As Kev recently wrote here on LeftBrainRightBrain, the main defense of Andrew Wakefield is not a defense at all, but an attack on Brian Deer. Rather than look at the facts laid out in the BMJ article, people are claiming that Andrew Wakefield couldn’t possibly have “fixed” the data (lead authors can and have do this, see our recent post). Also, that Andrew Wakefield didn’t have access to the full records of the children, so that he couldn’t have known that there were contradictory data in those records.
It is an odd argument in that it concedes that yes, indeed, the “facts” in the Lancet article do not match the children’s medical records.
It is also an odd argument because it ignores the citations that Brian Deer makes in his article. Mr. Deer cites where he gets the information that contradicts Andrew Wakefield’s reports. Many of which are not hidden in the child’s records but were available to Mr. Wakefield at the time he wrote his article for the Lancet.
Mr. Wakefield has reported in his Lancet article (now retracted) that “We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers. ”
Emphasis added.
As Brian Deer has noted in his article in the BMJ, this is not the case. Many of the children reported upon were not “previously normal”. We here at LeftBrainRightBrain have the luxury of more space than did Mr. Deer, so let’s check a few of Mr. Deer’s statements, shall we? Let’s look at the children that Mr. Deer commented upon in his article.
Early on in his article, Mr. Deer refers to Child 8. Child 8 was noted as having facial dysmorphisms. Further, the doctors treating Child 8 “…had significant concerns about her development some months before she had her MMR Vaccination”.
Here is a letter sent to Andrew Wakefield on 3 October, 1996. The Lancet article wasn’t published until 1998:
“ Dear Dr Wakefield
[Child 8’s] mother has been into see me and said that you need a referral letter from me in order to accept Child 8 into your investigation programme. I gather this is a specific area of expertise relating to the possible effects of vaccine damage and her ongoing GI Tract symptoms. As far as I am concerned, if [Mrs 8] is happy to proceed with this and it gives her any further information and peace of mind, I am sure it would be beneficial for both her and for [Child 8]. I enclose photocopies of some recent correspondence which gives a fair idea of [Child 8’s] current state. I would simply reiterate Dr Houlsby’s recent comment that both the hospital and members of the Primary Care Team involved with [Child 8] had significant concerns about her development some months before she had her MMR Vaccination. I take Mum’s point that she has video evidence of [Child 8] saying a few words prior to this vaccination being given and her vocal abilities are now nil but I do not think we can be entirely convinced as yet that the vaccine is the central cause of her current difficulties. However, I am quite prepared to support [Mrs 8] in her quest for further information and I hope some useful results come from these tests.
Best wishes.”
emphasis added.
This was presented to the GMC on Day 29 of the hearing. Mr. Wakefield knew Child 8’s physicians questioned whether child 8 was “previously normal” when he wrote the article in the Lancet. It is unclear if Mr. Wakefield sought out those physicians, or if the “recent correspondence” also noted those early signs. But we do know that Andrew Wakefield had more than just the parent’s report on the child’s history and that the physicians disagreed with the parent’s impression. Given the contradiction between the two sources, at the very least, Mr. Wakefield should have sought out the child’s records.
As an aside here, Child 8 was already funded by legal aid at the time of referral. Mr. Wakefield has claimed that children were not already a part of litigation when they were seen by him at the Royal Free. This is also noted in an doctor’s note in the transcripts:
“Mum taking her to Dr Wakefield, Royal Free hospital for CT scan and gut biopsies.
? Crohn’s – will need a letter.
Dr Wakefield to phone me.
Funded through legal aid.”
Again, the child was “funded through legal aide” before referral to Mr. Wakefield.
Here is how Child 4 is reported in The Lancet paper:
One child (child four) had received monovalent measles vaccine at 15 months, after which his development slowed (confirmed by professional assessors). No association was made with the vaccine at this time. He received a dose of measles, mumps, and rubella vaccine at age 4·5 years, the day after which his mother described a striking deterioration in his behaviour that she did link with the immunisation.
“Confirmed by professional assessors”. I find this interesting. One of the defenses of Mr. Wakefield is that “he was just reporting what parents told him”. But, there it is, “confirmed by professional assessors”. Andrew Wakfield had “professional assessors” check the validity of the claims. Have Andrew Wakefield’s supporters actually read the paper?
Was there anything in this child’s records that a “professional assessor” might flag as possibly showing signs of delay before vaccination? Here is the letter from Child 4’s doctor to Mr. Wakefield dated 1 July 1996.
“Following our recent telephone conversation I would be grateful if you could arrange an appropriate ECR appointment for [4] to undergo assessment regarding his possible autism and his bowel problems.
[Child 4] has had long standing difficulties and shows severe learning difficulties and also bowel disturbance and his mother has always found it difficult to accept that there was no known cause for [Child 4]’s disorder. A few years ago she was chasing the idea that he might have a metabolic disorder and I enclose a copy of a letter I wrote to Dr Wraith in Manchester at that time although his reply was he did not see any value in further tests along these lines. I’m aware that you are looking at the possible links between measles vaccine and various difficulties and [Child 4] certainly had MMR in 1988. In general [Child 4]’s mother thinks that he developed normally initially and then subsequently his problems worsened and he lost some of the milestones he had achieved but that he has subsequently improved on something of a restrictive exclusion diet. The professionals who have known [Child 4] since birth do not entirely agree with this however and there is a suggestion that some of [Child 4]’s problems may have started before vaccination.
Since 1994 4 has continued to have intermittent problems with his bowels and diarrhoea that [Mrs 4] relates to food intake; he has had a negative test for celiac disease and has on at least 2 occasions had giardia but he has had no further investigations regarding the cause of these symptoms.
As I say, [Mrs 4] is convinced that both [Child 4]’s behaviour and his diarrhoea are triggered by his diet and she has him on something of a restrictive exclusion diet. He has not gained weight and we have been very concerned about this and [Mrs 4] feels that this is despite him being on a more normal diet. We have therefore not made any assessment as to whether his failure to gain weight might be due to an inadequate diet or to possible malabsorption.
I would be grateful if you could arrange an appropriate appointment and would be very interested if you feel [Child 4] fits into the sort of category of patient that you are interested in looking at further”.
From Day 6 of the GMC hearing. Note that the “…had MMR in 1988” is likely incorrect and that it was the monovalent measles vaccine in 1988.
Again, Mr. Wakefield was alerted to a child having possible problems before MMR administration, but reported the child as “previously normal”. We are left with a question, did Mr. Wakefield just fail to follow up on this possibility or did he know the details and misreport them?
Here is a statement in the child’s records. Whether this was available to Mr. Wakefield at the time of writing the article in The Lancet is unclear:
A delayed development was acknowledged by the health visitor at 1 year of age but at this stage [Mrs 4] did not accept that [Child 4] was slow.
Here is a letter written to Child 4’s physician after his time with the Royal Free team:
“I will write to Dr Wakefield to see if I have any better luck at getting a summary of their investigations and conclusions. [Child 4] had a course of (I think) sulphasalazine after his investigation at the Royal Free Hospital. He became acutely distressed, apparently with abdominal pain and his autism and behaviour did not improve. It was therefore discontinued after a fortnight”.
Apparently, the therapies Mr. Wakefield’s team supplied were not always beneficial.
Let’s move on to Child 1. Mr. Deer reports in the BMJ:
The remaining five children served Wakefield’s claims no better. There was still no convincing MMR syndrome. Child 1, aged 3 years when he was referred to London, lived 100 miles from the Royal Free, and had an older brother who was diagnosed as autistic.76 Child 1’s recorded story began when he was aged 9 months, with a “new patient” note by general practitioner Andrea Barrow. One of the mother’s concerns was that he could not hear properly—which might sound like a hallmark presentation of classical autism, the emergence of which is often insidious. Indeed, a Royal Free history, by neurologist and coauthor Peter Harvey, noted “normal milestones” until “18 months or so.”
Child 1 was vaccinated at 12 months of age, however. Thus neither 9 nor 18 months helped Wakefield’s case. But in the Lancet, the “first behavioural symptom” was reported “1 week” after the injection, holding the evidence for the lawsuit on track.
Here’s the “new patient” note:
“New patient – recently posted from XXXX. Mum worried re hearing/wax in ears/? Discharge left ear … Reassured.” Then “(NB – older brother … ? behaviour probs and ? family dynamics ?)”.
Here’s the statement by Dr. Harvey (of the Royal Free): “after normal milestones a deterioration from 18 months or so”. The referral letter for this child, sent to the Royal Free, states that the child was normal until age 15 months.
Here is a statement from the records at the Royal Free (day 24 of the transcripts):
“Child 1 was admitted for further investigation of his autism and specifically to look into a possible association between his neurological condition and any gastrointestinal disorders. The main problems are a “classical” autism diagnosed a year ago and of diarrhoea.”
On page 50:
“His diarrhoea started approximately 18 months ago. He passes five watery stools a day which contain no blood or mucous. They do contain some undigested food. He appears to have no control over his bowel movements and frequency is increasing. His appetite has always been poor and there has been no obvious change in this. He has only very occasional episodes of vomiting.
He is up-to-date with his immunisations, including his MMR at 12 months of age. There is obvious parental concern that this has some bearing on his subsequent condition.”
Perhaps not consistent, but Andrew Wakefield knew that the child’s records did not place concern until much time had passed since the MMR vaccination.
The “onset of behavioral symptoms” reported in The Lancet does derive from parental report. But not a very strong report. A letter to Andrew Wakefield about child 1 put it like this:
“I saw this interesting child with autism which began some weeks following MMR although there was 7-10 days after the MMR at the age of 1 a brief illness during which he was pale, possibly had fever and his mother said he may have been delirious. [Mrs 1] was keen that you would have a look at a document that she got concerning homeopathic remedies and I am passing this on to you.”
So, Mr. Wakefield reported Child 1 as having first symptom 1 week after MMR. If you include “fever/delirium”. Not exactly an autism symptom. But developmentally the child was noted as being normal until 15 or 18 months? Is that “fixing” data or just something less than accurate?
The Wakefield 1998 Lancet article did not give an accurate picture of these children, based on the records available to Mr. Wakefield at the time. And that is the important fact: Mr. Wakefield had access to information that put his reported findings into question.
Left Brain Right Brain 
Where is the medical expert confirming what “previously normal” means. We cannot go by what Deer says. He does not know that “prospective developmental records from parents, health visitors, and general practitioners.” in the Lancet paper refers to the Red Book held by parents and not the prior clinical notes which the Royal Free team did not have.
Maybe you should read “Callous Disregard” which sets it out. Here is an extract:-
“Child 8’s history required particularly careful attention. In her first year of life, Child 8’s mother became concerned that she was not developing as rapidly as had her older sister. When she was 10 months old, she was referred to a developmental pediatrician.
His expert opinion was that her developmental trajectory was normal.
She was later diagnosed with coarctation of the aorta (a narrowing of the main artery leading from the heart). This was corrected by major surgery and she made an excellent recovery. From this point on, she made rapid gains in speech and other aspects of her development.
Contemporaneous records described her mother as having been “delighted” with her subsequent progress. She received her MMR at the age of 18 months. Twenty-four hours later, she developed a rash and fever and started having febrile convulsions, requiring hospitalization for 5 days. Her regression followed immediately with behavioral deterioration, loss of words and vocalization, screaming, hyperacusis (an excessive sensitivity to sounds), loss of coordination3 and nocturnal muscle jerks. There are multiple references in her medical records of her mother’s clear association between her daughter’s MMR vaccine and her dramatic deterioration.
Interestingly, her GP had referred her for developmental follow-up at 17 months of age, just 1 month before her vaccine.
The developmental pediatrician had assessed her and concluded that she was still developing normally, albeit at the slower end of the range, which was unsurprising in view of her aortic coarctation and major surgery.
What is striking is that when she was reviewed again by the same developmental pediatrician a matter of weeks after her MMR vaccine, he considered her to be
…globally developmentally delayed functioning at about the one
year level. “
lol…let me get this straight Clifford…you want us to take the word of Andrew Wakefield? Don’t think so.
Kev,
It’s simple. Andrew Wakefield was an early proponent of neurodiversity and accepted that “normal” includes the broad spectrum of human neurology. Must be it, right?
LOL – that is from the records in the GMC – all sets of medical records including those not available to the Royal Free Team.
So you don’t want to accept the word of the doctors who saw and treated child 8 before child 8 went to the Royal Free? Hah!
Desperate dissembling when Deer’s story has collapsed.
“If you are lying, then your book is lying” – Anderson Cooper to Wakefield. Does Clifford Miller not have access to the GMC transcript? He does, but he doesn’t like what it says, so he goes to his master’s official text.
Those are the opinions of the medical professionals who treated Child 8.
Child 8 was “previously normal” according to those prior independent opinions.
Deny it as much as you desire.
This debate has some frightening parallels with Tea Party vs. The World. You are (pointlessly)preaching to the converted.
I’m saying I don’t take Wakefield’s word for it in his book. I’ll do my own fact checking if you can’t supply a primary source.
So, Mr. Wakefield reported Child 1 as having first symptom 1 week after MMR. If you include “fever/delirium”. Not exactly an autism symptom.
Parents usually claim brain damage due to encephalitis (or the like) following MMR, taking the high fever as a symptom of the encephalitis.
Real vaccine damage by MMR looks a lot more dramatic than that (see for example juliagrimesjourney.blogspot.com):
Julia had been seizing most of the night, was transported to the nearest ER for stabilization, and then airlifted to Miami Children’s hospital, where she stayed in PICU and the neurology ward for nearly one month. Her diagnosis? Encephalitis (inflammation of her brain) most likely attributed to the MMR-V (measles, mumps, reubella, chicken pox) vaccine she had received nine days previously. When Julia left the hospital, she was functioning at an 8 week level. She is globally delayed, nonverbal and has significant left sided hemiplegia along with severe behavior issues.
You don’t have to be a medical expert to understand what “previously normal” means. Failing to meet milestones and being referred to a developmental pediatrician are not examples of “normal” development. I’m going to go with the BMJ editorial on this one, either Wakefield was knowingly committing fraud or he is a front runner for the single most inept doctor in British history.
I love the way Clifford seems to imply that Deer claims
Wakers had the ORIGINAL medical records and changed them. I doubt
that the original records exist anywhere but where they should
exist – in the office(s) of the physician who created them. Copies
of the records, however, are probably in several places. Nor did I
ever think Deer was saying Wakers had access to the original
records and changed them. Wakers probably had, as is usual in the
medical world, either copies of the patient’s file or a consult
note from the requesting physician. As any medical person will tell
you, most consult notes (at least where the GP isn’t trying to
imply the patient is – um – a little “off”) have some history to
them. When the problem began as reported to the GP, what the GP has
done in regards to treatment or other referrals, anything else
medically important for the consultant to know. If Child 8 was
referred to a developmental specialist at 8 months of age, child 8
was NOT developing normally – or at least what the GP recognized as
normally. While I can’t speak for the UK, here in the USA you would
not be sent to a specialist for normal development. The specialist
may have concluded the child was fine but that does not negate that
the parent(s) and GP felt something was wrong.
I think it’s pretty much established that Wakefield has
zero credibility. It’s kind of beating on a dead horse, so it would
be nice if the autism blogs just close this chapter and help send
this guy into oblivion faster. On the other hand the anti-vaccine
movement will go on no matter what the studies say and how much the
“doctors” and “scientists” from their camp are publicly
humiliated.
Leila,
I agree with you for the most part. I had hoped to put Mr. Wakefield behind me. I expect that after this burst of attention, he will drop once again into relative obscurity.
Two factors are at play here now. First is that there is a big interest in this from people not familiar to the story. The interest level is really high. Second, many people may have a hard time reconciling the shear audacity of the situation. Even though I have delved into this deeper than most, I still find it hard to believe that someone could stand in front of clear, damning evidence and try to wave it away. I find it even harder that people will abet this behavior.
Per Orac at the respectful insolence blog, the next installment in the BMJ series is supposed to be on the business schemes that Mr. Wakefield had planned. Much of this came out during the GMC hearing, and there are details that are, again, audacious and likely new to most readers.
Dear Dr Wakefield…
[Child 8’s] mother has been into see me and said that you need a referral letter from me in order to accept Child 8 into your investigation programme. I gather this is a specific area of expertise relating to the possible effects of vaccine damage and her ongoing GI Tract symptoms. As far as I am concerned, if [Mrs 8] is happy to proceed with this and it gives her any further information and peace of mind, I am sure it would be beneficial for both her and for [Child 8]. I enclose photocopies of some recent correspondence which gives a fair idea of [Child 8’s] current state. I would simply reiterate Dr Houlsby’s recent comment that both the hospital and members of the Primary Care Team involved with [Child 8] had significant concerns about her development some months before she had her MMR Vaccination. I take Mum’s point that she has video evidence of [Child 8] saying a few words prior to this vaccination being given and her vocal abilities are now nil but I do not think we can be entirely convinced as yet that the vaccine is the central cause of her current difficulties. However, I am quite prepared to support [Mrs 8] in her quest for further information and I hope some useful results come from these tests.
I’ve been following this since 2008, which is hardly long enough, but I’m perpetually surprised at how much continued misinformation keeps flooding out about this. I think it’s great that you keep breaking this down into fact and address this relentlessly, because it would’ve been so much easier to have just given up by now. This is the kind of quality, fact-driven information we need. Thank you!
Hey Kev,
It’s times like this I wished I Twittered. BBC Radio 4’s Media Show just called me and said they were having to cancel a discussion of MMR because they couldn’t find any journalist to speak against me.
That’s journalists not willing to appear on the Media Show.
Brian – you know thats because they’re not in the pay of the Illuminati like wot you are 😉
Sully, you’re a genius 😉
Kev,
Brian Deer should say whether he has the developmental pediatrician’s assessment of Child 8 cited in “Callous Disregard” which I quoted earlier:
“The developmental pediatrician had assessed her and concluded that she was still developing normally, albeit at the slower end of the range …”
Does he also have the review by the same developmental pediatrician:
“a matter of weeks after her MMR vaccine, he considered her to be
…globally developmentally delayed functioning at about the one
year level.”
ChildHealthSafety,
let’s look at the whole quote, shall we? I’ll hi-lite some passages (this is from the GMC testimony, hence the break with “..and he gives some detail in relation to that” statement):
According to Andrew Wakefield in “Callous Disregard”
“Twenty-four hours later, she developed a rash and fever and started having febrile convulsions, requiring hospitalization for 5 day”
Here’s what her pediatrician wrote:
“Her mother is now convinced that [Child 8]’s problems effectively started after her MMR injection. She had quite a severe reaction to this vaccine and was admitted with a febrile convulsion following an episode of gastroenteritis a few weeks after her MMR. ”
24 hours, or a few weeks? It is noted as “two weeks” after the MMR in other places,
including in the intake note for the hospital.(note–this part of this statement was incorrect)It appears as though “Callous Disregard” may be reporting the facts a bit off, doesn’t it?
For the record–those are from day 29 of the GMC transcripts
Thanks Sullivan for setting out Child 8’s condition after the MMR vaccine. [You left out this bit ” …. so a matter of a few weeks after the MMR. He says,…”].
But this is what the developmental pediatrician stated before MMR:-
“….. There were no neurological abnormalities and I felt that her development was within normal limits.
My impression was that she is a child who is developing within normal limits, but in whom I thought I may have found congenital heart disease as an incidental finding.”
Her development was previously normal prior to the MMR.
Thanks for your help. It shows that Wakefield in Callous Disregard is medically correct.
It seems to be the case that Brian Deer may have omitted to mention this sort of detail in the material he used to persuade the BMJ to make their allegation of fraud.
Why do you think that was?
Sullivan,
Where is the inaccuracy?
“Twenty-four hours later, she developed a rash and fever and started having febrile convulsions, requiring hospitalization for 5 days.”
Where does it say the hospitalization was within 24 hours?
It says she started having febrile convulsions 24 hours after MMR.
It does not say the first febrile convulsion led to hospitalization within 24 hours of MMR. It says “febrile convulsions” led to hospitalization. It is clearly a later one which did.
You seem to be grasping at straws. That one sentence is a summary of far more detail from the documents.
Is this the kind of detail Brian Deer used to persuade the BMJ to make allegations of fraud? It is starting to look like it.
And the allegations of fraud are about the content of The Lancet paper so lets see those first please.
But that puts paid to your first here about “Callous Disregard”.
ChildHealthSafety,
Do you want to address the issue that the child’s doctor clearly considered that she had developmental concerns before the MMR. And that the doctor still thought that, even after the seizures and gastroenteritis ensued?
“It says she started having febrile convulsions 24 hours after MMR.”
the book says this. The records do not.
Here’s another letter from the GMC transcript:
Shall we put these statements into a timeline?
10.5 months of age (May 1994): “There were no neurological abnormalities and I felt that her development was within normal limits”
17 months of age: “The problems that her mother perceives are failure to progress past developmental milestones.”
19 months of age (27 Janurary, 1995): MMR vaccination
7 February 1995: pediatrician makes a house call on the family “Reaction to measles vaccine and pink left ear – amoxyl”. No discussion of seizures.
13 February: notes indicating hospitalized after seizure.
From this we can conclude a few things. First off, the data at hand do not support the idea that the child had seizures within 24 hours of MMR as Mr. Wakefield states in his book. If you have another source to cite, I welcome it. There are indeed indications that the child was delayed before MMR. After the seizure, the child does appear to have had a decline.
Here is a statement by the child’s GP after age 3:
It also says ‘after an episode of gastroenteritis’ which was ‘a few weeks after’.
What an amazing coincidence that you missed that part out.
Pure amazing. The part that damages your arguement the most and you somehow managed to completely exclude it. No mention of it at all, despite the vast importance of it.
Let’s be fair to you and assume that was an oversight and not deliberate. If not, you owe Sullivan one hell of an explanation.
LBRB has only just posted @00:16 what we wrote @21:59 [shown as 22:59 on this blog].
So only now can we refer to it.
______________________________
Sullivan @00:12:-
It is the specialist’s opinion and not the guess-work of a non-specialist generalist General Practitioner which is applicable.
You say “This child had issues. Major ones. Possibly a reaction to the vaccine. But to claim this child was “normal” prior to the MMR vaccine is false.”
But the specialist developmental pediatrician disagrees. The developmental pediatrician stated before MMR:-
“….. There were no neurological abnormalities and I felt that her development was within normal limits.”
Her development was previously normal prior to the MMR.
And read The Lancet Paper specifically about child eight.
It says all these children had:
“a history of normal development followed by loss of acquired skills”
And it says about child 8:-
“Prospective developmental records showed satisfactory achievement of early milestones in all children. The only girl (child number eight) was noted to be a slow trained at the time or because behavioural features made children unable to communicate symptoms.”
Where is the “fraud” Brian Deer persuaded the BMJ to allege?
Show us.
Yes, at 10.5 months of age. By 17 months of age, there were signs of delay.
False. At 17 months of age, even the mother felt the child was missing developmental milestones “The problems that her mother perceives are failure to progress past developmental milestones”
The child was also not walking at 17 months. ” She stands holding on to furniture and pulls herself up. She is able to [walk] along the settee and will walk holding two hands. ” That’s delayed. That is not a delay that involves “unable to communicate symptoms”.
ChildHealthSafety,
I think we’ve covered Child 8 in depth. We even found out how Mr. Wakefield created a false appearance of a lack of developmental delay before MMR: he chose an evaluation at 10.5 months and ignored the 17 month evaluation.
You’ve ignored the other children mentioned in the above piece. Do you have an explanation for why their records were misreported?
Sullivan @ 01:56
You seem to have missed out age 15 months from your timeline where the developmental pediatrician stated:
“I felt that her abilities, although delayed on the average age of attainment were not outside the range of normal. Her growth has been satisfactory.”
That was two months before her MMR and takes into account the mother’s expressed anxieties.
So no, you have not covered child 8 in depth and particularly you missed the specialist’s assessment of child 8 two months before her MMR vaccination which records her development as within the normal range.
And are you going to distinguish between documents available to the Royal Free team from those not available?
And are you going to distinguish what others at the Royal Free provided to Wakefield from the bits the BMJ claim in broad brush are fraud?
So, again, please point out where the fraud is?
Sullivan @ January 12th, 2011 00:12:45
“It says she started having febrile convulsions 24 hours after MMR.”
“the book says this. The records do not.”
Let us look at the one sentence in the book [ie not The Lancet paper] which summarises the child’s position: “Twenty-four hours later, she developed a rash and fever and started having febrile convulsions, requiring hospitalization for 5 days.”
The records do show she developed a rash and a fever within 24 hours. The records do show she had febrile convulsions but do not record when they started. The records do show one of them lead to hospitalisation but not within 24 hours. So in that one short sentence summary the reference to 24 hours appears to be to the onset of rash and the fever.
And what is the mother’s account? Oh, yes, the GMC failed to call the mother. We only have the GPs account in August 2007 of events 11 and more years earlier.
The GP records appear a little on the vague side and the GP is not sure about dates either:-
“Q Is that correct?
A It is the 27th not the 7th I think. On mine it says the 7th but I think it was the 27th.
“Q What was the mother of Child 8’s perception of Child 8’s reaction to the vaccine?
A I felt that the mother was concerned fairly soon after the vaccine – I think I saw her at home on a home visit shortly after the vaccination – she had had a kind of feverish reaction to it. There obviously was no suggestion of delay at that point. Several months later her mum said she had been looking at a video when Child 8 had a little bit of speech before the vaccination and she felt that that had reduced post-vaccination.”
Not a very complete picture to start accusing anyone of fraud is it.
So where is the fraud?
The only instance of “rash” in the transcripts on Day 26 is this statement from July 1996:
emphasis added.
What are you basing the statement of a rash within 24 hours upon?
Do you have a similar set of arguments for the rest of the charges against Mr. Wakefield? Having shown that Mr. Wakefield not only crafted a story to his liking in the Lancet, we see that he did the same in his book.
Anderson Cooper called it correctly, it appears.
In the reply to Sullivan @ 01:56 that should read 18 months for 15 months [ie on 22 December 1994].
It seems Child 8 was aged 18 months when the developmental pediatrician stated:
“I felt that her abilities, although delayed on the average age of attainment were not outside the range of normal. Her growth has been satisfactory.”
And this was just over a month before her MMR vaccination.
Here’s the full statement from December 1994. I will emphasize the sentence ChildHealthSafety left out:
Brian Deer discussed child 11 first. It was a good choice because the facts and situation are so clear.
Child 11 was an American so the medical history received by Wakefield had to be records brought to the hospital or information supplied to the hospital.
According to the hospital discharge summary, the kid had signs of regressive autism a month before MMR vaccination. And a week after MMR vaccination the kid had a chest infection.
The paper reported that the first behavioral signs of Child 11 occurred one week after vaccination.
Nice and sweet.
The interesting thing about Child 11 is that he was American. As an American he was given the MMR with the Jeryl Lynn strain of mumps virus. Since the other children were in the UK they got another MMR vaccine depending on their age, the one used before 1992 had the Urabe strain of mumps.
So the questions are:
1) Which MMR vaccine was being studied?
2) If the biggest difference between the vaccines was the mumps strain, why is measles the focus?
Sullivan January 12th, 2011 03:42
“Here’s the full statement from December 1994. I will emphasize the sentence ChildHealthSafety left out”
You forget the point which made in The Lancet paper about Child 8 and all the children and over which the BMJ has inappropriately cried “fraud”. It says all these children had:
“a history of normal development followed by loss of acquired skills”.
And we have shown that according to the specialist concerned Child was develomentally normal.
That was the issue The 1998 Royal Free Lancet paper was reporting on scientifically and medically as an “early report” and calling for further investigation.
What you are all helping to demonstrate is that to a medical layman on a mission to discredit Wakefield, Brian Deer, just like LBRB, picks things which are not relevant to the scientific and medical issue in hand.
And the best example on the point appears to be Child 8 who was within the range of normal development but who was not misreported by anyone.
As was pointed out clearly in The Lancet paper: it says about child 8:-
“Prospective developmental records showed satisfactory achievement of early milestones in all children. The only girl (child number eight) was noted to be a slow trained at the time or because behavioural features made children unable to communicate symptoms.”
So where is the “fraud” Brian Deer persuaded the BMJ to allege?
Kev, Sullivan, Re sheldon101 January 12th, 2011 05:08
“Brian Deer discussed child 11 first. It was a good choice because the facts and situation are so clear.”
OK. Child 8 has been dealt with. To move on to Child 11 needs Brian Deer to confirm where he got Child 11’s medical records from first?
The information cannot have come from the GMC transcripts. Child 11 was not mentioned at the GMC.
If Child 11’s medical records were disclosed in the Wakefield v Channel 4 and Deer libel proceedings is there a Court order from Eady J or any other Judge authorising use by Brian Deer for publication in The Sunday Times, The British Medical Journal or anywhere else?
And if not what is the legal and ethical authority permitting the use Brian Deer, The Sunday Times and the BMJ has made of them? And is there a human rights waiver from Child 11’s parents.
“Child 11 was not mentioned at the GMC.”
Sure he was. On 11 different days. A detailed discussion of his medical records was not included.
Given that Brian Deer visited and interviewed Child 11’s father, who was highly critical of Mr. Wakefield, I don’t find it surprising that Mr. Deer may have information about this child’s records.
Yes, child 8 has been dealt with–except that you disagree and cherry pick a fragment of one evaluation notes.
ChildHealthSafety is deliberately missing the point.
The Lancet report (written by Wakefield) said that. The children’s own records said something different. That’s your fraud right there CHS.
Julian Frost @ January 12th, 2011
“ChildHealthSafety is deliberately missing the point.”
No. You have not been reading the posts. All dealt with above.
Sullivan @ January 12th, 2011 19:51:44
‘ “Child 11 was not mentioned at the GMC.” ‘
‘Sure he was.’
Day 64. Ms Smith cross examines Wakefield and mentions child 11 and that they have not looked at this child because “his records are not available”
“Doctor, before I go on to that child, because we know, of course, that that child, Child JS, was not one of the Lancet children, I just want to ask you one or two questions about the only Lancet child whom we have not looked at because his records are not available, and I think it is right that the other Lancet child, who is No 11 in The Lancet paper, you accept was a child from XXX?
A That is correct.”
So as previously stated, Brian Deer need to confirm where he got Child 11’s medical records from.
The information cannot have come from the GMC transcripts.
If Child 11’s medical records were disclosed in the Wakefield v Channel 4 and Deer libel proceedings is there a Court order from Eady J or any other Judge authorising use by Brian Deer for publication in The Sunday Times, The British Medical Journal or anywhere else?
And if not what is the legal and ethical authority permitting the use Brian Deer, The Sunday Times and the BMJ has made of them? And is there a human rights waiver from Child 11’s parents.
Child 11 was mentioned day 1, day 30, day 32, day 54….many days.
The fact is that we can’t confirm his records. What do we always hear in defense of Mr. Wakefield? Listen to the parents, isn’t that it? Here’s what the father said:
If you have data to refute the parent, I’d love to hear it. Otherwise we should move on.
Sullivan January 12th, 2011 @ 20:25
“Child 11 … The fact is that we can’t confirm his records.”
Does Brian Deer have the records or not?
If not how can he claim Child 11 is an example of fraud?
We have already seen that allegation does not stack up for Child 8 either.
That is 2 out of 12.
So where is the fraud? Still looking for it and it is not yet found.
Got any more examples of “fraud”? You have 10 to choose from next.
Again, ChildHealthSafety:
The children’s records said one thing, Wakefield’s paper said another. That’s where Wakefield committed his fraud.
‘From the information you provided me on our son, who I was shocked to hear had been included in their published study,’ he wrote to me, after we met again in California, ‘the data clearly appeared to be distorted.’
He backed his concerns with medical records, including a Royal Free discharge summary
(The stupid – it burns)
Julian Frost January 12th, 2011 @ 20:56
“The children’s records said one thing, Wakefield’s paper said another. That’s where Wakefield committed his fraud.”
Really? Not so far for Child 8 and Child 11.
Facts please not rhetoric.
Visitor January 12th, 2011 – 20:57
“‘From the information you provided me on our son … the data clearly appeared to be distorted.’’ …. He backed his concerns with medical records, including a Royal Free discharge summary.”
So where are these records and what information did Deer provide to the parent?
What is worse is that in his February 2009 Sunday Times Article Deer made a completely different claim. A fraud allegation for Child 11 does not stack up with what Deer has previously published.
The Feb 2009 article dealt in detail with the anomalies Deer alleged he had found including allegations of inconsistencies in developmental records. But nothing was said about an anomaly with Child 11’s developmental records.
We already know Deer’s word cannot be accepted:
* a fraud allegation cannot apply to Child 8
* there are no records for Child 11 so no one can base an allegation of fraud on that either.
So where is the fraud?
We have the parental report on child 11. If that’s not good enough for you, please take all other parental reports out of the discussion.
I find this exercise somewhat interesting. Delving deeper has shown more, not less misrepresentations by Andrew Wakefield. His mischaracterization of child 4 (claiming a reaction within 24 hours) shows me why he didn’t pursue his press complaints commission action. Clearly he was going to fail.
Doing a little more checking, Child 5 had serious febrile seizures long before the MMR. Age 11 months, 10 minute seizure, followed by 2 more. Sounds like the sort of detail I would have liked to know, rather than a claim of “previously normal”.
Here’s a note in the record for this child–
So, after the seizures his parents noticed a difference in his development. That’s April 1990. His MMR was August 1990. And, yet, Mr. Wakefield reported first behavioral symptom as 18 months.
Shall we go on? How many fabrications by Mr. Wakefield are needed to demonstrate fraud?
So childhealthsafety what’s your position on the two articles. You are a solicitor, aren’t you. Surely you realize that UK lawyers would have gone over them very carefully, especially the second article. I say especially the second article because Wakefield’s reputation isn’t worth much. But the university, hospital and people named do have valuable reputations, worth suing for defamation.
So is the first article a complete lie? Is the second article a complete lie?
Let’s review shall we, child 8 failed multiple milestones, child 8 possibly had minor facial deformations, both child 8’s parents and doctors had sufficient concerns about her development to refer her to a developmental pediatrician. The pediatrician on evaluating her concluded that child 8 was developmentally below average but probably within the range of normal (which is distinct to saying she was normal). The developmental pediatrician remained sufficiently concerned to require multiple follow ups of child 8 to monitor her progression.
From all this Wakefield simply reports “previously normal”. Now is this an accurate description or is it a fabrication? Considering the evidence in it totality I know which one I believe. However ask yourself this ChildHealthSafety would you use this phrase “previously normal” to sum up child 8’s medical history? If the answer is no then you probably have your answer about whether Wakefield committed fraud.
This Clifford Miller may be a solicitor, but he clearly has some kind of disorder. He simply keeps asserting over and over. No matter what you tell him, he will keep saying the same thing. No matter what the evidence is, he will keep saying the same thing. He then sums up on himself, saying the same thing. He has got something wrong with him.
Regarding Child 8:
It appears she had develpmental concerns early on, severe enough to warrant a referral.
It appears an formal assessment could not be carried out due to non-compliance.
She appeared low-normal based on observational assessment only, not formal (meaning standardised, normalised, or cross-rated) assessment.
There were enough residual concerns for a formal assessment to be warranted.
Formal assessment indicated she was developmentally delayed.
This seems like a fairly straight forward progression from reporting by parents up to formal assessment.
It’s very odd then, that this progression is causing CHS so much difficulty, given how easy it is to understand (because it’s openly stated) that the inital consultation did not include a sufficient assessment.
The assessment progression predates the purported cause by nearly a year, and does not contradict any earlier formal assessments (as there do not appear to have been any completed successfully).
It is not hard to imagine – as Sullivan directly quotes – that the review was the culmination of the assessment process, rather than a fresh assessment of previous non-existant impairments. As John Stone likes to point out, discrepancies are the norm. A harsh and noticable change in condition in a short space of time, in front of the same clinician, is something that would have undoubtedly been something of importance to include in the clinical notes.
Oddly, this information is lacking from CHS’s posts, despite the huge importance to it, and that fact that it would act as serious support for his arguement. One can only conclude that it therefore does not exist, and that Sullivans reading of the notes is therefore the most accurate.
Any evidence of a full assessment in the prior session would be good.
Dedj January 13th, 2011 @ 02:26
“Regarding Child 8: ….. Any evidence of a full assessment in the prior session would be good.”
This should help you:-
“May 1994 age 10.5 months: “There were no neurological abnormalities and I felt that her development was within normal limits”
17 months of age: “The problems that her mother perceives are failure to progress past developmental milestones.”
23 December 1994 (approx 18 months) – developmental pediatrician wrote: “I felt that her abilities, although delayed on the average age of attainment were not outside the range of normal. Her growth has been satisfactory.”
27 January, 1995: MMR vaccination
17 February 1995: The developmental pediatrician writes three weeks after MMR:
“When I reviewed her in clinic recently I confirmed that she is globally developmentally delayed, functioning at about a one year level on Denver Developmental Assessment. …… General examination is unremarkable. There were no neurological abnormalities other than the developmental delay.”
Why do you always edit out these key parts of the statement?
Pretty key information for someone to evaluate these claims.
Editing out key information seems to be not limited to Mr. Wakefield.
ChildHealthSafety,
do you consider lead poisoning to be an important confounding factor? Given that one child had lead levels over 2.5X the reference range for lead, couldn’t that be something that might be important to disclose to the public?
We can include the the full statement that ChildHealthSafety focuses upon, complete with the concluding statement from the testimony:
Emphasis added.
“Is that the first time that the worries that had been expressed at an earlier stage were formally confirmed on assessment”
That’s how the doctor interpreted the statement.
“This should help you:-”
Why was that supposed to be helpful?
It contained no new information, contains information that had to be handed to you on a plate, and does not contain the relevant information that I asked for.
It’s a rather worrying sign that maybe you do not understand how the assessment process works, and thus are unaware of the irrelevance of your answer.
There is the Denver Developmental Assessment mentioned in the review session, which is a fairly standard developmental assessment, but none is mentioned as being successfully completed in the initial session.
Does the following statement appear in relation to Child 8 or not?
“As I was unable to perform a satisfactory assessment, I am arranging to review her in two months time.”
If not, where and what was the initial assessment, was it the Denver or another standardised assessment?
If so, where is the clinicians note detailing the noticable and swift deterioration?
Sullivan January 12th, 2011 22:44
“We have the parental report on child 11. If that’s not good enough for you, please take all other parental reports out of the discussion.”
You miss the point. If Brian Deer is alleging fraud then he must compare the data and results provided to Wakefield by the Royal Free team with what is in the paper.
What he has done instead is compare the wrong information. Clearly, his lack of medical qualifications has resulted in the current mess he is now in over this.
Take the example of Child 8 – it is the specialist developmental pediatrian’s opinion which counts. Neither the GP nor the mother is competent to provide the specialist assessment of whether the child’s development was in the normal range. And neither of them did – it was the developmental pediatrician who did that.
So we say again, show us where the fraud is.
Re visitor and comment on Miller being a solicitor.
Not fair. It isn’t unusual for people to be perfectly rational except for one idea. When it comes to vaccine, Maher is one example. Another example is Leonard Lopate who does some great documentary-type radio work for WNYC.
“That’s how the doctor interpreted the statement.”
I’m amazed it can be interpreted any other way.
The assessment process had clearly not stopped at the initial session, and the wording of the outcome of the review session is firmly clear in the Denver Ax being in reference to previous concerns.
This before/after dichotomy of CHS is confusing, as none of the sources he uses mean what he claims they do. As you have aptly demonstrated, they say the exact opposite.
There is no evidence to suggest that the review session was because of new developmental concerns arising from the MMR (although the parents probably remember it that way).
If there were, it would be odd as it was a review session, not a fresh referral. Clinics do not retain clients they feel do not require their services.
All of the information to support Sullivans interpretation is explicit and non-ambiguous.
I notice our prior comment posted at 03:08 am your blog time [02:08 real time] has not gone up but several other posts have from Brian Deer’s defenders. This is not the first time that has happened.
You can therefore continue this dialogue on ChildHealthSafety here:-
“Wakefield & MMR – BRIAN DEER CANNOT TELL US WHERE THE FRAUD IS”
http://tinyurl.com/5vs8rwt
The challenge is out on CHS to Brian Deer to explain where the fraud is whether or not you post this or the prior one.
The Lancet paper stated at the outset that all these children had:
“a history of normal development followed by loss of acquired skills”.”
That was a main scientific and medical issue being examined.
Child 8 was developmentally within the normal range as repeatedly stated by the developmental pediatrician.
Nothing else is relevant to the issue the paper was examining – whether the children had a history of normal development.
Child 8 was the worst example you Sullivan chose for this blog and it has been shown that the 1998 Lancet paper is accurate on Child 8. Child 11 has no medical notes available so Brian Deer has insufficient information.
The following is the prior comment to which we referred and which still has not been posted. So you can post on CHS now instead here:
“Wakefield & MMR – BRIAN DEER CANNOT TELL US WHERE THE FRAUD IS”
http://tinyurl.com/5vs8rwt
POST STILL NOT POSTED
_____________________________________________________
ChildHealthSafety Your comment is awaiting moderation.
January 13th, 2011
03:08:08
Sullivan January 12th, 2011 22:44
“We have the parental report on child 11. If that’s not good enough for you, please take all other parental reports out of the discussion.”
You miss the point. If Brian Deer is alleging fraud then he must compare the data and results provided to Wakefield by the Royal Free team with what is in the paper.
What he has done instead is compare the wrong information. Clearly, his lack of medical qualifications has resulted in the current mess he is now in over this.
Take the example of Child 8 – it is the specialist developmental pediatrian’s opinion which counts. Neither the GP nor the mother is competent to provide the specialist assessment of whether the child’s development was in the normal range. And neither of them did – it was the developmental pediatrician who did that.
So we say again, show us where the fraud is.