non-existent in industrialized countries for some years.
In addition, we have seen the growth of an anti-vaccination community devoted to Wakefield’s cause, and so determined that they must oppose vaccination that they have made serious threats and filed lawsuits against respected vaccine researchers like Paul Offit. My crystal ball tells me that these people will consider Brian Deer’s meticulous investigation to be a pack of lies, like all the other “lies” told about vaccination. In that, they will be very little different from the people who opposed smallpox vaccination over a hundred years ago and suggested that since the smallpox vaccine was derived from cows (vaca, that is), vaccinated individuals would take on cow-like characteristics.
So, those were the real results of Wakefield’s efforts. Wakefield and his friends are disgraced in the eyes of all but the anti-vax crowd, who undoubtedly regard them as martyrs. Children got sick, and sometimes very sick, when they did not need to. And what was it all about? Money, folks, lots of money--- money out of your pocket and mine.
And what about autism? Well, here’s how it is. If your child is vaccinated against common childhood diseases, he or she may become autistic. If your child is not vaccinated, he or she may still become autistic , and he or she may also catch a contagious disease, and as a result of that disease there will be a small but real chance that he or she may die, lose hearing, become mentally retarded, or suffer a number of other lifelong handicaps.
With stakes like that, will you let your decision be dictated by an offshoot of venture capitalism?
Deer also looked into the motives that seem to have been behind Wakefield’s publication of distorted data, and published a discussion of these in the British Medical Journal on Jan 12 (“How the vaccine crisis was meant to make money”). I’ll summarize some of the points Deer described, but this is a long story, and I would strongly recommend that interested readers read the BMJ article for all the disturbing details.
Before the study even began, Wakefield had patented a test for measles virus in bowel tissue and products. Claiming that certain bowel diseases could be diagnosed by detection of measles virus, Wakefield proposed starting a company that would manufacture testing materials and calculated that such materials would bring in over 70 million pounds a year from Britain and America. This income would depend in part on government health administrations and on governmental legal aid funds for patients suffering from bowel diseases. This business proposal was followed by a patent for a single measles vaccine (rather than the usual combination of measles, mumps,and rubella) and the suggestion that there was a connection between measles vaccine, bowel disease, and autism-- a posited syndrome Wakefield called “autistic enterocolitis”. Among the participants in the ensuing business plan were Wakefield, a venture capitalist, and the father of one of the children in the 1998 Lancet study. Also involved was an entity called Freemedic, the commercial section of the merged Royal Free Hospital and the University College (London) Medical School, which later resisted strongly Brian Deer’s attempts to untangle these matters.
Wakefield’s plan thus appears to have been that he and a few others would reap enormous financial benefits from his patented tests and vaccines, and that much of their income would be derived from litigation by parents of sick children. This did not happen, and in fact neither the test nor the measles vaccine had their efficacy demonstrated by later research. (Although Wakefield was directed by his superior to do a controlled study to replicate his research claims, he did not do so.)
What did happen, instead, was that parents became frightened of vaccination and began to resist conventional medical advice about protection from contagious disease. Immunization rates in Britain and other countries dropped and there was an increase in the occurrence of diseases like measles, mumps, rubella, and pertussis, which had been almost non-existent in industrialized countries for some years.
In addition, we have seen the growth of an anti-vaccination community devoted to Wakefield’s cause, and so determined that they must oppose vaccination that they have made serious threats and filed lawsuits against respected vaccine researchers like Paul Offit. My crystal ball tells me that these people will consider Brian Deer’s meticulous investigation to be a pack of lies, like all the other “lies” told about vaccination. In that, they will be very little different from the people who opposed smallpox vaccination over a hundred years ago and suggested that since the smallpox vaccine was derived from cows (vaca, that is), vaccinated individuals would take on cow-like characteristics.
So, those were the real results of Wakefield’s efforts. Wakefield and his friends are disgraced in the eyes of all but the anti-vax crowd, who undoubtedly regard them as martyrs. Children got sick, and sometimes very sick, when they did not need to. And what was it all about? Money, folks, lots of money--- money out of your pocket and mine.
And what about autism? Well, here’s how it is. If your child is vaccinated against common childhood diseases, he or she may become autistic. If your child is not vaccinated, he or she may still become autistic , and he or she may also catch a contagious disease, and as a result of that disease there will be a small but real chance that he or she may die, lose hearing, become mentally retarded, or suffer a number of other lifelong handicaps.
With stakes like that, will you let your decision be dictated by an offshoot of venture capitalism?
Autism,Vaccines, and the Wakefield Study: I. Reasons to Reject Wakefield's Report
Early in 2010, there was an excited reaction to the retraction by the British journal Lancet of an article published by Andrew Wakefield and a number of colleagues in 1998. That article had claimed that research evidence supported the hypothesis that vaccination for some childhood diseases played a causal role in the development of autism. Wakefield’s paper has been a major focus of the anti-vaccine movement and has encouraged parents to refuse vaccination of their children-- with some predictable results in terms of disease and even death of children.
Now in the early weeks of 2011, the British Medical Journal has published two articles by Brian Deer, the Times reporter whose investigation has done so much to clarify the errors in Wakefield’s work. The first of these articles, “How the case against the MMR vaccine was fixed”, appeared on Jan. 5. A second piece, “How the vaccine crisis was meant to make money”, was published Jan. 12.
Lancet's retraction of the Wakefield 1998 paper received attention from bloggers, journalists, scientists, and concerned parents, as we might expect. I’ll summarize some of the criticisms, as they are discussed by Brian Deer in the Jan. 5 article and elsewhere.
The majority of the critiques focus on the ethical errors in Wakefield’s work. Indeed, there were ethical errors by the carload. Wakefield failed to disclose his financial interests in vaccine protocols or in a relevant lawsuit where he was acting as a consultant; he procured blood samples from children whom he knew personally, thus making it awkward for the children or their parents to hesitate to consent to the procedure; he ordered unnecessary and intrusive tests for some children. All these ethical errors would be reasons for reprimands, for the withdrawal of job opportunities, for ordering Wakefield to attend an ethical training program. His withholding of financial disclosure would be good reason for a journal to refuse publication, to print a correction if the article was already published, or in some cases to retract the published material.
However, repellant as Wakefield’s ethical conduct may be, it is not in itself sufficient to support the decision that an article’s conclusion is wrong. A researcher might fail to document informed consent, might intimidate parents and children to get them to participate, and might secretly be on the salaried staff of a corporation with strong related business interests, but if his or her conduct of research, collection of data, and analysis of data were beyond criticism, the research itself could still be of value. Another researcher might follow all rules about informed consent and financial disclosure, but if he or she failed to do a good job in designing and carrying out a study, the conclusions drawn from that study would be worthless. Ethical errors raise questions about the researcher’s integrity in collecting and handling data, but are not necessarily evidence that the basic work has been done incorrectly. Compliance with ethical rules suggests that the researcher approaches his or her tasks with integrity, but adds no credibility to data or conclusions when it’s clear that these do not follow design guidelines. Journals refuse or retract papers when ethical errors are evident, but this is not because their action assures the publication of good material only; it’s because success or failure in publication are the major carrots and sticks available to enforce compliance with ethical rules.
I have seen very few comments about the design flaws of Wakefield’s retracted paper, so I will briefly list some. A major problem with the paper is the small number of children studied. Errors due to chance are much more likely to occur when a study involves twelve children than when it includes 120 children. Such errors might give the impression that an effect is much larger than it really is, but they could also make it appear that it is much smaller than it would appear to be with more data to consider. This is an especially important point in the light of other studies looking at many thousands of children and failing to reach the conclusions reported by Wakefield.
A second major problem has to do with Wakefield’s method of ascertaining what symptoms children showed, and at what times in their lives. Rather than using objective records like notes or videotapes dating from the children’s early years, Wakefield asked parents to recall events that had occurred eight years or more earlier. In taking this approach, he ignored the fact that human memory reconstructs past events rather than plucking them intact from some sort of bookcase of internal recordings. Previous and subsequent events help to determine how, or even if, reconstruction takes place. Memory research dating back almost a hundred years has shown that memories are influenced by expectation and motivation, and that repeated recall, rehearsal, discussion, and consideration of events change the way memories are experienced. These problems are real reasons why Wakefield’s study cannot be considered to provide evidence genuinely supportive of the conclusion drawn and much promulgated.
According to Deer’s investigation, however, there were far more serious problems than flaws in research design. Interviews Deer carried out with parents of children who participated in Wakefield’s study indicated that details reported about their children were not correct. (Because the number of children was so small, parents were able to recognize which case numbers actually represented their own children.) In one case, an American father stated that the child’s autistic symptoms occurred months earlier than the report stated, and in fact began before he received the vaccine. In other cases, there appeared to be no child in the report whose background as described by interviewed parents matched the reported histories. Several of the children had developmental delays and physical problems that were apparent before vaccination occurred. Of nine children described as having “regressive autism” (rather than autistic symptoms existing from early in life), three had in fact not even been diagnosed as autistic.
Deer’s investigation has made it clear that Wakefield’s work was not only sloppy, but involved apparently intentional distortions of the data. Why would Wakefield “fudge” his work? In a second post, I’ll discuss the reasons that Deer has shown.
Now in the early weeks of 2011, the British Medical Journal has published two articles by Brian Deer, the Times reporter whose investigation has done so much to clarify the errors in Wakefield’s work. The first of these articles, “How the case against the MMR vaccine was fixed”, appeared on Jan. 5. A second piece, “How the vaccine crisis was meant to make money”, was published Jan. 12.
Lancet's retraction of the Wakefield 1998 paper received attention from bloggers, journalists, scientists, and concerned parents, as we might expect. I’ll summarize some of the criticisms, as they are discussed by Brian Deer in the Jan. 5 article and elsewhere.
The majority of the critiques focus on the ethical errors in Wakefield’s work. Indeed, there were ethical errors by the carload. Wakefield failed to disclose his financial interests in vaccine protocols or in a relevant lawsuit where he was acting as a consultant; he procured blood samples from children whom he knew personally, thus making it awkward for the children or their parents to hesitate to consent to the procedure; he ordered unnecessary and intrusive tests for some children. All these ethical errors would be reasons for reprimands, for the withdrawal of job opportunities, for ordering Wakefield to attend an ethical training program. His withholding of financial disclosure would be good reason for a journal to refuse publication, to print a correction if the article was already published, or in some cases to retract the published material.
However, repellant as Wakefield’s ethical conduct may be, it is not in itself sufficient to support the decision that an article’s conclusion is wrong. A researcher might fail to document informed consent, might intimidate parents and children to get them to participate, and might secretly be on the salaried staff of a corporation with strong related business interests, but if his or her conduct of research, collection of data, and analysis of data were beyond criticism, the research itself could still be of value. Another researcher might follow all rules about informed consent and financial disclosure, but if he or she failed to do a good job in designing and carrying out a study, the conclusions drawn from that study would be worthless. Ethical errors raise questions about the researcher’s integrity in collecting and handling data, but are not necessarily evidence that the basic work has been done incorrectly. Compliance with ethical rules suggests that the researcher approaches his or her tasks with integrity, but adds no credibility to data or conclusions when it’s clear that these do not follow design guidelines. Journals refuse or retract papers when ethical errors are evident, but this is not because their action assures the publication of good material only; it’s because success or failure in publication are the major carrots and sticks available to enforce compliance with ethical rules.
I have seen very few comments about the design flaws of Wakefield’s retracted paper, so I will briefly list some. A major problem with the paper is the small number of children studied. Errors due to chance are much more likely to occur when a study involves twelve children than when it includes 120 children. Such errors might give the impression that an effect is much larger than it really is, but they could also make it appear that it is much smaller than it would appear to be with more data to consider. This is an especially important point in the light of other studies looking at many thousands of children and failing to reach the conclusions reported by Wakefield.
A second major problem has to do with Wakefield’s method of ascertaining what symptoms children showed, and at what times in their lives. Rather than using objective records like notes or videotapes dating from the children’s early years, Wakefield asked parents to recall events that had occurred eight years or more earlier. In taking this approach, he ignored the fact that human memory reconstructs past events rather than plucking them intact from some sort of bookcase of internal recordings. Previous and subsequent events help to determine how, or even if, reconstruction takes place. Memory research dating back almost a hundred years has shown that memories are influenced by expectation and motivation, and that repeated recall, rehearsal, discussion, and consideration of events change the way memories are experienced. These problems are real reasons why Wakefield’s study cannot be considered to provide evidence genuinely supportive of the conclusion drawn and much promulgated.
According to Deer’s investigation, however, there were far more serious problems than flaws in research design. Interviews Deer carried out with parents of children who participated in Wakefield’s study indicated that details reported about their children were not correct. (Because the number of children was so small, parents were able to recognize which case numbers actually represented their own children.) In one case, an American father stated that the child’s autistic symptoms occurred months earlier than the report stated, and in fact began before he received the vaccine. In other cases, there appeared to be no child in the report whose background as described by interviewed parents matched the reported histories. Several of the children had developmental delays and physical problems that were apparent before vaccination occurred. Of nine children described as having “regressive autism” (rather than autistic symptoms existing from early in life), three had in fact not even been diagnosed as autistic.
Deer’s investigation has made it clear that Wakefield’s work was not only sloppy, but involved apparently intentional distortions of the data. Why would Wakefield “fudge” his work? In a second post, I’ll discuss the reasons that Deer has shown.
Subscribe to:
Posts (Atom)
