Valerie Foley

Surely we can do this better…

In Medical, Parent issues, Perceptions, Research on May 22, 2014 at 1:51 am

On 19 May, 2014 mainstream media put an issue to bed.

Vaccines don’t cause autism. Once and for all. Let’s all accept the truth and move on.

The headlines were based on a paper published by the University of Sydney. My hometown. A great university. My interest was piqued. Oddly, it was produced by a research unit within the Discipline of Surgery, but it’s got the university logo on there. Seemed legit. The author appeared on the radio, soon after, and spoke to his paper. It was an unusual interview but again, I’m involved and interested… so I went looking for the paper.

It’s called ‘Vaccines are not associated with autism: a meta-analysis of case-control and cohort studies’. And unless you live in a box, you will have heard something about it over the last couple of days.

This paper is truly one of the oddest things I have ever seen, and I have seen a few odd things.

From its curious authors, the vehemently inaccurate promotion of the paper, the gleeful grasping of spuriously false headlines and finally, and most importantly, the paper itself… in my opinion, it’s the academic embodiment of the Chinese ‘interesting times’ proverb.

Let’s take a look.

First though, read the paper. Right through. Follow the links to the studies it references.

Follow the links in this post. I’m not trying to make anyone think anything, and I could care less how people process their own choices.

Clearly I am pro-vaccine safety. What you are is your own business.

Give this some time. It actually deserves it, if you genuinely care about whether there is indeed a link between vaccines and autism.

 

First, lets take a look at the authors.

Luke E Taylor (1)

This individual, the number one author, is a bit of a mystery. He doesn’t seem to come up on PubMed, apart from this article.

Could be this guy, a recent graduate of Brown University. He’s listed as a ‘senior’ in 2013. I’m assuming they don’t mean me to insert ‘citizen’ after that. He’s very interested in coal divestment.

Or it could be some mysterious unpublished very recent graduate of an Australian university. See Amy L. Swerdfeder, below.

 

Amy L Swerdfeger (1)

She seems to be a recently graduated medical student, with a Bachelor of Surgery completed in 2013. No stated link to autism or child health. She contributed to this paper as a student, one would assume, unless the paper was thrown together in three months, which would surely be problematic, in academic terms.

Previous to her medical study, Amy was a chemical engineer with Roche. She has one publication listed on PubMed. It’s this one.

 

Dr Guy D Eslick (2)

The man is an epidemiologist. His stated research interests on the University of Sydney’s website are:

My research has primarily focused on determining risk factors and understanding the epidemiology of gastrointestinal diseases for the most part upper gastrointestinal cancers, predominantly, esophageal cancer and related disorders. I am also interested in understanding the epidemiology of Rare Cancers.

He’s highly published, very experienced, clearly credible in his field.

Am I the only one who thinks it’s odd that his field has never included autism, childhood disease prevention, autism… any of the stuff that would indicate an interest in this paper. Dr Eslick says in the New York Post he was inspired by watching ‘medical documentaries on the issue’… Which seems totally legit, because research dollars are just lying around on the floor of universities and inspired TV watcher-academics can just pick them up and use them for whatever.

 

To summarise:

The two lead authors have NEVER published (well, at least they don’t exist on PubMed and we’re told that’s where we should be looking) and unsurprisingly have not spoken on behalf of the paper in the media. They may or may not have been students when the paper was created.

The 2nd author, sometimes referred to as the ‘senior author’ or ‘corresponding author’ (presumably because he might be the only one with a current paying job in the field of academia) is well published, in other fields of medicine. His children had febrile seizures post vax, but he wasn’t scared away because he gave them paracetamol they are just fine now. Pretty solid proof that vaccines don’t cause autism, right? Well, solid enough that he included that little anecdote in the paper.

He spoke so poorly in the media on behalf of not just the paper, but the general area of autism causation, he may as well have not turned up. FWIW, if you are going to slam Wakefield (and it’s totally your right), it would make sense if you slammed as though you had read the retracted paper. Then you would be able to slam it accurately. TL/DR… it doesn’t mention not vaccinating kids. Not once. Even though you claimed it does on radio.

If a transcript or podcast for Guy Eslick’s interview on the ABC appears, I will link it, but aside from a lot of odd mumbling… he said something very unusual in an interview with Richard Glover on ABC 702 (our public broadcast station here in Sydney).

He said the paper references a study comparing autism rates in vaxed and unvaxed children. (It does no such thing. It references a study comparing children vaccinated with thimerosal containing vaccines and vaccines containing no thimerosal. A very very different thing).

A vaxed vs unvaxed study is the one thing that has not been done, and is the one thing that is being consistently called for by both the autism community and concerned members of the US Congress.

Why would a professional epidemiologist, ‘inspired’ by something he’d seen on a screen, make a mistake about an important key finding of his own study?

 

Then there’s the paper itself.

Touted in the media as a study that blows the lid off the idea that vaccines could cause autism, a study that involved over 1.2 million kids and a triumph for Autism Speaks (my personal favourite given that their only involvement unless there’s something going on that I can’t identify was to promote its publication on their website).

It’s not a study. It’s a meta-analysis. Calling it a study is like calling a cardboard shanty town a brand new housing development.

It’s not new information, and therefore not anything resembling news. Being a meta analysis, it collates and reviews old information. That’s the point. The idea that the autism community would somehow benefit from the arbitrary collation of information that most thinking parents are very familiar with and have ready access to is perverse to say the least.

It isn’t published by anyone with a link to previous autism research or vaccine science and works very hard to state its independence and lack of conflict of interest. Given its publication under the auspices of the University of Sydney, the authors should not need to state within the paper that they don’t feel remotely conflicted. Unless, of course, the lady doth protest too much.

Autism Speaks pushed this baby hard. So much so that their news release was shared 34.5 thousand times on FB (as of 3 days after they released it). Compare this with 737 shares of an older passionate John Elder Robison plea to self advocates, and 559 pitiful clicks for a gut bacteria article.

 

The content of the paper raises many hairs located on or near the back of my neck, as well.

Studies that drew their cohort from actual VAERS reports were excluded.

Papers that recruited their cohort of participants solely from the Vaccine Adverse Event Reporting System (VAERS) in the United States were not included due to its many limitations and high risk of bias including unverified reports, under reporting, inconsistent data quality, absence of an unvaccinated control group and many reports being filed in connection with litigation.

So, actual studies involving individual people who managed to get their adverse event report through the system (no mean feat) were excluded because of possible bias. But studies funded by public health officials, with legitimate vested interests in promoting universal vaccination and companies with stated interests in the area… they were a-ok. On other matters, I wonder, if VAERS is a cesspool of bias, where is the reliable information relating to adverse events in relation to vaccine administration? I guess it… um… doesn’t exist.

On VAERS, a fine system if you can kick it into gear, I hear, the authors seem to have forgotten something. It’s American. The authors are Australian, and while I fully concede the internet brings us all together in an amazing way, it doesn’t make us all American. Why an Australian epidemiologist would, in the conclusion of his paper, encourage me (an Australian reader who lives in his city) to make a report of an adverse event following vaccination to VAERS is beyond me. We have a fine system here called AEFI. It’s a different system as our governments are distinctly different. Unless, of course, the paper was not written for me, but for a distinctly American audience. Odd, as it includes in its analysis papers from the UK, Europe, and Japan (and strangely, no Australian data). Also odd, as it is a paper from the University of Sydney, but yay for globalism.

 

It’s a study of statistics.

Epidimiology is a wonderful field, that has saved many lives by analyzing and predicting trends in disease. But is it the best way to view the potential safety of individual vaccines on individual human children?

In my experience, using statistics to analyze and predict the safety of a vaccine to an individual child (because that’s what it comes down to when you do the ‘vax hold’ on your baby in the GP’s office) is an interesting tactic.

It’s like telling someone who is just about to slam on the brakes because a semi-trailer has jack-knifed at high speed in front of them, that its OK because this stretch of road has had less accidents on it than the road they took yesterday.

The two things are related, and semi relevant to each other,  just not in relation to the actual decision at hand.

But it’s powerful hoo doo for the family driving down the same stretch of road tomorrow. It’s way safer than the alternate route, statistically. So their chances of making it to Grandma’s house in one piece are high.

It means very little to yesterday’s driver. But very little means much to them, as they are (best case scenario) recovering from a serious road accident.

 

It’s spurious science anyway.

A couple of quotes from the paper that make me go, ‘Hmmm…’

“The only review to suggest that a link could not be excluded was that by Ratajczak looking into the aetiology of autism and concluded that it is multifactorial involving genetics and/or inflammation of the brain caused by a wide variety of environmental toxins, one of which may be mercury.”

Aaaaaaand, this isn’t significant because…? In a selective analysis that excludes studies of actual adverse events, one related study backs up the concerns of parents worldwide and it’s not significant because it’s only one of lots that say other things, statistically.

But sure, no link. Whatevs. No link in any of these either, right?

 

“Studies were included that looked at either MMR vaccination, cumulative mercury (Hg) or cumulative thimerosal dosage from vaccinations to ensure all proposed causes of ASD or regression were investigated.

ALL proposed causes of ASD or regression? That’s a broad church. One that is not even remotely charted by looking at three very limited issues.

 

“While at the level of the individual avoidance of immunisation may be seen as conferring lower risk by avoiding possible associated adverse events, the increase in parents deciding to take this course of action has substantially decreased ‘herd immunity’ among populations, subsequently increasing the risk of catching potentially more serious infectious diseases”

Apart from being the world longest sentence, and virtually impossible to decipher… I need some references on this one. How do we know parents choosing to not immunize because they want to avoid possible adverse events (and not because of their religious beliefs, social morays, they fear needles) has substantially decreased ‘herd immunity’. And while we are at it, why put herd immunity in inverted commas? Unless it might not be a totally reliable medical thing, but a very effective marketing strategy. After all, life long immunity from a naturally fought infection doesn’t require booster shots for anyone in the herd.

While I’m on this paragraph, how do those infectious diseases become MORE serious as a result of people choosing not to vaccinate against them? I’d really like a reference on that.

 

Finally, the title of the paper. ‘Vaccines are not associated with autism: An evidence based meta-analysis of case-control and cohort studies’

Good solid stuff right there. Sends a clear message to the punters.

It does however fail to acknowledge that the paper looks at studies that looked at the MMR, DTP/DT (known as DTaP in Australia) and ‘thimerosal-containing vaccines’. So, the other vaccines, the ones that don’t contain thimerosal, Hg mercury or aren’t the MMR (that would be the vast majority of the Australian vax schedule)… those ones are OK? Aren’t vaccines at all? Must be fine because these ones are totally OK?

This is really really dodgy PR. It’s not information parents can use to feel safer about the relationship between vaccines and ‘autism’ or the actual risks to their individual child.

Well, not if you look past the sound bites.

And if you do want to look beyond the soundbites, please please look here. Heather White’s detailed analysis of the science behind in this study is seriously the most useful thing you will read on this matter.

 

My questions.

1. Inspiration aside, why would academics, under the pump and struggling for resources, develop and  publish a paper on a subject area that is not their own?

Unpublished number one authors, total lack of experience in the area the paper focuses, odd American slant on an Australian university paper… what’s going on here?

This is like getting a caterpillar to teach nutrition because it likes to eat vegetables. It seems like a cute and semi-credible idea, but really it’s just plain odd.

 

2. Why did this paper get so much airtime?

It’s not new information. It’s all accessible. It ignores actual studies based on actual reports of adverse events reported in the USA. It ignores data from its own country.

Leave aside the science, and just look at the methods. This isn’t world shattering stuff, simply a new look at old data.

And yet, almost thirty five thousand shares from AS alone, in three days. 3.5 thousand hits on a google news search.

 

3. When people around the world, including Australia, have children whose major post vaccination afflictions include seizures, gastrointestinal disturbance, auto immune disease, encephalopathy, mitochondrial disorders and progressive connective tissue disorders… why do we continue to ignore them?

Maybe because it’s easier to think of those conditions as the mystery meat of developmental medicine than call them what they are – autism. Or maybe because what they are saying is scary. Or maybe because the change that would be required if we listened properly seems so huge, it’s better to let Forbes Magazine call them crazy. Over and over and over. It’s better to shut down rational thought, and replace it with a smokescreen of big words and calmative statistics.

A generation of ‘coincidental’ paediatric collateral damage is not good enough, as an outcome of this ‘discussion’. It’s just not.

I get people’s need to feel safe. I had it too. I felt really safe, before I vaccinated my child. I did the ‘right’ thing. And it all turned to health custard. My son is disabled for life, in a world that doesn’t recognize his disability as chronic, treatable, preventable or medical. That does not make me feel safe. I can’t contemplate what it will do for him when we are gone.

Comparing misery is a dirty game, so ‘would you rather a child with ‘seizures, gastrointestinal disturbance, auto immune disease, encephalopathy, mitochondrial disorders and progressive connective tissue disorders AKA autism or a kid with measles?’ is a very poor argument.

Standing up and asking the real questions, calmly, rationally, without fear mongering and without the might of Autism Speaks denial behind it, might just be a more mature approach.

Don’t you think?

Excuse me while I ask this guy.

 

Image

(OK, he’s a worm… damned internet, misrepresenting the ‘truth’ again)

 

 

 

  1. I am so with you!!!! I read this pseudo science and wrote a piece as well… I will add in your article into mine, if that is okay with you.

    My article: http://autismrawdata.net/1/post/2014/05/more-pseudo-science-vaccines-do-not-cause-autism-study.html

  2. Dear Valerie, thank you, thank you, thank you for writing this elegant, brilliant, incisive analysis. You are wonderful. Abdul (Sydney)

  3. Excellent work. I would like to add my two cents to blowing holes in this study. The Hviid and Madsen Danish studies are ineligible because of the actions of one Dr. Poul Thorsen: http://www.prweb.com/releases/2012/11prweb10153713.html

  4. My apologies, http://www.prweb.com/releases/2012/11/prweb10153713.html If the pro-vax mob can throw out Wakefield’s study( BTW there were 13 professional in evolved in that paper) because he was charged with “fraud” then 13 counts of wire fraud and 9 counts of money laundering should be enough to discredit the Danish studies. A argument could be made that Thorsens name does not appear on the Hviid study but he was at the same institution and had access to the grant money which ended up in his pocket and not used in the studies.

  5. Thank you for writing this Valerie. Much needed.

  6. Ms Foley – I think I can help unravel some of the factors in this study that appear to have confused you. Firstly, the authors. They are clinicians from within a discipline of medicine at Nepean Hospital Penrith. The first author has provisional medical registration – in other words, he is an intern who has done a research project with other senior colleagues.

    The research technique called meta-analysis is a well-recognised and rigorous methodology when done correctly. The authors need to describe their search stragegies, inclusion and exclusion criteria and list the included articles for all of us to review. Many major scientific questions have been elucidated through the use of meta-analysis – not just in medicine.

    Why has there been so much publicity? Because of all the discussion and publicity following on many years from Wakefield’s publication – who also was not published in the area of vaccination. It is well for the authors to declare their interest in the topic – this represents intellectual honesty.

    You are right that many, many children are afflicted with “seizures, gastrointestinal disturbance, auto immune disease, encephalopathy, mitochondrial disorders and progressive connective tissue disorders”. We can now stop looking to vaccines for answers and pump time and resources into more promising areas, to help those children. Many researchers around the world are doing just that. Some of them might even be motivated by being parents of young children.

    • Thanks Sue,

      All the answers you so kindly provided me were included in the original post via hyperlink. That’s when the words are blue and you can click them. You should try it. I find it helps me avoid being overly verbose and patronising my readers.

      But thanks. It clearly felt good to fill me in.

      • Apologies if you found my response patronising, Ms Foley. If all my answers were provided in the article, can you explain the paragraph which speculates about whether Luke E Taylor was interested in coal divestment?

        From your comments on authorship, it appeared that you did not understand that post-graduate trainees in medicine sometimes publish research. This was not mysterious to me, as I am familiar with the phenomenon, as I am with meta-analysis methodology.

        I would be interested to read your analysis of the validity of the meta-analysis’s inclusion and exclusion criteria.

      • Not my analysis, Heather White’s. Linked in the blog.
        And in my experience disclosure is routine when the work is student work, and it’s rare it gets international PR built in.

    • Sue,

      This was a poorly devised study, which I did break down.

      Here: http://autismrawdata.net/1/post/2014/05/more-pseudo-science-vaccines-do-not-cause-autism-study.html

      Further, research grants have two year timelines so that would place these “students” well in their undergrad degrees, which is extremely unusual when producing meta-analysis articles such as this ~ well I have not even heard of it before and research is my field. Particularly being the lead in an article. So, I question the credibility when these undergrad students have not had much more then their basics in course material, which leaves out a lot of research methods study.

  7. Ms Foley, I’m not sure what you mean by “student work”. It’s not uncommon for post-graduate medical trainees (graduate doctors who are working in hospitals and doing post-graduate training) to do research and get it published. The work is published on its merits as a piece of research work, not what the work seniority of the authors is. Many doctors doing either pre- or post-graduate research have their papers published.

    The merit of a meta-analysis depends on the validity of the methodology. That’s why studies like this spend a lot of time describing their search strategy and the inclusion and exclusion criteria for papers that end up in the final analysis.

    Other readers should be aware that a large amount of valid data has been derived through meta-analysis.

  8. I wanted to comment on what you said here (although you probably have already considered this):

    “Am I the only one who thinks it’s odd that his field has never included autism, childhood disease prevention, autism… any of the stuff that would indicate an interest in this paper. Dr Eslick says in the New York Post he was inspired by watching ‘medical documentaries on the issue’… Which seems totally legit, because research dollars are just lying around on the floor of universities and inspired TV watcher-academics can just pick them up and use them for whatever.”

    This is a biography from his publisher:

    “Dr. Eslick is a Clinical Epidemiologist and National Health and Medical Research Council (NHMRC) Public Health Fellow in the School of Public Health at The University of Sydney, Australia. Dr. Eslick has an international reputation in the field on noncardiac chest pain, which he has been researching for over a decade. Dr. Eslick has over 100 publications, is an Associate Editor of the American Journal of Epidemiology, and serves on the Editorial Board of the World Journal of Gastroenterology.”

    https://www.pluralpublishing.com/author_Guy_Eslick.htm

    My point is: The guy looks reputable! People have been able to pick apart numerous study authors because of bias. Here we have someone who’s professing a genuine interest in this problem and has been around the research field for quite a long time. Hey, he looks legit and has no bias (that we know of, at least), and I think that’s why he got the money to do the meta-analysis.

  9. Or maybe Dr. Eslick wants to reassure himself (and his wife) that his kids are ‘fine’ and that blind faith trumps (his own) ‘expert’ eyewitness observations of serious vaccine reactions.

    I can almost see him crossing his fingers each time his wife applied the ‘vax-hold’.

    He did look legit, he really did. But then he spoke.

  10. Yes then he spoke … Good one 🙂

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: