Help me make sense of MMR - hype or theory

[felicity10]

OK, so I've been through a few pages of previous posts, I must be missing something because I can't make sense of it!

DD is 1 and I've had a letter about the vacs from the GP. I've heard about the MMR in the news few years ago and about the link to autism, but I just would really value your views.

Single vacs with no mumps or the MMR? Can anyone point me in the direction of key MMR issues?

I just don't want to get to the gp's and then feel like I am getting bullied into having the mmr - it is normally very no nonsense nurses who barely speak english, so will be unlikely to give me a clear answer as to any risks.

I am amazed that we have this lack of clarity in the UK.

Many thanks in advance!

Gosh Leonie, that sounds distressing. I hope your DD is OK .

Agree with you about immune system.

Sorry Lenoie. Best wishes.

S -- you ignore everything anyone says who doesn't agree with you. Everything.

"The vaccines have been studied and studied ad infinitum. In particular the MMR."

No they haven't. Studies inadequate according to Cochrane. Half your epi studies weak and worthless. When will you stop with the lies and the misleading.

Never I guess. You ignore. You are here for a fight only.

Leonie apologies, wasted time responding to S there. Actually meant to ask you something.

Was this the first time that you saw a regression to a trigger, this week? You have said before that you noticed differences from birth. Your anecdote is terribly sad but very interesting, sorry that sounds bloody callous. But I wondered if you already used protocols like those suggested for children with suspected gut-vaccine damage and if not, would you be considering it in the light of what happened this week?

If you've said these things before then I have missed it. Also if you don't want to say that much, completely understand and so on.

Thankyou Leonie.

before the quake.. the japan panel finds no link between teh vaccine and the deaths

It's those underlying conditions again. Dismissively.

Beach; the needle in haystack analogy is not really valid because as an investigator you have a priori knowledge of the obvious differences between needles and straw, and given sufficient reason and resource you could design a screening test for needles that would probably approach 100% accuracy. X-raying the hay-bales, for example, would let you identify the needles beforehand and permit you to examine them.

However you may be making the oblique point that people are just not interested enough in the individual cases, to use population science in attempting to identify children at risk.

Apart from the obvious cases of immunosuppression and genetic predisposition, we are not even anywhere near identifying consistent factors in children who eventually become severely damaged by vaccines. Stata is right when she alludes to the power of epidemiological studies; the larger they are, the more sensitive they become, but you have to have included a variable in the analysis to detect its influence. This can be one reason why no link appears in the result; that something significant has been missed out. Until you do find something that is associated with vaccine damage, it is reasonable to conclude that the things which were included as variables and don't pan out as significant, do not have an influence. Often in such studies there are internal positive controls added - factors you already know to be present at low frequency in the population - and that are expected to appear as positives in the analysis. This gives the confidence to know that your study indeed has the power to detect factors at low frequency, and the absence of an association with a test factor means it is reasonable to conclude that it is not involved in the pathology.

Case/control studies do deal with actual cases rather than trying to pick them out of a larger population, and some are better controlled than others. As an example, such a study was performed by DeWilde et al. published in 2001 (Br J General Practice 51: 226-227). They used electronic medical records from a large GP database covering about 1 million people, and compared 71 autistic children diagnosed at age 3?4y with age-, sex-, GP practice-, and MMR month-matched controls. The hypothesis was that there would be increased frequency of consultation with GPs before the eventual diagnosis, so they looked specifically at the pattern of this in both the 2 months before and after MMR, and in the 6 months before and after.

No differences in consultation rate were found between cases and controls in relation to receiving MMR, but the method was sensitive enough to detect a significantly higher rate of consultation in autistic children 6 months before their diagnosis. So there is a study with demonstrable internally-controlled power to detect an effect of MMR on development of autism, using parental intuition as a marker for its onset, in actual cases versus controls... but it didn't.

OK - so where does that leave the children who have been damaged by MMR?

And where does that leave the children who are potentially susceptible to damage from MMR?

And why are single vaccines not routine (considering that the MMR has a bad safety record and is not necessary)?

If it is beyond science to figure out who is likely to be damaged by a combination vaccine, the only ethical route is to go back to singles (spaced out and given as necessary).

I find it very odd frankly, this unscientific desire, to defend an unnecessary and unethical combined vaccine....

"Apart from the obvious cases of immunosuppression and genetic predisposition, we are not even anywhere near identifying consistent factors in children who eventually become severely damaged by vaccines."

Perhaps we shouldn't be persecuting doctors who try to advance this area of science then?

Just a thought.

Of course persecuting doctors who want to investigate things is wrong, but the Wakefield study had almost no science in it; being a report of collected and individually-important cases. Epidemiologically it was flawed, and the laboratory side has now been discredited. For such an important claim about MMR, there needs to be supporting scientific backing of an unequivocal nature.

I am not here to argue about GMCs, BMJs, or Brian Deers, but since you talk about this and that being "scientific" and "unscientific", I think it is better that you say whether you are for the scientific method in trying to get to the bottom of this issue, or not. Then it is possible to discuss, rather than jumping in and out of science whenever it suits an argument, rather than recognising its rules.

Musukebba:had you read the thread you'd know that those who question vaccination are well aware of the status of Andrew Wakefield's study, and have had to educate the pro-vax brigade thereof. Epidemiologically it made no claim at all, so it is very odd for you to suggest it did. However you would also know, had you read the thread, that many of the epidemiological studies thrown into the pot by the pro-vax brigade are accepted as weak, flawed, and poorly designed by the scientific community itself. You would also know that "such an important claim" as a connection between autism and MMR was not made by Andrew Wakefield, and that he was calling for research which could supply or otherwise "scientific backing of an unequivocal nature". So it seems, all in all, now that you know these things, that you agree with us and with Andrew Wakefield after all. Welcome aboard.

"I think it is better that you say whether you are for the scientific method in trying to get to the bottom of this issue, or not. Then it is possible to discuss, rather than jumping in and out of science whenever it suits an argument, rather than recognising its rules."

Couldn't agree more Musukebba.

"For such an important claim about MMR"

The 1998 Lancet report made no claims about MMR - it just faithfully reported that some parents associated onset of symptoms with MMR vaccination/adverse reaction.

"Epidemiologically it was flawed"

Could you expand please - I don't see the weight or relevance of this statement within the context?

"but the Wakefield study had almost no science in it"

Could you expand please? If you are refering to the Lancet report, it was not 'Wakefield's study' but a case series contributed to by a whole team - including the eminent Professor Walker Smith.

Professor Walker Smith had already presented the findings of the clinical investigations of the children referred to the Royal Free, to his colleagues (independently of Dr Wakefield) as cause for serious concern and investigation.

"the laboratory side has now been discredited"

Could you expand please? - I know of no such evidence concerning the 1998 Lancet report. I think you are referring to an entirely different paper - and even then your statement does not stand.

So are we all agreed that there was almost nothing recognisable as science (epi or lab) in the 1998 paper, the same one on which Wakefield felt compelled to comment and make pronouncements about the safety of MMR in the press conference about the paper afterwards? It is clearly stated in the paper that even the physical and behavioural changes in the children might not be genuinely associated:

"Intestinal and behavioural pathologies may have occurred together by chance, reflecting a selection bias in a self-referred group"

So if that was realised, why stretch the bounds of incredulity even further by publically discussing MMR, especially after saying in print that:

"We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described. Virological studies are underway that may help to resolve this issue."

Notice that the behavioural and physical are now apparently a "syndrome" rather than separate events not proven to be linked. Surely this last quotation from the paper is admission that an association with MMR cannot be inferred from the results; therefore why did Wakefield also sit down and write an article with a colleague for a toxological journal suggesting the safety trials of MMR were inadequate? As a scientist you cannot be so irresponsible, and it is also very strange to make pronouncements and write articles that overide the caveats of your own research results. Also, if apparently presenting a balanced view, why ignore far better studies with real epidemiologically-based evidence from other countries like Finland, and imply that single vaccines are a way around an alleged combined vaccine problem that doesn't even have a proven existence, according to one's own interpretation of one's own evidence.

Yes many authors contributed to the 1998 paper. Wakefield as first and senior scientific author must bear most of the responsibility for what was written and it is customary to refer to papers in first-author terms like this; whether the paper is contentious or not. The last author - who at the time was a highly eminent figure in clinical paeds gastroenterology - would be regarded as the senior clinical author and perhaps sponsor of the study. Generally, in science publications the last author can be as important and sometimes more important as the first author, and his/her involvements and reputation can lend the paper a huge amount of authenticity. One could speculate that without the last name, the 1998 Wakefield paper would never have been published at all. Such was the lack of previous conclusive evidence regarding measles and IBD; as I said, even within the RFH group itself.

Re the laboratory evidence... forgive me but I was not clear that I referred to prior and subsequent studies; of course there was no laboratory evidence regarding MMR or measles presented in the 1998 Lancet paper. I meant the Chadwick paper from the Royal Free group in 1998 and the Uhlmann paper coming from the O'Leary lab in 2002. The latter results were brought under serious question by d'Souza et al, who used the same Kawashima primers and found they were very prone to amplifying non-specific RNA, rather than measles genome. The lid was effectively put on the case by molecular biology court evidence, given under oath at the Cedillo hearing, that many factors gave cause for concern during the lab work leading to the Uhlmann publication (positive results being recorded for samples where no reverse-transcription had occurred, discordant results being recorded as positive, for example).

So we have a 1998 paper with no science in it, either epidemiological or laboratory, yet tentatively suggesting that three occurrences are linked (a new type of gut pathology, the onset of a new type of behavioural disorder, and by inclusion, MMR). If you were clever, as an investigator you might try and convince people that two of these three new things were worthy of further investigation as being linked; but not all three, no matter at which forum you chose to pronounce.

Seeing as we're quoting each other, Beach you said in this thread:

Beachcomber Fri 28-May-10 10:10:45
"Nobody who has read the science and examined the epidemiology can conclude that MMR vaccines are not linked to autism and that includes Goldacre and his cronies."

So are you for or against the scientific method, and exactly what science were you referring to?

"So are we all agreed that there was almost nothing recognisable as science (epi or lab) in the 1998 paper"

Um, no, we are all not all agreed on this ridiculous and presumptuous twaddle.

As for the validity of the detection of measles virus in the guts of autistic children with gastrointestinal symptoms by the O'Leary lab used for the Uhlmann paper - well we all know that it has been vindicated by the Hornig paper. in which the O'Leary lab results were entirely consistent with two other labs.

Although the Hornig study failed in the majority to examine children who matched the profile of the children Dr Wakefield's hypothesis concerns, they did include 5 such children in the study. Of these five children - one of them did have measles virus RNA detected in his ileal biopsy sample. That this paper is touted as anything other than evidence that the Uhlmann paper is hugely concerning is ridiculous and unscientific.

We also should know that the expert witness at the Cedillo hearing gave his 'expert opinion' after being paid by the vaccine manufacturer to examine the lab under question. (And his testimony of his opinion can only be considered highly questionable in the light of the Hornig study.)

Why? Just why do people pretend that science/research/studies/evidence (whatever you want to call it), that the findings in the 1998 Lancet paper, and the hypotheses it generated, are not valid, biologically plausible (indeed likely), and ground-breaking for autism sufferers? Indeed why do so many try to pretend that this work does not even exist?

Even the FDA and the IOM now accept that children with what we call 'regressive' autism often present gut problems which are linked to their behaviour and skill level. They are currently fast tracking a drug intended to treat this phenomenon - a drug which directly treats an element that Dr Wakefield has been pointing out for years and indeed mentioned in the 1998 Lancet paper (impaired digestion of certain proteins, the by-products of which affect brain function).

I think we have been over this before in the thread but here is what we are looking at;

• A consistent patten of anecdotal and documented evidence that children with common points in their (and often their families) health history, reacted badly to MMR within a short time of it being administered (fever, rashes, swelling, redness, convulsions, screaming, agitation).

• These children tend to have a history of ear infections and heavy antibiotic use. They have often been vaccinated whilst on antibiotics. (If you wonder why this might be of note then consider that antibiotics upset gut flora equilibrium.) There are frequent histories of eczema, hay fever and removal of tonsils - all the above suggests that these children have an underlying immunological vulnerability.

• The children concerned, went on to develop gastrointestinal symptoms (often very severe with secondary incontinence). They also develop food sensitivities (notably to gluten and casein), or existing sensitivities worsen, ataxia, changes in sensory perception, failure to thrive, and of course behavioural symptoms and loss of previously acquired skills.

• When examined these children often have very elevated measles antibody levels. In some children these levels have remained high for many years. Levels such as these are generally only seen in a rare type of measles encephalitis following wild measles infection. Some of the children examined have persistent measles infection at the site of the inflammation they present in their guts. The profile of the inflammation is consistent with that which results from viral infection.

• When the children are treated for their gut inflammation and pain, their behaviour improves. This highlights the fact that the two are linked.

• When the children are placed on exclusion diets their behaviour improves (as does their gut inflammation). They stop hand flapping and head banging for example. Parents have consistently reported that many of their children's behaviours are related to how much pain they are in. (Behaviours worsen before bowel movements/improve upon treatment of gut inflammation.)

Then we have some children who present possible rechallenge cases.
These are children whose condition worsened significantly upon receiving a second MMR (booster or given by mistake). Rechallenge is considered to be powerful evidence of causation - it cannot be dismissed as coincidence. On examination, the gut inflammation and damage in these children is shown to be more extensive than in children who only received one MMR.

One of the children in the Lancet paper had been given an MMR at 4 months. He was revaccinated later at the standard age. This child's condition, behaviour and developmental age improved so much upon treatment, that the findings were presented at an international meeting on gastroenterologists by Professor Walker-Smith in 1997. (Note before the publishing of the Lancet paper.)

There is more of course but this post is getting a little long.

As to questions about the scientific method, well excuse me whilst I PMSL (despairingly).

The naysayers;

Fail to address that the MMR originally introduced to the UK was known to be unsafe. The vaccine was introduced in the UK in the same month it was withdrawn in Canada.

Fail to address that it is thereby highly unscientific to declare the MMR vaccine to have a sound safety record (although the DoH does so regularly).

Fail to address that they have yet to produce a solid, unflawed study which gets anywhere near even examining Dr Wakefield's findings, let alone challenging them.

Fail to address the fact that the disease documented in children with regressive autism who present gastrointestinal symptoms following vaccination with MMR is extremely similar to conditions such as CDD (childhood disintegrative disorder) - a condition which has been associated with measles encephalitis following wild infection.

Fail to address the documented evidence that the risk for IBD is elevated following atypical infection with mumps, measles and or rubella with close temporal relationship.

Fail to address the documented evidence of highly elevated measles antibodies in affected children - levels which are consistent with presentation of measles encephalitis.

Fail to address that fact that the MMR vaccine is neither necessary nor ethical.

Fail to address that regressive autsim with gastrointestinal symptoms has been consistently shown to be a condition which affects the gut, the brain and the immune system. (i.e. this condition has been consistenly shown not to be psychiatric.)

Fail to address that the incidence of the above syndrome is increasing (i.e. it cannot be a purely genetic phenomenon but must be one which has an environmental element).

Fail to provide any evidenced alternative explanation for what has happened to the children considered to have reacted badly to MMR vaccination (indeed fail to even examine the children in question).

Fail to address the fact that declaring that they know what has not happened to these children (whom they have not examined) whilst remaining entirely ignorant of what has happened to them, is a ridiculous and unscientific position.

Fail to address that the only explanation they have provided on the entire issue can be summed up in one unscientific word - coincidence.

Scientific method mon cul.

Beach I have not been talking about who got paid by who, or for what; deliberately so because I wanted to avoid clouding the discussion with non-science issues. You can see that to dismiss the testimony of an acknowledged expert on validation of PCR techniques because he was asked to act as an independent expert witness, only opens up the opportunity to draw similar conclusions about Wakefield on his external payment record, and thus a like-for-like dismissal of his Lancet publication. O'Leary has obviously received expert witness payments as well. So that line of discussion gets us nowhere.

What I do want to argue about is the scientific content, or lack thereof of the 1998 paper, and since you have yet not answered the question, please would you indicate what you see as the scientific content of that publication.

Re the Hornig study which you say supports O'Leary lab results: we do not know the identity of the participating labs, so that conclusion cannot be drawn. One lab did get some false positives, which meant extra aliquots had to be sent round again for testing. So nothing was "entirely consistent" at all.

Re the detection of measles in the gut - yes one case did appear to have authentic measles sequences detected, but so did one of the controls! I don't think you can have read the paper properly to present these basic results so one-sidedly. What's the point of quoting a case/control study as proof of something in the cases, if you ignore the findings in the controls? Here's the relevant section of the results:

"MV RNA in bowel biopsies
Analyses in all three laboratories found two ileal biopsy samples with MV F gene and H gene RNA: one from a boy in the AUT/GI group, the other from a boy in the control group. Real-time RT-PCR indicated a range of 2?7 molecules per PCR reaction, corresponding to approximately 50?500 MV RNA molecules per 100 ng of total RNA extract (Table 3). Sequence analysis confirmed that products of these samples were authentic. MV RNA was not detected in cecum of these subjects, or in ileum or cecum of any other subject. The presence of MV sequences was not associated with an AUT diagnosis (cases, 4%, controls, 8%).

The major conclusion of the Hornig paper is "This study provides strong evidence against association of autism with persistent MV RNA in the GI tract or MMR exposure".

The rest of your post is about gut disorders and ASD; something which is less contentious and I have acknowledged that there may be something worthy of investigation. It is the persistance of the view - in spite of overwhelming scientific evidence - that measles or MMR is involved in the development of that pathology that I argue against.

OK I didn't see you had replied with another spurious list of 'fail' statements - during which semantics appear to have left the building - and still not answering the question about science in the 1998 paper.

Am waiting for that before going any further... and why you appeared to ignore the results in controls from papers you quote.

The point about Dr Bustin's testimony was that it was his scientific opinion. That is why payment is of note. That scientific opinion has now been shadowed in major doubt following the validation of the O'Leary lab's methods as shown by the Hornig paper. Your statement that Bustin's testimony 'put the lid on' the issue is incorrect and unsubstantiated.

I have no objection to doctors acting as expert witnesses and being paid to do so. I object to them being paid to present their opinions as facts in major medical controversies. (And thereby 'put the lid on' a child with a clearly documented vaccine injury being refused compensation for reasons which are political. Bustin's report was prepared for the UK MMR litigation and the US Special Masters questioned the acceptability of its presence in the Cedillo hearing.)

The only way to resolve the biological issue of measles RNA detection, would be to examine children who fit Wakefield's criteria, for measles RNA in the relevant diseased areas of their guts. Something the Hornig study failed to do in the vast majority of subjects selected (curiously) - this scientific fact has not stopped the naysayers touting the study as having authoritatively addressed the issue of persistent measles infection in the children examined by Uhlmann (curiously).

I'm perfectly aware that one of the controls in the Hornig paper also showed measles RNA in their biopsy. Which is why I think the Hornig paper can only be described as inconclusive with regards to Dr Wakefield's findings with regards to autism. The controls in the Hornig study were "children with GI disturbances alone". Finding measles RNA in the GI tract of a child with GI disturbances is not a huge surprise - it just doesn't allow one to make any conclusions about autism.

I used the word consistent about the lab results because it is how the authors themselves describe the lab results;

We found no differences between AUT/GI and GI control groups in detection of MV sequences in RNA extracted from ileal or cecal biopsy specimens. Real-time RT-PCR assays with molecular controls engineered to allow differentiation of products arising from synthetic vs. bone fide MV RNA produced consistent results across three laboratories, with each laboratory site reporting less than 10 cDNA copies of MV F and H gene in ileal biopsies from one child with autism and one child without neurological disorder.

We are back to something that has been mentioned already further upthread. Autism is not one thing and there are many triggers which can lead to a child developing it. If you choose to study children who present rather different profiles to those studied by Dr Wakefield then you can hardly be surprised to find that their lab results are different too.

Whereas Wakefield and O'Leary in 2002 looked at bowel biopsies of 91 children whose autism and bowel disease followed the MMR vaccination, Hornig et al examined biopsies of only 5 children who had MMR before the onset of these symptoms. The remaining 20 children had MMR after onset.

www.ageofautism.com/2008/09/uks-cry-shame-o.html

The Hornig conclusion is not supported by the body of the paper and is an extraordinary pronouncement to make given the studies severe (and curious) limitations.

In other words if you choose to say examine a child who developed autism as the result of herpes infection, way before they were given an MMR, then you shouldn't be surprised that they do not have persistent measles infection. Nor however should you use this child's results to make pronouncements about autism in children thought to have developed autism in an entirely different manner. One wouldn't use the fact that children develop autism as a result of CRS to rule out the idea that they also develop autism following herpes infection for example.

Musukebba I don't understand what you mean by this "and still not answering the question about science in the 1998 paper." (Unless you are referring to your rather silly statement that it doesn't contain any science)

Anyway, we can all cheer up a bit, as at least in the US, the government is making an attempt is being made to address some of the failures I note above;

www.ageofautism.com/2011/03/list-of-us-government-support-for-vaccine-autism-studies.html

"US Department of Health and Human Services (HHS)

● Calls for the study of adverse events following immunization (e.g., fever and seizures) to see if they increase autism risk.

● Calls for an external expert committee to consider ?strengths and weaknesses, ethical issues and feasibility of examining outcomes in unvaccinated, vaccine delayed and vaccinated children.?

● Calls for the inclusion of autism as an outcome in the vaccine study.

● Calls for more research on ?the possible occurrence of ASD in a small number of children subsequent to MMR vaccination? especially given ?recent research around the incidence of mitochondrial dysfunction in children with an ASD phenotype.?

● Calls for studying adverse vaccine reactions in subsets of the ASD spectrum, especially in light of ?recent developments around mitochondrial dysfunction.?

● Reports that some subsets (ie, those with mitochondrial dysfunction) ?may be at elevated risk of reduced neurological functioning, possibly including developing ASD, subsequent to vaccination.?

● Reports that, ?in the context of vaccination research, the ASD clinical subset of particular interest is regressive autism.?

● Concludes that ?public concern regarding vaccines and autism, coupled with the prevalence and severity of ASD, warrant additional study in well defined subpopulations.?"

Forgot to say - what the Hornig study should have done was to examine children who developed GI disturbances and autistic regression following MMR (and who reacted to MMR at the time) with controls who presented classical early onset autism or autism as the result of a documented viral trigger such as Epstein Barr infection.

Would have been a much more useful way to go about things.

Apologies - had been overtaken by work...

OK let me repeat the question: "What I do want to argue about is the scientific content, or lack thereof of the 1998 paper, and since you have yet not answered the question, please would you indicate what you see as the scientific content of that publication."

"The point about Dr Bustin's testimony was that it was his scientific opinion. That is why payment is of note. That scientific opinion has now been shadowed in major doubt following the validation of the O'Leary lab's methods as shown by the Hornig paper. Your statement that Bustin's testimony 'put the lid on' the issue is incorrect and unsubstantiated. "

When you are asked to be an expert witness, you make a declaration that events, statements and opinions that you make are of an independent nature. Something along the lines of: "I understand that my overriding duty is to assist the court on matters that are within my expertise and that this obligation overrides any obligation to the solicitors or their clients." You are required to present findings, and give the same opinion as if you were doing it for the other side of the case. That is what Prof Bustin did: presented the findings as he discovered them from the computer files, PCR machine logs, witness statements, and handwritten notebooks. He was asked his opinion on some matters, but anyone with any experience of running PCR in a clinical diagnostic laboratory only has to look at the findings alone to see there were major problems. Here's a few of them (note these are findings presented under oath and not his "opinions"):

(1) Data on experiments showed that when RT step accidentally missed out, a PCR signal was obtained for measles virus. This must be contaminating cDNA from previous runs.
(2) Mismatching results with F and H gene primers were reported as positives
(3) Quantitation standard curve did not extend its lower range to encompass the patient samples. The signals were well below the bottom standard (calculated as 20,000 copies sensitivity limit).
(4) Approximately one-third of the negative controls had a positive signal, including environmental controls.
(5) GAPDH analysis post-RNA extraction showed some samples which were negative; however these were still inexplicably further analysed for F gene.
(6) The instrument used for majority of PCR runs had significant variation across the 96-well block.
(7) Some non-amplified signals were scored as positive
(8) Discordant replicates were always reported as positive
(9) FAM / ROX dye ratio sometimes doubled (twice amount of probe)
(10) Lab books had been altered over time

"I have no objection to doctors acting as expert witnesses and being paid to do so. I object to them being paid to present their opinions as facts in major medical controversies. (And thereby 'put the lid on' a child with a clearly documented vaccine injury being refused compensation for reasons which are political. Bustin's report was prepared for the UK MMR litigation and the US Special Masters questioned the acceptability of its presence in the Cedillo hearing.)"

No: the counsel for the petitioner questioned it; but that is a point of law, since lawyers on either side of a case are entitled to question the admissibility of evidence. Special Master Hastings, the legal figure in charge of the trial, had no hesitation in ruling that the evidence was admissible and reminded counsel that some two weeks previously he had been asked to consider it fully, and made a ruling of admissibility then. The petitioner lawyers also had the opportunity to cross-examine Bustin about his evidence.

"I'm perfectly aware that one of the controls in the Hornig paper also showed measles RNA in their biopsy. Which is why I think the Hornig paper can only be described as inconclusive with regards to Dr Wakefield's findings with regards to autism. The controls in the Hornig study were "children with GI disturbances alone". Finding measles RNA in the GI tract of a child with GI disturbances is not a huge surprise - it just doesn't allow one to make any conclusions about autism."

Then how would you describe Wakefield's 1998 study, in which there were absolutely no controls? At the very least, surely "inconclusive"..?

"I used the word consistent about the lab results because it is how the authors themselves describe the lab results"

Well you are allowed to make your own mind up about it, rather than quoting the author's conclusions, so what do you think about the stated fact that they got some inconclusive results first time and so had to send round another lot of samples? I can tell you that's not the way we do quality assurance in the NHS; we get scored on the set of results we send back each month and lose marks if they are not accurate. No-one can seriously say that the quality assurance elements of the Hornig paper was conclusive, simply by examining the lab once, and even then, several years after the event.

Have you read the 1998 Lancet paper?

Controls were used - even though it is not considered a requirement of case reports to do so. Dr Wakefield says that they went beyond the normal expectations of this type of report in order to pre-empt any cries of 'yah boo sucks they didn't use controls'.

If you do a 'control f' search you can find mention of controls without going to the effort of reading the paper

As to what I find scientific in the content of the paper - well, all of it, of course . Do you want me to copy and paste the whole thing and bold it? Or are you looking for a résumé of the main findings? Why don't you explain to me which bits of it you have a problem with and find unscientific - I still don't see what such a silly statement is supposed to mean. Do you mean unscientific in the way the conclusion of the Hornig study clearly is? Or massively flawed in the way the Hornig study sample selection is for example? Come on, I have clearly stated why I find the Hornig study flawed - why don't you do the same for the Lancet paper?

We cannot verify Bustin's testimony - and neither could the plaintiff or the Special Masters, in the Cedillo hearing. Why? Because, Bustin failed to present the O?Leary laboratory books he reviewed for inspection. We just have to take his (well paid) word for it it would seem . Bustin never provided the underlying documents to back up his testimony - this would never have been accepted in civil court under federal rule, on the part of a witness being paid by the manufacturer of the product under investigation. Indeed when the Cedillo family appealed, the judge was not impressed by the defence having failed to provide underlying data and having made no attempt to acquire the data and share it with the other side so that they could cross examine Bustin using the data he examined. The judge was also not impressed by the late entry of Bustin to the proceedings and the 'element of surprise' it caused - he admonished HHS for allowing such tactics in a court which is specifically designed to be 'non-adversarial' (if only...).

Basically Bustin rocked up at the last minute and made all sorts of claims about the O'Leary lab but failed to back up his findings by providing the relevant data. Even if the data had been provided, the plaintiff side would not have had time to examine it properly and prepare a cross examination. This is a funny way to go about things in a court designed with the intention of providing justice and compensation to those damaged by vaccines. Bustin's testimony turned the hearing into a defence of the MMR vaccine - it was no longer a hearing about what happened the Michelle Cedillo - it was about exonerating MMR at all cost. It is disgusting what has been done to that family.

Anyway Bustin testified that O?Leary?s laboratory was likely not to detect low levels of copy numbers. He did not contest the accuracy of the lab results in cases with high copy numbers and high levels of inflammation. Michelle Cedillo had high levels of inflammation and high copy numbers - even Bustin himself agreed on that. His unsubstantiated testimony was irrelevant to Michelle Cedillo's litigation. (Which rather begs the question as to why it was there at all?)

Anyhoo, Bustin's late arrival to the Cedillo proceedings with his costly (but unsubstantiated by underlying documents) scientific opinion has become a moot point with the subsequent publication of the Hornig paper and validation of the O'Leary lab's methods.

Oh and the conclusion of the Hornig paper is not supported by the body of the study and is an extraordinary pronouncement to make on such thin and limited results.