Monday, September 8, 2014

MMR, the CDC and Brian Hooker: A Guide for Parents and the Media

The anti-vaccine community has been in a tizzy lately over a supposed "CDC whistleblower", Dr. William W. Thompson, who, according to them, revealed fraud at the United States Centers for Disease Control and Prevention (CDC). To bolster their claim, they point to a new study from one of their own, Brian S. Hooker, that purports to show evidence of an increased risk of autism among African American boys who receive their first MMR vaccine late. However, the claims appear to be hollow and unfounded, and so they have chosen to rely on emotional arguments that may sound convincing to those who are not familiar with the issues and people involved. In a truly egregious fashion, they have erroneously and cynically compared this whole thing to the Tuskegee syphilis study, and equated the CDC with Adolf Hitler, Josef Stalin and Pol Pot, combined.

With that in mind, here is a brief FAQ for parents, news media and others to help them understand what the claims are and what the evidence actually says. The questions below have been raised or implied by anti-vaccine activists. Hopefully, this will prevent inaccurate reporting and help parents feel reassured about the MMR vaccine.

Did the CDC commit fraud?

A small group of vocal activists claim that the CDC committed fraud by intentionally covering up data. This group, which blames vaccines for a wide range of problems, offers no evidence in support of this claim. The closest they come is pointing to a statement released by a CDC researcher, William W. Thompson, in which he mentions a scientific disagreement over what data to publish in a 2004 paper on which he was an author ("Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan Atlanta"). The study examined the age of first MMR vaccination and autism but found no association. While one could read into Thompson's statement an implication of wrongdoing, he does not allege any fraud either on his part nor on the part of the rest of the team associated with the 2004 paper. Even though his statement makes no mention of fraud, some people who wish to scare people about vaccines and make others distrust the CDC point to his statement as evidence of fraud.

Did the CDC hide data from the public?

No. The data set used by the CDC in the 2004 paper has always been available to qualified researchers. Instructions on how to access these data are available on the CDC web site.

Did the CDC cover up a finding that the MMR vaccine is linked to autism?

From the facts that are known at this time, the CDC does not appear to have covered up anything. In 2004, the CDC conducted a study examined children with autism (cases) and those who don’t have autism (controls), then looked at the age of MMR vaccination to see if cases were more likely to have been immunized at a certain age than controls. While no clear association was discovered, they did notice that there was an odd finding that more cases than controls were vaccinated later than 24 months of age but before 36 months of age. To see if this apparent association was real, they gathered more information from state birth certificate records for all study subjects that had a Georgia birth certificate. This additional information allowed them to see if there might have been some other factor (e.g., birth weight, parents’ age, mother’s education level, etc.) that might have been responsible for the strange finding. Once the researchers controlled for these additional factors, the anomaly disappeared, meaning that there was no connection between MMR vaccination and autism. The published paper included the results of the birth certificate analysis by race and age at first MMR vaccination, but did not include a racial comparison from the larger group for age at first vaccination, because racial information was not available for all subjects, and that strange finding from the larger group was not reliable. Furthermore, as the subgroup analysis showed, that initial finding was wrong. In response to the noise from the anti-vaccine movement, the CDC released a statement in support of their original study.

Did CDC lie when they said they got more information from birth certificate records?

No. Many anti-vaccine activists, including Brian Hooker, have stated that the birth certificates do not contain the information the CDC researchers stated they obtained from them (birth weight, mother's education, etc.). While the birth certificates that parents receive have limited information, a more complete worksheet (PDF) is completed by the hospital staff and kept on file with the state. The information on the Georgia state birth worksheet is similar to the U.S. Standard Certificate of Live Birth (PDF). These complete birth records have information on birth weight, whether the birth was premature or at term, if the baby was a twin/triplet/etc., the mother's education level, and so on. [Edited to add (9/16/14): Parents' education, for example, has been on the standard birth certificate since 1969 and still on it for the 1989 revised version.] The CDC researchers used these complete birth certificate records in their 2004 study. More information on the standard birth worksheet, including revisions, can be found on the CDC's National Vital Statistics System web site.

Did CDC use the birth certificate requirement to exclude African Americans from the study?

No. An early claim among anti-vaccine activists was that the CDC researchers only required birth certificates for African American children in their study so they could exclude them from the birth certificate subgroup analysis. This, so the claim goes, was so they could hide an association between MMR vaccine and autism among African American boys. But the researchers used birth certificates for all of the children in their study. This is illustrated in Table 2 from the 2004 study (reproduced here for commentary):

Click to enlarge.
From: DeStefano, et al. (2004). "Age at First Measles-Mumps-Rubella
Vaccination in Children With Autism and School-Matched
Control Subjects: A Population-Based Study in Metropolitan Atlanta"
The birth certificate requirement was not used to suppress data on African Americans. This anti-vaccine claim appears to have been made specifically to exploit race and stir up fear and anger in the African American population.

Was the decision to use birth certificates arbitrary and irrelevant?

No. As the authors of the 2004 study note (emphasis added):
Among case and control children whose records we were able to match with Georgia birth certificate files, we performed a subanalysis to evaluate possible confounding by differences in birth and maternal characteristics.
The full study population data showed a possible association between age of first MMR and autism, but the data did not contain information that may have pointed to other causes of that association. The birth records did have that information, and allowed the researchers to discover that the MMR was not associated with autism.

[Edited to Add (7/27/15): Matt Carey at Left Brain Right Brain reported on the analysis plan for the paper. The birth certificate subgroup was part of the approved plan for the study. He also helpfully provides the analysis plan (PDF) for the paper, in which one will find that the supposedly intentionally suppressed data (i.e., analysis by race for the full study population) was not part of the study plan.]

[Edited to Add (1/24/16): According to the documents that Dr. William Thompson turned over to Sen. Bill Posey, the birth certificate analysis was part of the planned protocol from the beginning, well before any data analysis began.] 

Did CDC employees destroy data? [Added 11/6/15]

Doubtful. [See below for an updated.] This claim comes from a quote allegedly from Thompson mentioned by Congressman Bill Posey during a talk he gave during the House's Morning Hour:
At the bottom of Table 7 it also shows that for the non-birth certificate sample, the adjusted race effect statistical significance was huge. All the authors and I met and decided sometime between August and September ’02 not to report any race effects for the paper. Sometime soon after the meeting, we decided to exclude reporting any race effects, the co-authors scheduled a meeting to destroy documents related to the study. The remaining four co-authors all met and brought a big garbage can into the meeting room and reviewed and went through all the hard copy documents that we had thought we should discard and put them in a huge garbage can. However, because I assumed it was illegal and would violate both FOIA and DOJ requests, I kept hard copies of all documents in my office and I retained all associated computer files. I believe we intentionally withheld controversial findings from the final draft of the Pediatrics paper.
The first thing to note is that Thompson does not state that the authors destroyed data. They met to sift through hard copy documents to determine what needed to be retained and what could safely be destroyed. As biologist and autism parent Emily Willingham notes, this is not a smoking gun. With research in general, during the course of the study, there may be duplicate copies created, some paper, some digital. It is neither necessary, nor feasible, to retain every single document created. The U.S. Department of Health and Human Services' Guidelines for Responsible Data Management in Scientific Research states that not all raw data need be retained, so long as enough material remains for the study's findings to be reconstructed. Destruction of unencrypted documents may also be required to protect the privacy of individual subjects in the study.

The other thing to note about the claim that the CDC destroyed data is that it does not hold water. If they had destroyed data, then how did Brian S. Hooker conduct his reanalysis?

[Edited to Add (1/24/16): With the release of the documents that Dr. Thompson turned over to Sen. Posey, we now know that data was not destroyed, as anti-vaccine activists claim. We also know that Sen. Posey (or a staff that drafted the statement he read) cut out a lot of details from the quote. We further know that Thompson was present for the meeting during which the team reviewed hard copies and discussed which items should be retained and which should or could safely be destroyed. The documents that Thompson retained are largely redundant and offer little in the way of added information. The Thompson documents do not contain data that is unavailable in electronic format that the team retained on the Immunization Safety Office servers from the time of the study to today.]

Did William Thompson give 100,000 documents to Sen. Bill Posey? [Added 1/24/16]

No. Some anti-vaccine activists will claim that Dr. Thompson gave 100,000 documents (or alternately 100,000 pages of documents) to Sen. Bill Posey. The claim originated with Ben Swann, a television reporter for CBS46 (WGCL-TV) in Atlanta, GA, and author of the web site Truth in Media. On November 30, 2015, Ben Swann announced in an interview with Age of Autism that he had obtained copies of the documents from Sen. Posey's office. However, he did not disclose any of the documents at that time, instead stating that he was looking over them and that "very soon...you're going to have access to those documents yourselves."

Since the documents had been released to a public figure, and were thus in the public domain, in December 2015 Matt Carey at Left Brain Right Brain and law professor Dorit Reiss also requested and received the documents. Carey made the documents available to anyone who wished to view them. This is something that no one on the anti-vaccine side of things has done. If Brian Hooker and Andrew Wakefield had any of the documents, they did not make them public. Thompson did not make them public. Swann has not made them public, though he has said he will "release a Truth in Media documentary which details a study of CDC cover-up and suppression of medical findings. In addition, Swann will release the Thompson documents at TruthinMedia.com to anyone who wishes to learn more about what’s inside them" on January 26, 2016."

In the end, while there are a lot of redundant pages, certainly numbering in the hundreds or possibly thousands, there are, by no means, 100,000 documents, let alone that many pages.

Are the whistleblower documents available to the public? [Added 1/24/16]

Yes. Anyone who wishes to view the whistleblower documents that had been handed over to Sen. Bill Posey can access them via a dropbox set up by Matt Carey of Left Brain Right Brain. 

Did a more recent study find that there is an increased risk of autism in African American boys?

A study ("Measles-mumps-rubella vaccination timing and autism among young african american boys: a reanalysis of CDC data") published in August 2014 in the journal Translational Neurodegeneration by Brian S. Hooker did conclude that there was an increased risk of autism in African American boys who were given their first MMR vaccine between 24 and 31 months of age (Hooker cut off at 31 months, rather than 36 months as in the CDC study, because, after excluding low birth weight infants, there were "insufficient cases" at 36 months; the subgroup he analyzed is different than in the CDC's study). His study also found that there was no association between MMR and autism at other ages, nor was there any association for African American girls nor for children of any other racial category. However, his results regarding African American boys are almost certainly wrong.

The original 2004 study by the CDC was what is called a case-control study. (A case-control study takes two matched groups, one with a condition and one without, and looks to see how likely or frequently they were exposed to a potential risk factor. It can suggest associations, but usually doesn't prove causation.) The data for that study were collected with the case-control design in mind. Hooker's study appears to be a cohort study, which is a completely different type of study design, yet he used the same CDC data set that was designed for a case-control study. (A cohort study starts with people who do not have the disease of interest, then follows them to see if different levels of exposure to a suspected risk factor increases the risk of the disease or condition of interest.) Using data designed for use in one type of study design in a study with a completely different design can introduce errors into the analysis. Hooker then used an inappropriate statistical analysis (either Pearson's chi-squared test, as mentioned in the Methods, or Fisher's exact test, as noted in the tables) to analyze the data. This type of test ignores variables that can skew results, as well as making a small signal seem very large. Hooker admitted in a presentation at an anti-vaccine conference (around the 17:00 mark) on August 29, 2014 that he used a very simple technique, that "simplicity is elegance", and that he prefers to do simple things rather than intellectually challenging things. However, elegant does not mean correct; his "simple" analysis ignored confounding variables. Another shortcoming of the study is that Hooker does not report the number of individuals included in his subgroup analyses. The size of the groups matters. The smaller the group, the more likely a finding is due to chance. Since publication, the journal has withdrawn Hooker's study due to concerns about the validity of its conclusions as well as possible conflicts of interest that were not disclosed by Hooker or the peer reviewers who reviewed the study. [UPDATE (10/4/14): The journal has fully retracted Brian Hooker's paper due to undeclared conflicts of interest and invalid statistics and methods. See below for more details.]

Who is Brian Hooker?
 
Brian S. Hooker is the father of an autistic child. He has a degree in biochemistry, but has no formal training in statistics or epidemiology, nor is he trained in any field pertinent to the study of vaccines or autism (e.g., immunology, vaccinology, childhood development, developmental psychology, etc.). Hooker has an open case claiming vaccine injury for his son before the Vaccine Court. [UPDATE (6/28/16): Brian Hooker's NVICP claim that vaccines caused or worsened his son's autism was denied on May 19, 2016. An analysis of the ruling can be found here. The full 58-page decision can be read here.] He is also a board member of an anti-vaccine organization called Focus Autism. Focus Autism is the organization that funded Hooker's study. Hooker is also ideologically opposed to vaccines and the CDC, as evidenced by an email he sent to former director of the CDC, Julie Gerberding, in which he wrote, "I would personally urge you to review the Book of Matthew 18:6 and consider your own responsibility to all children of the U.S. including my own son." The referenced Bible passage reads (King James Version):
But whoso shall offend one of these little ones which believe in me, it were better for him that a millstone were hanged about his neck, and that he were drowned in the depth of the sea.
What do you mean by undisclosed "conflicts of interest"?

Authors of scientific articles are supposed to provide a clear statement of any conflicts of interest that might bias their results. The purpose is to make the reader aware of what might influence the author's conclusions regarding the data and findings they are reporting. In his study, Brian Hooker only disclosed that he “has been involved in vaccine/biologic litigation". The statement implies that he is not currently involved in litigation related to vaccines. In reality, Hooker has an active case before the Vaccine Court in which he is suing the government for what he claims is his son's vaccine-induced autism. He stands to benefit from studies that find a connection between vaccines and autism. He also fails to disclose that he is a board member of the anti-vaccine organization Focus Autism, which funded the study.

The journal in which Hooker published his study, Translational Neurodegeneration, allows authors to submit suggestions for possible reviewers. These reviewers ought to be experts in the relevant fields and should not have strong personal or business ties to the study authors. The journal may choose to use the reviewers suggested by the authors, or they might pick researchers who have published papers previously in the same journal on the same or related subject. We do not know who the reviewers were, but there are some likely candidates, none of whom are qualified to act as peer reviewers and have numerous conflicts of interest, including working relationships with Hooker.

Did Hooker's study prove Andrew Wakefield right?

No, it did not. Andrew Wakefield has long advocated the belief that the MMR vaccine causes autism. If we ignore all of the flaws in Hooker's 2014 study and assume that his findings are accurate, Hooker's study shows that the MMR is not associated with autism. In other words, Hooker's study, if it is accurate, proves Andrew Wakefield (and much of the anti-vaccine movement) wrong. The only group in which Hooker found an association (and even that association is not proof of causation) was among African American boys who got the MMR vaccine late (between 24 and 31 months). But, as noted above, Hooker's study was quite flawed and so his findings are very likely incorrect.

Was Hooker's study retracted?

Yes. On October 3, 2014, the journal Translational Neurodegeneration fully retracted Brian Hooker's study, issuing this accompanying statement:
The Editor and Publisher regretfully retract the article [1] as there were undeclared competing interests on the part of the author which compromised the peer review process. Furthermore, post-publication peer review raised concerns about the validity of the methods and statistical analysis, therefore the Editors no longer have confidence in the soundness of the findings. We apologise to all affected parties for the inconvenience caused.
PubMed has also updated their listing for the study, with large red box warnings that the study has been retracted and "RETRACTED" stamped in block print across the face of the study text:

Click to enlarge.

Did Brian Hooker get data from William Thompson or from the CDC? [Added 11/6/15]
According to Brian Hooker's retracted study, he got his data directly from the CDC, not from Dr. Thompson:
Cohort data were obtained directly as a “restricted access data set” from the Centers for Disease Control and Prevention (CDC) via a Data Use Agreement.
Furthermore, the number of subjects in Hooker's study match the numbers reported in the original DeStefano study. Those who claim that the CDC destroyed data showing that African American boys were more likely to suffer autism after receiving the MMR vaccine seem not to have read Hooker's own study. So either they are wrong, or Hooker lied about how he obtained the data and the number of subjects he analyzed.

Why does this matter? [Added 11/12/15]

Despite the lack of substance behind anti-vaccine claims about the MMR vaccine, they do evoke fear. Once fear takes hold, it can be very difficult to overcome, even when presented with facts. That fear leads to vaccine refusal and distrust of the people who try to prevent the spread of disease. This can have a significant negative impact on communities, especially among those who are already unserved or underserved due to poverty or other social or economic factors. The "CDC whistleblower" episode targets the black community. But, this isn't the first time that the anti-vaccine movement has done so.

Author David Kirby had started sowing the seeds of fear among the Somali community in Minneapolis around 2005 as he toured his book Evidence of Harm. Over the following years, other anti-vaccine activists targeted Minnesota Somalis, such as J.B. Handley, who told them to get vaccine exemptions and not to trust the state health officials. The fear sown by Kirby, Handley and others led to a sharp drop in MMR uptake. Then, in 2011, there was a measles outbreak, infecting 21 people (4 adults, 17 children). Two-thirds of those infected were hospitalized.

The Minnesota measles outbreak is a good illustration of what happens when anti-vaccine activists sow fear of vaccines in a community. Just like they did then, they are trying to sow fear of vaccines among black communities now, but on a much grander, nationwide scale. In 2014, the U.S. saw its greatest number of measles cases in over 20 years. We also saw the largest measles outbreak in recent history. As anti-vaccine fear spreads among the black community, creating pockets of low vaccine uptake, we will see hundreds more cases of measles, many of whom will be hospitalized, and potentially some deaths. But that suffering can easily be avoided through immunization.

The Bottom Line

Despite much noise being made by the small, yet incredibly vocal, anti-vaccine community, there is no evidence of fraud on the part of the CDC, nor is there convincing evidence of any cover-up. Brian S. Hooker's study contains a number of flaws leading to a spurious, and biologically implausible, conclusion. In fact, the quality of the study is such that the journal that published it withdrew it pending further investigation, citing serious concerns about the validity and potential conflicts of interest. This entire issue is, in reality, much ado about nothing. It is just another example of anti-vaccine activists doing bad science to put your children at greater risk of harm, all because they cannot accept their own children as they are.
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Further Reading:

Posts discussing Hooker's allegations, excluding anti-vaccine sources

Timeline

Posts discussing Hooker's allegations from anti-vaccine sources

Timeline
Other links

49 comments:

  1. Thank you, this is incredibly valuable.

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    1. That's not quite accurate. I hope I never have to use this tort personally. But I do think that if a parent rejects expert opinion and leaves their children at risk of disease, and someone is harmed by that, the parent should pay for the consequences of their actions to those they injured.

      It's part of personal responsibility.

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    2. The guidelines for parenteral aluminum applies to parenteral nutrition, which is typically given for days to weeks at a time, not one-time acute exposure. So the information you have posted is a misrepresentation and highly misleading.

      Also, there are not 64 vaccines. There are 16, some of which require boosters to ensure protection. Thank you for demonstrating that you are, in fact, anti-vaccine, rather than simply pro-safe vaccine.

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    3. I'm actually interested in breaking the silence that's instilled by places like Age of Autism. See here for more on why I chose this name for my blog. Harpocrates was also the protector of children. That's one of the main drives for me. Perhaps if you actually had facts on your side, you wouldn't feel the need to engage in personal attacks.

      As to Marlboro, guess who figured out that cigarettes caused cancer? The same physicians, medical community and government that you rail against.

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    4. "The HEP-B shot alone is almost 14 TIMES THE AMOUNT OF ALUMINUM THAT IS FDA-APPROVED. "

      Here's a great example. The guy who runs Focus Autism recently discussed online about how he's heard that Cuba has almost no autism. "They must be doing something right" in regards to vaccines, he tells us.

      Well, they not only have the birth dose of Hep-B, they also have a birth dose of BCG.

      Focus Autism is the organization that funded Mr. Hooker to do the study being discussed above.

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    5. Chris' maths aren't correct and comparing IV administration to SQ or IM injection. He should read Keith et al. like the rest of us have.

      Delete
  2. Here we have a nice example of how someone opposed to vaccines misrepresents those who support vaccines.

    1) I base my opinion on the totality of the scientific literature, not on just the CDC. The world is a lot larger than the U.S., with scientists, universities, independent research organizations and governments around the world supporting the safety of vaccines. Against that, we have a handful of individuals putting out highly flawed research.

    2) Please point to where I have called Thompson an "anti-vax crackpot". You won't be able to, because I did not. And as noted in his statement, his position involves this: "Decisions were made regarding which findings to report after the data were collected". In other words, he disagreed with his coauthors about which findings were reported. That is a scientific disagreement. It is not an allegation of fraud.

    3) While I cannot speak for others, I go where the evidence leads, rather than what any one person or group of people says. Contrast this with the anti-vaccine movement, which quickly repeated the Tuskegee, Hitler, Stalin and Pol Pot comparisons, often without even reading Hooker's study, let alone critically evaluating it.

    4) First off, it is Poul Thorsen, not Paul Thorsen. Second, I have written in support of him facing whatever punishment he deserves if he is convicted of the monetary fraud he is alleged to have committed. Third, Dr. Thorsen's misconduct does not invalidate the scientific results of the studies on which he was a minor contributing author. Fourth, as with my first point, there are many other studies besides those with which Thorsen was involved, so even if those two studies were retracted (which they haven't, it should be noted), there is still plenty of scientific literature out there on the safety and efficacy of vaccines. Finally, could you please point me to the most wanted lists on which Thorsen is listed? I checked both the FBI and CIA, and neither of them list him. So, do you have evidence of this, or are you merely parroting what other anti-vaccine web sites have said?

    Finally, if you feel that I unfairly characterize you as anti-vaccine, please show me wrong by stating which vaccines on the current childhood schedule you feel should be given to children at the ages recommended.

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  3. 22 counts of fraud charges is not the same as "on the most wanted list in 22 countries". I will continue to wait for you to either support your claim that he is "on the most wanted list in 22 countries" or you admit you were in error.

    Autism is certainly prevalent (which is the word I think you meant, since "pandemic" makes no sense in context). However, there is no quality evidence that vaccines are associated with it.

    You dodged my question about which vaccines you think should be given to children at the ages recommended. Which vaccines do you think are safe and effective according to the current schedule? You claim that you are for vaccine safety. Very well, what specific safety problems do you see? Are those problems big enough that people should not use the vaccines? Keep in mind the risks of the diseases they prevent when you explain your stance.

    I heard of SV40, yes. Interestingly, it was "Big Pharma" that discovered it, reported it, and worked to fix the problem, in collaboration with FDA. While every effort should be made to ensure no contaminants are in our vaccines, to date there is no evidence that that episode has actually resulted in any harm.

    Dr. Thompson's main concern appears to be a lack of transparency. I agree with him that research and government should be transparent. However, I do not see, based on the evidence currently available, a reason to suspect fraud. Deciding what to publish and what not to publish is not necessarily fraud, as I discussed in one of my other posts on this subject. Unless the study protocol is published somewhere for others to evaluate, and Thompson makes clear what aspect of the protocol was supposedly violated, we cannot make any firm conclusions as to whether it invalidated the study's findings, let alone constituted fraud, as many anti-vaccine activists are claiming. Having served on an IRB, I'm quite aware of the range of things that constitute a protocol violation. Some make no difference, others have a huge impact. Without more data, I certainly cannot conclude that there was fraud; can you? Again, from Thompson's statement: "Reasonable scientists can and do differ in their interpretation of information." That does not sound like he thinks they committed fraud.

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  4. I note you pointed to no actual problem with the Denmark studies, on which Thorsen was just one of several authors.

    Luckily, federal law assured all parents will have at least the opportunity of informed consent, by requiring they be given the Vaccine Information Sheet before administration of each vaccine. You can't force parents to read it, but they have what they need for informed consent for each vacvine on the schedule.

    And no, given the lack of any startling disclosures in Thompson's statement - as explained in the post above - it doesn't cast doubt on anyn CDC studies, let alone any others.

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  5. Excellent article. And written without rhetoric, vile or otherwise

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  6. "Few links for Mr Thorsen, google it, its 22 counts "

    Why google it? Most of us know the story. The fact that he's on the OIG list was I believe first reported by myself. A pro-science autism parent.

    There are a few set answers thrown up as chaff whenever the discussion of autism and vaccines comes up. Thorsen is one. Bernadine Healy's statements are another. Then people start pulling in general "pharmaceutical companies have been caught before, so they must be doing wrong now" topics like Vioxx. And now you have another topic to misrepresent, Mr. Thompson.

    But if you felt your position on Mr. Thompson were strong, you would discuss Mr. Thompson. Not bring in Thorsen.

    If Mr. Thorsen is guilty, and it does look bad for him, he's done a lot more harm than steal $1M. He's broken the trust and given people an angle to attack good research. That could potentially cost much more than $1M to fix.

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  7. 1 in 100,000 34 yrs ago? That would be 1980, after the Camberwell Study in the UK found 20 in 10,000. That study confined itself to the special school population in the county of Middlesex. So it would not include all those in mainstream education who make up the majority of autism cases now we include autism of the Asperger type in the syndrome. Feel free to make up "facts" to suit your argument but do not expect anyone with real data to take you seriously.

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  8. "Why bring in my Thorsen, maybe because he has co authored 21 out of the 25 cdc attempts to debunk the link being discussed."

    Was he involved in the paper Hooker discussed? Nope. But, hey, if it's all about conspiracies, great. That is interesting to many people. Some of us are interested in this topic because we have autistic kids. So, let's work the problem at hand.

    Does the recent news indicate that vaccines cause autism? No. Is there hard evidence of malfeasance vs. a tough scientific decision? No.

    Take a look at the talk Brian Hooker gave in the past few weeks. It's on YouTube. He says a lot about the whistleblower in this one paper. (Hooker backtracks on some of his obvious incorrect statements, like the fact that the birth certificate data requirement was not only applied to African Americans).

    Hooker then talks about the work where Thompson played a senior role--mercury and autism. What does the "whistleblower" say about those studies? Apparently NOTHING. Hooker doesn't say anything. Gee, a whistleblower told him so much, but he has nothing to attack the thimerosal work?

    So, if you want to use this one event to extrapolate wildly into all autism research, go ahead. But the evidence actually is against you.

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  9. "1 in 2 projected for 2025 based on such documented existing historical proportion"

    Well, only a few years ago the autism prevalence in Korea was something like 1 in 10,000. Then people published 1 in 38. That was in 2011.

    If we can just draw lines through datapoints and extrapolate, ignoring common sense, the autism prevalence in Korea should be >100% by now.

    What was the autism prevalence in 1980--using the same methods and the same understanding of what autism is as is used today?

    Answer--you can't tell me. Well, you can, but you would be making something up.

    How much of the increase in autism prevalence in the past few decades has been due to social factors, not a secular increase in autism prevalence? *At least* 40%. How much has been shown to be a possible "true" increase? About 10%. Extrapolating from that, we get about 80% of the increase is socially driven (changes in what constitutes an autism diagnoses, better identification, awareness, etc.) and 20% is "real".

    That 10% "real" part? That's due to an increased risk of autism from older parents. Like Down Syndrome has an increased risk with older parents. People in the US are having kids later and, thus it is calculated and argued, there are more autistic kids. So, the "real" increase so far is a combination of social changes and probably genetics.

    Want the citations? If so, why are you making the claims you are without already having read them?

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  10. "no matter how much the collective is willing to sacrifice for the greater good."

    Do you know the irony of that statement?

    Thompson didn't want to be made public. His identity was released by people who felt it was for the greater good. It's a good way for them to justify betrayal of trust.

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  11. Has Chris Scherrer said anything yet that indicates he actually read the article above? He seems to have jumped straight into the canned talking points of those who want to scare people about vaccines.

    There's discussion--give and take--and there's knee jerk responses. I'm seeing the latter.

    Just my observation.

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  12. This is very interesting and very thorough.

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  13. Anyone interested in this issue for any reason needs to read this article. I hope some of them do; it couldn't be more clearly explained.

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  14. Let’s make a deal. If you’re right about vaccines doing no harm despite tens of thousands of parents that have witnessed immediate regression in their children within days and sometimes hours of the jab, the anti-vax community will disperse and move on.

    If you’re wrong, we (the federal government & CDC) can disband the federal vaccine injury court and they can retroactively bill YOU for the $2.7 billion in vaccination injury settlements they’ve already made to parents and all future claims from the parents you’ve misled will be billed directly to you. Deal?

    Please supply your mailing address if you agree.

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    1. A couple things wrong with your proposal. First off, it's silly and absurd on its face, since it would not be in any way legally binding, since neither of us can make any commitment on behalf of the federal government or its agencies. That aside, let's take a look at the rest of it.

      1) Please point out where I say anything about "vaccines doing no harm". You will not be able to do so, since I never said that.
      2) I doubt that you speak for the entirety of the anti-vax community. Given the track record of their integrity, or lack thereof, I don't expect anyone in the movement to honor your proposal. For starters, it would require a legally binding contract signed by every person currently in the anti-vaccine community, as well as every person who joins before whatever evidence you will accept becomes available.
      3) Even if vaccines cause all of the harm that you presumably ascribe to them, that is not grounds to disband the VICP. In fact, it would argue for keeping the program.
      4) You would not be able to legally bill me for any injuries claimed to be caused by vaccines.
      5) I'm not about to give out my mailing address because, quite frankly, I don't relish the idea of anti-vaccine activists harassing me at home or (for the more violently inclined) doing me harm.

      Resolve all of those issues, then maybe we can talk.

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    2. Childish challenges are not support for your case; they show you have none. Nor are your points in any way valid. I think Todd covered most of this, but I'd like to reiterate and emphasize some.

      A. No serious person says vaccines cause no harm. What we point out – and the evidence shows – is that serious harms from vaccines are very rare. That doesn’t mean that those rare injuries shouldn’t be compensated: they should. Although the NVICP’s lax standards mean that many cases compensated probably were not because of vaccines, some certainly were, and those people deserve the faster, more certain mechanism of a no-fault scheme.

      B. The question whether vaccines cause autism has been asked, and answered, in many studies, time after the time. The anti-vaccine movement has rejected the answers it didn’t like, however well supported. So a promise to disband means nothing: past experience suggests they will never accept error.

      C. Publicly speaking up and explaining what the science says is not an offense, and is not a tort. It wouldn’t be even if you’re wrong. The closest you can get is the tort of negligent misrepresentation that causes physical harm – and for that you’d need to show negligence. It’s much more likely to be shown against the promoters of anti-vaccine misinformation.

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    3. "2.7 billion in vaccination injury settlements they’ve already made to parents..."

      Oh, dear brave "unknown", can you do a small bit of arithmetic, like take a fraction. Let's look at this table of NVICP statistics since 2006. Go to the bottom of the page and take the number that represents the total number of vaccines given, and then go over an find the total number of claims that have been compensated. Take the first number and divide it by the second number.

      Is the result large or small? What does it mean?

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  15. Hi, I was wondering about your statement "Hooker's study appears to be a cohort study, which is a completely different type of study design, yet he used the same CDC data set that was designed for a case-control study." According to Dr. Hooker, he used the SAME data set as the CDC, the SAME methodology as the CDC, he used the SAME computer program as the CDC, and got the SAME results as the CDC, he simply did published all the results. Have you watched his presentation? http://www.youtube.com/watch?v=RiU3I1yUnyM Can you please explain the discrepancy between your statement that he used a different methodology and his statement that he used the same methodology as the CDC?

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    1. @Polymath Mom

      Well, for starters, there is Hooker's study, which states, "In this paper, we present the results of a cohort study using the same data from the Destefano et al. [14] analysis." Other scientists have also noted that his design appears to be a cohort design, rather than a case-control design.

      He did use the same data set; that is not in dispute. However, per his paper, he did not use the same methodology as the CDC. He notes that he used a Pearson's chi-squared test and "a conditional logistic regression design
      similar [emphasis added] to the Destefano et al." He also divided up his subgroups differently, for example, excluding low-birth-weight African American children. Regarding the same software, the DeStefano study doesn't note what software or programming they used, though they mention various models. Hooker just used SAS.

      In evaluating his study, we need to go by what he published, not what he says after the fact. If what he says afterward contradicts what is in his paper, then that calls his study even more into question: what else did he misrepresent in the paper? what else did he leave out?

      As I noted in my post, he did use the same data set as the CDC researchers, but, based on his written report, he does not appear to have used the same methodology or the same software. He does not appear to have analyzed the same subgroups, nor does he appear to have used the same study design. I hope that answers your questions.

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  16. I want children to not get vaccinated and then compare them. Then I want to put the people who made this horrible vaccine to be strapped in The Electric Chair. I want to tell them it wont hurt, they will be ok, its for their own good. I want to flip the switch and see if they can walk away. Knowing that I fried their brain, I will finally feel safe knowing they wont be smart enough to do their job ever again.

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    1. @DidNotVoteForObama

      I'll try to be cordial, even though you are advocating killing people.

      "I want children to not get vaccinated and then compare them."

      That would be unethical. We know that vaccines work and that they are safe compared to the diseases. I recommend that you read my four-post series on a vaccinated vs. unvaccinated study (part 1 can be found here). It goes over the ethics involved in such a study.

      "Then I want to put the people who made this horrible vaccine to be strapped in The Electric Chair. I want to tell them it wont hurt, they will be ok, its for their own good. I want to flip the switch and see if they can walk away. Knowing that I fried their brain, I will finally feel safe knowing they wont be smart enough to do their job ever again."

      You are advocating murdering the people involved in making the MMR. Know what happens to people strapped into an electric chair that is then turned on while the operator walks away? They die. That's very classy of you. It's also an attitude that seems to be fairly common among anti-vaccine activists - wishing harm upon those who either made or promote the use of vaccines.

      Contrast that with my attitude. Although I vehemently disagree with your position, I do not wish any harm upon you or your children. In fact, I sincerely hope that your children to not suffer the diseases that are prevented by vaccines. Although it might educate you and show you that you are wrong, it would be the needless harm and suffering of someone who bears no guilt for your mistaken beliefs.

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    2. "Then I want to put the people who made this horrible vaccine to be strapped in The Electric Chair."

      The MMR vaccine was introduced in 1971 in the USA. If it caused autism in children it would have been noticed during the 1970s and 1980s, because the USA is much larger than the UK, and had been used for two decades before Wakefield realized it existed.

      What documentation do you have dated before 1990 that autism rose in the USA during the 1970s/80s coincident to the use of the MMR vaccine? Providing that to us would be much more productive than advocating murder.

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  17. Thank you. Very useful, clear and detailed explainer for.those who have only seen the hash tag from afar and do not, anyway, feel the need to read fear mongering, confusing and false "background info" from all the wrong, and highly self-interested people.

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  18. I have read through this post with interest. Wanted to make some comment in general. As a layman I am outside of scientific models you are obviously intellectually versed in and in some ways constrained by. I cannot help but be aware, even suspicious of your emotional emptiness when talking about the possibility of side effects to vaccinations. The tit for tat almost seems like a pissing contest at times.

    There is corruption within the medical and pharmaceutical industry that is a certainty. After all it is big business. I guess I just feel disappointed with the obvious greater shift towards the corporate agenda in recent years.

    Pro vaxers, anti vaxers, I like to believe at their hearts the common thread is they are pushing for what they believe is safest for our children. My thoughts are there is a link. too higher risk at too young an age. I've read a lot of info so I'm informed but ultimately I go with my gut feeling. I know that doesn't really count in the science model. It's how I like to live.

    Here's a link to an ad. It simply highlights how every generation of infallible smart people can be so unforgivably wrong at times.

    http://youtu.be/D-y_N4u0uRQts

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    1. Keith,

      Thank you for your comment. I am a layman like yourself. I am not a scientist or physician, though I have endeavored to learn from those who are well-versed in both. When I write about these topics, I try to keep emotion out of it, because I know how easily emotion misleads us. When we talk about risks and benefits, we need to look at what the facts say, not what we want them to say.

      There is certainly some level of corruption in the medical/pharma industries. But, it is not a certainty that it affects every medical or pharmaceutical endeavor. By the same token, there is corruption in the alt-med/anti-vaccine communities, but it is not a given that it is at work in everything they say or do. What we need to do is weigh what is claimed against the evidence.

      I agree with you that, in large part, many people on both sides of the issue are trying to do what they believe is best for kids. The difference, I think, lies in which side has evidence on their side to support those beliefs. When it comes to something like vaccination, those beliefs have an immediate impact on more than just the individual getting or refusing the vaccine. If it were a matter of, say, choosing whether or not to undergo chemotherapy for cancer, that's a personal decision and doesn't affect the health of anyone other than the patient. With vaccines, the patient's decision is the difference between whether they become another opportunity for a disease to spread, or if they become another shield protecting those who cannot be immunized or for whom the vaccine fails. So when you choose to go with your gut and live your life accordingly, bear in mind that you are not making a decision for yourself alone, but also for everyone with whom you (or your children) come into contact.

      As to your ad, you are forgetting a very important piece of the picture. While many doctors were, sadly, supportive of smoking back in the 1940s and 1950s, not all were. Moreover, the scientific community suspected the risks of smoking and published evidence that it was, contrary to tobacco company ads, bad for your health. By the time that commercial aired, it was already established in the scientific community that smoking was strongly associated with lung cancer and other negative health effects. It was also known that tobacco smoke contained carcinogenic substances, a fact acknowledged by tobacco companies. The tobacco companies put lots of money into advertising and kickbacks to doctors to convince the public that smoking was okay. They, the doctors who spoke for them, and the public at large ignored the scientific community and the evidence they presented about the risks of smoking. In the same way, anti-vaccine activists and alternative medicine hucksters today ignore the scientific community and the evidence that there is no causal association between vaccines and autism.

      I'll just close with this: no one is infallible, nor do I claim that anyone is. We are all human. We all make mistakes. But on the topic of vaccines and autism, the likelihood of one side or the other being wrong depends a great deal on the amount and quality of evidence supporting them. In this case, the body of evidence overwhelmingly supports vaccines as safe, compared to the diseases they prevent.

      Here are some links on the history of smoking risk awareness that you might find interesting:

      Proctor (2012). The history of the discovery of the cigarette-lung cancer link:evidentiary traditions, corporate denial, global toll. Tobacco Control.
      Doll (1998). Uncovering the effects of smoking: historical perspective. Statistical Methods in Medical Research.
      Gardner and Brandt (2006). "The Doctors' Choice is America's Choice" The Physician in US Cigarette Advertisements, 1930-1953. American Journal of Public Health.

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  19. You neglect to mention one truly crucial detail, William Thompson, the CDC whistleblower behind this story, did in fact release a public statement. He publicly acknowledged that he and his CDC co-authors on the study arrived at the same conclusion as Brian Hooker when they analyzed the data. He regretfully admits that they made a conscious decision to omit the data that showed the link between the MMR vaccine and autism-like symptoms in a subset of the population. Regardless of what you think of Dr. Hooker and his methodology, you just can't get around Dr. Thompson's admission. If you're really so interested in the truth, well, I'm not sure why you wouldn't mention this...http://www.morganverkamp.com/august-27-2014-press-release-statement-of-william-w-thompson-ph-d-regarding-the-2004-article-examining-the-possibility-of-a-relationship-between-mmr-vaccine-and-autism/

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    1. Judging by your comment, I suspect that you did not even read the original post, where I note only talked about Thompson's statement, but also included links to it. Perhaps you should go back and read the post again.

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  20. This comment has been removed by the author.

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  21. Re your claim that Brian Hooker's study has flaws leading to a "spurious, and biologically implausible" conclusion.

    Recent research shows that there is a genetic difference in the response to vaccines, and that people of African descent have a much stronger response to rubella that Europeans. (http://www.ncbi.nlm.nih.gov/pubmed/24530932) Thus it is in fact highly likely that people of different genetic backgrounds will respond differently to MMR.

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    1. Immunity and autism are not the same.

      Hooker's errors have to do with mucked statistics on a tiny sample size, Besides the children in that specific group most likely had a diagnosis before the MMR vaccine, which they received in order to attend special ed. preschool.

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  22. The author suggests Hooker has no relevant academic training or relevant experience in research methods and statistics. Why did the author fail to mention Hooker's Master's and PhD degrees in biochemical engineering? Someone with these degrees surely has both education and experience in statistics and research methodology. Seems this is simply an attempt to discredit the man, not the data.

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    1. He has no medical research/biostatistics experience. His research was in plants, not animals. Also, he botched the statistics badly, which is discussed in several of the links.

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    2. And the writers of the article have none of that experience either. They don't even have the research in plants and animals that you mention. So if Hooker is unbelievable since he doesn't have the 'proper' degree/experience then I guess that says the same for the writers of this article, right?

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    3. Dear Ms. Dennis, the words that are in blue text are links to other websites. Many of them are by people who do statistics for a living, and discuss the very botched work done by Hooker. His lack of statistical skill is just one facet of the mess he made of the data.

      The other being that he failed to declare a conflict of interest.

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  23. I cannot believe that there still is a question of a link between Vaccines and Autism. Whether one can 'prove' it or not at this given point in time, if you have or know anyone who has a child with autism, and they were perfectly normally developed kids and then all of a sudden after their vaccines regress into incredible physical and psychological disabilities, you KNOW it's the truth. The fact that the CDC has never to date conducted a Vaxxed vs Unvaxxed study ? Deplorable and that should spell it all out right there that they are hiding something huge. Big Pharma isn't behind this coverup ? then why are they opposed to splitting up the vaccines into M, M and R ?? Because that would open the market to competitors and Mercx has the vaccine market sewn up with their MMR vaccine. I don't have children, but I do have a cousin and a dear childhood friend with children with autism and I saw with my own eyes what happened to them after vaccines. I also volunteer at a riding therapy program and many of the children we work with have autism and I speak to their parents. Speak to the parents of children with autism and you'll know the truth. The tide is changing, people are becoming aware.
    Everyone should go see Vaxxedthemovie

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    1. "The fact that the CDC has never to date conducted a Vaxxed vs Unvaxxed study ?"

      Actually they have, along with public health agencies in other countries. Now if you don't like how they were done, then do it yourself. Design your perfect study making sure it conforms to the Belmont Report, have it approved by an IRB, then write a funding grant to send to SafeMinds, the Dwoskin Family Foundation, Autism Trust, Generation Rescue, etc. Then get it done.

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  24. The experience needed is a matter of context. Hooker claimed to write a paper on vaccines, an epidemiological paper. He has no relevant experience or expertise for that.

    This post isn't in those fields or in medicine. It describes a conspiracy theory. You don't need medical or scientific background for that.

    But our host values accuracy, and since he said so multiple times, I'm sure that if you point to any real errors he will correct them.

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