The MMR vaccine and autism


in Law, Rants, Science

I am glad to see that an American court has rejected allegations that the MMR vaccine causes autism. The anti-vaccine movement that is gaining ground in Europe and North America is a worrying one. It is worrying on a direct level because it exposes children to new dangers and raises the risk that diseases that have been all but eradicated will return. It is also worrying insofar as it demonstrates the depth of the lack of trust between large elements of the population and doctors and scientists.

As with the alternative medicine craze, a disturbing number of people have decided that evidence-based medicine is lacking and have opted for alternatives that range from relatively harmless quackery to dangerous malpractice. It leaves one wondering if there is any mechanism through which broad public confidence could be restored.

{ 107 comments… read them below or add one }

R.K. February 14, 2009 at 7:07 pm

I think half the reason people turn away from real doctors is that they don’t feel as though they get enough personal attention and treatment.

There is a tension there, between giving people what they want (like unnecessary drugs) or ignoring their requests and losing their confidence.

La Canadienne February 14, 2009 at 7:25 pm

I agree that this anti-vaccine business is no good. I’ve been several different kinds of excited about the HPV vaccine, and am quite discouraged by the girls surrounding me rejecting it. I understand everyone gets to decide what to do with their body, but I wish that they would give the vaccine more credit. And I wish the CWHN would shut up a little, and stop being quite so anti. *lesigh*

Milan February 14, 2009 at 7:48 pm

Without a doubt, these unfounded vaccine fears cause real damage. From the linked article:

In Britain, which has no compulsory vaccination, rates of MMR vaccination fell from 92 percent to as low as 80 percent. Herd immunity slipped away; as a result, last year there were 1,348 British measles cases, including two deaths and hundreds of hospitalizations, compared with 56 cases in 1998.

In Simon Singh’s book, he talks about a study conducted on alternative medicine practitioners. Most of them counseled their clients to not vaccinate their children. Most homeopaths also suggested (worthless) homeopathic remedies to prevent malaria, for people visiting areas where it is endemic.

Seonsam February 14, 2009 at 8:27 pm

I agree on the most of the points you raised, but the trend not only among the public but among the professionals of discrediting the so-called hard scientific evidences from the doctors does not purely flow from their misconceptions and distrust toward the doctors. It also has some ground in the analysis of the past data which we used to find totally ‘scientific’ thus, ‘factual,’ but turns out to be rigged in the benefit of the medical community aligned with scientic and phamaceutical industries. Actually it all comes down to the issue of medicine being a science. In other words, it’s the matter whether you emphasize the scientic end or art end of the spectrum on which medicine lies.

alena February 14, 2009 at 8:43 pm

Although I support vaccinating children, I also believe that much could be done to make these types of injections safer by using less harmful preservatives. If a child has a severe reaction to inoculation during infancy such as seizures or paralysis, I can understand why a parent may want to use alternative methods. However, this only happens in a few cases. In developing countries there are more problems with vaccination. For example, when we lived in Pakistan, we used to go to a “UN” doctor who routinely vaccinated us with water and charged us huge amounts of money for the alleged serum. His fraud was only uncovered after I was residing in Boston. My mother used to work with refugees in Sudan and she found that vaccines were routinely sold on the black market and who knows what the kids were vaccinated with. Some vaccines like the flu shots are of questionable benefit to a healthy person.

Magictofu February 14, 2009 at 9:53 pm

On alternative medicine, I have recently heard an interesting argument supporting them in a debate about whether the French government should continue to cover them under a drug insurance plan.

The doctor defending them basically said that there was very few scientific evidences supporting most of the different practices falling under the label of alternative medicine but that they permitted the use of the placebo effect to the improvement of the life of a great number of people. He went further and argued that many scientific studies confirmed that just being taken care of by someone, no matter what the treatment was, actually helped patients recover faster than having the same treatment administered with minimal social relations.

He was arguing that it did not matter whether or not the treatments were beneficial in themselves because the use of the placebo effect and other socio-psychological aspects of health was sufficient to justify the practice.

It should be said however that homeopathic medicine is often practiced by medical doctors in France and under some level of governmental regulations.

The vaccine question of course is a completely different issue and is probably reflecting more a world of competing practices than complementary ones.

Since then, I am a bit more conflicted about expressing my opinion on such issues.

Tristan February 15, 2009 at 12:54 am

On alternative medicine,

I think it’s reasonable to admit that evidence based medicine is quite bad in some situations – i.e. those situations where it is very difficult to do experiments. Specifically, in those cases where Freedom is a real issue, where the difficult relation between human qua free and human qua atoms makes the data sets messy.

In these cases, which tend to get studied only as a “placebo effect” (although, to be fair, the placebo effect is sometimes taken quite seriously by the establishment), it seems reasonable that other kinds of medical research might be acceptable. The problem with placebo effect trials is that they only work when what you are giving the patient is a placebo. What about medicines where its success requires both an actual chemical stimulation, as well as a “placebo effect”, i.e. ideogenetic, originated by the “mind”, i.e. “you” qua free human.

Along my line of reasoning, I’m quite ready to dismiss most alternative medicine, insofar as it acts like a replacement for established evidence based medicine. However, I don’t think it’s appropriate to dismiss categorically the possibility of medicine which relies on properties of the human – drug interaction which cannot itself be studied, because the process is too individuated and you could never be certain of any sample enough to call the evidence statistically meaningful.

Milan February 15, 2009 at 12:57 am

Evidence-based medicine also benefits from placebo effects.

Give a patient a sugar pill, in the right social context, and they might get better due to a placebo effect.

Give them a pill of effective medication, and they might improve both because of the action of the medication and because of any placebo effects associated with attention, being given medication, etc.

Tristan February 15, 2009 at 1:52 am

My point is, “placebo” effects concern only subconcious reactions to the taking of medicine. So, you can only expect so much consistency in a sample, which will restrict the ability to do evidence based research.

Worse, however, is when some form of willing is required – how can you say “every member in this sample has practiced having x frame of mind concerning this issue”? The possibility for evidence based research breaks down, but the potential for benefit doesn’t.

seonsam February 15, 2009 at 5:01 am

The trouble, however, with a ‘human’ factor you raised is how we can substantiate it , thus giving it a proper epistemological place in medical encounters, or even in our physico-chemical makeup of our bodies. The discussion then lead us to the messy world of ontological problems. I am not sure if I got the discussions right, but the issues raised here seem very interesting.

seonsam February 15, 2009 at 5:05 am

(above comment is on Tristan’s comment. Hello Tristan. My name is Seonsam. I am a regular visitor of Milan’s page. I can’t revise my comment already submitted, so I write this again. Is there a way to edit the comment?)

oleh February 15, 2009 at 9:18 am

I am also troubled by the segment of a population who does not take vaccines because they want the benefit of the vaccine being widely taken by others without the risk or inconvenience of taking it themselves. The person is this category is basically relying on mass compliance and is protected by that mass compliance. However, this breaks down as the taking of the vaccine becomes less universal.

My concern also applies to parent of children with the same attitude , that is they want the benefit of the vaccine being widely taken by children of others without the risk or inconvenience of having their own children take ing it.

Regarding medicine and science in general, there will always be flaws. However the medical or scientific method is to have an open exchange of information to identify flaws and make improvements. There will even be occasional steps backwards. However, overall this reliance on science and evidence has worked in providing better medical care.

Tristan February 15, 2009 at 12:07 pm

“how we can substantiate it , thus giving it a proper epistemological place in medical encounters, or even in our physico-chemical makeup of our bodies. The discussion then lead us to the messy world of ontological problems.”

Exactly – I’m talking about a region of medicine that can’t be substantiated. However, I disagree that having no “proper epistemological place” leads us to “messy ontological problems”. Why do we presume that knowing precedes being? Unless we are some kind of crazy relativists, we think that we know something is true because it is true, not that it is true because we know it to be true. Therefore, there might be true things that we don’t know, and maybe even ones we can’t know with certainty. Certainty is a bad ontological standard – and this comes up all the time in Science, because it’s impossible to know anything with certainty so you have to act before certainty. Climate change is an interesting case for this, where people argued that you need to act at 90% certainty rather than 99% because the risks are so high, if the acting is economically beneficial.

However, I’m not talking about differences between 90 and 99, I’m talking about instances where statistical research is categorically impossible. This in no way proves that the medicine doesn’t work, it just so happens that it’s impossible to prove, according to conventional epistemic standards, that it does work. But this isn’t in itself a reason to dismiss it’s ontological status.

The tyranny of epistemology over ontology is a relatively new phenomenon, basically post-enlightenment. It’s great if you want cell phones, power dams, the internet, etc…, but if you want a more subtle and non-mathematical relationship with nature, it’s really going to fuck you up.

Milan February 15, 2009 at 1:11 pm

I don’t think treatments that cannot be tested statistically can qualify as ‘medicine.’

That being said, there is a distinction between methods and precise treatments. For instance, it might be necessary to treat a person with their own stem cells. Such a therapy could, however, be evaluated statistically.

I am not sure what you would call a treatment so personalized that it never rises to the scale where statistical examination is possible, but I would certainly not have very much confidence in it working.

Sasha February 15, 2009 at 1:11 pm

I think this debate hinges on what you consider “alternative” medicine and what counts as “normal” medical care.

My major objection to the assertion that we should all rely on a pharmaceutical-based approach to medicine/health care (which is what many seem to see as normal) is that I cannot trust pharmaceutical companies, be they the ones trying to repress studies that show BPA turning frogs into hermaphrodites, or the ones who clawed a migraine medication my doctor had me trying off the market because, ooops, most of the testing had been on men, so the elevated risk of heart disease it brought on in young women wasn’t originally noticed. As poet Shane Koyczan wrote, “When doctors become business men, who will we turn to for doctors?”

On the other hand, I’ve had notable success with so-called “alternative medicine.” Last spring, after weeks of stomach pain, my doctor diagnosed me with gastritis, a condition where the stomach lining erodes, leading to ulcers. She gave me a prescription for a proton-pump inhibitor, which reduces acid flow into the stomach. The only downside to that is stomach acid kills hostile bacteria and other microbes in the stomach, so I was warned that I would be more susceptible to infection, parasites, etc. I diligently took the pills for the prescribed month, but when the pills ran out, the stomach pain came back. I refilled the prescription and was on them for four months. Each time the bottle ran empty, the problem came back.

Frustrated by the lack of progress I was experiencing, I began seeking advice from “alternative” practitioners – a nutritionist, an herbalist, even a yoga teacher. I developed new breathing techniques t help me deal with stress and ensure I wasn’t over-tensing my stomach muscles when stressed. I was given the advice I needed to totally overhaul my diet. I was able to identify ways to control my amount of stomach acid naturally by paying attention to PH and using things like honey as antacid. I searched for tinctures and supplements with key ingredients (naturally occurring kinds of glycol, largely) to support the health of mucus membranes such as the stomach lining. I am far healthier today than I was a year ago, and it isn’t dependent on artificially suppressing stomach acid. How can so-called alternative therapies *not* make a difference when they involve measure like changing your diet, coping with stress better, etc? While I’m not ready to believe that hyper-diluted extract of violet will cure malaria (or whatever it is), I do think we write off “alternatives” too quickly.

…and none of that is to say anyone shouldn’t vaccinate their children. It’s the free markets game and everyone has to do their part.

Milan February 15, 2009 at 1:14 pm

As for the individual variation in response to treatment, that is precisely why statistics and evidence-based medicine are crucial.

With a sample size of ten (and a control group of the same size), it is often impossible to work out whether different results arose from the treatment, subtle differences between the subjects, differences in psychology, etc.

By the time you have 5000 people on each side of the ledger, it is relatively easy to separate out random chatter and isolate the effect of the treatment itself.

Milan February 15, 2009 at 1:15 pm


I can’t revise my comment already submitted, so I write this again. Is there a way to edit the comment?

Unfortunately, there is not.

There are some plugins that modify WordPress to allow this, but I dislike them because they are often ugly and clunky, and they raise security concerns.

Milan February 15, 2009 at 1:19 pm


The distinction I am drawing is between evidence-based medicine (of any kind), and treatments that cannot produce statistics to back up their efficacy. That is quite different from a distinction between ‘Western’ and ‘Eastern’ medicine, or between ‘Modern’ and ‘Traditional’ medicine.

Certainly, there are reasons to be concerned about financial pressures undermining good medicine. That is just as true when it comes to ‘alternative’ practitioners, however. Greed is just as strong a motivation for homeopaths as for cardiologists, and the latter group is under much more effective scrutiny.

As for personal experiences, I really do think they confound our judgment. It is psychologically powerful to try a treatment, get better, and be convinced that the treatment was the cause. With a sample of one, it is basically impossible to be sure of that. Nonetheless, it opens the door to a lot of confusion and abuse.

. February 15, 2009 at 1:27 pm
Tristan February 15, 2009 at 1:46 pm

“I don’t think treatments that cannot be tested statistically can qualify as ‘medicine”

This seems deeply implausible. It would mean that neolithic cultures that gave moldy bread to the sick, (we now say that it contained antibiotics), was not “medicine”. Just because we can’t do the evidence testing doesn’t mean that something isn’t medicine. Medicine is that which does heal the body, not what can be known to heal the body. We call things true because they are true, we don’t say things are true because we call the true.

Tristan February 15, 2009 at 1:50 pm

“, it is relatively easy to separate out random chatter and isolate the effect of the treatment itself.”

So, if it turrns out that Sasha’s treatment program is not testable, or that testing it proves it to be “random chatter”, would you say it was no better than doing nothing? Or that it was merely a “placebo effect”, not medicine?

It seems quite clear that adopting certain practices, such as yoga, do in fact have complex effects on the body’s ability to heal itself. This seems to me enough to call it part of “medicine”.

We also need to be careful about a contradiction – when we tell people that something is only a “placebo effect”, we treat them as symptomatic, unfree bodies, and thereby disable the ability of the free body to produce the placebo effect. Dis-heartening people, by calling something a placebo effect, destroys the placebo effect.

Milan February 15, 2009 at 1:50 pm

In a sense, ‘medicine’ of the neolithic variety was subjected to statistical scrutiny. Those to whom it was badly misapplied (perhaps, the ones who got deadly mold instead of the antibiotic sort) tended to be eliminated. Of course, without large and properly designed studies, it could not be rigorously established that the bad bread was doing the killing, rather than parasites, some environmental toxin, or something entirely different.

In any case, it doesn’t make sense to say: “In some circumstances, we cannot rigorously evaluate the effectiveness of treatments, therefore we should not do it now.” We have the resources and techniques to test antibiotics, surgical techniques, vaccines, etc. We would be foolish not to use them.

Milan February 15, 2009 at 1:52 pm

Another example of how damaging evidence based on personal experience can be comes from a doctor who I met. She explained that, once parents have a single child with autism, it becomes virtually impossible to convince them to vaccinate any more children.

The connection between the two is spurious, but the psychological force of personal contact overwhelms a dispassionate analysis.

R.K. February 15, 2009 at 2:01 pm

Probably, the best way to convince the public of the wisdom of vaccinating is to wait, let fewer and fewer people do it, then produce charts showing how deaths from measles, mumps, and rubella are way up while the incidence of autism hasn’t fallen.

By ‘best’ I don’t mean ‘the wisest way’ I mean ‘the way that will convince the most people.’

. February 15, 2009 at 2:06 pm

Vaccines for measles, mumps and rubella in children

Demicheli V, Jefferson T, Rivetti A, Price D


Using the combined vaccine for protection of children against measles, mumps and rubella

Measles, mumps and rubella are three very dangerous infectious diseases which cause a heavy disease, disability and death burden in the developing world. Researchers from the Cochrane Vaccines Field reviewed 139 studies conducted to assess the effects of the live attenuated combined vaccine to prevent measles, mumps and rubella (MMR) in children. MMR protects children against infections of the upper airways but very rarely may cause a benign form of bleeding under the skin and milder forms of measles, mumps and rubella. No credible evidence of an involvement of MMR with either autism or Crohn’s disease was found. No field studies of the vaccine’s effectiveness were found but the impact of mass immunisation on the elimination of the diseases has been demonstrated worldwide.

Key Findings

The systematic review’s key findings are that:

  • There is no credible link between the MMR vaccine and any long-term disability, including Crohn’s disease and autism.
  • MMR is an important vaccine that has prevented diseases that still carry a heavy burden of death and complications where the vaccine is not used consistently.
  • The lack of confidence in MMR has caused great damage to public health.
  • People arguing for or against the use of any therapy need to make sure that they base their conclusions on carefully collected evidence, not just on biased opinion, speculation or suspicion.
Anon February 15, 2009 at 5:23 pm

Ideally, when investigating the effectiveness of a medicine, you want two things:

1) An explanation of why it works


2) Evidence of it working.

If you have just evidence (say, from statistics), you are worse off than when you have both evidence and a plausible explanation of the method of action. If you have a plausible explanation but no observational evidence, you don’t really have anything at all.

This can be applied pretty easily to something like yoga. Say, we want to know whether it increases flexibility. In a non-ideal case, we test the flexibility of a bunch of yoga practitioners and compare it with otherwise similar non-yoga practitioners. In a better case, we divide a group of similar people randomly into two groups, then make one do yoga and one abstain.

If we do find evidence that yoga increases flexibility, it makes sense to look for an explanation. We could, for instance, examine other activities that require a lot of stretching. It may well be that something like gymnastics has similar effects. Where there are differences, we can evaluate the differences between gymnastics and yoga.

These approaches are simple, but with patience and determination they can be used to unravel very complex mysteries.

Tristan February 15, 2009 at 5:52 pm

“We have the resources and techniques to test antibiotics, surgical techniques, vaccines, etc. We would be foolish not to use them.”

Of course – but, if you considered my previous argument, there will always be possibilities for medicines which do not submit to resources for testing. This should not be a reason, however, for not pursuing these interesting avenues for treatment, although, certainly people should understand that they are dealing with non-statistically based medicines. The fact that they didn’t have the resources for testing antibiotics didn’t stop the neolithics, and the fact that we don’t have the resources for statistically testing drugs which rely on a combination of real and placebo effects shouldn’t stop us from using ones that work this way.

Tristan February 15, 2009 at 5:57 pm


There are many problems with your idea of comparing yoga with gymnastics. Depending on which account of stretching you believe, yoga doesn’t involve any stretching. And the practice of gymnastics itself is not stretching, although stretching is required to become a good gymnist. However, since every exercise is the opposite of a stretch (it contracts muscles), comparing different sports to see how well they do stretching is like comparing two sorts of motor racing to find out which has the best fuel economy. If you really wanted stretching, you’d do a regiment of stretching and no exercise, that would make you very flexible very quickly – but who would want that?

Anyway, the way yoga is practiced varies a lot in different sorts of yoga, and even in different practitioners of the same sort. How could you control for individual differences? Even if there is an understood paradigmatic way of doing yoga, how can you know that 70 or 80 percent of the practitioners are doing it properly, even the teachers? You can’t. You can’t always tell the difference on the outside what’s happening inside – unless you want to go around measuring people’s muscle tension while they are doing the stretches – which would probably make doing yoga impossible anyway.

Milan February 15, 2009 at 5:57 pm

the fact that we don’t have the resources for statistically testing drugs which rely on a combination of real and placebo effects shouldn’t stop us from using ones that work this way.

Lots of statistical studies have been done on ‘alternative’ treatments like homeopathy and acupuncture. The studies show that these treatments don’t work.

We had the resources, used them, and got a result.

Anon February 15, 2009 at 6:04 pm


The issues you raise are matters of detail, not method.

Perhaps gymnastics isn’t an effective control, but that doesn’t matter. The methods described above can be used to determine the effects of any particular form of yoga, to a high degree of confidence.

The question here isn’t how yoga, in particular, can be evaluated. It is whether there are methods of investigation through which robust results can be found, in relation to complex subjects.

All it requires is good experimental design.

Tristan February 15, 2009 at 7:01 pm

You can’t test people’s inner psychic states. So, if that is ever important to some activity, you can’t test that activity. So, if a medicine works because of a combination between placebo and real effect, you can’t design an experiment to deal with it.

Tristan February 15, 2009 at 7:04 pm

“Lots of statistical studies have been done on ‘alternative’ treatments like homeopathy and acupuncture. The studies show that these treatments don’t work.”

Again, you are assuming that you can actually do a statistical study on it. Now, with regards to homeopathy, I agree with you – you can do experimentation on this, and it’s been disproven. However, you can’t use an example of something that can be studied as a proof that everything can be studied. You can’t do such a proof through enumeration, you need to show how for any x where x is a possible medicine, x can be studied. And you can’t simply define medicines as those things which can be studied or you’ll have begged the question.

I don’t know of any alternative medicines which would pass my test of un-experimentable, although aspects of yoga and alternative psychic drug practices might be thinking in the right directions.

Milan February 15, 2009 at 7:05 pm

You can’t test people’s inner psychic states.

In some cases, you can.

You can give people treatment in a way they are unaware of. Say, you add the medication to food or drugs they are already taking.

That way, psychology doesn’t enter into it.

You could even do that with some people while administering the drug normally to others. That would isolate the psychological placebo effect.

Milan February 15, 2009 at 7:09 pm

Something un-experimentable would be something like this:

“Your disease can only be cured by this particular arrangement of planetary orbits, which only happens every billion years.”

If you happened to get better at that moment, you could never know whether the planets were the cause (though there is no known mechanism through which orbital configurations cure diseases).

I maintain that ‘cures’ of this type are not medicine. At best, they are a kind of weird anecdote.

Milan February 15, 2009 at 7:16 pm

Probably, the best way to convince the public of the wisdom of vaccinating is to wait, let fewer and fewer people do it, then produce charts showing how deaths from measles, mumps, and rubella are way up while the incidence of autism hasn’t fallen.

Sadly, this seems to be the route we are taking. It speaks very poorly of the ability of the general public to sensibly assess medical questions. Arguably, it also speaks poorly of the medical profession, for failing to make it easier to do so.

Tristan February 16, 2009 at 1:00 am

“That would isolate the psychological placebo effect.”

This is a bit annoying. I’ve been very clearly trying to articulate the position that the kind of alternative medicine we need to allow for is specifically that in which the placebo effect cannot be isolated from the chemical effect. You might argue that it’s impossible for the chemical and placebo effect to interact in an interesting way, but it’s hard to see how you could know this in advance.

If we do believe that the world is prior to our investigations of it, it’s not unscientific to assume that the world has properties which we can’t know with certainty or according to experimentation.

seonsam February 16, 2009 at 7:48 am

The discussion seems already have touched all the major issues concerning the medicine, medical activities, placebo effects, the limit and possibility of a science, and the mind stuff, finally.

I should say I am in the quite middle in the epistemic or moral confidence in science or scientific medical research that has been enumerated in these discussions. I believe science has come long way so as to be the ‘discipline’ in modern worlds, but my degree of belief in EBM and other medical researches is not really high. EBM itself is considered by some as a post-modern approaches to medicine already give a forlorn hope to the finding of the ultimate causal mechanisms of the human phathology. The probability construal itself is very much contested as you might well know. When it comes down to the bottom line, sometimes many arguments often ends in a degree of ‘belief’ , in this case, in the belief in science, in which case the premises is science has already become which they themselves can not handle with its own method.

However, I don’t also endorse the ‘agnosticism’ Tristan seems to uphold regarding the phenomena in human body. I believe there could be some explanations in the workings of the body as in Saha’s case of gastritis in which the internal acid regualtion might have been mediated through the controls in the muscle movements rather than the direct ‘ph’ control in the gut linings. If you approach the whole problem in the chemical perspectives, that way of being healed *will be considered to be out of ken of ‘science,’ but which science is it?

I suppose we can’t really push aside the materiality of the substances easily. The psychic thing which we think we exist only in our mental realm surely has some conterparts in our tangible body, be it a nerve connections or muscle contraction. It’s a whole different matter from that of ‘testing’ or ‘measuring’ those things, but one’s line of thinking regarding the possibility of pinning down the character of the entitiy must be quite important in futher researches. It might even be reduced to the everyday concepts we use, but claiming it as ‘unknowable’ will make us quite hard to lead our way forward.

Milan February 16, 2009 at 8:44 am

If we do believe that the world is prior to our investigations of it, it’s not unscientific to assume that the world has properties which we can’t know with certainty or according to experimentation.

Do you not agree that the experiment I described would isolate the placebo effect as a factor? Surely, there cannot be a placebo effect when the subject is unaware of the treatment.

There may be situations in which doing so is impossible (it is hard, for instance, to have someone exercise withut knowing it), but the general trend has certainly been towards being able to isolate and test more and more things. Who would have thought, for instance, that we would be able to know the temperature, amount of ice cover, and amount of cosmic ray activity on the planet 800,000 years ago? Likewise, who would have thought, a hundred years ago, that we would be able to track bloodflow in different parts of the brain in real time?

Finally, what’s so special about treatments where the real effect cannot presently be isolated from a placebo effect? To me, it seems like ‘medicine’ in a question mark category: of uncertain value, at best.

Milan February 16, 2009 at 8:54 am

Ethical issues aside, it would also be possible to isolate the placebo effect of some treatments by testing them on people in comas or vegetative states.

It should also be possible to tease apart the different aspects of the placebo effect. Indeed, interesting work has been done on exactly that. You can test the ‘being paid attention to’ component by giving the same attention to two people, then giving real treatment to one and a placebo to the other. You can test the importance of the perceived authority of the person giving the treatment by making patients believe they are getting it from a nurse, a doctor, the dean of medicine, a Nobel prize winner, etc.

There have definitely been studies on whether people get the biggest placebo boost from red pills or yellow pills, big ones or small ones, etc. That information could be incorporated into the design of real pharmaceutical products – though the concerns raised above about profit motivations must be borne in mind.

. February 16, 2009 at 8:57 am

The end of homeopathy?

“The placebo response is about far more than the pills – it is about the cultural meaning of a treatment, our expectation, and more. So we know that four sugar pills a day will clear up ulcers quicker than two sugar pills, we know that a saltwater injection is a more effective treatment for pain than a sugar pill, we know that green sugar pills are more effective for anxiety than red, and we know that brand packaging on painkillers increases pain relief.

A baby will respond to its parents’ expectations and behaviour, and the placebo effect is still perfectly valid for children and pets. Placebo pills with no active ingredient can even elicit measurable biochemical responses in humans, and in animals (when they have come to associate the pill with an active ingredient). This is undoubtedly one of the most interesting areas of medical science ever.”

Tristan February 16, 2009 at 10:17 am


You keep trying to talk about how to isolate the placebo effect from the chemical effect. I completely agree with you that in every case where this is possible, you can have your statistical, research based science.

However, I’m talking about possible cases where a medicine only functions because of an interrelation between placebo and chemical effects. In other words, the placebo effect wouldn’t work without the chemical effect, and the chemical effect wouldn’t work without the placebo effect.

I don’t think the non-agnostic position is very respectable, actually. I think it amounts to “Science will tell us everything about everything about the body, there is no need to be skeptical at all about it or imagine that it there might be limits to what it can tell us” – this is the kind of view of Science which was endorsed by “end of science” people during the days when logical positivism was not yet a zombie.

We might also consider that for all the evidence based medicine which we “know” works now, the one thing we can be fairly certain of is that our explanations are wrong – that chemistry, physics, etc will be replaced by more advanced paradigms and our current medicine will appear as Newtonian physics does to contemporary rocket engineers – useful, but not perfect. The goal of perfection in a constantly evolving discipline is a false idol, and the notion that only what we can know perfectly could be perfectly puts the direction of causality with regards to knowing the wrong way round.

If we do believe that the world is prior to our investigations of it, it’s not unscientific to assume that the world has properties which we can’t know with certainty or according to experimentation.

. February 16, 2009 at 10:21 am

Australia declared measles free

Dani Cooper
Wednesday, 11 February 2009

High take-up rates of the infant measles-mumps-rubella (MMR) vaccine has led to the elimination of the endemic measles virus in Australia, immunisation experts say.

Researchers from the University of Sydney, writing in the Bulletin of the World Health Organisation, claim that in 2005 and 2007, Australia satisfied the main criteria of having a low level of measles infection, with less than one case per million people.

A total of 125 cases were reported in 2006 – equivalent to six cases per million – but more than half of these were attributed to a outbreak linked to the tour of a foreign spiritual group.

The study examing the future of measles cases in Australia was prompted by a move to change the delivery of the second dose of measles vaccine from four years to 18 months.

Until recently Australian children were given the MMR vaccinations at age 12 months and four years.

Milan February 16, 2009 at 10:32 am


Do you have any examples of treatments that “only function… because of an interrelation between placebo and chemical effects?” In virtually all cases, it seems like controlled trials can deal with this. In an ideal clinical test, the only difference between the control group and the treatment group should be that one receives the real treatment and the other an indistinguishable placebo. In such experiments, any treatment that only worked in conjunction with the placebo effect would appear in the treatment group, but not the control group. You could then conduct a second experiment where two groups get the treatment, one with knowledge and one without, and thereby isolate whether both chemical and placebo effects are really necessary.

Letting people argue that their treatment only works in conjunction with the placebo effect gives them an infinite amount of space in which to hide treatments with no actual medical effect. In situations where there is neither clear statistical evidence nor a plausible explanation for a method of action, we should be very sceptical indeed.

We might also consider that for all the evidence based medicine which we “know” works now, the one thing we can be fairly certain of is that our explanations are wrong – that chemistry, physics, etc will be replaced by more advanced paradigms and our current medicine will appear as Newtonian physics does to contemporary rocket engineers – useful, but not perfect.

I agree, but don’t think this is as important as you seem to. The beauty of the dual evidence/explanation system is that the explanation can be revised while maintaining confidence about the evidence. The first people who used willow bark to treat pain had no idea why it worked. People who use acetylsalicylic acid now have a better idea. People in fifty years will probably have a better idea still. None of this undermines the validity of evidence-based medicine.

Having high statistical confidence that something works has no necessary connection to understanding why it works. We have built a lot of things in the confidence that gravity will keep working, even though we still don’t really understand why it exists.

Milan February 16, 2009 at 10:35 am

A total of 125 cases were reported in [Australia in] 2006 – equivalent to six cases per million – but more than half of these were attributed to a outbreak linked to the tour of a foreign spiritual group.

That right there seems like pretty good evidence that people going around and telling parents not to vaccinate are causing real harm.

One can only imagine the effects when the disease in question is more lethal than measles. Say, for instance, with the HPV vaccine.

Milan February 16, 2009 at 10:44 am

Resistance to vaccination also helped undermined the global effort to eradicate polio. The inexpensive vaccines for this illness reduced global cases from 350,000 in 1988 to 1300 in 2007. Now, the dieases is only endemic in Nigeria, India, Pakistan and Afghanistan.

If the vaccine had been universally administered during the last eradication drive, there is a good chance no human would have ever suffered from the illness again.

Tristan February 16, 2009 at 12:13 pm

“In an ideal clinical test, the only difference between the control group and the treatment group should be that one receives the real treatment and the other an indistinguishable placebo. In such experiments, any treatment that only worked in conjunction with the placebo effect would appear in the treatment group, but not the control group.”

I can see why you would be inclined to believe this is a rock-solid proof that every placebo and placebo-related medicine can be tested completely with statistics and maths.

This comes down to the organic versus inorganic relations debate. If you think all relations are in principle abstractable from the particular content they take up at any moment, then you’d come to this kind of an experimental conclusion. But, if you think that relations in the body are in principle always more complex, more specific, than it is possible to abstract, you’d need to leave a space, a remainder, for the real which is not knowable.

If you look at the world as the kind of thing which is just the entire content of what’s possible knowable through maths and statistics, I’ll never be able to convince you otherwise. It seems to me you’ve made an a priori assumption, and if that is really the basis for your anti-agnosticism with regards to medicines, then there is no use arguing about it.

Milan February 16, 2009 at 12:35 pm

The causes really don’t matter. It’s all about the methods.

You are saying: “what about situations where you need A and B, where A is the chemical effect and B is the placebo.”

Answer: first, test that A and B produce the effect in combination. Then, remove A and check that the effect goes away. Then, remove B and make sure the same thing happens.

This method works regardless of your philosophy and what you are testing. The only issues with it are practical ones, such as whether it is possible to give the treatment in a concealed way.

Milan February 16, 2009 at 12:46 pm

In any case, it would be good to see some more discussion on how to renew confidence about vaccines within the general public.

Hopefully the ‘let a bunch of children die and they say I told you so’ strategy is not the only effective one available.

Milan February 16, 2009 at 12:54 pm

One other side point on experimental design:

Incidentally, the ‘treatments’ being tested with these methods need not be medical.

The same approach could be used to test the effect of different fertilizers on plants, or the effect of different forms of teaching language to children.

The methods are intended to isolate and test variables of whatever kind.

Sasha February 16, 2009 at 1:37 pm

This discussion continues to focus on a certain ideological approach to medicine; namely, that surgeries and prescriptions are what constitute medicine. Anything else seems to be being written off as a placebo. While homeopathics and accupuncture may lack evidence, there are certainly “medical” approaches not included in that scope that can easily be proven. Anyone, for example, who denies that a person’s diet cannot affect their health isn’t paying enough attention to what they eat, and similar sentiments apply to exercise. “My case” was no statistical anomaly of alternative medicine working, but rather a success of the most proven, whole-person-oriented “medicine” we have – healthyliving. “Alternative” practitioners of the varieties I mentioned can help people look past symptoms to their overall health, and by improving overall health, improve also the body’s own ability to respond when all is not well. Alternative therapies that offer instant cures for symptoms are phooey. Alternative approaches to medicine that promote overall health and well-being, however, can definitely be useful. In fact, I would argue that type of preventative health care is what we should focus on, both to reduce costs of health care and to reduce societal dependence on dubious pharmaceuticals that mightn’t be needed if the body were healthier to begin with.

Milan February 16, 2009 at 1:47 pm


As I said above: “The distinction I am drawing is between evidence-based medicine (of any kind), and treatments that cannot produce statistics to back up their efficacy. That is quite different from a distinction between ‘Western’ and ‘Eastern’ medicine, or between ‘Modern’ and ‘Traditional’ medicine.”

If ‘alternative’ therapies have therapeutic value, it will show up in clinical trials. There is nothing inherently ideological about investigating the effectiveness of treatments.

Alternative approaches to medicine that promote overall health and well-being, however, can definitely be useful.

I think you are right about this, and I am confident that the value of approaches that focus on overall health could be substantiated through clinical trials. Indeed, I am virtually certain this has already been done for lots of healthy living combinations involving exercise, good diet, etc.

Furthermore, I agree that diet is important (and tonnes of good medical research backs that up) and that preventative medicine pays dividends (a position also supported by much evidence).

Magictofu February 16, 2009 at 1:50 pm

I think what Milan is suggesting is not that we should reject alternative medecine but that we should reject any type of medecine that has been proven to be inneficient or detrimental to health… this includes big pharmaceutical pill giving practices as well as every other types of therapy.

Milan February 16, 2009 at 2:03 pm

The same scrutiny should most definitely be applied to new pharmaceuticals, surgical procedures, and so forth. Some very poor past medical techniques have been eliminated through the intelligent use of statistics. Just look at how Florence Nightingale used statistics to make a compelling case for higher standards of hygiene in hospitals.

A key part of being rigorous is also countering those who have a personal or financial interest in a certain result. To achieve that requires a lot of oversight, replication, and regulatory effort. While there are certainly plenty of examples of cases where appropriate protocols have not been followed, that is an argument for using quantitative methods better, not abandoning them in favour of some kind of holistic alternative that does not produce results which can be replicated and are robust, with expressed levels of uncertainty and listed sources of error.

Magictofu February 16, 2009 at 2:19 pm

There are many cases of diseases or injuries for which do not have access to evidence based treatments. Given the fact that the placebo effect and other psychological aspects of health are not insignificant, is alternative medicine more effective in such cases?

Faced with a patient suffering from an illness for which there is no cure, should a doctor suggest a patient to try homeopathic medecine (or something else) or simply let her go without treatment telling her that there is nothing that could be done?

Is truth about alternative medicine more socially valuable than the psychological benefits we can expect from them particularly when considering how important such psychological aspects can be in the process of healing the body?

Are there other socially acceptable ways a doctor can use of the placebo effect to help a patient?

Milan February 16, 2009 at 2:56 pm

There is a whole chapter in Simon Singh’s book which considers these questions: whether doctors should lie to enhance the placebo effect, whether placebos are valuable because they can offer some hope in hopeless situations, etc.

Singh concludes that the benefits that arise from these behaviours are not sufficient to make up for the transformation of doctors into agents that deceive their patients for their own good. Generally speaking, I agree with him. Giving up on rigour for stronger placebo benefits is not a good trade.

The ethics of placebos are definitely a contentious question, and one that is far from settled. Another good example is how doctors should respond to patients who demand drugs they do not need. As an alternative to disappointing patients (either by refusing the drugs or refuting the patient’s beliefs about why they need them), some have argued that doctors should be able to prescribe placebos. Reputedly, some already use drugs with relatively few side effects for exactly this purpose.

Sarah February 16, 2009 at 2:57 pm

It is a shame that public debates over health are often so ill-informed (e.g. unsubstantiated fears over MMR) because it obscures some interesting issues. Last week I had a discussion with my doctor about whether to change my asthma medication in response to a huge study suggesting that using Serevent improperly leads to increased mortality, and we agreed to leave things be since I know not to use it improperly and have responded less well to alternatives. I then had a discussion with the nurse who conducted my PAP test about whether they would administer and whether I might want an off-label HPV vaccination (off-label because I am a little older than the group it is currently approved for). Both of these touch on interesting questions about the relationship between the safest or most cost-effective treatment for a broadly defined group versus the most appropriate treatment for an individual, as well as about the balance of decision-making between doctor and patient, but it is hard to discuss such issues when the media and many of the public continue to behave like irrational fools over medical evidence. My encounters with medical professionals suggest to me that most of them are absolutely prepared to discuss one’s treatment options and research concerning the risks and benefits of drugs or vaccinations, provided that the patient is willing to inform themselves a little, to ask sensible questions and to listen to the answers.

. February 16, 2009 at 3:26 pm

Edgy mumps ad designed to shock
February 4, 2009

Donovan Vincent

One might say Ontario’s health ministry is showing a lot of balls with its latest awareness campaign about getting a mumps vaccination.

A public service ad posted on YouTube this past weekend depicts a man unzipping his pants and showing his, well, swollen parts to shocked players of his hockey team.

There is no nudity.

The theme is that mumps is back and it can cause more than just your face to swell. Other complications can include painful swelling of the testicles in teenage boys and men, or the ovaries in women and girls, and deafness.

Milan February 16, 2009 at 3:46 pm

If you think all relations are in principle abstractable from the particular content they take up at any moment, then you’d come to this kind of an experimental conclusion.

In the Morton book, I just came across a nice expression of materialism:

“Proteins are, after all, intrinsically sculptural. They are shapes that translate an action into a volume, that give verbs bodies. And they do so in a purer form than any art. The shape of photosystem II doesn’t just represent the process by which light is brought into the service of life. The shape is that process; there is nothing to the process but that shape. Make something that shape – as living creatures have been doing for the best part of three billion years, maybe more – and it will do what it does.

Physicists went looking for the secret of life, for a new starting assumption that would allow biology to be rebuilt as physics had been. Instead, they found that, down among the molecules, there was no secret. Just atoms in shapes. Simple shapes like the double helix; complex ones like photosystem II.”

Morton, Oliver. Eating the Sun. p. 139 (hardcover).

Litty February 16, 2009 at 8:48 pm

You know, your Google ads are chock full of exactly the kind of businesses you are condemning in this post.

That seems to be true for most of your entries on alternative medicine.

. February 17, 2009 at 12:02 pm

Doctors call for weight loss industry regulation

Last Updated: Tuesday, February 17, 2009 | 11:09 AM ET

Many weight loss products like pills, herbs and some private clinics fail to deliver on their promises and governments should be regulating scientifically unproven therapies, obesity doctors say.

North Americans spend $50 billion a year on pills, potions, diets and programs promising nothing short of miraculous weight loss. Many of them are nonsense, according to an editorial in this week’s Canadian Medical Association Journal.

“Before we can truly address the devastating obesity epidemic, we must first stem the centuries-old flow of snake oil,” the editorial authors wrote.

“We call on governments to require formal accreditation of weight-loss providers to ensure quality and to provide consumers with an easily recognizable means of identifying evidence-based services.”

. February 17, 2009 at 5:05 pm

Vitamin Pills: A False Hope?

Published: February 16, 2009

“I’m puzzled why the public in general ignores the results of well-done trials,” said Dr. Eric Klein, national study coordinator for the prostate cancer trial and chairman of the Cleveland Clinic’s Glickman Urological and Kidney Institute. “The public’s belief in the benefits of vitamins and nutrients is not supported by the available scientific data.”

Milan February 22, 2009 at 10:46 pm

Apparently, Bohemian Drive circuits are a placebo.

This might interest those who follow an obscure web comic.

. February 22, 2009 at 11:37 pm
. February 23, 2009 at 6:18 pm

2009: Shaping up to be a really bad year for antivaccinationists

Published by David Gorski

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.

. March 8, 2009 at 2:51 pm

Why you should listen to celebrities

Sure, Ms. McCarthy is something of a celebrity. She’s very pretty, attracting attention, and is actually very funny (yes, I have a sophomoric sense of humor sometimes), so it’s no surprise people might be tempted to listen to her.

But what she says is so mind-numbingly mind numbing.

Vaccines cause autism. She cured her son of autism. Her son is an Indigo child. And so on.

Her latest?

“I love Botox, I absolutely love it,” she said. “I get it minimally, so I can still move my face. But I really do think it’s a savior.”

I see. So injecting kids with scientifically-proven medicine that can save their lives and the lives of countless others is bad because of a fantasy-driven belief that it causes autism, but injecting a lethal pathogen — in fact, the most lethal protein known — into your face to help ease the globally threatening scourge of crow’s feet is just fine and dandy.

. March 15, 2009 at 4:37 pm

measles, mumps, rubella—or autism

Yes, that’s a deliberately provocative headline. I chose it because that’s what the media would like you to think your choices are. You can vaccinate your kids and risk giving them autism, or protect them against a number of dangerous, miserable, and potentially crippling communicable diseases. Does that protection cause autism? Is that really the choice? Or is it a false hypothesis hyped by the media and unsupported by real research? Is the Measles, Mumps and Rubella (MMR) vaccine a commercial conspiracy by pharmaceutical companies to make money, or are vaccines an actual health benefit?

We tend to have a love/hate relationship with science, often forgetting the many great things we owe it, like longer life spans, safe food, sanitation, miracle drugs, and technological wonders like the device on which you’re reading this. As Louis CK pointed out in a video that’s making the rounds, we’re happy to bitch about our airline delays as though it were a day spent in Auschwitz while forgetting the mind boggling fact that we can fly. We’re quick to point out the fact that thalidomide causes horrible birth defects and to ignore its effectiveness as a treatment for myeloma and skin lesions associated with leprosy. And in this case, we’re eager to see a conspiracy of greed behind the rise in autism, instead of remembering that the lives of thousands, if not millions, of children have been saved and improved by vaccines. Even though a special US court has ruled that there is no evidence linking vaccines and autism, that disinformation is still being spread around, maligning a public health initiative that’s really vital.

. March 15, 2009 at 4:40 pm

“Wakefield [source of the original allegations] and his team found some traces of measles virus in the gut of 12 children with autism. That’s the measles virus, not MMR. This lab finding has proved extremely hard for other labs to replicate. Professor John O’Leary of Coombe Women’s Hospital in Ireland, a collaborator of Wakefield’s, seems to have replicated the finding, and might have shown that the virus was from the vaccine, but it turns out maybe not. It’s a very complex technical dispute, because it’s hard to do the laboratory studies to prove if the traces are from a vaccine or infection, and it’s not known what effect measles virus in the gut would have anyway. Either way, these are inconclusive laboratory findings on their own. And that, along with a number of understandably distressed parents, is the sum total of the case against MMR. It proves nothing about causation. It’s all circumstantial: I’m sure you could find 12 children who hate Harry Potter, or have a missing toe, and have measles virus in their gut. That would prove nothing about MMR and hating Harry Potter, or missing toes. And children were starting to talk, or not, at about 18 months, for millennia before MMR was even dreamt of.”

. March 15, 2009 at 4:42 pm

Never mind the facts

Channel Five’s new drama about the link between MMR and autism makes great TV. But it gets the story, and the science, disastrously wrong. How did we get to such a level of confusion and hysteria about this vaccine? Ben Goldacre unravels the real MMR story

Ben Goldacre
The Guardian, Thursday 11 December 2003 11.27 GMT

There’s not a lot you need to know about the link between MMR and autism, except that there’s very little evidence to suggest any link at all. You don’t have to take my word for it, because I’ll describe the science later, and, if you’re interested, give you all the references you need to follow it up. But there is an interesting story here, and that is how a debate on scientific evidence became a question of personalities, and how the standard of reporting, and public understanding of science, has deteriorated to the point where Channel Five feels entitled to broadcast the poisonous and biased drama on the triple vaccine for measles, mumps and rubella you will be treated to – and it is a treat – next Monday.

The only things that the writers of Hear the Silence get wrong, to be fair, are the science and the story. As a drama, it’s moving and convincing. But when you watch it, and you must, make sure you have this paper next to you. Use it as a tick chart for the half-truths, distortions and omissions.

. March 15, 2009 at 4:44 pm
. March 25, 2009 at 5:08 pm

Vaccine refusals spur outbreak fears


Associated Press

March 25, 2009 at 7:20 AM EDT

KIEV, Ukraine — A widespread scare about vaccine side effects in Ukraine has led to a sharp drop in immunizations that could result in disease outbreaks spreading beyond the former Soviet republic, international and local health officials say.

Hundreds of thousands of fearful Ukrainians have refused vaccines for diseases such as diphtheria, mumps, polio, hepatitis B, tuberculosis, whooping cough and others this year, according to official estimates. Authorities have cancelled a UN-backed measles and rubella vaccination campaign funded by U.S. philanthropist Ted Turner, and will have to collect and incinerate nearly nine million unused doses in coming months.

“I never thought I’d see the day where perfectly good vaccines are being destroyed,” said Michael Bociurkiw, a spokesman for UNICEF.

In 2003, imams in northern Nigeria fomented a boycott of polio vaccinations claiming they were a Western plot to make Muslims infertile or infect them with HIV. Authorities in Indonesia are discussing a plan to end childhood immunizations against a number of diseases out of fears that foreign drug companies are using the country as a testing ground. A budding movement of parents getting exemptions from pre-school vaccination laws is seen as partly responsible for a spike in U.S. measles cases.

Experts blame the Ukrainian scare on government mismanagement and irresponsible media coverage of an anti-vaccination campaign launched after the May death of a 17-year-old boy who had received a combined shot for measles and rubella.

Activists including members of the homeopathic and alternative healing industries blamed his death on the vaccination. Ukrainian authorities said they needed to investigate and halted the campaign to revaccinate nine million Ukrainians aged 16-29 for measles — a leading cause of childhood death — and rubella, which can cause serious birth defects.

Milan March 25, 2009 at 5:11 pm

That article about what is happening in Ukraine is frightening and worrisome.

It shows the real damage that is being done as the result of anti-vaccination campaigns.

Given that people in most countries are no longer vaccinated for diseases like polio and smallpox (because they are not around to be contracted), lower rates of vaccination in places where such diseases do exist could lead to worldwide epidemics.

. April 1, 2009 at 10:39 am

California schools’ risks rise as vaccinations drop

A rising number of California parents are choosing to send their children to kindergarten without routine vaccinations, putting hundreds of elementary schools in the state at risk for outbreaks of childhood diseases eradicated in the U.S. years ago.

Exemptions from vaccines — which allow children to enroll in public and private schools without state-mandated shots — have more than doubled since 1997, according to a Times analysis of state data obtained last week.

The rise in unvaccinated children appears to be driven by affluent parents choosing not to immunize. Many do so because they fear the shots could trigger autism, a concern widely discredited in medical research.

. April 1, 2009 at 11:58 am

The Hawthorne Effect
Why parents swear by ineffective treatments for autism.
By Sydney Spiesel

Autism can present in many ways—hence “autism spectrum disorders”—but that range is nothing compared with the diverse techniques that parents use in their attempts to cure, ameliorate, or disrupt the progress of the disease. In the 60-plus years since autism was first described, many methods to treat it have been proposed—one research paper identified 111 recognized treatments or strategies. Studies have found that parents try an average of between 4.3 and seven interventions simultaneously; one family reported using 47 different treatments at one time.

Alas, almost none of these treatments are evidence-based, and some have been clearly demonstrated to be worthless. In dealing with other medical problems, like the common cold, I’ve always annoyed medication-seeking parents by pointing out the obvious: If there is any illness for which 100 treatments are available, you can be sure that none of them works. But with autism, the stakes are much higher.

The problem is this: When it comes to human behavior, almost any (positive) attention or intervention is likely to be somewhat beneficial. Between 1924 and 1932, some industrial psychologists and efficiency experts studied the Western Electric manufacturing plant in Hawthorne, Ill., to determine what interventions might lead to an increase in productivity. Increase the lighting, even a little bit? Definite improvement for a while. Shorten the workday? Definite improvement for a while. Lengthen it? Definite improvement for a while. Dim the lighting? Definite improvement for a while. It looks as if environmental alteration, especially if coupled with increased attention and perhaps expectation, often leads to change in human behavior. It’s called the “Hawthorne effect.”

. April 1, 2009 at 5:43 pm

Treating Autism as if Vaccines Caused It
The theory may be dead, but the treatments live on.
By Arthur Allen
Posted Wednesday, April 1, 2009, at 12:25 PM ET

“The medical records … reflected that Colten did poorly after every round of chelation therapy,” Vowell wrote in her opinion. “The more disturbing question is why chelation was performed at all, in view of the normal levels of mercury found in the hair, blood and urine, its apparent lack of efficacy in treating Colten’s symptoms, and the adverse side effects it apparently caused.”

The answer can be traced, in part, to a Chicago laboratory that performs most of the chemical testing for alternative doctors like Bradstreet who treat autistics. Doctor’s Data Inc., which tests about 100,000 urine samples for toxic metals each year, presents the results in such a way that it almost guarantees a finding of “toxicity” for each child.

According to a recent federal report on complementary medicine, about 72,000 children were chelated in 2007. Most of them were probably seen by doctors loosely allied to an organization called Defeat Autism Now! The doctors, naturopaths, and other practitioners in DAN! frequently order up exhausting regimens of testing for each child in the belief that people with autism are out of whack with nature. They test the children for viruses, bacteria, yeast, immune system elements, and brain antibodies, drawing copious amounts of blood, as well as spinal fluids and biopsy material, before prescribing immune globulins, vitamins, enzymes, and other pills and infusions. The tests and therapies run into the tens of thousands of dollars per child.

. May 6, 2009 at 1:29 pm

Say It Ain’t So, O
Why is Oprah Winfrey promoting vaccine skeptic Jenny McCarthy?
By Arthur Allen
Posted Wednesday, May 6, 2009, at 11:47 AM ET

Chastising a celebrity is an exercise in futility. You feel like a kitten being held by the scruff of its neck, scrabbling wildly in the air without drawing blood. Pointless as this may be, though, I will try to talk some sense into Oprah Winfrey, who has decided to go into business with vaccine skeptic Jenny McCarthy.

There is abundant evidence that vaccines don’t cause autism. More than a dozen studies, as well as trend data from California and other states, show that neither the mercury-containing preservative thimerosal nor the measles-mumps-rubella vaccine causes autism. In March, a federal court dismissed both of these theories in a most definitive way after hearing weeks of testimony and gathering thousands of pages of evidence.

Jenny McCarthy begs to differ. McCarthy dropped out of nursing school in 1993 to become a Playboy bunny and later starred in an MTV show that focused on her bodily functions. She believes that vaccines made her 7-year-old son autistic—and that she “recovered” him with alternative therapies, as she details in her parenting books. McCarthy has appeared regularly on Larry King Live and Oprah to blast the medical establishment, and last year she led a march on Washington to demand that children get fewer vaccines.

. May 6, 2009 at 1:29 pm

“Her boyfriend, actor Jim Carrey, is even more clueless. At the rally last year, I asked Carrey to give an example of a childhood vaccine we could dispense with. Tetanus, he said. That answer did not reflect a strong—or any, really—grasp of infectious diseases. Children who get tetanus—fortunately, it has been extremely rare in the United States since tetanus vaccination began in the 1920s—suffer horrendous pain, arch their backs, and go into terrible spasms before dying. It’s a very natural disease, to be sure, because the germ causing tetanus lives in dirt. It’s a germ that will be with us forever, and the only way to prevent it is through vaccination.”

. May 18, 2009 at 8:50 pm

Dear Oprah,

I have to confess, I have never watched more than a few minutes of your show. Probably not the best way to start a letter to you, but I want to be honest. And the truth is, I think you’re making a terrible mistake.

Last weekend, I spent more time listening to and watching you than in the rest of my life combined. My family and I were sitting in the Duke stadium, looking down on the thousands of giddy graduates (including my older brother), the esteemed faculty in their rainbow regalia, and the charming, if a bit over the top, fake castle festooned with flags representing the different academic schools. I had no idea you were the commencement speaker until the student speaker, Robert Paul Jones, pretended to get a cell phone call from Parking & Transportation services about your limo double-parked in front of the chapel.

Having only seen you in short commercial clips and on the cover of your magazine, I wasn’t sure what to expect from your speech. I was pleasantly surprised. You were warm and funny, your voice clear and yet dressed with feeling, and I am sure you meant every word. Over the course of those 20 or 30 minutes, I developed a great respect for you as a talented speaker.

But I couldn’t leave the stadium wholly inspired by you, as I’m sure many others did. To me, it is clear that a significant number of people look up to you, and trust your advice and judgment. That is why it is such a huge mistake for you to endorse Jenny McCarthy with her own show on your network.

Surely you must realize that McCarthy is neither a medical professional nor a scientist. And yet she acts as a spokesperson for the anti-vaccination movement, a movement that directly impacts people’s health. Claims that vaccines are unsafe and cause autism have been refuted time after time, but their allure persists in part because of high-profile champions for ignorance like McCarthy. In fact, ten of the thirteen authors of the paper that sparked the modern anti-vaccination movement retracted the explosive conclusions they made due to insufficient evidence. Furthermore, it is now clear that the study’s main author, Andrew Wakefield, falsified data to support these shaky conclusions.

We have come close to eradicating life-threatening and crippling illnesses because of vaccines, but are now struggling to prevent outbreaks because of parents’ philosophical beliefs that vaccines are harmful. Realize this: when someone chooses not to vaccinate their child, they aren’t just putting their own child at risk, they are putting everyone else around them at risk. Diseases with vaccines should normally be of little concern even to unprotected individuals due to herd immunity – with the majority of the population immune, unprotected individuals are less likely to come into contact with the pathogen. Unfortunately, herd immunity disintegrates as fewer people are vaccinated, putting everyone who hasn’t yet been vaccinated at greater risk for infection. Now, the rates of infection by diseases for which we have safe and effective vaccines are climbing, thanks to anti-vaccination activists like Jenny McCarthy.

. May 31, 2009 at 2:23 pm

A Broken Trust: Lessons from the Vaccine–Autism Wars

Researchers long ago rejected the theory that vaccines cause autism, yet many parents don’t believe them. Can scientists bridge the gap between evidence and doubt?

Liza Gross
Senior Science Writer/Editor, PLoS Biology, Public Library of Science, San Francisco, California, United States of America

Until the summer of 2005, Sharon Kaufman had never paid much attention to the shifting theories blaming vaccines for a surge in reported cases of autism. Kaufman, a medical anthropologist at the University of California, San Francisco, knew that the leading health institutions in the United States had reviewed the body of evidence, and that they found no reason to think vaccines had anything to do with autism. But when she read that scientists and public officials who commented on the studies routinely endured malevolent emails, abusive phone calls, and even death threats, she took notice.

“Hecklers were issuing death threats to spokespeople,” Kaufman exclaims, “people who simply related the scientists’ findings.” To a researcher with a keen eye for detecting major cultural shifts, these unsettling events signaled a deeper trend. “What happens when the facts of bioscience are relayed to the public and there is disbelief, lack of trust?” Kaufman wondered. “Where does that lead us?”

Struck by how the idea of a vaccine–autism link continued to gain cultural currency even as science dismissed it, Kaufman took a 26-month hiatus from her life’s work on aging and longevity to investigate the forces fueling this growing divide between scientists and citizens (see Figure 1). She wanted to understand how parents thought about risk and experts, how these attitudes shaped parents’ decisions about vaccination, and what the vaccine wars might teach us about the long-term erosion of public trust in science.

. June 3, 2009 at 2:01 pm

MEASLES: A dangerous illness by ROALD DAHL
Wednesday, April 29, 2009 – LivingwithKids Blog

Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fi ngers and her mind were not working together and she couldn’t do anything. “Are you feeling all right?” I asked her. “I feel all sleepy, ” she said. In an hour, she was unconscious. In twelve hours she was dead. The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her. On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.

. September 22, 2009 at 10:27 am

Autism rates back MMR jab safety

By Michelle Roberts
Health reporter, BBC News

Latest autism figures should dispel any fears about the MMR jab being linked to the condition, say experts.

The NHS Information Centre found one in every hundred adults living in England has autism, which is identical to the rate in children.

If the vaccine was to blame, autism rates among children should be higher because the MMR has only been available since the early 1990s, the centre says.

This is the first time the rate in adults has been evaluated.

Tim Straughan, chief executive of The NHS Information Centre, said: “This landmark report is the first major study into the prevalence of autism spectrum disorders among adults to be carried out anywhere in the world.

“While the sample size was small and any conclusions need to be tempered with caution, the report suggests that, despite popular perceptions, rates of autism are not increasing, with prevalence among adults in line with that among children.

“It also suggests that, among adults, rates of autism remain broadly constant across age groups.

“The findings do not support suggestions of a link between the MMR vaccine and the development of this condition.”

A Department of Health spokesperson said: “There is no credible evidence to support the link between the MMR vaccine and autism.

“MMR vaccine has been used extensively and safely around the world for over 30 years and is the best way of protecting your child against measles, mumps and rubella.”

Concern over the measles, mumps and rubella vaccine was sparked by a paper published in The Lancet in 1998 by Dr Andrew Wakefield.

This research has since been discredited.

. September 28, 2009 at 1:55 pm

Swine Flu Scare Tactics

How anti-vaccine advocates are using the H1N1 shot to scare parents about all vaccines.

Thanks to breathless news coverage of the swine flu, we’ve heard a lot about disaster preparedness: antiviral stockpiles, pandemic flu kits (just $15.95 on Amazon!), and, most significantly, vaccine priority lists. The Center for Disease Control recently announced that the first 3.4 million doses of the H1N1 vaccine will be released shortly.

Anti-immunization advocates are excited about the shot, but not because they think it will save them from the swine flu. They have taken the hysteria surrounding the H1N1 vaccine as an opportunity to spread conspiracy theories about this vaccine and vaccines in general. These anti-vaxers reject scientific evidence about the safety of the H1N1 shot, and they’re scaring already-anxious parents on message boards around the Internet.

At the heart of the anti-vaccination effort is a deep skepticism about the government and the medical establishment. If it’s “official,” it’s suspicious. If it’s “mandatory” (for public school admission, say), it’s fascism. I’m not saying the government or the American Academy of Pediatrics have never made mistakes when it comes to health policy. But I do tend to trust my son’s pediatrician and the Obama administration more than some random bloggers with no medical credentials who insist they alone know the truth.

. October 6, 2009 at 1:22 pm

It is also widely acknowledged that immunisation programmes are a victim of their own success.

In the West, the long absence of many childhood diseases is taken for granted as debilitating and sometimes fatal diseases – including poliomyelitis, diphtheria, whooping cough, measles and meningitis – have either been eliminated or are very rare.

But it is estimated that within the 53 countries of the WHO European region, more than 500,000 do not receive full immunisation and 32,000 die each year from vaccine preventable diseases.

The WHO says access and cost is often the problem, but that there is apathy on the part of health professionals as well as parents who have never seen a case of such diseases.

In some areas of the former Soviet bloc there is also general mistrust of authorities and the services – including immunisation – they provide.

There are also the points at which fear of the vaccine becomes greater than fear of the disease, and no vaccine is without risk.

The young girl who died last week after receiving the vaccine against the virus which causes cervical cancer is now known to have been killed by a malignant tumour in her chest.

But the vaccine will cause a severe, life-threatening reaction in around one in a million, so at some point a young girl may well die.

This however must be juxtaposed against the risks of the disease itself. In 2007, nearly 1,000 women died of cervical cancer.

. October 9, 2009 at 5:10 pm

Autism just as common in adults, so MMR jab is off the hook

Autism affects 1% of the adult population, the same rate as for children, says a large study, which undermines claims that the MMR vaccine is to blame, Tuesday 22 September 2009 14.58 BST

Autism is as common among adults as it is in children, according to the world’s first big study of its prevalence, undermining the theories of those who claim the MMR jab is responsible for the rising toll in recent years.

The survey, carried out by the National Centre for Social Research in collaboration with the University of Leicester, shows that one in 100 adults in England have an autism spectrum disorder, which can range from a serious disability to difficulties in socialising, and includes some people with extraordinary artistic talents.

At 1%, the adult prevalence is the same as that in children. The measles, mumps and rubella combined vaccination was introduced in 1990-91. If the theory first put forward by Dr Andrew Wakefield in 1998 of a link between MMR and autism were correct, there should be a higher incidence of the disorder in children and young people in their early 20s than in older adults, who were never given the jab.

The study was published today by the NHS Information Centre, which commissioned the research as part of the Adult Psychiatric Morbidity Survey in 2007, funded by the Department of Health. Although Wakefield’s theory has been widely discounted by scientists, there remains some public anxiety. MMR vaccination rates have never fully recovered from the scare.

. October 10, 2009 at 3:49 pm

British tabloids endanger lives with bad reporting on cervical cancer vaccine

By Cory Doctorow on health

When a British girl — who had an undiagnosed tumor — died shortly after receiving the HPV (cervical cancer) vaccine, the British tabloids jumped on the story as proof that vaccines are evil and pad and deadly and dangerous. They even quoted respected scientists who agreed with them. Except they misrepreented those scientists’ views, got the science completely wrong, scared people away from potentially life-saving treatment, and failed to adequately own up to their mistakes. Ben Goldacre, the “bad science” columnist for the Guardian, has written a scathing indictment of the way the press handled the story.

. October 15, 2009 at 1:21 pm

Indeed, there’s nothing more universal than fear of shots. “I just think there are people wired that way,” says Gregory Poland of the Mayo Clinic. “They operate on the basis of emotion and anecdote—what they read at the University of Google—rather than a fact-based or data-driven point of view.” In the 19th century, people thought the cowpox vaccine would cause pieces of cow to grow out of their arms. Canadian medical giant William Osler was widely mocked when he urged British troops at the beginning of World War I to get inoculated against typhoid fever. The French government stopped offering vaccinations for hepatitis B in schools in 1998 while it investigated the relationship between shots and multiple sclerosis. (Subsequent studies found no causation.)

. October 21, 2009 at 6:41 pm

A Pox on You
My son has cancer. He can’t go into day care because of unvaccinated children.
By Stephanie Tatel
Posted Tuesday, Oct. 20, 2009, at 12:06 PM ET

Current public opinion about childhood vaccinations sometimes seems to be influenced less by science and more by Jenny McCarthy. But here’s something that rarely gets discussed: the threat posed by nonvaccinated on children who are immunosuppressed. Last year, while searching for child care for our 2-and-a-half-year-old son, my husband and I thought we had we found the perfect arrangement: an experienced home day care provider whose house was an inviting den of toddler industriousness. Under her magical hand, children drifted calmly and happily from the bubble station to the fairy garden to the bunnies and the trucks, an orchestrated preschool utopia. But when I asked: “Are any of the children here unvaccinated?” the hope of my son’s perfect day care experience burnt to a little crisp. As it turned out, one child had a philosophical or religious exemption—a convenient, cover-all exemption that many doctors grant, no questions asked, when a parent requests one. (I still do not understand how the state can allow one to attribute his or her fear of vaccines and their unproven dangers to religion or philosophy. But that’s a question for another day.)

. October 27, 2009 at 9:54 am

Refusing to get vaccinated is selfish
Juliet Guichon and Ian Mitchell

Canadians who decide against having the flu shot should consider the harm that might come to other people and the health-care system

. December 8, 2009 at 3:44 pm

“The United Kingdom has more such outbreaks than any other wealthy country, and that comes as no surprise as Dr. Andrew Wakefield—a key proponent of the theory that additives in vaccines cause autism—started his anti-immunization career in the U.K., in 1998 publishing now thoroughly refuted “evidence” of an autism link. Wakefield is now the subject of a hearing conducted by the U.K.’s General Medical Council for alleged medical misconduct. The discovery that he was secretly funded by personal-injury lawyers that sued vaccine makers has further fueled inquiries. Still, Wakefield’s ideas continue to resonate in the UK, to the dismay of the country’s pediatricians. Today, 20 percent of U.K. children enter primary school without having completed their full schedule of basic vaccinations— 40 percent, in some parts of the country—according to the Department of Health.

. January 28, 2010 at 9:38 am

MMR scare doctor to be given verdict on research

By Nick Triggle
Health reporter, BBC News

The doctor who first suggested the link between MMR vaccinations and autism is to hear whether he is guilty of unethical research practices.

Dr Andrew Wakefield’s 1998 Lancet study prompted one of the biggest health scares for years.

It caused vaccination rates to plummet, resulting in a rise in measles – but the findings have now been discredited.

However, the General Medical Council case has focused on how he carried out his research – which he stands by.

During the two-and-a-half years of hearings – one of the longest in the regulator’s history – Dr Wakefield was accused of dishonesty and poor standards.

. February 2, 2010 at 2:05 pm

Lancet accepts MMR study ‘false’

The medical journal which originally published the discredited research linking autism and MMR has now issued a full retraction of the paper.

The Lancet said it now accepted claims made by the researchers were “false”.

It comes after Dr Andrew Wakefield, the lead researcher in the 1998 paper, was ruled last week to have broken research rules by the General Medical Council.

The publication caused vaccination rates to plummet, resulting in a rise in measles.

The Lancet had already issued a partial retraction.

. March 13, 2010 at 10:47 am

‘Vaccines court’ rejects mercury-autism link in 3 test cases

The finding supports a broad scientific consensus that the mercury-containing preservative thimerosal does not cause autism, and will likely disappoint parents who are convinced otherwise.

Reporting from Washington and Los Angeles

The federal “vaccines court” ruled Friday in three separate cases that the mercury-containing preservative thimerosal does not cause autism, a finding that supports the broad scientific consensus on the matter but that greatly disappointed parents who are convinced that their child’s illness was caused by vaccines.

The court had ruled 13 months ago that a combination of the measles-mumps-rubella vaccine, commonly known as the MMR vaccine, and thimerosal does not cause the disorder, so the new ruling may finally close the bulk of litigation on the matter. The earlier ruling has been appealed to the U.S. Court of Appeals, and this one most likely will be also, but most experts think the court will uphold the decision.

A claim that the MMR vaccine alone causes autism has been withdrawn by parents.

More than 5,300 parents had filed claims with the vaccines court, a branch of the U.S. Court of Federal Claims, seeking damages because they believed their children had developed autism as a result of vaccinations. And they reacted bitterly to Friday’s ruling.

“Find me another industry where the U.S. government defends their product in court and funds the science that exonerates them,” said J.B. Handley, a founder of Generation Rescue in Sherman Oaks and father of a child with autism. “The average citizen has no hope.”

The cases that three judges, called special masters, chose to rule on as test cases were considered among the strongest, so the outlook appears grim for others making the same claim. Each ruled on one case.

. March 13, 2010 at 10:48 am

“Largely because of parental fears, thimerosal was removed from all childhood vaccines by 2001, except for multidose vials of influenza vaccine. Despite that action, the prevalence of autism has continued to grow, and it is now thought to affect as many as one in every 100 children, according to the Centers for Disease Control and Prevention. “

. May 25, 2010 at 10:58 am

MMR doctor struck from register

By Nick Triggle
Health reporter, BBC News

The doctor who first suggested a link between MMR vaccinations and autism is to be struck off the medical register.

The General Medical Council found Dr Andrew Wakefield guilty of serious professional misconduct over the way he carried out his controversial research.

It follows a GMC ruling earlier this year that he had acted unethically.

Dr Wakefield, who is now based in the US, has consistently claimed the allegations are unfair. He now says he will appeal against the verdict.

His 1998 Lancet study caused vaccination rates to plummet, resulting in a rise in measles – but the findings were later discredited.

The GMC ruled in January Dr Wakefield had acted “dishonestly and irresponsibly” in conducting his research, but under its procedures the sanctions are made at a later date.

The case did not investigate whether Dr Wakefield’s findings were right or wrong, instead it focused on the methods of research.

. June 3, 2010 at 10:59 am

Wakefield’s First Try
Before the disgraced doctor Andrew Wakefield said that the MMR vaccine caused autism, he thought that it led to Crohn’s disease.
By Nayanah Siva
Posted Wednesday, June 2, 2010, at 12:32 PM ET

Last week, Andrew Wakefield, the man who is associated with proposing the highly controversial link between the MMR vaccine and autism, was struck off the U.K. medical register—essentially, he lost his license. The author of the infamous 1998 Lancet paper retracted earlier this year by the publication, Wakefield is also known for his inappropriate attempts to prove his hypothesis: At one time, he even bragged about subjecting children at his son’s birthday party to blood tests and paying them 5 pounds a pop. He is also said to have conducted other invasive procedures on children that he wasn’t qualified to perform, without proper ethical approval. The General Medical Council said that he had “callous disregard for the distress and pain the children might suffer.”

Over the last decade, Wakefield has been named a hero by several autism groups and endorsed by former Playboy Playmate Jenny McCarthy. But rather than making him a pariah, last week’s decision seems only to serve as further fuel for him to plug his conspiracy stories as he travels around the United States promoting his new book Callous Disregard. The man is said to be responsible for a sharp reduction in the number of children being inoculated for MMR, allowing the number of measles cases in the United Kingdom to soar to more than 1,300 in 2008, compared with 56 in 1998. It is deeply troubling that Wakefield’s new book rocketed into Amazon’s list of best-selling parenting titles.

. June 9, 2010 at 3:05 pm

Autism caused by wide array of rare gene changes: study

Carolyn Abraham Medical Reporter

Toronto — Globe and Mail Update Published on Wednesday, Jun. 09, 2010 1:08PM EDT Last updated on Wednesday, Jun. 09, 2010 2:33PM EDT

The big hunt for the genes behind autism has hit upon a big, if humbling discovery – for each person who suffers from it there’s a different genetic explanation.

After sifting through the DNA of 1,500 families, a Canadian-led international team has found the roots of autism involve dozens of genes fouled up by long stretches of missing or duplicated pieces. But which genes and which stretches differ from person to person, making diagnosis by DNA no simple matter.

“I highly doubt you will find two families with the same combination of genetic variants,” said study investigator Stephen Scherer, senior scientist at the Hospital for Sick Children in Toronto. It explains why the neurological condition varies so widely in symptoms and severity that autism is considered a “spectrum of disorders,” he said.

. September 13, 2010 at 10:47 am

Family To Receive $1.5M+ In Vaccine-Autism Award

“‘The first court award in a vaccine-autism claim is a big one. CBS News has learned the family of Hannah Poling will receive more than $1.5 million for her life care, lost earnings, and pain and suffering for the first year alone. In addition to the first year, the family will receive more than $500,000 per year to pay for Hannah’s care. Those familiar with the case believe the compensation could easily amount to $20 million over the child’s lifetime. … In acknowledging Hannah’s injuries, the government said vaccines aggravated an unknown mitochondrial disorder Hannah had which didn’t ’cause’ her autism, but ‘resulted’ in it. It’s unknown how many other children have similar undiagnosed mitochondrial disorders. All other autism ‘test cases’ have been defeated at trial. Approximately 4,800 are awaiting disposition in federal vaccine court.’ How did this happen when all the scientific data points otherwise?”

. September 13, 2010 at 11:28 am

“According to the Centers for Disease Control the number of autism cases among 8-year-olds increased 57 percent from 2002 to the 2006,. Looking back over the last 20 years, the rates of autism have gone up 200 percent. Today, 1 in 70 male children has some form of autism spectrum disorder.

When those numbers were released, it seemed absolutely nuts. Parents around the world panicked. Something must be causing autism numbers to rise, right?

Early on, a bullseye was painted around vaccines because symptoms seemed to show up about the same time as kids were getting vaccinated. Once they had a target, a cluster, they failed to see all the other correlations. After years of research and millions of dollars, vaccines have been ruled out, but some parents and celebrities refuse to accept the findings. Singling out vaccines while ignoring the millions of other factors is the same as noting the Titan hit an iceberg but omitting it had sails.”

. December 30, 2010 at 3:46 pm

Explaining autism
Energy drain
The cause of autism may be faulty mitochondria
Dec 2nd 2010 | from PRINT EDITION

AUTISM is a puzzling phenomenon. In its pure form it is an inability to understand the emotional responses of others that is seen in people of otherwise normal—sometimes above normal—intelligence. However, it is often associated with other problems, and can also appear in mild and severe forms. This variability has led many people to think of it as a spectrum of symptoms rather than a single, clear-cut syndrome. And that variability makes it hard to work out what causes it.

There is evidence of genetic influence, but no clear pattern of inheritance. The thought that the underlying cause may be hereditary, though, is one reason for disbelieving the hypothesis, which gained traction a few years ago but is now discredited, that measles vaccinations cause autism.

One suggestion that does pop up from time to time is that the process which leads to autism involves faulty mitochondria. The mitochondria are a cell’s powerpacks. They disassemble sugar molecules and turn the energy thus liberated into a form that biochemical machinery can use. Mitochondrial faults could be caused by broken genes, by environmental effects, or by a combination of the two.

. January 7, 2011 at 12:15 am

On 5 January 2011, the BMJ published the first of a series of articles by Brian Deer, detailing how Wakefield and his colleagues had faked some of the data behind the 1998 Lancet article. By looking at the records and interviewing the parents, Deer found that for all 12 children in the Wakefield study, diagnoses had been tweaked or dates changed to fit the article’s conclusion.

. January 23, 2011 at 4:47 pm

Parents who won’t vaccinate their kids should pay higher insurance premiums

Writing on CNN, pediatrician Rahul K. Parikh suggests that parents who allow the irresponsible lies of publicity-mongers like Jenny McCarthy to scare them into not vaccinating their kids should have to pay higher insurance premiums.

I think this sounds like a good start, but I’d go further: I think that kids should have to show a certificate of vaccination to use public schools — because vaccinations don’t confer resistance on all people, we have to rely on “herd immunity” (that is, a preponderance of people taking vaccination) to keep all of us safe. Here in Hackney, London, we’ve got live measles, whooping cough and other terrible, preventable childhood diseases in the field, thanks to this kind of fearmongering. For those of us with kids who are too young to be vaccinated, it means that other parents’ uninformed fear create a health risk for our families.

. February 13, 2011 at 10:52 pm

“CNN has an interesting interview with Bill Gates who says that unbelievable progress is being made in both inventing new vaccines and making sure they get out to all the children who need them. The improvements could cut the number of children who die every year from about 9 million to half that. But Gates has harsh words for those who engage in anti-vaccine efforts, especially Dr. Andrew Wakefield, who falsified data to ‘prove’ a fraudulent link between vaccines and autism. ‘It’s an absolute lie that has killed thousands of kids,’ says Gates. ‘Because the mothers who heard that lie, many of them didn’t have their kids take either pertussis or measles vaccine, and their children are dead today.'”

. July 14, 2012 at 2:57 pm

Vaccination rates
Herd at risk
A trend away from vaccinating children spells trouble

The case for vaccination is clear. First, it makes the vaccinated individual either immune or resistant to a disease. Second, and more important, it interferes with contagion and thus makes the entire community safer, including those members, like newborn babies or the very sick, who cannot be vaccinated for medical reasons. The vaccination rate for herd immunity varies by disease, but usually falls between 85% and 95%.

The case against vaccination, by contrast, is not clear. One view seems to be that the diseases in question merely give you a rash and are a nuisance, whereas the vaccines will make your child autistic. That particular myth, still peddled on the internet, originated with Andrew Wakefield, a British doctor, who published a paper in 1998 that suggested a link between the common MMR shot (against measles, mumps and rubella) and autism. The paper has since been entirely discredited, and Dr Wakefield censured.

Other parents fret about thimerosal, a preservative that contains trace amounts of mercury. Not only were these amounts minute and safe, but thimerasol has now been eliminated from all vaccines, with the exception of multi-dose flu shots. Often these parental conversations then turn into new-agey free-for-alls, where vaccines somehow join the list of conventionally grown avocados and unfiltered tap water as lethal menaces.

John Talarico, the chief of immunisation in California’s public-health department, says that vaccination rates will probably keep dropping in some demographic groups for a while longer. The root problem is that today’s parents are the first in history with no memory of the maiming and killing caused by polio, tetanus, diphtheria or measles. At some point an epidemic will remind them.

. May 6, 2016 at 5:50 pm

In most countries such refuseniks are only 2-3% of parents. But because they tend to live in clusters, they can be the source of outbreaks. A bigger problem, though, is the growing number of parents who delay vaccination, or pick and choose jabs. Studies from America, Australia and Europe suggest that about a quarter of parents fall into this group, generally because they think that the standard vaccination schedule, which protects against around a dozen diseases, “overloads” children’s immune systems, or that particular vaccines are unsafe. Some believe vaccines interfere with “natural immunity”. Many were shaken by a claim, later debunked, that there was a link between autism and the MMR vaccine, which protects against measles, mumps and rubella.

In America, some poor children miss out on vaccines despite a federal programme to provide the jabs free, since they have no regular relationship with a family doctor. Some outbreaks in eastern Europe have started in communities of Roma (gypsies). Members of this poor and ostracised minority are shunned by health workers and often go unvaccinated.

Several governments are trying to raise vaccination rates by making life harder for parents who do not vaccinate their children. A measles outbreak last year that started with an unvaccinated child visiting Disneyland and spread from there to seven states prompted California to make a full vaccination record a condition of entry to state schools. The previous year, in a quarter of schools too few children had been vaccinated against measles to confer herd immunity. A dozen other states are considering similar bills. After a toddler died from measles last year, Germany recently started to oblige parents who do not wish their children to be vaccinated to discuss the decision with a doctor before they can enroll a child in nursery. Australia’s new “no jabs, no pay” law withdraws child benefits from parents who do not vaccinate, unless they have sound medical reasons.

. October 1, 2018 at 2:32 pm

None of this is a surprise. In the past decade, measles-vaccination rates in some European countries have often fallen below those in parts of Africa. Italy, France and Serbia, for example, have lower child-vaccinations rates than Burundi, Rwanda and Senegal. In some years, vaccine shortages were to blame, especially in parts of eastern Europe. Both Ukraine and Serbia have had irregular supplies of the MMR vaccine (which protects against measles, mumps and rubella) since 2014. Even after recent outbreaks, they were not able to procure enough doses to cover older cohorts, health-workers and other groups at risk of becoming infected.

. July 18, 2019 at 3:02 pm

Across Europe, the rise of populism is damaging public health. A common feature is scepticism of vaccines. Immunisation rates are declining and the diseases they are designed to stop are on the rise. Measles cases are at a 20-year high. In Italy, which used to be a model of good vaccination practice, take-up has fallen since 2005 to a level lower than that of Ghana. Between 2016 and 2017 the number of measles cases rose sixfold, to around 5,000. France, Serbia and Greece have also seen notable spikes, but the trend applies across almost the entire continent.

. July 18, 2019 at 4:29 pm

Paul Offit of the Vaccine Education Centre at the Children’s Hospital of Philadelphia says that the religious exemption to vaccines is, in fact, a “misinformed–parent exemption.” Vaccines were invented long after the main religious texts had been written and no widespread religious doctrine says people cannot be vaccinated, says Dr Offit. Proposals to abolish non-medical exemptions have been introduced in several state legislatures this lawmaking season. But such bills—as well as some that would make it easier to avoid vaccines—are a perennial feature in many states; some never get to a vote. By and large the trend in recent years has been to make non-medical exemptions harder to obtain (by asking parents for more paperwork or to renew the request every year, for example).

California bucked the trend and abolished non-medical exemptions in 2015 in response to a big measles outbreak. Vaccination rates went up, but so did the rate of medical exemptions. It turned out that some doctors were writing bogus ones—and parents would go to great lengths to find them. One child who came down with measles had received an exemption from all vaccines from a doctor’s practice in a town several hundred miles away.

. March 9, 2020 at 3:34 pm

He also campaigns, reminding Americans, lest they forget, how vaccines protect them. As a paediatrician in the 1980s he recalls the horror of diagnosing children with “invasive Hib”, an aggressive strain of meningitis. Recovery was agonising, and parents would be traumatised. Worse, it killed some 1,000 American children a year. Then a Hib vaccine was licensed in 1987 and almost magically, within a few years, it had all but gone. Now barely 40 cases are identified in America each year.

The problem is that people forget, within a generation or two, the illnesses that once stalked them. In America he counts at least 14 vaccines that have eradicated, or nearly, diseases including tetanus, diphtheria, mumps and rubella, polio, hepatitis and smallpox. He points out how, before mass vaccinations in the 1960s, measles sent 50,000 infected children to hospital each year, and typically killed 500 of them.

Yet anti-vaxxers brush aside measles as trivial (though in 2018, around the world, the disease killed over 140,000 people). In the past decade the anti-vax movement has only grown stronger, warns Mr Hotez. Though most American parents still vaccinate their children, pockets of scepticism and vaccine refusal are growing. Misinformed celebrities are stirring up fear—none more than Robert F. Kennedy junior, a charismatic environmental campaigner turned vaccine obsessive. Online, companies profit by seeding doubts about science, then selling homeopathic and “natural” remedies. Firms like Amazon and Facebook meanwhile fail to discourage those who spread lies on their platforms.

Officials, doctors and scientists do push back, hoping to educate parents by sharing worthy statistics on vaccine safety. That has limited impact. Tara Smith, at Kent State University, who studied how to address the spectrum of outright vaccine deniers, the vaccine-hesitant and merely curious “lurkers”, says parents almost never lack facts. Instead they are stirred by emotional anecdotes, especially the most egregious tales of patient harm. Mr Hotez argues for fighting back harder. “We need people to get emotionally involved,” he says. He equates anti-vaxxers to a destructive, religious cult and wants scientists to deliver direct, “declarative”, even confrontational messages against them. Worried parents remember and share stories, not statistics, he says. Mr Hotez, whose own daughter is autistic, has written a memoir explaining that vaccines did not cause the condition, as a large number of parents have come to believe.

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