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When you can’t win on science, invoke the law…

Late last week, the anti-vaccine underground was all atwitter. The reason was the announcement of an impending press conference, scheduled for yesterday at noon in Washington, DC that proclaimed:

Investigators and Families of Vaccine-Injured Children to Unveil Report Detailing Clear Vaccine-Autism Link Based on Government’s Own Data

Report Demands Immediate Congressional Action

Directors of the Elizabeth Birt Center for Autism Law and Advocacy (EBCALA), parents and vaccine-injured children will hold a press conference on the steps of the U.S. Court of Federal Claims (717 Madison Place, NW in Washington, DC) on Tuesday, May 10 at 12:00 PM to unveil an investigation linking vaccine injury to autism. For over 20 years, the federal government has publicly denied a vaccine-autism link, while at the same time its Vaccine Injury Compensation Program (VICP) has been awarding damages for vaccine injury to children with brain damage, seizures and autism. This investigation, based on public, verifiable government data, breaks new ground in the controversial vaccine-autism debate.

The investigation found that a substantial number of children compensated for vaccine injury also have autism. The government has asserted that it “does not track” autism among the vaccine-injured. Based on this preliminary investigation, the evidence suggests that autism is at least three times more prevalent among vaccine-injured children than among children in the general population.

I could hardly wait.

After all, the anti-vaccine flacks at Age of Autism started flogging this press conference announcing this report relentlessly immediately upon its announcement. So did other anti-vaccine groups, including SafeMinds, the Autism Action Network, and others. I knew this because I’m on the mailing list for a number of anti-vaccine groups. I do it for you, to keep my finger on the pulse of the anti-vaccine movement and as an early warning system to let me know when they’re up to various forms of chicanery. Being thus plugged in to anti-vaccine blogs and various mailing lists, I can report that the entire anti-vaccine crankosphere was abuzz with excitement and anticipation over the release of this report, so much so that I was starting to wonder if there would be anything there that might be be worth paying attention to. Even FOX News took the bait:


As is usually the case when the anti-vaccine movement announces the impending announcement of some “blockbuster” study or report that will demonstrate—or so they say—beyond a shadow of a doubt that, even against the mountains of epidemiological evidence indicating no correlation between vaccines and autism, there really, truly is a good scientific reason to suspect that all that evidence is wrong and that vaccines are the cause of an “autism epidemic,” when the press conference rolled around yesterday and the report was published, I was disappointed. I thought it would be a challenge. It wasn’t. Still, I view it as my duty to explain why this report is a whole lot of nothing that in fact is entirely consistent with the current scientific consensus that vaccines don’t cause autism, not so much because I have any hope of changing any minds among those who released the report, but for the good of the fence sitters who might come across this report and find it convincing.

Not surprisingly, the report was written by anti-vaccine stalwarts, namely Mary Holland, Louis Conte, anti-vaccine lawyer Robert Krakow, and Lisa Colin and is entitled Unanswered Questions from the Vaccine Injury Compensation Program: A Review of Compensated Cases of Vaccine-Induced Brain Injury. Apparently the buildup was too great. Now that I’ve actually read this report I can’t believe it. It’s just that bad.

If there’s one thing that cranks routinely do when they can’t win their case on science is to shift to other venues to convince people that they are not, in fact, cranks. After all, if they stuck to arguing facts, science, and evidence, they wouldn’t be cranks. They also wouldn’t have a prayer of obtaining influence because the science is so much against them. So, failing at science yet again, what the anti-vaccine movement has done yet again is to move over to law. In essence, they are implying that legal decisions can mean that there is a scientific case to be made in favor of the hypothesis that vaccines cause autism. This is an utterly fallacious argument at its core, because findings of law all too often have very little to do with findings of science. Examples abound, but my favorite one is the scare over silicone breast implants during the 1980s and 1990s. The science supporting the claims that silicone from these implants was causing systemic diseases, such as cancer, autoimmune diseases, and a panoply of other conditions, was never good. In fact, it was weak to nonexistent. None of that stopped an avalanche of lawsuits from bankrupting Dow-Corning in 1995 Later, as more studies were carried out, it was found that there was no correlation between silicone implants and the conditions attributed to them. Even so, it wasn’t until 2006 that the FDA approved these implants again for cosmetic use.

Basically, law is not science, and, as much as lawyers would like you to think that the law can deal with science easily, the two cultures, law and science, are very, very different. In law, for example, the object is to win your case, not to find out how nature works and develop models (i.e., theories) that accurately describe it and predict its behavior. In law, there are no truly objective right or wrong answers about issues of science. There is only the law and how it has been interpreted by courts. Advocacy for one’s position using every tool at one’s disposal and denigrating or ignoring evidence that conflicts with that position is not just acceptable, but mandatory. And that’s what Holland et al do, with little exception. In fact, they go so far as to use the common legal tactic of making like Humpty Dumpty in this passage from Lewis Carroll’s Through the Looking Glass:

‘When I use a word,’ Humpty Dumpty said, in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

‘The question is,’ said Alice, ‘whether you can make words mean so many different things.’

‘The question is,’ said Humpty Dumpty, ‘which is to be master — that’s all.’

Alice was too much puzzled to say anything; so after a minute Humpty Dumpty began again. ‘They’ve a temper, some of them — particularly verbs: they’re the proudest — adjectives you can do anything with, but not verbs — however, I can manage the whole lot of them! Impenetrability! That’s what I say!’

And that’s what Holland et al also appear to say, as well. Impenetrability based on legal jargon is their shield and their sword. They also fall back on the famous “just asking questions” ploy, so beloved of cranks, which is colloquially known among critical thinkers as JAQing off, which they do blatantly here:

This assessment of compensated cases showing an association between vaccines and autism is not, and does not purport to be, science. In no way does it explain scientific causation or even necessarily undermine the reasoning of the decisions in the Omnibus Autism Proceeding based on the scientific theories and medical evidence before the VICP. Nor does this article have anything to say about state childhood immunization mandates in general.

What this article does point to are unanswered questions about vaccines and autism, a thorny issue that affects approximately one in one hundred and ten children.10 On this point, this study strongly suggests the need for further Congressional and scientific investigation to explore the association between vaccine-­induced brain injury and autism and the integrity of this federally-­administered compensation program.

If you admit that what you are peddling is not science (and it most definitely is not), and you can’t show convincing evidence of an association between vaccines and autism (which can only be shown by science anyway), then why even bother? The answer is easy if you understand the authors’ purpose. It is not to demonstrate whether there is a true correlation between vaccination and autism or whether vaccines do cause or increase the risk of autism. Rather, it is advocacy. It is persuasion. It is a tool to use to try to get legislators to change the law, science be damned.

It is propaganda.

The core of the argument in Holland et al appears to boil down to three claims. First, they claim to have found 83 cases of autism associated with vaccine-induced brain injury, which, they claim, makes autism three times more prevalent in children compensated by the Vaccine Injury Compensation Program (VICP). Second, because they base this estimate primarily on children for whom there are reports of “autistic-like” symptoms or who ultimately developed autism, they argue that there is no difference between autism and having been noted to exhibit “autism-like” behaviors or symptoms. Finally, they claim that this means that autism is three times more prevalent in VICP-compensated children than in the general population. Let’s look at these one at a time.

Looking at the second claim first, only a non-physician could make such a risibly silly argument as this and not be expected to be subjected to ridicule:

Because autistic disorder is defined only by an aggregation of symptoms, there is no meaningful distinction between the terms “autism” and “autism-­like symptoms.” This article makes the distinction only to accurately reflect the terms that the Court of Federal Claims, caregivers, and others use. It is not a distinction to which the authors attach significance.

It is not as uncommon as we would like in medicine for conditions and diseases to be defined primarily (or even only) by aggregations of symptoms. Irritable bowel syndrome is an example. Ditto tension headache. Moreover, it is often the context within which those symptoms arise that distinguish one diagnosis from another. In any case, the DSM-IV provides fairly clear diagnostic criteria for autism. If the child doesn’t have enough of these criteria to be diagnosed as autistic, that child could have “autism symptoms” but not autism. In other words, if a child shows a number of odd behaviours but not the classic triad of impairments, then they might have ASD or Asperger’s Syndrome or HFA, but they don’t have autism because the diagnosis of autism depends upon a specific set of diagnostic criteria, and the child doesn’t meet those criteria. If he did, he’d have a diagnosis of autism. It’s just that simple, but Holland et al try to obfuscate by trying to make terms like “autism-like symptoms and similar terms mean what they want them to mean.

Humpty Dumpty indeed.

Nor are diagnostic criteria for a condition like autism spectrum disorders a difficult concept for most people; certainly they aren’t for doctors. Apparently, however, they represent a very difficult concept indeed for Holland et al, who seem to be arguing that any child with autism-like symptoms must have autism. This is akin to arguing that anyone who has a belly ache or diarrhea must have irritable bowel syndrome or that someone who experiences a headache must have migraines. In addition, such an argument assumes that all symptoms are equal when it comes to making the diagnosis of autism.

Regarding the first claim, if we take at face value the claim that there are 83 children compensated by the VICP, it is first essential to compare this number to the number of children compensated by the VICP. This the authors try to do but utterly miss the point in doing it:

This discussion must start with the caveat that we are able only to interpret the subgroup of eighty-­three compensated cases that we have located. Out of a total number of approximately two thousand five hundred compensated vaccine injury claims,137 we recognize that this is a small subset. It is our hope that this preliminary study will lead to more complete study of all cases of compensated vaccine injury. Such a study might provide a far more comprehensive understanding of vaccine injury.

83/2,500 results in an estimated prevalence rate of approximately 3.3%. On the surface, this seems to support the claim that the prevalence of autism/ASD is three-fold higher in VICP-compensated children than it is estimated to be in the general population (around 1%). Of course, there’s at least one problem. The authors are even forced to admit it. Specifically, of these 83 children, Holland et al could only find documentation of autistic symptoms for only 39. The rest of those 83 were “diagnosed” solely on the basis of a parental questionnaire. This lower number results in an estimated prevalence of autism of around 1.6% in the VICP-compensated population, an estimate that is falling into the range of what we would expect in the general population. Given that the VICP population is a skewed sample, most of whom have developmental disabilities, I’d be shocked if the prevalence of autism/ASD symptoms in this group weren’t significantly higher than they are in the general population, given how much overlap there is between symptoms exhibited by children with developmental delay and children with autism. Of course, this “study” is not good evidence that the prevalence of autism/ASD even is higher in the VICP-compensated population. Taking into account the skewed population and the noise inherent in looking at a small population over 20 years, the prevalence of autism in VICP-compensated children does not appear to be detectably different than it is in the general population. That’s even accounting for very loose criteria used by the authors to define who might be autistic. As Prometheus put it:

If the prevalance is higher among people compensated by the VICP, there is a basis for further investigation. It still wouldn’t “prove” that vaccines cause autism – it would simply be an indication for further study.

If, on the other hand, the prevalence of autism among people compensated by the VICP is the same as the general population (or less – see below), the argument that “vaccines cause autism” receives yet another (totally redundant) nail in its coffin.

The problem is that the autism prevalence numbers for the general population – even the educational numbers – use much tighter criteria than used by the authors of this study.

According to a Generation Rescue telephone survey (in other words, a “study” by the anti-vaccine movement iteself), the prevalence of autism is even higher than what Holland et al found in the VICP-compensated group of children. It’s even worse than that, though. In fact, the timing of this study’s release is very, very bad indeed. In an ironic twist of fate that leads me to think that there might justice in the universe after all, shortly before the anti-vaccine movement tried to make hay out of this poorly argued, scientifically nonsensical report, a real scientific study, was released out of South Korea that found the prevalence of autism to be considerably higher than previously believed. Steve Novella even discussed this study earlier today. Basically, in this study, researchers administered a screening test for autism spectrum disorders in a population and then did more detailed tests on children who screened positive. Their results were stunning. The study estimated that the prevalence of autism spectrum disorders was 2.64% in the population studied and that 2/3 of those cases were undiagnosed. True, this study will need to be replicated, but it adds more support for the hypothesis that autism spectrum disorders are more common than previously thought and that a significant proportion of them are subclinical and thus undiagnosed. The timing of this study, of course, couldn’t be worse for Holland et al, because it simply reemphasizes that the prevalence of autism that they think they measured in the VICP population is almost certainly not higher than the prevalence in the general population.

In other words, Holland et al did all that work and wrote all those words in order to add yet more evidence to support what we already know from copious evidence from a large and robust existing body of studies: That vaccines do not cause autism.

They just refuse to realize or admit that that’s what they’ve done.

Posted in: Neuroscience/Mental Health, Politics and Regulation, Public Health, Science and the Media, Vaccines

Leave a Comment (19) ↓

19 thoughts on “When you can’t win on science, invoke the law…

  1. daedalus2u says:

    Wouldn’t it be nice if non-lawyers could interpret the law the way these non-scientists want to interpret science?

  2. ConspicuousCarl says:

    The JAQing is one symptom of BS.

    Another is the “announcing-that-you-are-going-to-announce-something” trick. It stretches out the anticipation buzz, and allows the claim to settle into people’s minds for a while before anyone can refute the unrevealed data.

  3. BillyJoe says:

    “…allows the claim to settle into people’s minds for a while before anyone can refute the unrevealed data.”

    The internet and internet bloggers are correcting this problem.
    In fact, the refutation took less than 24 hours!
    …thanks to David Gorski.

  4. Davdoodles says:

    “…autism is at least three times more prevalent among vaccine-injured children than among children in the general population…”

    I thought autism is what the pro-polio cranks call a “vaccine injury”?

    If so, the above statement is nonsensical. Like saying that broken legs are three times as common among children with fractures as among the general population. Or something.

    Then again, logic is not a strong point for shills for “Big Iron-Lung”…
    .

  5. Nikola says:

    Excellent read, David. Thanks.

  6. _Arthur says:

    Doodles, there were 5000-odd claimants in the VICP that claimed that “vaccines” caused their kid to become autistic.
    At the Vaccine Omnibus proceedings, they had the occasion to present 2 (was supposed to be 3) causation theories, with 3 test cases each. They didn’t win, so they aren’t part of the 2500 compensated cases.

    But, one of the 6 kids who was supposed to be one of their test case example, the little Hannah P., was removed from that case, and chose to be compensated as a “table injury”.
    We don’t have access to her complete medical file, but Hannah’s case did present “autism-like seizures”. Hannah is not believed to be autistic.

    Hannah is certainly counted in the “83″ count in this report.

  7. aeauooo says:

    RE: Hannah Poling

    Vaccines and Autism Revisited — The Hannah Poling Case
    http://www.nejm.org/doi/full/10.1056/NEJMp0802904

    http://www.nejm.org/doi/full/10.1056/NEJMc086269

  8. tortorific says:

    I agree with the general points of your article there were some things that had me bristling.

    “In law, for example, the object is to win your case, not to find out how nature works and develop models (i.e., theories) that accurately describe it and predict its behavior.”

    Not quite, in law your object is to be an advocate, to put forward the strongest argument that exists for one side, the advocate on the other side does the same thing and an impartial observer is then equipped to make a decision only about the specific circumstances of the case. According to your ethical standards you should not be trying to win only to ensure that you put forward the strongest argument for the side you represent. This may mean giving the other side evidence against your side or refraining from presenting evidence when you have reason to believe a witness for your side is lying.

    “In law, there are no truly objective right or wrong answers about issues of science. There is only the law and how it has been interpreted by courts.”

    That’s only true in regards to how evidence is presented, for example when you can present fringe opinions and with what qualifiers. There is a difference between the lunatic fringe and a theory that is probably wrong but has plausibility and therefore might have to be considered in order to determine that the court actually has to hear from experts on both sides. Obviously judges often do not have the expertise to make these decisions but that’s an entirely different issue.

    Advocacy for one’s position, using every tool at one’s disposal and denigrating or ignoring evidence that conflicts with that position, is not just acceptable, but mandatory.

    I think you are confusing the idea of being impartial, the judge and jury are impartial, the lawyers are not. Lawyers are to put forward one side and one side only. This is actually to reduce bias, as if you had your lawyers attempt to be impartial you would have the danger of bias invading the presentation of evidence as well as the final decision. You are also not allowed to use “every tool” the integrity of the court system must always come first. Misleading the court would be misconduct.

    There are problems with the system but they are not the problems you present. You probably should have talked to a lawyer about it first.

  9. kopride says:

    The main problem with comparing the legal process and the scientific method is that they are fundamentally different. In law, there is a factfinder, either a judge or jury who essentially views a limited body of evidence (what is actually presented in the courtroom or tribunal) against a stated proposition of law and determines what is or is not true. A jury could theoretically weigh certain evidence and could conclude the truth that eating apples causes cancer; if the only evidence presented was that apple eating people got cancer and non-apple eating people didn’t. Their decision would be logically based upon the evidence presented to them. And then you have belief complicating truth. For example, a significant minority of the country believe that Obama was born outside the country. If you get a jury that overwhelmingly comprises “Birthers,” a jury could reach a verdict that Obama is not American. In other words, if an advocate can convince a jury (or judge) that something is “true,” than it is true for the the purposes of that proceeding. The scientific method does not determine “truth” by a popular vote of a limited jury; or the decision of one wise sage. How a group of people view the reality or whether it is persuasive is irrelevant to whether the scientific method supports a certain hypothesis. The main problem with the public’s evaluation of scientific information is that everything becomes a trial in the court of public opinion. As with law, if enough people believe it to be true, then it becomes true.

  10. David Gorski says:

    Apparently my post hit a nerve. J.B. Handley over at Age of Autism has written one of his typical ad hominem screeds:

    Dr. David Gorski’s Unique Brand of Moronism

    Stay classy, J.B. Stay classy.

    In any case, I think I hit a nerve. Either that, or J.B. is so embarrassed over his handling of the settling of an offer he made to turn the domain pauloffit.com back over to Dr. Offit that he decided to redirect his anger at me.

  11. pmoran says:

    Is this is an example of how ad hominem merely engenders more ad homimen, irrespective of how subtle, unconscious, or well-deserved it may be?

    Thousands of words later there will still be people with genuine, quite understandable concerns about vaccines, and still uncertain as to whether the medical profession is taking those concerns seriously.

    I was thus dismayed when no one explicitly took on the “eight point challenge”. Perhaps most of that material has been dealt with elsewhere, probably even by David, but may we not need to be as relentless and in-your-face with our information as those who challenge the safety of vaccines? Not responding will probably also be mercilessly exploited.

    Readers will also not follow a lot of links, especially if that is to long-winded late-getting-to-the-point articles.

    JB Handley has gotten across his most telling personal point, with this —

    Is it the mercury? Is it the MMR? I have no idea. What I know, Dr. Gorski, is that the phone calls and the stories about the kids going upside down after the vaccine appointments keep coming. A real doctor would care deeply about these real reports from tens of thousands of real parents with real babies. A real doctor would be asking real questions.

    The autism-vaccination connection is founded upon this and a couple of other very simple perceptions, none of which are wholly unreasonable. These get overlooked once debate is distracted into arguing about possible mechanisms and the personalities of those involved..

    If we have solid evidence against those perceptions, let’s make sure it is delivered somewhere in as few words as possible.

  12. Harriet Hall says:

    @pmoran,

    Solid evidence against the perception that the kid showed signs of autism after the MMR? No, the perception is real. We don’t have evidence that the MMR didn’t cause it; what we have is NO evidence of a causal connection or even of a correlation, after multiple studies. The data are convincing to a scientist but useless against the post hoc ergo propter hoc thinking of a parent. They are not operating in the same universe of discourse, so communication and persuasion are next to impossible.

  13. David Gorski says:

    @Peter Moran

    Defending J.B. Handley? At least, that’s what you appear to be doing. If that’s the case, I submit that you also appear not to know with whom you’re dealing. I’ll explain.

    Let’s put it this way. Do you think Steve Novella is too “strident,” “insulting,” or “sarcastic”? No? Steve’s not like that nasty old Dr. Gorski at all, is he? He’s far more civil and far less sarcastic, isn’t he? He nearly always treats his opponents with respect, doesn’t he? It’s one of the great things about Steve that I admire.

    But guess what? Steve’s careful civility didn’t stop J.B. Handley from launching an attack on him very much like the one he launched on me:

    http://www.ageofautism.com/2009/04/dr-steven-novella-why-is-this-so-hard-to-understand.html

    What about journalists? For example, Amy Wallace? She wrote a respectful but critical article about the anti-vaccine movement:

    http://www.wired.com/magazine/2009/10/ff_waronscience

    The result was a misogynistic attack by—you guessed it—J.B. Handley:

    http://www.sciencebasedmedicine.org/?p=2415

    Meanwhile, Mr. Handley gloats about declining vaccine rates, as he tacitly supports the demonization of Steve Novella and several others who speak out against the anti-vaccine movement, including Chris Mooney, who wrote this article:

    http://discovermagazine.com/2009/jun/06-why-does-vaccine-autism-controversy-live-on/

    I note that Mooney has been widely criticized by defenders of science for advocating a position very much like the one you do, namely to engage with his opponents, not to be too critical of certain positions, etc. It didn’t save him from the wrath of the anti-vaccine movement. He was savaged online, and Steve was portrayed as a baby-eating cannibal:

    http://www.sciencebasedmedicine.org/?p=4259

    Meanwhile, Paul Offit, who was also in the picture reproduced above portrayed as a baby-eating cannibal with Steve, is also the very height of civility and does nearly everything you have suggested, always trying to stay civil, and he gets this treatment:

    Thousands of people revile Offit publicly at rallies, on Web sites, and in books. Type pauloffit.com into your browser and you’ll find not Offit’s official site but an anti-Offit screed “dedicated to exposing the truth about the vaccine industry’s most well-paid spokesperson.” Go to Wikipedia to read his bio and, as often as not, someone will have tampered with the page. The section on Offit’s education was once altered to say that he’d studied on a pig farm in Toad Suck, Arkansas. (He’s a graduate of Tufts University and the University of Maryland School of Medicine).

    Then there are the threats. Offit once got an email from a Seattle man that read, “I will hang you by your neck until you are dead!” Other bracing messages include “You have blood on your hands” and “Your day of reckoning will come.” A few years ago, a man on the phone ominously told Offit he knew where the doctor’s two children went to school. At a meeting of the Centers for Disease Control and Prevention, an anti-vaccine protester emerged from a crowd of people holding signs that featured Offit’s face emblazoned with the word terrorist and grabbed the unsuspecting, 6-foot-tall physician by the jacket.

    “I don’t think he wanted to hurt me,” Offit recalls. “He was just excited to be close to the personification of such evil.” Still, whenever Offit gets a letter with an unfamiliar return address, he holds the envelope at arm’s length before gingerly tearing it open. “I think about it,” he admits. “Anthrax.”

    So what has this award-winning 58-year-old scientist done to elicit such venom? He boldly states — in speeches, in journal articles, and in his 2008 book Autism’s False Prophets — that vaccines do not cause autism or autoimmune disease or any of the other chronic conditions that have been blamed on them. He supports this assertion with meticulous evidence. And he calls to account those who promote bogus treatments for autism — treatments that he says not only don’t work but often cause harm.

    As a result, Offit has become the main target of a grassroots movement that opposes the systematic vaccination of children and the laws that require it. McCarthy, an actress and a former Playboy centerfold whose son has been diagnosed with autism, is the best-known leader of the movement, but she is joined by legions of well-organized supporters and sympathizers.

    Civility is a good thing, but there are times when it is ineffective. Dealing with someone like Mr. Handley, who is interested in civility only when it’s advantageous to him , when you agree with him, or when you are not criticizing him on anything more than superficial matters that are not core to his beliefs that vaccines cause autism, is not one of those times.

    Harriet is right. Moreover, I don’t care about “converting” or “engaging” with Mr. Handley or die-hard anti-vaccine zealots like them, at least not anymore. There was a time when I did, perhaps five or six years ago. I have since been forced to conclude that it’s complete a waste of time and effort. Mr. Handley is not convertible. He is not interested in “engaging” with his opponents. He is interested in defeating them by any legal means he can. If that means smearing them, attacking them, and poisoning their Google reputation, so be it. Mr. Handley’s attacks are actually part of an intentional strategy to make it so unpleasant for anyone who criticizes him and/or his organization that critics will think twice before risking his wrath. Refusing ever to risk being uncivil is in essence playing J.B.’s game. All cards have to be on the table, and all strategies available. The sooner you understand that, the sooner you’ll stop clutching your pearls at heated rhetoric from people on “your side.”

    What needs to be done is to combat their misinformation and to do our best to try to prevent parents who are either ignorant of the issues or on the fence from being persuaded by the anti-vaccine movement. It is also to place information out there that combats anti-vaccine propagation, so that parents can find it when they Google the relevant topics.

    As for solid evidence against their perceptions? Jumpin’ Jesus on a pogo stick! Do you even read this blog? I’m sorry, but my frustration arise from your remark being made in spite of the fact that I’ve lost track of the number of times I’ve discussed how often all human beings mistake correlation for causation because that’s how we’re wired. Over the last three years between all of us we’ve written 182 posts about vaccines, many of them discussing exactly these issues. Other SBM bloggers, who don’t have my logorrheic tendencies, have done just what you asked for in a more succinct form than I am known for. I really don’t know what else we can do, other than perhaps my resigning as managing editor and never writing another blog post for SBM again. Either that, or perhaps if I started writing happy shiny blog posts in which never is heard a discouraging word that would satisfy you. That last option would be as boring as hell, both for our readers and for me, I’m afraid.

    Quite frankly, I’m not sure what’s happened or where you’re coming from anymore, but you seem to have a huge blind spot. You spend most of your comment time, at least on this blog, attacking those on “your side” and finding every reason you can to excuse the behavior those who support pseudoscience, no matter what sorts of contortions it takes. It’s gone beyond “balance”; in fact, the balance appears to have shifted in favor of people like Handley when it comes to your comments. I don’t get it.

  14. pmoran says:

    Yes, of course you are right that there is a huge amount of ad hominem on the “anti-vax” and CAM side. I have myself been subjected to merciless attack, to the extent of once to advise on the relevant bodies to check with in order to prove that I had never ever been under investigation for malpractice.

    So I shouldn’t have mentioned ” ad hominem engendering ad hominem”; even as I wrote that I was aware of some of the attacks on Harriet, one who also generally sticks to the questions.

    Nevertheless there is still the question of how best to get critical information across to those whose concerns have been aroused (David and Harriet, I never had in mind trying to convert Handley and his ilk! I have been through that mill, too.).

    I suggest that we need both detailed and unbiased scientific analysis of the data, which David is superb at, but also an easily accessible summary of the data relating to key points, in simple terms for the average person, to which any blog post dealing with the matter can link to. Do you know of one?

  15. Scott says:

    I suggest that we need both detailed and unbiased scientific analysis of the data, which David is superb at, but also an easily accessible summary of the data relating to key points, in simple terms for the average person, to which any blog post dealing with the matter can link to. Do you know of one?

    Why yes, there’s one very handy. See the “SBM Topic-based reference” up there at the top of the page? That’s what it’s meant to be. Check it out. If you should have suggestions on improving it, I expect the SBM crew would be interested in hearing them.

  16. pmoran says:

    David:Quite frankly, I’m not sure what’s happened or where you’re coming from anymore, but you seem to have a huge blind spot. You spend most of your comment time, at least on this blog, attacking those on “your side” and finding every reason you can to excuse the behavior those who support pseudoscience, no matter what sorts of contortions it takes.

    What is wrong with me, David? I will try and explain once and for all, for any who care.

    I differ from the average skeptic only in that I am perhaps more prepared to allow that CAM-based medical activity may have a beneficial role in some people’s lives.

    Even in my earlier, more “skeptically correct” days, I was always a little uncomfortable with the complete dismissal of some types of quite dramatic CAM testimonial. They seemed consistent with the influence of placebo and other non-specific effects of medical attentions. I knew from my own practice how simple reassurance can terminate some kinds of illnesses, and how powerful suggestion can be.

    So it was always reasonable to believe that charismatic CAM practitioners, free of many of the constraints upon normal medical practitioners, might better exploit such influences on patient outcomes. CAM use could be of particular help to some who have not found satisfaction within conventional medical care for a number of likely reasons, or for those for whom there are simply no entirely suitable EBM-endorsed treatments.

    There is nothing very unusual in that belief — Harriet seems to share it to some extent. It is not clear what others here think.

    But for a long time I didn’t want to give an inch to CAM. Isimply found the pseudoscience and the fraud intolerable. I happily went along with those reassured by the views of Goetsche et Al and Hrobjartsson et Al, whose studies seemed to suggest that placebos don’t really do that much. CAM then had one less place to hide. The testimonials were obviously mainly illusion, or people just making things up, we thought.
    .
    It’s not so clear now. Study of the placebo over the last decade or so seems to be permitting much stronger and more “real” effects (with subjective complaints and psychosomatic conditions — not usually underlying disease processes).

    How to resolve this contradiction?

    My AHA! moment came when I twigged to the fact that the Goetsche and Hrobjartsson studies weren’t really showing what was claimed. Their data was derived from studies the design of which is calculated to inhibit placebo and non-specific influences. It told us nothing at all about what might be possible under more favorable conditions.

    Wow! The big surprise, and a somewhat transforming experience for me, was not so much that my first instincts might best fit the facts after all, but that so many skeptics including myself were so biased against CAM as to be overlooking a bleeding obvious flaw in our own self-justifications!

    Nevertheless, there remained over-riding reasons for an uncompromising, blanket opposition to CAM, — didn’t there?

    Well, to my further surprise, as I applied fresh, less biased thinking to previously unquestioned skeptical wisdom, I found I had to question much of it.

    Some seemed to be utter tosh, such as the suggestion that medical science could actually crumble under the supposed assault of pseudoscience. More often it was a matter of degree: unscientific dogmatism, overgeneralizations and over simplifications. (Of course medicine is such a complex field that every time we open our mouths we will be guilty of at least one of these. But we could do better).

    Mainly, the issues resolve into this: once you accept that CAM-based activity (note not usually the specific CAM modalities) may have non-zero benefits the cost/risk/benefit equations that determine medical decision-making have to be recalculated, and separately for a wide variety of different clinical and public health settings and also possibly for some individual medical needs. -

    OK, “no worries”; we now say, no one really needs CAM. Doctors will be able to harness the same influences. I regret having to say, for my allegiance is still very strongly with the mainstream, that for now this is probably another self-reassuring skeptical fantasy. If you look at Harriet’s recent (incomplete) list of factors which might encourage non-specific responses to medical care within CAM,

    http://www.sciencebasedmedicine.org/?p=12523

    very few of them can operate without some form of deception, or the recruitment of our own mainly-placebo therapeutic rituals (e.g. massage for back pain, although preferably something a little more mysterious or dramatic). So the usual ethical considerations will forbid them.

    So what is wrong with me? You decide.

  17. pmoran says:

    Scott, as I pointed out once before, such a search yields far more material than the average person will bother rummaging through.

    Much of it is very technical, or tangential to the matters that sustain concern (mainly the apparent increases in autism as vaccination as increased, and the anecdotes suggesting regression after vaccines).

    The simple summary I have in mind does not need to be on this site. However a google search doesn’t yield anything suitable either, on the first few pages. The CDC doesn’t seem to have anything.

  18. VentureFree says:

    “Much of it is very technical, or tangential to the matters that sustain concern (mainly the apparent increases in autism as vaccination as increased, and the anecdotes suggesting regression after vaccines).

    The simple summary I have in mind does not need to be on this site. However a google search doesn’t yield anything suitable either, on the first few pages. The CDC doesn’t seem to have anything.”

    Here’s how it seems to work amongst anti-vaxxers. Any science based FAQ about vaccinations will either include detailed information, in which case it’ll be rejected as just an attempt to obscure the issue with a lot of unnecessary and/or irrelevant facts, or it will not include those details, in which case it will be rejected as making unsubstantiated claims because there are no details presented to back it up.

    The simple fact is that if you don’t want to just take the word of the experts, you’re going to have to wade through those details. If you don’t want to wade through those details, then you’re going to have to take the word of the people who have (a.k.a. experts).

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