Archive | January, 2011

The Big Lie – what Andrew Wakefield did was possible and fraudulent

10 Jan

Earlier this week, the blog Child Health Safety published a piece claiming it was impossible for Andrew Wakefield to have acted fraudulently. Earlier today, JB Handley of Age of Autism published a similar piece:

“It was not possible for Wakefield or anyone else to falsify the prior clinical records of the children because no one at the Royal Free Hospital London had them nor is it normal practice for them to have had them. So there could be no fraud over ‘altering’ those histories. It just was not possible.”

Plain English: In Britain, when you are referred from a local doctor to a major hospital, like the one where Andy worked, your previous doctor’s records DO NOT travel with you.

Hmmm. Lets look at the definition of the claim of fraud from the editorial in the BMJ.

The Office of Research Integrity in the United States defines fraud as fabrication, falsification, or plagiarism. Deer unearthed clear evidence of falsification. He found that not one of the 12 cases reported in the 1998 Lancet paper was free of misrepresentation or undisclosed alteration, and that in no single case could the medical records be fully reconciled with the descriptions, diagnoses, or histories published in the journal.

This quite clear – but don’t CHS blog and JB Handley have a point? If Andrew Wakefield couldn’t see the NHS records, how could he have falsified data? He might have been wrong, but fraud? No. If Wakefield couldn’t have seen those NHS records he could not have altered data from them to enhance his Lancet piece.

Except he _did_ see these children’s NHS records. From the very paper itself, we can glean the following:

12 children (mean age 6 years [range 3–10], 11 boys) were referred to a paediatric gastroenterology unit
with a history of normal development followed by loss of acquired skills, including language, together with diarrhoea and abdominal pain. Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records.
Ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture were done under sedation. Barium follow-through radiography was done where possible. Biochemical, haematological, and immunological profiles were examined.

…

Developmental histories included a review of prospective developmental records from parents, health visitors, and general practitioners.

This is quite clear. Wakefield saw the NHS records of the Lancet 12. The claim that he didn’t is incorrect at best.

Increased autism risk found in closely spaced pregancies

10 Jan

Prof. Peter Bearman is the Jonathan Cole Professor of the Social Sciences at Columbia University. His team has been delving in-depth into the California Department of Developmental Services (CDDS) data on autism.

There are some big caveats to using the CDDS data. These include:
The CDDS dataset is based on administrative prevalence. In other words, it is a listing of individuals who sought and were successful getting services. It is not a listing of all autistics in California and it the standards of inclusion are not standardized over time and geography.

In terms of shear size, it is probably the largest such dataset in the U.S.. So, taking the limitations to heart, it is worth taking a look at what one can do with these data.

The authors note this:

Use of administrative records of the California DDS for identification of autism represents a strength of the study, facilitating population-based analyses over 11 years of birth records from this populous and diverse state. However, inclusion as a case subject depends on seeking services and receiving a qualifying diagnosis, with previous reports estimating that 75% to 80% of people with autism in California register with the DDS.

The authors are: Keely Cheslack-Postava, PhD, MSPH, Kayuet Liu, DPhil, and Peter S. Bearman, PhD.

The team took the data and asked, is there an increased risk of autism for children based on how long the parents waited after a previous birth?

Consider second-born children. If a mother gets pregnant right after her first born, is the risk of autism the same, greater or less than if she waits? Based on what they found, the Columbia group would say that the risk is higher if the mother gets pregnant again shortly after giving birth.

Here is a blurb on the study:

INCREASED AUTISM RISK FOUND IN CLOSELY SPACED PREGNANCIES
 
An examination of California birth records found second-born children were more than three times more likely to be diagnosed with autism if they were conceived within 12 months of the birth of their older sibling. The farther apart pregnancies were spaced, the lower the risk of autism. The study, “Closely Spaced Pregnancies Are Associated With Increased Odds of Autism in California Sibling Births” published in the February 2011 issue of Pediatrics (published online Jan. 10) examined the odds of autism among more than 660,000 second-born children. Compared to children who were conceived more than three years after the birth of an older sibling, children conceived after an interpregnancy interval (IPI) of less than 12 months were over three times more likely to be diagnosed with autism. Children conceived after an IPI of 12 to 23 months were 1.86 times more likely to have been diagnosed with autism, and children conceived after an IPI of 24 to 35 months were 1.26 times more likely to have been diagnosed with autism.
 
One possible explanation for the increased risk of autism is that women are more likely to have depleted levels of nutrients such as folate and iron, as well as higher stress levels, after a recent pregnancy; however, these factors were not tested in the current study. Study authors suggest the finding is particularly important given trends in birth spacing in the U.S.; between 1995 and 2002, the proportion of births occurring within 24 months of a previous birth increased from 11 percent to 18 percent. Closely spaced births occur because of unintended pregnancies but also by choice, particularly among older women who delay childbearing. The study was funded by the NIH Director’s Pioneer Award Program.

Here is the abstract:

OBJECTIVE: To determine whether the interpregnancy interval (IPI) is associated with the risk of autism in subsequent births.

METHODS: Pairs of first- and second-born singleton full siblings were identified from all California births that occurred from 1992 to 2002 using birth records, and autism diagnoses were identified by using linked records of the California Department of Developmental Services. IPI was calculated as the time interval between birth dates minus the gestational age of the second sibling. In the primary analysis, logistic regression models were used to determine whether odds of autism in second-born children varied according to IPI. To address potential confounding by unmeasured family-level factors, a case-sibling control analysis determined whether affected sibling (first versus second) varied with IPI.

RESULTS: An inverse association between IPI and odds of autism among 662 730 second-born children was observed. In particular, IPIs of 36 months. The association was not mediated by preterm birth or low birth weight and persisted across categories of sociodemographic characteristics, with some attenuation in the oldest and youngest parents. Second-born children were at increased risk of autism relative to their firstborn siblings only in pairs with short IPIs.

CONCLUSIONS: These results suggest that children born after shorter intervals between pregnancies are at increased risk of developing
autism; the highest risk was associated with pregnancies spaced <1 year apart. Pediatrics 2011;127:000

Simply put, they claim that indeed there is an increased risk of autism if a follow-on pregnancy comes shortly after the first. In fact, the odds of having an autistic child are

Here is Figure 2 of the paper. This shows their computed odds ratio as a function of IPI–inter-pregnancy interval.

The authors conclusion is:

This study provides evidence of an inverse association between IPIs and autism risk, with a more than threefold elevated odds in pregnancies conceived within a year of a previous birth. This finding is particularly important given trends in birth spacing in the United States. Between 1995 and 2002, the proportion of births occurring within 24 months of a previous birth increased from 11% to 18%. Closely spaced births occur in some part because of unintended pregnancies but also by choice, particularly among women who delay childbearing. Therefore, additional research to confirm this association in other populations and to undercover underlying mechanisms is particularly critical.

As with any study like this, replication is critical. But, if there isn’t some unkown artifact at play here, this could point to more information on causation in autism.

Scientific fraud allegations: Wakefield is not unique

9 Jan

Most readers have likely already heard about the BMJ pieces calling out Andrew Wakefield’s research as fraudulent. Mr. Wakefield has tried to deflect these criticisms by claiming that Brian Deer, the investigative reporter who initially broke the Wakefield story years ago and who wrote the main article for the BMJ, is part of a consipiracy funded by pharmaceutical interests with the goal of discrediting Andrew Wakefield and his work. Besides these wild claims, Mr. Wakefield and his supporters have offered the defense that it would be impossible for one man to perpetrate scientific fraud of this sort.

Unfortunately, scientific fraud does happen. A quick google search of scientific fraud gathers many hits. One prominent hit is this piece by Politics Daily, U.S. Scientists Top Research-Fraud List — How Concerned Should We Be?

You won’t be surprised to hear that the blog Retraction Watch has a goal of “tracking retractions as a window into the scientific process” and has reported on the recent BMJ article on Andrew Wakefield.

Most retractions are far more mundane than Mr. Wakefield’s. Consider this article in Retraction Watch: Authors of Journal of Immunology paper retract it after realizing they had ordered the wrong mice.

Some retractions are as complex, if not as damaging, as Mr. Wakefield’s paper. Consider the case of Jan Hendrik Schön, a researcher for the prestigious Bell Labs in the United States. Schön reported amazing breakthroughs on single-molecule semiconductors. Others were unable to replicate his results and, as time went on, people started to notice anomalies in his papers–like identical data being reported for very different experimental conditions, in multiple papers. When investigated he was unable to produce the data to support his work.

In the end, at least 21 of his papers were retracted. These were in highly respectable journals: Science, Nature and Physical Review B. His university went so far as to revoke his Ph.D..

Research fraud happens. Rarely, but it happens. Even with co-authors and peer review.

Another part of the defense Mr. Wakefield and his supporters offer is an attempt to focus all attention on the retracted paper in The Lancet. They state that the Lancet Paper did claim proof of a link between MMR vaccination and autism. Mr. Wakefield’s research improprieties did not start nor end with the 1998 Lancet paper. Even though the Lancet study did not prove a link between MMR and autism (even if it were not a case of research fraud), Mr. Wakefield made public statements about his beliefs that the MMR vaccine was linked to his new (and still unproven) “syndrome” of autism and gastrointestinal disease.

The BMJ has called for a review of more of Mr. Wakefield’s papers. They are quite right to make this call. Many of Mr. Wakefield’s studies are likely contaminated by biased case selection, if nothing else.

One paper that absolutely deserves review is the paper by Uhlman, Wakefield and others which claimed to find evidence of measles virus RNA in the intestinal tissues of autistic children:


Potential viral pathogenic mechanism for new variant inflammatory bowel disease.

Uhlmann V, Martin CM, Sheils O, Pilkington L, Silva I, Killalea A, Murch SB, Walker-Smith J, Thomson M, Wakefield AJ, O’Leary JJ.

Department of Pathology, Coombe Women’s Hospital, Dublin 8, Ireland.

Abstract

AIMS: A new form of inflammatory bowel disease (ileocolonic lymphonodular hyperplasia) has been described in a cohort of children with developmental disorder. This study investigates the presence of persistent measles virus in the intestinal tissue of these patients (new variant inflammatory bowel disease) and a series of controls by molecular analysis.

METHODS: Formalin fixed, paraffin wax embedded and fresh frozen biopsies from the terminal ileum were examined from affected children and histological normal controls. The measles virus Fusion (F) and Haemagglutinin (H) genes were detected by TaqMan reverse transcription polymerase chain reaction (RT-PCR) and the Nucleocapsid (N) gene by RT in situ PCR. Localisation of the mRNA signal was performed using a specific follicular dendritic cell antibody.

RESULTS: Seventy five of 91 patients with a histologically confirmed diagnosis of ileal lymphonodular hyperplasia and enterocolitis were positive for measles virus in their intestinal tissue compared with five of 70 control patients. Measles virus was identified within the follicular dendritic cells and some lymphocytes in foci of reactive follicular hyperplasia. The copy number of measles virus ranged from one to 300,00 copies/ng total RNA.

CONCLUSIONS: The data confirm an association between the presence of measles virus and gut pathology in children with developmental disorder.

Testimony presented at the Omnibus Autism Proceeding by PCR expert Stephen Bustin demonstrated clearly that the PCR experiments in this study were performed in such a way as to make accurate analysis impossible. A crucial step was missing in the process.

Further, and more damning, was the testimony of Dr. Chadwick, a former researcher with Andrew Wakefield at the Royal Free Hospital. Dr. Chadwick discussed how PCR results from his laboratory showed no presence of measles virus–in many of the same children used in Mr. Wakefield’s reported research. Yes, Mr. Wakefield knowingly ignored data, from his own research group, which went against his conclusion.

Clearly this paper should be subjected to review and, I believe, should be retracted.

In terms of perpetrating research fraud, Mr. Wakefield is not unique. There are other examples of gross fraud. However, there is a major difference between the Jan Schon’s of the world who waste a lot of other researchers time and money and the Andrew Wakefield’s of the world who put public health at risk, and cause great harm to autistics and their families. While it is tiring to hear the Andrew Wakefield saga come to the fore again and again, the story is not over. His misconduct neither started with nor ended with the Lancet paper. The retractions will not end there either.

Wakefield’s Lancet Paper – Lancet published vs NHS records

8 Jan

One of the key things that Brian Deer’s reporting has done is thrown doubt on the oft-repeated claims that

a) The papers subjects nearly all suffered from some form of colitis
b) The papers subjects nearly all suffered from regressive autism
c) The papers subjects nearly all regressed in the days following their MMR jab.

Nowhere is the more apparent than in the data tables supplied by Brian Deer in his report for the BMJ. They are replicated below:

In this first table above, the data shows that contrary to Wakefield’s Lancet data which shows 9 out of 12 having regressive autism, the kids NHS records are either inconclusive or negative, giving a _maximum possible_ amount of kids with regressive autism as 6 out of 12. Wakefield et al were ‘wrong’ about at least 3 kids.

In this second table above, the data shows that Wakefield et al Lancet data shows 11 out of 12 kids having non specific colitis. By comparison their NHS records show that 3 out of 12 have non specific colitis. Wakefield et al were ‘wrong’ about 9 out of 12 kids.

In this last table above, we can see that Wakefield reported in the Lancet that 8 out of 12 kids showed symptoms days after MMR. However, according to these same kids NHS records, a _maximum_ of 2 out of 12 showed symptoms days after receiving their MMR. Wakefield was ‘wrong’ about 6 children.

There is supplementary data on bmj.com

The BMJ claim fraud. It is very difficult to disagree with them.

Why does it matter what happens to Andrew Wakefield?

8 Jan

People have been questioning the necessity of these latest revelations about Andrew Wakefield and suggesting that enough is enough or maybe that all this latest round of publicity will do nothing except make him a heroic martyr. This is possible.

However, for a number of reasons I really feel it is vitally important that not only is there some response but that that response comes at least partly from the autism community.

Firstly, I believe it is necessary for there to be a response full stop. These might be the same set of _facts_ that were uncovered during the GMC hearing but the difference here is that for the first time it has been established that the facts against Andrew Wakefield came about through what the BMJ refer to as fraudulent. This is a huge difference. Up until now it could’ve been argued that Andrew Wakefield simply made a mistake. After the events of the last two days, that can never be honestly argued again.

Secondly, there are a set of people who have been at the rough end of Wakefield’s fraud for the last 13 years. A set of people who have struggled to make new parents understand that there is no risk of autism from the MMR vaccine. Doctors. Particularly paediatricians and GP’s. It is vital that by establishing what Wakefield has done as fraud, the media ensure that the message is spread far and wide. They (the media) have something to atone for in this respect, being the original spreaders of the message that the MMR caused or contributed to autism. They now need to recognise their role in the past and help the medical establishment by ensuring Wakefield can never again spread his fraudulent claims via their auspices.

Thirdly, there is another set of people who have been at an even rougher end of Wakefield’s fraud. The sufferers of the falling vaccination rates of MMR. Its been well documented in numerous places, including this blog how people – particularly children – have been injured and died in the UK and US. The concept of herd immunity, no matter what some might claim is a real concept and when it falls, the level of protection falls. When it falls to far then the people who suffer are the very young, the very old and those who for genuine medical reasons cannot be vaccinated. Wakefield’s fraud needs to be spread far and wide in order for people to realise what he is, what he tried to do and what the consequences were in order to have some confidence in the MMR jab.

Fourthly, there is another set of people who have suffered heavily. This set of people are the silent victims of Wakefield’s perfidy. Autistic people. Wakefield and his supporters, TACA, NAA, Generation Rescue, SafeMinds, Treating Autism et al have turned autism into a circus. The aim of the last decade amongst serious autism researchers and advocates has been to

a) Raise awareness
b) Find evidence-based therapies that will help the life course and independence of autistic people
c) Protect the educational rights of autistic people

and getting research monies to meet these aims is long, hard and slow. Andrew Wakefield and his hardcore of scientifically illiterate supporters have actively derailed that process, dragging research monies away from these principled activities and towards their core aim of degrading vaccines and ‘proving’ vaccines cause autism. Wakefield himself has taken over US$750,000 worth of money to pursue a legal battle against the UK Gvmt. Just think of how that money could have enriched the life of just one autistic person.

However, this same set of people claim to be representative of the autism community. They write nonsense books about autism. They hold celebrity studded fundraisers for autism. They participate in rant-filled rally’s for autism. But none of them are really about autism. What they’re about is anti-vaccinationism.

Every one of these activities denigrate autism and autistic people. They take attention away from where it is needed.

We, the true autism community, made up of parents, autistic people, professionals of autistic people need to do two things. Firstly, we need to wrest back control of the autism agenda from these one-note people. Secondly, we need to speak to society at large and say ‘yes, some members of the autism community believed the fraudulence of Andrew Wakefield but not all of us did. Please don’t tar us all with one brush.’

What Andrew Wakefield has done has impacted everyone. We need to make sure that he and people like him can never affect us all in this way again. To do that we need to speak out about him, loudly and as long as it takes.

Al Jazeera on the Wakefield fraud, less false-balance

8 Jan

One of the really bad parts of the past few days has been watching the media fall into the same old traps. Instead of taking this opportunity to sideline Andrew Wakefield and his supporters, they have given them a lot of airtime to make unsubstantiated, and sometimes just wild, accusations and claims. It is the false balance idea–give both sides of the story.

I ran across this video of Al Jazeera which gave a brief quote of a response by Mr. Wakefield but otherwise discussed the fraud and the fallout.

As time goes on I hope that even less time will be given to Mr. Wakefield and his supporters. If they won’t address the very real and very serious questions of fraud, what’s the point in hearing about the vast conspiracy that they claim is ongoing?

Videos show rape of disabled women, police seek help to ID attackers

7 Jan

The package left at the LA County Sheriff’s Department sickened even the most jaded detectives – 100 hours of video of men who appear to be sexually assaulting severely disabled women.

From the LA Times:

The attacks appeared to have taken place at residential care centers, authorities said, and most of the attackers are believed to be employees. One suspect appears to be a paraplegic patient, hoisting himself off his wheelchair, before removing his diaper and that of his victim’s, and beginning his assault.

The footage, dropped off in March, has left detectives with few leads. Though authorities are confident the scenes were shot in residential care facilities, it’s unclear if they are located in Los Angeles County. Much of the footage is so grainy that only the faces of four of the estimated 10 men could be made out.

Authorities have released still shots to the public, hoping that someone who recognizes an individual or setting in the video will come forward. You can see those images here.

The package containing the video was left with authorities last March, and it has taken months to enhance and analyze the images. Detectives say the victims appear to be between 20 and 40 years old, and that some appear almost “entirely unresponsive.”

The men appear to also be between 20 and 40. The footage, detectives said, appears to be a collection, with some men appearing in more than one scene. Some of the footage was shot with a handheld camera, with the rest appearing to be captured by a security camera, detectives said.

Anyone with information is asked to call Special Victims Bureau detectives at (866) 247-5877. Anonymous tipsters can call (800)222-TIPS.

One of the rooms where attacks took place.




Alison Singer from Autism Science Foundation on CNN

7 Jan

Here’s the video:

http://i.cdn.turner.com/cnn/.element/apps/cvp/3.0/swf/cnn_416x234_embed.swf?context=embed&videoId=bestoftv/2011/01/07/exp.am.intv.chetry.autism.cnn

If anyone finds the Transcript from this video please post the address in the comments 🙂

LA Times: Authorities seek identity of men videotaped sexually assaulting disabled women

7 Jan

Ken Reibel has already covered this story here. This is horrific. I am seriously at a loss for words except to say that I want as many of these men prosecuted. To that end, I wanted to put the sketches of the perpetrators on the blog just in case anyone might recognize them.

The LA Times gallery of photos is here. I have copied the sketches below.

Anyone with information is asked to call Special Victims Bureau detectives at (866) 247-5877. Anonymous tipsters can call (800) 222-TIPS.

A true autism hero

7 Jan

This story is nothing to so with vaccines or Andrew Wakefield but all to do with a genuine autism hero. A man who risked – and lost – his own life to help an autistic friend:

on Monday afternoon Dunn was ‘doing what he often did: teaching a student a life lesson by walking him across the street to buy a soda.’ According to police, a public transit bus was turning left and hit Dunn, while barely missing the student. Illinois State Police are investigating ‘initial witness statements that Dunn pushed the child out of harm’s way.’

Aside from the weirdness of referring to a 19yo as a child, this report genuinely moved me. Amid the sordid crap coming from the autism-vaccine community about their hero, its uplifting to read a story about a genuine man with genuine motives who did nothing except exemplify the human spirit. I hope my autistic child meets many like Thomas James Dunn throughout her life and I hope his family can take solace from the fact that their father/husband/son was and is a true hero.

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