'Evidence-Based' Medicine: A Coin's Flip Worth of Certainty

[Mirzam]

I think this is a brilliant article, it has so many interesting quotes that I would love to include, but alas, I would break the board's copyright rules, so go read it!

What if 90% of the peer-reviewed clinical research, the holy grail of the conventional medical system, is exaggerated, or worse, completely false?

http://www.greenmedinfo.com/blog/evidence-based-medicine-coins-flip-worth-certainty

[prosciencemum]

Right. This is why science/evidence based medicine works on a body of work (ie. multiple independent studies) instead of just single results. Definitely important that all of us interesting in researching vaccine decisions remember this. :) 

However I disagree with the interpretation of the author that this means that all science/evidence from the mainstream should be tossed out. It just means the consensus is more important that single deviant studies.

[kathymuggle]

Originally Posted by prosciencemum 

Right. This is why science/evidence based medicine works on a body of work (ie. multiple independent studies) instead of just single results. Definitely important that all of us interesting in researching vaccine decisions remember this. :) 

Most people do make their decisions on a body of evidence.  While people do look at single results, I doubt anyone uses just single results for their decisions.  People are pattern makers - they look for patterns.  One story (unless it is your own) is unlikely to sway people on a medical decision. 

Single results add up to multiple results…which add up to a body of evidence. 

[kathymuggle]

I really liked the following from article:

"Scientism is the idea that natural science is the most authoritative worldview or aspect of human education, and that it is superior to all other interpretations of life. Furthermore, scientism accepts as real and valid only those things which it can confirm empirically; those things it does not or cannot confirm it is skeptical about, e.g. homeopathy, the existence of the soul, an innate intelligence in the body, or worse, outright denies as unscientific, or "quackery."……...

Also, scientism – this false sense of certainty in knowing -- leads inevitably to medical monotheism: the belief that there is only one true and right way to prevent and treat disease, and that all disbelievers are intrinsically inferior and treated as either uneducated, insane, or as heretics, to be prosecuted to the fullest extent of the law."

I like science (is there anyone on the vax forums who does not like science?).  I have some concerns with scientism (which I regularly see on this forum).  

Here is pbs.org on scientism:

Scientism

Unlike the use of the scientific method as only one mode of reaching knowledge, scientism claims that science alone can render truth about the world and reality. Scientism's single-minded adherence to only the empirical, or testable, makes it a strictly scientifc worldview, in much the same way that a Protestant fundamentalism that rejects science can be seen as a strictly religious worldview. Scientism sees it necessary to do away with most, if not all, metaphysical, philosophical, and religious claims, as the truths they proclaim cannot be apprehended by the scientific method. In essence, scientism sees science as the absolute and only justifiable access to the truth.

Edited by kathymuggle - 11/9/12 at 8:21am

[Rrrrrachel]

People don't make decisions on the basis of a single study, unless that study is done by Andrew Wakefield, I guess.

Ita with proscience, this is why consensus is so important.

[kathymuggle]

Originally Posted by Rrrrrachel 

People don't make decisions on the basis of a single study, unless that study is done by Andrew Wakefield, I guess.
 

I don't think people did. 

If Wakefield caused a lowering of the vaccine rate, I think it has more to do with the idea that vaccines may be linked to autism resonated with people.

He may have gotten the ball rolling, but that is about it.  

Wakefield's study had 12 people in it, I doubt it caused most people to go "oohh, let's not vaccinate."   It may have caused people to go "let's delay vaccinating until we study this further" - which is a totally legitimate choice.  

Edited by kathymuggle - 11/9/12 at 12:15pm

[Rrrrrachel]

That's not how I remember it.

[kathymuggle]

Do you mean "remember it" or do you mean "interpret it?" 1998 was a while ago - and even then the internet (with information at your fingertips) was not what it is now. In any event - I think if you asked most non-vaxxers how much Wakefield influenced their decision - the answer would be "very little to none."

[midstreammama]

Not that it has anything to do ,necessisarily, which the article..but..

It annoys the heck out of me when people assume that we don't vax just because of the Andrew Wakefield paper. They always counter wiith something to the affect of mmr shot not the cause of autism and how it was disproven. There are plenty of other reasons to not vax.

Ok, back to lurking I go.

[fruitfulmomma]

Yes, please just stop it...I didn't even know who the man was until maybe three years ago and mmr has never been a major concern of ours. 

[Bokonon]

Originally Posted by kathymuggle 

Do you mean "remember it" or do you mean "interpret it?" 1998 was a while ago - and even then the internet (with information at your fingertips) was not what it is now. In any event - I think if you asked most non-vaxxers how much Wakefield influenced their decision - the answer would be "very little to none."

I didn't even hear about the Wakefield study until months after I decided to discontinue vaxxing my kids.  And I've never heard of anyone saying that Wakefield was the reason they didn't vaccinate, or even just didn't allow MMR.  

[MamaMunchkin]

Wakefield has - nothing - to do with my decision either.  TIme for a poll - curious ...

[Rrrrrachel]

I didn't mean to imply anyone was making their decision based solely, or at all, on Wakefield now. Just that I remember a whole lot of people not vaccinating based in it then. As someone already said, the Internet was barely around back in those days, and tere was a huge drop off in mmr uptake after and as a result of that study.

[Mirzam]

It was know long before Wakefield that there were problems with the MMR vaccine.

http://vactruth.com/2012/08/30/government-document-vaccine-unsafe/

Then there was the Pluserix/Immravax/Trivirix (with the Urabe strain mumps vaccine in it) fiasco. The vaccine was know to have caused meningitis in children. It was withdrawn in Canada in 1988 and in the UK 1992. This was well known and caused a decrease in the uptake of the vaccine. Wakefield's research didn't come out until much later, so if it had any effect it was to reinforce the already known dangers of the triple vaccine.

[Rrrrrachel]

That may be partially true, but there was a sharp decline in vaccination rates in the uk in the two years following the study as it got increasing media coverage. I guess neither of us really knows why people chose not to vaccinate, but I have my guess!

[MamaMunchkin]

Originally Posted by Rrrrrachel 

That may be partially true, but there was a sharp decline in vaccination rates in the uk in the two years following the study as it got increasing media coverage. I guess neither of us really knows why people chose not to vaccinate, but I have my guess!

So, the decline was across the board, not just for MMR?  Hm ... I wonder what WHO stats look like ...

[kathymuggle]

www.parliament.uk/briefing-papers/SN02581.pdf

(link is acting weird - you might have to cut and past it into your address bar)

The above was a very interesting read on measles, vaccines and the UK.

There was a drop in MMR vaccines in the UK .  There are two graphs that are interesting - one shows rates of 2 year old getting the MMR and one shows rates among 5 year olds - those who have had one and two shots.  

The rate among 2 year olds did fall (up to 10% at its peak) from the early 1990's, but the rate among 5 year olds did not fall so much (perhaps people were delaying?)

Here is a quote from the article:

"Initially, the findings were largely ignored by the media; however, by 2002 controversy about the safety of MMR had escalated to the point where it was the most heavily discussed science story in the opinion, editorial and letters pages of the UK national press.

Source: Factiva full article searches of ‘MMR’ in UK national papers for each year specified

As media coverage intensified, public perceptions of the MMR vaccine shifted. Opinion polls over the period showed increasing levels of public distrust and confusion over the safety of MMR. The change in attitudes may be reflective of the tone of the news stories during this period, which commonly echoed and elaborated upon the Wakefield link: between January and September 2002, less than a third of news stories about MMR pointed to scientific evidence that it was safe"

It is no real surprise that parents were hesitant about MMR if it was the most common news story and most of the news people heard was that it was not safe.

I do agree it is the body of evidence that matters in making decisions.

I also think it is acceptable to pause in a preventative treatment (which is what vaccines are) to sort out how a story/study/issue relates to the body of evidence.  

[pers]

Originally Posted by Mirzam 

It was know long before Wakefield that there were problems with the MMR vaccine.

http://vactruth.com/2012/08/30/government-document-vaccine-unsafe/

That particular link fails to reveal any problems with the MMR.  See:  http://www.mothering.com/community/t/1361925/uk-foi-documents-on-measles-vax#post_17135669

Quote:

Then there was the Pluserix/Immravax/Trivirix (with the Urabe strain mumps vaccine in it) fiasco. The vaccine was know to have caused meningitis in children. It was withdrawn in Canada in 1988 and in the UK 1992. This was well known and caused a decrease in the uptake of the vaccine. Wakefield's research didn't come out until much later, so if it had any effect it was to reinforce the already known dangers of the triple vaccine.

I was curious as to how much of a role this played so did a google image search for MMR uptake rate graphs, and they don't seem to support this idea.  It was just a quick search, but...

From a BBC news article: 

Numbers from Scotland: 

Basically it appears MMR uptake rates were going up in the UK approaching 1992 when the vax was recalled.  Following that, they floated up and down a little, but mostly were fairly constant until 1998 when they began to drop sharply.  In Scotland they swung back up a little bit in 2000 (this upswing doesn't show up on the graphs for the UK as a whole, it would be interesting to know why it was different), then drops sharply again to reach a low in 2003.  In 2004 Brian Deer's report on Wakefield comes out, and vaccine rates began to rise. 

Not that proves it was all from Wakefield - there could have been other factors at play.  But Wakefield's was front page news in the UK and got a fair amount of international attention.  It's quite likely that many people had never heard of a possibility of a link between the MMR and autism before they saw the headlines.  I don't think many people looked at the study and decided based on it alone not to vaccinate without looking any farther/at anything else, but I do think all the press and attention did a lot to feed concerns and probably was the primary factor behind the drop in vaccination rates. 

[Bokonon]

Originally Posted by pers 

That particular link fails to reveal any problems with the MMR.  See:  http://www.mothering.com/community/t/1361925/uk-foi-documents-on-measles-vax#post_17135669

I was curious as to how much of a role this played so did a google image search for MMR uptake rate graphs, and they don't seem to support this idea.  It was just a quick search, but...

From a BBC news article: 

Numbers from Scotland: 

Basically it appears MMR uptake rates were going up in the UK approaching 1992 when the vax was recalled.  Following that, they floated up and down a little, but mostly were fairly constant until 1998 when they began to drop sharply.  In Scotland they swung back up a little bit in 2000 (this upswing doesn't show up on the graphs for the UK as a whole, it would be interesting to know why it was different), then drops sharply again to reach a low in 2003.  In 2004 Brian Deer's report on Wakefield comes out, and vaccine rates began to rise. 

Not that proves it was all from Wakefield - there could have been other factors at play.  But Wakefield's was front page news in the UK and got a fair amount of international attention.  It's quite likely that many people had never heard of a possibility of a link between the MMR and autism before they saw the headlines.  I don't think many people looked at the study and decided based on it alone not to vaccinate without looking any farther/at anything else, but I do think all the press and attention did a lot to feed concerns and probably was the primary factor behind the drop in vaccination rates. 

Isn't it possible that some pediatricians were concerned and cautioned their patients?

[pers]

Originally Posted by Bokonon 

Isn't it possible that some pediatricians were concerned and cautioned their patients?

Yes, it's possible.  I don't think it would have been common enough to account for the drop, but that's just my assumption, and who knows for sure. 

Even if peds were cautioning the parents of their patients often enough to cause the drop,  wouldn't that still come back to the impact of Wakefield's study as the source?  Why else would peds suddenly start cautioning the parents to cause a drop at the time of Wakefield's paper and then stop cautioning to thus bringing rates back up again around the time of Brian Deers expose  if not as a reaction to Wakefield's paper Brian Deer's outing of him respectively?