Archive for the ‘Hard Conversations’ category

Hard Conversations: Vaccines and Autism, Part 4: Response to Dr. Healy

April 19, 2009

This post has been hanging in my drafts for a bit – I’m still not happy with it, but I felt like sitting on it longer would make it just irrelevant. I might edit it significantly to make it more readable or understandable. Infact I’d like to make it a collaborative effort – feel free to post comments about how to improve this piece, and if it’s reasonable I may change it accordingly.  Heck, feel free to post general suggestions to improve this blog. Everything from “Your grammar sucks, work on it”, “get a darn thesaurus, stop saying disappointing so much”  to “you really need to get off of this topic, it’s no longer relevant to me”. Go wild with it! 

This post is a reaction to Bernadine Healy’s recent post on US-News & World Report. Dr Healy’s post can be found here. Please also read Parts 1,2, and 3. Our resource to educate today is “Vaccines and Autism: A Tale of Shifting Hypotheses” published in Clinical Infectious Diseases, full citation at end of post.

I was planning on leaving Dr Healy for another day. Originally Part 4 was going to be my breakdown of the “mitochondrial disease” hypothesis of autism-vaccine connection! Unfortunately Dr Healy wrote a post that I found so profoundly incorrect it required immediate response. Age of Autism advocates have touted Dr Healy’s credentials and her seemingly ambiguous position on this issue as proof that they have a legitimate concern, and this can no longer be tolerated.

Let’s be clear, this post is not an ad hominem, but before discussing the content of her post we’ll start by talking about who she is. I have the utmost of respect for Dr Healy as a cardiologist. I don’t know enough, and don’t have enough time to learn about whether she was a competent head of the NIH. By all accounts she was a good dean at Ohio State University College of medicine. I will not in discuss her tenure as president and CEO of the American Red Cross. In passing I’d like to mention that Dr Healy was a member of the Advisory board of The Advancement of Sound Science Coalition (TASSC). TASSC is a lobby group funded initially by Philip Morris that promotes the idea that scientific research on issues such as smoking and global warming is “junk science”. It is operated by Steve Milloy and I encourage you to investigate that connection yourself. Dr Healy was also declared Age of Autism’s Person of the Year.

None of this immediately invalidates anything Dr Healy says. A shady connection does not discredit someone altogether. It’s important to look at the connections someone has, but it’s also important not to impugn someone’s reputation entirely on the basis of connections – I will not be committing a tobacco shill gambit here. One must look at, and weigh the evidence, then come to an appropriate conclusion. Note the difference between my position on this, and the position advocated by many of our anti-vaccine commenters, who ignore evidence if they can find even a passing conflict of interest in opposing viewpoints.

Here’s the problem: Dr Healy has neglected her responsibility to educate herself before she speaks from her pulpit. When you are not an expert on something yourself, you had darn well better do your homework before talking! I’m extremely disappointmed in Dr Healy for this article and for her position on this issue in general. Dr Healy is not an immunologist. Dr Healy is not a pediatrician. Dr Healy is not a scientist. Dr Healy does not express an understanding of the evidence in her article.

We’ll start at the beginning.

McCarthy and Carrey and two colleagues from the autism advocacy group she founded, Generation Rescue, took the AAP to task for its unwillingness to give at all in the controversy over vaccine safety and, while holding up a vaccine ad in its journal, accused the group of shilling for vaccine manufacturers.

Firstly, McCarthy and Carrey did not found Generation Rescue, J.B. Handley did. Secondly, complaining that the AAP won’t “give” is the Gray Fallacy, that we addressed in Part 1. Just because the AAP says “vaccinate” and someone else says “Don’t vaccinate” doesn’t mean that the appropriate response is in between. Generation Rescue is wrong. Terribly wrong. Disturbingly wrong. So wrong that no doctor should be advocating for them! Lastly, she reiterates McCarthy and Carrey’s pharma shill gambit. The pharma shill gambit does not a real argument make. Early on Dr Healy reveals a lack of understanding of the basic issues at hand.

Next Dr Healy brings up the “Vaccine overload hypothesis”, which we have discussed in part 3.

the United States now gives more vaccines to all its children, and earlier in life, than the rest of the developed world: some 36 doses before our little ones hit kindergarten, with most crammed into the first 18 months of life. If you look at the best-performing countries in terms of infant and early-childhood mortality, the average number of doses is 18, with most of the Scandinavian countries, Japan, and Israel mandating just 11 to 12.

To support her hypothesis she brings up a non peer reviewed “study” by Generation Rescue complaining that we give more vaccines than other countries . I will not discuss this study here at all, it doesn’t even pretend to be science, and has been thoroughly disassembled by Dr David Gorski here.

Next up she complains about specific vaccines: Hep B, Rotavirus, Hep A, and chicken pox.

The extras here include protection against the sexually transmitted hepatitis B virus, which many countries (and the United States in the past) recommend only for infants at high risk because of an infected mother; a vaccine against the rotavirus, which causes some cases of infant diarrhea…

Rotavirus is a group of viruses that cause lots of childhood diarrhea – actually they’re the single largest cause of childhood diarrhea. They also cause the less known, but more embarrassing med-student-on-pediatrics-rotation diarrhea. Per the CDC, rotavirus leads to the hospitalization of 55000 children in the US and the deaths of 600000 children worldwide each year. Yet another fact has been glibly ignored by the good doctor.

She also makes a mistake I thought no doctor would make “sexually transmitted hepatitis B”. Tsk tsk Dr Healy. Lest we forget our basic virology, Hep B is body fluid transmitted, not just sexually transmitted. This often chronic disease is regularly missed in patients before they do lots of liver damage, and if a child is infected young, they are far more likely to get chronic disease, that will lead to liver failure, and death.

She complains about loosening the vaccine schedule, I won’t paste her entire argument here, all I’ll say is this: There isn’t a study showing a good reason to loosen the vaccine schedule. If you were to loosen the schedule, what infectious disease would you decide to bring back first? Polio? Tetanus? Measles? Hepatitis?

Even more disappointing, she brings up the idea that many people are susceptible to side effects of vaccines – and brings up Hannah Poling and mitochondrial disease and implies a connection with autism. We’ll be discussing this in the next part.

Some have lobbied to keep vaccines out of the government’s autism research agenda, because they see the case as closed and fear further study will threaten confidence in vaccines. Doing so would be just plain wrong.

This is ridiculous, those lobbying to keep vaccines out of the government’s autism research agenda are doing so because further study won’t reveal any more evidence, and will be like flushing money down the toilet. Not because it will threaten confidence in vaccines. Doing so would be just plain right.

Finally there is this pearl, where Dr Healy really reveals that NIH director or not, she is no scientist.

so is a study comparing groups of vaccinated and unvaccinated children.

Now someone with much less education made the very same suggestion earlier on this blog, and I called it unethical. She suggests  that this is completely reasonable. Bravo Dr Healy. Bravo. Not one immunologist thinks that we need that data. Not one expert in the field sees this as necessary. Only a thorough misunderstanding of science, and statistics, makes that sound like an OK idea. Of course, Dr Healy doesn’t actually believe in evidence based medicine, as she said here. It’s hard to imagine going from the thorough misunderstanding of EBM shown there to being able to suggest reasonable science.

 

 

Ref:Gerber, J., & Offit, P. (2009). Vaccines and Autism: A Tale of Shifting Hypotheses Clinical Infectious Diseases, 48 (4), 456-461 DOI: 10.1086/596476

Science Based Medicine, and Hard Conversations

April 10, 2009

Before I disappear for the holiday weekend, I wanted to put out one last post.

Firstly, go check out Science Based Medicine – a blog about the battle against pseudoscience. Go check it out! I’ll wait right here. I promise it’s relevant to the rest of this post.

Secondly, through the short lifetime of this blog my goal has been to educate people about science and evidence based medicine. This has proved more difficult than I initially hoped.

In my initial posts I at least try to keep the language understandable to the generic educated lay person. Sadly by about comment 3, a pseudoscience advocate cites 3-10 articles that they don’t understand, or that are thoroughly out of date. Then by comment 10, multiple scientists have appropriately responded, but the thread is no  longer in reach for the very people I was hoping to reach with this blog.

Unfortunately, journal articles are just as easy to manipulate into pseudoscience as any other resource. Google-fu now makes it easy to put multiple citations and some 10 dollar words between a loving family and the appropriate evidence.

I’m going to try to make some changes going forward to make this blog still more accessible, and hopefully keep the discussion more relevant and understandable. Unfortunately, to do so I’m having to make some hard decisions. I banned my first poster last night, which greatly disappointed me. I was hoping by keeping a respectful tone I’d be able to have an open engaging discussion with both sides of the aisle.

I was warned before I started that affording respect to those who will abuse it would burn me. Some sites don’t have this problem – without the courteous tone I’ve encouraged, it’s very easy to burn the pseudo-scientific offenders out. Sadly, until now it’s been very easy for someone to just keep citing random articles and throw out a few “I don’t understand”‘s to sound reasonable enough, yet derail any progress.

Now after the holiday weekend – I’ll be swearing off the Internet from when this post comes up on line until Monday – I will post updated guidelines for the Hard Conversations series, and for this posting on this blog in general. I’ll continue to be soft on patients, but I will be much Harder on Woo. I apologize if that makes this blog feel less open, less free of speech, but I now think it’s necessary to ensure we are not hijacked by the unscrupulous minions of ignorance.  

So how does this connect to the Science Based Medicine blog? The post series in particular is by the wonderful Kimball Atwood, “Harvard Medical School: Veritas for Sale” . I have linked to the first post in that series. It may not be entirely appropriate reading for one segment of my audience – the parents/patients  among you will find it dry. The scientists and doctors may find it an entertaining, and disturbing look at the big business of medicine. I find this relevant because if Harvard can’t get it’s business in order on science based medicine, how in the world can you?!

The reality is that, it’s a complicated task to keep up with what is science and what is pseudoscience. I will endeavour to cover and explain science based medicine to the best of my ability. Please continue to let me know where I can improve guys, I really appreciate your input.

For now, enjoy!

-Whitecoat Tales

Hard Conversations: Vaccines and Autism, Part 3

April 7, 2009

ResearchBlogging.org

 

The “Vaccine overload” Hypothesis.

For those just joining us, we have previously discussed 2 ideas linking autism and vaccines(Catch up with part 1, part 1.5, and part 2) and this is what we have learned.

1.       The initial “link” between vaccines (MMR) and autism was bad science. It involved small numbers of patients, and could not be replicated. The initial investigator had a large, undisclosed conflict of interest. He is now being investigated for his conduct in this study. Our initial link was weak at best.

2.       Thimerosal was never proven to do anything bad, and was removed preemptively. Additionally, there was never thimerosal in MMR vaccine, which is often the one implicated by parents of ASD children.

A commenter on part 1 was trying to assert a third hypothesis. This is one of the McCarthy crew’s new favorites: “Too many, too soon”. Here’s the idea: “Maybe infant’s immune systems can’t handle all those vaccines.”   

Before we start, let’s comment on science. Science is restrained. To get scientific evidence, we need questions that are testable. In medical science, we’re further restrained: our testable question also need to be ethical.

Ideas 1 and 2, science had no problems dealing with. This is because they were both theories that easily give testable hypotheses that we could answer by looking at what’s already happened, or through experiments that we don’t think will hurt people. 

The first problem is developing a testable question – “too many too soon” is too vague – how many do the anti-vaccers think is too many? How soon is too soon? How are we measuring too many?

Let’s start with how we measure “too many.” Is it by number of antigens, or number of organisms we vaccinate against? Antigens are chunks (protein or polysaccharide) of whatever organism we’re vaccinating against. We form antibodies to these chunks, which are then the basis of our defense against the organism vaccinated against. Essentially an antigen is a practice target.

All that makes “number of antigens” seem like a reasonable way to measure “too many.”  Just one problem – in the last 20 years the number of antigens in our total vaccine schedule has decreased, not increased. How can that be? We’ve gotten better at identifying what antigens are important. Once we’ve identified those good targets, we “conjugate” those targets – we make them more visible to the immune system. In 1980, the full vaccine schedule had over 3000 targets. Today’s vaccines only have around 125 targets.

What about how many organisms we vaccinate against? Well I’ll entertain that thought. Just tell me which horrible, preventable disease is the one you’d like to see back. Then tell me how you’ll prove bringing that disease back won’t result in more problems. The anti-vaccine advocates are generally too young to remember how devastating even seemingly innocuous childhood diseases are.

Measles, Mumps, Rubella – they all have “rare” complications that kill, and less rare complications that require hospitalization. But “rare” complications aren’t that rare when the entire country gets a disease. Some of the opposition have said “yes but the mortality rate of [X] disease is only 1 in 1000/10000/otherobscenelylargenumber.”

The problem with that argument is that this isn’t what the mortality would be today. Hospitals aren’t set up for infectious disease anymore. We don’t have isolation wards to stop the spread within the hospital. Heck, at my hospital system (a major metropolitan academic hospital, and major academic pediatric hospital in the Midwest) we’ve rarely had an empty bed, let alone 100 more for an infectious disease ward for sick children. Many hospital systems are at their breaking points as it is, if you add another stress like additional illness that could have been prevented, children will die. I won’t even argue about diphtheria, pertussis, or polio – no one should have to see those diseases, period.

What about “too soon”? We run into problems here as well. Turns out the fetal immune system can respond to antigens at 14 weeks. This is actually surprisingly intuitive, once you consider birth. At birth, a baby moves into the world through the vagina – not exactly a sterile environment. If the infant’s immune system wasn’t pretty healthy from the get go, birth itself would result in a tremendous number of infections. Any OB/GYN worth their salt will tell you that there are a pretty small number of infections that normally happen right around birth; few enough that med students need to know the majority of them for our board exams.

A moment for Jenny McCarthy specifically: in her new book she recommends only taking HIB (haemophilus influenza type B) and tetanus. That’s grossly irresponsible. In a vulgar, arrogant, and ignorant response McCarthy blamed Big Pharma for any deaths that result from her advice. Numerous other bloggers have catalogued the ridiculousness of that position. As we’ve seen, no one has given us something at all convincing to say vaccines are unsafe. Don’t get me wrong, Big Pharma’s not out to help anyone – they’re out to make money, but the burden of proof is on someone to prove their product isn’t safe, and that just hasn’t happened.

With the exception of the paragraph pertaining to the hospital system is based on my own personal experience, the paragraphs discussing ethics, and the paragraph pertaining to Jenny McCarthy, the ideas in this post are based on my interpretation of the below article from the journal “pediatrics.”

 Link to part 4 here.

 

 

 

 

 

Offit, P., Quarles, J., Gerber, M., Hackett, C., Marcuse, E., Kollman, T., Gellin, B., & Landry, S. (2002). Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System? PEDIATRICS, 109 (1), 124-129 DOI: 10.1542/peds.109.1.124

Hard Conversations: Vaccines and Autism, Part 2

April 4, 2009

So where did this hype about autism and vaccines come from?

In 1998 Andrew Wakefield published a case series of 12 children who had behavioral problems including autism (9 of the patients), and also gastrointestinal problems. In all except but 2 cases, the parents said that the onset of behavioral problems was around the same time as the MMR vaccination. He took these children and did a bunch of testing on them including colonoscopy with biopsy, lumbar puncture, EEG, MRI, and a bunch of lab studies on their blood/serum. All the children had something abnormal on colonoscopy – but not necessarily the same thing in any of them, just something.

So firstly, do we all remember where case series are on our evidence scale? They were right near the bottom, just over expert opinion. This is exactly why. Wakefield cherry picked 12 children with ASD (which we have described as relatively common) and linked them with gastrointestinal problems. How often has your child, ASD or not, had gastrointestinal problems?

Based on this, not at all convincing evidence, Wakefield called for a suspension of the MMR vaccine, claiming that somehow these GI findings provide a mechanism for autism to be caused by autoimmune disease (There is a lot of hand waving here, I can’t even make it sound more reasonable than this if I tried). But the evidence never showed bore this out; in fact, large studies in both Europe and here show no correlation between MMR and ASD. The Institute of Medicine and the Cochrane collaboration also failed to find any such link.

In kind of a follow up to this study Wakefield and his collaborators put up a couple of studies showing that you could get measles virus from the intestines, and/or blood cells of ASD patients with GI problems. I won’t get into detail except that to say the labs where these studies were done were subsequently plagued with contamination problems. No one could replicate those results.

A key to science is replication of results. We believe gravity because I know, I can always drop an apple, and it will always hit the ground. The results from Wakefield’s studies have so far been not replicable, only Wakefield and his collaborators can get those results. Studies using more accurate technology have pretty definitively ruled this theory out; you can’t find measles in a patient vaccinated with MMR, that’s not related to the cause of ASD.

Now here’s the ironic kicker: often advocates of Wakefield’s position often accuse people who disagree with them of being paid off by Big Pharma, something one blogger has described as “the pharma shill gambit.” However, Andrew Wakefield, in 1997 filed a patent for a vaccine that would have been a competitor to MMR. Additionally it turns out, some parents in the original study were working with lawyers to sue the manufacturers of the MMR vaccine, and the UK legal aid board paid 55,000 pounds to help fund the research in that Lancet article. If that wasn’t enough, Wakefield was personally given 400,000 pounds by the lawyers in the MMR suit. Currently, Wakefield is being investigated for professional misconduct for all the shady activities in this sad story.

But wait, we’re not done – despite the fact that we still have no initial reason to suspect vaccines aren’t safe, since the article purporting that link was just revealed to be pretty fraudulent the anti-vaccine advocates said “well ok, Wakefield may be wrong, but let’s try again.” The next question raised was about thimerosal, a mercury containing preservative used in some vaccines. It was pointed out in the discussion of part 1, that MMR never contained thimerosal. Mercury is bad right? Let’s just take it out and not worry about it. That’s exactly what the FDA did, they called for the removal of thimerosal, and it has been removed. This is important: no one ever proved thimerosal does anything bad. They took it out. Since it’s been removed, other studies have shown the rate of autism continues to climb. Which simply wouldn’t be the case if thimerosal was to blame.

A small side note: in the discussion on part 1, someone said that there might be “trace” amounts of mercury still in vaccines – there’s no reason for that to be true, any more than there should be trace amounts of cyanide, or trace amounts of gold in vaccines. And even if there were trace amounts of mercury in vaccines, so what? The dose makes the poison, we encounter mercury in everyday life in higher doses than “trace” amounts, among other places in seafood.

This post is primarily a summary with discussion of “Autism Spectrum Disorder : No causal relationship with vaccines”, so rather than post a reference to each individual study they reference, I have reposted the reference to the review article, and Wakefield’s Lancet article.

Link to part 3 here.

On Deck: a quick wrapup of one last hypothesis for vaccine-autism connection, “Vaccine overload.”

In the pipeline: A discussion of why Hannah Poling doesn’t mean every ASD child has a mitochondrial disease.

For those who hit their saturation point on autism: Once we wrap up this series of posts, I’ll intersperse some more personal stories, hopefully some fun things, and “cool science” instead of just serious things, but the next series of Hard Conversations will either be about Naturopathic medicine, TCM/acupuncture, or chiropractics . Please email me if you have any specific thoughts on which one should be next, it’ll either be by popular demand or whatever has the most interesting articles in the popular press when I’m ready to tackle it.

 One more sidenote: Someone appropriately pointed out that the comments swiftly leave the realm of “can be understood by a layperson”.  I’ll endevour to steer the discussion back in the “clear and understandable” direction when I can.

References

1.Autism Spectrum Disorder: No causal relationship with vaccines DOI: 10.1111/j.1440-1754.2007.01239.x

2. Wakefield study: doi:10.1016/S0140-6736(08)61345-8
 

Hard Conversations: Vaccines and Autism, Part 1.5

April 2, 2009

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.

Hard Conversations: Vaccines and Autism, Part 1

April 1, 2009

 Before I get into the meat of this series of posts, let’s start with a word or two for any parents or loved ones of someone with autism reading this, because this whole series of articles is really for you. I understand that receiving a diagnosis of autism is frightening and while I’m not a parent, I understand that nothing could possibly be more important to you than the well-being of your child. I feel for you, and know that it must feel like the world is changing and the ground shifting underneath your feet as you react to this information. I’m sure that what you want is some certainty. It must kill you to hear things like “We don’t really know what causes autism.” Or “We don’t have a cure for autism”.

 I know that you want what is best for your child. Because that’s what you want, I encourage you to not act rashly after getting a diagnosis. Before you make decisions about how to change your lifestyle and how to help your child, you should do some research.  I welcome you to start here, and later on in this series I’ll compile a list of some good resources. Along the way, I hope to also point out the bad resources, and how to determine what is a good or bad resource.

To start with, I’d like to talk about autism in the media. Autism has been in the news a lot lately, most recently TIME magazine had a q&a with Jenny McCarthy who is releasing a new book on the subject.

The biggest problem with how the media has covered Autism is that the media has committed the Gray fallacy. Briefly, the Gray fallacy says “well if you say black, and he says white, surely the truth must be grey”.  This is not correct.

A more nuanced description of this is the Relativity of Wrong. The relativity of Wrong explains that there are differing degrees of correctness. The classic example is that the earth is neither flat, nor spherical. However spherical is much closer to the truth than flat.

How does the media commit these mistakes? When the media covers autism, they often present autism as if “Vaccines cause autism” and “Vaccine’s don’t cause autism” are equally valid points. These points are not equal.

For those who don’t like reading about science, skip down a bit.

There is alot of scientific information suggesting vaccines do not cause, and are not correlated with autism.1,. I have yet to find one good article that supports the hypothesis that vaccines cause autism. If you find such an article, please email me (my contact information is available on the contact page of this blog) and I will read the article, and post my thoughts. I encourage parents to read my references at the bottom of the page here.

The scientific case for “Vaccines cause autism” is just slightly better than the scientific case for “The earth is flat”.

 For those people who struggle to see the science here, at least consider the common sense point. We do not know what causes autism, there are almost as many explanations of autism as there are experts on autism. What are the odds that one particular explanation, which lacks any evidence on its side, is correct?

Extraordinary claims demand extraordinary evidence. While the Anti-Vaccine proponents often offer anecdotal evidence, and then give made up numbers, such as Jenny McCarthy’s

“All you have to do is find a schoolteacher or principal and ask them that question. They would say they’ve never seen so much ADHD, autism, OCD as in the past. I think we’re overdiagnosing it by maybe 1%.”

 You’ll notice, she doesn’t give evidence, she offers an anecdote. Anecdotes are not real evidence, everyone has a story of  a friend of a friend. Thats why we do evidence based medicine. After that she gives a completely unsubstantiated number saying we’re overdiagnosing by maybe “1%”. This is not science. This is not medicine. This is deception.

 In my next few posts, we’ll talk about why you should trust scientists over Jenny McCarthy or any other celebrity. Afterwards I will detail some of the science on this subject, through explanation of at least one scientific study. I will also explain some of the biases that crop up when we use anecdotal evidence instead of science.

Please feel free to post any comments, thoughts, or questions you have. If something I’ve written is unclear, absolutely ask me here to clarify, my goal with this is to make the science as accessible as possible to as many people as possible.

For now, enjoy!

-Whitecoat Tales

Link to Part 2 here.

PS: Hat tip to Orac over at Respectful Insolence both for his numerous posts raising awareness of this issue, and his most recent post bringing the Time magazine article to my attention.
PPS: When commenting, please remember: keep the comments respectful, especially to people with autism, and their parents and loved ones.

References
1.Autism Spectrum Disorder: No causal relationship with vaccines DOI: 10.1111/j.1440-1754.2007.01239.x
2.DeStefano F (2007). “Vaccines and autism: evidence does not support a causal association”. Clin Pharmacol Ther 82 (6): 756–9 doi:10.1038/sj.clpt.6100407. PMID 17928818.

 

Last edit on 4/23/09: added link to part 2

My guidelines for “Hard Conversations”

March 31, 2009

Soon I’ll be posting the first in a new column of posts for me – “Hard Conversations”. In Hard Conversations I’ll be discussing a variety of science or medical issues generally being talked about in the popular press. Generally speaking, these will be posts discussing what many call pseudoscience, mocktroversy, or otherwise what I’ll call “Bad Medicine.”

I want to be clear; there isn’t any scientific controversy in what I’ll be writing about, only media hype. I’m calling them “Hard Conversations” because I will be discussing things people hold strong and cherished beliefs about, in long, generally multi-part posts. Often we’ll be discussing things people hold responsible for their own pain and suffering. For example the first Conversation will be about vaccines and autism. I understand just how polarizing these issues can be. I’m not aiming to just shout at suffering people and say “Can’t you see the science! Don’t be stupid!” I think a lot of bloggers do that sort of thing much better than I would. Make no mistake though, I will not compromise science. Ethically, and morally, I have an obligation to explain these issues to the best understanding we have in the medical world. I’m not going to pander to people who specialize, knowingly or unknowingly, in giving people false hope or false beliefs to make money, or for their own perverse pleasure.

These posts to be a resource for people affected by the conditions I write about, or people who believe the ideas I explain. These posts aren’t aimed at the advocates on either side of the debate. Generally you guys already have far too strong opinions on these subjects for me to attempt to influence.

Since I’m aiming these posts at people affected by serious conditions, or their loved ones, respect is extremely important. I will take a heavy hand to disrespectful comments by anyone, on either side of the issue. Please take a second look at my disclaimers page and review my policy on banning users.

 

Once again, the first Hard Conversation will be about vaccines and autism, part one will be coming to a blog near you soon!

As for now, Enjoy!

-Whitecoat tales