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#1 of 67 Old 04-18-2009, 01:09 AM - Thread Starter
 
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Is the case closed? We have been told scientific consensus supports no association between autism and vaccines. Please take the time to read the studies for yourself and decide for yourself if the case really should be closed.

fourteenstudies.org

Deborah had the idea to do a read along of the studies on the fourteenstudies.org website in this original thread to open discussion and critique of the studies we are being told close the case completely.
Here is a link to the first study we are looking at.

Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study

If you have already posted to the other thread, please contribute here. If you can copy and paste previous intros or commentaries, or reintroduce in your reply that would be great.

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#2 of 67 Old 04-18-2009, 01:44 AM
 
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Thanks so much for taking this on!

Here is my post from the other thread:
Quote:
There are actually 19 studies on the site, so we'll be at this for 5 months if we do one a week. By the end we should know a lot about reading and analyzing journal articles.

Here is the page with the complete list, scroll down to see the MMR group. http://www.fourteenstudies.org/studies.html

As you read the article, here are some questions to ask yourself:
1) What are the authors trying to figure out?
2) Why are they looking at this question?
3) What means do they use?
4) Would you approach the problem in the same way? Or?

Everyone who is working on this, please feel free to add more discussion questions. I'd like to recommend dropping from your mind any commentary, pro or con, that you have already encountered about a particular study. Just read it as if you had never heard of it before and try to take an objective look.

Should be interesting. We'll take one week for each study, so read ASAP and then jump in with your thoughts.
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#3 of 67 Old 04-18-2009, 05:48 PM - Thread Starter
 
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Finally had time to finish reading the study. I am a complete layman at this, so my observations are logical rather than educated.

First I agree this is a ridiculously small and lopsided number of study participants. If a study was conducted with 25 cases/13 controls showing a causality between MMR and autism it would be laughed away merely for that fact alone so I'm not sure why these findings should be considered significant. And why did it take them so long to recruit such a small number? Two years or am I reading this wrong?

Why were all of the findings looked at by median age? How does this affect accuracy of the factual data? Seems like it could distort the findings significantly.

Quote:
If MMR is causally related to either GI disturbances or AUT it
should precede their onset. Similarly, if GI disturbances contribute
to AUT they should precede onset of AUT.
I see several problems with this line of thinking. First off the age at onset of autism is so young how could we know with certainty they weren't experiencing discomfort unknown to caregivers? It seems quite plausible that GI disturbances could go unnoticed until the child was of an age to communicate it or have obvious behavioral symptoms. And even if GI disturbances were noted before MMR that doesn't mean the MMR vaccine didn't drastically exacerbate an already existing problem. These children were years away from their last MMR (with the exception of one I believe) so how likely was it that MV would have been found presently, even if it had contributed to the GI disturbances and/or autism isn't it likely it could have been cleared from the body by this point? I haven't read the Wakefield study, so now I must so I can compare it!!!

Quote:
There were no significant differences in the proportion of cases
and controls with MMR before onset of GI episodes: 12 of 25
cases (48%) received MMR before GI episodes began as compared
with 3 of 13 controls (23%; P = 0.13; Table 2).
If 48% vs 23% isn't considered significant what numbers would be?

And someone please explain why the positive findings were tested repeatedly until they were negative. I'm not sure I get the reasoning behind this and if it is valid to do this.

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#4 of 67 Old 04-18-2009, 07:05 PM
 
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We should compile a few of the worshipful press-releases spread around after the publication of this study, just to add verisimiltude to an otherwise unconvincing narrative!

Isn't anyone going to explain why this study is really wonderful?
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#5 of 67 Old 04-18-2009, 08:53 PM
 
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Re-posting my original thoughts...I'll check back to add to the "book club" discussion as we go along...




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.

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#6 of 67 Old 04-18-2009, 10:50 PM
 
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Here is an example of the publicity about this article and how it was spun: http://www.wellsphere.com/general-me...vaccine/258879

Quote:
Corresponding author W. Ian Lipkin, John Snow Professor of Epidemiology and director of the Mailman School's Center for Infection and Immunity says, "Over 20 epidemiologic studies have reported no temporal relationship between MMR vaccine and autism, however, no published studies from other research groups have addressed whether measles virus RNA is present in bowel of autistic children with GI disturbances. Here we report results of independent, blinded testing in this particular subgroup for the presence of measles virus RNA in bowel tissues."

The authors write, “This study provides strong evidence against association of autism with persistent MV (measles virus) RNA in the GI tract or MMR exposure. The study results should help parents when making decisions regarding childhood vaccine programs.
Read the article and then comment on this thread. Do you think the study provides "strong evidence"?
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#7 of 67 Old 04-18-2009, 11:46 PM - Thread Starter
 
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Yeah, strong evidence that they're full of sh**.

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#8 of 67 Old 04-18-2009, 11:47 PM
 
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what a cool idea.... i hadn't seen the site before, case closed...no more vaxing for us so i haven't been doing alot of research

my first observations:

2 of the study authors are from the cdc and 1 is from the aap so it would seem that at least 3 of these folks have a vested interest in proving the safety of vaccines
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#9 of 67 Old 04-19-2009, 01:20 AM
 
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Originally Posted by MissRubyandKen View Post
First I agree this is a ridiculously small and lopsided number of study participants. If a study was conducted with 25 cases/13 controls showing a causality between MMR and autism it would be laughed away merely for that fact alone so I'm not sure why these findings should be considered significant. And why did it take them so long to recruit such a small number? Two years or am I reading this wrong?
You have to balance the number of recruits with the seriousness and rarity of the case definition. These were kids undergoing major surgery and my understanding is that this surgery is considered a last resort. The concern should be whether they cherry-picked only the best cases. The authors don't report how many declined their invitation to participate in the study although they do report those that accepted but did not complete the study. The reasons for dropping out of the study seem reasonable to me. Without knowing how many cases were asked but declined, I can't really determine if the cases were cherry-picked. I don't think their inclusion criteria lead to a selection bias.

Also, this study was repeating Wakefield's study with only 12 cases. If Wakefield got positive results with 12 cases, then this study should also see positive results, especially with 3X the number of cases and 2X the number with autism. The cases were also similar to Wakefield's, mostly boys with median age of 6.

The number is small, but how would a larger study change the result? What do you think the small numbers missed?

Quote:
Why were all of the findings looked at by median age? How does this affect accuracy of the factual data? Seems like it could distort the findings significantly.
This seems to be standard practice. The authors seemed to be aware of this limitation and used statistics to test for distortion (and found none). I'm not a statistician, so could you please explain what distortions would you expect that weren't accounted for by the authors? Do you accept the method the authors used to check this hypothesis and if not, what would you use instead?

Quote:
I see several problems with this line of thinking.
This line of thinking, that MMR leads to gut disturbance which leads to autism, was Wakefield's and the authors are trying to confirm his findings. You can't change the question to something you like better. If Wakefield's hypothesis is true, it has to go MMR to GI disturbance to autism. It was Wakefield's hypothesis that the MV RNA would be persistent and causing the gut disturbances.

Quote:
First off the age at onset of autism is so young how could we know with certainty they weren't experiencing discomfort unknown to caregivers? It seems quite plausible that GI disturbances could go unnoticed until the child was of an age to communicate it or have obvious behavioral symptoms.
So if I understand you correctly, you are saying that you think the number of cases with autism then GI disturbances is off and you think that there is actually more cases of GI then autism. OK, then how does that change how many had the MMR before before GI? How would that change the numbers? I think you have a point, but this study defined the GI disturbances as something that was clinically observable. I think you'd need a totally different study design to look for GI disturbances that are clinically apparent. What makes you think that type of study should be done?

Quote:
And even if GI disturbances were noted before MMR that doesn't mean the MMR vaccine didn't drastically exacerbate an already existing problem.
The hypothesis isn't that the MMR exacerbated a pre-exisiting problem. The hypothesis is that MMR caused the problem. What you are saying may be true, but it isn't the focus of this study.

Quote:
These children were years away from their last MMR (with the exception of one I believe) so how likely was it that MV would have been found presently, even if it had contributed to the GI disturbances and/or autism isn't it likely it could have been cleared from the body by this point?
Again, the hypothesis was that the persistence of MV RNA is what caused the problem. What you are saying may be true, but it isn't the focus of this study.

Quote:
If 48% vs 23% isn't considered significant what numbers would be?
I'm not a statistician, so I wouldn't know. I totally depend on reviewers that would know this to cry "foul". If the authors made such a huge mistake as to interpret the stats wrong, I have to trust greater minds would have been all over it. As someone who has published research papers, I find reviewers are very critical and nit-picky. I have a hard time believing such a huge mistake would have been ignored by both reviewers and those that have commented on the paper since it was published.

Quote:
And someone please explain why the positive findings were tested repeatedly until they were negative. I'm not sure I get the reasoning behind this and if it is valid to do this.
RT-PCR is extremely finicky. You have to know what you are doing to get valid results. False positives can be a major problem with a technique as sensitive as RT-PCR. A major criticism of Wakefield's paper was he screwed up the RT-PCR and this paper fixes those problems. Supplement 2 explains how this was done with a diagram, but here it is in words. To help validate their results, these authors (coordinating lab) made sure that the appropriate positive/negative controls were done, blinded their samples, had the samples tested by three different labs that had previously shown they could accurately do RT-PCR, had the labs report to a different lab (Biostatistics Core) that unblinded the results. They tested the samples for two different MV genes, with 2 different primer sets, in triplicate, and both had to be positive before they concluded that MV RNA was in the sample. Furthermore, at least 2 out of the 3 labs had to have the same result with the test samples. If that didn't happen, the authors sent the sample again to all 3 labs, and all 3 labs tested the sample a second time, reported the results to Biostatistics Core, which then confirmed if there was concordance. This is NOT repeating the test until they got the answer they wanted. This was validating the test results and gives tremendous validity to their test results.

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#10 of 67 Old 04-19-2009, 01:59 AM - Thread Starter
 
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I'll do my homework and read Wakefield's paper next, as I said I would, to have a basis to compare the two. I'm in no way defending his paper as I haven't read it yet. I was offering my thoughts on the study linked in this thread.

My thoughts definitely wondered if the participants were hand picked, but it didn't seem too likely. I do get that the amount of children getting this procedure wouldn't be astronomical, but they were only recruited through one clinic, right, sooooo, I'd have to guess they could have found more. Though if Wakefield's study only included 12 I can see the reasoning behind this.

As I said I am a complete layman at this. I understand that they did this by median age on purpose (of course), just not why. It makes no sense to me when they had the children's actual ages for all of the categories. So why average them out and use those numbers instead? If you look at the charts it seems obvious that results could differ greatly doing this rather than actual age. But I guess they know what they're doing, and it isn't skewing numbers, right? I would love to see charts with the actual ages of all participants for all categories to compare. This would seem to be the most significant thing this study could have offered, imo.

And if false positives are so likely would false negatives be also? I guess this 'finicky' test is the best they have for this job?

None of us know exactly what is causing the rise in autism, could be more than one thing seperately in individuals, a compilation of things, or even just one thing. I think it is important to look at every angle we possibly can, not just throw out a hypothesis completely as false when there may be something to it. After all this is the basis for the greatest scientific discoveries.

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#11 of 67 Old 04-19-2009, 02:10 AM - Thread Starter
 
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The clinical indications for endoscopic/colonoscopic procedures
commonly noted in both AUT/GI and GI groups included
recurrent abdominal pain (RAP), gastroesophageal reflux, vomiting,
and food allergies.
Text quoted from study. I thought that these procedures were considered minimally invasive, not major surgery? Did I miss a part saying they were having major surgery or am I completely misunderstanding? And the list of conditions really don't sound rare to me.

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#12 of 67 Old 04-19-2009, 02:14 AM - Thread Starter
 
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Honestly I generally tend to think that statisticians need to blow off and leave us with REAL, factual numbers to look at. Especially when the numbers are so small one with the brain the size of a pea could rightly compare them.

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#13 of 67 Old 04-19-2009, 02:54 AM
 
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This thread totally does it for me....
There is a problem here with the use of medians. Simply put, if 100000000 subjects got a vaccine at one year, and then 1 kid got a vaccine at 5 years old, the median would be 3 years. A mean would be closer to 1 year. In terms of a small sample, I also am scratching my head at why they'd choose a median over a mean. Industry standard is to play with means. It raises flags. The funding source raises flags. Bazillians of authors are common in medical research, but this is on the high side even for them. The journal is one I've never heard of, and I've gotta be honest, for my recent research I accessed over 10,000 articles related to child development. hmmmmm.
The set up of the article is scrappy, all the parts are in the wrong parts so it's a pain to find the relevant information. Similar perhaps to a pp I've got APA-brain...If I have this right, and by no means did I scour the thing, so correct me if I'm wrong.....
1. they were looking for rna indicating the gut was polluted with mmr, and found one kid in each group with that problem.
2. didn't see anything in their lit review about length of time from shot to mmr pollution and resultant gi trouble...and no comment about it--but it was something I was curious about---how long does it take for this condition to develop, autism or not?
3. i've seen some stuff about weak immune systems or gi troubles before a shot and then resultant autism--so why isn't it mentioned at least for them to rule out?
4. I see no recommendations for future research or how to better replicate their study..bad research.
5. so about the only conclusion they can make here is that around 10% of their subjects were found to have the mmr junk in the gut and had gi trouble, autism or no. That's creepy in itself, especially when it looks as if it's years after the shot. makes me wonder if the others had dtap junk or polio junk or....
And that's all I have for now..
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#14 of 67 Old 04-19-2009, 02:57 AM
 
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LOL, MissRuby,
I was also coming back to say that endoscopy/colonoscopy wasn't necessarily considered surgical.

The biggest sample size issue, gr8blessings, is exactly your question: "Would a bigger size done something different?" Have you published in this area? I'd like to know the rules regarding samples. Because in my area, there is no way you could get away with not justifying things like why your sample is or is not representative. At this level, this is more of a case study. I realize there are likely standardized rules in this area and perhaps that's why they didn't go into it? Of course, that logic doesn't hold true in other disciplines...

As it stands, there's no way to know from the study is it's representative of GI ASD kids as far as region, age, medical history, race, class, diet, or religion. Only "sex" is covered. Probably we could add 10 more categories that are significant pretty easily. That's what I'd like to see in a bigger sample. If it's representative, I have no problem with it being small-ish (though I consider this sample extreme for use in medical decision-making for our family).

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#15 of 67 Old 04-19-2009, 03:45 AM
 
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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.
The testing is valid.

Quote:
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).
Wakefield's sample was smaller and didn't include controls. Table 1 addresses your concerns about race & ethnicity. What would be the relevance of class and religion? The methods state that the cases were recruited from "the Pediatric Gastroenterology and Nutrition and LADDERS Clinics (MGH) in the years 2003 to 2005", so one hospital. The authors shared your concern about the sibling pairs so they state: "The study sample included two sibling pairs; three of these children were controls (2 males, 1 female) and one was a case (male). Data from sibling pairs were retained after determining that patterns of results were unaltered by sibling pair exclusion."

Quote:
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...?
I don't see your point if there is no correlation between the vaccine and autism. Are you saying they would have gotten autism if they got the MMR + were sick or if they got the MMR and were vegetarian? Or are you saying that being vegetarian would negate the effect of the MMR causing autism?

Furthermore, you suspect that these "coincidences" would favour one group or the other masking the significance of the stats? Coincidences would be randomly distributed. I think the word you are looking for is confounder. The authors mention "differences in patient age, sex, origin (Europe vs. North America), GI disease, recency of MMR vaccine administration at time of biopsy, and methods for confirming neuropsychiatric status in cases and controls." Do you feel that the cases and controls were not matched in regards to these factors?

Quote:
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?
That is exactly what Wakefield claimed to find. This study was trying to duplicate his results. His hypothesis was that the MV RNA would be persistent.

Quote:
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!
My understanding is that the authors used the standard criteria to diagnose autism. They didn't make this criteria up and the diagnosis was made by experts. How would you have done it differently?

Quote:
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.
GI problems: "The clinical indications for endoscopic/colonoscopic procedures
commonly noted in both AUT/GI and GI groups included recurrent abdominal pain (RAP), gastroesophageal reflux, vomiting, and food allergies."

Autism: "Data were obtained from parents by trained clinical raters using
standardized data collection forms." and "Regression status (loss of language and/or other skills) was established according to well-validated CPEA algorithms [27,48–49]. All diagnostic information (ADI-R, CDI, clinician diagnosis) was reviewed by a single pediatric neurologist to ensure
consistency."

Vaccines: "Pediatrician records were acquired to confirm parent-reported dates, types, brands, and lot numbers of immunizations."


Quote:
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?
Read the discussion again. Significance - could not reproduce Wakefield's results with finding the MV RNA in gut tissue, and could not establish a temporal correlation between MMR, GI disturbances and autism. The presence of controls adds validity that isn't present in Wakefield's study. Their study design was comparable to Wakefield's but produced different results. These differences could be due to "differences in patient age, sex, origin (Europe vs. North America), GI disease, recency of MMR vaccine administration at time of biopsy, and methods for confirming neuropsychiatric status in cases and controls."

Quote:
8.Ditto with time of onset. Why does this study put the issue to rest when others find the opposite? (5)
"X2 analyses indicated no role for MMR in either the pathogenesis
of AUT or GI dysfunction (Table 4)." I'm not a statistician, so could explain why their statistical does not indicate what they say it indicates?

Quote:
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.
"Study procedures were approved by the Institutional Review Boards of
Partners/MGH, CU Medical Center, and the CDC and by the Ethics Committee of Coombe Women’s Hospital prior to study initiation."

The approval was for children older than 7, together with their parents, which included only 3 subjects (2 cases, 1 control). How would this skew the data?

Quote:
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.
Since the issue was does GI disturbances cause autism, and autism was defined using the current standard diagnosis, I don't see your point. A GI clinic seems like a good choice if you are looking for kids with GI problems. The number of cases were greater than controls, so there was no problem recruiting autistic kids with GI problems. What would be different if you went to a major hospital? The kids would still have GI problems. The autistic kids would still be autistic.

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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.
Actually, they confirmed that the autistic kids were indeed autistic and that the controls were indeed NOT autistic. They used the current standard for diagnosis. This actually gives their study validity and does not discredit it.


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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.
Apparently so - "Regression status (loss of language and/or other skills) was
established according to well-validated CPEA algorithms [27,48–
49]." Nevertheless, the authors do acknowledge in their discussion that if you change the definition of "autism" that you could get different results.

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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.
LOL. You discredit the study because you don't like the format for the citations? The format is determined by the journal and has nothing to do with the authors nor the quality of their science. Would you trust their results if they re-formatted the paper according to the Chicago Style Manual?

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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 understanding is that the term "autism" is a catch-all for anyone displaying certain behaviours, as defined by the DSM, and as such, could very well have several biological pathologies. Some kids with autism have GI disturbances and some kids with autism do not. The authors are saying that the GI disturbances are not caused by MMR. They are also saying that it isn't clear if GI disturbances are part of autism, and future research needs to determine this.

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#16 of 67 Old 04-19-2009, 04:04 AM
 
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LOL, MissRuby,
I was also coming back to say that endoscopy/colonoscopy wasn't necessarily considered surgical.
Endoscopy is not surgical, but the biopsy is.

"Families of potential subjects were invited to participate if
ileocolonoscopy with biopsy was specifically indicated as part of
clinical care."

"Biopsy material was obtained from terminal ileum and cecum under direct supervision of the team gastroenterologist. For analyses of MV RNA, four random samples were taken from superficial mucosae of ileum and cecum. Additional specimens were acquired at sites indicative of inflammatory GI lesions, if present."

They cut out 4 chunks of tissue from various parts of the gut. This is done under general anesthetic which is pretty risky for little kids.

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Have you published in this area?
No.

And stats wasn't a strong point in my university career either. LOL

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Anyone have a link to the Wakefield study handy or the full title so I can find it easier? TIA.

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#18 of 67 Old 04-19-2009, 10:44 AM
 
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Anyone have a link to the Wakefield study handy or the full title so I can find it easier? TIA.
It's on the 14 studies website under "our studies". First paper under #7. This paper has been retracted by 10 of the 13 authors. Notice that the 14 studies website fails to mention that this paper isn't even credible with the majority of its authors. Interesting since that credibility was such an important part of the ranking of the "fourteen studies". This paper fails on "conflict of interest", "ability to generalize", and "post-publication criticism".

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Hi Blessings,
Could you find the text of the actual retraction on the Wakefield paper? I have a feeling that this has been widely misrepresented. It would be good to see what the authors actually retracted. I don't think it was the entire paper.
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#20 of 67 Old 04-19-2009, 11:04 AM
 
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Just wanted to add that this is a great discussion!
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It's on the 14 studies website under "our studies". First paper under #7. This paper has been retracted by 10 of the 13 authors. Notice that the 14 studies website fails to mention that this paper isn't even credible with the majority of its authors. Interesting since that credibility was such an important part of the ranking of the "fourteen studies". This paper fails on "conflict of interest", "ability to generalize", and "post-publication criticism".

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Thanks. Hadn't perused the whole site yet. Will try to read it today. I did read before about the the retractions, but my layman's brain wondered if they 'folded under pressure' so to speak, rather than rescinded the actual data.

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gr8blessings-

Do you think this study is strong enough to be cited among those that close the case? Aside from discrediting Wakefield's study do you think it stands on its own to prove there is no causal association between vaccines and autism? Do you feel it has much merit as a piece of evidence against association even, aside from discrediting Wakefield? I suppose including it in their list has no other purpose? While I understand why they thought it was important to do, I admit I'm rather disappointed at its inclusion in the 'case closed' category of studies I'm supposed to believe in and feel comforted by as a parent trying to make decisions about vaccines.

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"Biopsy material was obtained from terminal ileum and cecum under direct supervision of the team gastroenterologist. For analyses of MV RNA, four random samples were taken from superficial mucosae of ileum and cecum. Additional specimens were acquired at sites indicative of inflammatory GI lesions, if present."

They cut out 4 chunks of tissue from various parts of the gut. This is done under general anesthetic which is pretty risky for little kids.



gr8blessings
Thanks for clarifying. Is 'chunks of tissue' accurate in these cases? I thought biopsy was collecting samples of cells and/ or possible removal of lumps if there are any. Any way about it I feel for the kids and their families. This isn't anything any parent would want their child to go through.

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#24 of 67 Old 04-19-2009, 12:25 PM
 
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Hi Blessings,
Could you find the text of the actual retraction on the Wakefield paper? I have a feeling that this has been widely misrepresented. It would be good to see what the authors actually retracted. I don't think it was the entire paper.
Here is the reference to the formal retraction: Lancet. 2004 Mar 6;363(9411)

I don't think I can put the text here as it would violate copyright. Basically, the retraction emphasizes that this paper does not support the link between MMR and autism, despite how it has been portrayed in the media, and merely raises this as a hypothesis. I also misquoted the information as it was 10/12 not 10/13.

The Royal Free Hospital Ethics Committee slaps Wakefield's wrist for not declaring conflict of interest here: Lancet. 2004 Mar 6;363(9411):824.

More information on the context of the retraction from the editors of the Lancet is here:
Lancet. 2004 Mar 6;363(9411):747-9
Lancet. 2004 Mar 6;363(9411):820-1

More clarification from the retracting authors is here:
Lancet. 2004 Mar 6;363(9411):821-2
Lancet. 2004 Mar 6;363(9411):822-3

Wakefield's response:
Lancet. 2004 Mar 6;363(9411):823-4

It would have been nice of GR to host all the information regarding the controversy directly associated with the 1998 paper, because as they say "the devil is in the details".


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Thanks for clarifying. Is 'chunks of tissue' accurate in these cases? I thought biopsy was collecting samples of cells and/ or possible removal of lumps if there are any. Any way about it I feel for the kids and their families. This isn't anything any parent would want their child to go through.
I'm not sure how large the sample was. I think that quite a large piece is needed for histology and probably about a gram for RNA isolation. I picture a piece of tissue about the size of chunky chocolate chip, but I don't know for sure if that is correct. I'm assuming the amount of tissue collected for the biopsy is specified somewhere, but I'm not too keen on spending the time tracking it down.

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gr8blessings-

Do you think this study is strong enough to be cited among those that close the case? Aside from discrediting Wakefield's study do you think it stands on its own to prove there is no causal association between vaccines and autism? Do you feel it has much merit as a piece of evidence against association even, aside from discrediting Wakefield? I suppose including it in their list has no other purpose? While I understand why they thought it was important to do, I admit I'm rather disappointed at its inclusion in the 'case closed' category of studies I'm supposed to believe in and feel comforted by as a parent trying to make decisions about vaccines.
I don't know enough to say. I'm really weak in the design of epidemiological and human studies so I wouldn't know a good study from a bad one. I suck at stats. I don't have any background in autism. If I take the paper at face value, it seems pretty convincing to me. Those that do have the required background to understand the study say that the study is pretty convincing. Those that don't have the background to understand the study say that the study is not convincing.

Unfortunately there isn't just one great paper that closes the case, but instead a whole whack of circumstantial evidence. I agree that this circumstantial evidence certainly makes it difficult for those outside the field to determine who is correct.

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I'll read the retraction info as I find time. Interested in your opinion gr8blessings, assuming you have read these? Do you feel the retractions and reasons for were valid? And as far as the 'slap on the wrist' for conflict of interests, I was under the impression that conflicts of interest were quite common. Why did he get called out on it? I thought it was generally accepted. Or is it just accepted from certain authors?

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#28 of 67 Old 04-19-2009, 01:31 PM
 
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He got reprimanded because he didn't disclose the conflict of interest. The editor of the Lancet wasn't too impressed with that either. If he had disclosed the conflict of interest, then it is all good. Wakefield responded that he didn't feel it was a conflict, so he didn't disclose. His boss and the editor felt that that decision should have been made in consultation with them. Even if he had a conflict, that doesn't necessarily mean it biased his results. It just gives him motivation to bias his results. I might have motivation to rob a bank, but that doesn't mean I'm going to go out and do it.

I'm still thinking about what I think about the whole contoversy regarding Wakefield. I know that there is a lot more to the story then what was just directly linked to the Lancet paper. As a scientist, the ethics of his actions greatly interests me. I've seen some pretty dubious ethics by leading researchers in my field. Ethics is definitely an area open to a lot of interpretation and debate.

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#29 of 67 Old 04-19-2009, 01:42 PM
 
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Very interesting discusion.

But where did this come from:
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Originally Posted by gr8blessings View Post
Those that do have the required background to understand the study say that the study is pretty convincing. Those that don't have the background to understand the study say that the study is not convincing.
Personal opinion or what?
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#30 of 67 Old 04-19-2009, 03:14 PM
 
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Personal opinion or what?
Or what.

from the website: Generation Rescue is a parent-founded and parent-led non-profit organization with more than 1,000 parent volunteers all over the world.

The guest critics of the paper are from similar organizations.
NAA's board of directors does not contain a single scientist: http://www.nationalautismassociation.org/board.php

SafeMinds is a small non-profit corporation governed by a volunteer board of directors who are family members or friends of individuals with developmental issues like autism, likely caused in whole or in part by exposure to mercury in early development.

CryShame is a campaigning group co-founded by a number of UK parents and professionals who are concerned about the catastrophic rise in autism spectrum disorders and in the potential link with environmental toxins– particularly MMR and thimerosol (mercury) containing vaccines.


The critisism attributed to Wakefield contains a couple of dubious points that I'd want to look into more closely. I haven't read the 2002 study yet, but just because O'Leary's lab got it right the 2nd time, doesn't mean they got it right the first time. I also have a hard time buying that a CDC scientist makes a mistake reading a CDC paper, so I want to look into that more carefully. The criticism does not give the reference, so I'll try to track it down. He also admits that the Hornig study does indeed prove what it intended to prove.

I just quickly browsed the criticisms and my initial impression was that these criticisms were not written by scientists. Furthermore, these groups have a strong interest is discrediting this study since it disproves their beliefs. If I am wrong, please correct me.

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