Look how studious I am.
Here's my contribution this week. I'll follow Deborah's first three basics, so we shouldn't need to rehash them, but the "what would I do differently" section is a merely a mass of potential problems I wish were addressed by you all, or by the study.
1. There are 3 Questions at hand here:
Do autism/GI kids (25 = 88% regressive autism) have more measles virus rna in their GI tracts than GI neurotypical (13) kids (“the control group”)?
Does MMR timing relate to onset of autism?
Does MMR timing relate to onset of GI issue?
(Answer = No on all counts)
2. Why ask them? Because no one interested in the MMR/MV connection has addressed ASD kids WITH GI issues, they've simply studied ASD kids.
3. The methodology: Case/Control study: not random, retrospective, and not double–blind (ie can’t technically establish a causal relationship). Same critique as the Gen Rescue study.
Finally, my contribution. I'm a social scientist, so I'll leave the final page of the study to science heads who may care how samples were handled. But most of my problems with the study do comes from that perspective as one who is not schooled in measly (snicker) 7-page studies. Oh my. I need MORE. Much, much more. My questions/problems:
1.TESTING: I have no idea if the method for testing for Measles virus RNA is accurate, conducted by the same people, or if medical training alters the results. That it was reviewed by different labs seems to address only part of my concern about MV samples.
2.SAMPLE: Is this a wildly teeny sample size or is this seriously a-ok in the medical sciences? And this is all at the same hospital in the same city or a bunch under the same corporation? What about race, ethnicity, class, religion, etc., rather than just a discussion of "sex"? And 2 sibling pairs aren’t going to alter results? I'm not sure why not when ASDs may have a genetic component and measles is easy to spread in families (3).
3.MMR VACCINE QUESTIONS: All study members had received “at least” 1 MMR. Were they sick at the time? Any other "coincidences" which might be important in such a small sample, like they all got MMR during cold season, or ate vegetarian, or...?
4.AGE OF PARTICIPANTS: Is 5.3 years young to find measles virus in the guts of ASD kids? What did Wakefield find? Does the level or presence change over time? And isn't there a diagnostic issue about kids so young, like that we're excluding a good population of ASD kids?
5.DIAGNOSIS: Diagnosis of autism is always problematic, esp. in 2008 post-asperger's being added. Oy. No discussion about this other than a DSM lovefest? My gawd. Nothing left to say about this one. It angers me. I'm angry!
6.TIMING OF MMR RESEARCH QUESTIONS There's no discussion of how they determined GI problems or autism relative to MMR timing. Doctor’s records? Parent reporting 4 years after the fact? There's some math mumbo jumbo but no real way to get these numbers reliably.
7.THEY DON'T JUSTIFY THEIR STUDY: There's no discussion of how this study’s findings differ so much from previous ones mentioned. What makes this study better than the other?
8.Ditto with time of onset. Why does this study put the issue to rest when others find the opposite? (5)
9.7 year olds are able to provide consent????? Not in the social sciences, so why on earth regarding medical testing? Ew. This is a good way to skew their sample even more so than relying on parent consent, which is already going to create a problematic sample for this study, esp. when working with the sample size they've got.
10. Subjects all recruited at a gastro clinic. What kinds of ASD GI kids go there? Maybe only specific kinds of ASD GI kids would present there, or have docs who work there. Perhaps the majority go to some regular hospital, or maybe parents of ASD kids may feel more comfortable at a hospital that has more experience with ASD rather than just GI issues. Another sample issue.
11.Did they just say they rediagnosed kids for autism? Again, I have huge problems with diagnosing autism in general. It's a major controversy in a billion fields. So to not address it as problematic is a gaping hole in the transparency of their research. They need to justify this. Other than merely finding one single person to re-test sick kindergartners in a hospital setting before their colonoscopy. I'm sure those results were fabulous.
12.OTHER SUSPICIONS: There is a “well-established” method for measuring regression? (6) I disagree on principle. This should have mentioned parents' reports, OTs if applicable, etc.
13. It’s just plain creepy to not use Wakefield’s first name in his first mention in the body of the work. I’m bothered and hence I distrust their results. It's the Chicago Style Manual under my pillow talking.
14. Finally, the study authors speculate that GI ASD is a “different” kind of autism that bears further study. Given their use of the DSM to rediagnose these kids, are they covertly suggesting that ASDs should be removed from the DSM and considered a physical/biological disorder rather than a neurological one? At least the regressing kids with GI issues?
My conclusions: Not much to this that I didn't get from the abstract.