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One reason why I vaccinate

3 Mar

I know this isn’t at all autism related, but this story just keeps bugging me.

South Bend couple loses baby to pertussis

The story is heartbreaking. A couple has fertility problems and tries for years to have a baby.

But the couple’s desire to have children soon turned to heartache as Katie suffered miscarriage after miscarriage.

“We started to think that it would never happen,” Craig said during a recent interview at the family’s home.Katie later went to see a specialist in Chicago and was diagnosed with a rare blood clot disorder that doctors said was affecting her ability to carry a baby to full term. She was prescribed medication.

Finally, after five years, Katie became pregnant with a baby girl that far surpassed previous pregnancy terms.

They finally have a baby, only to lose her at one month from pertussis.

Days later, pertussis tests came back positive.The diagnosis blindsided the family. How could Callie have contracted the illness? She had been far too young to yet be immunized against the bacterial infection. Series of shots against pertussis do not begin until infants are 2 months old.

The couple had also kept outside family and friends away while Callie was home in an effort to protect her from sickness. She had been home from the hospital only 2 1/2 weeks.

St. Joseph County coroner Dr. Michael O’Connell confirmed to The Tribune that Callie likely died of an infectious-type illness such as pertussis, but he said conclusive tests will not be complete for several more weeks.

These sorts of stories are very difficult to discuss. This family is going through pain beyond anything in my experience and I certainly don’t want to add to that. But this story is a real example of one reason I vaccinate myself and my family. I can’t imagine thinking that I or one of my family had passed on an infectious disease to a family with an infant or someone else vulnerable.

Parental Vaccine Safety Concerns in 2009

1 Mar

A paper in today’s issue of pediatrics looks at vaccine safety concerns amongst parents. The paper

Parental Vaccine Safety Concerns in 2009
by
Gary L. Freed, Sarah J. Clark, Amy T. Butchart, Dianne C. Singer, and Matthew M. Davis. All of the University of Michigan.

the abstract states:

OBJECTIVE: Vaccine safety concerns can diminish parents’ willingness to vaccinate their children. The objective of this study was to characterize the current prevalence of parental vaccine refusal and specific vaccine safety concerns and to determine whether such concerns were more common in specific population groups.

METHODS: In January 2009, as part of a larger study of parents and nonparents, 2521 online surveys were sent to a nationally representative sample of parents of children who were aged ?17 years. The main outcome measures were parental opinions on vaccine safety and whether the parent had ever refused a vaccine that a doctor recommended for his or her child.

RESULTS: The response rate was 62%. Most parents agreed that vaccines protect their child(ren) from diseases; however, more than half of the respondents also expressed concerns regarding serious adverse effects. Overall, 11.5% of the parents had refused at least 1 recommended vaccine. Women were more likely to be concerned about serious adverse effects, to believe that some vaccines cause autism, and to have ever refused a vaccine for their child(ren). Hispanic parents were more likely than white or black parents to report that they generally follow their doctor’s recommendations about vaccines for their children and less likely to have ever refused a vaccine. Hispanic parents were also more likely to be concerned about serious adverse effects of vaccines and to believe that some vaccines cause autism.

CONCLUSIONS: Although parents overwhelmingly share the belief that vaccines are a good way to protect their children from disease, these same parents express concerns regarding the potential adverse effects and especially seem to question the safety of newer vaccines. Although information is available to address many vaccine safety concerns, such information is not reaching many parents in an effective or convincing manner. Pediatrics 2010;125:654–659

The study was a survey of households with children. They contacted extra Hispanic and African-American households to get better statistics on those groups. But they normalized the data to account for this “oversampling”.

Table 3 shows that 11.5% of parents have rejected at least one recommended vaccine. Most listed the HPV (human papillomavirus) as the rejected vaccine. HPV is new, and is given to teenage girls to prevent a viral infection known to be a cause of cervical cancer. (click to enlarge)

Parental Vaccine Refusal

Table 4 shows parental attitudes for a number of vaccines. Reasons for rejecting vaccines vary from “I would rather my child got this disease” to “I personally know someone who experienced a harmful adverse event”. (click to enlarge)

Parent experiences and attitudes on childhood vaccines

The survey explored the views of parents on the autism/vaccine question:

One current specific immunization safety concern has been the spurious association of vaccines with autism. Although peer-reviewed original scientific research and multiple expert committees that have reviewed all available data on this issue have failed to show any association between vaccines and autism, anecdotally the concern continues to affect parents. Our study indicates that a disturbingly high proportion of parents, >1 in 5, continue to believe that some vaccines cause autism in otherwise healthy children. This finding indicates that current public health education campaigns on this issue have not been effective in allaying the concerns of many parents. Officials must attempt to develop more effective and targeted education campaigns that focus directly on this issue if their goal is to match parents’ level of concern with the available scientific evidence. Recently, the use of newer social marketing techniques have been suggested as potential strategies to address vaccine safety concerns.

>1 in 5 believe the “vaccines cause autism” story. Amazing. I’m sure that will be seen as a both a victory and a challenge to the groups pushing that message.

I hate to say it, but someone needs to. This study may be the most valuable study the trial lawyers working on autism/vaccine cases have seen. Much more so than the bad science of the Geiers or the speculation in Medical Hypotheses. Where this will be valuable will be in helping select a jury that is as sympathetic to their cause as possible.

Successful blogging by Steven Novella: the Desiree Jennings story

26 Feb

I stayed away from this story until now. It isn’t about autism at all, except that “Jenny McCarthy and Jim Carrey’s Autism Organization–Generation Rescue” decided to take the story on. Why a supposedly autism organization took on the story of an adult who was supposedly injured by a flu vaccine is not clear to this reader. But, this story shows the power of quality blogging to affect the discussion of a national topic.

Short version of the story: Desiree Jennings was given a seasonal flu vaccine. Sometime after that she developed problems in movement and speech. She attributed these problems to the vaccine, citing dystonia as the condition. This was questioned by some bloggers, including a neurologist, Dr. Steven Novella. As a neurologist, Dr. Novella is experienced in conditions such as dystonia. Ms. Jennings was treated by a well known name in the autism-alternative-medicine community, Dr. Rashid Buttar. The story was given national attention, including a segment on the U.S. TV show Inside Edition.

The whole story of the alleged vaccine injury is long and strange. The current status, it gets even stranger. Ms. Jennings appears to have made a full recovery, walking and driving a car. She talks better, with the addition of a rather strange accent. This was found when Inside Edition decided to do a followup on Ms. Jennings, apparently after reading Dr. Novella’s take on the story. From Dr. Novella’s recent blog post:

Another angle to this case was the mainstream media coverage. The story was made national primarily by an Inside Edition segment in which they took her claims of being horribly injured by the flu vaccine at face value. They did throw in a caveat that doctors say the story should not dissuade the public from the vaccine (the “not” was incredibly and deceptively edited out in the YouTube version of the story). But generally it was among the worst science reporting of 2009.

So I was a bit surprised when I was contacted by a producer from Inside Edition about a possible follow up segment on the story. He had read my blog posts on Ms. Jennings and realized they got the story entirely wrong. To his credit he wanted to do follow up (unfortunately rare in mainstream journalism) and tell the real story. This resulted in the segment that aired last night

One reason to bring this story up now is highlighted by Dr. Novella: the effect of science bloggers on a major news story:

And finally (if you will forgive the self-serving observation) the story highlights the new power of the science-blogging community. The Inside Edition follow up segment was entirely due to the science bloggers who covered the story – and told the real story behind the media sensationalism. We are influencing the media cycle in a good way. At the very least we are making ourselves a valuable resource to the mainstream media, and hopefully raising the quality of science journalism in general.

Dr. Novella did well in blogging this story, and Inside Edition did well to reconsider the story in light of the well-reasoned discussion of Dr. Novella.

Video of the recent Inside Edition segment is here:

ABC Radio interviews Brian Deer

25 Feb

RearVision, an ABC (Australia) radio news program, has an interview with Brian Deer titled The MMR vaccine scare. They have both audio and transcript available.

Even before Keri Phillips of ABC gets to Mr. Deer, she makes it clear that this isn’t going to be some fluff piece with faux-balance:

What Richard Horton didn’t know at the time, and neither did some of Wakefield’s 13 co-authors, was that some of the claims in the paper were false. It wasn’t bad science but rather outright fraud that ultimately led to the finding of misconduct against Andrew Wakefield. We’ll come to that in a moment, but first, what really set this story running was a press conference that Wakefield held at the Royal Free Hospital where he worked as a gastroenterologist.

My guess is that most readers here know the Wakefield story, so I won’t quote discussion of that. I will note the suggestion of moving away from anonymous peer review made by Trisha Greenhalgh. I, for one, am not in favor of that. I feel that referees will be less critical if they know that the authors will know the referees names.

Here is a closing statement by Brian Deer:

The thing that really concerns me is that there’ve been three kinds of victim in all of this. Firstly there’ve been children who’ve developed measles, and we’ve had children in the UK who’ve died of measles as a result of this. They’re the first victims. The second victims are parents who really agonised and gone through hell over whether they should vaccinate their child. But there’s a third kind of victim, which I think people often forget, and these are parents who blame themselves for their child having autism because they took that child to be vaccinated. And you can imagine the nightmare that these parents go through, and I’ve spoken with some of them, and I’ve had mothers just collapse sobbing saying, ‘Not a day goes past when I don’t blame myself for taking my child to be vaccinated. It’s my fault that he’s got autism, it’s my fault that his life will never be the same as that of other children.’ And I really feel for those parents, and I think we should remember these victims of this scare because these mothers have suffered.

Then there are those of us who have seen 12 years of “autism” advocacy groups who can’t concentrate on anything but vaccines and 12 years of useless research trying to support what Keri Phillips calls not “…bad science but outright fraud.”

Andrew Wakefield’s Autism Organization?

22 Feb

There has been a major push to show support for Dr. Andrew Wakefield following the clear and decisive ruling against him in by the General Medical Council and the retraction of his flagship paper in The Lancet and his departure from Thoughtful House.

I have some advice for those who are supporting Dr. Wakefield. I realize advice from me is about as welcome to them as me seeing Dr. Wakefield in my pediatricians’ office, but here goes:

If you want to show real support, add him to your board of directors. Add him to your Science Advisory Boards. Call yourselves “Andrew Wakefield’s Autism Organization”. When big donors call, have them speak with Dr. Wakefield. When you lobby the legislature, bring Dr. Wakefield.

Don’t keep him at arm’s length while trying to rehabilitate his reputation.

The way I see it, right now Dr. Wakefield is a liability. It is one thing to write blog posts or letters to newspapers. It is quite another to spend your organizations reputation.

Between the time I started a draft of this post and it now, Dr. Wakefield has made his first public statement about his departure from Thoughtful House. He mentions that he has an “entirely new sort of opportunity that will allow me to continue my work on behalf of autism families”. Who knows, maybe one or more of the existing orgs will take him on.

Mark Blaxill attempts to support Andrew Wakefield?

20 Feb

As most have now gathered, Andrew Wakefield’s career in the UK is finished. However, the PR machine keeps spinning in the USA as a new fascinating web piece from Brian Deer reveals.

Brian tells the story of how Max Clifford’s daughter – who works for her father – had apparently been ready to take on Andrew Wakefield as a client:

They are looking to take us on for a few months…

However, her father – who previously refused to work with Michael Jackson – had other ideas:

It’s my company, and my daughter works for me, he said

…

We are not involved, and we will not get involved unless they are backed by top medical experts…

Heh. Not much chance of _that_ happening.

During the piece Brian discovers who might be financing Andrew Wakefield’s about-face in the public eye. He suggests a couple of names to Clifford’s daughter who confirms the participation of one Mark Blaxill:

…she appeared to take the bait over Blaxill. “Right, Mark. Okay. Mark is…” But then she paused to ask: “Brian, what’s your background?

Amazing that someone who was preparing to work with Brian Deer didn’t know who Brian Deer was but more interesting to me was the possibility that Mark Blaxill was preparing to fund Max Clifford’s PR firm to try and rehabilitate Andrew Wakefield’s public image. Go read the whole thing, its pretty interesting.

It’s official, Dr. Krigsman to leave Thoughtful House

20 Feb

Thoughtful House, the clinic and research center founded by Dr. Andrew Wakefield, is losing both Dr. Wakefield and, now, Gastroenterologist Dr. Arthur Krigsman.

From a Yahoo group (as posted by Mike Stanton in the comments on LeftBrainRightBrain):

Re: Dr. Krigsman

Dr. Krigsman’s decision to relocate his clinical practice to a facility outside Thought House reflects his belief that the complexities inherent in a referral-based practice can be best addressed by his working independently. We will continue to refer patients for GI evaluations when appropriate, and we look forward to continuing to work with Dr. Krigsman on research projects. We are grateful to Dr. Krigsman for his dedication to Thoughtful House and for the work he does on behalf of the children we serve.

Just to be clear, this is official.

Jane

Fees for the Omnibus Autism Proceeding hit $7M

20 Feb

In the United States, the court hearings on whether vaccines cause autism were held under the Omnibus Autism Proceedings (OAP). These proceedings represented over 5,000 families who filed for consideration that they had a child who (a) suffered a vaccine injury and (b) this injury resulted in autism.

The OAP heard six “test cases”. Each test case represented both the question of whether the specific test-case child considered suffered a vaccine injury and also the general question of whether the idea that vaccines cause autism was proven.

The first three test cases considered the question of whether the MMR vaccine could cause a vaccine injury resulting in autism. The second three test case considered the question of whether thimerosal containing vaccines could cause vaccine injury resulting in autism.

The decisions from the MMR cases have been handed down, and they were unanimously and definitively against the MMR causes autism theory. These have been appealed and that appeal was denied. I believe an appeal to the U.S. Supreme Court has been either filed or planned.

The decisions in the thimerosal cases have not been handed down yet.

The OAP was a very long process, starting in 2002 and still ongoing, involving multiple law firms and many lawyers and experts. It has been an expensive process. We are slowly learning just how expensive.

Last year an interim award of over $2M in legal fees was granted for lawyers working on the Cedillo test case. That was the first case heard in the MMR segment of the AOP.

The Court has now granted an interim award of $2,300,000 for the King test case, the first heard in the Thimerosal segment of the AOP.

During an unrecorded telephonic status conference on July 1, 2009, the law firm of Williams, Love, O’Leary, and Powers (WLOP) agreed to reduce its interim attorneys’ fees and costs request from $3,101,764.84 to $2,300,000.00, including $2,070,000 in fees and $230,000 in costs. Respondent’s counsel then indicated that respondent will not object to that amount. WLOP’s reductions included: the withdrawal of time and expenses relating to direct legislative lobbying, that is, any activity relating to efforts to affect the outcome of the political process; the withdrawal of time and expenses relating to “case specific” work in cases other than this claim, and unrelated to “general causation” work on the OAP; the withdrawal of time and expenses WLOP conceded were related exclusively to civil cases outside of the Vaccine Program; and the withdrawal of time and cost claims relating to public relations and media work during the pendency of the OAP. In addition, WLOP generally reduced the fees it requested for time spent on the OAP. Finally, WLOP agreed to significantly reduce the expenses for which it sought reimbursement, particularly those costs incurred while on travel.

Let me highlight a couple of statements:

the withdrawal of time and expenses WLOP conceded were related exclusively to civil cases outside of the Vaccine Program.

and

WLOP’s reductions included: the withdrawal of time and expenses relating to direct legislative lobbying, that is, any activity relating to efforts to affect the outcome of the political process

Bold is mine.

Apparently, the law firm applied for and was denied funding for work done for civil cases that were outside of the vaccine program and for lobbying efforts. What were they thinking trying to get tack that onto their fee request? Let’s face it, the Omnibus has already subsidized any upcoming civil cases by giving the lawyers time to research their arguments and pay experts. And, really, asking the program to pay for lobbying?

This is only an “interim” fee request. Fees are still mounting, and not all the past fees have been assessed:

Of note, this Decision resolves all fees and costs requested by the WLOP firm in the King interim fees application, at Tabs A & B of that application. This Decision does not resolve the amounts requested at Tabs C through U of that application.

I don’t know how much is involved with “Tabs C through U”, but it sounds like the remaining fees could be considerably more than the $2.3M granted.

It is interesting to note that the father/son team of David and Dr. Mark Geier have expert fee requests submitted (and as yet unpaid) for this case, even though they were not called as witnesses and, to my knowledge, did not submit expert reports:

This does not resolve the vast majority of fees and expenses relating to Drs. Geier and Young. The majority of expenses relating to Dr. Geier, David Geier, and Dr. Young are included in the PSC Committee Costs, at Tab C of the initial Fee Application

The Geier’s are well known “experts” in the vaccine court. Young, I suspect, is the same person as co-authored a paper with the Geiers purporting to show a link between neurodevelopmental disorders and thimerosal in vaccines. That paper was reported to have been recieved funding “…from the Autism Petitioners’ Steering Committee of the no-fault National Vaccine Injury Compensation Program (NVICP).”

I am all for petitioners in the Vaccine Court having access to good experts. I don’t consider the Geier team to meet that standard. Should the Petitioners’ Steering Committee have decided to fund this reasearch, I see that as their expense, not one that should be passed on to the vaccine program. Dr. Mark Geier has been referred to in court documents as:

There are multiple cases where Dr. Geier’s opinion and testimony have been given little or no weight because they exceeded the scope of his expertise.

and

Dr. Geier is “a professional witness in areas for which he has no training, expertise, and experience”

I frankly suspect that funding The team of Young, Geier and Geier in this instance is another attempt to get the Vaccine Program to pay for work the lawyers expect to use in the civil cases that will follow the likely rejection of the Vaccine Court hearings. Remember, they weren’t called as expert witnesses in the Omnibus.

One other expert witness of note, Dr. Vas Aposhian, is also mentioned in the fee ruling:

This decision resolves the $34,048.25 that WLOP requested for expenses related to Dr. Aposhian ($31,750.00 in fees; and $2,298.25 in expenses incurred in May 2008). This decision does not resolve the $207,382.53 in fees and expenses included in the PSC Committee Costs for costs relating to Dr. Aposhian, nor does it resolve the $7,910 requested by Williams Kherkher for costs associated with Dr. Aposhian. See Tab C at 3887 and Tab E at 4396-98.

We don’t have the decisions from the King hearing yet, but here are some comments from the Cedillo decision:

Thus, concerning this issue [genetic hypersensitivity to mercury], I conclude that the testimony of Drs. Brent and Cook was persuasive, and that the testimony of Dr. Aposhian was not.

I find that Dr. Brent’s testimony on this point [the lack of an established mercury efflux disorder] was persuasive, and that the testimony of Dr. Aposhian was not.

I wonder if Dr. Brent, whose expertise was persuasive, will be paid anything like the roughly quarter million dollars that Dr. Aposhian has billed.

So we have $2M in fees granted for the Cedillo hearings, and now $2.3M for the King hearings. This is part of a total of over $7,000,000 requested in interim fees:

In their application, the petitioners sought a total of $7,202,653 for interim fees and costs. This total reflected the fact that this case was, as explained above, one of the “test cases” in the OAP. Because this was a “test case,” in which the petitioners sought to present all of the “general causation” evidence concerning the theory that thimerosal-containing vaccines can cause autism, several different law firms participated in the development and presentation of the evidence, while five expert witnesses prepared expert reports and testified at length for petitioners during the evidentiary hearing. The high total sought reflects the participation of all those law firms and expert witnesses.

I don’t think anyone is surprised that this is a very expensive proceeding.

Millions of dollars were spent trying to prove the now discredited (and never well supported) hypothesis of Dr. Wakefield. The thimerosal hypothesis also never had much substance, and has cost millions more.

One thing good out of all this is that the proceeding also paid to compile expert reports from some real experts debunking the MMR and Thimerosal myths.

Was Dr. Wakefield the complainant in his own GMC case?

19 Feb

Pop quiz: of these two people, who was the first to request that the General Medical Council (GMC) investigate Dr. Andrew Wakefield

a) Brian Deer
b) Dr. Andrew Wakefield?

Ah–trick question! Brian Deer didn’t ask the GMC to investigate Dr. Wakefield. Mr. Deer offered and gave information to the GMC, but, it turns out, only after Dr. Wakefield called for an investigation.

Let me start by saying I hesitated to publish this post as it will be just make it seem like there is a real controversy here. There isn’t. But after noting that the addendum to the Press Complaints Commission (PCC) complaint filed against Brian Deer included citations to LeftBrainRightBrain I decided to check into the “complainant” question.

Here’s the PCC complaint. Here’s the addendum.

There is a long “forensic analysis” argument to make the case that supposedly Brian Deer was the complainant. This struck me odd. Why do a “forensic” argument, unless you don’t have substantial proof.

In the matter of Dr Wakefield and the GMC, and based upon forensic analysis of all the available documentary evidence, one is entitled to believe that Mr. Deer was the original and only substantive complainant to the GMC, whether or not he was the ‘Complainant’ who instructed the legal prosecution of the case (which was the GMC through its lawyers Field Fisher Waterhouse).

OK, Brian Deer was the complainant, whether or not he was the ‘Complainant’. Everyone got that? Clear as mud?

It wasn’t to me, so I contacted the General Medical Council to ask a simple question:

I am sorry to bother you, but I was hoping you could help with a question. Is it public knowledge whether Mr. Brian Deer was a “complainant” for the Wakefield case? Was there any “complainant” or was this case brought forward by the GMC itself?

I received a very simple answer:

Dear Sir/Madam

The General Medical Council can act in response to complaints about doctors but we do not require someone to make a formal complaint to us before we can act. We can in fact initiate action against doctors of our own volition. This enables us to launch an investigation in response to publicly expressed concerns about the conduct of doctors, whether or not those concerns have been directly and formally referred to us.

The case against Dr Wakefield, Professor Walker-Smith and Professor Murch was brought by the GMC there was no complainant in this case.

I hope you find this information helpful and if you have any further queries relating to this case please do not hesitate to contact me.

When I asked if I could make this public, I was informed that this information is already public. Yes, I forgot the fact that Brian Deer had a letter from the GMC’s attorneys already. That is from May, 2005. I guess this whole, “he’s a complainant even if he isn’t a Complainant” thing has been going on for some time.

The “forensic analysis” seems to rest on the fact that Brian Deer has communicated with the GMC. There doesn’t seem to be any actual complaint filed, but, as we are told:

But what Deer does not reveal is that on February 25, 2004, three days after his article attacking Wakefield had been published in the Sunday Times, he had written to the GMC…

Yes, according to this timeline, Brian Deer published his article and then contacted the GMC 3 days later. It is characterized as a “spontaneous” communication in the complaint. As in, Brian Deer just out of the blue decided he needed to contact the GMC.

Dr. Wakefield left out an important part of the timeline. Namely, his own call for a GMC investigation. Here is a timeline:

February 22, 2004, Brian Deer’s article, Revealed: MMR research scandal is published.

February 23, 2004: Dr Wakefield states, “I’d welcome inquiry”

“Serious allegations have been made against me in relation to the provision of clinical care for children with autism and bowel disease, and the reporting of their disease. It has been proposed that my role in this matter should be investigated by the GMC. I not only welcome this, I insist on it and I will be making contact with the GMC personally.”

Two days later, on February 25, 2004: Brian Deer emails the GMC. This appears to be the first contact between Mr. Deer and the GMC. According to the excerpt in the PCC complaint filed by Dr. Wakefield:

email from Brian Deer to Tim Cox-Brown, Caseworker GMC, 12.16 pm 2.25.04. This is a sixpage letter concluding with the statement “As a matter of public duty, I write to offer this outline of my main findings, and to offer the GMC my fullest cooperation in getting to the bottom of these matters”.

Which, according to Dr. Wakefield, makes Brian Deer the “complainant” in the GMC hearing:

This reads as a spontaneous and intentional contact with the GMC for the purpose of requesting to put before them the substance of his complaint and in fact, doing so i.e. making a complaint.

Spontaneous? I guess if you leave out critical details like Dr. Wakefield’s own call for investigation. As I titled the post, couldn’t one say that Dr. Wakefield is the complainant? After all, it is Dr. Wakefield who appears to have called for the investigation.

Dr. Krigsman “steps down” from position at Thoughtful House?

18 Feb

In an article in the Times Online, the departure of Dr. Wakefield from Thoughtful House is confirmed, but also a statement is made:

It has also emerged that Arthur Krigsman, director of the gastroenterology clinic at Thoughtful House, has stepped down in recent weeks. The departure is not thought to be directly related to Dr Wakefield’s situation

Dr. Krigsman is still listed on the Thoughtful House website, where he is still listed as director of the gastroenterology clinic.

Dr. Krigsman is the director of the gastroenterology clinic at Thoughtful House Center for Children in Austin, Texas.

I am unclear on whether “stepping down” means he is still with Thoughtful House but not as director, or whether he has left Thoughtful House altogether.

Dr. Krigsman is the lead author on a paper which came out recently purporting to support Dr. Wakefield’s research.

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