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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 To the extent that that ProQuad vaccine had to be withdrawn.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1) Proquad has not been withdrawn.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.

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.

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.

noblegiraffe Sat 20-Apr-13 12:32:56

Wakefield interview where he makes his claims here:

Beachcomber Sat 20-Apr-13 13:15:15

It all hangs on Dr Wakefield doesn't it?

The whole MMR house of cards hangs on Dr Wakefield being not only Wrong but Bad and Crazy and Evil and Horrid.

Which is interesting.

Dr Wakefield had a rather distinguished career until he questioned MMR safety. He was respected and had published a large quantity of research and was considered to be an excellent researcher.

Bit like Professor Walker Smith - he was considered an eminent and world wide recognised expert on paediatric gastroenterology until he began examining and publishing clinical evidence of autistic children.

Which is also interesting.

Especially given that the vast majority of parents of the children who were examined/treated/helped by these two doctors speak about them with respect as men of integrity and who listened to and cared about their patients.

Dr Wakefield et al published their paper in 1998 and yet the witch-hunt goes on still in 2012. Extraordinary really. I'm surprised the government and the media don't just drop it if they are so sure that he is Wrong, Bad and Dangerous. People would quickly forget.

noblegiraffe Sat 20-Apr-13 13:26:33

Beachcomber, do you think this coming from him was a lie or poor research?

The problem with Wakefield is that people come on here and defend him and say he was struck off because of politics and whatnot (the blood samples at a birthday party thing at the minimum shows he was unprofessional). So if is he is really the blameless victim of some government conspiracy to promote MMR, a brave doctor simply trying to find out the truth, then why is he spouting easily disproved nonsense like I have quoted above?

noblegiraffe Sat 20-Apr-13 13:28:05

I mean, this isn't a witch hunt based on what happened in 1998, this is something new and recent.

noblegiraffe Sat 20-Apr-13 13:34:34

"He was respected and had published a large quantity of research and was considered to be an excellent researcher."

Then you would think the above claim was a deliberate lie rather than poor research?

Beachcomber Sat 20-Apr-13 14:20:11

Noblegiraffe, I have read your OP and I have read the transcript you link to. Thanks BTW for the transcript it is very interesting.

But having done those two things, I'm not too sure what you are accusing Dr Wakefield of.

Is it that he said the vaccine was withdrawn rather than specifying that the vaccine wasn't recommended for use? (Which seem to me to amount to the same thing, non?) The recommendation may be different again now, I don't know, I don't live in the US.

The interview you link to is not research - it is an interview. The language, precision and use of words are rather different in a chatty interview situation to that of published peer reviewed medical research.

I know a lot of people like to examine every word that Dr Wakefield has ever said and try to pick holes in them but I really think you are clutching at straws here.

Are you suggesting that medicine should turn its back on Dr Wakefield's ground-breaking research into Crohn's for example because said 'withdrawn' in an interview rather than 'no longer used' or 'no longer recommended for use'? Really?

I hope you scrutinise Professor Salisbury's every word with the same vigour. Unfortunately you don't appear to with Dr Offit's as you have previously linked to an article of his which says that a child could easily be given 10,000 vaccines in one day (and that wasn't an interview, it was a published document).

Beachcomber Sat 20-Apr-13 14:28:45

And saying as you ask the question, I think Dr Wakefield is neither a liar nor incompetent. And the same goes for Professor Walker Smith.

I would not be able to say the same of Professor Salisbury (who was instrumental in the decision to expose British children to a vaccine known to cause meningitis) nor of Dr Offit who advises that children can be given 10,000 vaccines in one day.

Unfortunately both of them play important roles in major decisions about how millions of children are to be vaccinated against infectious disease.

noblegiraffe Sat 20-Apr-13 14:46:01

The claim that the vaccine was withdrawn and it wasn't would be less of an issue (although still suggests that the increase in adverse events was serious and the vaccine dangerous - it's not) if he then didn't completely misinterpret the data in order to draw a conclusion what was unwarranted. In no way can you look at that adverse event data and conclude that the problem was giving too many vaccines in one day, because the comparison was between that, and another method of giving exactly the same number of vaccines.

It's nothing to do with a poor choice of words, or a chatty tone, it is to do with a complete misrepresentation of the facts (either through ignorance or deceit) in order to 'prove' his argument that giving many vaccines at the same time is more dangerous than spaced out because the body can't cope.

Now he has been splashed all over the news lately, claiming that the measles outbreak in Wales shows that he was right about single vaccines. Back in the 90s he was recommending single vaccines. He is clearly passionate about single vaccines.

So why the bloody hell has he made such a basic error when arguing in their favour? I mean, I'm not a doctor or a researcher but it was the first thing that leapt out at me when I reviewed the data. The number of vaccines given was the same.

Forget Prof Walker, the GMC, even forget the MMR controversy. How can you defend him making this claim?

noblegiraffe Sat 20-Apr-13 14:55:09

Dr Offit doesn't advise that children be given 10,000 vaccines in a day, he says the immune system could probably cope with it. I don't think he expects anyone to do it!

The Proquad vaccine is still recommended for use as the booster jab. Recommending that the separate jab be used for the first dose instead of Proquad where it used to be that Proquad was recommended over the separate jab isn't the same as recommending that proquad not be used at all, just that the separate jab was better. Clearly there's not much to choose between them.

Beachcomber Sat 20-Apr-13 15:47:49

Dr Offit doesn't advise that children be given 10,000 vaccines in a day, he says the immune system could probably cope with it. I don't think he expects anyone to do it!

Oh well, that's alright then. hmm He used that claim to patronise and silence parents over their legitimate questions about the safety of giving multiple vaccines.

Which doctor would you go for? I mean in a personal decision about your own child's care.

A) Offit - "your child can be given 10,000 vaccines in one day. Well, I mean, my theory is that they can."

B) Salisbury - "this vaccine is considered dangerous in Canada and the manufactuers no longer wish to be liable for it because it causes aseptic meningitis at unacceptably high rates, but I'm sure, your child will be fine."

C) Wakefield - "we are concerned that some autistic children have gut disease that worsens their quality of life and puts them in serious pain and distress. Their parents observed the children apparently reacting badly to a triple vaccine. We listened to their concerns and examined the safety testing of that vaccine and the medical literature available concerning the viruses in question and the way they can manifest disease in humans. What we found suggests that the parent's concerns may be legitimate. Although we cannot be sure at this moment in time (even though we have now examined over 100 children with similar issues) we are concerned enough to recommend extreme caution due to the seriousness of the illness we are investigating. We therefore suggest that the triple vaccine is investigated, that more research and investigation is done on children thought to be affected and that in the mean time, in order to continue to protect against infectious disease, alternative vaccines are used. I suggest we proceed with caution and your child be given vaccines about which we do not have similar safety concerns at this moment in time."

Now....let me think.

Beachcomber Sat 20-Apr-13 15:55:54

Or the members of the GMC.

"Professor Walker Smith, the eminent father of paediatric gastroenterology is being struck off because he cannot tell when a child is ill with gastric disease that warrants clinical examination and cannot tell the difference between research and clinical medicine. He is guilty of gross misconduct."

"Ooopsy actually forget that. It seems that we cannot tell the difference between research and clinical medicine or when a child is sick. Don't strike him off after all. He is guilty of nothing. Hope our mistake hasn't caused any inconvenience or influenced public opinion or made any doctors worried about doing the same sort of work as Professor Walker Smith in case we strike them off by mistake too."

noblegiraffe Sat 20-Apr-13 15:58:19

Why are you dodging the issue and bringing other doctors into this?

You made the same error as Wakefield, said that giving an extra vaccine caused problems. Did you hear it from him? (not clear, as you at least didn't claim the vaccine was withdrawn). Or from someone repeating his claim?

Beachcomber Sat 20-Apr-13 16:44:04

Because that is what this whole business comes down to now - which doctor to trust, which side to believe. Much of the science is a mess and has been made that way due to politics, conflicts of interest and arse covering.

That is why Dr Wakefield has asked Dr Offit and Dr Salisbury if they will join him in open public debate about the safety of MMR vaccines.

Noblegiraffe, neither Dr Wakefield nor I have made an error. The MMRV quad vaccine caused problems in the way neither the MMR did nor the MMR + single V did. And no, I didn't 'hear' it from him, I wasn't aware he had spoken about it. There are actually thousands of people other than Dr Wakefield who talk about and examine the issue of MMR safety.

I know people would very much like this to be all about Dr Wakefield. But it isn't. If this were only about one corrupt doctor trying to pull a fast one it would all have blown over a long long time ago. Dr Wakefield would have had his 15 minutes of fame and people would struggle to even remember his name today.

Beachcomber Sat 20-Apr-13 17:05:21

In no way can you look at that adverse event data and conclude that the problem was giving too many vaccines in one day, because the comparison was between that, and another method of giving exactly the same number of vaccines.

And this.

Have you checked the viral unit content of Proquad compared to MMRII + single V?

Have you researched how the bodily mechanisms and the immune system react to 4 viruses being administered in one injection compared to separated injections? Has anyone?

Anyway the point of talking about Proquad is to note that children reacted differently to their vaccines depending on how the combination was delivered. (Although as I say the viral load may also be different. I don't know though I haven't checked.)

High-titer measles vaccines have long been known to cause harm in children so it isn't a big surprise to anyone with an ounce of common sense that children are actually real live human beings, not pincushions, and they react differently to different drugs or different combinations of administration. Google high-titer Edmonston-Zagreb measles vaccine - a high viral load vaccine that killed children.

noblegiraffe Sat 20-Apr-13 17:19:47

This thread is certainly all about Wakefield, or at least that was my intention, it's pretty clear from the title smile

You did make an error, you said there was a problem with vaccinating against 4 viruses at the same time instead of 3. You were trying to provide support for a vaccine overload theory. But the comparison was made against vaccinating against 4 viruses at the same time. And Wakefield was very clear in that he was talking about the number of vaccines given in a day - there was no extra vaccine, it was the same number of vaccines. I wonder if Wakefield made the error himself then, or just picked up the same snippet that you say is being bandied about by other people and blindly repeated it without doing even the most basic fact checking.

By the way, science isn't about authority figures, it's about the quality of the evidence. But if you see it in terms of trusting doctors, I'm not sure why anyone would continue to trust Wakefield after this demonstrably false claim without taking a very close look at the evidence themselves.

noblegiraffe Sat 20-Apr-13 17:23:34

And incidentally, seeing as Wakefield seems to have set himself up as an authority figure, especially in regard to single vaccines with his shameless self-publicity recently, isn't it really important that he makes sure he knows what he's talking about?

CatherinaJTV Sat 20-Apr-13 18:25:50

it seems to be something in the ProQuad that causes the increased risk of febrile seizures, if you give MMR into one leg/arm and Var into the other, the risk of febrile seizures is not increased (and immunity to Var is also better as far as I remember). Every time I listen to Wakefield and pick a claim to check "liar or incompetent" is the question. Neither is particularly flattering.

Beachcomber Sat 20-Apr-13 18:40:17

Noblegiraffe we need two pieces of information. Unfortunately Merck doesn't clearly provide either of them.

We need to know how Proquad performs against MMR given alone.

We need to know how Proquad performs against Varivax given alone.

We also need to know the viral loads of the all the combinations.

We don't know because Merck chose to compare their vaccine against MMR + Varivax - but even then it performed worse in terms of safety.

I looked up the viral loads, you can find them on the package inserts. Unfortunately Merck has not chosen to give them all in the same format which makes comparing them rather tricky.

noblegiraffe Sat 20-Apr-13 18:52:27

Beachcomber, you don't need any of that stuff to know that what Wakefield was saying was incorrect. He clearly thought that the increased adverse events were associated with an extra vaccine (no extra vaccine was given) and he also said that the increased adverse events caused the vaccine to be withdrawn (it wasn't).

This information is easily available on the Internet. He clearly didn't know what he was talking about, but said it anyway.

bruffin Sat 20-Apr-13 20:35:03

Did you know about this one as well Noble

Again either a fraud or incompetent

Beachcomber Sat 20-Apr-13 21:53:24

Noblegiraffe, obviously neither of us can be sure because it was a bit of a throwaway comment. If it matters that much to you why don't you contact Dr Wakefield and ask him to clarify?

According to the CDC the varicella viral load in Proquad is higher than in Varivax;

The titer of Oka/Merck varicella-zoster virus is higher in MMRV vaccine than in single antigen varicella vaccine, VARIVAX® (Merck), a minimum of 3.13 log10 plaque-forming units (pfu) versus 1,350 pfu (approximately 1.13 log10), respectively.

So we have a bit more info.

Why is the varicella load heavier? Why does it need to be heavier?

Beachcomber Sat 20-Apr-13 22:06:30

This is interesting;

Measles-like rash and fever during days 5-12 were more common after the first dose of MMRV (rash, 5.9%; fever, 27.7%) than after M-M-RII and VARIVAX (rash, 1.9%; fever, 18.7%). The incidence of other adverse events were similar between groups. Response rates were >90% to all vaccine components in both groups. Geometric mean titers to measles and mumps were significantly higher after 1 dose of MMRV than after administration of M-M-RII and VARIVAX.

Especially this bit - Geometric mean titers to measles and mumps were significantly higher after 1 dose of MMRV than after administration of M-M-RII and VARIVAX

It appears that in the 4 in 1 the varicella component potentiates the measles and mumps elements (perhaps because the varicella component is higher than in Varivax or perhaps because they are given as a single injection).

Beachcomber Sat 20-Apr-13 22:09:06

Which does rather lead one to wonder what the results of a test would be where Proquad was compared to MMRII.

Of course, unfortunately it appears that Merck didn't do one (I can't find it but would be interested if it exists) - rather remiss of them IMO.

noblegiraffe Sat 20-Apr-13 22:31:13

Beachcomber, it's interesting that you are trying to do the research that Wakefield clearly didn't, but this won't let him off the hook!

A bit of a throwaway comment? It was an argument designed to dismiss a doctor who has argued against the idea of vaccine overload, and incidentally apparently pissed off Wakefield. It had been thought through, there were figures and details involved. It was in an 'special' interview where he was introduced as a pioneer, a prominent researcher. There was much gushing. And he then goes on to spout this bollocks.

And yet you are refusing to admit that he even made an error when he claimed an extra vaccine was the cause. Once again, there was no extra vaccine.

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