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Wakefield: Proquad claims. Liar or incompetent?

(235 Posts)
noblegiraffe Sat 20-Apr-13 12:32:00

This just came up on another thread, and I thought it was worth wider publicity, given Wakefield's apparent continuing influence, and the current measles outbreak.

I was discussing whether 'vaccine overload' had any basis in science, or any evidence for it. (No, btw).

I was directed to the claim that giving a 4 in 1 jab against measles, mumps, rubella and chicken pox (called the MMRV) doubled adverse reactions. I found an interview with Wakefield where he claimed this showed that giving extra vaccinations at the same time was dangerous. He said:

"If you just take for example, MMR and you add in the varicella vaccine, the chickenpox vaccine, MMRV as ProQuad what happens is you double the rate of convulsions as an adverse reaction. So just adding one and not 999,000 but just one extra vaccine in, you double the rate of an adverse, a potentially serious adverse reaction. To the extent that that ProQuad vaccine had to be withdrawn. So the notion that you could give a child a hundred thousand vaccine antigens on one day is utter nonsense. And what is extraordinary, what is telling I suppose is that no other immunologist or vaccinologist or any other person with any credible standing has stood behind Dr. Offit and said yes, you can go for it."

2 points need to be made
1) Proquad has not been withdrawn. It is still licensed for use. The advisory body in the US did amend their recommendation in light of the extra adverse reactions (4.3 extra febrile seizures per 10,000). ProQuad used to be their preferred injection for both initial and booster jab, now it is just recommended for the booster jab.
https://www.merckvaccines.com/Products/ProQuad/Pages/recommendations

2) Wakefield suggests that it was giving an extra vaccine that caused the extra adverse events (vaccine overload), however the comparison of adverse events was not between the MMRV and the MMR (4 vaccines versus 3) but the MMRV versus the MMR plus the chickenpox vaccine given on the same day (4 versus 4). Nothing to do with an extra vaccine, and he is trying to use this to make a point which simply isn't valid.
www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm123798.htm

Now Wakefield still has an agenda regarding spaced out single vaccines (as recent headlines show).
Was he lying when he made these easily researched incorrect claims about ProQuad, or was he simply too thick to correctly assess the information widely available?

Now if he wanted to discuss why there were more adverse events to the 4 in 1 versus the 3+1, he might have a point (I'm not sure they contain exactly the same vaccines) but he didn't. He made a completely false point, one which is proudly featured on an antivax website.

Please treat anything Wakefield says with the caution it deserves.

Beachcomber Sat 20-Apr-13 22:42:19

Honestly noblegiraffe, I think you should ask him to clarify. I once emailed about a question I had and it took a while to get a response but I did get one and it was very precise and thorough. It was when he was at Thoughtful House so I was able to contact him fairly easily - I'm not sure how you would go about that now (sorry).

I know he has talked before about how when you add viruses to make a combined vaccine, you have to tinker with the levels as there is viral interference, synergy and potentiating so if I were you (and it were important enough to me), I would check.

I find it interesting that you seem ok with Dr Offit's 10,000 vaccines nonsense.

Beachcomber Sat 20-Apr-13 22:45:19

Forgot to say;

Once again, there was no extra vaccine.

Vaccination doesn't work quite as simply as that. Titer levels are very significant.

noblegiraffe Sat 20-Apr-13 22:49:36

Bruffin, that revised graph made my head hurt it was so badly put together. The temptation is to think that he didn't know what he was doing, but the careful deletion of certain words makes it very suspicious.

Does he think that people will just take his word for things and not go back and actually look at the source?

I started this thread because I genuinely didn't know what to make of the error he made in the OP. I didn't go looking for it, I certainly haven't been googling 'Wakefield errors' or anything like that. When I found the interview, I didn't even realise it was Wakefield at first making the mistake.

I always thought of Wakefield as someone who got a bit carried away with their own self-importance, genuine intentions, a bit misguided. Then in the newspapers the other day, the whole 'I was right' thing pissed me off as there probably wouldn't have been a big demand for single vaccines without his discredited pronouncements anyway. So then I thought he was an arrogant twat. Then by chance I found him making this stupid error. I mean, really stupid error. Someone who cared about the truth wouldn't make that error.

And now this graph bruffin posted. Well, there's something not quite right there isn't there? Graph legends don't just amend themselves do they? I tend to think the best of people in terms of intentions, but, well, hmmm.

noblegiraffe Sat 20-Apr-13 22:58:35

Beachcomber, I don't need to email him to clarify, his words are really clear. He is clearly talking about adding an extra vaccine to the MMR. He is talking about adding a chickenpox vaccine. He is talking about adding an extra antigen in a day. He is not talking about virus levels or anything like that, he is talking about adding chickenpox. To try to read it any other way is just grasping at straws.

But in the comparison, the chickenpox vaccine was already being administered the same day.

noblegiraffe Sat 20-Apr-13 23:10:33

Should I email him to confirm that when he said that the increased adverse events caused the vaccine to be withdrawn, he didn't actually mean that the vaccine was withdrawn, merely that it's no longer the first choice vaccine but is still in use?

sashh Sun 21-Apr-13 03:26:21

Dr Wakefield had a rather distinguished career until he questioned MMR safety.

So did Dr Shipman.

Dr Mengale did some interesting research in Auschwitz. And what did he say? "I personally have not killed, injured or caused bodily harm to anyone."

www.youtube.com/watch?v=b9hFBLQphOg

Beachcomber Sun 21-Apr-13 10:27:54

Bruffin or noblegiraffe can you explain (in your own words) what your problem is with the graph. And I mean specifically (not just 'he added a line' or 'he combined data').

Because as far as I can see, both graphs show an increase in autism in both the US and the UK after the introduction of MMR vaccines.

The notion that autism cases are not increasing has been rejected ages ago - even the CDC don't try to say that anymore.

Increasingly in the US, scientists are looking for environmental causes.

noblegiraffe Sun 21-Apr-13 11:02:59

Ok, the Canada data is not a set of data detailing how many cases of autism have been diagnosed each year since the 60s, it is a snapshot of data of a group of people diagnosed with autism. So they have a bunch of people who have been diagnosed with autism and ask them their year of birth. A few of the people were born in the 60s, many more were born in the 80s. Using a time series graph for that data is inappropriate because it looks like in the 60s a few people were diagnosed, then more and more. The data for the 60s wasn't collected in the 60s, the data for the 70s wasn't collected in the 70s, that was simply when these people were born.
Of course there are many reasons why in a given group of people diagnosed with autism you might have fewer people born in the 60s and more born in the 80s (the article suggests a baby boom I think, as one reason).
Removing the word 'enrolled' from that graph legend hides the fact and suggests instead that it is the number of diagnoses per year - although the original choice of doing a time series graph was poor, this compounds the error.

Regarding the UK data, there wasn't much info on how that was collected so can't comment on that part of the graph in detail.
However, the axis on the right starts at 0, the axis on the left starts at 100. You can't do that, it's just bad graph drawing and very misleading.

Then, these two graphs which contain very different data have been forced together. This is inappropriate.

Then, from what I can gather, the little arrows are very misleading as the MMR wasn't introduced all at once to a particular birth cohort. In fact, I found it a bit confusing as to what those little arrows were supposed to indicate at all. Year of introduction of MMR?

noblegiraffe Sun 21-Apr-13 11:25:41

Just to clarify further, the reason having the two different graphs plotted against two different axes is misleading is because if they were both plotted starting at zero (as they should be for a fair comparison), the California data wouldn't even appear on the UK scale, it would be way above it. This would prompt people to think 'hey, why did California have loads more autism in the 60s than the UK even before the MMR?' and then they would look at the original data and realise that the graph didn't show autism in the 60s at all.

That you have looked at the graph and thought it showed an increase in autism following the MMR in two different places just shows that that is exactly what you were meant to see, not because that is what the data says. The graph has been produced deliberately to make that impression and has required several slights of hand to do so.

noblegiraffe Sun 21-Apr-13 11:33:46

Does that help, Beachcomber? I typed it on an iPhone while feeding a baby so it might not be very coherent, I already spotted I said Canada instead of California! If you don't understand anything, I'd be happy to clarify further. It took me ages to get my head around what bruffin's link was saying.

bruffin Sun 21-Apr-13 11:51:19

Its just basically that he was comparing 2 different sets of data ie year of birth in California and year of diagnosis in London.

messybedhead Sun 21-Apr-13 11:51:39

Forgive me for commenting on something I know very little about, but surely if he is comparing 4 in 1 to 3 in 1 +1, and there are more incidences of febrile convulsions, then he is showing that 4 in 1 injections are more harmful than the same 4 separately (3+1 and 1) in a day.

You cannot argue against this? They are both 4 in one day, but not both all at the same time?

noblegiraffe Sun 21-Apr-13 12:02:23

Messy, yes, but Wakefield is arguing that it is because there was an extra vaccine given on the same day, which is simply untrue.

It's not clear why the 4 in 1 showed more side effects, I'm not sure that it contained exactly the same vaccines as the 3 + 1, (in some studies I looked at, the chickenpox vaccine was different) so that would be a starting point.

noblegiraffe Sun 21-Apr-13 12:03:42

When I say it's not clear, I mean it's not clear to me, but I've only looked at the data briefly.

messybedhead Sun 21-Apr-13 12:07:30

So surely the fact that they were both given on same day but not at the same time, it's even worse?

noblegiraffe Sun 21-Apr-13 12:08:40

Bruffin, it's not just that, it's that he took deliberate measures to hide that fact that worries me. I mean, he must have looked at the California data way above the UK data and made a decision to fudge the axes. He must have got his delete key, and erased key words.

I'm assuming it was Wakefield himself who did the manipulation. This would suggest liar. If it was someone else and he just found it somewhere, we're back to incompetent.

noblegiraffe Sun 21-Apr-13 12:09:53

What do you mean, messy? The 3 + 1 would have been given at the same time, one in each arm I expect, like baby jabs.

racheael76 Sun 21-Apr-13 12:12:47

What's happening in Wales can happen anywhere where vaccination rates are low. It's happening in my hometown. I sincerely hope it won't happen in yours.

bruffin Sun 21-Apr-13 12:15:36

I realise that Noble grin

noblegiraffe Sun 21-Apr-13 12:32:19

Ok, that graph gets more confusing. The handy little arrow is pointing to 1985. The UK graph shows number of new cases per year. The MMR wasn't introduced until 1988. Why isn't the arrow pointing to 1988? Why has it been rather oddly placed a few years earlier? Is it because there is a clear trend of increasing new cases of autism before 1988? The introduction of MMR if placed correctly on that graph wouldn't appear to have made much difference to the trend.

Beachcomber Sun 21-Apr-13 14:57:57

Thank you for explaining what bothers you although to be honest I'm not really seeing the issue. The data no doubt isn't perfect (it never is in epidemiology) - and it is the data of the Talylor et al study (widely touted as being perfectly solid when it argues against an association between autism rates and MMR use!!).

Either cases of autism have risen or they have not. Dr Wakefield's graph shows that they have - anyway we know that they have, the CDC agrees that they have, alarmingly.

This increase has happened since the introduction of MMR.

The increase has happened in the UK and it has happened in the US. It started to happen earlier in the US than in the UK. The periods of the increase in both cases (10 years apart) correspond to a change in vaccination policy.

The data are not exactly the same for the two countries because they have been gathered in a different way, hence the three axes and the explanation that the graph is a juxtaposition. The US data is for the number of people with an autism diagnosis - it shows a big increase in the number of people with an autism diagnosis since the introduction of MMR.

The UK data show a big increase in new autism diagnoses since the introduction of MMR.

Of course such data sheds no light on causation as epidemiology cannot provide that. But it shows an association in two different countries implementing the same change 10 years apart. Looks like a pretty solid case of association to me.

In addition the same diagnostic criteria is used in the two countries and the increase was not predicted by the relevant authorities.

Temporal trends for autism in the USA (California*) and the UK (north-west London) In 1998 the expected numbers of newly diagnosed autistic children in California should have been 105–263 cases according to DSM-IV; the actual figure was 1685 new cases. The temporal trend in north-west London is almost identical, although the rise is delayed by about 10 years. The two countries use the same diagnostic criteria. The sequential trends are consistent with the timing of introduction of MMR to both regions. *Data from Department of Developmental Services, Sacramento,1987–98 (www.dds.ca.gov)

Noblegiraffe, if you read the text presented with the graph (rather than looking at the graph out of context with nearly all of its text missing on somebody else's website), it explains that the arrow for the UK is for 1996 - the first birth cohort of the MMR catch up campaign. Anyway the graph clearly states that the arrow is for the first eligible birth cohort not year of introduction of the vaccine.

www.medicine.mcgill.ca/epidemiology/seminars/MMR_wakefield.pdf

Beachcomber Sun 21-Apr-13 15:01:59

And the point that Dr Wakefield is making with the graph is that the epidemiological data suggests that it is illogical to rule out MMR as a factor in autism increases and that more investigation is warranted.

Seems fair enough to me.

Beachcomber Sun 21-Apr-13 15:19:53

And the original link is just to a blog. A blog by someone who says he contributes to LBRB which is known to be very oriented and to post some pretty unpleasant stuff. And anyway even his graphs once he'd rejigged the format showed increases in autism rates following the introduction of MMR (turn them sideways).

bruffin Sun 21-Apr-13 16:22:51

The point is that AW had to fiddle with the graph to make that point which again you excuse.
The origin was an article in Drug Safety Magazine which the author replicated in his own blog.

Its highly hypocritical of you to criticize the author when you rely on Martin Walker, whale, mercola AOA etc for your lovely conspiracy theories.
As to the birth cohort the UK may have bern correct but the US one wss not. The US intruduced MMR in 1972 so the cohort should have been around 1970 not 1977 which givesva different picture.
Brent Taylor himself criticized AW for misinterpretating the data from North London.

CatherinaJTV Sun 21-Apr-13 16:54:09

Rachael - you are so right - amazing how this is overlooked in a lot of the current discussions.

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