Wakefield: Proquad claims. Liar or incompetent?

[noblegiraffe]

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 To the extent that that ProQuad vaccine had to be withdrawn.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 Proquad has not been withdrawn.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

stitch, I'm really not convinced you can say that the measles vaccine surpresses the immune system and leaves it vulnerable to infection because in the month and a half following vaccination it was common for children to get a cold, given that its common for children to get colds anyway.

Beachcomber, one major vital issue with the data is that it doesn't control for population size, it's simply a head count. In California, is there the same number of people in each year of birth? Of course not. Look at the population of the UK and the problem with primary school places: there are way more children this year than in previous years. If 1% of children have autism and you did a head count, then you'd have more cases in this cohort than the last cohort. Does that mean autism has increased? No, just that the number of children has increased.

The Calfornia data is utterly useless at assessing prevalence of autism in the general population if you don't know how many people in each year are in the general population. Any sort of sensible analysis would do a head count of autism per 10,000 population

And the idea that Wakefield can make a shit argument simply because it was in a published letter rather than a study is laughable. He's making this claim, he's supposed to be the expert on it. Was he saving his good arguments for something else?

PS I said it was indisputable that autism diagnoses are on the increase, not that autism is.

OK noblegiraffe, I can see that you have a strong opinion on this. I disagree with you on the data - no it doesn't allow one to draw solid conclusions about the general population. That isn't the point though.

The point is that in two areas a marked increase in autism cases was reported and that this happened 10 years apart and that a common factor was the change in vaccination policy, 10 years apart.

The point is not to say 'MMR causes autism' - epidemiology is not the tool to do so anyway. The point is to say that we have this data that suggests more investigation is warranted.

Would you be so critical if the data showed no association? Are you less critical of the Taylor et al study for instance (which was a large study publicly trumpeted to have put the MMR question to bed)? Or are you just critical of anything and everything with Dr Wakefield's name on it because we all 'just know' that Dr Wakefield is the villain?

And I really CBA to do the 'autism diagnoses have risen' argument. When you have official government body data that says ASD rates are 1 in 50 - you have a problem. Autism diagnoses have risen because more children have autism. (see article for discussion on the loosening and tightening of diagnostic criteria). And the problem is going to make itself very much heard as the first generation of these children reaches adulthood and their parents and carers will inevitably become too old to look after them. It is so many parents worst nightmare - they are afraid of what will become of their children when they can no longer care for them. The infrastructure just isn't there (and these children need love not institutions).

I know it is very important to those who cling to the notion that the MMR vaccine is very safe, to deny that autism cases are more prevalent than before. Unfortunately though, that means denying the very existence of a great number of children who are in distress, who are sick. It means denying that their condition exists - and that means that these children are denied appropriate medical treatment.

So I'll stick with Dr Wakefield. I'll stick with the doctor who doesn't deny that these children exist and who tries to find out what is wrong with them and to relieve their suffering. I mean rather than support a pharma company, a bunch of career doctors and a public health programme that seems to have forgotten that all children count and that they are not just data of collateral damage.

(high titer measles vaccines have been shown to lower children's immune capacity for long periods following vaccination, it would be logical to think that lower titer vaccines do to, perhaps there are studies on this?)

The point is that in two areas a marked increase in autism cases was reported and that this happened 10 years apart and that a common factor was the change in vaccination policy, 10 years apart.

The point is that anyone with an ounce of intelligence would not look at that graph and plonk that arrow on it and use it to support the argument that the vaccination policy was responsible for the shape of the California graph. Anyone with an ounce of intelligence who knows the data would realise that it's a bit more complicated than that (and that's an understatement and a half). And any scientist with any intellectual integrity would have read the accompanying report, agreed with the authors that the data was unsuitable for that type of analysis, and wouldn't have amended graph axes to hide this fact.

And besides that, in order to show a correlation with a completely different set of UK data, he had to fudge where to put the arrow, in a manner criticised by the people who collected the data.

The point is Wakefield is making untrue claims and exceptionally dodgy arguments.

Or are you just critical of anything and everything with Dr Wakefield's name on it

I'm critical of anything and everything that turns out to be bollocks. If that seems to coincide with Wakefield's output, that's hardly my fault is it? I've got a maths degree, I'm a maths teacher. If it's any consolation I'm just as appalled that the Lancet published that piece of rubbish graph apparently unchallenged(?) as I am at Wakefield for trying to pass it off as credible.

If you want to 'stick with Wakefield', wouldn't you prefer that he supported his claims with good arguments? I mean, caring about the children is one thing, but not talking bollocks is also important when it comes to trusting someone.

but the claim is neither bollocks nor untrue. autism cases have increased. they have increased since the introduction of mmr. and thousands of parents in several countries report that their child regressed and became ill with intestinal disease after mmr vaccinaton.

Beachcomber, you have stated that you'll stick with ex-doctor Wakefield.

You are not swayed by the fact that he is a liar, a cheat and a fraud and has been struck off.

Just to check, will you admit that anything he has said is bollocks or untrue?

and autism cases have continued to rise in Japan, as mmr was reduced

Beachcomber,
You do realise that by sticking with Mr Wakefield you are ignoring the scientific consensus on the MMR autism link. It's not just that Wakefield's research was fraudulent, it's that the weight of the scientific evidence is that the MMR does not cause autism. It's not just one paper, it's not just one way of approaching the question, it's all sorts of ways of looking at the question and they all (by scientists all over the world) come to the same conclusion that there is no causative link between autism and the MMR. Wakefield is a liar, he has acted in many despicable ways, he fabricated his results etc. But, you know what? He could still have been right about a link. I reckon he would still have been disgraced and removed from the medical register anyway. But, the thing is he was wrong about a possible link between the MMR and autism (which I suppose you will acknowledge he appears to promote the idea of?).
Leaving aside the fact that Wakefield has done lots of really unforgivable stuff, and his name is mud in the scientific community, there is overwhelming evidence that the MMR does not cause autism.
Is this clear?
Or do you have evidence to the contrary?
Cheers.

Beachcomber,
Could you also, please, stop the "you think the MMR is safe therefore you are insulting/hating/dismissing the parents of autistic children!" garbage.
It's insulting rubbish.
Cheers.

Magdalen don't twist my words.

I said it is important to a lot of people to think that MMR is very safe. To hold the thought that MMR is very safe has meant for a lot of people also holding onto the idea that autism cases have not increased. Therefore it is to deny the existence of the children that represent that increase.

To believe that Wakefield is a fraud is to believe that these children are not sick with complex and novel intestinal gut brain issues and/or that these children don't actually exist.

You can't have it both ways. You cannot say Wakefield is wrong, a liar and a fraud but I agree that these children exist.

So either Wakefield is right

or

the children and their suffering don't exist.

(I am not saying this for all children with ASD - there are children who have been affected by other factors such as congenital rubella syndrome for example.)

Piglet John - what is your opinion of Professor Walker Smith? Do you think he is a liar, a cheat and a fraud? Do you think he should have lost his appeal?

Beachcomber,
I believe there are children with ASD whose parents believe they regressed or developed ASD because of the MMR. I don't deny their existence. I don't think the MMR has anything to do with their ASD, and/or regression and nor does the scientific community.
I am not trying to have anything "both ways", so stop pretending I am. It is pathetic.
Cheers.

Beachcomber,
So it's back to Walker-Smith and Mitting, again, is it? I seem to have posted on this subject before, but it bears repeating, since you set such store by Mitting. The very Mitting who appears to go out of his way to contrast Walker-Smith's behaviour with that of one Mr Wakefield (who failed to appeal, let alone succeed). From Mitting's judgement:
First up the whole situation with the legal aid and the firm of solicitors. The judgment quotes from a letter from Walker-Smith to Wakefield:
"My position as with measles, MMR and Crohn's disease is that the link with MMR is so far unproven. It is clear that the legal involvement by nearly all the parents will have an effect on the study as they have a vested interest. I myself simply will not appear in court on this issue.
I would have been less concerned by legal involvement if our work were complete and we had a firm view. Never before in my career have I been confronted by litigant parents of research work in progress. I think this makes our work difficult, especially publication and presentation.
I am very excited by this work and it is very worthwhile. Simon Murch and I met today and have drawn up a draft for patient selection for your comment please."
I don't really need to comment, I think Walker-Smith is quite clear in his views.
The judge talks about Wakefield's press conference:
"At a press conference, which Professor Walker-Smith did not attend, convened to accompany publication, Dr. Wakefield stated publicly the view which he had previously expressed privately to Professor Walker-Smith that he could no longer support the giving of MMR vaccine. The joint view of Professor Walker-Smith and Dr. Murch, stated in a letter to Dr. Wakefield on 21st January 1998, was that it was inappropriate to emphasize the role of MMR vaccine in publicity about the paper and that they supported government policy concerning MMR until more firm evidence was available for them to see for themselves. They published a press release to coincide with publication stating their support for "present public health policy concerning MMR". Dr. Wakefield's statement and subsequent publicity had a predictable adverse effect upon the take up of MMR vaccine of great concern to those responsible for public health. There is now no respectable body of opinion which supports his hypothesis, that MMR vaccine and autism/enterocolitis are causally linked."
May be it's just my interpretation, but don't you think the judge is here drawing a definite distinction between the behaviour of Walker-Smith and Wakefield?
Then the ethical approval issue, that gets a mention too:
"Professor Walker-Smith gave unchallenged evidence that this was the last draft of the paper which he saw. Dr. Murch said, again in unchallenged evidence, that there was then a meeting attended by all of the researchers and clinicians involved to discuss the draft, which they approved. At the end of the meeting there was a discussion between Dr. Murch, Professor Walker-Smith, Dr. Thomson and Dr. Wakefield about the reference to Ethics Committee approval of "this clinical investigation", because it was a clinically driven investigation which did not require Ethics Committee approval. Dr. Murch said that Dr. Wakefield had assured them that he would liaise with the Lancet to ensure that appropriate wording was substituted. The wording in the published paper which neither Dr. Murch nor Professor Walker-Smith saw before publication was,
"Ethical approval and consent
Investigations were approved by the Ethical Practices Committee of the Royal Free Hospital NHS Trust, and parents gave informed consent."
This statement was untrue and should not have been included in the paper."
Oh, look, is it Mr Wakefield who is off putting untrue statements into the published papers, against the express wishes of Walker-Smith and the rest?
I like Respectful Insolence's take on this:
scienceblogs.com/insolence/2012/03/08/andy-wakefield-exonerated-because-john-w/
I agree with the blogger that the judge doesn't seem to have the firmest grasp of medical research issues, but then he is a Judge not a scientist. I have linked to the blog, but will quote from its final paragraph:
"From my perspective, Judge Mitting?s decision strongly implies that, rather than being involved in Wakefield?s professional research misconduct, Walker-Smith was an unwitting dupe. Neither conclusion speaks particularly well of Walker-Smith, but I suppose it?s better to be an honest dupe than a dishonest research cheat. Personally, I?d rather be neither. No matter how hard the antivaccine movement tries to spin this as some sort of exoneration of its hero Andy Wakefield, it?s not."
Cheers.

That link again:
scienceblogs.com/insolence/2012/03/08/andy-wakefield-exonerated-because-john-w/

You can't have it both ways. You cannot say Wakefield is wrong, a liar and a fraud but I agree that these children exist.

This makes literally no sense to me. You say if you agree that autism is on the rise, you can't say Wakefield's talking nonsense, despite the demonstrable nonsense posted on this thread?

What about the option: children with autism exist (does anyone doubt this???), Wakefield is wrong about the cause (with an optional side order of fraud)?

It's not a choice between these children have autism and the MMR caused it, and these children don't have autism.

Can I just add that to say 'data is data' shows an utter lack of appreciation for the limitations of data.

All data is collected in a context and will have associated limitation.

A good scientist will appreciate and respect those limitations.

A bad scientist will take an inappropriate dataset and try to manipulate it to produce their preferred end point.

I believe there are children with ASD whose parents believe they regressed or developed ASD because of the MMR. I don't deny their existence. I don't think the MMR has anything to do with their ASD, and/or regression and nor does the scientific community.

Right. You think they are deluded.

You think that you know better than the actual parents and doctors of these children.

What exactly is 'the scientific community'? There are scientists who have examined the children in question and who have found clinical evidence that points to them suffering from vaccine strain measles damage (many of these children have sky high levels of measles antibodies for example. They developed symptoms of measles after vaccination such as fever and rash, they have measles virus in the lesions in their intestines).

This subject is massively controversial and political, science does not exists as a neutral in a vacuum. Much of the 'scientific community' who refuse the idea that these children are sick as a result of the triple vaccine are the people who are responsible for the children having the vaccine in the first place. Go figure...

As for Professor Walker Smith well I'm afraid I find Orac's sneering tone and vocabulary both offensive and immature. Calling parents of sick children "the antivaccine crankosphere" is just nasty. I don't know what his interest in the subject actually is, but his contribution seems to only be spreading misinformation, writing propaganda, stroking his own clever clogs ego and being bullying and nasty to others. He is a knob with a rather too high opinion of himself for someone who gets his facts wrong so much of the time. For some reason he has a small following of cheerleaders - I always wonder what sort of person takes his nasty immature writing seriously TBH.

It is interesting (well sort of, in so much than anything that Orac produces can be considered of interest) that he admits that he knows almost nothing of Professor Walker Smith and considers him 'at best peripheral'.

Right. So Orac obviously knows very little about the team at the Royal Free and their work if he considers the main clinician and world renowned paediatric gastroenterologist as 'at best peripheral'. That of course doesn't stop him having an opinion almost as large as his ego on the matters that occurred there . People lap it though as it all adds to the B movie caricature of Wakefield The Villan.

they have measles virus in the lesions in their intestines

no they don't - unless someone shows that who is not Wakefield or has "Andy" written under their shoe, which I believe has not happened.

Beachcomber, you have stated that you'll stick with ex-doctor Wakefield.

You are not swayed by the fact that he is a liar, a cheat and a fraud and has been struck off.

Just to check, will you admit that anything he has said is bollocks or untrue?

Noblegiraffe do you remember when people absolutely insisted that there was no link between ASD and intestinal disease?

It wasn't that long ago that there was a volte face of official opinion on that.

They have had to stop trying to deny that particular link because it is just too inhumane to continue to withhold appropriate treatment from the children concerned in order to prove a point about Wakefield The Villain.

Wakefield, Walker Smith et al were right about the Lancet children. They were right about there being a link between autism and the gut. They were right about GFCF diets, they were right about the role of vitamin B12, they were right about cases of ASD increasing. Most importantly, they were right that if a child's gut problems are treated, their behavioural problems can often be helped - and the child suffers less all round.

These things have all been grudgingly admitted by magdalen's 'scientific community'. Finally. And it is getting easier for children to access medical treatment that so far has been denied them either through ignorance or politics or fear of ending up in front of the GMC and being struck off like Professor Walker Smith.

Forget about autism for a minute - one of the main struggles of these families has been in having their children's intestinal disease treated. Indeed even in having the fact they they are physically sick recognised. Children who are doubled over and screaming in pain who are failing to thrive and who have impacted bowels and or constant diarrhoea, who have multiple allergies, leaky gut and intestinal lesions have been denied treatment all because Dr Wakefield was right about their condition and he listened to the parents and the parental observation over and over and over again is that they reacted to their MMR and were never the same again. And there is no way they and he can be allowed to be right about that.

That is what I mean when I say that to cling to the idea of MMR as very safe is to deny these children's suffering and existence. They don't just exist as data - they exist as children with specific and novel health issues. To say, yeah children with autism exist but the reality and history of their physical condition does not, is inadmissible.

I understand why people need to cling to the 'MMR is safe' mantra - it has now become about more than just vaccines. But the children hurt by MMR are not to blame, they shouldn't be the ones to pay and neither should the doctors who dare to treat them.

that's a "no," then.

Beachcomber,
There are lots and lots of papers readily available which fail to implicate the MMR in regressive autism or ASD in general. Could you please supply some (not by Wakefield, obviously) that actually support this connection?
Because if there are all these children then I would guess the appropriate studies would have been done and published in at least a few cases.
I also have a question for you, if Wakefield was so "right" was it purely some weird pathological need which made him construct such a fraudulent paper in the Lancet? Or do you have an alternative explanation?
briandeer.com/solved/bmj-wakefield-1-2.htm
Cheers.

no they don't - unless someone shows that who is not Wakefield or has "Andy" written under their shoe, which I believe has not happened.

What? Excuse me?

Can you hear yourself?

no they don't

How on earth do you know different to the parents and their doctors? Who are you to know better than the people who care for these children? Who do you think you are to say something like that about a major health concern in children you have not even met.

This again is what I mean by denying the existence of these children. We grudgingly allow autistic children to perhaps exist in higher numbers before - just not the ones who inconvenience us with their inflamed guts which present symptoms of viral infection. Of measles infection. These children cannot be allowed to exist. And therefore they do not, for people like CatherinaJTV, have positive test results for measles in their diseased intestines. They may exist as statistics of autsim rates but not as actual real live people who have sick guts. How generous.

Anyway thank you CatherinaJTV for illustrating so well the success of the campaign against Wakefield in this sad and sorry medical fuck up - a campaign that so many are willing to swallow, cheerlead and prop up.

no they don't - unless someone shows that who is not Wakefield or has "Andy" written under their shoe, which I believe has not happened.

If Wakefield found the measles in their guts it doesn't exist. If anyone associated in any way with Wakefield finds measles in their guts, it doesn't exist. Erase Wakefield, erase the measles, erase the condition, erase the suffering, erase the children. They are far far too inconvenient.

Like I said earlier, data is data. If the data shows that these children have measles in their diseased guts, they have measles in their diseased guts - regardless of who found it and how much they may have pissed off the UK government by doing so.

A witchhunt of one man can only last so long. These children exist and they are sick. And like I also said earlier they are growing up and their families will one day no longer be able to care for them. It is becoming more and more difficult to pretend that these children don't exist. Their parents know what happened because they saw it with their own eyes and they have heard thousands of other parents tell the same story as theirs. They have medical records, viral tests, antibody tests, brain scans and they know what happened to their children. They will not stop their fight and therefore the truth will come out. It already is bit by bit.

No it isn't a 'no' PigletJohn. Don't put words in my mouth.

I was going to get round to your rather silly question when I had a moment. Sorry not to have given it the importance you think it deserves but it is a bit of a pointless question really in a discussion of serious health issues.

will you admit that anything he has said is bollocks or untrue

I think you need to more specific for your question to have much point. If Dr Wakefield were to say that Orac was a lovely fellow, I would think that were bollocks. HTH.

I haven't actually read everything that Dr Wakefield has ever written or said so your question is rather hors sujet.

I know that all the main points he has made about children with autism and gut issues who regressed following MMR vaccination have been proved true and are now accepted by people adamant he was wrong years ago - the damaged gut, the GFCF diet, the gut dysbiosis the vitamin B12, the similarities to childhood disintegrative disorder, the rise in autism cases, the healing of the gut helping the brain, etc, etc.

He hasn't been wrong on much yet.

magdalen I'm really struggling to take you seriously with your links to Brian Deer and Orac.

Beachcomber,
Are you happier with a whole load of scientific papers all of which completely fail to replicate Wakefield's findings? Do you prefer the fact that Wakefield is a fraud coming from the editor of the BMJ?
I am struggling to take you seriously at all, with your mindless defence of the indefensible Wakefield and complete inability to provide any scientific evidence to back up your claims. You want scientific papers showing no link between regressive autism and the MMR, I have lots. You want papers showing zero evidence of a link between MMR and ASD I have loads of them too.
What have you got? A weird need to believe the disgraced, discredited Wakefield is a "scapegoat" or victim of a "witch hunt".
Could you come up with something a little better?
Cheers.