Friday, February 13, 2009

Dr. Wakefield: Don't Poke the Aspie.

Warning! Science in Progress (Rocket) shirt

The news is filled with the shocking, utterly shocking news that three special masters of the US Vaccine Court have found no scientifically credible correlation between Mercury and Autism, and further, that what slight evidence that suggested the connection in the first place, way back in 1998 - was bogus.

In a statement to be published in the March 6 issue of The Lancet, a British medical journal, the researchers conceded that they did not have enough evidence at the time to tie the measles, mumps and rubella vaccine, known as MMR, to the autism cases. The study has been blamed for a sharp drop in the number of British children being vaccinated and for outbreaks of measles.
This aspect of the movement featured often truly disgusting rhetoric that brought uncomfortable memories of the legacies of the Eugenics Movement - offered in defense of behavior-mod strategies that are of debatable benefit at best and torture at worst.

Autistics themselves were instrumental in fighting back against unscientific hysteria and outright abuse of process nobably by contributing to and disseminating credible science, intervening in attempts to enforce orders that ABA therapy be paid for from the public purse and devestatingly effective responses to unscrupulous practices within the "research community" the anti-vax movement depended upon. And ultimately, the questions raised led to the right questions being asked,
regarding the fundamental research that led to this mess.

Celebrate Neurodiversity stamp

Memeber of PeTP People for the ethical tr... shirtIt should be noted that the questionable motivations and associations in the "pro-cure" wing have been documented and observed by Actual Real Scientists for some time. This was just the final straw, and the barely concealed outrage at the perfect storm of stupidity, incompetence and venality is manifest in the conclusions of the Special Master's report, dismissing with utter finality the claims that MMR was in even the slightest sense contributory to autism.

Conclusion: A “loving, caring, and courageous” family “misled by physicians who are guilty of gross medical misjudgment”

The record of this case demonstrates plainly that Michelle Cedillo and her family have been though a tragic and painful ordeal. I had the opportunity, in the courtroom during the evidentiary hearing, to meet and to observe both of Michelle’s parents, and a number of other family members as well. I have also studied the records describing Michelle’s medical history, and the efforts of her family in caring for her. Based upon those experiences, I am deeply impressed by the very loving, caring, and courageous nature of the Cedillo family. Those family members clearly have done a wonderful job of coping with Michelle’s conditions, and in caring for her with great love. I admire them greatly for their dedication to Michelle’s welfare.

Nor do I doubt that Michelle’s parents and relatives are sincere in their belief that the MMR vaccine played a role in causing Michelle’s devastating disorders. Certainly, the mere fact that Michelle’s autistic symptoms first became evident to her family during the months after her MMR vaccination might make them wonder about a possible causal connection. Further, the Cedillos have read about physicians who profess to believe in a causal connection between the MMR vaccine and both autism and chronic gastrointestinal problems. They have visited at least one physician, Dr. Krigsman, who has explicitly opined that Michelle’s own chronic gastrointestinal symptoms are MMR-caused. And they have even been told that a medical laboratory has positively identified the presence of the persisting vaccine-strain measles virus in Michelle’s body, years after her vaccination. After studying the extensive evidence in this case for many months, I am convinced that the reports and advice given to the Cedillos by Dr. Krigsman and some other physicians, advising the Cedillos that there is a causal connection between Michelle’s MMR vaccination and her chronic conditions, have been very wrong. Unfortunately, the Cedillos have been misled by physicians who are guilty, in my view, of gross medical misjudgment. Nevertheless, I can understand why the Cedillos found such reports and advice to be believable under the circumstances. I conclude that the Cedillos filed this Program claim in good faith. [emphasis added]

Thus, I feel deep sympathy and admiration for the Cedillo family. And I have no doubt that the families of countless other autistic children, families that cope every day with the tremendous challenges of caring for autistic children, are similarly deserving of sympathy and admiration. However, I must decide this case not on sentiment, but by analyzing the evidence. Congress designed the Program to compensate only the families of those individuals whose injuries or deaths can be linked causally, either by a Table Injury presumption or by a preponderance of causation-in-fact evidence, to a listed vaccination. In this case the evidence advanced by the petitioners has fallen far short of demonstrating such a link. Accordingly, I conclude that the petitioners in this case are not entitled to a Program award on Michelle’s behalf. (pp. 173-174)

The Special Master had some particular words for Dr. Wakefield, et al, in an earlier section, which I repeat in full.

On “autistic enterocolitis”: “Defective or fraudulent science”

As explained above, Dr. Krigsman based his general causation opinion on the reliability of the Uhlmann study’s general conclusion that children with both developmental disorders and gastrointestinal problems are often infected with measles virus in their intestines, while developmentally normal children with GI problems are rarely so infected. However, as previously discussed, I have concluded that the Uhlmann study was unreliable. Therefore, with the Uhlmann study discredited, Dr. Krigsman’s general causation theory is simply left without any evidentiary support.

Dr. Krigsman has not pointed to any other possible basis for his theory. For instance, Dr. Krigsman did not point to examples in medical history of any type of virus persisting in intestinal tissue and causing chronic GI symptoms. To the contrary, Dr. Hanauer, an expert well-qualified concerning GI inflammation, testified that he is unaware of any examples of viral persistence in intestinal tissue causing chronic inflammation. Neither Dr. Krigsman nor any other expert for petitioners contradicted Dr. Hanauer on this point. Moreover, in constructing his general causation theory, Dr. Krigsman clearly based his theory on the “autistic enterocolitis” theory that evolved from Dr. Wakefield’s seminal 1998 article mentioned above. In his expert report, Dr. Krigsman indicated that he sees a causal connection between the MMR vaccine and a disease category that he described as “autistic enterocolitis.” And at the evidentiary hearing, Dr. Krigsman again used the term “autistic enterocolitis” to describe the disease category that he believes to be MMR-caused. Indeed, Dr. Krigsman’s use of the term “autistic enterocolitis,” along with his assertion that Michelle Cedillo’s illness is a “classic” case of “ASD-GI disease,” perhaps might create the impression that “autistic enterocolitis” is a recognized disease category, accepted by the medical community. That, however, is not the case.

To the contrary, Dr. Hanauer, very experienced in the specific area of inflammatory bowel disorders, testified that the term “autistic enterocolitis” is not utilized in any gastrointestinal textbook of which he is aware. Similarly, Dr. Gershon stated that both the terms “autistic enterocolitis” and “ASD-GI” are not recognized by “gastroenterologists as a scientific community.” Dr. Fombonne and Dr. MacDonald both testified that there exists no evidence to support such a diagnostic category. And Dr. Krigsman himself admitted that two leading textbooks on gastroenterology, which he acknowledges to be authoritative, do not use the terms “autistic enterocolitis” or “ASD-GI.”

Thus, it is clear that the diagnostic category of “autistic enterocolitis,” developed by Dr. Wakefield and adopted by Dr. Krigsman, is not a medically-recognized category. In fact, the record indicates that the term “autistic enterocolitis” evolved from Dr. Wakefield’s above-mentioned 1998 article; the term appears in several articles published over the following years by Dr. Wakefield and a small group of his followers. One such article using the term “autistic enterocolitis” was published in 2000 by Wakefield and colleagues. And it is clear that Dr. Krigsman, in developing his causation theory, was influenced by those articles. For example, Dr. Krigsman testified that his initial idea, that autistic children with gastrointestinal symptoms might be suffering from IBD, was triggered when he read that very Wakefield 2000 article. Given that Dr. Krigsman’s general causation theory was influenced by the “autistic enterocolitis” theory developed by Dr. Wakefield and colleagues, it is fair to note that Dr. Wakefield’s “autistic enterocolitis” theory, and his credibility in developing the theory, have come under severe criticism. For example, see the discussion […] above concerning various committees of medical experts who have considered and rejected Dr. Wakefield’s causation theory. Further, respondent’s experts in this case provided much testimony relevant to the credibility of Dr. Wakefield’s procedures in developing his theory.

For example, Nicholas Chadwick in 1996 was a Ph.D. student working in a London laboratory for Dr. Wakefield, performing PCR testing for measles virus. Chadwick’s interactions with Dr. Kawashima’s laboratory, which was collaborating with Wakefield in the area of measles detection, convinced Chadwick that Kawashima’s positive results in measles virus testing were “false positives,” the result of contamination. Chadwick related that conclusion to Dr. Wakefield. Nevertheless, Wakefield submitted for publication a manuscript relying on the purportedly positive results from Kawashima’s PCR testing. Chadwick asked that his own name be taken off the manuscript, because he was not comfortable with the data. Dr. MacDonald described the Wakefield 2000 article as “deception,” in two respects. He opined that the article deliberately described normal findings in the intestines of the autistic children as “pathology”—i.e., abnormality indicative of disease—in order to create the false impression that the autistic children had much more intestinal pathology than the non-autistic children in the study. Dr. MacDonald also testified that the article misrepresented a photograph of a child’s cecum (a part of the large intestine) as being a photograph of the child’s ileum (a part of the small intestine). He opined that it was “highly unlikely” that this misrepresentation was a mistake, as opposed to deliberate deception. Dr. Rima described an interaction with Dr. Wakefield, in which he informed Dr. Wakefield of a specific contamination error in Wakefield’s measles detection efforts. Dr. Wakefield, however, did not retract his claim that measles material had been identified.

Further, as noted above, after public criticism of the “autistic enterocolitis” theory, ten of Wakefield’s twelve co-authors on the original 1998 article published a letter in which they formally “retract[ed]” the causation interpretation suggested in the original article. At the same time, the British medical journal that published the 1998 article, the Lancet, reviewed allegations of impropriety by Dr. Wakefield and his co-authors in the submission of the article. The Lancet editors noted that some of the children described in the article were also part of the legal action against the vaccine manufacturers, in which Dr. Wakefield was also involved. The editors concluded that this circumstance constituted a financial conflict of interest by Wakefield, which Wakefield should have disclosed to the Lancet, but did not. Dr. MacDonald, indeed, went so far as to opine that Dr. Wakefield’s “autistic enterocolitis” theory was merely an “invention” created for litigation purposes. Similarly, Dr. Rust summarized Wakefield’s process of developing and disseminating his general theory, and described it as “scientific fraud.”

To be sure, the petitioners in this case have stressed that they rely upon Dr. Krigsman as their expert concerning the causation of GI symptoms, not Dr. Wakefield. Thus, they argue that criticisms of the personal integrity of Dr. Wakefield are not relevant here. However, because Dr. Krigsman’s general causation approach clearly was strongly influenced by Dr. Wakefield’s theory, criticisms of Dr. Wakefield’s “autistic enterocolitis” theory are relevant, and criticisms relating to Dr. Wakefield’s credibility in developing that theory are of relevance as well. Therefore, it is a noteworthy point that not only has that “autistic enterocolitis” theory not been accepted into gastroenterology textbooks, but that theory, and Dr. Wakefield’s role in its development, have been strongly criticized as constituting defective or fraudulent science. (pp. 141-144)

In other words - it is the the opinion of the special masters that the case is not merely invalid on it's merits - that the science presented is factually insufficient - but that key portions of it are fraudulent - a position underscored by the public position of The Lancet and the withdrawal of names from the foundational "study" that started this mess.

It shows a fundamental contempt for justice, contempt for the best interests of autistics subjected to the highly questionable treatments Wakefeield and his co-conspiritors advocate, and should deeply trouble the governing boards of those issuing their respective professional certification. There is a reason why there is a growing lack of trust in authorities and it is because that over the last several decades, there has been a general perversion of the entire concept, various systemic and significant abuses of public trust and, of course, an entire culture has developed to claim that criticizing the perpetrators is evidence of some dark conspiracy.

I could just as easily point to climate change deniers or the people who insist in the face of all respected opinion on economics that "trickle down" economics really did work, and that more tax cuts and less regulation is the real answer to a problem that was in significant part made worse by tax cuts and absolutely made possible by lack of regulation and willful disregard for what regulations existed.

But then, you might very well ask, whom should I trust? How do I choose between two positions, founded as they are upon science that's well above my comprehension level?

Well, in all honesty, it's not easy, but there are a few principles that will allow you to avoid being easily fooled - and I learned these in nineth grade. You see, you don't usually have to dig into the technical arguments. If you do have to, than what you see is most likely a legitimate scientific or technical dispute. In which case, you may do as do I - wait for a consensus.

In the case of climate change, that consensus exists to an extent that it really absolves you from having to consider the ideas of bias or fashion. The data agree, the vast majority of scentists agree, at least in the broad strokes and of equal importance, those who dissent are not just a minority, but very few of them are dissenting from a background that permits us to be unskeptical of their motives, in some case, fairly obvious, such as researchers paid by oil companies coming to conclusions that any oil company would be happy to have. Wonders! Astonishment! You can safely assume such studies to be junk science if they oppose a general, interdisciplinary consensus AND directly benefit both the researcher and the interest group that paid him. (Now, if they should turn out differently, that's an entirely different kettle of penguins.)

In the case of Dr. Wakefield, well, Dr. Wakefield was neither particularly clever in his scientific fraud nor in concealing his connection to litigation arising from his entirely convenient "research."

Or not to put too fine a point on it, Dr. Wakefield prostituted himself in order to make a buck. He presumed upon his authority, his status, his profession and his credentials in order to fabricate evidence that would permit him and the odious lawyer he colluded with to make hundreds of thousands of dollars. All that was required was for him to not care about the consequences to society, his profession, the reputations of his colleagues or the impact upon public health.

The principle illustrated here is called "Quo Bono" - that is to say, who profits by me believing this?

Let's look at one of the still active and strident proponens of the anti-vax myth: Age of Autism. This is their sponsor's reaction to the Omnibus Decision which I quoted from above:

National Autism Association Response to Autism Omnibus Court Decision:

You can pretty much stop reading there, because their own summary tells you all you need to know about the level of honesty and the ethical culture of the "National Autism Association" and those willing to publish it's dubious defense. The only proper, ethical approach would have been a public statement for regret, condemnation of Wakefield, and a sincere promise to clean house. At a decent miniumum.

Oh, I could respond in kind - although it would be a lot like pushing baby ducks into a pond. I'll leave that to another aspie's perseveration. I merely wish to point you to all the various advertisements for "biomedical interventions" and "treatments" and cures on that site. Might there not be a tiny, barely perceptible financial incentive here to dissuade you to consider the merits of the scientifically credible positition?

Moreover - and this is an important point - the site relys heavily on two rhetorical techniques; emotional persuasion and anechdotal evidence.

Neither is proper when speaking of diseases and cures, for diseases and cures are matters of provable fact, with discoverable mechanisms, treatments subject to testing. But most critically, their first and primary response is to question the motives of those criticizing them.

That's a rather bizarre claim, from those who's motives are so clearly questionable. So, as I say, who will benefit, that you believe that these "interventions" will provide some benefit to your autistic child? Who will benefit if you choose to believe - in the face of overwhelming and entirely respectable science to the contrary?

Doctor Wakefield - a proven scientific fraud, will benefit. The lawyers will benefit. But the overwhelming evidence to date is that if you believe the quacks, your child will not - and if you act upon the assumption that your child is at risk from the MMR vaccine, you are directly contributing to the very real and deadly serious risk of an epidemic.

This is why we all have the responsiblity to curb our credulity, to ask the hard questions of people who claim to be authorities and expect answers that are substantial and proven; particularly when they nostrums and treatments come with substantial and obvious risks.

This is true in the Autism community, it is equally true within communities of faith, where misrepresentations of core texts have mutated into entire denominations, within the finacial and poltical communities of western culture - and it is all due to a failure to hold authorities to account; of an inappropriate, and frankly lazy willingness to inappropriately trust people on the basis of nothing more than a jutting chin and a confident seeming assertion. Donald Rumsfield seems to spring to mind, for some reason. But since he does, it is difficult to think of someone being more obviously and confidently wrong than "Cakewalk Rummie."

The simple principle here is "Fool me once, shame on you; fool me twice, shame on me." I have no problem with people having a reasonable belief that thimerisol and autism might be linked, or that Iraq had weapons of mass destruction. It is not reasonable to presume that someone in authority is lying when you have no basis for that assumption. But, should those assertions be true, then there are certain logical steps to be expected, certain actions, certain patterns that MUST occur IF that assertion is to be established as a fact.

Instead, in both cases, bullshit was piled upon bullshit. And really, that's all you need to know. The second shovelful of bullshit proves beyond a doubt that whatever the truth might be, it won't be coming from that source. Move along, withdraw your support, direct your attention and energy elsewhere, for nobody ever got anything but the top slot on a sucker list by believing a famous liar.

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