Trust me, I’m a scientist

So John, I think we agree. You have dissected this study and reveal
it has insufficient power, and no confidence intervals. Inevitably
therefore it cannot reject the null hypothesis and ought to be declared
'flawed' for the purposes it was being quoted. It is simply too small a
study, and falls far short of a "robust National Register".

This study was selected and quoted by the NHS Information Service.
No comment was made about study methodology or power ( but you will notice
that the NHS MMR information site makes comments about inadequate
methodolgy against those studies showing possible harms... )

I said in my "Close to agreement":-

"I do agree the need for some very robust data on the incidence of
Autism. A closely-defined National Autism Register being a major
objective.....Is [there] a real increase ( implicating a new environmental
cause), or merely an increased awareness ( detection bias)? A robust
historical incidence register, with cross-referencing capability to
vaccination status ) would go a long way toward exonerating or implicating
particular vaccines, such as MMR. An NHS-constructed postal survey of
parents , and specialist registers would be a good start. The NHS already
holds a robust vaccination register. And a close 10-year tracking follow-
up of the non-randomised UK national study of MMR-accepters versus MMR-
refusers would be well worth publication"

I would like to close this discussion by agreeing with you that we
REALLY DO NEED BETTER SCIENCE if we are to deserve people's trust.. We
need to get on and do that work.

Competing interests:
I am paid as an NHS GP if proportions of children ( regardless of parental consent ) vaccinated meet targets

In ‘The Dawn of McScience’, the third chapter of his book ‘MMR:
Science and Fiction’, Dr Richard Horton wrote,

“Science has long been ripe for industrial colonization. The
traditional norms of disinterested inquiry and free expression of opinion
have been given up in order to harvest new and much-needed revenues.
Universities have reinvented themselves as corporations. Scientists are
coming to accept, and in many ways enjoy, their enhanced status as
entrepreneurs. But these subtle yet insidious changes to the rules of
engagement between science and commerce are causing incalculable injury to
society, as well as to science.”

Bravo Dr Horton!

And in the same chapter he references the words of journalist George
Monbiot who wrote, [1]

"The scientific establishment is rotten from top to bottom, riddled
with conflicts far graver than Dr Wakefield's. Such is the state of
science today that if, for example, there has been a genuine rise in the
incidence of autism, and if that rise is linked to an environmental
pollutant or the side-effects of a valuable drug, it's hard to see how we
would ever find out."

And in the last paragraph of that article, Monbiot says,

"So, given that undisclosed conflicts of interest in science are
everywhere, why is it only Dr Wakefield whose bloody remains are being
dragged through the streets? The obvious answer is that his alleged
cooption works against the interests of the drugs companies, while almost
everyone else's works in their favour. Why? Because in science, as in all
fields of human endeavour, you get what you pay for."

I am left wondering what GMC registered doctors think they are
getting for their money ... apart, from the vile spectacle of a bloodied
body "with the label "cheat" hung round its neck" ... being dragged
through the streets of London.

[1] George Monbiot. The corporate stooges who nobble serious science.
The MMR scandal shows a business riddled with conflicts of interest. 24
February 2004.
http://www.guardian.co.uk/education/2004/feb/24/highereducation.uk

Competing interests:
None declared

John makes many good points, and obviously does not have a closed
mind on causality, nor the urgent need for good research into autism and
vaccine safety. And I thank David for his helpful and conciliatory points
of agreement.

As the Rapid responders state, a conviction that MMR is safe has not
actually been tested by the appropriate science - a blinded prospective
RCT. Instead we are forced to cast about retrospectively looking for
second-best survey evidence, which for what it is worth shows no good
reason for alarm. It hasn't persuaded doubting parents, and in part we
are all to blame ( whether by accidentally poor communication,
authoritatrian or ridculing approaches, or flat-earthist mentalities ). So
it is highly relevant to public trust in science and doctors, that Flu-
vaccine continues to be robustly tested by blinded RCT, otherwise next
month there will be all-hell to pay !! We used to think HRT was safe,
until the RCT was done. We used to advocate Aspirin widely for primary
prevention, until the rigorous analysis of the RCTs this year !! And
I've lost count of how many drugs have been withdrawn in my lifetime as
evidence of harm emerged !!

I do agree the need for some very robust data on the incidence of
Autism. A closely-defined National Autism Register being a major
objective. In yesterday’s Daily Telegraph ( it was lying in my hotel
lobby ) reported a NHS Information Centre released study on 4000
households, reported to show no difference between autism rates between
adults and children, suggesting therefore that there has been no
discernible increase over a generation. Yet so much anecdote and
experience tells us that autism is on the increase… Is this a real
increase ( implicating a new environmental cause), or merely an increased
awareness ( detection bias) ? A robust historical incidence register,
with cross-referencing capability to vaccination status ) would go a long
way toward exonerating or implicating particular vaccines, such as MMR.
An NHS-constructed postal survey of parents , and specialist registers
would be a good start. The NHS already holds a robust vaccination
register. And a close 10-year tracking follow-up of the non-randomised
UK national study of MMR-accepters versus MMR-refusers would be well worth
publication. Perhaps I missed it ?

Time, gentleman, please .. to pursue the research ?

Competing interests:
I am paid by the NHS to vaccinate people.

Sam Lewis

I'd go along happily with the "MMR debacle". The word "hoax" perhaps isn't ideal, but of course I was quoting Goldacre's excellent account of the debacle.

I agree too that anything that causes mistrust must be addressed. And of course the innocent mum who has been misled by some air-headed celebrity should no be ridiculed (though perhaps the celebrity should be).

Of course you are right that "Measles, Mumps and Rubella damage too many children, and too many reasonable parents do not trust us." And of course one must "perform the appropriate science". I do think though, despite the implausibility of Wakefield's work even at the time, it was taken seriously and the necessary work was done (short of RCTs which. I'd imagine, would be impossible to arrange).

Most of the people who have commented are against all sorts of vaccination and they endanger their children and other people's children. Noel Bell Thomas tries to divert attention from this by restricting himself to swine flu, but of course that isn't a big danger (at the moment). Measles, mumps, mubella, polio and diphtheria are.

Competing interests:
None declared