Video of Dr Wakefield speaking at the annual meeting of the Association of American Physicians and Surgeons. This story IS going to come out.

[Beachcomber]

Video of Dr Wakefield speaking at the annual meeting of the Association of American Physicians and Surgeons. The story is coming out in the US.

Issues that come up of particular note;

The UK government's decision to use Urabe strain MMR despite information showing it to be unsafe.

Information showing Deer's BMJ articles to be defamation.

Info on how the single mumps Urabe vaccine did not cause meningitis in the way the Urabe MMR did - clear evidence of viral interference in combined live vaccines. Posing a serious question over the safety of the MMR vaccines.

How Professor Walker Smith alerted the government to the work at the Royal Free and the potential problem with the MMR in 1996.

How Dr Wakefield wrote a 250 page report on the inadequate safety data on the MMR, to highlight the problem and argue the case for single vaccines.

A copy of the ethics committe approval for the Lancet case report.

I think I have lost track of what the crux of the matter is.

it's not really hard to keep track seeker, but you could alwys re read the thread if you are struggling.

And I get accused of being chippy!

I may be very stupid, but the are at least 5 different things being talked about on this thread. Vaccination. Whether or not a cfgf diet is helful to children with autism. Wakefield. The attitude of the medical establishment to children with autism. Whether or not autism and bowel disease are inextricably linked.

Which is the crux?

I don't htink you do, seeker, but happy to be corrected if so. you do get accused of bringing in tangential arguments, which you have done on this thread again and again.

I have answered some of them.

that is all.

if you cannot keep track of the many strands, then maybe you shoudl not introduce so many of them?

I think the crux is that politics are being mixed with science.

Wakefield is being attacked for political reasons not scientific ones.

Children are being denied treatment for political reasons not scientific ones.

If I were to be extremely charitable I would suggest that these political reasons are not entirely in-altruistic (if that is a word). I think there is an element of protecting the vaccine programme, at all costs, as a Good Thing.

And vaccines have done good things - I think vaccinating teenage girls who are not immune to rubella is a good thing for example.

But we must not let the good things blind us to the errors. I think the triple MMR vaccine is a loose canon. And I think we should just admit it and go back to singles.

I haven't introduced a single thing to this thread. (except to compare the reaction to Ben Goldacre's apparent conflict of interest to that to Wakefield's). I have merely responded to what others have said. You must be mistaking me me for someone else.

ok, let me rephrase that.

possibly, instead of questioning side issues, if you find it so hard to keep track of different strands you could try discussing the main subject of the thread.

yes, I know threads move, debate is fluid, etc etc. but you honestly never do answer the main issues - you ask questions to deflect form the difficult, unanswerable ones (like why the UK gov intorduced the Urabe strain anyway)

you ignore main points to bring in snidey little asides about other threads (which don't even make sense, tbh).

you ignore posts you cannot answer, and pop up again later with another tangential question.

and then, when those questions get answered, you say you find it hard ot keep track of so many different things.

baffling, tbh.

Amidst little asides? Yes, the Ben Goldacre remark was. Can't see any others.

I have non idea why the NHS used the Urabe strain vaccine. It was a big misake.

Tangential questions- like what?

seeker, perhaps instead of continuing to try ot deflect this thread, you could address osme of the points (preferably the original ones) that have been made on it?

Catherina I have a couple of questions for you.

You have a blog right? This has been referred to numerous times on MN so it is hardly news to any of us.

Your blog has a very clear stance on vaccination. You seem to think that anybody who doesn't agree with you is 'anti-vaxxine' (why the immature thought process and spelling I ask myself for a fleeting second, although, I'm not actually terribly interested in that.)

On your blog, you clearly state that you frequent blogs where Brian Deer posts. You have a section on Deer on your blog.

You have a post on your blog in which you reproduce the words of Dr Sears. A post he wrote on his forum about you in 2009. Basically he says that you and your mate are a nuisance on his forum.

You also post quite a lot on the vaccine section of MN.

You have a large icon (an advert?) on your blog which links to this site www.flu.gov/

So, considering all of the above, here are my questions.

Do you agree with Brian Deer that the Lancet 12 children, and children like them, were/are not sick with GI issues?

Do you agree with Deer that these children should not be treated for GI issues?

Of course you are under no obligation to answer me. Public forum and all that. I just like to know who I'm dealing with. You know? Bit like when seeker was good enough earlier to outline her views.

Cheers!

Anyhoo, this is for seeker with regards to the treatment aspect.

As silverfrog says, there are different types of autism and no one thing will be able to help. What works for one child will not work for another - I guess it depends on why the child developed autism in the first place. One would imagine that it would be very difficult to treat a child who was born with autism as a result of congenital rubella for example.

Dr Wakefield has a theory about one type of autism. His theory concerns children who regress after MMR vaccine and who develop autism in conjunction with GI disease. He treats children according to that theory and to the best of currently available knowledge about the children's condition.

From what I can see, the children in the documentary are 'lucky' - in the sense that their condition has responded to treatment.

There are lots of children who do not respond so well - there are no magic wands. Just hard work and trying to find what is wrong and what can be done to help.

Like I said before, autism is a biological puzzle and these children seem to have a lot of issues which need treating (for example the sulphation issues referred to earlier, which I would still like to comment on.)

There are lots of families who have tried everything under the sun and their children are still very unwell, unfortunately.

But some children do improve, and not just their bowel issues, their autism becomes less severe too. Some of them actually recover.

There is still A LOT still to be done in this area.

The first step though is for doctors to stop ignoring the bowel issues in these children and relieving their suffering in this domain.

The flu icon is an info link - nothing commercial - I have no commercial interests.

1. I am no MD and I have not seen the kids' medical records. From what I have heard, I am pretty certain that the kids did have gut issues. From what I have read in Wakefield's papers and the scientific and medical papers and discussions following (and with the caveat that I am not an MD), there is serious doubt about whether the gut finding constitute some sort of new/specific autistic enterocolitis (i.e. an inflammation that is unique and/or characteristic for children with autism and also follows a certain temporal sequence, i.e. first vaccines, then gut issues, then autism, as is often alleged "associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers"). Hornig et al (2008) reported difficulties even recruiting such a cohort. It is pretty clear in the literature that children on the spectrum do have a range of feeding/GI issues which are often more severe in severely autistic children. There is no agreement about the temporal relationship though.

So did the 12 have gut issues? I believe so. Did they have autistic enterocolitis brought about by the MMR? I do not believe so.

1. Of course I believe that children who are suffering from gut issues need help. Things that I have read here (GP shrugging their shoulders) are not ok, making up specific gut issues is not ok either. Thorough clarification what is going on is important (there are general guidelines for that in the US, also for treatment, not sure about the UK, but they would be suitable to print out and whack the GP with if they shrug their shoulders).

as for the retraction - peer review is definitely better than no peer review, but it is no guarantee that things are not overlooked. The retracted paper was jam packed full of scientific problems (unequal group sizes, non random allocations to groups, lack of proper blinding to the treatment, assessment through a single observer, rather than at least two independent observers to name a few problems). The non-disclosed COIs are trivial given those problems.

Sorry, I'm popping in and out of the thread when I have time...

So, I also found the BMJ MMR special from last year and have flicked through that.

Is it not the case that rather than saying, 'These children do not have GI problems', the argument is more, 'these children do not have colitis'?

I haven't read all the ins and outs and ad hominem stuff as I find that all rather tedious, but do you know if Wakefield's team ever found a pathologist to stand up and say, "yes, I assessed the biopsy slides for the (1998) paper and diagnosed colitis"?
I initially assumed they'd just got a lab monkey to do all the work and then not credited them on the paper (speaking as a bitter former lab monkey!), but this doesn't seem to be the case?

the gmc verdict rests on the fact that the children have no GI issues (allegedly ) - otherwise they cannot say tht the team at teh Royal Free were wrong to have carried out clinical investigations (on the children, as patients, not as research subjects).

it is not unethical for a doctor to order investigative tests for a patient presenting with the severe problems that these children had. since the verdict is he acted unethically in doing so, then it must mean that the gmc believe the tests were not clinically indicated, ie the GI issues were not as described, and the children were not as severe as they were said to be.

there is no other way out of it, I 'm afraid.

Just to say I do not think I have deflected this thread even slightly, and I would be amazed- and then grovellingly apologetic- if anyone can show me where I have.

How do you define GI issues? A child can be terrible constipated, or have Gastro-oesophageal reflux, but still no autistic enterocolitis. I must admit that I have not read the GMC transcripts, but did they really say the kids had no issues (if yes, could you point me to a day please?)

Thank you for your response Catherina.

Another question, if I may. Why do you think Professor Walker-Smith would make up a condition and then publish a paper on it? Professor Walker-Smith is the founding father of paediatric gastroenterology and an eminent and highly respected expert in the field.

Do you think, Deer the journalist knows better than Professor Walker-Smith? Do you think Deer knows better about children he has never examined (thank God) and that he is not qualified to examine? Do you think Deer knows better than the parents about the timeline of their children's illness?

I don't. Indeed I think it is risible to the point of being offensive to even suggest such a thing.

I disagree with your analysis (or Orac's analysis) of the primate study. I think it was done extremely carefully - the authors knew that if they didn't do the study to the letter and with the highest of standards, it would be too easy to refuse the paper at peer review level. I imagine they also wanted to do good solid scientific work given the importance of the subject and the potential ramifications. Any potential CoIs were declared in an extremely open manner BTW - I find it concerning that you seem to think that they were not.

The rest of your criticisms don't actually make much sense.

From those pesky parents again.

?Prior to 2005, [Carol Stott] and [Andrew Wakefield] acted as paid experts in MMR-related litigation on behalf of the plaintiff. [Laura Hewitson] has a child who is a petitioner in the National Vaccine Injury Compensation Program. For this reason, [Hewitson] was not involved in any data collection or statistical analyses to preclude the possibility of a perceived conflict of interest.?

Hey Boulevard you are back!

I have a question for you too if you would be so good.

You said earlier, IIRC, that the sulphation issues which exist in many children with autism, meant to you that the condition is probably genetic.

Could you expand on why you said that? Thanks.

The answer to your question WRT the BMJ/pathology thing is actually answered in the video I linked to in the OP. You may not have had time to watch the video though so I'll summarise it for you in a moment. Off to do a coupla things first.

I am not terribly obsessed with Deer, so I don't speculate too much about what he knows or thinks. He seems like someone to me whom you don't want to cross. The stories I have read from him make sense and have obviously held up in court (not that this is the ultimate proof of truth or anything).

Do I believe an expert would "just make something up"? Nope, not universally. But there are plenty of examples of eminent researchers misinterpreting their results and deluding themselves. The temptation is great and the transition from misinterpretation to (intentional) fabrication is gradual.

I guess we will have to disagree on the paper design. I maintain that very unequal group sizes, non randomization of groups and non blinding of the ONE observer who assesses behaviours is a HUGE problem (see for example here: www.ncbi.nlm.nih.gov/pubmed/12782533 and here: www.nature.com/news/2011/110928/full/477511a.html). There were further problems with the parameters in the paper, but I you have probably read them and disagree with them. It is unlikely that we will resolve this.

The COI statement lacks description of the connections of several authors with Thoughtful House. They did stand to benefit directly or indirectly from a "verification" of their vaccine - gut injury - autism claims. But as I said, the COI is a distractor really, the main points are the study design and parameters in that study, which are poor.

Gosh Catherina, you have put yourself out on a limb, haven't you!

Just one thing, briefly, as this post was intended to be in answer to Boulevard.

You speak, not entirely clearly, if I may be so bold, of vague undisclosed interests on the part of unnamed authors of the primate study. If I understand correctly, you seem to be saying that these authors had a CoI due to their connections with Thoughtful House. You go on to say that this connection with Thoughtful House was a CoI because the primate study (as published for a limited period by Nerotoxicology), could benefit these authors by verifying their 'vaccine - gut injury - autism claims'.

Now, I have two problems with that;

1. As we can see from the paper, only 3 authors were attached to Thoughtful House at that time - and this is clearly declared in the heading. Those three authors make a clear disclosure of any potential or perceived CoIs in the relevant section of the paper. Indeed all the authors make it extremely clear with which establishments they are affiliated.

1. The paper mentions neither 'gut injury' nor 'autism claims'. Indeed, it has nothing to do with either.

Which kind of leads me to wonder if you have actually read this study which you criticise and dismiss as 'undoubtedly poor'.

You appear to have made up some undisclosed CoI which does not exist, at all, on any level. You might want to be careful with posting that sort of thing on a public forum. (We regulars try to respect MNHQ by not getting them into trouble by making unfounded allegations on their forum.)

(There is an extremely clear conflict of interest statement on pages 8/9 for anyone interested.)

Silverfrog
Under his contract it was stipulated that he was not to be involved in clinical management of patients. He ordered tests such as lumber punctures which were not clinically Indicated or ethically approved.
Nobody has every said that the children were not ill, just that they were not ill in the way that was claimed in the paper.
Nor were they children that were perfectly normal before mmr, their medical records showed a different story.

Why genetic? Ummm...good question....

Because when a whole metabolic pathway goes wrong like that, it usually means there's something fundamentally wrong with the enzyme(s) that are supposed to be running that pathway.

And when something is wrong with an enzyme like that, it usually means there's a problem with the DNA code the body was using to make it.

An example of genetic problem => defective enzyme => major problems would be something like phenyketonuria, one of the things they check for in the heel prick test on babies.

Sorry. I can't help it. I am pedantic and deplore bucketheadness.

Catheriana said;

non randomization of groups - the groups were semi-randomized according to protocols for studies of this nature.

Animals were allocated to either the vaccinated (exposed) or saline/no injection (unexposed) groups on a semi-random basis in order to complete peer groups for later social testing (Ruppenthal and Sackett, 1992) such that each peer group contained animals from either the unexposed or exposed study groups. Once a new peer group was started, new animals were assigned to this group until it consisted of 3 or 4 infants, the ages of which were less than 4 weeks apart from their peers.

Catherina said;

non blinding of the ONE observer who assesses behaviours is a HUGE problem ; it is clearly stated in the study that the observer was blinded.

Infants were raised identically and tested daily for acquisition of 9 survival, motor, and sensorimotor reflexes by a blinded observer.

Here we examine, in a prospective, controlled, observer-blinded study, the development of neonatal reflexes in infant rhesus macaques

Catherina, have you read the study or are you just repeating Orac's witterings words?

In answer to Boulevard who asked;

do you know if Wakefield's team ever found a pathologist to stand up and say, "yes, I assessed the biopsy slides for the (1998) paper and diagnosed colitis"?

OK, apparently what happened was this. The biopsies were taken (as we have seen the procedures were being done were clinically indicated according to the expert opinion of Professor Walker-Smith). They were sent to the lab and analysed by the routine pathologist.

The routine pathologist did not detect disease.

Professor Walker-Smith (PWS) and his clinical team were in the habit of holding a weekly meeting to discuss cases. At this weekly meeting they discussed the analysis of the routine pathologist/s and questioned them. PWS disagreed with the routine pathologist/s. In order to settle the matter the biopsy slides were then sent to the expert pathologist Dr Dhillon. Dr Dhillon found there to be inflammation and evidence of non-specific colitis. Dr Dhillon's ratings were those included in the Lancet paper and he is therefore included as one of the paper's authors.

Dr Dhillon has made a statement on the above.