I will begin this post with a bit of an explanation. Between one and two weeks ago, there appeared two momentous news about the manufactroversy regarding vaccines and autism. No doubt, many SBM readers were expecting that I, as the resident maven of this particular bit of pseudoscience, would have been here last week to give you, our readers, the skinny on all of this. Unfortunately, as some know, my wife’s mother died, coincidentally enough, on the 200th anniversary of Darwin’s birthday and a day when one of those two momentous bits of news was released to the public, which is why I used one of my handful of posts written and then held in reserve. I’m back now, though, and I don’t think it’s too late to comment on these bits of news because now that over a week has gone by what I’ve seen has led me to draw some conclusions that I might not have been able to do, had I done my usual bit and been first off the mark (at least among SBM bloggers) discussing the story.

2008: The Best of Years for the Antivaccine Movement

But first, let’s take a look at last year. In 2008, Jenny McCarthy was the new and fresh celebrity face of the movement that believes that autism and all manner of other neurodevelopmental disorders are caused by vaccines and that the government and big pharma are suppressing The Truth. She had emerged in the fall of 2007 after having tried to erase from the Internet her previous involvement in the “Indigo Child” movement in preparation for becoming an “autism advocate” who could write a book that could land her on Oprah’s show. Thanks to her and, perhaps even more so to the star power of her boyfriend Jim Carrey, who is just as wrong about vaccines and medicine as Jenny is, the antivaccine movement came roaring into prominence in a way that it had never managed to pull off before. After all, let’s face it, a former Playboy Playmate of the Year and a famous comedian are far more “interesting” public figures for various media outlets to interview than previous celebrities who spearheaded the vaccine manufactroversy, such as Robert F. Kennedy, Jr. or Don Imus and his wife Deirdre.

Indeed, Jenny’s combination of good looks and utter obnoxiousness led to her showing up all over the media in 2008. For example, on April 1 (appropriately enough), she appeared on Larry King Live! and shouted down physicians who had the temerity to tell her that her Google University knowledge was just plain wrong. The pinnacle of her influence came during the summer, when, having now supplanted J.B. Handley as the public face of the antivaccine group Generation Rescue and transforming GR into “Jenny McCarthy’s autism charity,” she led the “Green Our Vaccines” rally in Washington, DC. True, at most there were several hundred people there, but it got wide news attention, and Jenny was all over the news. She rapidly followed it up by releasing a second book Mother Warriors: A Nation of Parents Healing Autism Against All Odds and appearing on The Oprah Winfrey Show yet again.

When Amanda Peet joined the fray on the pro-vaccine side, it let the media to portray the vaccine issue as a celebrity cat fight. Meanwhile, thanks to Jenny’s ties with the Playboy organization and her celebrity friends, she was able to fill Generation Rescue’s coffers with the proceeds of celebrity “autism” events where luminaries such as Britney Spears, Charlie Sheen, and Hugh Hefner would show up. Add to that her promotion of Celebrities Against Autism and her partnering with professional wrestling and celebrity poker events with Lance Armstrong, and that’s a chunk of change that’s allowed GR and the equally antivaccine and quackery-friendly TACA to rebrand themselves in the eyes of the public as respectable autism charities, rather than crank organizations pushing a scientifically discredited idea and thereby endangering public health.

Then there was the Hannah Poling case, which has been extensively discussed here, both by me and Steve Novella. In brief, the government awarded compensation for vaccine injury through the Vaccine Injury Compensation Program to the family of a girl named Hannah Poling, manifested a regressive encephalopathy with features of autism spectrum disorder after a “catch up” vaccination session. It was later determined that Hannah suffers from a highly unusual mitochondrial disorder, which rendered her susceptible to neurologic injury from high fevers. She had high fevers after the vaccine, but she had also had a series of ear infections. The antivaccine movement has done its best to make Hannah its poster child as “smoking gun proof” that the government had admitted that vaccines can cause autism in susceptible children, when it had done nothing of the kind. Because the science is difficult, and because mitochondrial disorders are so uncommon, though, David Kirby and his fellow mouthpieces at Age of Autism had a field day twisting the scientific evidence and, as Mark Crislip likes to say, making therapeutic (or, in this case causative) mountains out of clinical molehills.

Truly 2008 was the high water mark of the antivaccine movement.

Still, not all was positive for the the disease promotion movement, even in 2008. For example, the second half of the year, after at least four years of no activity there was actual pushback against it. Amanda Peet spearheaded the Every Child By Two initiative, which was designed to encourage parents to have their children vaccinated. Not long after, Dr. Paul Offit, to antivaccinationists the Dark Lord of Vaccines, a veritable Darth Vader, Lord Sauron, and Satan Incarnate himself, released his excellent book telling in clear, easily accessible language, exactly why scientists conclude that vaccines do not cause autism and why the various “biomedical treatments” recommended for “vaccine injury” in the form of autism are virtually all quackery. Finally, as the year wound to a close, a group of scientists from Cornell tried to replicate the results of one of the godfathers of the antivaccine movement, Andrew Wakefield. Wakefield’s studies, starting in 1998 in The Lancet, had concluded that the measles virus in the MMR vaccine somehow invaded the gut and caused a syndrome that led to regressive autism and inflammatory bowel disease–and found no correlation between MMR vaccination and any such syndrome. Andrew Wakefield, as you recall, is the man who, more than anyone else, caused the anti-MMR scare in the U.K. and Europe that has resulted in the resurgence of measles. Indeed, he is a hero of the antivaccine movement, so much so that the antivaccine propaganda blog Age of Autism gave him the “Galileo Award” for 2008, completely ignoring the fact that, for a “maverick scientist,” it is not sufficient to be reviled. One must also be right, which Wakefield was most assuredly not.

Because one of the two body blows to the antivaccine movement that have already occurred in 2009 involves Andrew Wakefield, this is the perfect place to segue from the best of years for antivaccinationists to (thus far) the worst of years.

2009: The Worst of Years, thanks to Andrew Wakefield

As 2009 dawned, the antivaccine movement seemed strong and getting stronger. Having successfully framed themselves as “pro-safe vaccine, not antivaccine” and popularized the cleverly Orwellian slogans “Green Our Vaccines” and “Too Many Too Soon,” they had stoked fear of vaccination on both sides of the Atlantic, to the point where vaccination rates had begun to fall below the level necessary for herd immunity, and outbreaks of vaccine-preventable diseases were becoming apparent. In the U.K., thanks to Andrew Wakefield and the antivaccine movement his work had spawned, over the last decade, MMR vaccination rates had fallen below 80% (and in some parts of London, below 60%), leading a disease once considered defeated to come roaring back to the point where last year U.K. health authorities had to admit that it is once again endemic. Meanwhile in the U.S., outbreaks of vaccine-preventable diseaseas were occurring among unvaccinated populations, such as in Minnesota, while measles was also making a comeback.

One thing I could never understand about Andrew Wakefield is why so many believed him. The British press ate his bad science up and were complicit in contributing to the decline in vaccination rates that endanger public health now. I, for one, was not at all surprised at the first blow to the antivaccine movement that occurred in 2009, namely Brian Deer’s revelations that Andrew Wakefield had almost certainly falsified data used in his original 1998 Lancet paper. Specifically, and in brief, this is what Wakefield was found to have done:

However, our investigation, confirmed by evidence presented to the General Medical Council (GMC), reveals that: In most of the 12 cases, the children’s ailments as described in The Lancet were different from their hospital and GP records. Although the research paper claimed that problems came on within days of the jab, in only one case did medical records suggest this was true, and in many of the cases medical concerns had been raised before the children were vaccinated. Hospital pathologists, looking for inflammatory bowel disease, reported in the majority of cases that the gut was normal. This was then reviewed and the Lancet paper showed them as abnormal.

A detailed account by investigative journalist Brian Deer (whom I met during his visit to the University of Michigan two weeks ago) can be found here, as can an account of how the MMR scare led to a return of the measles.

It’s not as though this revelation should have come as a surprise. After all, the signs had all been there right from the beginning that something was not right, indeed at least as early as 2002. Indeed, advocates of science-based medicine everywhere owe Brian Deer a huge debt of gratitude for having pursued this case for so long, as this is what he found out about Wakefield and his work. Moreover, it’s not as though warning signs weren’t there in the very paper. As Brian Deer described at the University of Michigan a couple of weeks ago, something didn’t smell right in the Lancet paper. What he meant was that the results looked too good to be true.

The original 1998 Lancet paper made two key claims based on its findings studying twelve children, which, according to the Wakefield, had been, “consecutively referred to the pediatric gastroenterology unit at the Royal Free Hospital and School of Medicine in London. First, it claimed that eight of the twelve children studied had manifested developmental regression within two weeks of the MMR vaccine, and one had developed regression after a measles infection, the clear implication being that there was a close temporal relationship between MMR vaccination and the onset of regression in 75% of the children. The second claim was that all 12 of the children demonstrated “intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration.” Although the paper stated that the authors “did not prove an association between measles, mumps, and rubella vaccine and the syndrome described” and that “virological studies are underway that may help to resolve this issue,” Wakefield at his press conference to announce the findings stated that he had preliminary virological evidence showing measles virus in the gut. It took him four years to follow up these results with a paper in Molecular Pathology that reported measles virus in 75/91 children with ileal inflammation and children with developmental disorders. Although Wakefield was careful not to use the word autism in the actual text of the paper–or even the word vaccine–the implication of the paper was plain, and, if it wasn’t to some, Wakefield made sure to drive home what he thought the implication was: That the MMR is associated with a syndrome of developmental disorders, including autism, and inflammatory bowel disease.

Unfortunately for Wakefield, Deer’s instincts ultimately proved to be correct. The first shoe to drop was Deer’s 2004 Channel 4 documentary exposing Wakefield’s incompetence and conflicts of interest. As it turned out, Wakefield did not have the viral data in 1998. Indeed, a young investigator named Nicholas Chadwick had been unable to detect measles virus in any of the samples from the 12 children and had told Wakefield. Wakefield kept that data out of the original Lancet paper because it did not support his hypothesis. How, then, to explain Wakefield’s subsequent paper in 2002 that reported the detection of measles virus sequences in a large proportion of the ileal biopsy specimens of children with “autistic enterocolitis”? In 2007, during the beginning of the proceedings for the test cases in the Autism Omnibus case (more on that in the next section), Stephen Bustin, arguably the preeminent expert in the use of the polymerase chain reaction (PCR) to detect DNA sequences, testified for the government about the methods used in the laboratory that did the PCR analysis for Andrew Wakefield. Suffice it to say that this had to be about the sloppiest laboratory I’ve ever seen. Also suffice it to say that the negative controls were amplifying measles sequence, meaning that it was impossible to tell a signal was a true signal or a false positive. In fact, Bustin’s investigation concluded that what Wakefield was reporting was almost certainly all contamination from plasmids made in an adjacent laboratory. Ironically, this was the same laboratory that participated in the 2008 attempt to replicate Wakefield’s results. Clearly, it had cleaned up its act by then.

The other problem revealed in the 2004 documentary was that Andrew Wakefield had a massive conflict of interest. Teamed up with antivaccination crank extraordinaire Hugh Fudenberg, he had come up with a combination single agent vaccine/therapeutic (which he characterized as a “cure for autism“) agent based on the quack favorite “transfer factor.” Not only this, but he had filed patent applications for this concoction. In other words, Wakefield stood to profit handsomely if the MMR was discredited as being safe. Not long after these revelations, ten of the thirteen authors of the original 1998 Lancet report renounced its conclusions and asked to have their names removed from the paper.

But it was even worse than that.

At the end of 2006, the second shoe dropped. It turned out that Wakefield’s conflict of interest was even worse than that. In fact, it turned out that Wakefield had been paid by lawyers seeking to sue vaccine manufacturers for “injury” due to the MMR. In fact, his services had been bought and paid for to the tune of paid £435,643 in fees, plus £3,910 expenses. Neither this conflict of interest nor the conflict of interest inherent in having an alternative vaccine for measles, a single vaccine, with its patent pending were reported in the Lancet paper. It was these revelations that triggered an investigation by the General Medical Council in the U.K. into research malfeasance and ethic violations.

But it was even worse than that. Unfortunately, it took two more years to find out just how bad.

Two weeks ago, Brian Deer reported in the Sunday Times that, not only had Andrew Wakefield had massive conflicts of interest, but he had falsified data in his original paper. Indeed, consistent with the revelations that there had never been any detectable measles viral sequences, Deer reported that one father had taken his child’s specimen to be tested by a different laboratory and that that laboratory had failed to find any trace of measles virus. More importantly, however, none of the children studied for the Lancet paper actually even came from the Royal Free Hospital’s catchment area of North London; indeed, none of them even came from London. In fact, they were not “consecutively referred,” either. Rather, they had been recruited through the anti-MMR antivaccine underground and 11/12 of them were involved in anti-MMR litigation. Thus, they were a highly selected group. In addition, ccording to Deer’s account of the records examined by the GMC, in most of these children autistic features were present before they had received their MMR vaccination and in others such features only became apparent after a much longer interval than a few days after MMR. In other words, what was reported in the Lancet paper in 1998 and what was found in the children’s medical records differed significantly.

In other words, one of two things happened, neither of which is flattering to Wakefield. Either he took the history only from parents, who were litigants in vaccine injury cases and for whom confirmation bias could easily have led to remembering incorrectly that their child’s behavioral changes were noted shortly after the MMR rather than before it or months later. If this was the case, Wakefield was incompetent for not having examined the medical records. Alternatively, Wakefield did examine the medical records and lied about them in the Lancet paper. If this is the case, he is dishonest.

In fact, I might have been willing to give Wakefield somewhat of the benefit of the doubt, viewing the discrepancies between the medical records and what he reported in the Lancet paper as being yet more evidence of his incompetence and his resultant shoddy research methodology rather than dishonesty, were it not for the major discrepancies between what Wakefield said about the histology of the biopsy specimens in the paper. What was reported in the paper does not jibe with what the pathologists who first examined the specimens saw, where, in all 12 cases, no abnormalities had been reported on the initial examination of the specimens. Yet Wakefield reported a distinctive pattern of gut inflammation, specifically “colitis and ileal-lymphoid-nodular hyperplasia.” The Lancet paper had pointed out the “uniformity” of the pathological changes. What had happened?

Not happy with the readings of the pathologists, apparently Wakefield’s research team met for a “research review” of the biopsy specimens. This in and of itself is not unusual. However, it is unusual that the research team overturned the original readings of so many of the specimens. It is even more unusual (i.e., suspicious) that the reinterpretations of the original readings all went in the same direction: towards a reading of inflammation consistent with Wakefield’s hypothesis that the measles virus from the MMR was somehow involved in causing gut abnormalities and autistic regression. Even if I wanted to attribute Wakefield’s problems to incompetence, it’s pretty hard to do, given the confluence of evidence from multiple sources pointing to malfeasance.

2009: The Worst of Years, as the Special Masters Weigh In

If the revelations about Andrew Wakefield’s research fraud were the only event thus far, 2009 would already be shaping up to be a bad year for antivaccinationists. However, less than a week after Deer’s revelations were reported, the long-awaited ruling in a huge legal action made up of approximately 5,000 parents who are convinced that vaccines caused their children’s autism. I’m referring to the Autism Omnibus proceedings.

In the U.S., because of rising litigation that jeopardized the vaccine program and threatened to drive pharmaceutical companies out of the vaccine business, Congress passed the National Childhood Vaccine Injury Act of 1986 (Public Law 99-660), which created the National Vaccine Injury Compensation Program (VICP). The idea was to create an alternative to the tort system through which people injured by vaccines could be efficiently compensated. Vaccine litigants, if denied compensation, could still sue in conventional courts, but all claims for compensation had to go first through the VICP. Moreover, the standards of evidence in the Vaccine Court of the VICP are arguably markedly lower than in conventional federal courts. For example, Daubert rules for scientific evidence do not apply. Indeed, all that is necessary is a scientifically plausible-sounding mechanism by which a plaintiff might have been injured by vaccines, and compensation can be awarded. In essence, lowering the Daubert standard and allowing “science” that has not yet been peer reviewed makes meeting the standard of evidence showing a 51% or greater chance that the plaintiff was injured by the vaccine in question easier because it opened the door to an antivaccinationist version of the Gish Gallup, forcing the defense to answer and refute all sorts of bad science.

Be that as it may, as the number of litigants claiming that vaccines caused their children’s autism ballooned to close to 5,000, threatening to bankrupt the VICP unless massive infusions of new money from Congress were provided, it was decided that the proceedings should be bundled into one massive legal action known as the Autism Omnibus. As part of this proceeding, litigants were to choose what they considered to be the best cases representing their hypothesis of causation by which vaccines could produce autism and other neurodevelopmental disorders. The court would hear these cases, make a rulings, and then these rulings would be used as the basis for all similar cases as follows:

The Petitioners’ Steering Committee (PSC) has advanced three different theories of “general causation,” i.e., how the vaccines involved can cause autism, in the Omnibus Autism Proceeding. The Office of Special Masters (OSM) has assigned three Special Masters to resolve the autism cases. The OSM instructed the PSC to designate three “test cases” for each of the three theories, a total of nine test cases. The three theories of “general causation” are: (1) the theory that MMR vaccines and thimerosal-containing vaccines can combine to cause autism; (2) the theory that thimerosal-containing vaccines can cause autism; and, (3) the theory that MMR vaccines, without regard to any thimerosal additive, can cause autism.

After more than a year and a half after the proceedings began, on February 12, the Special Masters released its decisions on the first three test cases, Cedillo v. HHS (Case No. 98-916V), Hazlehurst v. HHS (Case No. 03-654V) and Snyder v. HHS (Case No. 01-162V). In all three cases, despite the “best” that the antivaccine contingent could throw at the courts, the Special Masters decisively rejected all three hypotheses of causation. Indeed, the results surprised me, as I had expected, given the extremely low bar for evidence, that there would have been a little bit of wiggle room in the decisions that would leave the door open for the antivaccine fringe to claim that there was a possibility that further causation cases would be entertained. No such wiggle room was granted. Since the decisions together run hundreds of pages, this article has become quite long, and other bloggers have posted excerpts, I will be judicious in selecting key quotes.

First, from the ruling on Cedillo v. HHS, written by Special Master George L. Hastings, Jr., we have these:

  • “This case, however, is not a close case. The overall weight of the evidence is overwhelmingly contrary to the petitioners’ causation theories. The result of this case would be the same even if I totally ignored the epidemiologic evidence, declined to consider the video evidence, and/or excluded the testimony of Dr. Bustin. The result would be the same if I restricted my consideration to the evidence originally filed into the record of this Cedillo case, disregarding the general causation evidence from the Hazlehurst and Snyder cases. The petitioners’ evidence has been unpersuasive on many different points, concerning virtually all aspects of their causation theories, each such deficiency having been discussed in detail above. The petitioners have failed to persuade me that there is validity to any of their general causation arguments, and have also failed to persuade me that there is any substantial likelihood that Michelle’s MMR vaccination contributed in any way to the causation of any of Michelle’s own disorders.”
  • “Nor do I doubt that Michelle’s parents and relatives are sincere in their belief that the MMR vaccine played a role in causing Michelle’s devastating disorders. Certainly, the mere fact that Michelle’s autistic symptoms first became evident to her family during the months after her MMR vaccination might make them wonder about a possible causal connection. Further, the Cedillos have read about physicians who profess to believe in a causal connection between the MMR vaccine and both autism and chronic gastrointestinal problems. They have visited at least one physician, Dr. Krigsman, who has explicitly opined that Michelle’s own chronic gastrointestinal symptoms are MMR-caused. And they have even been told that a medical laboratory has positively identified the presence of the persisting vaccine-strain measles virus in Michelle’s body, years after her vaccination. After studying the extensive evidence in this case for many months, I am convinced that the reports and advice given to the Cedillos by Dr. Krigsman and some other physicians, advising the Cedillos that there is a causal connection between Michelle’s MMR vaccination and her chronic conditions, have been very wrong. Unfortunately, the Cedillos have been misled by physicians who are guilty, in my view, of gross medical misjudgment. Nevertheless, I can understand why the Cedillos found such reports and advice to be believable under the circumstances. I conclude that the Cedillos filed this Program claim in good faith.”

Next, from the second case, Hazlehurst v. HHS, Special Master Patricia Campbell-Smith concluded:

Having carefully and fully considered the evidence, the undersigned concludes that the combination of the thimerosal-containing vaccines and the MMR vaccine are not causal factors in the development of autism and therefore, could not have contributed to the development of Yates’ autism. The weight of the presented evidence that is scientifically reliable and methodologically sound does not support petitioners’ claim. Petitioners have failed to establish entitlement to compensation under the Vaccine Act.

Finally, from the third case, Snyder v. HHS, Special Master Denise Vowell wrote:

To conclude that Colten’s condition was the result of his MMR vaccine, an objective observer would have to emulate Lewis Carroll’s White Queen and be able to believe six impossible (or, at least, highly improbable) things before breakfast. The families of children with ASD and the court have waited in vain for adequate evidence to support the autism-MMR hypothesis. Although I have the deepest sympathy for families like Colten’s, struggling emotionally and financially to find answers about ASD’s causes, and reliable therapies to treat ASD’s symptoms, I must decide Colten’s case based on the evidence before me. That evidence does not establish an adequate factual basis from which to conclude that Colten’s condition was caused by his vaccines.

Petitioners have not demonstrated by a preponderance of the evidence that Colten’s condition was either caused or significantly aggravated by his vaccinations Thus, they have failed to establish entitlement to compensation and the petition for compensation is therefore DENIED.

Ow. That last one’s going to leave a mark.

A more emphatic refutation is hard to imagine. Even better, Special Master Hastings recognized one of the main drivers of the scare over the MMR and vaccines in general as a “cause” of autism: Money. Indeed, a veritable cottage industry of “biomedical” quackery, dubious therapies, and pseudoscience depends upon keeping the idea that vaccines cause autism alive. “Luminaries” of this cottage industry include the aforementioned Andrew Wakefield, who has now infested the United States (the State of Texas, specifically) with his brand of quackery at Thoughtful House, now that the U.K. is investigating him. Also included are Mark and David Geier, who have been touting the use of a powerful anti-sex steroid medication to treat autistic children, and, until recently, Dr. Rashid Buttar, who is now facing sanctions by the North Carolina Board of Medical Examiners and has been banned from treating children. Add to that ambulance-chasing lawyers like Clifford Shoemaker, who have been raking in money hand over fist, thanks to the fact that the VICP actually pays the petitioners’ attorney fees regardless of whether the petition results in compensation, and it is easy to see why this industry won’t easily let parents be disabused of the fears over vaccines that it has stoked. (Indeed, Shoemaker even tried to abuse the subpoena process in order to quash reports of how much money he was making representing VICP litigants, an action for which he was sanctioned by the courts.) In the case of Andrew Wakefield, attorneys looking for big payouts from the pharmaceutical industry have even paid for research. Meanwhile, as documented on this blog before, some researchers producing reports implicating vaccines in autism are actually petitioners in the Autism Omnibus, for example, Laura Hewitson, whose husband works for Wakefield, while compounding pharmacies advertise their supplements and other dubious “remedies” right on the Age of Autism.

Those of us who support science- and evidence-based medicine were quite heartened by the revelations about Andrew Wakefield and the ruling in the Autism Omnibus. True, we wondered why it took 11 years for the revelations about Wakefield’s incompetence and outright fraud to see the light of day, but we were glad that they finally had. One reason is that, to the vast majority of lay people who are parents, the science is hard to understand, and the antivaccine movement had, more or less successfully, framed the issue as big pharma protecting its interests and a conflict between “brave maverick” doctors against government and pharma experts. However, fraud is something that people understand all too well. Demonstrating that Wakefield’s results were riddled not just with conflicts of interest but with outright scientific fraud made the issue very clear, driving home that there was no scientific basis to suspect that the MMR had anything to do with autism or other neurodevelopmental disorders. Similarly, the ruling of the Vaccine Court on the first three test cases surprised me. As I mentioned earlier, I had expected some wiggle room and was heartened to see that, contrary to what I had expected, science won unequivocally and resoundingly in court, at least in this case.

Antivaccinationists circle the wagons

The reaction of the antivaccine fringe to the rulings of the Special Masters and the revelations about Andrew Wakefield’s scientific fraud are instructive. Let’s examine the reaction to the Wakefield revelations first.

I don’t know about you, but if I passionatedly believed that the MMR vaccine causes autism or, even worse, caused autism in my child, I would be feeling very betrayed right now. In fact, I’d turn on Wakefield like a wild boar. But that’s just me. Apparently, that’s not the reaction of most of the antivaccine fringe. Indeed, the antivaccine propaganda blog Age of Autism and David Kirby, along with other antivaccine groups, immediately orchestrated a smear campaign against Brian Deer based on the flimsiest of pretenses. For example, in response to Keith Olbermann’s having correctly picked Andrew Wakefield as his “worst person in the world” for February 10, 2009, David Kirby cleverly played upon Olbermann’s hatred of Rupert Murdoch, pointing out that The Times of London is a Murdoch paper. This allowed Kirby to brag before the February 11 “Worst Person in the World” segment that he had persuaded Olbermann to name Brian Deer as one of the “worst persons in the world,” even publishing the script. Truly, Olbermann had been played for a fool by the antivaccine movement. The specious claim? That somehow Deer had a huge conflict of interest because he made the complaint to the GMC about Wakefield, a meme started by the British version of David Kirby, Melanie Phillips. It’s also a claim that, even if true, would mean nothing, as it does absolutely nothing to refute the findings in Deer’s reporting or the results thus far of the GMC’s investigation. Indeed, the ad hominems went beyond that. For example, Jane Bryant of OneClick Group has tried to paint Brian Deer as “out of control,” during which she couldn’t seem to resist trying homophobia on for size, stating:

By all accounts a gay man and therefore unlikely ever to have to face the multiple vaccine risk agonised over by parents from around the world in relation to their children, Brian Deer has made it his business to portray the parents of these autistic vaccine damaged children as deluded mendacious chancers.

I find this particularly ironic and despicable, given that chief antivaccine propagandist David Kirby is almost certainly also gay and that his previous jobs have included reporting for Outweek and The Advocate. One’s sexual orientation is completely irrelevant to one’s arguments. Only data, evidence, reason, and science should matter.

Finally, when all else fails, the antivaccine movement plays the conspiracy card, as John Stone of the British antivaccine group Cry Shame did on–where else?–Age of Autism:

And yet the medical and political establishment has been constructing its case against Wakefield on Deer’s reporting for the last five years. It was on the back of his first report that Wakefield was held to be “discredited” and the world was brow-beaten into believing it was so. UK National Health Service websites link up to Deer’s website, and the longest medical disciplinary hearing in British history was launched on the basis of his complaint. It is a game in which everybody hides behind everybody else, pretending they can’t be seen – but actually they are all standing there, and their trousers are down.

Never once does it occur to Stone or, for instance, any of the pro-Wakefield commenters here that the reason Wakefield is in such trouble is because he is a dishonest, incompetent, and unethical scientist. This, of course, is a perfect segue into the reaction to the Autism Omnibus rulings, which cranked the antivaccine fringe into ever more histrionic fits of conspiracy mongering. Indeed, leave it to our “old friend” J.B. Handley to connect the two by insinuating that the U.S. Department of Justice had tipped off Brian Deer somehow, so that his revelations could be published in close temporal proximity to the announcement of the first Autism Omnibus rulings:

That said, I found it rather odd that Brian Deer torpedoed Andy over the weekend with a seemingly made-up outrage piece, only days before the judges ruled in the Vaccine Court. The timing struck me as odd.

Meanwhile, the ever-reliable antivaccine advocate Kent Heckenlively, whose understanding of science is astonishingly bad, posted “analyses” of each decision. Some tidbits follow.

Regarding the Cedillo decision:

In his closing remarks he notes that the decision was not even close, and that the Cedillos have been misled by physicians who saw an opportunity to take advantage of a family who thought their child had been injured by a vaccine.

As much as those of who have children with autism and choose to help them are under great stress, I just viscerally respond to this attack against those physicians who are doing their best to help our children.  They choose to enter this fight, knowing they will be attacked, but strengthened by the conviction they can help some of our children.  To many of them, we owe our children’s future.  And when they have not been able to find the answer, they continue to fight.

It is apparent to anybody who looks at this unfolding tragedy that the pharmaceutical companies have no interest in helping us, the medical universities and research facilities can offer us no help, and now we know we have no friends in the vaccine court.

Regarding the Hazlehurst decision:

The sad truth of the matter is that we are massively out-gunned in terms of research dollars.  The medical personnel who undertake our cause do it knowing full well there will be many defeats.  Judges will be dazzled by experts who claim to know so much, except for the question of what causes autism.

And, finally, regarding the Snyder decision:

I’ve tried to figure out how to explain this decision, and the best I can come up with is an example from the book, “Blink” by Malcom Gladwell.  In the book Gladwell recounts the difficulty female musicians had in being hired by professional orchestras, particularly for the wind instruments.  They were thought to lack the lung capacity of men.  But when the auditions began to use screens, so the conductors couldn’t see the gender of the person playing, the number of women hired by professional orchestras increased five-fold.

Now the conductors would probably have sworn they were free of sexism, and may have truly believed it, but something else was clearly at work.  Although the claim was made that they were simply listening to the music and picking the best people, the different results obtained after the use of the screens showed a significantly different mental process going on.

I can only conclude that something similar is at work in the minds of the Special Masters, and perhaps many people who will look at what we allege.  Despite their efforts to carefully weigh the evidence, something else is tipping the scales.  I don’t believe it’s money, at least in the crudest sense of the word.  It’s money in the sense that it’s built the entire edifice and world-view in which the Special Masters are looking at these claims.

Or, to translate: The pharmaceutical companies paid for the verdict, and the judges were unconsciously biased against all those “brave maverick doctors” testifying for the plaintiffs.

But perhaps clearest, most blatant “it was fixed” argument comes from Dr. JayDon’t Call Me AntivaccineGordon in two posts he wrote for that repository for antivaccine posturing, The Huffington Post, entitled “There Is No Proof that Cigarettes Cause Cancer” and The Vaccine Court Was Wrong. Let’s take a look at his first bit of idiocy:

It took fifty years before the courts finally acknowledged that cigarette smoking causes cancer.

There were billions of dollars at stake.

The dozens of court decisions that there “was no proof” were supported by physicians, expert witnesses of all types and hundreds of millions of dollars spent on attorneys.

Experts and doctors alike stated over and over again that we need not continue studying this issue because there was just no proof.

Let me state very simply, vaccines can cause autism.

No real scientist would encourage us to stop studying this possibility.

Note the blatant straw man argument (“No real scientist would encourage us to stop studying this possibility”). Note the specious and false comparison that antivaccine advocates love to use: Comparing tobacco research to vaccine research. No matter how easy it is to demonstrate how wrong they are, they think it’s a slam dunk comparison that bolsters their paranoid, conspiracy mongering world view. After all, decades ago, scientists kept finding scientific and epidemiological evidence that tobacco smoking causes lung cancer and all manner of other health problems. Tobacco companies funded a well-financed denialist campaign of lies, bad science, and outright pseudoscience to try to convince the public that there was no link between smoking and cancer in order to protect their profits and forestall the regulation or banning of cigarettes by the government. So to antivaccinationists, it seems perfectly reasonable to claim that claiming that vaccines cause autism is the same thing, except with the evil big pharma vaccine manufacturers suppressing the “truth” to protect their profits and keep themselves safe from lawsuits.

Note another thing. Note the absolute certainty with which Dr. Jay states unequivocally that “vaccines can cause autism.” He even uses boldface and italics in the font, but that isn’t even enough to convey his level of certainty. He has to underline it too! (I congratulate him for his restraint in not using all caps as well.) Note that Dr. Jay’s certainty comes with no scientific evidence presented whatsoever to support it. None. Zero. Zip. Nada. This is very consistent with his past behavior, in which he apparently believes that simply asserting something is the same as proving it. It isn’t; argument by assertion is the lamest form of argument. In any case, apparently, just like the antivaccine movement for which he is an apologist, Dr. Jay just knows that vaccines cause autism, science be damned. Indeed, he demonstrates this utter belief–not science, belief–that the “proof” will someday be found:

The proof is not there yet. It will be found. Let’s hope it doesn’t take another fifty years and hundreds of court cases to convince the government and the public. Private industry is once again duping the FDA, doctors and the public. The conflicts of interest are obscene and illegal.

The diseases against which we vaccinate are still dangerous and still present in other countries and in America but simple risk/benefit analysis would show that the risks from the way vaccines are manufactured and administered far outweighs the risks of harm from these relatively rare illnesses.

Sure thing, Dr. Jay, and The Truth Is Out There. Fox Mulder and Dana Scully have taught us this, and Dr. Jay wants to believe. Oh, does he ever want to believe!

And that’s why these two victories for science will not, as many hope, put a damper on the antivaccine movement. They just won’t. To those who cling to the scientifically discredited idea that vaccines cause autism against the mountains of evidence that do not support it, as Kev points out, it is not about science. It is about winning and convincing people that they are right. It is about finding someone or something to “blame” for their children’s autism. To them, doctors have no authority. Scientists have no authority. The Special Masters have no authority. The scientific method means nothing. Only their personal experiences and the conclusions they draw from them, no matter how fallible humans are at drawing inferences from them, matter. To them, as Dr. Jay Gordon made explicit when he spoke to the “Green Our Vaccines” rally last summer, and said that his die hard belief that vaccines cause autism is based on states that he bases his conclusions that vaccines probably cause more harm than good on “over 30 years” of his own experience and above all (emphasis mine) “listening to you,” meaning the parents who believe vaccines “injured” their children.

That’s because the battle between parents who believe that vaccines cause autism and scientists is a battle about, more than anything else, two world views. Scientists, knowing how easily humans fool themselves into confusing correlation with causation when drawing conclusions from personal experience and anecdotes, rely on epidemiology and the scientific method to answer the question of whether vaccination is associated with autism. In contrast, the believers cannot accept that they can be fooled. Dr. Rahul K. Parikh described this conflict well in a recent article on the Omnibus decision:

Among those expressing shock and disappointment was Rebecca Estepp, the mother of an autistic child, who is one of the claimants and the national manager of the advocacy group Talk About Curing Autism. “It’s tough when you’re taking parent support calls and you hear the same story day after day,” she told the Wall Street Journal. “When does anecdotal evidence become enough?”

Her question isn’t a new one, especially in a society where belief, emotion and science so often conflict. For scientists, the answer to Estepp’s question is never. Developing a hypothesis from anecdotes or observations (whether one or a hundred of them) is merely the first step in a longer process. Next comes the hard part: testing that hypothesis to see if you can back it up with hard data, and then sharing the data with others to see if they can reproduce the findings, often multiple times.

Even more accurately, Dr. Parikh states:

Now, read that headline again: “Vaccines Didn’t Cause Autism, Court Rules.” It doesn’t say, “Vaccines Didn’t Cause Autism, a Decade’s Worth of Rigorously Conducted and Verified Medical Research Rules.” That may not be as sexy as the recent headline, but it is the truth. The scientific community disproved the vaccine-autism connection long ago, multiple times.

Which is true (except that it’s well over a decade’s worth of research), and to which I would add: The scientific community only continues to study the vaccine-autism connection, churning out negative study after negative study because it hopes to convince those who are unconvinceable by science. Indeed, just how unconvinceable they are is summed up in this poem by Rolf Hazelhurst, the father of one of the three complainants:

If we win, we keep going.
If we lose, we keep going.
If we win, the going will be easier.
If we lose, the going will be more difficult.
However, the Court rules, we will keep going.

That is a religious, cultish attitude. A little thing like a news report revealing the hero of the antivaccine movement to be a scientific fraud or a court ruling that, even under the most favorable standards of evidence imaginable, vaccines do not cause autism will not change the mind of someone like this, nor will it make the antivaccine movement have second thoughts about its cultish beliefs. The only hope that we who support science-based medicine can have is that these two body blows to the antivaccine movement will finally–finally!–drive home the message to the media that, when it comes to the claim that vaccines cause autism, there’s no there there, as they say. We can also hope that the fence-sitters, those parents who may have heard Jenny McCarthy ranting about how vaccines caused her son Evan’s autism and how she cured him with various biomedical interventions may see these two repudiations of the myth that vaccines cause autism and be reassured.

A guy can hope, can’t he?

Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.