Andrew Wakefield has a new video with stunning new revelations of malfeasance by the CDC. Well, that’s what he wants you to think. Let’s take a look and see how well his story stands up to scrutiny, shall we? To do this I’ll highlight two of the problems with the video. The first I’ve already discussed some: Mr. Wakefield claims the CDC hid a result but the CDC actually published it. For the second problem, let’s follow Mr. Wakefield as he creates a timeline showing us how the CDC’s research plan was supposedly revised in response to some analysis results. Then let’s piece together the real timeline.
We will start with problem one. The basic idea of Mr. Wakefields argument in his new video is that the CDC hid an association in a group of kids allegedly susceptible to becoming autistic due to the MMR. This group are those with “isolated autism”: autism without intellectual disability, birth defects or other possible cause.
There’s a lot of smoke and mirrors in the video, but here’s the main result. An increased odd ratio for “isolated autism” for kids vaccinated before 36 months. Calculated odds ratio is 2.48. With a confidence interval that doesn’t span 1 (1.16 to 5.31).
There’s much drama in the video about this. For example, here’s what Brian Hooker had to say (about 3:25 into the video).
What CDC employees do, when they see an effect, then they will get in a room together and they will work until that association goes away
Followed by Mr Wakefield:
But that didn’t seem to happen. They deviated further from the analysis plan by limiting the isolated group to only those with no mental retardation. Even changing the age categories and composition of the isolated subgroup may not have achieved the desired effect. Since, in the end, the simply omitted the relevant findings from the paper altogether.
That’s an amazing claim, isn’t it? The CDC allegedly just buried the result. “Omitted the findings altogether.”
Except that the CDC didn’t hide the result. They reported on autism without MR. Here’s table 4 from the paper in Pediatrics.
If you want to say, “well autism without MR isn’t the same thing as ‘isolated autism’, consider this: the answer is basically unchanged from what Mr. Wakefield claims was “omitted”. Take a look at the table: in the total sample, the group without MR has basically the same result as was supposedly hidden. Odds ratio 2.45 (compared to 2.48), with confidence interval from 1.20 to 5.00 (compared to 1.16 to 5.31). Which is to say: the CDC published the result that Mr. Wakefield claims was hidden.
Smoke. Mirrors. Wakefield. Hooker.
This result is 10 years old. And no one, not Wakefield, Not Hooker, not anyone in the real advocacy community has made a big deal out of it until now. I do not profess to understand how Mr. Wakefield nor Mr. Hooker think, but here’s one reason why most people haven’t considered this “autism without MR” result a big deal: this is a raw data result. A result unadjusted for any possible confounders. The adjusted result, also highlighted in the figure above, shows a confidence interval that spans 1. In other words, there’s no suggestion of a real effect when one does a full analysis.
Which of course shows us why people do full analyses. Sometimes associations change when one controls for other factors. Sometimes associations get stronger. Sometimes they go away. Sometimes things that appear to not be associations are shown to be associations.
Now that we’ve seen that the conclusion from Mr. Wakefield’s video is wrong, let’s consider a second problem with this new video: the way in which Mr. Wakefield manipulates his audience. He creates a timeline for the CDC’s actions that allows Mr. Wakefield to use his new favorite “f” word. Fraud. Let’s go through the timeline.
At about 2:20 in the video, Mr. Wakefield shows us a fraction of a page of the analysis plan. The protocol. Dated September 5, 2001.
We then get this ominous voiceover. Complete with the analysis plan page going up in flames. Very dramatic:
“Over the ensuing months, after the data after the data had been collected and analyzed, and strictly forbidden in the proper conduct of science, the group abandoned the approved analysis plan, introducing a revised analysis plan to help them deal with their problem.”
And to “prove” that months later the CDC introduced a new analysis plan we are shown notes supposedly documenting that the CDC team were creating that revised plan:
You are supposed to say, “they revised the analysis plan! That’s bad!” But do you see what I see? That these are notes from September 6, 2001
2011? Not after the “ensuing months” but one day later after the plan was finalized. I guess we weren’t supposed to look at the date, just the scary words “revised analysis plan”.
From these notes it appears to say that there will be a records review on September 12th and that in advance of that, whoever wrote these notes needs to get the revised analysis plan. Not, “hey, let’s fabricate a new analysis plan” but, “Hey, the plan was revised yesterday and I should get a copy”. Or, to put it another way: how sinister does the note read sound when the plan was just finalized the day before?
So, when did the CDC do the analysis that Mr. Wakefield shows in his video? You know, the analysis that the “revised” plan was supposed to avoid? November, 2001. Two months later after the plan was finalized and, importantly, two months after those notes were taken. Here’s a screenshot from a talk Mr. Hooker recently gave about his work and the DeStefano paper. He showed one of the same tables that Mr. Wakefield uses in his video (29:11 into the video). Notice the date? November 7. In the audio he says “they did see a statistically significant result as early as November 7th, 2001″. Mr. Wakefield’s first video (the ugly, race-baiting one) also references the November 7th meeting. So it looks like this is the earliest evidence Mr. Wakefield and Mr. Hooker have of the CDC obtaining results for this study.
Now, let’s compare how Mr. Wakefield presented a chain of events and what actually happened.
The impression Mr. Wakefield gives in his video is that:
(a) first the plan for the research was finalized by the CDC team,
(b) then they found data which showed an effect they didn’t like and
(c) after “ensuing months” the CDC team then held a meeting in which notes were taken that they had to revise the plan.
Here’s what the actual events appear to be
(a) the research plan was finalized on Sept. 5,
(b) on Sept. 6, someone (likely Mr. Thompson) took notes that he had to get the revised plan and
(c) on November 7, what appears to be the first pass at data analysis were presented presented in an internal CDC meeting.
No evidence of revising the plan after the analysis. The image of the meeting notes are being used as props to craft a story. Andrew Wakefield apparently doesn’t understand the first rule of documentaries. And apparently whatever ability he had for reporting factually has long since faded since he left grad school.
And, Brian Hooker? He’s not just a prop in these videos. He’s an active participant. His organization has paid Mr. Wakefield for at least the first video. The race-baiting video.
The autism communities deserve better. Better than Andrew Wakefield. Better than Brian Hooker.
By Matt Carey