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Steve Novella vs. Julian Whitaker on vaccines at FreedomFest

Steve Novella vs. Julian Whitaker on vaccines at FreedomFest

I’ve just returned from TAM, along with Steve Novella and Harriet Hall. While there, we joined up with Rachael Dunlop to do what has become a yearly feature of TAM, the Science-Based Medicine workshop, as well as a panel discussion on one of our favorite subjects, “integrative” medicine. Between it all, I did the usual TAM thing, meeting up with old friends, taking in some talks, and, of course, spending the evenings imbibing more alcohol than I probably should have so that I could look and feel my best for our morning sessions, particularly given my difficulty adapting to the time change. One thing I did was completely unexpected, something I learned about the night before our workshop when I happened to run into Evan Bernstein. He informed me of something that our fearless leader Steve Novella was going to do the next day right after our workshop. In a nutshell, Evan told me that Steve was going to debate an antivaccinationist. Evan didn’t know any details other than that Michael Shermer had arranged it and that Steve had been tapped at the last minute. Evan didn’t even know who the antivaccinationist was going to be or what the event was. Naturally, I was intrigued.

So, the next morning I asked Steve about it. I turns out that the event was FreedomFest, a right-wing/Libertarian confab that happened to be going on at the same time as TAM up the road a piece on the Strip at Bally’s. Steve didn’t know who the antivaccinationist was going to be either, which made me marvel at him. I don’t know that I’d have the confidence agree to walk into the lion’s den with less than a day’s notice not even knowing who my opponent is. Steve was more than happy to invite me along. Clearly, this was was an opportunity that I couldn’t resist. So we met up with Michael Shermer, and it was from him that I learned that Steve’s opponent was to be Dr. Julian Whitaker.

My eyes lit up.

To my surprise, neither Steve nor Michael knew who Dr. Whitaker was. Being more than happy to give them some background on Dr. Whitaker, I told them. Regular readers here might remember that I’ve mentioned Dr. Whitaker before. First off, he’s a big fan of Dr. Stanislaw Burzynski, serving as the primary pro-Burzynski medical “expert” in that propagandistic paean to the brave maverick doctor, Burzynski: The Movie:

Dr. Whitaker is also big among the “alternative medicine” crowd for his claims to be able to cure diabetes “naturally,” without food or drugs (of course!). In doing so, he claims that metformin doesn’t work, antibiotics don’t work (because, apparently, they don’t succeed in saving every diabetic foot) and that, in general, conventional medicine doesn’t work. At his Wellness Center, he treats patients with diabetes and heart disease with acupuncture, nutritional supplements, diet, hyperbaric oxygen, chelation therapy, and a wide variety of other questionable therapies. (Hyperbaric oxygen could work for diabetic feet, but chelation therapy is useless and dangerous and acupuncture is nothing more than placebo medicine).

If you really want to know all you need to know about him in a nutshell, I’ll simply state that Dr. Whitaker is apparently one of Suzanne Somers’ doctors and was featured prominently in her cancer quackery book Knockout.

But how did this whole event come about? According to Shermer, apparently the doctor who was originally going to be Dr. Whitaker’s opponent, a local pulmonologist, became ill at the last minute and couldn’t appear. I rather suspect in retrospect that Dr. Whitaker probably now wishes that his original opponent hadn’t been forced to bow out. (You’ll see why soon enough.) The next question I wondered about was: Why was this pseudodebate going to be held at FreedomFest? That’s easy. If you look at the FreedomFest program and scroll down to Dr. Whitaker, you’ll note that he is the founder of the Freedom of Health Foundation, which is, as you probably guessed, an organization designed to promote “health freedom” (or, as I like to call it, freedom for quacks from pesky government interference directed at protecting the public). Not surprisingly, he is very much opposed to California Bill AB2109, which would mandate informed consent for parents who want to claim religious or philosophical exemptions to school vaccine mandates. Kimball Atwood has written about these sorts of organizations before and mentioned Dr. Whitaker in particular.

So, the stage was set. Michael Shermer invited us to hop into his car, and we headed up to the strip to join the battle.

The debate

We arrived at Bally’s about 45 minutes before the debate was scheduled, wending our way through the casino and hotel to easily find the convention area where FreedomFest was being held. Even though we hadn’t registered and didn’t have a badge, the organizer Mark Skousen was more than happy to let us wander around the exhibit area until it was time for the debate. It was an interesting experience, but not really appropriate for SBM. (Maybe I’ll discuss it elsewhere at my not-so-super-secret other blog. For one thing, we saw Steve Forbes walk right past us.) In any case, we arrived at the Silver Room, where the debate was to be held, and I immediately saw that something else was wrong. As we entered the room, we immediately encountered a woman passing out pens and small note pads. That wasn’t the problem. The problem was that she was also passing out a newsletter, Dr. Whitaker’s Health & Healing: Your Definitive Guide to Wellness Medicine. It was the September 2011 issue, and, emblazoned across the page was a large headline Vaccinations: The Destruction of Our Country. This does not bode well, I thought, as I thumbed through the newsletter, which packed pretty much every major antivaccine trope into a single article.

As you might imagine, I immediately recognized Dr. Whitaker. He’s not hard to miss, being a rather large, gregarious, and somewhat imposing man, who immediately came up to greet Shermer.

Then I saw the moderator.

My first thought was that she looked very, very familiar, but I just couldn’t remember who she was. Then, hanging in the background given that I wasn’t the featured speaker and was basically tagging along for support, I saw her introduce herself and Dr. Whitaker to Steve and Michael as Leslie Manookian. It was then that I knew that this was going to be a typical pseudodebate over pseudoscience. Before Steve went up on stage, I warned him that I thought Dr. Whitaker was probably pretty slick and might well be able to do the Gish gallop with aplomb. I also warned him that the moderator was a die-hard antivaccine propagandist, having made—you guessed it!—a propaganda movie that I reviewed last year, The Greater Good. I later learned that there were going to be two screenings of the movie at FreedomFest, one at 8 PM that night and one the next afternoon. Lovely, I thought. The health freedom wing of the Libertarian movement is flaunting its embrace of antivaccinationism at one of its big conferences. Marvelous.

And so the debate began. Manookian started out by saying she never questioned vaccines until “she met a guy.” Apparently, this guy believed that his child had been rendered autistic by vaccinations, having regressed within a fairly recent time frame after a round of vaccines. She then “did research” and became increasingly appalled by what she found, which, from what I could tell, were mostly anecdotes and the usual pseudoscientific arguments used by antivaccinationists. As a result, Manookian became an antivaccinationist—sorry, a vaccine “skeptic”—so much so that she went on to make an antivaccine propaganda movie, to which I subjected myself in order to review.

She then went on to start the debate out by asking Drs. Whitaker and Novella why there is a “debate” about vaccines. At this point, my teeth immediately began to grind, to the point where I feared for my molar enamel. This is a typical framing of what I (and many others) like to call a “manufactroversy.” Basically, the word manufactroversy is short for “manufactured controversy” and is basically a pseudocontroversy that is created to oppose conclusions overwhelmingly supported by the evidence and/or science. Examples abound, of course: Anthropogenic global warming, vaccines, much of alternative medicine, “9/11 Truthers,” and “birthers.” The bottom line, is that there is no scientific controversy over whether vaccines cause autism. The question has been asked multiple times and answered multiple times: No. Of course, being a scientist, I have to qualify that just a little bit by saying that “no” means that we can’t detect an effect above the noise level of the epidemiological studies that have been done. In other words, even if there is an effect, it is so small that it can’t be detected by current epidemiological methods, which can detect pretty darned small effects. For all intents and purposes, as far as science can tell, vaccines do not cause autism. Neither does the mercury in the thimerosal preservative that until 2001 was used in many childhood vaccines. They just don’t; scientists have moved on, regardless of what antivaccinationists claim.

Dr. Whitaker started out with what was essentially the same old tropes, including confusing correlation with causation, harping about how autism prevalence has appeared to skyrocket since the 1980s and 1990s. He made the claim that almost no child was developmentally disabled 30 years ago but now one in 88 children are diagnosed as having an autism spectrum disorder. During this segment, he also went on about how chronic diseases are skyrocketing along with autism and that it must be the evil vaccines. OK, I added the “evil” part, but it was quite clear that Dr. Whitaker thinks that they are evil. He made that very clear. So did Manookian, for that matter.

This was just the warmup. Steve, as you might imagine, easily demolished these arguments, pointing out that correlation does not equal causation. He also discussed how there have been several very large studies that controlled for relevant variables have failed to find even (as I like to put it) even a whiff of a hint of a correlation between vaccination and either autism prevalence or onset. He discussed how we as humans are hard-wired to infer causation from observed correlation, which makes it very understandable that people mistakenly conclude that vaccines cause autism? Why? Because, as we’ve discussed time and time again here, autism is often diagnosed in the age range when children receive a lot of vaccines, which means that by random chance alone we will often see diagnoses made in close temporal proximity to a round of vaccinations. Moreover, it was easy for Steve to point out that diagnostic criteria were broadened in the early 1990s, that schools started screening for autism, and that schools also got funding from the government to help autistic students. Again, Dr. Whitaker’s arguments were softball pitches, easily hit out of the ballpark as Prince Fielder hit balls out of the ballpark three days earlier in the pre-Allstar Game Home Run Derby. In essence, Dr. Whitaker made the same sort of ignorant arguments that Dr. Jay Gordon regularly makes, as exemplified in the comments after this excellent post by Emily Willingham why the “autism epidemic” is no epidemic at all.

There are only two areas where I would have added more than what Steve added. It doesn’t take much time to do so, but it can be very illuminating to the audience. First, I have some examples that I like to use to demonstrate why it’s silly to infer that vaccines cause autism just because autism prevalence has increased correlating with an increase in the number of vaccines. For example, what else happened in the early 1990s? Cell phones started to make an appearance, and by the early 2000s were ubiquitous. Maybe cell phones cause autism! (Wait, it’s probably already been claimed.) Or here’s another one. Before 1990, Internet usage outside of universities was pretty minimal. Even I, the wired, blogging, connected individual that I am now, did not have consistent online access until 1990 and didn’t use it a lot until two or three years later. Indeed, Netscape Navigator didn’t even show up until 1994. The point, of course, is that during the 1990s, Internet usage took off. So obviously the Internet causes autism!

The second thing I like to emphasize is that it’s a general rule in medicine that the more you look for something, as in launching mass screening programs, the more you will find it. Always. Consider ductal carcinoma in situ (DCIS), which is a premalignant precursor of breast cancer, a certain percentage of which (not fully known) will progress to become breast cancer. Back in the early 1900s, DCIS was rare because by the time it grew large enough to be a palpable mass, it almost always had become invasive cancer. Now, thirty years after mass mammographic screening programs became prevalent, DCIS is a common diagnosis. Indeed, approximately 40% of breast cancer diagnoses are in fact DCIS, and a recent study found that DCIS incidence rose from 1.87 per 100,000 in the mid-1970s to 32.5 in 2004. That’s a more than 16-fold increase over 30 years, and it’s pretty much all due to the introduction of mammographic screening. This sort of thing should not be surprising to doctors, but apparently sometimes it is.

Dr. Whitaker emulates Penn Jillette, but not in a good way

It was at this point that Dr. Whitaker lived up to the name of Penn Jillette’s Friday night party at TAM: He brought the stupid. Oh, man, did he bring the stupid! I’m sorry. I know that we’re not supposed to be quite so harsh here on SBM, but it’s been a long time since I’ve seen such a glaring example of mathematic, statistical, and scientific illiteracy. First, he stated unequivocally that he thought that vaccines were the primary cause of autism, scoffing at the idea that it was primarily genetic in nature or that vaccines were not causing it. As bad as that was, worse was to come, and it did when Dr. Whitaker showed this graph (sorry for the poor quality; the room was dark and all I had was my iPhone):

I reproduced this graph from his newsletter because I instantly saw that it was the same graph:

I want you to sit back for a minute and drink in the utter silliness of this graph, the utter lack of science, the utter nonsense. It’s been a long time since I’ve seen its like. I’m sure many of you can figure out what’s wrong with it on your own, but my duty as blogger demands that I explain, and I’ll give it exactly the time it deserves. Take a look. Notice how Dr. Whitaker extrapolates from a small dataset to produce curves that go right up to 100/100, or 100%. Steve’s jaw (and mine and, I daresay, Michael Shermer’s jaws) dropped in astonishment. That’s right. Dr. Whitaker produced a graph that predicted that by the year 2032 all boys will be diagnosed with an ASD and that by 2041 all girls will also have autism. I kid you not. Lest you think that this wasn’t Dr. Whitaker’s intention, that he didn’t know the implications of his extrapolation, I will quote from the relevant section of Dr. Whitaker’s newsletter discussing the graph:

Let’s do some simple math based on these solid statistics. Beginning in 1990, when the mass vaccination program took off, the incidence of autism and autism spectrum disorder in children exploded. The projections indicate that by the year 2031, virtually all male children will be diagnosed with autism or autism spectrum disorder, followed by all girls in 2041. Autistic kids will surely outnumber normal kids in the relatively near future. How will our society function if all kids age 10 and younger are so disables. This is the most frightening projection I can imagine, and it is simple math!

What is going on? The one obvious and absolute constant for these skyrocketing numbers of autistic and learning disabled children is vaccinations. Over the last 25 years, the number of vaccinations forced on our children has virtually exploded. Why? Are measles, mumps, chicken pox, and flu really that dangerous? In my opinion, irrevocable harm caused by vaccinations is infinitely worse than the diseases we vaccinated against.

Later, Dr. Whitaker writes:

There are only two things that can stop this madness. First, parents must have the right to decide what is injected into their children. Second, laibility must be borne by the pharmaceutical companies.

If these two things happen, we might recover from this nightmare. If they don’t, armed guards will be escorting our children to vaccination centers, and, within a few decades, our children—and our country—will be destroyed. Many of you will live to see this devastation. But most of your children and grandchildren will be so damaged by vaccinations that they will not notice it. They will be lost to autism. That, my friends, is simple math.

Apparently Dr. Whitaker doesn’t recognize the difference between “simple” and “simple-minded.” I do rather admire the apocalyptic imagery for its sheer paranoia. Fortunately, he restrained himself from using imagery quite as overblown during the debate.

To cap it off, Dr. Whitaker scaled the Y-axis to go up to 120. This was so bad that I almost felt sorry for Dr. Whitaker. When Dr. Novella explained why these graphs were so silly, the audience “got it” instantly, and it was at that point that Dr. Whitaker began to lose the audience.

It was also at this point that I realized that I could actually do what Steve does. On balance, I knew how to answer all of Dr. Whitaker’s arguments as well as he did. In some cases, Steve did better than I probably could have. In other cases, I think I could have demolished Dr. Whitaker’s arguments even better than Steve did. What I lack is Steve’s preternatural ability to stay calm and not openly reveal his contempt for such a silly argument. Maybe I need to learn that. In the meantime, I was content to serve as Steve’s bulldog, which is why I went up to the table to see Dr. Whitaker after the talk and ask some pointed questions about how he generated the graph. There was a real statistician there who also couldn’t believe how bad that graph was and was asking questions that I hadn’t thought of. Together, we completely flummoxed Dr. Whitaker.

We didn’t pull any punches, either, asking where he got the data, how he generated the data, what mathematical model he used to produce the graph, how he fitted the curve, how he could justify extrapolating so far from such a limited data set, how he decided what curve to fit, and how he can justify a curve that goes to 100% when there is virtually no condition that 100% of the population will suffer from except for (eventually) death. His answers were—shall we say?—not exactly convincing. He said the data were from the CDC (fair enough, although it would be interesting to know more specifically where he got his dataset) and that he just projected from the existing data. He had no clue, however, what mathematical model was used, what computer software was used, or what assumptions were made. He took my email address and promised to get send me the information. I have yet to receive it, despite sending Dr. Whitaker a friendly reminder on Twitter (@WhitakerMD; so feel free to “remind” him). To be fair, I will post about this again if he ever comes through. In the meantime, I really need to train myself to be more like Steve in these situations.

At least, I did get this amusing picture out of it.

I’m totally making this my Facebook profile picture for a while. I have other ideas of fun things to do with it. Another byproduct of my having met Dr. Whitaker is that I now know that he knew who I was and had read my review of The Greater Good. The best riposte he could come up with about it was to say, voice dripping with sarcasm, that he agreed that it was horrible that Leslie Manookian had changed her name. Of course, if you read my actual review of The Greater Good, you’ll realize that my point was that I thought she might have done that to make it harder to figure out that there is evidence on the web that she has practiced as a homeopath. Given his performance in the debate, I highly doubt he could refute one bit of science in it.

And all the rest

But enough of my shortcomings. How did the rest of the debate go? Well, it actually went pretty much like the first part of the debate. Steve basically mopped the floor with Dr. Whitaker. There was nothing left, not even a stain on the chair—metaphorically speaking, of course. It was actually rather painful to watch, in the way that it’s painful to watch one baseball team get pummeled by 12 runs, even when it’s a baseball team I really detest, like the New York Yankees. However, there was no “mercy rule” in debate. Basically, Dr. Whitaker trotted out a number of antivaccine “greatest hits,” and Steve pummeled him for it. For instance, Dr. Whitaker showed this graph:

Yes, this graph is yet another example of one of the oldest and most deceptive antivaccine tropes, one that I like to call the “vaccines didn’t save us” gambit. Basically, this intellectually dishonest—downright deceptive, actually—tactic involves pointing out that mortality was falling from a given infectious disease before a vaccine for it was introduced. In this case, it was measles and a few other diseases. The implication that antivaccinationists want people to draw is that hygiene, sanitation, and the like were the “real” causes of the decrease. The long version of the rebuttal this gambit is here. The short version is that disease incidence does not equal mortality and that measles incidence plummeted after the introduction of the vaccine. The reason mortality was falling before the vaccine was for other reasons. Medical care was getting better, and a smaller percentage of people who got the disease died from it. In fact, Dr. Whitaker explicitly stated the false premise behind this gambit, saying at one point that incidence equals mortality. Quite appropriately, Steve called him out on it, and did it in a way that the audience understood it.

Other issues that came up included some dubious antivaccine studies that we’ve covered at various times before, including some dubious antivaccine studies that we’ve covered at various times before. Dr. Whitaker also called for a “vaxed vs. unvaxed” study, but completely misunderstood the issues involved. He apparently thinks that such a study would could consist of just looking at vaccinated versus unvaccinated children without controls for various confounding factors. However, at times he seemed to be calling for a randomized “vaxed vs. untaxed” study, because at one point he complained about studies not having placebo controls. Steve pointed out that such a study would be unethical. Dr. Whitaker also complained about randomized studies of new vaccines because the placebo control wasn’t just saline but had all the other ingredients besides the antigens, including adjuvants, seemingly not realizing that, scientifically speaking, that is an even more appropriate control than saline.

Finally, the bulk of the last one third of the debate was more about politics than about science. Dr. Whitaker brought up a Supreme Court decision last year related to vaccines, specifically Bruesewitz v. Wyeth. He didn’t call it by that name, however; but it was obvious that that was what he was talking about. Not surprisingly, he also misrepresented the decision as stating that parents cannot sue vaccine manufacturers for vaccine injury. This is, of course, nonsense. The National Vaccine Injury Compensation Act of 1986, signed into law by President Ronald Reagan, established a no-fault compensation system, paid for by tax dollars, for children injured by vaccines. It created a new special court, the Vaccine Court, through which claims for compensation have to go through first.

This law was necessary because a flood of lawsuits was threatening the very foundation of the vaccine program, and Congress feared that there would be no vaccine manufacturers left in the United States because liability concerns would drive them out. Reasons for the law aside, not only do parents who think their children have been injured by a vaccine have recourse to the Vaccine Court, where, win or lose, their attorneys’ fees are paid by the government, parents who do not prevail in Vaccine Court can then sue in regular courts. The law simply says that they have to go through this special court first. The Vaccine Court also happens to have easier rules of evidence (i.e., not applying Daubert tests to expert witness testimony) and in essence bends over backward to try to compensate children injured by vaccines. Not only that, but the Vaccine Court reimburses claimants for reasonable attorney and court costs and, as a result, has become a bit of a gravy train for a certain group of lawyers who represent parents in front of the court. In any case, although there are a bunch of nuances about product liability and other issues, when you boil it down to its essence, all Bruesewitz v. Wyeth says is that the law as written currently prevents parents who do not prevail in Vaccine Court from suing in state court. They have to go to federal courts.What Dr. Whitaker harped on is what antivaccinationists always harp on about this decision is a line from the dissent by Justice Sotomayor about vaccines being “unavoidably unsafe.”

That was the CliffsNotes version of the ruling. You can find out more here and here.

The final question was a simple one: Should there be mandatory vaccination? Obviously Dr. Whitaker railed on about “health freedom” and how parents should have the right to control the health care of their children. I also rather suspect that this was the main reason most people attended, because the audience definitely got antsy when the discussion veered away from this topic after the question was mentioned. Steve wisely took the tack that this is a political question, not a scientific question. He then reiterated that the science is clear: School vaccine mandates lead to higher vaccination rates, which lead to lower rates of vaccine-preventable illnesses. It is thus up to us and the political process what we wish to do with these scientific findings. And that’s what I usually say, too. Science informs policy, but it is the political process that determines policy. School vaccine mandates work, and at the very least it should be as hard to get exemptions, be they religious or philosophical, to such mandates as it is to follow the vaccine schedule. But that’s just my view. Unfortunately, this was not the first time that FreedomFest has promoted antivaccinationism and “alternative” medicine. Later, I found last year’s list of FreedomFest speakers, and Dr. Whitaker was listed there, having presented a talk entitled Vaccines: Good or Bad? (gee, I wonder on which side he came down), and in 2010 he presented a talk entitled “Treatment for Heart Disease, Diabetes, and Cancer; the good, the bad, and the stupid.” There’s no doubt that Dr. Whitaker is good at presenting stupid arguments. The problem is that he doesn’t know which arguments are stupid and which are not. I don’t know which conclusion flowing from Dr. Whitaker’s performance is scarier: That he actually believes this stuff and can’t see how unscientific it is or that he knows how unscientific his arguments are but makes them anyway.

When all is said and done, I must admit that I was actually rather shocked at the outcome of this debate. I say that not because I don’t have total faith in Steve’s abilities and didn’t expect him to acquit himself well, but rather for the same reason that I’ve always thought it was a bad idea to debate pseudoscientists. I realize that not everyone agrees with me about this, and, because Steve and I are brothers in arms against quackery, it was a no-brainer to support him in any way I could. Be that as it may, I expected Dr. Whitaker to be much slicker and harder to handle than he in fact turned out to be, such that in the end the audience might have been left with the impression that there were two scientifically legitimate sides to this issue (exactly the reason why I don’t like “debates” with pseudoscientists). Quite frankly, though, Dr. Whitaker was painfully bad, and I felt really stupid for having so massively overestimated his capabilities at debate and rhetoric. On the other hand, it’s always better to overestimate your opponent than to underestimate him. In any case, Dr. Whitaker made easily rebutted arguments, couldn’t even Gish Gallop very well at all, was ignorant of the science, even bad studies that purport to show a link between vaccines and autism, and appeared completely flummoxed by obvious points that any halfway decent debater would expect his opponent to make. In short, he looked every bit as though he had expected a cakewalk and as though he is used to adoration, not challenge. Steve gave him a challenge, and more, and from the reaction of the audience I’m also pretty sure that Steve got through to at least a few fence sitters. Even in an audience predisposed towards “health freedom,” good arguments can win out over bad. Still, I wonder whether they would have won out if Dr. Whitaker hadn’t been such an atrocious debater.

I will finish by pointing out that it’s one thing for an antivaccine “party” like the Canary Party to link up with a local Tea Party organization, as Kent Heckenlively crowed about recently. It’s quite another thing when a national meeting in which many of the luminaries of conservatism, libertarianism, and the Tea Party movement go to pow-wow together allows such rank antivaccine nonsense a prominent place in its program, complete with a pseudo-”debate” and two screenings of a movie that is nothing more than rank antivaccine propaganda disguised as a “tell both sides”-style “balanced” documentary. I noted above that this is not the first time this has happened, but I also checked the 2008 and 2009 speaker lists. There was no Dr. Whitaker, nor were there any talks on vaccines. That makes me think that giving the “health freedom” and antivaccine movements a forum is a relatively recent feature of FreedomFest for which Mr. Skousen should be profoundly ashamed. One can only hope that he is sufficiently embarrassed by Dr. Whitaker’s and Ms. Manookian’s performance that he does not invite them back next year. That they were ever given a forum at all at FreedomFest will be a blight on the conference for years to come.

Posted in: Neuroscience/Mental Health, Politics and Regulation, Vaccines

Leave a Comment (454) ↓

454 thoughts on “Steve Novella vs. Julian Whitaker on vaccines at FreedomFest

  1. BiggsHoson says:

    I would really like to see this debate (I, for one, enjoy watching a good one-sided battle). Do you know if there was any plan to post it to the interwebs?

  2. Jimmylegs says:

    I hope someone recorded this debate, I enjoy watching debates to see how people argue and what counters can be used for said arguments.

    There was one bit of your post I found confusing, perhaps I’m reading it wrong or misunderstanding.

    “[P]arents who do not prevail in Vaccine Court can then sue in regular courts.”
    compared to:
    “Wyeth says is that the law as written currently prevents parents who do not prevail in Vaccine Court from suing in state court. They have to go to federal courts.”

    The wording for me was a bit confusing so I ask for clarification.

    I also commend Dr. Novella for accepting the debate offer in, what I would say, an unacceptable time frame. I say it speaks volumes for his ability to think on his feet and with minimal prep.

    I hope someone did record it and if I find it I will forward it to here.

  3. Chris says:

    Oh, I wish I could have been there!

    I am also very curious about that graph. Typically on a graph you put larger points (or other graphics) to designate those locations that you have actual data. The line would only be the estimated fit for the graph. This is why the graphs actually have points that are not on the line, and you hear the terms “R-squared” and “nonlinear regression.”

    In other words: extrapolate past the available data with caution. Especially if you think going to 120 out of 100 is actually feasible. I actually like the imaginary* number, but that is ridiculous!

    I want to know where those big fat points come from. Especially the ones that actually show a change of exponential slope above 90%. Why does it decelerate then? Actually, there are well known caveats and biological mathematics that would have caused that line to level out. They are even mentioned in my engineering math book! I am sure that anyone who has done epidemiology or biological statistic is familiar with them.

    It is really an example of making stuff up that has no relation to reality.

    * When I refer to a “imaginary” number, I mean the square root -1, aka “i” (or “j” for electrical engineering). Despite the name, it is a very real mathematical concept, and is very important to many engineers.

  4. I am, of course, glad with how Dr. Novella performed, but I don’t see the point of these debates. All it does is give these psychotic wackjobs a platform for their nonsense.

    I believe it was in “A Devil’s Chaplain” that Dawkins wrote to Mayr, advising him to no longer debate creationists, because doing so gives the illusion that evolution and creationism are on the same level, as if both are equally probable. Similarly, when a well respected medical doctor debates an idiot anti-vaccinationist, it makes it seem as if either platform is likely correct.

    That said, great job Dr. Novella.

  5. daedalus2u says:

    A slight correction. The Vaccine Court does use the Daubert standard, it is applied by the Special Masters after hearing testimony (because they are sophisticated enough to apply the Daubert standard themselves). It is the level of proof that is relaxed. Normally it is the “preponderance of the evidence”, in Vaccine Court it is “more likely than not”.

    What I like about the graph projecting the incidence of autism is that when the incidence in the general population reaches 100%, the incidence in girls is still only 70% or so. Now that is a serious disease when the incidence can be 100% while not everyone is affected.

  6. Mojo says:

    @daedalus2u

    By that point the incidence in boys will be around 120%, hence the y-axis on that graph.

  7. Chris says:

    I knew that the lines had no basis in reality (and it was way past my bed time when I first saw this), so it makes sense that the none of the lines would converge near, or even at 100%.

  8. David Gorski says:

    A slight correction. The Vaccine Court does use the Daubert standard, it is applied by the Special Masters after hearing testimony (because they are sophisticated enough to apply the Daubert standard themselves).

    Well, yes and no. Daubert is normally used to determine what expert testimony will be allowed during a hearing. Since the Special Masters allow pretty much all testimony (hence some of the quacks and pseudoscientists who testified at the Autism Omnibus hearings), it’s not unreasonable to say that Daubert standards are not used to decide who is allowed to testify. I could have perhaps made that more clear. I have also pointed out how the standard of evidence allowed in the vaccine court is lower than it is in regular courts, but perhaps I didn’t do it strongly enough here.

  9. dariaclone says:

    I’m a relatively new follower to this blog–arriving here after my aunt was looking “to go to Mexico” for her cancer treatment. I have a four-month old, so I’m particularly frustrated by the anti-vaccine types right now. I’ve been subjected to anti-vaccine article after article via Facebook (from close relatives, so not really the type to re-friend). And one hand, I agree with SkepticalHealth that arguing gives them legitimacy. But the problem is that if doctors don’t, who does? By letting some of the arguments hang unanswered, it does draw new people in–I’ve seen it happen. Or is it my job as a non-medically trained person? I think I would actually like to see more argument.

  10. daedalus2u says:

    It is a minor point, the Daubert standard is like a “gatekeeper” as to what evidence is sufficiently valid to be admitted as evidence and used to determine the outcome of the trial. That standard didn’t change in the Vaccine Court, the special masters applied it after hearing evidence rather than applying it before the testimony was given. The Special Masters specifically mentioned this in the trial.

    The only reason the special masters could do that is because they are sufficiently knowledgeable to apply that standard themselves. A jury of non-experts can’t apply that standard because they don’t have the expertise, hence the court has to apply it before evidence is submitted to the jury.

    It is a subtle point, but it is like how scientists of sufficient expertise can read non-peer reviewed articles and separate the wheat from the chaff, while non-experts cannot. Expertise doesn’t change that the standard of care still has to be based on the best and multiply-validated science, but lower levels of evidence can be used for lesser purposes, such as hypothesis generation. Similarly, while anecdotes are not enough evidence to treat someone, anecdotes of adverse effects can be enough to stop a treatment that seems to be doing something harmful, but that depends on a lot of other things.

    What I find interesting and surprising is how none of the Libertarians seem to mind being lied to and deceived by quacks and charlatans. That graph is egregiously and stupidly wrong. It could easily be disproved with fourth grade arithmetic. Yet no one pointed this out to the presenter and he had it printed up and embarrassed himself with such a silly and stupid mistake.

    What that means is either no one who knew fourth grade math had reviewed it, no one who knew fourth grade math reviewed it and bothered to report the mistake, or anyone who reported the mistake was not listened to. This reflects not just on the presenter, but also to every audience that he has ever presented this graph to.

    Is this really what Libertarians want? The freedom to be lied to and defrauded? Their children endangered by vaccine denialists?

  11. icewings27 says:

    Actually, that graph might be correct. Have you hung around a playground lately? There are so many kids that are on the autism spectrum it’s ridiculous.

    Personally, I think that there’s a genetic predisposition to autism, and it is brought out by the poor diets and lack of social interaction these kids have early in life. I can’t tell you the number of parents that say, “Oh, my two-year-old only eats hot dogs and Spagettios.” Or something horrible like that. And, they watch hours and hours and hours of “screen time” every day. No wonder their brains are addled.

  12. CarolM says:

    I thought the antivaxers blamed the thimoseral preservatives for autism. Or did they just go on to some other theory? because I heard the manufacturers stopped using thimoseral years ago, with no effect on the number of new autism diagnoses.

    Oh never mind..I guess the antivax movement is too *robust* to be slowed down by that anyway.

  13. Chris says:

    icewings27:

    Actually, that graph might be correct. Have you hung around a playground lately?

    Yes, and very often you cannot tell the autistic child against any other child. Most kids are perfectly normal.

    And no, you cannot have 100% of all kids having autism, and yet only about 70% of the girls. That graph cannot be correct if it has that kind of simple adding error.

  14. David Gorski says:

    What I find interesting and surprising is how none of the Libertarians seem to mind being lied to and deceived by quacks and charlatans.

    Actually, that’s not entirely true. A statistician attending the conference joined me in challenging Dr. Whitaker after the talk. If anything, he was even blunter than I was in challenging Dr. Whitaker. As we left the meeting room, it was clear to me that he was definitely angry that a session presenting such pseudoscientific arguments and pure antivaccine propaganda had made it onto the program of FreedomFest. In fact, you remind me; I promised to e-mail him a link to my post (his wife gave me her business card).

  15. PJLandis says:

    “I thought the antivaxers blamed the thimoseral preservatives for autism. Or did they just go on to some other theory? because I heard the manufacturers stopped using thimoseral years ago, with no effect on the number of new autism diagnoses.”

    I think “too much, too soon” is the biggest claim these days. That somehow taking too many vaccines, at an early age, causes autism or whatever else develops at that age.

  16. Jimmylegs says:

    @icewings27:
    ” “Oh, my two-year-old only eats hot dogs and Spagettios.” ”

    I have to comment because my mom would try to get us to eat other things when we were kids but all we wanted were hot dogs. It should be noted we ate hot dogs a lot because we were poor and were denied food stamps (dad made $20 too much per month) but that’s another point entirely. When we could eat other food, we didn’t want it. At some point that changed, what age I cannot say cause I do not know but it could not have been too much after the age of 5 because schools don’t always serve hot dogs for lunch.

    The point I’m making is that a food preference does not mean anything, if the kids at the play ground are kids of friends ask again what the kids like to eat in a year it will probably change. Another point of that quote, did you ask if they are offered anything else or do they demand hot dogs and Spagettio’s?

    An interesting thing about the graph, because you feel it might be correct, is why does it have a nice smooth curve, but at the end it gets a sharp “turn?” Where did this change occur and why? Well we already know, from Dr. Whitaker that “He had no clue, however, what mathematical model was used, what computer software was used, or what assumptions were made.” So until Dr. Gorski gets an e-mail explaining, in mind numbing detail, how this graph was made I will assume he pulled it out of his ass.

    For the future how is the command to quote? Is it the same in forums?

  17. Chris says:

    jimmylegs:

    For the future how is the command to quote? Is it the same in forums?

    No, not quite. It is a blockquote. Also, instead of the square brackets it is the less and greater than brackets.

    How to use a blockquote: <blockquote>Put paragraph of person you are quoting in here.</blockquote>

  18. Neil J says:

    @Jimmylegs

    An interesting thing about the graph, because you feel it might be correct, is why does it have a nice smooth curve, but at the end it gets a sharp “turn?”

    This one’s easy. The graph was obviously made in Excel (there’s strike one right there), and the person who produced it simply fit an exponential growth curve to the existing data. I won’t even get into how contrived and improper it is to choose an exponential growth trend in this instance. Anywho, they hit a point where the extrapolated data for the next year would exceed 100%, so they clumsily cut it down to exactly 100%, thus the dropoff in slope for these final data points.

    A better approach would have been to pick out the x-coordinate where each trendline hits y=100, and stop plotting them there.

    And the y-axis going up to 120 is just the default setting for Excel scatter plots. Whoever made this put about as much effort into making it look nice as they did into having it make sense. I’ve made plots that look this terrible before, but never in a million years would I have considered publishing them.

  19. BillyJoe says:

    icewings27,

    “Personally, I think that there’s a genetic predisposition to autism, and it is brought out by the poor diets and lack of social interaction these kids have early in life. ”

    Who cares what you personally think. What matters is what neurologists have concluded based on the accummulated evidence. Against that, you personal opinion is not worth [expletive deleted]. ;)

  20. It’s pretty interesting that every non-scientific allegation that claim sth extraordinary make the same pattern of mistakes. Most notable is the correlation-causation and the cherry-picking, with all the variance of bias. For I scientist this is really boring, but not for the general public. The most important of the “debate” it’s to show to public that data was manipulated in order to make them believe in this emotion claim. Oh my kid !

  21. pmoran says:

    With respect to all this emphasis on correlation not proving causation, don’t forget that correlation is definitely permissive of causation. In most instances where we make this point there are a lot of other plausible or more plausible explanations for the outcomes observed. That is not the case with vaccines and autism. Toddlers don’t use mobile phones, for example.

    So highlighting this point up front is as much as admitting that there is a correlation to be explained while lacking a ready alternative explanation.

    Most of our case is that there is no real increase in autism rates, is it not?

    Our case is that there is no correlation.

  22. David Gorski says:

    None of us have ever said that correlation doesn’t suggest causation. Correlation might mean causation, but often it does not. That’s why we often say that “correlation does not necessarily mean causation.”

    In any case, there is a correlation, at least in the US, between the number of vaccines and autism prevalence, although it’s a weak one and the antivaxers often have to find ways to exaggerate the number of vaccines in order to give the appearance of a correlation. Autism prevalence, measured in the standard ways, clearly rose rapidly over the last 20 years. There is no debate about that. The point is to hammer antivaccinationists for assuming it must have been the vaccines when there are other explanations that explain this apparent increase, such as broadening of the diagnostic criteria, increased screening, and diagnostic substitution. Then the point is to hammer that there are other things that correlate with the rise in autism diagnoses in order to hammer home that point. It’s reductio ad absurdum.

  23. lilady says:

    For the time being…and until Dr. Whitaker pulls down my comments and his replies to me on his blog…for your “reading pleasure”

    http://www.drwhitaker.com/new-legislation-seriously-misleads-parents-about-vaccine-safety

  24. jwa says:

    my favorite mathematical artifact of the “Autism Incidence in US Children” graph is that “Gen’l Population” of US Children reaches 100% autism after “Boys” but several years before “Girls” reach 100%. I guess Girls+Boys is not equal to Gen’l child population.

  25. norrisL says:

    In Australia the Fed Gov pays families $2100 to complete a child’s course of vaccines. Don’t complete or worse still don’t start, no money. UNLESS………….

    UNLESS you are a conscientious objector, then you can also have your 2100!!!!!

    WHAT THE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    How stupid could a government be; to pay people to NOT vaccinate their children?

    aaaaaaarrrrrrgggggghhhhhhh

    Pleas let me know if you can make sense of this, because I cannot

  26. pmoran says:

    None of us have ever said that correlation doesn’t suggest causation. Correlation might mean causation, but often it does not. That’s why we often say that “correlation does not necessarily mean causation.”

    In any case, there is a correlation, at least in the US, between the number of vaccines and autism prevalence, although it’s a weak one and the antivaxers often have to find ways to exaggerate the number of vaccines in order to give the appearance of a correlation. Autism prevalence, measured in the standard ways, clearly rose rapidly over the last 20 years. There is no debate about that. The point is to hammer antivaccinationists for assuming it must have been the vaccines when there are other explanations that explain this apparent increase, such as broadening of the diagnostic criteria, increased screening, and diagnostic substitution. Then the point is to hammer that there are other things that correlate with the rise in autism diagnoses in order to hammer home that point. It’s reductio ad absurdum.
    .

    By which time everyone’s asleep, dulled by obvious and largely irrelevant points of logic — irrelevant because it is the basic premise (that there is a massive increase in autism rates) that we are mainly challenging, not so much what follows from it. If there IS a significant increase in autism rates over the relevant period, we have no easy way to wholly exonerate vaccines, because nothing much else has changed over the relevant period. So far as I can see, we can at most point to some plausibility issues and some defects in the correlations.

    We should be able to run rings around intellectual lightweights like Whitaker. That is a poor basis for what looks very like smugness and complacency. The people for whom we need a clear, consistent, simple, obviously trustworthy message are mothers who are reluctant to subject their precious charges to even the potential for immediate risk. Remote, hypothetical risks and doctors’ public health concerns will always take second place with them.

    What do we say to them? Is there a clear message to be found anywhere? I suggest that the worst thing we can do is to appear to be in any way overly dismissive of their concerns and I think we can easily do that unwittingly, even by regarding the matter as scientifically completely closed, even while lacking the high levels of evidence that we usually demand in answer to other important medical questions (even Whitaker is aware of that). Mothers also know that we doctors would be pushing for vaccination even if at small risk to some individuals.

    What is the precise science-based message — that there are small risks to vaccines, but that on the evidence we have autism is not often, if ever, solely due to vaccines? What did Steve say, from the neurologist’s perspective?

  27. lilady says:

    I disagree with you P. Moran. First of all, you assume that only “mothers” are making decisions about if and when to vaccinate their children…fathers have equal footing when it comes to those decisions.

    When I worked in public health, I dealt with parents and physicians who had questions about vaccines, the spacing of them, contraindications/precautions about each vaccine on the schedule and…questions about side effects or adverse reactions. This was long before the infamous Stonybrook University study that “linked” the birth dose of the hepatitis B to autism in the male children and, long before Andrew Wakefield published his since debunked study that linked the MMR vaccine with “autistic enterocolitis”.

    In my County we had a few crank doctors who had a “following” along with a number of chiropractors who “advised” parents about their childrens’ immunizations.

    I’ve been “out there” providing accurate information to parents, grandparents and adults who themselves were concerned about adult immunizations such as Td boosters, seasonal influenza vaccine, pneumonia vaccine and hepatitis B vaccine for the partners and household contacts of chronic carriers.

    During measles outbreaks and food-borne illness outbreaks, I and my colleagues handled hundreds, sometimes thousands of telephone calls, answering questions about times of exposure and the vaccines (MMR and Hepatitis A) and the immune globulin that we provided in special large clinics for post exposure prophylaxis.

    Do you really think that I am unable to teach “civilians” about immunizations, while still discussing these same immunizations with physicians?

    Now, with the advent of the internet and the huge amount of pseudoscience in cyberspace, I chose to post on many, many science and parenting blogs about immunizations…to inform parents about basic immunology, each of the immunizations that are on the current year’s Recommended Childhood Vaccine Schedule, and the diseases that these vaccines prevent.

    I also had a profoundly, multiply handicapped son who had autistic-like behaviors, since deceased. After his birth thirty-six years ago, I began a long journey of advocacy on his behalf and on behalf of all developmentally disabled children and adults in my State. So, I’ve “been there, as well”. Many of my internet colleagues have children or a close family member who has been diagnosed with an autism spectrum disorder. Would you believe P. Moran, that some of these people who post are also “on the spectrum”.

    We all bring our unique sensitivities and insights to the blogs that we post on. We have empathy and compassion for parents whose children are developmentally disabled. Yes, we are all “out there”, educating parents about immunizations, about autism and other developmental disabilities, and dispelling the pseudoscience and voodoo medicine that is dispensed by physicians on the internet.

  28. David Gorski says:

    By which time everyone’s asleep, dulled by obvious and largely irrelevant points of logic — irrelevant because it is the basic premise (that there is a massive increase in autism rates) that we are mainly challenging, not so much what follows from it. If there IS a significant increase in autism rates over the relevant period, we have no easy way to wholly exonerate vaccines, because nothing much else has changed over the relevant period. So far as I can see, we can at most point to some plausibility issues and some defects in the correlations.

    Gee, Peter. If you don’t like my writing style and tendency to go into detail such that my posts occasionally top 5,000 words, then there’s a very simple solution: Don’t read them. Seriously. Problem solved. Save yourself the pain, boredom, and irritation that you loudly proclaim here. I rather suspect, however, that something about my posts compels you to read them. Otherwise, you probably would not subject yourself to them time and time again on such a consistent basis and then complain about how strident, long-winded, and, apparently, uncaring I supposedly am.

    Be that as it may, these “points of logic” that you dismiss so blithely and self-righteously are neither obvious to the vast majority of readers nor irrelevant. It’s necessary to take a two-pronged approach, to point out that correlation does not necessarily equal causation and that the apparent correlation is probably an artifact of better diagnosis, more screening, and broadening of the diagnostic criteria. I mean, seriously. There IS a major APPARENT increase in autism prevalence that occurred over the last 20 years. That is undeniable, and it is this “autism epidemic” that antivaccinationists harp on to produce the appearance of a correlation. It is real in that the prevalence numbers are real. It is probably not real in that there are other explanations for the rise in apparent prevalence than a real increase in autism diagnoses. I have explained this time and time again, in many ways, in many posts, and in many places over several years. You know this. At the same time, it is also necessary to reiterate again and again that, even if this increase were real, correlation does not necessarily equal causation.

    Finally, we do have a good way to exonerate vaccines: Multiple large, well-designed epidemiological studies comprising, taken together, many hundreds of thousand of children that fail to find a whiff of a hint of a wisp of a correlation between vaccination and autism prevalence or onset. As I reiterated in this post, the vaccine-autism hypothesis has been falsified about as well as anything can be falsified in medicine, so much so that we can use the shorthand of saying that vaccines do not cause autism.

    Is that a simple enough message for you?

    We should be able to run rings around intellectual lightweights like Whitaker. That is a poor basis for what looks very like smugness and complacency. The people for whom we need a clear, consistent, simple, obviously trustworthy message are mothers who are reluctant to subject their precious charges to even the potential for immediate risk. Remote, hypothetical risks and doctors’ public health concerns will always take second place with them.

    “Intellectual lightweights” like Whitaker have outsized influence, far out of proportion to their lack of intellectual firepower. Think of “Dr. Bob” Sears, Dr. Jay Gordon, and a whole host of other intellectual lightweights who promulgate antivaccine propaganda and keep the myth that vaccines cause autism alive. They use their MD degrees to bolster their credibility as they spew pseudoscience and quackery. It is not smugness and complacency to refute them. In fact, I would argue exactly the opposite. It would be smugness and complacency if, knowing how vacuous their arguments are, we were to ignore them because they are such intellectual lightweights. Now that would be smugness and complacency! Ignoring them is not an option if you’re serious about countering their influence. Maybe in your ideal world it is, but here on the ground it really isn’t. Finally, we do have a clear, consistent, simple, trustworthy message. The problem is that, if there’s one thing intellectual lightweights like Whitaker are good at, it’s twisting and casting doubt on that message.

    What do we say to them? Is there a clear message to be found anywhere? I suggest that the worst thing we can do is to appear to be in any way overly dismissive of their concerns and I think we can easily do that unwittingly, even by regarding the matter as scientifically completely closed, even while lacking the high levels of evidence that we usually demand in answer to other important medical questions (even Whitaker is aware of that). Mothers also know that we doctors would be pushing for vaccination even if at small risk to some individuals.

    “Overly dismissive of their concerns”? Jumpin’ Jesus on a pogo stick! Have you been paying attention here the last four years? No one here—and I mean, no one—has advocated dismissing parental concerns. We often go out of our way not to dismiss parental concerns. I myself have written about where those concerns come from, how they come from cognitive features of humans and how we think that are, basically, “features, not bugs” and how they don’t mean parents are stupid, a frequent straw man leveled at skeptics. Also, what do you mean by “high level evidence”? Multiple huge epidemiological studies ARE high level evidence. Do you tell your patients that there’s doubt about whether smoking causes lung cancer because our primary data to indicate it are epidemiological studies and we don’t have any randomized, double-blinded studies demonstrating it?

    Perhaps what you mean are the concerns of die-hard antivaccinationists. My response to that is simple: We do not cater to them, because their minds, with very, very few exceptions, are not changeable. In fact, they are the ones who promote antivaccine misinformation and pseudoscience. They are committed, and we are highly unlikely ever to convince them they are wrong. Fortunately, their numbers are small compared to our real targets: The fence-sitters, the parents who have heard the antivaccine propaganda or maybe have heard arguments like the ones used by Dr. Whitaker and do not have the mathematical or scientific background to recognize them as, well, B.S. They’re worried about vaccines because a bunch of doctors and parents spew superficially plausible-sounding pseudoscience that they don’t have the tools to recognize as pseudoscience. In Steve’s case in this venue, as far as we could tell from our observations (not having a before-and-after survey and all), this sort of strategy was wildly successful. Steve was calm, but he pulled no punches. At points using the word “deception” to describe the mortality vs. incidence bait and switch that Dr. Whitaker tried to use, and called the graph above ridiculous because, well, it is ridiculous. The audience, by all measures, ended up on Steve’s side.

    That is how you do it, the way Steve did it. You don’t do it by handwringing and hedging. Steve did exactly what you say you want; he provided a simple message that demolished pretty much everything that Dr. Whitaker could throw at him.

  29. Harriet Hall says:

    @pmoran,

    “What is the precise science-based message — that there are small risks to vaccines, but that on the evidence we have autism is not often, if ever, solely due to vaccines? What did Steve say, from the neurologist’s perspective?”

    There is no “neurologist’s perspective.” The precise science based message is this: autism is no more correlated with vaccines than with pirates, vaccines have been ruled out as a possible cause of autism, and while there are VERY small risks with vaccines, the risks of not vaccinating are far greater.

    Did you really say autism is “not often” solely due to vaccines? Why on earth would you phrase it that way? There is no evidence that it is “ever” due solely to vaccines.

  30. papertrail says:

    The CDC says autism rate increases aren’t only due to diagnostic changes. So right there, we need a more definitive assessment; I don’t know if their conclusion is sound or not, but they ought to know how important it is to get that right.

    This debate comes up a lot, re: how certain scientists can be, and with what level of confidence they can convey to the public, that vaccines separately or in combination don’t cause autism. Can they say never? I know a vaccine researcher who cringes at any certitude about vaccine side-effects, or about anything, for that matter. I think we can assure that more than a dozen of the best studies found no link to autism, while deconstructing the bogus anti-vax claims.

    I try to be careful not to say “vaccines are safe” or that no one has ever suffered brain damage from a vaccine. I think I’ve lost credibility with some people when I’ve taken that approach.

    That said, I love your article, Dr. G. Steve did a fantastic job. I am thoroughly impressed. Did anyone videotape the debate?

  31. David Gorski says:

    Did you really say autism is “not often” solely due to vaccines? Why on earth would you phrase it that way? There is no evidence that it is “ever” due solely to vaccines.

    Holy crap. Somehow that statement of Peter’s didn’t register. Now that you’ve pointed it out, I have to ask Peter:

    Do you or do you not think vaccines can cause autism, either “solely” or otherwise? Since you’re castigating us for not giving sufficiently simple and compelling answers, I would prefer a simple yes or no answer.

  32. David Gorski says:

    @papertrail

    Sadly, as far as I know, no one videotaped the debate. As far as I know, they didn’t ask Steve to sign a release, which he’d have to sign if he were being videotaped, and FreedomFest wanted to do anything with the video. Steve would be the better person to ask, though.

  33. lilady says:

    @ pmoran: Here’s another little tidbit for you. If you have *reservations* about Dr. Novella debating Dr. Whitaker and Dr. Gorski blogging about that debate…you’re gonna *love* this explanation of Dr. Whitaker’s graphs that he posted on his blog yesterday:

    http://www.drwhitaker.com/new-legislation-seriously-misleads-parents-about-vaccine-safety

    Oh look, many of the posters on Whitaker’s blog challenged him for each and every fallacious argument he presented about the vaccine-autism link, the numbers (40 million kids), that he postulated had suffered “adverse events” from vaccines 1990-1992 inclusive and, the veracity of reports made and listed on the VAERS database.

    *One* of the posters even referred him to the Vaccine Safety Datalink website, to see how post licensing vaccine safety is monitored for the 8 million people (3 % of the United States population), whose every vaccination is entered into the database and whose every doctor’s visit, ER visit and hospitalization records are monitored to determine side effects, or serious adverse events, after vaccination, that require medical interventions.

    You do realize, don’t you, the impact that the SBM bloggers have? You just need to “google” Dr. Whitaker’s name to see how other science bloggers with their own audiences, link to the articles written by Dr. Gorski, and the other bloggers on this site.

    “What is the precise science-based message — that there are small risks to vaccines, but that on the evidence we have autism is not often, if ever, solely due to vaccines?”

    No, we don’t say that P. Moran. Our message is that there are exceedingly rare risks (on the order of 1:1,000,000 doses or less), but that the risks to any child whose parents “opt out” of vaccines, greatly exceed that:

    http://www.pkids.org/immunization/consequences_not_vaccinating.html

    Our message about the vaccine-autism link is simply. There is no risk that has ever been proven, in spite of dozens of large studies conducted by researchers in the United States, in Europe and in Japan.

  34. Harriet Hall says:

    I chimed in and asked Dr. Whitaker how the incidence in the entire population could be 100% when the incidence in females was much less. My comment is in moderation.

  35. lilady says:

    Good on you Dr. Hall. I am staying away from that blog because my personal stalking troll has followed me there. Troll also followed me to other articles about vaccines that I commented on, on Dr. Whitaker’s blog.

  36. pmoran says:

    Multiple large, well-designed epidemiological studies comprising, taken together, many hundreds of thousand of children that fail to find a whiff of a hint of a wisp of a correlation between vaccination and autism prevalence or onset.

    Yes, you do also often say that, David. But, — prospective randomized studies? If these exist, and they compare normal vaccination schedules with no vaccines, and they are of sufficient size and quality and consistency in their results that they indeed dispose of any “whiff of a hint” of such an association — the case is closed (and let’s be having them next week.)

    However, the question then becomes why the hell would you not be saying that at the outset, rather than bothering with all the condescension and the equally off-putting implication “if you were as smart as I you would not need to worry so much”? Buried within that extreme anti-vax nonsense there is a tenable hypothesis on the evidence that is directly available to the public. We should respect that and respond to it as directly and factually as we can. It is a difficult enough task; doubt is easily sustained and contagious, whereas trust and personal commitment requires a solid case.

    Harriet, I doubt if vaccines cause autism, although I do have to wonder, as a non-neurologist, whether severe febrile convulsions after some vaccines could be a triggering or exacerbating factor in the susceptible (Dr Novella?).

    Again, I make no apology whatsoever for critically examining the content and manner of the messages we send out on a supposedly science-based (implied non-propagandist) forum. We set ourselves the highest standards of rationality, honesty, informed consent, self-awareness and ethics in other ways, why relax those herein?

  37. Patrick says:

    “If these two things happen, we might recover from this nightmare. If they don’t, armed guards will be escorting our children to vaccination centers, and, within a few decades, our children—and our country—will be destroyed. Many of you will live to see this devastation…”

    Wow. This is nothing more than grade A slippery slope logic. I thought that person like him would at least be able to avoid a classic logical fallacy of this nature!!!

  38. lilady says:

    I still don’t “get” what you are “getting at”, P Moran.

    You know there are no prospective randomized vaccinated-vs-unvaccinatated studies out there. It is unethical, to leave some children unprotected, and others protected, against childhood diseases.

    Why the tone trolling behavior? You are not new to this blog and you are aware of Dr. Gorski’s *style*, especially when it comes anti-vaccine doctors…he reserves particular scorn when it is a licensed physician and not just crank bloggers like David Kirby or Mike Adams-the “Health Ranger”.

    Have you ever visited the notorious anti-vaccine sites such as the National Vaccine Information Center, that Dr. Whitaker touts on his blog? Have you seen the utter nonsense written by the *journalists* at Age of Autism about the pseudoscience theories of vaccine-induced autism?

    These are dangerous people who flood cyberspace with their theories, made even more dangerous because they are an important source of information for credulous parents.

    “Harriet, I doubt if vaccines cause autism, although I do have to wonder, as a non-neurologist, whether severe febrile convulsions after some vaccines could be a triggering or exacerbating factor in the susceptible (Dr Novella?).”

    I’m not a neurologist P. Moran but I will state my opinion. If a child has a high fever that triggers a febrile seizure the very nature of a febrile seizure does not predispose a child to autism or any other developmental disability:

    http://www.ninds.nih.gov/disorders/febrile_seizures/detail_febrile_seizures.htm

    “Are febrile seizures harmful?

    Although they can be frightening to parents, the vast majority of febrile seizures are short and harmless. During a seizure, there is a small chance that the child may be injured by falling or may choke from food or saliva in the mouth. Using proper first aid for seizures can help avoid these hazards (see section entitled “What should be done for a child having a febrile seizure?”).

    There is no evidence that short febrile seizures cause brain damage. Large studies have found that children with febrile seizures have normal school achievement and perform as well on intellectual tests as their siblings who don’t have seizures. Even when seizures are very long (more than 1 hour), most children recover completely, but a few might be at risk of subsequent seizures without fever (epilepsy).

    In other words, between 95 and 98 percent of children who experience febrile seizures do not go on to develop epilepsy. However, although the absolute risk remains small, some groups of children–including those with cerebral palsy, delayed development, or other neurological abnormalities–have an increased risk of developing epilepsy. The type of febrile seizure also matters; children who have prolonged febrile seizures (particularly lasting more than an hour) or seizures that affect only part of the body, or that recur within 24 hours, are at a somewhat higher risk. Among children who don’t have any of these risk factors, only one in 100 develops epilepsy after a febrile seizure.”

  39. lilady says:

    @ Harriet Hall…You made it through moderation, but Dr. Whitaker has not responded to your query…yet.

  40. pmoran says:

    Why the tone trolling behavior? You are not new to this blog and you are aware of Dr. Gorski’s *style*, especially when it comes anti-vaccine doctors…he reserves particular scorn when it is a licensed physician and not just crank bloggers like David Kirby or Mike Adams-the “Health Ranger”.

    On THIS blog he is in a sense representing me, and everyone else interested in the integrity and the proper application of medical science. I cannot in all conscience keep quiet when I am fairly sure that our position is not being presented with sufficient clarity or accuracy, or with the respect that is rightly due to our main target audience and likely eavesdroppers.

    Dr Gorski has his own blog on which to pursue his own very inter-personal, highly combative approach to “alternative” matters. That probably has its place and it certainly helps reassure the hangers-on. It is also a fact that most of his contributions here are brilliant. On odd occasions the urge to educate about logic and to focus upon the other scientific pecadillos of lay people trying to understand complex material, does get in the way of the provision of more critical and potentially more influential information ( such as the supposed “whiff of a hint” material ).

  41. pmoran says:

    Oh, and thanks, Lilady, for the link concerning febrile convulsions, which is mildly reassuring.

  42. David Gorski says:

    What?

    I’m representing you?

    Really?

    No, Peter, I am not. I represent myself, and, to a lesser extent SBM. I will not be held hostage to your idea of what I should be doing and how I should be explaining things. Understand? Honestly, I can’t think of a way to make that more crystal clear.

  43. Harriet Hall says:

    @pmoran,
    “Harriet, I doubt if vaccines cause autism, although I do have to wonder, as a non-neurologist, whether severe febrile convulsions after some vaccines could be a triggering or exacerbating factor in the susceptible (Dr Novella?).”

    There is no evidence to support your speculation. Even if a small minority of children were “susceptible” to autism (whatever that means), and even if febrile convulsions “triggered” or “exacerbated” them, existing studies that didn’t find a correlation tell us that any such minority would have to be VERY small not to show up on the statistics in large studies. Anyway, vaccines prevent diseases that cause fever and febrile convulsions, so even if convulsions caused a problem, vaccines would be more likely to PREVENT those convulsions.

  44. lilady says:

    P. Moran: I still don’t understand what is driving your compulsion to critique Dr. Gorski’s article about the debate between Drs. Whitaker and Novella. Was I among the missing here, when you were appointed the arbiter of good taste and professional integrity for this blog?

    You made several statements about ethics, sensitivity and then febrile seizures possibly being associated with autism onset. I provided you with my opinion and the link to the NIH website. Your reply to me…

    “Oh, and thanks, Lilady, for the link concerning febrile convulsions, which is mildly reassuring.”

    How dismissive of you P. Moran. I can assure you that answering parents’ questions about their child’s febrile seizure is VERY reassuring.

  45. pmoran says:

    “Oh, and thanks, Lilady, for the link concerning febrile convulsions, which is mildly reassuring.”

    How dismissive of you P. Moran. I can assure you that answering parents’ questions about their child’s febrile seizure is VERY reassuring.

    Of course it is, but that was not what I was asking for reassurance about and I this was a brief afterthought when I realised I had failed to acknowledge your link.

    Without more detail as to the size and methodology of the studies referred to I cannot regard them as definitely excluding the provocation of autistic symptoms as an uncommon effect of febrile convulsions. It would require a very much larger study to detect, say, a two-fold increase in rate of expression of autism than it would take to compare mental performance in cohorts with and without a history of febrile convlusions.

    Such a connection might easily be overlooked and attributed to the the fact that many autistic children are prone to epilepsy, anyway. I have looked for specific information on this point with little success which is why I asked if Dr novella had more direct information.

  46. pmoran says:

    David: No, Peter, I am not. I represent myself, and, to a lesser extent SBM.

    That puzzles me. Just as Dr Barrett came to be THE voice of anti-quackery, and handled that role with grace, dignity and the most rigorous reliance upon factual data, you have the potential to be, if not THE voice, at least a valued voice of Science-Based Medicine. Surely your first allegiance when posting here has to be to science of the highest order and the regaining of public trust in scientific medicine.

    Yet, no one else seems to be bothered, so perhaps its just me. So I’ll rest my case for now. Should I await those studies that remove any “whiff of a hint” of an association between vaccines and autism or not? I’m on your side in wanting to support vaccines, so I should be easy to convince if the data says what you say it does.

  47. WilliamLawrenceUtridge says:

    Without more detail as to the size and methodology of the studies referred to I cannot regard them as definitely excluding the provocation of autistic symptoms as an uncommon effect of febrile convulsions. It would require a very much larger study to detect, say, a two-fold increase in rate of expression of autism than it would take to compare mental performance in cohorts with and without a history of febrile convlusions.

    …and Dr. Hall’s comment about vaccines preventing illnesses which prevent febrile seizures? You seem to be asking for absolute assurance that no vaccines ever caused autism or had a side effect. We’ll never be absolutely certain of anything, but no signal has arisen from the noise despite many studies. Continuing to throw money at an extremely improbable chain of reasoning that genuine experts in the area don’t believe is worth investigating just to ease the minds of people who aren’t going to be reassured, ever, seems like a bad idea.

    Pete, though I found your website fascinating, I just can’t line it up with your ongoing comments here. How can you be so skeptical of cancer quackery, but have such a different standard for other forms of quackery? I also don’t see why you feel the need to keep calling out Drs. Gorski and Hall for failing to adhere to your disproportionately high standards for CAM when they pretty clearly have laid out, repeatedly, why CAM doesn’t deserve funding (research or practice). It sounds less like an attempt to have a reasoned debate and more like a personal grudge that comes out as pedantic nit-picking.

  48. David Gorski says:

    Peter doesn’t like me for some reason. Or maybe he doesn’t like my online persona. (In person, I’m really all warm, fuzzy, and cuddly. Oh, wait. Except to Dr. Whitaker.) Whatever Peter doesn’t like about me, I suspect it’s because he thinks I’m too “strident” and not sufficiently “respectful” of believers in certain forms of “CAM” for his taste. I also reject some of his premises regarding his “What’s the harm?” attitude with respect to certain forms of CAM. Or maybe it’s because he thinks he can mold me into his apparent vision of what a gentleman quackbuster should be if he just badgers me enough. I don’t know. He can’t, I assure you, and his continued trying will only continue to frustrate him and to annoy me. That’s why I tell him he should simply stop reading me if I annoy him so much.

    Whatever the reason for Peter’s dislike of me, you are correct. Traditionally, Peter has been every bit as “strident” as I am when it comes to cancer quackery. That’s one thing I really liked about him. In fact, his website on cancer quackery was a major inspiration to me back in my early days on misc.health.alternative, long before my first blog was ever even a gleam in my eye (or I even knew what a blog was, for that matter) and remains so today. Indeed, I’ve referred to his analysis of Gerson’s cases and continue to use his explanation of breast cancer testimonials (with attribution) in my talks today. Granted, I have expanded considerably on his explanation, but his explanation still serves as a sturdy basis upon which to build my discussion of primary versus adjuvant therapy, etc., and how testimonials often confuse, either unintentionally through ignorance or willfully, adjuvant with primary therapy.

    That makes it all the more puzzling that he seems all too willing—eager sometimes,— to give other forms of quackery a lot more of a pass. In particular, I am disturbed by his apparent lack of familiarity about the extensive evidence base regarding vaccine safety, which includes many large, well-designed epidemiological studies in multiple countries that have failed to find a correlation between vaccines and autism, such that the degree of uncertainty regarding the falsity of the claim that vaccines cause autism is about as low as any level of uncertainty in medicine can be. It’s not as though we at SBM haven’t explained this many times before and analyzed examples of some of these studies. In fact, we have a sampling of them here:

    http://www.sciencebasedmedicine.org/reference/?p=1

    I realize this list is hopelessly out of date; we do need to update it. It is, however, a sampling, and not even a comprehensive one by any means. Perhaps I could ask Peter a question: What studies lead you to believe that there might be a link between vaccines and autism? Which specific studies make you uncertain?

    Finally, I do find Peter’s comparison of me to Stephen Barrett rather interesting. Dr. Barrett has never been exactly shy about calling a quack a quack, an antivaxer an antivaxer, and a charlatan a charlatan using language almost as “strident” as mine. (Even Steve Novella sometimes approaches my level of “insolence.” He sure did at this debate.) Yet, for some reason, to Peter, Barrett is the epitome of what a spokesperson for SBM should be, while I, apparently, am a brilliant but vile and disrespectful human being who is not worthy of whatever microscopic prominence I have achieved thus far as a spokesperson for SBM.

  49. Scott says:

    I cannot in all conscience keep quiet when I am fairly sure that our position is not being presented with sufficient clarity or accuracy,

    And then you suggest a position statement that is either grossly and materially inaccurate, or so completely unclear that anyone reading it would infer a grossly and materially inaccurate conclusion?

  50. weing says:

    I get the distinct impression that pmoran tends toward the essentialist camp as described by Popper. Am I way off base?

  51. lilady says:

    @ P Moran: You asked about fever and febrile seizures post immunization being associated with autism. I provided you with my opinion, based on all the research I have done about the various types of seizures… including febrile seizures… and the onset of developmental disabilities…including autism. I also provided a link for you to look at.

    You were dismissive of my opinion, my research and my link, stating that you found my comments and my link, (finding them) “…..mildly reassuring”.

    Now you are switching the goal posts, by “proposing” a study with your own criteria..

    “Without more detail as to the size and methodology of the studies referred to I cannot regard them as definitely excluding the provocation of autistic symptoms as an uncommon effect of febrile convulsions. It would require a very much larger study to detect, say, a two-fold increase in rate of expression of autism than it would take to compare mental performance in cohorts with and without a history of febrile convlusions.”

    You are a physician P. Moran and have access to articles published in journals such as Pediatric Neurology, which are behind pay walls. So why don’t you find additional articles that would prove or disprove your concerns about febrile seizures triggering autism? Why not write up an article and have it published here? We would all be interested in your meta analysis of the articles about febrile seizures that are linked, or not linked, with autism, that have been published in medical journals.

    Here is a short list of the 83 articles (2008-2011 inclusive) about autism, and its causes, that have been published in medical journals:

    http://autismsciencefoundation.org/research-year

    IMO, you are being naive about the impact that “notorious anti-vaccine” websites have on the general public and on young parents. You are also naive about the collective goal of these websites…

    http://www.ageofautism.com/2010/03/tinderbox-us-vaccine-fears-up-700-in-7-years.html

    “With less than a half-dozen full-time activists, annual budgets of six figures or less, and umpteen thousand courageous, undaunted, and selfless volunteer parents, our community, held together with duct tape and bailing wire, is in the early to middle stages of bringing the U.S. vaccine program to its knees.”

    -J. B. Handley

    I might add, that I personally am not willing to have charlatans, health care providers and yellow journalists drive the “debate” about the totally, and absolutely debunked junk science, that links vaccines with autism.

  52. torgoguy says:

    Looks like the debate is available for purchase. It is $5.

    It still has the old speaker’s name listed, not Dr. Novella’s: http://miracleofamerica.com/MP3-2012/152-12-152-mp3.html

    Anybody care to pony up the cash and have a listen?

    Also, on a previous version of this page, it mentioned that the last 20 minutes may not have recorded, so it is a bit unclear if it is the whole debate…

  53. pmoran says:

    Basically I am against sloppy science, and poorly targeted argument, and this is not a sudden switch. Long ago I began to realize how “we” (as always I include myself and I really mean only some of us), are not as good at this anti-quackery stuff as we like to think we are, irrespective of the amount of praise that is heaped on us by our fellows. And I have been saying so since I started posting here.

    The whole environment encourages a low quality of thought and debate because most of the time we are talking to people who know little about medicine or have a poor grasp of science, and all the answers seem so obvious to us. That is a trap. There are people out there with good noses for any “whiff of a hint” that we are overstating our case and/or not taking valid public concerns seriously. And that is the very worst thing we can do because we are basically dealing here with public trust, towards the gaining of which science is a tool, not an answer in itself.

    If you read what I have to say about anecdotal evidence on my web site you will detect the same line of thought. I am critical there of the lazy use of “it’s only anecdotal evidence” in relation to cancer “cures” (when not bothering to explain anywhere why that matters with a normally highly predictable condition like cancer).

    Medical committees have regularly and (seemingly) arrogantly dismissed what looks like highly suggestive evidence to any lay person without usually offering any detailed account as to why. An opportunity may have been missed to put quacks under more pressure to produce proper documentation of their supposed cancer cures (fat chance) or at least to have the public looking more critically at those testimonials.

    If there was a better way to play into the hands of the poor. persecuted cancer quack than appearing not to be giving him the time of day, I don’t know what it is. On my web site I try to fill in the detail that leads us to believe that no extant “alternative” cancer cure is likely to have a significant beneficial impact on established human cancer (note precise wording).

  54. Harriet Hall says:

    @pmoran,

    I don’t think “we are overstating our case and/or not taking valid public concerns seriously.”

    “On my web site I try to fill in the detail that leads us to believe that no extant “alternative” cancer cure is likely to have a significant beneficial impact on established human cancer.”

    This whole website is about filling in the detail. And it has explained in depth why anecdotal evidence is inadequate.

    For some reason, our best efforts are never enough to suit you. I have asked before and am now asking again: why don’t you write guest articles showing us the way we should be doing it? Lead by example instead of just finding fault.

  55. lilady says:

    @ P Moran: I never doubted your blogging skills about cancer treatment…but this particular blog is about the debate between Dr. Whitaker an anti-vaccine physician and Dr. Novella…not cancer. The thread, that you started, is about Dr. Gorski’s *style* in reporting the debate.

    I don’t claim knowledge about cancer treatments and bogus cancer treatments, but I do *know* pediatric neurology and I do *know* developmental disabilities and am acutely aware of the impact that Dr. Whitaker and other bloggers have, about the totally junk science of immunizations causing autism.

    Would you care to stay on topic?

  56. David Gorski says:

    There are people out there with good noses for any “whiff of a hint” that we are overstating our case and/or not taking valid public concerns seriously.

    Straw man argument. Again. Seriously, Peter, tell me where we at SBM haven’t taken public concerns about vaccination seriously. It exasperates me to try to figure out just what in the heck you are talking about. Give me a concrete, specific example, but realize that taking public concerns about vaccination seriously does not mean taking an antivaccine quack like Dr. Whitaker seriously.

    As for a “whiff of a hint,” I stand by that characterization 100%. It’s a phrase I have used many times and plan on continuing to use, whether you like it or not. If you think there’s science to refute my “whiff of a hint” characterization of the existing data, stop whining (yes, you are whining) and have at it! Believe it or not, my mind can be changed, but you have to show me with actual scientific studies and evidence. Prove it to me. Show me studies that contrast with my narrative and characterization of the state of vaccine safety evidence of sufficiently good design and strong conclusions that it can convince me that perhaps my summary of the data is too strong.. I say that because if you ask someone like Paul Offit (a real vaccine expert) or any other real vaccine expert, you will get an answer like mine: The question of whether vaccines cause autism has been asked and answered, and, as far as we can tell to a high degree of certainty, the answer no. Yes, that is a bit of an appeal to authority, but it’s an appeal to legitimate authority designed to point out to you that my view is in line with the scientific consensus.

    If you can’t do that one simple thing and produce some evidence to cast doubt on the strength of my statement, you take the risk of coming off sounding like a concern troll.

    And that is the very worst thing we can do because we are basically dealing here with public trust, towards the gaining of which science is a tool, not an answer in itself.

    And I am using that tool in line with the currently existing scientific consensus. Again, if you think I’m not, then stop whining and show me where I’m wrong. Before you do that, though, realize that I’ve been at this for a decade. You’d better be sure you have the goods, because I am familiar with all the major studies on vaccines and autism, as well as the studies and arguments often trotted out to claim the question is not as settled as the scientific consensus states.

  57. pmoran says:

    David: That makes it all the more puzzling that he seems all too willing—eager sometimes,— to give other forms of quackery a lot more of a pass. In particular, I am disturbed by his apparent lack of familiarity about the extensive evidence base regarding vaccine safety, which includes many large, well-designed epidemiological studies in multiple countries that have failed to find a correlation between vaccines and autism, such that the degree of uncertainty regarding the falsity of the claim that vaccines cause autism is about as low as any level of uncertainty in medicine can be. It’s not as though we at SBM haven’t explained this many times before and analyzed examples of some of these studies. In fact, we have a sampling of them here:
    >http://www.sciencebasedmedicine.org/reference/?p=1

    So having to rummage through all this with its broken links and varied relevance is the best that we on SBM can offer? That is pathetic. Similarly, but less so, with Lilady’s references. Surely there is one site that we can refer people to to access a simple summary of the key points and the most critical evidence

    The CDC only offers evidence on imputed mechanisms such as thiomerosal and certain claims regarding MMR vaccine.


    I realize this list is hopelessly out of date; we do need to update it. It is, however, a sampling, and not even a comprehensive one by any means. Perhaps I could ask Peter a question: What studies lead you to believe that there might be a link between vaccines and autism? Which specific studies make you uncertain?

    Normal scientific caution should apply here, as elsewhere where evidence is not wholly conclusive for the intended purpose.

    On his blog post The Alleged Autism Epidemic Steve Novella shows how, when he says: ”

    The current state of evidence strongly suggests that the dominant reason for the increase in numbers is due to changes in diagnostic behavior.
    There are many similar epidemiological questions in the world of medicine. I am content to let the chips fall where they may, and will gladly alter my opinion as new evidence comes in.”

    I have no argument with the “current state of the evidence strongly suggests — “. That is the proper voice of science. . Steve is also allowing that all knowledge is tentative to some degree and subject to revision on good evidence.. He elsewhere goes as far as saying that the available evidence should easily have demonstrated a 5 or 6 fold increase in autism incidence, which is also fair enough comment, but well short of what others are claiming.

    Moreover, we are talking about risk here. Elsewhere we do apply lower standards of evidence for risk than we do for efficacy or matters of fact. We issue warnings about even the potential for risk.

    Weirdly, we don’t claim that vaccines carry NO risk in other respects, yet we were striving for such a position on autism even before there were many studies at all looking at the question. I suppose there was an immediate threat to vaccination rates, and we were reacting to that, and some entirely unlikely theories as much as any solid evidence. That has come back to bite us. We have manoeuvred ourselves into being required to provide something approaching absolute proof of no connection at all, when we know full well that that is an impossible task, also that our failure to do so will be held against us.

    I am as guilty as any. You David, have even created a situation where you have been publicly challenged by an antivax identity to present evidence on certain matters and you have been forced to choose that point to break off public discussions that you had up until then enthusiastically engaged in. It looks bad (“what are they hiding?”). I let that pass at the time, biting my tongue fiercely.

    What we can prove is that IF there is such a risk it is very much lower than some parties suggest and still much less than the risks that the same children will be exposed to if vaccination rates drop (as Harriet rightly says).

    This is NOT a normal scientific debate where you can get away with “well, there’s no real evidence of that!” In normal everyday medical science “absence of evidence” usually does equate, more or less, for practical purposes, to “evidence of absence”, partly through habitual modes of thought, but more fundamentally for reasons of economy of endeavor.

    How sensible is it to expect concerned mothers (and fathers) to quietly go along with that? It is disrespectful of them to expect them to quietly knuckle under to medical authority and its standards, and its pontifications that “there is no evidence”, when everywhere else they are hearing about the “autism epidemic”, and how supposedly perfectly normal children went downhill after vaccines, and how doctors have no satisfactory other explanation for higher rates of autism, and “anyway doctors would probably think the risks of not vaccinating are greater but I am not so sure in my situation”.

    Not only that, but we now have a public that is increasingly aware (since we tell them so) how scientific studies are not as trustworthy as we once thought, through their susceptibility to bias.

    So I think there are some grounds for thinking carefully about our approach to these matters. You should be thinking about what is in mothers’ minds, not mine.

  58. pmoran says:

    Harriet: For some reason, our best efforts are never enough to suit you. I have asked before and am now asking again: why don’t you write guest articles showing us the way we should be doing it? Lead by example instead of just finding fault.

    The fact is that I am quite happy to have you and Steve and David speak for me on most scientific issues. You will all do it better than I.

    I merely, rightly or wrongly, think I have certain insights into the CAM mind and a sense of how easy it is to reinforce damaging perceptions. Fortunately, sticking rigidly within the limits of what our science permits and using normal, cautious scientific language avoids most of those risks. We may still not prevail, but it feels right to being doing that. Dialogue certainly runs more smoothly.

    I have repeatedly said that I have no problem with your dealings with CAM. I admire Steve’s measured, articulate and extremely clear articles on scientific matters, and I have only ever taken issue with him on what looks to be to me to be an overly simplistic understanding of the history of CAM and of the main factors which sustain it.

    I also admire David’s unravelling of complex scientific matters. Am I to be forced to spell out all the reasons why I think a few of his posts would be more suited to a personal blog?

    I have said all I have to say. There are points made above that might bear thinking about, or that everyone can ignore if they prefer.

  59. pmoran says:

    WLU: and Dr. Hall’s comment about vaccines preventing illnesses which prevent febrile seizures? You seem to be asking for absolute assurance that no vaccines ever caused autism or had a side effect. We’ll never be absolutely certain of anything, but no signal has arisen from the noise despite many studies. Continuing to throw money at an extremely improbable chain of reasoning that genuine experts in the area don’t believe is worth investigating just to ease the minds of people who aren’t going to be reassured, ever, seems like a bad idea.

    Pete, though I found your website fascinating, I just can’t line it up with your ongoing comments here. How can you be so skeptical of cancer quackery, but have such a different standard for other forms of quackery? I also don’t see why you feel the need to keep calling out Drs. Gorski and Hall for failing to adhere to your disproportionately high standards for CAM when they pretty clearly have laid out, repeatedly, why CAM doesn’t deserve funding (research or practice). It sounds less like an attempt to have a reasoned debate and more like a personal grudge that comes out as pedantic nit-picking.

    I think I have clarified some of this. For example I have never “called out” Dr Hall.

    I am not calling for more research. We (meaning some of us) have adopted a stance that only prohibitively expensive and unethical studies could support. We have to make do with lesser evidence, but let our language and lines of argument reflect that.

    I always value your input, by the way.

    1. Harriet Hall says:

      @pmoran,

      OK. You are saying that you have no problem with me, but you feel Steven Novella has shown an “overly simplistic understanding of the history of CAM and of the main factors which sustain it.”

      “We (meaning some of us) have adopted a stance that only prohibitively expensive and unethical studies could support. We have to make do with lesser evidence, but let our language and lines of argument reflect that.” I assume this is directed mainly at David Gorski.

      I’m afraid I still don’t fully understand what you’re saying. Could you please provide 3 examples each of specific things Steve and David have written that bothered you, explain what you think is wrong with them, and offer a revision of their words that says what you think they should have said?

      Let it be known that I admire and support every writer on this blog and agree with almost everything they write, and while we have different approaches and different styles, I don’t think I’m doing anything that is essentially different.

  60. pmoran says:

    Harriet, I will continue as I have so far, if you don’t mind, because it is obvious that after the homework you have set me (requiring me to try and find specific old posts on this huge blog as examples), you would still not be ready to see what I am getting at.

    And I understand why. I once would have been as defensive and as circling of the wagons as you if confronted with a critique like mine. We scientists can’t stand anyone suggesting we might be wrong about anything and this is, in part, why some of us may not be dealing with CAM and anti-vaxers and fellow medicos with differing opinions with sufficient sophistication.

    My approach to medical fraud and quackery has evolved from something like David’s, partly through a very long process of talking to the people whose minds we wish to influence but also through an obsessive examination of my own positions in the mirror. I was forced to ask whether I was part of the problem that I was trying to resolve.

    Incidently, there is nothing odd about my position(s). A large chunk of mainstream medicine is more relaxed about CAM ( in some ways) than us. Note how “we” (on this occasion meaning Steve, Kimball, David and others) complain bitterly about that all the time. It may be equally valid to ask the holders of those intense views to justify their stances in what is currently a very complex medical and political slurry.

    In that vein, if you want to weigh in regarding present matters, what about you providing an example of a study that disproves any possible causal association of vaccines with autism? I am agreeing that “the evidence is consistent with there being no strong link” or some such moderately strong statement, but we are talking about the “whiff of a hint” level of vehemence we have already conveyed to the opposite camp. This is no joke. Nor is it a debating strategy. We are being asked to produce just that evidence by vaccination critics. It must be dealt with.

    I think I have provided enough information above, for now. I will try and attract your attention next time I have one of these matters to comment upon.

  61. David Gorski says:

    In that vein, if you want to weigh in regarding present matters, what about you providing an example of a study that disproves any possible causal association of vaccines with autism?

    You do realize, don’t you, that this sort of question is the same tactic that J.B. Handley, Jenny McCarthy, Meryl Dorey, Barbara Loe Fisher, Dan Olmsted, Mark Blaxill, and many other antivaccinationists use all the time, so much so that I’ve nicknamed it the “show me just one study” gambit, as in “show me just one study that completely disproves a vaccine-autism link.” In fact, I can generalize this tactic to just about any form of crankery or quackery. Anthropogenic global warming denialists frequently say, “Show me one study that proves AGW.” Evolution denialists (a.k.a. creationists) frequently say, “Show me just one study that proves evolution” or “Show me one study that disproves ‘intelligent design.’” I’ve even seen someone demand “just one study” linking cigarettes to lung cancer. The list goes on and on.

    I’m giving you the benefit of the doubt here by assuming that you don’t realize that you’ve just used (inadvertently, apparently) a classic crank strategy. That being said, however, I’m disappointed. I had assumed that you knew that medical science doesn’t work that way. No single study ever settles anything, positively or negatively, and it is utterly impossible for a single study to rule out with 100% certainty (which is what you appear to be demanding) any possible causal association between vaccines and autism.

    That’s a huge straw man anyway, because that’s not what I said. You focus on my “whiff of a hint” analogy, which is an accurate assessment of the state of the totality of the existing evidence, particularly when you take into account my further comments on the issue:

    The bottom line, is that there is no scientific controversy over whether vaccines cause autism. The question has been asked multiple times and answered multiple times: No. Of course, being a scientist, I have to qualify that just a little bit by saying that “no” means that we can’t detect an effect above the noise level of the epidemiological studies that have been done. In other words, even if there is an effect, it is so small that it can’t be detected by current epidemiological methods, which can detect pretty darned small effects. For all intents and purposes, as far as science can tell, vaccines do not cause autism. Neither does the mercury in the thimerosal preservative that until 2001 was used in many childhood vaccines. They just don’t; scientists have moved on, regardless of what antivaccinationists claim.

    Please, Peter, tell me how the above passage doesn’t do exactly what you have been demanding. I’d really like to know. I also remind you that I’ve answered your demand. I provided a link that lists not just one study but many studies that address the question.. Did you bother to read any of them? I sincerely doubt that you did, which is why I think that listing more (which I could easily do) would be a waste of my time. You appear to be perseverating over that one phrase and ignoring everything else I wrote (such as the passage above). That is cherry picking.

    I really did think you understood science a bit better. It is the totality of existing evidence that must be taken into account. That means not just the multiple epidemiological studies that have failed to find a whiff of a hint of a correlation between vaccines and autism, but also everything else we know about autism, such as studies suggesting that it is mostly genetic, structural abnormalities found in the brains of children with autism, what we know about the neurobiology of autism, and many other converging strands of science. Now, you might be right in that the public doesn’t understand that there is not and never will be “just one study” that forever banishes the contention that vaccines cause autism to the realm of discredited hypotheses (although lots of studies, taken together, do). The answer to that is not to acknowledge more uncertainty than there is (which is what you appear to want). There really isn’t much uncertainty at all from a scientific standpoint. The answer it to educate parents on how science really works, not how they think it works.

  62. lilady says:

    P. Moran: Again, did I miss your appointment here, as the sole arbiter of the *style* which bloggers on this website, must adhere to? Perhaps you don’t realize it, but you are engaging in the practice of “concern trolling” and “tone trolling”.

    When was the last time you spoke to a parent in person or through an internet post, regarding their concerns about immunizations? I posted a number of times on Dr. Whitaker’s blog and provided links to reliable web sites in an effort to educate parents about the science of immunology, vaccine safety, the VAERS database and the Vaccine Safety Datalink website…which monitors the vaccine history of 8.2 million (3 % of the United State’s population), and any and all side effects/serious adverse reactions to every childhood and adult vaccine. Your lack of posting on Dr. Whitaker’s website and other websites, has been duly noted.

    http://www.drwhitaker.com/new-legislation-seriously-misleads-parents-about-vaccine-safety

    Have you ever heard the phrase “shifting hypotheses” within the anti-vaccine movement…because that is what you attempted to do, with your silly post above, about febrile seizures post immunization…

    ““Harriet, I doubt if vaccines cause autism, although I do have to wonder, as a non-neurologist, whether severe febrile convulsions after some vaccines could be a triggering or exacerbating factor in the susceptible (Dr Novella?).”

    I provided you with a link to the NIH about febrile seizures…you dismissed it, stating it was “mildly reassuring”…yet…you are unable… or unwilling, to provide a PubMed citation that links a post-immunization febrile seizure to the onset on autism.

    Here’s a link to Dr. Paul Offit’s article about “Shifting Hypotheses”. Why don’t you contact Dr. Offit to inform him that you have *found* another “shifting hypothesis” for a *possible* cause of autism?

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908388/

  63. Harriet Hall says:

    @pmoran,

    “it is obvious that after the homework you have set me (requiring me to try and find specific old posts on this huge blog as examples), you would still not be ready to see what I am getting at.”

    Wow! Talk about cop-outs! I simply asked you not only to present specific examples of what you have been alleging but to re-word them in a way that would satisfy you. Because after all your generalizations, I really don’t understand what you mean. You are not even willing to play the game: you decided to take your marbles and go home and to insult me in the process.

    “what about you providing an example of a study that disproves any possible causal association of vaccines with autism?…we are talking about the “whiff of a hint” level of vehemence ”

    Wow! As David has pointed out, no study can disprove any possible causal association, and you are enough of a scientist to know that very well. If you think there is a whiff, why not show it to us?

    I am sorely disappointed. I expected more from you.

  64. David Gorski says:

    Wow! As David has pointed out, no study can disprove any possible causal association, and you are enough of a scientist to know that very well. If you think there is a whiff, why not show it to us?

    Exactly. If Peter thinks my characterization of the scientific consensus with respect to vaccines and autism is incorrect, he is perfectly welcome to produce studies that cast doubt on my assessment. I will consider them. He has not done so and shows no sign of doing so. He won’t do so because high quality studies whose conclusions suggest a vaccine-autism length do not exist. Sure, there are some crappy studies (such as Andrew Wakefield’s and the odd Mark and David Geier study, for instance), but those studies are so bad that they are easily dismissed in comparison to the much larger and more robust body of evidence that has failed to find a hint of a whiff (or was it a whiff of a hint?) of a link between vaccines and autism.

    And, yes, I’m using that phrase intentionally, to make a point.

  65. weing says:

    @pmoran,

    Lemme get this straight. Are you saying that your position has evolved to that of a shruggie?

  66. papertrail says:

    (or was it a whiff of a hint?)

    I think you said a wint of a hiff. ;-)

    All I can dichipher is that maybe Dr. Moran is saying that science-based proponents should only speak in terms of the science, which means you’d only say things like “the preponderance of the evidence fails to show a connection…” rather than ever asserting that “there is no connection.” Scientific findings are not cast in stone.

    Sorry Dr. G, but I do sometimes feel I must prepare certain people who I refer to this site that it is not straight science-based analyses but it is a “blog,” and so they will hear strong pro-vaccine and anti-quackery personal expression – along with brilliant scientific analysis of various claims that no one else is answering, or not as well. For people who are, let’s say, vaccine hesitant because they have bought into some anti-vax assertions (some of which do have semblance and kernals of truth – that’s why we need sites like this one), some will be immediately put off here, identifying with the ridicu… um, the questionable claims. On the other hand, maybe some will respond best to hearing: hey, there isn’t a hint of a whiff or a wint of a hiff that vaccines cause autism, or that homeopathy cures illness, etc., etc. and here is why I say that….

  67. pmoran says:

    David asked for my comment upon this.

    The bottom line, is that there is no scientific controversy over whether vaccines cause autism. The question has been asked multiple times and answered multiple times: No. Of course, being a scientist, I have to qualify that just a little bit by saying that “no” means that we can’t detect an effect above the noise level of the epidemiological studies that have been done. In other words, even if there is an effect, it is so small that it can’t be detected by current epidemiological methods, which can detect pretty darned small effects. For all intents and purposes, as far as science can tell, vaccines do not cause autism. Neither does the mercury in the thimerosal preservative that until 2001 was used in many childhood vaccines. They just don’t; scientists have moved on, regardless of what antivaccinationists claim.

    This is scarcely more measured a statement than your –

    Multiple large, well-designed epidemiological studies comprising, taken together, many hundreds of thousand of children that fail to find a whiff of a hint of a wisp of a correlation between vaccination and autism prevalence or onset.

    — and still considerably stronger than Steve Novella’s –

    the evidence did not support a link between vaccines in general, the MMR vaccine specifically, or thimerosal in vaccines with autism or any neurodegenerative disorder. I did not begin my investigation with that conclusion”.

    or his —

    “the now “discredited notion that vaccines are a significant cause of autism ” (my emphasis).

    This last is more or less what I, and I believe scientists would support without question..

    Does the different mode of expression matter? Not much in scientific circles. Other scientists might think you are overstating the case a little without being bothered enough to comment on it.

    Those who already trust us and need minimal reassurance will also not bother to think further on it. Likewise no regular reader of SBM would dare challenge it, other than this annoying, tone-trolling, contrarian. Harriet sees no problem with it. Is there also a risk that more moderate language will be interpreted as admitting there IS a risk?

    So do we let that become the standard answer to the generic meta-question : — whether vaccines can somehow affect the expression and/or onset of autistic tendencies in some children?

    Let’s think. Does the end justify the means anyway? We oppose that viewpoint elsewhere.

    Perhaps also the target audience matters. Once you enter into public dialogue with anti-vax and “vaccine safety” identities you are entering a very different arena to that which SBM represents.

    There you will certainly come into dialogue with many people who have been under the influence of other evidence (to them) concerning an “autism epidemic” and the stories about children going downhill after vaccines. These folk already suspect that doctors may not be being perfectly honest in this matter. It is not easy to overcome that but a simple matter to make it worse. All you have to do is make dogmatic claims but then suddenly find the claimed studies hard to produce. The level of certainty expressed does produce a subtle shift in where the onus that of “proof” (to the extent that such a thing is possible) lies in many minds.

    Of course nothing will influence some minds but we ought to still present our case in the best way we can devise.

    Even after presenting all the evidence some listeners will still wonder whether bias has influenced the interpretation of the studies. I contend that they will be less likely to do so when provided with transparent process and the cautious language of normal scientific discourse. That is full of desirable caveats, such as those you hint at above and as implied within such expressions as “the currently available evidence suggests —”.

    I have also been challenged to say what I would do instead. Well, I began this thread by indicating that I would not start off with the off-putting “me smart – not so sure about you” implication and the scant relevancy of “correlation does not indicate causation” . I would work away directly at the perceptions that I know are worrying more reasonable minds, placing less poorly deserved emphasis on absurdist extremes.

    Otherwise I would merely favor Steve’s careful use of words and avoid the making of statements that we have no way of easily supporting.

  68. pmoran says:

    Lilady:I provided you with a link to the NIH about febrile seizures…you dismissed it, stating it was “mildly reassuring”…yet…you are unable… or unwilling, to provide a PubMed citation that links a post-immunization febrile seizure to the onset on autism.

    You misunderstand. I made a simple query, and found your link only mildly reassuring for the reasons that I mentioned. I am not saying that there is such a link. I do want to be prepared for that claim. There is no doubt that at some point this question will come up, if only because autistics are prone to epilepsy and presumably also to febrile convulsions after those vaccines that provoke fever. There is scope for another spurious causal theory.

    Here’s a link to Dr. Paul Offit’s article about “Shifting Hypotheses”. Why don’t you contact Dr. Offit to inform him that you have *found* another “shifting hypothesis” for a *possible* cause of autism?

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908388/

    I am not sure why you would assume I am unfamiliar with all this. David can assure you that I have argued about hte very same matters on newsgroups and mailing lists.

    Disproving those theories does in fact weaken the overall case for ANY association of vaccines with autism a little, by showing how certain apparent associations can be spurious and that the anti-vax movement is on the whole founded upon unreliable approaches to science.

    But it does not constitute a killer blow.

    I mknow that as much as anyone. There remains the little matter of how to best explain the scientific position when we lack killer in is still the little matter That is a different thing to claiing that we have every oanswer

  69. papertrail says:

    Since this topic of vaccines, febrile seizures and brain damage came up, here’s a relevant article – with an unconditional title – “Genetics and the myth of vaccine encephalopathy” by Asif Doja. The author says “there is no evidence to suggest that the fever caused by vaccines predisposes a person to seizures, any more than fevers from other causes (8). This is reinforced by the fact that children with seizures after vaccination are no more likely to go on to have afebrile seizures or developmental problems than children who have febrile seizures from other causes (7). Overall, there is no evidence to suggest that vaccines cause central nervous system injury, epilepsy or infantile spasms (8).” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603512/

  70. papertrail says:

    pmoran says: “But it does not constitute a killer blow. ”

    What would constitute a killer blow? I suspect nothing could meet that criterion.

  71. papertrail says:

    pmoran said: “Is there also a risk that more moderate language will be interpreted as admitting there IS a risk?”

    Yes. More than just risk; anti vax activists and vaccine fearful parents do this consistently. It’s possible that Dr. G and Dr. Offit and others who convey that the jury has reached a decision may well be reaching those who hear what you call moderate language as an admission of risk.
    I can hear it now: “They don’t even know for sure if the mmr vaccine causes autism.”

    Btw, the CDC regards the risk of encephalopathy following vaccination as so rare that it’s “too hard” to determine causation. Many will even hear that as a failing on their part, that they’re too lazy or cheap to figure it out, rather than as a limitation due to how rare it is.

    Genetic explanations (mutations that cause epilepsy) are emerging for why complex seizures and brain damage sometimes occur temporally after vaccination.

    You can criticize Dr. G’s style all you want, but meanwhile you sound rather unprepared to explain to parents why vaccines are extremely unlikely to be the cause of their child’s complex seizures and brain damage.

  72. David Gorski says:

    What would constitute a killer blow? I suspect nothing could meet that criterion.

    Exactly. To Peter, apparently nothing constitutes a “killer blow”—or could ever constitute such a blow. No matter how much evidence there is, he asks for more and insists that there is more scientific uncertainty than there in fact is. Why he does this, I don’t know, because if there’s a form of quackery that does easily demonstrable harm to children, it’s antivaccine quackery. The fact that he objected to my quite reasonable discussion of the tiny level of uncertainty there is in the current scientific consensus speaks volumes, as does his utter failure to produce countering evidence to support his contention that I overstate the case for vaccine safety with respect to autism causation.

    Peter also fetishizes Steve’s allegedly “more moderate” stance. He wasn’t at the debate, however. I was. So readers will just have to believe me when I assure them that, for all his politeness, at the core Steve was just as strong as I was in this post—perhaps more so than I was in this post—in stating publicly and unequivocally that science has asked and answered the question of whether vaccines cause autism and found the answer to be “no.” (I paraphrase, but that’s what Steve said—politely but firmly, of course.) If Peter is going to be intellectually consistent, he therefore needs to criticize Steve for being too “concrete” and “dogmatic,” as well, or consider that maybe—just maybe—he’s bending over a bit too far backwards to seem “reasonable” and “even-handed” and in doing so is elevating antivax arguments far above what they deserve based on science and evidence as well. As I recall, at one point Steve also stated that “science has moved on,” and he was right. Science has moved on from this question, except when forced to do the same studies again and again by activists, even though the same studies find the same thing again and again: There is no detectable correlation between vaccines and autism. Because when it comes to a vaccine-autism link, there’s just no “there” there. Meanwhile, Steve used the word “deception” or “deceive” several times to describe the sorts of evidence that Dr. Whitaker was using to support his claim that vaccines cause autism and are dangerous in other ways, in particular the two graphs he used.

    Let’s compare. Let me take Peter’s tack on autism and vaccines when talking about, for instance, Gerson therapy: The evidence base for and against Gerson therapy is lousy; so maybe it works. Maybe there’s a basis for saying that we can’t rule out completely that it works, just as you say we can’t rule out completely a link between vaccines and autism. Or what about Laetrile? There really aren’t any large randomized clinical trials looking at Laetrile efficacy; maybe we should do one. Maybe it works. It is, after all, a drug, and there is much less evidence that it doesn’t work against cancer than there is that vaccines don’t cause autism! Yes, Peter has a double standard, accepting perfectly reasonable evidence against cancer quackery, such as Laetrile or the Gerson therapy, as more than sufficient to state unequivocally that these therapies are dangerous quackery even though that evidence base doesn’t rise to the level of large randomized double-blind, placebo-controlled trials. In comparison, even though there is a much larger and robust evidence base that supports the hypothesis that vaccines do not cause autism, he insists that we should be going out of our way to leave the door open to a link. One wonders if he has actually made up his mind himself over whether there is a link. He says he has, but he writes as though he hasn’t. If that’s the case, one also wonders what evidence it would take to assuage his doubts.

    In any case, seriously, Peter. I see where you’re coming from here, but I think that, in your effort to be empathetic and communicate you’ve actually gone directly in the wrong direction. Your ideas make communication of vaccines benefits and risks with parents more, not less, difficult.

  73. David Gorski says:

    Yes. More than just risk; anti vax activists and vaccine fearful parents do this consistently. It’s possible that Dr. G and Dr. Offit and others who convey that the jury has reached a decision may well be reaching those who hear what you call moderate language as an admission of risk.

    Indeed. I’ve written about this before. Doctors and scientists are at a disadvantage in the PR war because we do have to acknowledge at least small degrees of uncertainty, as I did in my post. Antivaccine zealots are under no such limitation, and they seize on even the slightest expression of uncertainty to gin up the vaccine-autism “manufactroversy.” Peter seems to think that we don’t consider these issues, but Steve Novella, Paul Offit, I, and many other science and medicine bloggers have written about such issues extensively, if not here, then at our other blogs. This is not an issue that Peter has “discovered.” We’ve been debating it for years.

    So what to do? It’s a fine line between dismissing uncertainty too much and expressing so much uncertainty that you give antivaccinationists an opening. One also needs to remember that our targets are not the antivaccinationists promoting the myth that vaccines cause autism. Our targets are the undecided or the parents not aware of the scientific issues involved who have heard antivaccine fear mongering and are worried because they don’t know if they’re real dangers.

    But, maybe I’m wrong in my assessment of the state of the evidence supporting the scientific consensus that vaccines do not cause autism. Peter is always welcome to provide evidence to that effect, in the form of a study or two that provide compelling evidence that vaccines might be associated with autism. He has yet to do so, despite multiple requests. I will continue to remind him of this every time he complains about my “tone” or about my assessment being too “certain.”

  74. pmoran says:

    Who is being inconsistent? I am fairly sure that if the boot was on the other foot David would be the one asking for studies of the type I asked for when he first made the “whiff of a hint” claim.

    This is what I said–

    Yes, you do also often say that, David. But, — prospective randomized studies? If these exist, and they compare normal vaccination schedules with no vaccines, and they are of sufficient size and quality and consistency in their results that they indeed dispose of any “whiff of a hint” of such an association — the case is closed (and let’s be having them next week.)

    Papertrail, this would be the “killer blow”, so far as “the science” is concerned, and we both know why David is unable to deliver. Our case is quite strong, but it is based upon inferences from data from a lot of different sources none of which quite hits the sweet spot for normal standards of “proof”.

    We then apply one of those rule-of-thumb conventions of mainstream medical science that can be a total mystery to those not subject to our special role and responsibilities, the one that says that if there is no clear evidence in support of a question we (as in we doctors and scientists) don’t need to worry too much further about it.

    The problem is that whether we like it or not sections of the public are already worried by the “evidence” they encounter and I think we have to go well beyond the “you think that, you prove it!” stance that David is adopting with me, if we are to reassure enough people and sustain vaccination rates.

  75. pmoran says:

    So what to do? It’s a fine line between dismissing uncertainty too much and expressing so much uncertainty that you give antivaccinationists an opening. One also needs to remember that our targets are not the antivaccinationists promoting the myth that vaccines cause autism. Our targets are the undecided or the parents not aware of the scientific issues involved who have heard antivaccine fear mongering and are worried because they don’t know if they’re real dangers.

    Valid points, if hinting a little at “the end justifying the means”.

    In any case, I do think that can be done without overstating the case and thereby provoking challenges from the anti-vaxers and vaccine safety that we cannot meet or causing reasonable people to wonder about our strength of claim, instantly nullifying any influence.

    It has been implied that I have changed my tune from dealing with cancer quackery. Not so. If you look at my web site you will find similar caution of expression, because it is deliberately addressing those with an interest in or with sympathy for CAM.

    I am extremely careful to go only so far as the clinical evidence permits. I know from extensive experience (probably longer than yours) that this audience has an extra nose with which to sense any hint of dissemblance or overstatement. They will stop listening and go off with reinforced suspicions the instant there is the least hint of that.

    This is why I also tried to pull you up when I thought you were overstating the implications of the NIH-funded comparison of the Gonzales method and chemotherapy. That study had severe procedural defects that we would normally not tolerate when making such a call as you were making. It did support lesser claims.

    For the same reason I don’t make too much of plausibility issues when writing for less scientific audiences. Almost by definition they mean little to the average CAM sympathizer,

  76. David Gorski says:

    Who is being inconsistent? I am fairly sure that if the boot was on the other foot David would be the one asking for studies of the type I asked for when he first made the “whiff of a hint” claim.

    Of course, one notes that I provided a link with lots of studies to back up the scientific consensus that there isn’t a “whiff of a hint” of an association between vaccines and autism. I could easily provide more, but what’s the point? You’ll just dismiss them with a haughty wave of your hand as not being “up to the normal standards of scientific proof.”

    Papertrail, this would be the “killer blow”, so far as “the science” is concerned, and we both know why David is unable to deliver. Our case is quite strong, but it is based upon inferences from data from a lot of different sources none of which quite hits the sweet spot for normal standards of “proof”.

    Papertrail, that would be the “killer blow” that proves evolution, so far as “the science” is concerned, and we both know why evolutionists are unable to deliver. Our case is quite strong, but it is based upon inferences from data from a lot of different sources, none of which quitequite hits the sweet spot for normal standards of “proof”.

    Papertrail, that would be the “killer blow” that proves anthropogenic global warming, so far as “the science” is concerned, and we both know why climate scientists are unable to deliver. Our case is quite strong, but it is based upon inferences from data from a lot of different sources, none of which quite hits the sweet spot for normal standards of “proof”.

    Peter, in science, when we have many lines of evidence from different sources that all converge on the same conclusion, that is one of the “normal standards of proof.” In fact, your use of the word “proof” demonstrates your problem. Scientists rarely, if ever, speak of “proof.” They speak of evidence, and the evidence that vaccines do not cause autism is, by any reasonable standard of science, overwhelming to a very high degree of certainty, more so than a lot of things we accept as scientific consensus in medicine.

    I again refer to the example of tobacco smoke. Do you believe that tobacco smoke causes lung cancer and heart disease? It’s a truism in medicine, but there has never been a randomized, double-blind, placebo-controlled trial to demonstrate it and, for ethical reasons there never will be, just as there will never be a randomized, double-blind, placebo-controlled trial testing the current vaccination schedule versus no vaccines to test the hypothesis that vaccines cause or contribute to the development of autism. Indeed, as I’m sure you’re aware, in mouse studies, it’s very difficult to cause lung cancer with cigarette smoke (which was one of the arguments tobacco companies used to make to spread the proverbial “fear, uncertainty, and doubt”—FUD—about the evidence linking smoking to cancer). Does that mean that there is sufficient doubt about cigarette smoke causing lung cancer that we should bring these things up every time we discuss it? No! The evidence that demonstrates the connection between tobacco smoke and lung cancer, for example, consists of a combination of epidemiological studies plus basic science studies demonstrating that chemicals in cigarette smoke can be carcinogenic. In other words, it consists of evidence from various different sources that all converge on the same conclusion.

    Using your argument here, if you were to be intellectually consistent, you would have to conclude that there is still doubt that smoking causes lung cancer and chastise “our side” (the American Cancer Society, for instance) for saying that smoking causes cancer. I look forward to such a statement from you, to demonstrate that you are not applying a double standard.

    At this point, you seem to be just being contrarian for the sake of being contrarian on the issue of the evidence base. In fact, you clearly don’t even know the evidence base and haven’t bothered to investigate. Otherwise, you would be able to show me some studies.

  77. David Gorski says:

    It has been implied that I have changed my tune from dealing with cancer quackery. Not so. If you look at my web site you will find similar caution of expression, because it is deliberately addressing those with an interest in or with sympathy for CAM.

    Hmmm. Let’s take a look at some of your statements from your website, shall we? For instance, let’s start with the main page:

    If someone promoting a treatment to you as a possible cure is unable to produce contemporary facts and figures, and cannot introduce you to patients with well-documented cancer that went away with their treatment and that treatment alone, then you are entitled to regard them as a charlatan or crackpot.

    Those claiming that patient privacy prevents such openness are frauds. I never met a patient cured of cancer who was not happy to talk to others in the same predicament. At worst the promoters of the treatment could forward information to your doctors, who share confidential information all the time..

    Those who have never published any clinical results (i.e. effects upon cancer in humans), not even in any of the many “alternative” medical journals now in operation are likewise unworthy of your trust. It is inconceivable that sane, moral persons with an important cancer treatment would not wish to promote it in every way possible. Books about cancer cures usually aren’t worth the paper they are written on. Web sites are no better. These are promotional materials targeting the lay public wherein the author can invent, select, exaggerate and misrepresent with impunity.

    Strong words. Excellent words. All without a whiff of a hint of uncertainty included! You even referred to the quacks as charlatans and crackpots! I heartily approve! I can’t help but ask, though, Peter: Doesn’t the use of words like “crackpot,” “charlatan,” and “fraud” risk offending people who are interested in or sympathetic to CAM? I might quibble that perhaps someone wanting a patent on his discovery might not want to promote it just yet, but such people are usually not selling their product and are instead engaged in gathering data to demonstrate that it works; so it’s fine.

    There is one exception to my unvarnished praise. That bit about patient privacy was a rather harsh, blanket statement that goes too far even for me. (Yes, Peter, you showed more certainty and dogmatism on this issue than I would have.) I wouldn’t conclude that those who claim patient privacy are necessarily frauds. It is true that the vast majority of them probably are, but some of them are probably just true believers or genuinely believe they are protecting patients. In any case, in the US at least, we have the rather severe HIPAA privacy law. So, even for a legitimate practitioner, it’s not entirely unreasonable. That’s why it sounds so plausible when quacks say it. Oh, and I have met the occasional patient cured of cancer who didn’t want to talk to others. Anecdotal evidence to counter your anecdotal evidence.

    Still, overall the sentiments are very good, and not at all the mushy, wishy-washy uncertainty that you seem to be advocating that we use when dealing with antivaccinationists now. You even accused cancer quacks of lying:

    The patient always has the right to determine their own fate and run their own risks. Treatment is by their choice, but ideally only after full and trustworthy informed consent. It is with the latter that “alternative” sources habitually fall short when not frankly mendacious.

    One notes that I’ve written almost exactly the same thing more times than I can count. I even coined a term (“misinformed consent”) to describe what it is that CAM practitioners and antivaccinationists use. Basically, they slant the data and story so much against vaccines or conventional treatment that a rational person faced with only this source of information would be foolish not to go along with what the quack wants.

    Finally, I heartily approve of these words:

    History shows that nothing can for long withstand the inevitable and relentless accrual of evidence that attends the valid claim – not even the dogma of a powerful religion, in the case of Galileo’s. This would apply in triplicate to a cancer cure. Little more than rumour and a few dubious claims have been enough to provoke intense media interest and public hysteria, and even force Government action in relation to some cancer “cures”. Examples are Laetrile, the Di Bella treatment in Italy, and recently the Holt treatment in Australia. Imagine the impact of even a handful of genuine cures of serious cancers.

    One notes that there has never been a large randomized clinical trial of laetrile. There never was a randomized trial of the De Bella treatment. The trials done in Italy were open label in which the patients chose the therapy. The evidence base you require to reject these therapies is far weaker than the evidence base you appear to require to reject any “whiff of a hint” of an association between vaccines and autism.

    Maybe you should revise your website in light of your more recent sentiments. However, I sincerely hope you don’t. I liked the old Peter Moran much better. I miss him. Your website is just fine as it is—an achievement of which you should be justly proud. In fact, I’d love to see more material like what’s there now. Indeed, the old Peter Moran was a guy who a decade ago, among others, inspired me to go into combatting cancer quackery in particular and quackery in general. (I even used his excellent post about breast cancer testimonials as the inspiration for one of my very first substantive posts on my other blog and still use it today in my talks about cancer quackery.)

    I hardly recognize this new guy.

  78. Harriet Hall says:

    @pmoran,

    I’d like to second David’s comments.

    You suggest that “We are rejecting the vaccine/autism claim only because “there is no clear evidence for causation” and that the Gonzalez study “did support lesser claims.”

    We reject the vaccine/autism claim because it has been tested repeatedly and the results constitute convincing evidence against causation.

    I can’t even imagine what “lesser claims” you think the Gonzalez study might have supported. Please explain.

    And you never did answer my challenge to find 3 each of David’s and Steve’s statements that you object to and to re-word them to show what you think they should have written.

  79. Justin says:

    I would like to second many of Peter’s statements in this thread. I will provide a quote from an article in the Dec. 2009 issue of Neuron (a highly regarded journal), which I feel more accurately portrays the message that should be disseminated based on the extant scientific evidence. The article is entitled: “Breaking Boundaries in Neural-Immune Interactions”

    Finally, neural-immune crosstalk also has profound implications for public health policy. Growing evidence that maternal immune activation could increase the incidence of autism or schizophrenia in offspring suggests that healthcare providers should revisit the pros and cons of using anti-inflammatory drugs in pregnancy with the goal of developing drugs that prevent a proinflammatory response in the CNS without damaging the fetus. Another issue for society right now is whether, and when, pregnant mothers should be given the seasonal flu and H1N1 vaccines. While the flu can be extremely harmful to pregnant women, the effects of stimulating the immune response with two flu vaccines during pregnancy are unknown.
    Absent the luxury of waiting for large-scale study results, recommendations that pregnant women receive both vaccines are valid based on current knowledge of the dangers of natural flu infection during gestation. However, since the negative effects of immune stimulation during pregnancy are likely determined by susceptibility factors, our understanding of factors that cause aberrant baseline immune responses in some pregnant women must be improved and better methods for susceptibility screening developed soon.

    It is also important to note that neuralimmune crosstalk could be affected by the current schedule of childhood immunizations. Although there is some epidemiological evidence that immunizations are not likely to have a direct role in the ontogeny of autism (Immunization Safety Review Committee, 2004), it is still possible that responses to the number and combinations of vaccinations given at some visits could contribute to cognitive changes in children who may already have altered immune responses. Natural infections in an individual with a dysfunctional immune system might have an equally deleterious effect. Thus, a better understanding of the effects of immune activation during gestation and early postnatal development, especially in the context of increased disease susceptibility, will be critical to either validate our current health policies or modify them for specific populations of individuals.

    This was written in 2009, since then an exponential increase in studies related to immune dysfunction/maternal immune activation and autism have been completed. It is becoming more of a reality that immune dysfunction and maternal immune activation play a critical role in the ontogeny of a large cohort of children with autism. When this fact is coupled with the relative dearth of information regarding specific immune reactions in infants from the normal vaccine schedule, including time dependent effects, one has to consider that it is a plausible avenue to further explore.

    I think Peter’s suggestion that prospective epidemiological studies will be needed to more thouroughly understand the complex interrelations between vaccines, the developing immune system, and immune dysfunction in autism, is a very sound suggestion. In fact, I have suggested this on a few occasions in the past. Prospective nested case/control studies that take into account a number of relevant biomarkers will be the first step. I have also suggested that there is no need to have a vax vs. unvax study to learn something that may be very important. A completely vaxxed cohort would be just fine, it is in the details of what biomarkers are surveyed, genetic background, and time dependent effects that are of greater importance.

    Lastly, I would like to second the idea that if you want to have any credence, picking the easy fruit isn’t how you are going to accomplish that. I would find it a million times more instructive if Dr. Gorski, or Dr. Novella had debated someone like the author of the quote or Paul Patterson, both who are well regarded researchers in the fields of autism and neuroimmunology. Both of these people are not antivaccine, but have orders of magnitude more knowledge regarding the neuroimmunological aspects of autism, which, in my mind is a prerequisite to intelligently discussing the vaccine/autism (link/non-link, I am still undecided).

  80. papertrail says:

    I knew you meant a RCT when you said killer blow but that will never happen because it’s immoral to let kids die by not vaccinating them. Besides, the anti-vax would only accept a sample population of EVERYONE before they’d be satisfied. And, you’d have to compare those with all vaccinations on the schedule (because now the claim is that vaccnes are interacting with each other to cause brain damage or are too close together) against completely invaxed kids. So, you will never ever see a true “killer blow” study. And am I wrong in thinking that it’s best to first discern through lesser studies if a consistent strong correlation even exists? Is anyone even sure that autism has increased and not that kids who used to be just quirky are now on the spectrum?

  81. lilady says:

    @ Justin:

    “Another issue for society right now is whether, and when, pregnant mothers should be given the seasonal flu and H1N1 vaccines. While the flu can be extremely harmful to pregnant women, the effects of stimulating the immune response with two flu vaccines during pregnancy are unknown.”

    Apparently, the concern about the effects of stimulating the immune response by administering the seasonal flu vaccine along with the H1N1 seasonal flu vaccine to pregnant women, is no longer “unknown”.

    http://www.nlm.nih.gov/medlineplus/news/fullstory_127090.html

    “A Danish study that included more than 53,000 pregnant women, 13 percent of whom received the H1N1 vaccine, found no increased risk of major birth defects or pregnancy problems.

    “We compared the vaccinated with the unvaccinated pregnancies with respect to a number of adverse events — major birth defects, premature birth and fetal growth problems. None of these adverse events were more common among H1N1-vaccinated pregnancies. We conclude that H1N1-vaccinated pregnancies are not at increased risk of these adverse events,” said Dr. Anders Hviid, a senior investigator at Statens Serum Institut, in Copenhagen.”

    @ Papertrail: That “killer blow” study ain’t ever going to happen, because of the ethics involved and the ever-moving goalposts. The AoA and every other “notorious anti-vaccine” organization are still calling for the vaccinated-unvaccinated study and have “moved on” to vaccine-associated causes such as “too many too soon”, testing of every pregnant woman for “mito disorders” and the latest…aluminum adjuvants.

    Has anyone come up with a citation for P Moran’s statement about febrile seizures post immunization?

    “Harriet, I doubt if vaccines cause autism, although I do have to wonder, as a non-neurologist, whether severe febrile convulsions after some vaccines could be a triggering or exacerbating factor in the susceptible (Dr Novella?).”

    And then this statement from P Moran, that clarified his dismissive answer to me…

    “You misunderstand. I made a simple query, and found your link only mildly reassuring for the reasons that I mentioned. I am not saying that there is such a link. I do want to be prepared for that claim. There is no doubt that at some point this question will come up, if only because autistics are prone to epilepsy and presumably also to febrile convulsions after those vaccines that provoke fever. There is scope for another spurious causal theory.”

    I didn’t misunderstand P Moran, and all your rephrasing and posturing doesn’t change the facts of these studies of reported “vaccine encephalopathy”, due to DTP vaccinations.

    http://www.ncbi.nlm.nih.gov/pubmed/21844054

    http://www.ncbi.nlm.nih.gov/pubmed/20447868

    “INTERPRETATION:

    Vaccination might trigger earlier onset of Dravet syndrome in children who, because of an SCN1A mutation, are destined to develop the disease. However, vaccination should not be withheld from children with SCN1A mutations because we found no evidence that vaccinations before or after disease onset affect outcome.”

    Again, P Moran, who appointed you as the sole arbiter of the style of bloggers on SBM? I like Dr. Gorski’s posts for the wealth of information he imparts…as well as his style.

  82. Chris says:

    Justin:

    I have also suggested that there is no need to have a vax vs. unvax study to learn something that may be very important. A completely vaxxed cohort would be just fine, it is in the details of what biomarkers are surveyed, genetic background, and time dependent effects that are of greater importance.

    Go ahead and design a study, make sure it complies with the Belmont Report, get it IRB approved, write a grant, and then submit it for funding. Suggestions for organizations to fund your study would be Autism Speaks, SafeMinds, Autism Trust and Generation Rescue.

    Good luck, and do read up on the Belmont Report, and this study from Germany comparing the health between unvaccinated children to vaccinated children.

  83. lilady says:

    I have a comment stuck in moderation…to many links, most probably.

    @ Chris: Too bad P Moran doesn’t venture out to some of the blogs that we post on, where we post information about vaccines and great links for reliable information on each of the Recommended Childhood Vaccines.

    (The only time we get *snarky* is when trolls and their sock puppets come posting)

  84. pmoran says:

    David and Harriet, sorry, but you are both still wrong in saying I am applying a double standard to cancer quackery and vaccine evidence . Here are relevant extracts from two areas dealing with Gerson on my site and one with Gonzales. I am sure you will find the same caution of expression everywhere that there is any consideration of evidence.

    In relation to Gerson’s “famous” fifty cases —

    On the other hand, we cannot say with certainty that Gerson’s approach NEVER works. All we can say is that the number of probably or possibly favourable outcomes arising out of a practice treating hundreds of cancer patients yearly over some decades is not enough to overcome extreme scepticism as to the worth of most of the components of his therapy (coffee enemata, extreme low salt diet, thyroid hormone etc). We experience a significant number of unexpected outcomes within conventional medical care, and none of Gerson’s theories have found support in half a century of subsequent research.

    and that clinic’s study with melanoma cases —

    My Verdict: No convincing effect, and certainly none on more advanced cases. A small beneficial effect not excluded but these are extremely disappointing results for the cancer thought to be most responsive to this very intense and life-consuming treatment method.

    In relation to the Gonzales study I say

    The final results of that study have been published http://jco.ascopubs.org/cgi/content/abstract/JCO.2009.22.8429v1 They are disastrous for the Gonzales/Kelley (“enzyme”) approach.

    Due to small numbers of suitable patients accepting randomisation, the study had to be completed on the basis of patients choosing which treatment to receive. This can introduce bias and there were small biases towards sicker patients in the Gonzales/Kelley group such as more with distant metastases. Gonzales also alleges that some of the patients allotted to him were too sick to follow or complete his treatment. This is certainly possible. Inoperable pancreatic cancer is a rapidly progressing and debilitating condition, and patients may have also exaggerated their ability to consume the required diets and handfuls of supplements in their eagerness to be accepted for the study.

    Yet even if we doubled the survival of the Gonzales/Kelley patients at 10 months so as to completely exclude some obviously excessive early mortality in this group, there is still no indication of any beneficial influence from this complex regime over the average medical care that the SEER figures reflect..

    David said that this study showed chemotherapy produced three times better survival rates than Gonzales at some unspecified end point. It is nowhere near a strong enough study to justify that claim, and for at least two obvious reasons.

    I wasn’t defending Gonzales when I objected to that. I was defending the application of uniform standards to the interpretation of scientific evidence — for the sake of one of our own mantras, if not also to avoid some CAM bright spark using this as proof of our Big Pharm bias and OUR double standard in looking at evidence. I won’t describe David’s reaction to this challenge to his scientific authority other than to say that it helped put a target on his back.

    I understand that we will all at times overstate our case, especially in informal discussions amongst ourselves. But this is a supposedly science-based forum that spends a great deal of its time being critical of the scientific standards and logic of others. It also reaches out to a much wider audience every time it has dealings with CAM.

  85. Harriet Hall says:

    @pmoran,

    You said “the Gonzalez study “did support lesser claims.”
    What lesser claims? You yourself said the study was “disastrous” for that approach. Now you say both that it was flawed and that it supported lesser claims. You can’t have it both ways.

    “David said that this study showed chemotherapy produced three times better survival rates than Gonzales at some unspecified end point.”

    When David said the study showed 3X better survival for the chemo group, he was merely stating what the study itself said it showed, and they clearly specified that the end point was 1 year. That doesn’t mean there weren’t flaws in the study. And it doesn’t mean there is support for any “lesser claims.” Another point is that if sicker patients can’t follow his regimen, it isn’t useful for treating sicker patients.

    You seem to be grasping at straws just to find any way to criticize our approach; but I can’t see that it is much different from yours.

  86. lilady says:

    Harriet Hall posted back at P Moran…

    “You seem to be grasping at straws just to find any way to criticize our approach; but I can’t see that it is much different from yours.”

    There is a world of difference here, Dr. Hall.

    You and Dr. Gorski, did not invade P Moran’s blog to critique his *style*, his *approach*, his *conclusions* and his *concern* for the general public who are fence sitters, who contemplate, or who dabble in, CAM cancer treatments.

    Where are P Moran’s studies/citations about the post-vaccine risks for autism, associated with febrile seizures?

  87. papertrail says:

    @Justin. I found this review of Patterson’s book on Patterson’s own website: “While he concludes that the evidence for an association between postnatal vaccination and autism is negligible, there is more uncertainty regarding the balance of safety and efficacy for prenatal maternal vaccination, depending on the stage of pregnancy and other maternal factors.”

    This discussion is about childhood immunizations and autism. I think “negligible” isn’t saying the door is closed but it doesn’t sound like Patterson wants to belabor that proposed connection. (I don’t know, just going on what I just read.)

    @Lilady – about a vax-unvax study, that’s what I said, that it ain’t gonna happen.

  88. lilady says:

    @papertrail:

    Cripes, I need a scorecard to keep track of all the *theories* out there about how vaccines *might* cause autism.

    That is why I *lurk* at the AoA website…to keep up with the conspiracies and the nonsense:

    http://www.ageofautism.com/2009/10/but-theres-mercury-in-the-h1n1-vaccine-curiouser-and-curiouser.html?cid=6a00d8357f3f2969e20120a5e9d891970b

    Did you know, that it isn’t just seasonal flu vaccines and the separate H1N1 vaccine administered to a pregnant woman that affected her fetus and *caused* autism?

    Did you know, that a Rhogam shot administered to a postpartum Rh (-) mother, could cause autism in a child born from a subsequent pregnancy?

    Did you know, that childhood vaccines, administered to a woman twenty or thirty years earlier, could cause autism in one or more of her children?

    Dr. Gorski’s “friend” blogged about a child, who, along with a slew of other family members, required rabies post-exposure prophylaxis following a bat exposure, and who was, sometime later, diagnosed as being on the autism spectrum? That was a “classic”.

    Where are P Moran’s studies/citations about the post-vaccine risks for autism, associated with febrile seizures?

  89. papertrail says:

    @lilady. I see no end to the hypothesis. Billion so dollars worth of hypotheses, even though after more than a dozen studies, there isn’t a whiff of a… er, um…the preponderance of the evidence favors a rejection of a causal relationship.

    @Justin re: Patterson.

    I found more on his attitude about the flu vaccine for pregnant women. Here’s an excerpt from a good article that interviewed him, not about flu shot and autism but schizophrenia (he probably would say the same about autism, but I’m not going to waste my money buying his book to find out). In sum, he’s a bit schizoid himself when it comes to the connection. On the one hand, he announced that he wouldn’t want his own wife to get the flu shot while pregnant yet concedes that getting the flu itself could be much worse and recommends that everyone else’s pregnant wives should get the shot. Too late, Patterson! Once you tell the world that you wouldn’t recommend it to your own wife, that is the same thing as telling other pregnant women not to get the shot, regardless of admitting that the CDC are more expert on these matters yourself.

    “The research into the links between maternal flu and schizophrenia is still considered preliminary, which makes any policy conclusions premature, but scientists studying the connection are starting to worry.”

    …”Obviously, the safe thing to do is to go with the experts, and the experts are the CDC,” said Paul Patterson, a professor of biology at the California Institute of Technology and one of the leading researchers into the link between maternal infections and schizophrenia. “However, if it was my wife, I would not [want] her vaccinated.”

    Patterson said he would try to protect a pregnant family member from the flu by suggesting she keep away from infected people and by enforcing a regimen of regular hand-washing among all family members.

    However, he conceded that such measures might not be as effective as flu shots and that women who get the flu because they don’t get a flu shot might not only put their future children at increased risk for schizophrenia, but also incur numerous other risks from the illness. Careful prevention techniques, moreover, are unlikely to help pregnant women who have toddlers, because small children tend to bring home endless streams of viral infections.” http://www.washingtonpost.com/wp-dyn/content/article/2007/11/23/AR2007112301327.html

    It seems likely to be about fever during pregnancy, not about the flu shot, per se: http://articles.latimes.com/2012/may/23/news/la-heb-fevers-pregnancy-autism-20120523

  90. pmoran says:

    Harriet: You said “the Gonzalez study “did support lesser claims.”
    What lesser claims? You yourself said the study was “disastrous” for that approach. Now you say both that it was flawed and that it supported lesser claims. You can’t have it both ways.

    Again with the selective quoting. The “lesser claims” referred< reasonably clearly< to ones short of the Dr Gorski "call" I was responding to. I mentioned no other claims.

    The lesser claims might go like this: — because of the study defects, we are limited in our conclusions other than that this particular selection of patients did fare rather "disastrously" when compared to the other groups. Also, since not one of these 32 patients did obviously well with the Gonzales method, it would seem to have no useful effect on patients with this kind and stage of cancer (if not actually harnful). Since Gonzales and others was claiming that he gets particularly good results with pancreatic cancer we can also doubt whether he can legitimately claim better results with any other kind of cancer.

    The whole point is that you can make a solid, and more obviously non-prejudged, case with proper scientific argument. You don’t need to go beyond what the quality of the data permits, thus risking that our very argument will destroy our credibility in some minds.

    I am obviously an extremely poor communicator, in not being able to get across that my complaints have to do with poor scientific expression (for some of our purposes). They are NOT meant as a defence of CAM or anti-vax sentiments (Lilady — please note — you also are not getting the point).

  91. pmoran says:

    Justin: I think Peter’s suggestion that prospective epidemiological studies will be needed to more thouroughly understand the complex interrelations between vaccines, the developing immune system, and immune dysfunction in autism, is a very sound suggestion

    I am not suggesting that, Justin. As a non-expert in this field I would first suggest following up the 53,000 women in Lilady’s Danish study to see if there is any hint of increased autism in the offspring of those receiving vaccines during pregnancy. (You need such data, too, Lilady).

  92. Harriet Hall says:

    @pmoran,

    “because of the study defects, we are limited in our conclusions other than that this particular selection of patients did fare rather “disastrously” when compared to the other groups. Also, since not one of these 32 patients did obviously well with the Gonzales method, it would seem to have no useful effect on patients with this kind and stage of cancer (if not actually harnful). Since Gonzales and others was claiming that he gets particularly good results with pancreatic cancer we can also doubt whether he can legitimately claim better results with any other kind of cancer.”

    I will critique your words the way you have been critiquing David’s: your use of the word “disastrously” will incline your readers to distrust you. You should have simply explained (without any whiff of disdain) that the outcomes seemed to be poorer than the chemo group but only for this one cancer in this one experimental setting that was probably not a credible study because it was flawed for the following reasons….It doesn’t rule out the possibility that a select subgroup of pancreatic cancer patients might respond. It doesn’t rule out the possibility that Gonzalez really does get better results with his patients because of something he does that was not carried out properly in this study. Even if you assume that his results are poorer than he claims for pancreatic cancer, that doesn’t rule out the possibility that he might get better results with other cancers. There is always room for doubt, so you shouldn’t come across as dismissive or as rejecting the Gonzalez treatment, or your readers will perceive your words as biased. We shouldn’t make any sweeping conclusions without more information. We should follow up on all Gonzalez’s patients to see what can be learned from more data. We should try to learn why patients turn to the Gonzalez regimen and have sympathy and understanding for them. We should admit that some of these patients may have benefitted from the treatment in other ways than in prolongation of life. Gonzalez may be really helping these people in ways that a rigorously scientific mindset doesn’t recognize. We should not discourage patients from trying it.

    Of course this goes too far. So did you.

  93. pmoran says:

    That is not worthy of comment. Keep the wagons circled. I may be back.

  94. lilady says:

    @ P Moran: The H1N1 vaccine was administered to high risk individuals first…including pregnant women….starting October 2009. Those infants born to those Danish women are now at least two years old and some are approaching their third birthdays. The H1N1 strain has been incorporated into every seasonal influenza vaccine since then, starting with the the 2010-2011 influenza vaccine:

    http://www.cdc.gov/flu/about/qa/vaccine-selection.htm

    Wouldn’t we *know* by now, if there is an uptick in the number of children being reported as showing signs of autism? Oh wait, those toddlers would have received other vaccines as well. Perhaps we should space out the vaccines, relying on “mommy intuition” to determined if and when a child receives a particular vaccine…or any vaccine, for that matter. That is the determining factor that Dr. Jay Gordon uses. Perhaps, we should look into Dr. Bob Sears’ “alternative schedule”…so that kids don’t receive “too many too soon”?

    Now about that original question I asked about post-immunization febrile seizures; you still are unable to provide a citation, are you? Why not? You are the one who raised that point, when you were pointing out to Dr. Gorski his expressions about the certainty of his statements, that vaccines are not implicated in a later diagnosis of autism.

    Sorry, but your nitpicking, comes across as *concern trolling* or *tone trolling*.

  95. Harriet Hall says:

    @pmoran,

    “That is not worthy of comment. Keep the wagons circled. I may be back.”

    Translation: “you are being mean to me by parodying my well-intentioned criticism. I’m taking my marbles and going home. I’ll probably return in future threads to repeat the same criticisms.”

    You never did what I asked you to do: give specific examples of Steve’s and David’s statements that you disapprove of and re-write those statements to show what you think they should have said. That is even more important now that David has pointed out some of the equally strong statements on your own website. I am not circling the wagons, I’m just trying to pin you down on exactly what you mean.

  96. papertrail says:

    Too bad this topic was raised and carried forward as a personal criticism rather than a subject that could be rationally discussed.

    I think it is a valid question. What is the preferred approach to expressing scientific findings to the public regarding vaccinations (or any important health matter). We have to consider that when vaccination fear takes hold and spreads, disease injuries and fatalities result. This is important.

    Assuming your goal is not to persuade but to provide objective, accurate information to enable parents to make an informed decision, would vaccine-hesitant parents be just as well informed of the truth if you say “vaccines don’t cause autism” (let’s say along with general reference to a large number of studies that have been done) as if you couch the conclusions in terms of the strengths and limitations of the various studies and the findings of credible systematic reviews, like the IOM?

    If the goal is to persuade, is it more persuasive to sound definitive (which may be perceived as confident and reassuring) or is it a turn-off for some who believe the science that was done on this question has its limitation?

    One thing I can say is that some of the terms scientists use are often heard by the public differently than intended (I used to do this too). “Association” and “link” or “correlation” means “it causes it”. “Consistent with or indicating causation” means “it causes it.” Media headlines describe study conclusions. All studies are regarded as “evidence” no matter how small, preliminary, implausible the hypothesis, unreplicated, unpublished – as long as they support your own beliefs. “Bias” is interpreted as personal and the research becomes suspect.

  97. papertrail says:

    “Bias” is interpreted as personal and the research becomes suspect.”

    I meant to say the researchers themselves become suspect.

  98. daedalus2u says:

    papertrail,

    I was at a talk by Paul Patterson

    http://autism.mit.edu/patterson

    A year (2008) after the article (2007) where he was quoted he would not get his wife vaccinated for flu if she was pregnant. He said that if all flu during pregnancy was eliminated, that the incidence of schizophrenia would go down by ~30%.

    He also reported that he was at a conference of experts in immunology and schizophrenia, and the question was asked about flu vaccine during pregnancy and to a person, those experts all said they would have their wives vaccinated because flu during pregnancy was so bad.

    He has written several things since that interview (in 2007).

    The symptoms of schizophrenia are essentially the opposite of those of autism. In other words, neurologically typical is in the middle and schizophrenia and autism are at two opposite extremes.

    http://www.ncbi.nlm.nih.gov/pubmed/18578904

    If this is correct (I think it is based on my understanding of both), then the mechanism by which an infection can cause both is via a mismatch of pro-inflammatory and anti-inflammatory effects.

    In other words, during an infection there is a release of pro-inflammatory and anti-inflammatory cytokines. These have different effects in different tissue compartments depending on a lot of different things. A major player (perhaps the major player) in that balance is nitric oxide. Nitric oxide is probably the major anti-inflammatory cytokine, but because it is a small molecule isn’t always recognized as such. Nitric oxide signaling also happens to be used in a lot of regulation of neurodevelopment, differentiation, proliferation, apoptosis, etc., etc., etc. Screwing up NO physiology during differentiation is going to cause problems. Thalidomide happens to be a nitric oxide synthase inhibitor. The teratogenic effects of thalidomide are probably all related to its effects through nitric oxide.

    Too much NO causes neural tube defects, as does too little NO. What is needed is the right balance and that right balance can be difficult for physiology to regulate when things like infection happen.

    My hypothesis of autism and schizophrenia causation is that it depends on the NO levels in utero, which differentially epigenetically programs the fetal brain and then has life-long effects. To high an NO level and you get schizophrenia, too low an NO level and you get autism (this is a gross simplification, but then so is everything about nitric oxide physiology). The NO level is highly regulated, which means there is lots of feedback. An infection causes high NO levels through expression of iNOS, high NO causes expression of pro-inflammatory cytokines to compensate for the high NO. Balancing the NO vs superoxide in all tissue compartments simultaneously is difficult, which is why sepsis still kills ~1/3 of patients despite Dr Crislip’s best efforts.

    Too high an NO level and mitochondria get shut off, too low a NO level and there is down-regulation of chaperone proteins and autophagy (a lot of other stuff too). What is needed is the right amount and that is impossible to regulate externally because it is too complex.

    Normally pregnancy is a high NO state. That is probably what causes the nausea of morning sickness (which is why morning sickness correlates with good pregnancy outcomes). High NO is especially good during the first trimester when differentiation and epigenetic programming is happening. NO is an excellent antioxidant (a few thousand times better than vitamin E). Whacking nitric oxide physiology during the first trimester is not a good thing.

    I don’t think it is possible to predict the outcome of vaccination with flu vaccine during pregnancy (other than resistance to infection by flu). I think it is correct that flu during pregnancy would be much worse. A very large variable is when the exposure happens. For thalidomide there is a couple day window when thalidomide causes autism. It is only when very specific critical structures are whacked that things happen. Different structures develop at different times, so the details of what happens is not knowable in advance.

    Autism and schizophrenia are life-long conditions of variable intensity that occur mostly during in utero brain development in the first trimester. That is when teratogenc can cause autism, that is when the life-long characteristic neuroanatomy of minicolumn density occurs.

    There is zero evidence of post natal vaccinations causing autism. One may argue that “autism-like” conditions caused by brain damage can be caused by certain types of immune system stimulations, but those are not autism. Autism is characterized by larger brains, with more neurons and with more minicolumns. The idea that there is “brain damage”, or “nerve damage”, or effects due to “toxins” is not correct.

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