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Want a lollypop with free chickenpox virus?

7 Nov

No, there isn’t some company which has some manufacturing contamination infecting kids. Instead, this is a response by people who want to set up “chickenpox parties” but can’t. The vaccine has been rather successful, you see, and one can’t find neighborhood kids sick with chickenpox. So, via the magic of the internet, parents are striking the deal and sending lollypops (and other items) which are only slightly “used” by their chickenpox infected children.

Yes, sick kids are slobbering on candy and their parents are sending them to other parents.

I’m a little late to this pox-party, so here’s some full discussions:

Emily at The Biology files as The antivax women who mail pox: Who are they?

Mike the Mad Biologist in ‘Pox Parties’ and Bioterrorism

Aitiology and Chickenpox parties–just a Facebook friend away

ToddW (Hapocrates Speaks) in Pox by Post.

Besides being strange, and a bad idea, it’s also illegal to ship infectious material through the mail. The same people who complain that vaccines are “biological wastes” if disposed of have no problems sending infectious agents in the post.

It doesn’t stop with chicken pox. Measles, mumps, rubella.

Remember the “why do we vaccinate children against hepatitis B? Kids are sexually active or using needles.” Well, how about sharing lollipops with an infected kid? HepB is blood borne. Unlike HIV, HepB can live outside the body for a considerable time. But, hey, so what if a kid gets an extra infection or two from a stranger’s lollipop? It’s natural immunity, right?

Another question: when do the parents who have subjected their kids to “pox parties” or the slobber of random strangers through the mail, when do these people quarantine their children?

There’s a lot of uncertainty as to when a child will be contagious after exposure.

When Is a Person Contagious?
A person with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs.

It takes between 10 and 21 days after contact with an infected person for someone to develop chickenpox.

So, somewhere between 8 and 20 days after exposure, the child will be contagious. And a danger to other children and people with compromised immune systems.

Unless these parents quarantine their children starting from 8 days after exposure, they are “inviting” everyone they meet to a special “pox party”. Nice, huh?

The Prevalence of Autism Spectrum Disorders in Toddlers: A Population Study of 2-Year-Old Swedish Children.

6 Nov

A recent study, The Prevalence of Autism Spectrum Disorders in Toddlers: A Population Study of 2-Year-Old Swedish Children, considers changes in prevalence in very young children and the effect of early screening:

Autism Spectrum Disorder (ASD) is more common than previously believed. ASD is increasingly diagnosed at very young ages. We report estimated ASD prevalence rates from a population study of 2-year-old children conducted in 2010 in Gothenburg, Sweden. Screening for ASD had been introduced at all child health centers at child age 21/2 years. All children with suspected ASD were referred for evaluation to one center, serving the whole city of Gothenburg. The prevalence for all 2-year-olds referred in 2010 and diagnosed with ASD was 0.80%. Corresponding rates for 2-year-olds referred to the center in 2000 and 2005 (when no population screening occurred) were 0.18 and 0.04%. Results suggest that early screening contributes to a large increase in diagnosed ASD cases.

The prevalence for this young age group in Gothenburg Sweden showed a dramatic rise: from 0.04% in the year 2000, to 0.18% in 2005 and a big jump to 0.80% in 2010.

I’m sure many things have changed in Gothenburg in the past 10 years. However, the implementation of an early screening program is cited as having the major impact, as this was in place in 2010, but not for 2005 or 2000.

For those who will undoubtedly ask: the vaccine schedule for Sweden did not change remarkably in that time period.

2007: A revised schedule is implemented from 2007, including a diphtheria-tetanus-pertussis booster at school entry (DTaP) and at school leaving (dTap), and also a lower age for the second MMR (6-8 years). The new schedule starts with children born from 2002. Children born 1995-2001 receive a single dose pertussis catch-up in form of DTaP instead of DT at 10 years.

2009: PCV7 was introduced into the national childhood vaccination programme and recommended at 3, 5 and 12 months of age to all children born from October 2008 onwards.

2010: HPV introduced into the national childhood vaccination programme on 1st January 2010.

The 2007 change doesn’t affect children 2 1/2 and under. The 2009 addition of PCV7 doesn’t affect the children in 2005, where the prevalence was over 4 times higher than in 2000. HPV doesn’t affect children aged 2 1/2. Thimerosal was removed from vaccines in Sweden in the early 1990’s, so that exposure was unchanged over the entire period. My guess is this won’t stop people from pointing to the PCV7 vaccine as the “toxic tipping point” for Swedish kids.

Call me biased. I’m going with the authors on this one and giving credit to the hard work of the screening program implemented.

The Wakefield Rehabilitation? Not really.

18 Oct

Reading about Andrew Wakefield gets old and tiring. I’m sure that isn’t news to readers here. Writing about Andew Wakefield gets very tiring. Who wants to keep reminding him/her self about a man who has caused so much harm to both the autism communities and public health in general? Who wants to read about dishonesty and unethical behavior?

I can only imagine that Brian Deer must want to put his award on a shelf and move on.

Which all begs the question: why do I think people reading Left Brain/Right Brain might want to read about him again? Because in this case it isn’t about Mr. Wakefield. Rather it is about his supporters. People who put aside the proved charges of dishonesty and unethical behavior. People such as Kent Heckenlively of the Age of Autism blog who are looking for The Wakefield Rehabilitation. It’s about how and why authors cite previous literature, and not reading too much into citations.

Beyond the hopes of those supporting Andrew Wakefield, there is some good research here and a bit of information about how and why people cite certain papers in the scientific literature.

First, how is Mr. Wakefield being “rehabilitated”? Answer: his papers were recently cited in a recent study. Seriously, something that small. That’s how hard people have to look for validation for Mr. Wakefield. A few citations and he’s on the road to rehabilitation.

The new paper isn’t by just any team, though. The study, recently out in PLoS One is Impaired Carbohydrate Digestion and Transport and Mucosal Dysbiosis in the Intestines of Children with Autism and Gastrointestinal Disturbances. The study is a follow-on to the PLoS One paper by Hornig et al., Lack of association between measles virus vaccine and autism with enteropathy: a case-control study.

Why is that important? “Lack of association…” is the paper which definitively put an end to the Wakefield MMR hypothesis. The team tried, with meticulous attention to detail, to replicate the most important factors of various Wakefield MMR-autism papers. They studied children with autism and gastro-intestinal complaints. They restricted their study to children who had demonstrated clear need for endoscopy (one major difference from the Wakefield studies). They were very careful about correctly reporting the patient histories (another major difference). They tested intestinal biopsy samples for measles virus (similar to as study by the Wakefield team), but were very careful to avoid contamination (unlike the Wakefield studies). The recent study used multiple laboratories to test for measles virus (Wakefield used two: his own and the O’Leary laboratory). Unlike Mr. Wakefield, the recent study reported on results from all the laboratories (Mr. Wakefield neglected to mention the results from his own laboratory which were contradictory to his theory).

Hornig et al. wrote:

The work reported here eliminates the remaining support for the hypothesis that ASD with GI complaints is related to MMR exposure. We found no relationship between the timing of MMR and the onset of either GI complaints or autism. We also could not confirm previous work linking the presence of MV RNA in GI tract to ASD with GI complaints.

About as clear a conclusion as I’ve ever seen. “The work reported here eliminates the remaining support for the hypothesis that ASD with GI complaints is related to MMR exposure.”

So, what about the new paper and the citations? Well, members of the team that produced the Hornig et al. study did further research on the tissue samples taken. Brent L. Williams heads up the author list on the new study.

Here is the (highly technical) abstract from the new study by Williams et al.:

Gastrointestinal disturbances are commonly reported in children with autism, complicate clinical management, and may contribute to behavioral impairment. Reports of deficiencies in disaccharidase enzymatic activity and of beneficial responses to probiotic and dietary therapies led us to survey gene expression and the mucoepithelial microbiota in intestinal biopsies from children with autism and gastrointestinal disease and children with gastrointestinal disease alone. Ileal transcripts encoding disaccharidases and hexose transporters were deficient in children with autism, indicating impairment of the primary pathway for carbohydrate digestion and transport in enterocytes. Deficient expression of these enzymes and transporters was associated with expression of the intestinal transcription factor, CDX2. Metagenomic analysis of intestinal bacteria revealed compositional dysbiosis manifest as decreases in Bacteroidetes, increases in the ratio of Firmicutes to Bacteroidetes, and increases in Betaproteobacteria. Expression levels of disaccharidases and transporters were associated with the abundance of affected bacterial phylotypes. These results indicate a relationship between human intestinal gene expression and bacterial community structure and may provide insights into the pathophysiology of gastrointestinal disturbances in children with autism.

If this were really about the autistics and not about Andrew Wakefield, those claiming that there is something different about the GI disturbances in autistics should be extatic. Here is a top notch team pointing to a possible real difference. In the kids tested, the genes were expressing enzymes and transporters–i.e. the genes are performing differently–for autistic kids. Also, they are seeing differences in the bacteria in the autistic kids.

Not only that, but these kids benefited from dietary intervention, although it isn’t specific to the autistic kids: “Beneficial effects of dietary intervention on GI disturbances were reported for all AUT-GI and Control-GI subjects with FA.”

But, it apparently isn’t about the autistics or the research when it comes to the Age of Autism. It’s about rehabilitating Andrew Wakefield’s reputation. (With apologies in advance–the image that comes to mind is a team that has been performing CPR on his reputation for years now. It’s time to move on.)

The important piece of this study, according to Mr. Heckenlively, is that they cite some of Andrew Wakefield’s papers. In particular:

Wakefield AJ, Anthony A, Murch SH, Thomson M, Montgomery SM, et al. (2000) Enterocolitis in children with developmental disorders. Am J Gastroenterol 95: 2285–2295.

Wakefield AJ, Ashwood P, Limb K, Anthony A (2005) The significance of ileo-colonic lymphoid nodular hyperplasia in children with autistic spectrum disorder. Eur J Gastroenterol Hepatol 17: 827–836

Ashwood P, Anthony A, Torrente F, Wakefield AJ (2004) Spontaneous mucosal lymphocyte cytokine profiles in children with autism and gastrointestinal symptoms: mucosal immune activation and reduced counter regulatory interleukin-10. J Clin Immunol 24: 664–673.

Mr. Heckenlively appears to have built a nice straw man argument in which every thing Mr. Wakefield has done is now discredited. Somehow citing a paper by Mr. Wakefield then becomes some sort of a statement that everything he did was actually right. Both sides of that argument are false. The authors should cite what is in the literature. By citing, say, the Ashwood (2004) paper, they aren’t saying that, say, the 1998 Wakefield Lancet paper is now “rehabilitated’.

Notice that the authors didn’t cite the 1998 Lancet paper. One big reason: it’s been retracted. Which begs the question, why are the authors citing Wakefield et al. (2000)? The paper in the American Journal of Gastroenterology has also been been retracted:

On 28 January 2010, the UK General Medical Council’s Fitness to Practice Panel raised concerns about a paper published in the Lancet by Dr Wakefi eld et al. (1). The main issues were that the patient sample collected was likely to be biased and that the statement in the paper, that the study had local ethics committee approval, was false. Th ere was also the possibility of a serious conflict of interest in the interpretation of the data. Th e Lancet has now retracted this paper (1). Th is paper in the American Journal of Gastroenterology (AJG) (2) also includes the 12 patients in the original Lancet article and therefore we retract this AJG paper from the public record.

One really shouldn’t cite things that have been retracted from the public record. So, is there some message that Williams et al. are trying to send us? Are they saying that Andrew Wakefield was correct all along? Hardly. That paper was retracted in May of 2011, the same time that Impaired Carbohydrate Digestion and Transport and Mucosal Dysbiosis in the Intestines of Children with Autism and Gastrointestinal Disturbances was submitted to PLoS One. The authors weren’t aware of the retraction. Says a lot about how closely they follow Andrew Wakefield, don’t it?

Apparently, the authors have contacted PLoS about the citation, and it will be corrected to notify readers of the retraction. That is the right thing to do. It isn’t a statement about Mr. Wakefield’s research, other than this paper was retracted.

Authors can’t control the message bloggers may try to create from their research (heck, one of the authors, Ian Lipkin, consulted on the recent movie “Contagion”, a main character is a blogger whose message is unscientific and irresponsible). From what I’ve heard, the authors are still very clear on the message of their first PLoS paper: “The work reported here eliminates the remaining support for the hypothesis that ASD with GI complaints is related to MMR exposure. ”

I think the point was made pretty clearly. Mr. Heckenlively in his excitement read way too much into this new paper. Not surprisingly, he just goes on and on making more mistakes. Consider this paragraph:

Isn’t Dr. Wakefield supposed to be some super-villain, leading all of us gullible parents to believe that vaccines aren’t quite as safe as sugar water? Didn’t he make up fake diseases? So, after being stripped of his license to practice medicine in the U. K., it turns out there really is something called autistic entercolitis and ileo-colonic lymphoid nodular hyperplasia in children with autism. At least Dr. W. Ian Lipkin seems to think so.

Wow. All this is extrapolated from a single sentence in the introduction of the paper: “Macroscopic and histological observations in ASD include findings of ileo-colonic lymphoid nodular hyperplasia, enterocolitis, gastritis, and esophagitis [2], [3], [4], [5], [6], [7].”

What does that sentence mean? Simple interpretation: others have reported these findings. Not “we confirm that these findings are real”. Given that reference [3] (a retracted Wakefield paper) may be removed or noted to be retracted, the only support for “enterocolitis” will be gone from the paper.

Mr. Heckenlively wrote “Although this study used a relatively small sample of gut biopsies from children with autism (Hey, isn’t that what Wakefield got in trouble for? Or is my memory failing me?),”

Mr. Heckenlively, your memory is failing you. The findings of the General Medical Council are easily found online.

Let me remind you of some of that document:

The Panel concluded that Dr Wakefield’s shortcomings and the aggravating factors in this case including in broad terms the wide-ranging transgressions relating to every aspect of his research; his disregard for the clinical interests of vulnerable patients; his failure to heed the warnings he received in relation to the potential conflicts of interest associated with his Legal Aid Board funding; his failure to disclose the patent; his dishonesty and the compounding of that dishonesty in relation to the drafting of the Lancet paper; and his subsequent representations about it, all played out against a background of research involving such major public health implications, could not be addressed by any conditions on his registration. In addition, the Panel considered that his actions relating to the taking of blood at the party exemplifies a fundamental failure in the ethical standards expected of a medical practitioner. It concluded that conditional registration would not mark the seriousness of such fundamental failings in his duty as a doctor

and

The Panel made findings of transgressions in many aspects of Dr Wakefield’s research. It made findings of dishonesty in regard to his writing of a scientific paper that had major implications for public health, and with regard to his subsequent representations to a scientific body and to colleagues. He was dishonest in respect of the LAB funds secured for research as well as being misleading. Furthermore he was in breach of his duty to manage finances as well as to account for funds that he did not need to the donor of those funds. In causing blood samples to be taken from children at a birthday party, he callously disregarded the pain and distress young children might suffer and behaved in a way which brought the profession into disrepute.

Mr. Heckelively also poses the question: “Didn’t he [Andrew Wakefield] make up fake diseases?”

That would be “autistic enterocolitis”, a term Andrew Wakefield coined and a condition which still, 13 years later, doesn’t have support. Autistic enterocolitis is not just any and all GI disturbances in autistics. Enterocolitis is “…an inflammation of the colon and small intestine”. Note the “and”, there. Even more important, the PLoSOne paper is not about inflammation at all.

Mr. Heckenlively finishes with the rather hopeful, wishful thinking statement: “But if a big shot scientist like Dr. W. Ian Lipkin is quoting Dr. Andrew Wakefield as a reliable source, maybe the rest of the world will soon be doing the same thing.”

Again, wow. Here we have Ian Lipkin, one of the team that just put an end to the Wakefield-MMR hypothesis. Again, let’s remind ourselves, Ian Lipkin is part of the team which wrote: “The work reported here eliminates the remaining support for the hypothesis that ASD with GI complaints is related to MMR exposure.” There is such a major disconnect between that statement (which, yes, Dr. Lipkin stands by) and what Mr. Heckenlively wrote that I am just left in amazement.

This isn’t a story about rehabilitation. This is a story about diversion. Diversion of attention away from important subjects in autism. These include the medical treatment of major health problems. How does one treat something like bowel problems in individuals with communication and/or sensory difficulties? That’s a big question that gets lost in this whole “Andrew Wakefield” discussion. Research like this new paper is important in that respect: is there something specific to kids with autism, regression and GI disease? Leave aside any discussion about GI being linked to the regression, how do you treat it? I, for one, am glad to see something come out of this research project than just the “MMR doesn’t cause autism and GI disease” conclusion. Instead of trying to read the tea leaves of this paper and try to recoup the damage Andrew Wakefield did to his reputation, why don’t we just read the paper in the context of what this might tell us about the health problems of autistics?

Defending alternative medicine and autism: the charges against Anju Usman

14 Oct

In Illinois charges DAN doctor with unethical behavior, LBRB writer Ken Reibel discussed the case recently brought against alternative medical practitioner Dr. Anju Usman. These charges follow on a civil suit brought by the parent of an autistic child seen by Dr. Usman. This charges in this case will require that Dr. Usman defend many of the common practices in alternative medicine.

The complaint is:

DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION of the State of Illinois,

v.

ANJUM I. USMAN, M.D.

No. 200904994

One short paragraph in the complaint sums up a big piece of where this suit has the possibility to strongly influence how alternative medicine “treats” autism: None of the treatments described above has been proven to influence the course of autism.

Here is a section of count 1:

17. Hair analysis does not provide a basis for the diagnosis of heavy metal toxicity.
18. Provoked urine testing does not provide a basis for the diagnosis of heavy metal toxicity. The American College of Medical Toxicology has determined that provoked testing has not be scientifically validated, has no demonstrated benefit and may be harmful when used for assessing patients for metal poisoning.
19. Porphyrin testing does not provide a reliable basis for the diagnosis of heavy metal toxicity.
20. Although chelation therapy is FDA-approved for treating lead poisoning, it should not be used unless a non-provoked blood (not urine) test shows an extremely high level of lead.
21. Respondent did not obtain a confirmatory blood lead test or record any source of lead exposure.
22. The record contains no basis for concluding that chelation therapy was appropriate.
23. The record does not contain adequate infonlled consent for any of the prescribed nonstandard tests or treatments. The consent fonns used did not accurately present the risks and/or benefits of tests and treatments. Although it mentioned experimental drug use, these were not administered as part of a proper experimental protocol.
24. The informed consent form states that chelation therapy “is considered controversial for the generalized treatment of chronic low or high level lead toxicity, mercury toxicity, or for other heavy metal toxicities, either acute or chronic.” This statement is misleading because there is a clear scientific consensus that it is inappropriate for treating lead toxicity without demonstrating that toxicity exists and that the level is very high.
25. Throughout the treatment period, Respondent made statements to AC’s mother that the prescribed treatments had positive clinical benefits for children with autism, despite the lack of empirical research supporting Respondent’s position.
26. The record does not document any reason why AC should have received unproven treatments.
27. Spironolactone, which is potentially dangerous, was prescribed without justification.
28. Despite a nonnal selenium level, Respondent repeatedly and unnecessarily prescribed selenium supplements and continued to do so even when AC eventually showed a high level.
29. That Respondent abused the physician/patient relationship by taking unfair advantage of a patient’s vulnerability in that Respondent utilized unproven drugs and medicine to treat AC, a pediatric patient diagnosed with autism.
30. That the foregoing acts and/or omissions of Respondent are grounds for revocation or suspension of a Certificate of Registration pursuant to 225 Illinois Compiled Statutes (2002), Section 60122(A)(20), relying on the Rules for the Administration of the Medical Practice Act, Illinois Administrative Code Title 68, Section 1285.240(b)(1 )(C), and (2) (C).

There are many methods by which “heavy metal toxicity” is diagnosed by alternative medical practitioners. These methods are not demonstrated to be accurate, and are not accepted by actual medical toxicologists. These include hair analysis, provoked urine testing and porphyrin testing.

A prime example is provoked urine testing. A thorough discussion can be found here. A provoked urine test involves giving an individual a chelator and then testing the urine for heavy metals. Everyone (every thing, every animal) has some level of mercury. A chelator will force the body to excrete some level of the heavy metals inside, so it is no surprise that the levels obtained are “elevated”. The problem is that there is no standard by which one can compare the provoked urine to determine if the person actually has heavy metal poisoning.

The method is also called “challenge” testing. The American College of Medical Toxicologists have a position statement on this:

It is, therefore, the position of the American College of Medical Toxicology that post-challenge urinary metal testing has not been scientifically validated, has no demonstrated benefit, and may be harmful when applied in the assessment and treatment of patients in whom there is concern for metal poisoning.

More quotes from the complaint:

From Count III

That Respondent made false or misleading statements regarding the efficacy or value of the medicine, treatment, or remedy prescribed by Respondent in the treatment of any disease or other condition of the body in that Respondent made false or misleading statements regarding the efficacy of chelation therapy in the treatment of autism.

From Count V

29. That Respondent engaged in a pattern of practice or other behavior that demonstrates incapacity or incompetence to practice in that Respondent:
a. Repeatedly prescribed and administered unproven and medically unnecessary treatments to AC despite the lack of empirical research demonstrating the effectiveness of the prescribed treatment plans; and
b. Demonstrated extreme departure from rational medical judgment in the care and treatment of AC.

This isn’t a criminal complaint. Rather it is an ethics or “professional regulation” complaint. The disciplinary action called for if the case is proven involves Dr. Usman’s license:

WHEREFORE, based on these allegations, the Department of Financial and Professional Regulation of the State of Illinois, by Laura E. Forester, its Chief of Medical Prosecutions, prays that the Physician and Surgeon license of ANJUM I. USMAN, M.D., be revoked, suspended, placed on probation or otherwise disciplined.

The 2011 “Vaccine Safety Conference” in Jamaica

6 Oct

Earlier this year, a conference was held in Jamaica. The declared subject: vaccine safety. Even from the beginning, it was clear that this was no ordinary scientific conference. It had all the signs of a junket. A meet-and-greet for vaccine “skeptics” and wealthy patrons. Precisely the sort of junket that people complain about “Big Pharma” hosting. Well, not precisely. I suspect even Big Pharma doesn’t put on such a lavish event.

The number of speakers was small (only 19), and didn’t include anyone who is a vaccine researcher. 21 presentations were made in the course of a week, leaving a lot of time for people to enjoy the resort and to network.

Talks included “Rethinking the germ theory”, “Vaccination Programs: Prevention or Corruption?” and “Gardasil: Prophylaxis or Medical Misconduct?”.

Getting a picture of the conference agenda? And by “agenda”, I do not mean the schedule.

The conference received some brief public attention when Anderson Cooper interviewed Andrew Wakefield. Mr. Wakefield (who refused to be on the segment if Seth Mnookin were included) appeared via Skype from that conference in Jamaica. Mr. Wakefield’s talk at the conference: “Autism & Vaccines: a Research Strategy Focused on Cause”.

The event was titled: Vaccine Safety|Evaluating the Science Conference. A nearly one week event (January 3-8) in the Tryall Club in Jamaica.

I’ve been to a lot of scientific conferences. I’ve even helped organize scientific conferences. None of them were ever held in a place remotely similar to the Tryall Club. Heck, when I think of “big pharma” hosting junkets for doctors, it’s in places not nearly as nice as the Tryall Club.

In case you didn’t get a chance to see the website, here’s a picture of the Tryall Club:

Nice, isn’t it? The Tryall Club isn’t a hotel. It is a collection of 86 Villas (including 73 privately owned estate villas) plus 13 “great house” suites.

The property’s 86 villas offer visitors a dazzling array of options, from beachfront bungalows to elegant hillside chalets. Each carefully situated villa offers distinctive architectural elements, a singular style and a unique floor plan. A couple may choose a cozy one-bedroom retreat, while an extended family of several generations may opt for a 7- or 8-bedroom manor.

Consider as an example, the six bedroom “Twin Palms” Villa. Cost for 1 week: $30,000, or $5,000 per bedroom. (Cost is $40K/week if you include the master suite). The Villa comes complete with a staff of 9 and “Dining areas are designed to seat 20 guests or more. Formal dining is in the 80’ dining room under Italian chandeliers at place settings of Lalique crystal, Tiffany china and silver from France.”

As I said, not like any conference I’ve ever attended.

So, who put this conference on? Aside from a stay in Jamaica, were the attendees compensated? I wondered these questions so I emailed the contact address on the website. Here’s the response:

The conference was co-sponsored by the National Vaccine Information Center and private individuals and family foundations who are concerned about the safety of vaccine ingredients, preparations, combinations and schedules. Speakers volunteered to speak as is customary for scientific conferences, and accommodations were provided in private homes donated by or as guests of individuals who are concerned about vaccine safety. No funds exchanged hands except to reimburse for travel expenses, which were funded by donations to the National Vaccine Information Center.

The Vaccine Safety Conference

“No funds exchanged hands except to reimburse for travel expenses, which were funded by donations to the National Vaccine Information Center.” Nice. Reimbursing the speakers directly probably isn’t tax deductible. Donating to NVIC is. And it lets NVIC look like they are pulling more money.

Who put this on? The sponsors are listed clearly on the conference website:

Albert J. and Lisa Claire Dwoskin Family Foundation

Cmdr. Richard and Joan Curtis

Mark and Candace Hart

Daisy and Paul Soros

Danny and Stency Wegman

One name jumps out (to me at least): Soros. Sponsors Paul and Daisy Soros. Paul Soros is the brother of George Soros, but is quite well off in his own right.

We are talking some serious money was backing this conference.

Case in point. First in that list is the Dwoskin family. Claire Dwoskin has worked as a board member of the National Vaccine Information Center.

The Dwoskins have hosted fundraisers for political candidates at their home and been guests at White House dinners.

Apparently, they also set up the “vaccine safety” conference website. Mrs. Dwoskin is listed as the contact for the website:

Administrative Contact:
Dwoskin, Claire novaccine4me@XXXXX.com
Vaccine Safety Conference

No, I did not make that email address up. It really is listed as “novaccine4me”. Pause a moment to consider that choice.

The physical address given for the website contact is that of the McLean, Virginia home of the Dwoskins. It is sizable and valuable. As the domain registration reports, this is also the address for “Vaccine Safety Conference”. It seems reasonable to assume that the Dwoskins are the primary organizers of the conference. The Dwoskins also appear to own other valuable property. Mr. Dwoskin is a real estate developer, so this is no great surprise. But, one property which they (or their business) are associated with: Twin Palms. Yes. the 7 bedroom Villa in Jamaica described above. What leads me to believe this? The website twinpalmsjamaica.com is registered to A.J. Dwoskin & Associates.

Seems reasonable to think that the first tier of presenters at the conference were hosted in Twin Palms.

In case you are curious as to the Dwoskins’ position on vaccines, Mrs. Dwoskin wrote in an email to John Stossel of Fox: “Vaccines are a holocaust of poison on our children’s brains and immune systems.”

Seriously. A holocaust of poison.

There is nothing wrong with wealthy people hosting gatherings of people on a subject they feel strongly about. Anyone who chooses an email address “novaccines4me” and considers vaccines “a holocaust of poison” certainly has strong feelings.

Wealthy people have a right to offer their hospitality to people who may promote their views. People with less means have the right to accept the largess of the wealthy.

I have the right to voice my opinion. This was a junket. Seriously. 6 days to have 19 speakers present? Rooms costing $5,000 a week? I wonder how much time at the “vaccine safety” conference was spent talking about safety and how much was spent talking about the “holocaust of poison” view of vaccines.

Next time I hear or read about Big Pharma buying off doctors with exotic junkets I’ll be thinking of Andrew Wakefield, talking via Skype from the Tryall Club in Jamaica.

Childhood mortality and vaccines

2 Oct

One of the ideas that gets presented as fact all too often on the internet is “the United States is the most vaccinated country in the world and has one of the worst childhood mortality rates”. There are variations of this, of course. Unfortunately, this notion gets put forth by autism-parents and even autism-parent organizations.

This sticks in my mind since a rather blatant attempt at misinformation from Generation Rescue in the form of a pseudo-paper “special report”: AUTISM AND VACCINES AROUND THE WORLD: Vaccine Schedules, Autism Rates, and Under 5 Mortality. I wrote about the many failings of that document at the time.

One major failing in the childhood mortality comparisons is that the U.S. measures infant mortality (which is a big piece of under 5 mortality) differently than other countries. As Bernadine Healy (a source highly respected by groups such as Generation Rescue) wrote:

While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that “First, it’s shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless.

But why bring this up again? The reason is simple: I found a very interesting source of data and in reviewing it, I found information on vaccines and on childhood mortality: the Google Public Data Explorer. The Wold Bank dataset includes childhood and infant mortality figures.

What does the childhood mortality rate look like as a function of time for the United States? Not surprising (to most) it has been dropping over the past 30 years. In fact, from 1989 to 2009 the rate dropped from 12.1 per 1,000 to 7.8 per 1,000. (click to enlarge):

Why pick 1989 onward? This is the period when the vaccine schedule in the U.S. increased dramatically. If the idea that vaccines are somehow linked to worse childhood mortality we would expect this trend to be increasing, not decreasing.

Here is a good example of why we can’t say that correlation means causation. Consider childhood mortality for a country. Consider CO2 emissions for a country. Guess what, there is a big trend towards lower childhood mortality with higher CO2 emissions. (click to enlarge)

The “effect” (quotes mean it isn’t real) is huge. Note that the graph is a log-log plot. Countries with high CO2 emissions have 20 times, or more, lower childhood mortality. If we were in the “correlation equals causation” camp, we would decide that CO2 prevents childhood mortality. We could take this another step into the ridiculous and say, “Since CO2 emissions will coincide with higher atmospheric mercury due to coal burning and other sources, mercury must prevent childhood deaths”.

So keep that lesson in humility in mind as we play armchair epidemiologist and look further into the World Bank data. What is correlated with childhood mortality that might make sense? Being from a country in sub-Saharan Africa is correlated with high infant mortality rate. Low income countries have high infant mortality rates. Having a skilled person to attend the birth is correlated with low infant mortality rates.

Vaccines? What about them? They only have data for measles vaccine uptake. Again, not surprisingly, childhood mortality is lower for countries with higher measles vaccine uptake (click to enlarge)

I chose 2003 for the year for this comparison. That year has data as well for the fraction of births attended by skilled health staff. The datapoints are color coded with this to show that this is a big correlate. The more births have a skilled health worker in attendance, the more kids live. Could be a proxy for some hidden variable, but it makes some level of sense that having a health worker would reduce infant mortality. It also makes sense that countries with access to healthcare in general would have lower infant mortality.

But, that brings us back to the measles vaccine and infant/childhood mortality. Does the vaccine reduce infant mortality? Certainly in countries where measles is endemic. But measles vaccination isn’t the reason why childhood mortality figures are higher in, say, Chad than in the United States. And that’s why researchers try to control for other factors, like wealth and access to health care, when trying to correlate factors and diseases.

Otherwise, you end up with “mercury causes autism”. Or, using the World Bank data, “Cell phones cause low fertility rates”. Or other strange ideas.

While I think these data show pretty clearly that childhood mortality is not likely increased by vaccines, they also show the pitfalls of being an armchair epidemiologist. With the internet, data abound. One can find many correlations. Some are just random. Some are due to some unseen variable. Some are an indication of actual causation.

Do I believe that there is a reason why childhood mortality is lower in wealthy countries? Yes. Do I believe that there is a reason why childhood mortality is lower in countries with high CO2 emissions? No*. Both show correlations. What about the idea that measured autism rates went up as the exposure to thimerosal increased? Sure, there’s a correlation, just like with CO2 and childhood mortality. And, just like with childhood mortality and CO2, there are other factors at play.

*note–CO2 emissions are linked to countries with greater wealth. In that respect, yes there is a reason for the correlation. But there is no direct correlation of CO2 and childhood mortality.

Worries About Autism Link Still Hang Over Vaccines

30 Sep

A story just out from National Public Radio in the United States: Worries About Autism Link Still Hang Over Vaccines. Part of the survey on how the public views vaccines was a question on autism:

Do you believe any of the following are linked to vaccines?
1. Autism
2. Cancer
3. Diabetes
4. Heart disease

The answer: about 21% of Americans say yes to the autism/vaccine link.

The highest levels of “yes” were in those aged 35 to 64, with middle-income status, some college education and who have children.

About 1/4 said their opinions of vaccine had changed in the last 5 years, with about 60% of those responding that their opinions had changed for the worse.

Of the main reasons cited for vaccine fear, autism was the top. By far.

21.4% of respondents said they believe vaccines can cause of autism, 9.2% said they believe vaccines can be
linked to cancer, 6.9% believe they play a role in diabetes, and 5.9% cite a connection between vaccines and
heart disease.

Is this because there is actual evidence, or because of a vocal campaign to put the message of a vaccine/autism link into the public mindset? Well, since there is no convincing evidence of an autism/vaccine link (and a lot of evidence against the primary theories: mercury and MMR) I’d go with the media campaign as the reason this idea still has traction with the public.

And I’m not alone, at least in thinking that the effort of some vocal members of the autism community have had an impact. Last time such a survey came out, it was trumpeted by some of the more vocal sections of the autism-parent community, with one blogger telling his readership to take credit for an increase in belief in the vaccine/autism idea and fear of vaccines:

With less than a half-dozen full-time activists, annual budgets of six figures or less, and umpteen thousand courageous, undaunted, and selfless volunteer parents, our community, held together with duct tape and bailing wire, is in the early to middle stages of bringing the U.S. vaccine program to its knees.

What was even more disturbing than those words were the conclusion of the article:

…mark my words, the results from the next survey will show that the trust continues to erode. Keep fighting, parents, America is really listening.

Yep, Keep fighting. Not to get the message out, but to erode trust in public health. The message seems to have morphed over the years. From informing the public of an idea (albeit unsupported by good data) to one of fear. As we can see from the NPR/Reuters survey, the idea that vaccines and autism are linked is still out there.

We saw a form of this idea surface recently when Michelle Bachmann recently made comments linking the HPV vaccine and mental retardation. I sent an email to the National Vaccine Information Center asking about the Bachmann claim. Here is the response I received:

Sorry to just be getting back to you but we have been inundated with emails about Michelle Bachmann.There’s no information to support her claim and now she has withdrawn it.

I chose the NVIC for this inquiry because they are an organization which I believe has rather lax standards on proof of vaccine injury. If anyone were going to support Ms. Bachmann’s claims, it would be the NVIC. The fact is that even they see this as an unsupportable comment.

But to bring this back to the NPR survey: yes, there are concerns about vaccines in the American public. Concerns are one thing. We should all be concerned about such an important part of the public health system. Fears. That’s another thing. Unfounded fears. Discounted fears. That is yet something else. And we are at the point where unfounded fears and disproved fears are still promoted, largely by autism parents. And that is why autism parents like myself feel the need to counter the misinformation. Because these fears have consequences:

As parents fret, vaccination rates for kids have dipped. Childhood vaccination rates against measles, mumps and rubella (MMR), for instance, fell almost 3 percentage points to 90.6 percent in 2009 from the year before, according to data from private insurers.

As vaccine rates drop, the risks to us all, and infants in particular, rise. In the words of Simon Murch, colleague of Andrew Wakefield in the now-retracted Lancet study which fueled the modern fears of MMR and other vaccines:

“If this precipitates a scare and immunization rates go down,” Murch warned, “as sure as night follows day, measles will return and children will die.”

Law Firm Faces Legal Action Over Handling Of MMR Vaccine Case

21 Sep

This story is in the U.K. version of the Huffington Post. The article, Law Firm Faces Legal Action Over Handling Of MMR Vaccine Case, brings the question of MMR litigation back up, but in a different way. First, the families are claiming that encephalitis, not autism, was the claimed injury. Second, they are suing the law firm that handled the case, not the vaccine manufacturers.

Three families who claim their children suffered a potentially fatal illness from the mumps, measles and rubella (MMR) vaccine are suing a law firm they say grouped them with a now discredited case over a link between the jab and autism.

A case was brought against the manufacturers of the MMR jab – Smithkline Beecham, Smith Kline & French Laboratories and Sanofi Pasteur MDF – in 2007, over claims that the jab caused autism in children. However three families who say the vaccine caused encephalitis in their children, not autism, believe they were unable to claim compensation because of the way the case was dealt with.

Note that the Huffington Post has the dates wrong in the section quoted above. The case was brought in the late 1990’s and abandoned in 2003 when lack of evidence resulted in a loss of public funds to support the investigation further.

The BMJ also covers the story, noting that in 2002 the then chairman of the UK’s Committee on Safety of Medicines, Alasdair Breckenridge, said: “There is sound evidence that mumps vaccine containing the Urabe stran of virus is associated with a risk of meningitis and [has} no proven additional benefits. The risk to children of a potentially serious neurological complication makes its use unacceptable.”

Since the focus here at Left Brain/Right Brain is primarily autism, and the Wakefield case has been discussed (and discussed, and discussed), I expect that most readers know the basic story. But, indulge me for a moment while I give a short history.

Back in the mid-1990’s, some families believed that MMR caused their child’s autism. They sought both legal and medical expertise to pursue their case. The legal end was led by Richard Barr of the firm Alexander Harris. For medical expertise, they (parents and leagal team) approached Andrew Wakefield, a research gastroenterologist who had just recently implicated the measles vaccine in Crohn’s disease.

After Mr. Wakefield and his team published their first paper in The Lancet in 1998 (a paper since retracted), he became even better known for his views on MMR. Sometime after this, attorney Richard Barr was contacted by a public health insider with concerns about the MMR. Mr. Barr and Mr. Wakefield met with this “whistleblower” in secret.

The thing is, the concern was about encephalitis from the mumps component. Not autism from the measles component, as was Mr. Wakefield’s hypothesis.

The meeting between Mr. Wakefield and this gentleman became known only recently, 1998, while Mr. Wakefield faced charges before the General Medical Council. Mr. Wakefield released details of his story and threatened to disclose the name of the “whistleblower”. Mr. Wakefield later followed through on this threat.

This raises very important questions. Most notably, why didn’t the legal and scientific team working on MMR litigation follow up on the mumps/encephalitis question? The idea was known to Mr. Wakefield and Mr. Barr. The MMR litigation went forward with the theory that the measles component was causing autism, and failed.

And now some parents consider these events to be a strong enough case to sue a law firm handling their case: Alexander Harris.

The families claim the MMR vaccine brought neurological injury and are suing the law firm that brought the original litigation against the vaccine’s manufacturer.

As part of the group autism case, the families claim they were deprived of the compensation likely to come from bringing individual actions.

Mr. Wakefield’s discussion of his meeting with the “whistleblower”, together with commentary from Brian Deer, is in the video below:

While Mr. Deer focuses on how Mr. Wakefield is treating the “whistleblower”, another big question is left open by this discussion: did Mr. Wakefield act on the information he was given? Did the attorneys? The secret meeting in the train station makes a rather dramatic story, but it doesn’t really reflect well on Mr. Wakefield.

Michele Bachmann stands firm on her vaccine comments. As firm as someone who “has no idea” can be.

17 Sep

Some people never back down from a fight. It sounds strong, but in reality many of these people are fools. Never back down from a fight? There are times when a person is in a bad position, often of his/her own making, and it would be better for all to cut one’s losses.

Sure there are many examples of people unwilling to back down from a fight in the autism/vaccine discussion which we could point to. For today, let’s consider a relative newcomer as our case in point: Michele Bachmann, United States presidential candidate. Recently she made comments about the HPV vaccine. She gave a story of the HPV vaccine resulting in mental retardation.

Here’s the video of her speaking on the HPV vaccine.

“Could potentially be a very dangerous drug”

“It can have very dangerous side effects”

“There is no second chance for these little girls if there is any dangerous consequences for their bodies”

Ms. Bachmann held a fund raiser in the San Francisco bay area recently. One attendee wrote about the even in the San Francisco Chronicle Politics blog, an article GOP presidential candidate Michele Bachmann refuses to back down on HPV, slams Solyndra (VIDEO)

Ms. Bachmann is quoted:

On Thursday, Bachmann maintained she was making no claims regarding the drug this week, and that she was merely trying to underscore “an abuse of power” by Texas Gov. Rick Perry in mandating the vaccine for girls in his state.

“I didn’t make any statements that would indicate I’m a doctor, I’m a scientist, or making any conclusions about the drug one way or the other,” she said, adding she was merely relating the concerns of a woman who was “very distraught” and who supported her view that Perry’s actions were wrong.

Not a doctor, not a scientist. Where have I heard that before?

As to the rest of the statement all I can say is, really? And, not good enough. She made some strong statements. Is “”Could potentially be a very dangerous drug”” consistent with “not one way or the other”?

Here’s another video of her defending her statement, Video: Bachmann Asserts Right to Talk Nonsense About Vaccines:

http://c.brightcove.com/services/viewer/federated_f8/823619053

She points out that Rick Perry admitted making a mistake. Like this is a bad thing. This is a time for her to follow his example.

She won’t even answer the question of whether she will apologize for the remark. Come on. Take a stance. Either you made a mistake or you didn’t. Either apologize or tell us that you won’t.

In short: Lead. You are running for president. Show leadership.

In a later story, from Yahoo News, Ms. Bachman adds a qualifier to her “I’m not a doctor…” statement: Bachmann: ‘I have no idea’ if HPV vaccine causes mental retardation

Yes, she “has no idea”.

“I have no idea,” Bachmann said, before repeating the story about the woman. “I am not a doctor. I am not a scientist. I am not a physician. All I was doing was reporting what a woman told me last night at the debate.”

I think the words she is looking for are, “I’m sorry” and “I made a mistake”. That would be leadership. Own your mistakes. Learn from the people in the vaccines-cause-autism camp. Well, learn from their mistakes. A big mistake you can learn from: don’t hang on to disproved ideas that are really out of your area of expertise. When you are shown to be wrong, admit it and move on.

Lessons from the MMR scare

13 Sep

Fiona Godlee, editor of the British Medical Journal (BMJ), recently presented to the National Institutes of Health on the “Lessons from the MMR scare”.

The talk is now online at the NIH site (no embed link is obvious to me at present).

The talk gives a nice hour long discussion of the issues surrounding Andrew Wakefield’s research efforts in autism and the MMR vaccine.

One of the points Ms. Godlee goes into is a good example of the sort of falsification that is prevalent in the Lancet paper. She discusses the fact that 11 of the 12 families thought that the MMR vaccine was linked to developmental regression. The paper reported that only 8 families felt there was a link. Earlier drafts of that more families thought there was a link, but those families reporting long times to onset after MMR were removed.

Another discrepancy to emerge during the GMC hearing concerned the number of families who blamed MMR. The paper said that eight (1, 2, 3, 4, 6, 7, 8, and 11) linked developmental issues with the vaccine. But the total in the records was actually 11. The parents of child 5, 9, and 12 were also noted at the hospital as blaming the vaccine, but their stated beliefs were omitted from the journal.

It is one of those very simple arguments that shows misrepresentation of the facts.

How did the misconduct become exposed? She discusses how 4 factors played into why this case of fraud was exposed:

1) A skilled investigative reporter was put on the case (Brian Deer)
2) the freedom of information act was enacted in 2000 (allowed access to information)
3) Mr. Wakefield’s decision to sue Brian Deer. (This forced Brian Deer to do further digging to defend himself.)
4) The GMC’s decision to take up the case. (This placed much data in the public domain)

It has been discussed a number of times previously that Mr. Deer gained access to the medical records after the lawsuit was started, and that the lawsuit was withdrawn literally as he was reviewing the documents.

She discusses the backlash that the BMJ has received with negative comments. Also some very strange misrepresentations. For example, an article in “Natural News” is incorrect (not surprising to those familiar with the site) in stating “BMJ admits that fraud claim against Dr. Andrew Wakefield has no basis in fact”.

She discusses the claim that Andrew Wakefield’s work has been replicated. It is a common argument that comes up. And, it isn’t true. There are attempts to replicate which his work which failed to do so.

No legal challenge from Mr. Wakefield and no complaints to the press complaints commission. Interestingly (to me at least) is that he declined an offer from the BMJ to write a reply.

I find it intersting that she couldn’t even recall Jim Carrey’s name (and had even less recall of Jenny McCarthy’s name).

She points out that the GMC was not really the proper forum to investigate the research fraud. But, at present the UK has no office of research integrity.

She poses the question of what could have been done to prevent this. She suggests that greater oversight needs to be in place. She also points out that co-authors need to take a more active role in oversight of data reporting. Better peer review is needed. But when an author lies, it is difficult for an editor to discover it. There should be some level of penalty for research fraud–as in, why isn’t this a criminal act?

She calls for better research on vaccine safety research. Also for better autism research.

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