MMR: Science and Fiction. Exploring the Vaccine Crisis; MMR and Autism: What Parents Need to Know
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7473.1049 (Published 28 October 2004) Cite this as: BMJ 2004;329:1049
All rapid responses
I was interested to read in the press today that the GP gaoled for
fraud had been able to earn £70,000.00 a month by giving single injections
rather than MMR. Short terms financial gains of this magnitude are not in
anyone's interest except the GP.
In an earlier eLetter I raised the possibility of staggering
reimbursemnts for operations performed delaying some 50% to further
increments 2, 5 and even 10 years later. How might this system of
reimbursement be successfully applied to physicians and GPs? By rewarding
GPs for reducing the number of times a patient seeks retreatment for any
given condition such as back pan? By adjusting their reimbusements for
detecting cancers for the stage at which the disease is detected? By
rewarding them for detecting vascular diseases before aneurysms are
excessively large and/or before organ dysfunction or damage occurs? What
of vaccines? By rewarding GPs for preventing diseases and deferring
reimbursements for 5, 10 or even 15 years. Deferred reimbursements might
be especially successful in preventing obesity and its sequelae and in
achieving and maintaining weight reducion in the morbidly obese. In
raising the potential for profits from innovations loans could be obtained
and outside investors even attracted without any risk of unacceptable
conflicts of interest.
The beauty about this proposal is that it would not only address
governmental and patient needs it would also address the costs of failed
treatments and GP/physician pensions. In such a system savings would be
effectivly enforced and a GP or physician might even be able to afford
to retire long before a surgeon with a busy private practice. Most
importantly effort and clinical excellence would be rewarded. The system
would not, however, work unless patients had private insurance. The
gaoled GP is highly unlikely to have committed fraud in such a system.
Competing interests:
None declared
Competing interests: No competing interests
The definition of Trolling offered above is incorrect.
An accurate definition is easily found with the most minimal
research.
Heptonstall says: - "
"Dr Donegan's report was based on no independent research, and most of the
published papers cited by her in support of her views turned out to either
support the contrary position or at least to give no support to her
own...".
It does not state "supports the opposite conclusion" - it speaks of
position, not conclusions, which is a situation or circumstance one
arrives at after assessing all facts available (if necessary despite any
conclusions an author may reach)."
For most of us, in a situation where someting is one or the other
thing, contrary is the same as opposite.
Heptonstall is either trolling here, or genuinely has an inability to
understand something quite simple.
Either way, he will be fed no longer by me.
Competing interests:
None declared
Competing interests: No competing interests
I am intrigued by the link between the religious right in the US and
the anti-vaccination movement. I browsed the site Good News Doctor
(www.gnd.org) mentioned in last night's Dispatches programme and I am
genuinely interested in finding out how much of the anti-vaccination
movement is this strange mix of religion and fringe science? I have tried
posting on anti-vaccination websites with no reply so I wonder if Mr Stone
could answer my query?
I had an interesting experience recently of a minister telling me
about a secret cancer cure developed by a Christian doctor, which has
parallels with the Good News Doctor website message.
Competing interests:
None declared
Competing interests: No competing interests
In all fairness I have posted many times on this site to correct
unfounded allegations against Andrew Wakefield, notably above under the
present topic, but also under Joanna Lyall, 'Editor in the Eye of the
Storm': http://bmj.bmjjournals.com/cgi/eletters/328/7438/528. To date no
one has found any grounds to take issue with me on any of the relevant
posts.
It may also be of interest that in response to the new allegations a
website will be opening tomorrow: http://www.mmrthequestions.com. The
immediate brief of the site will be to address the new allegations
although it is hoped that it will broaden its focus in the near future.
Competing interests:
Parent of an autistic child
Competing interests: No competing interests
There will be a programme about the deceptions behind the MMR scare
on Thursday night by Brian Deer, the journalist behind previous
revelations about Andrew Wakefield. (Dispatches, Channel 4, 9pm)
Competing interests:
None declared
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Sir
As must be clear already from my last response to Midgley, I am not
interested in what the judge/s decided, having read the transcripts of the
summaries of case and appeal courts from which my opinions were formed for
my last response to Midgley, I am interested in the evidence Midgley can
provide to support his statement
"if someone holding themselves out as an expert witness says that a
paper supports a conclusion, then the judge does not expect on reading it
to find that it in fact supports the opposite conclusion. This is the
situation the judge remarked on, adversely, and which has resulted in
further investigation".
The only reference Midgley gives, contrary to his submission that 2
out of 3 references 'contain the information I need to decide what the
judge objected to', that might come close to supporting his statement is
36 but that leaves much to be desired...it says that
"Dr Donegan's report was based on no independent research, and most
of the published papers cited by her in support of her views turned out to
either support the contrary position or at least to give no support to her
own...".
It does not state "supports the opposite conclusion" - it speaks of
position, not conclusions, which is a situation or circumstance one
arrives at after assessing all facts available (if necessary despite any
conclusions an author may reach).
Midgley accuses Dr Donegan of stating that a paper supports a
conclusion that it does not. Nowhere can I find that accusation being made
of Dr Donegan by the court in the references Midgley cites.
So I ask again
What evidence does Midgley have that any paper cited by Dr Donegan
"supported a conclusion that the judge, on reading it, found that it in
fact supported the opposite conclusion"?
I can only read into 36 that she reached positions from particular
papers that were not reached by either the authors or the judge/s who read
those papers. She was an expert witness, employed for opinion born of
experience, not a regurgitator of scientific papers which are on their own
notoriously inadequate if one wishes to form an opinion on a complex
subject. Presumably the judge/s did not have sufficient scientific
expertise in those areas, unlike Dr Donegan, to be capable of reading into
those papers anything other than the positions adopted by the authors?
I note that in Andrews et al 2004, the paper on Thimerosal in DTP/DT
recently published, the authors cite several times that there is an
apparent protective effect of thimerosal against certain neurological
problems in children - the authors reached that 'position'. I questioned
them on Pediatrics Journal Rapid Responses on that position, and received
a reply from Andrews saying they do not 'conclude' that thimerosal has a
protective effect against certain neurological problems on children.
Someone less versed in science might accept the 5 references in Andrews et
al to the 'apparent protective effect of thimerosal' as a position which
could be seen as a conclusion - according to the authors it is not.
I note how Midgley 'damns' Dr Donegan with "As to Jayne Donegan, the
judgement (1)is damning, but polite, and that isn't censorship either"
and, together with his assertion (yet to be justified by him with
references and fact) that she said that papers supported conclusions when
they did not. I think a retraction is in order from Midgley.
Regards
John H
Competing interests:
None declared
Competing interests: No competing interests
Hitherto I have been unfamiliar with the term "trolling" but
understand it means "being offensive". I am sure that John Heptonstall did
not mean to be offensive, and I am equally certain that Adrian Midgley
intended to be rude about him (without presenting any arguments which I
can see). I do not think that it is the necessary consequence of what John
was arguing that the judge was lying, only that the judge was mistaken.
Competing interests:
Parent of an autistic child
Competing interests: No competing interests
No you wouldn't.
http://bmj.bmjjournals.com/cgi/eletters/329/7473/1049#83016
Above, and to which something posing as a reply has been posted.
Two of the three references given contain exactly the information you
need to decide what the judge objected to.
Unless you care to state that the judge lied in his summing up?
Its trolling.
Competing interests:
None declared
Competing interests: No competing interests
Sir
I would very much welcome Midgley's explanation, with sufficient
factual evidence, to show how he arrives at the opinion shown by his
statement:-
"If someone holding themselves out as an expert witness says that a
paper supports a conclusion, then the judge does not expect on reading it
to find that it in fact supports the opposite conclusion. This is the
situation the judge remarked on, adversely, and which has resulted in
further investigation".
I am of the opinion that the problems Dr Donegan faced in that court
were far more complex, and my own response alludes to that fact, than
Midgley would have us believe through his oversimplifications.
Regards
John H.
Competing interests:
None declared
Competing interests: No competing interests
Re: Editors choosing is not censorship; junk science
Since Dr. Donegan has now been totally cleared of all charges,
perhaps the label of "junk" could be removed from her science? Just as a
matter of courtesy?
The news blackout on the successful outcome of her case has been
quite interesting...
Competing interests:
None declared
Competing interests: No competing interests