Hard Conversations: Vaccines and Autism, Part 1.5
Part 2 was originally going to be a detailed overview of the first of the review articles I mention in part 1. However to be more complete, I’m delaying posting that until tomorrow. This way I’ll also be able to review an article or two suggested by those who believe vaccines cause ASD. I’ll also use that time to discuss why it is important to understand different levels of evidence, and different levels of credentials (Huge hat tip to leigh for the suggestion).
Until I get finished with all that, I wanted to lay down a few thoughts I’ve had since writing the first post and reading the reactions to it.
I’m trying to write as I would talk to a patient, or patient’s family, in the hospital. I hope this leads overall to a tone that’s not at all typical Google U, but much more like the conversation you might have had with your physician, with bonus hyperlinks.
When I talk to patients, if they’re considering alternative therapies, or alternative explanations for their disease process, I focus on evidence. Maybe I’m not good at presenting evidence, but I have yet to see a lot of patients jump up and say “Yes I’d love to read the New England Journal of Medicine.” Instead I get a lot of “What do you think?” And so within these posts, I’m telling you what I think, but I’m trying to focus on why I think it, and I’d like to convince you with the best evidence we have.
The Google University education, and the celebrity endorsement is beginning to be more trusted than the information one obtains from a doctor. Part of this is our fault; physicians as a whole have had a less than stellar record of communicating well to patients. But another big part of it is just the ease of access to information on the web. The problem is that you can get just as much misinformation, and it isn’t easy to tell which is which.
There’s a reason evidence is important. Evidence isn’t here to hold down good cures. Evidence isn’t here for Big Pharma to hold the little guy down. Evidence is here to stop people from taking advantage of you. Before we studied these things it was easy to be a snake oil salesman. One could knowingly peddle junk to vulnerable people who don’t know better, and make a lot of money doing so. Now a potential solution is checked, weighed, measured, and if it’s found wanting, it doesn’t get very far in clinical practice. Is this model perfect? Of course not, lots of times good drugs take a while to get to market, because it takes a long time to prove things. But one thing evidence based medicine is good at, it’s identifying frauds.
Evidence based medicine also shows us that a lot of our intuitions are wrong. People love finding patterns; we’re very good at it. We’re also very good at finding patterns where there aren’t any. It’s easy to confuse correlation and causation, and it’s easy to see correlation when really there is none.
How does this relate to autism, or our discussion now? One of the reasons why the link between ASD and vaccines seems so obvious to parents is its timing. Autism often begins to manifest right around the ages children are getting vaccinated. It’s so closely timed, that a badly designed scientific study might see a correlation, where a good study would show that this is incorrect. Which leads us to Part 2.
On deck, part 2: a discussion of levels of evidence, levels of credibility, and a breakdown of the evidence for and against connecting vaccines and autism, if I’m lucky, maybe I’ll be able to fit in some tips and tricks for parents and patients to judge evidence, and credibility for themselves.
Also in the pipeline: An overview of the Hannah Poling case, and a breakdown of mitochondrial disease.